Psychocardiology: A practical guide for doctors and psychologists

368 Pages·2022·5.453 MB·English

by  Christoph Herrmann-Lingen, Christian Albus, Georg Titscher

Christoph Herrmann-Lingen
Christian Albus
Georg Titscher   Editors
Psychocardiology
A practical guide for doctors and
psychologists
Psychocardiology
(cid:129) (cid:129)
Christoph Herrmann-Lingen Christian Albus
Georg Titscher
Editors
Psychocardiology
A practical guide for doctors and
psychologists
Editors
ChristophHerrmann-Lingen ChristianAlbus
DepartmentofPsychosomaticMedicine DepartmentofPsychosomatics
andPsychotherapy andPsychotherapy
UniversityofGöttingenMedicalCentre MedicalFacultyandUniversityHospital,
Göttingen,Germany UniversityofCologne
Cologne,Germany
GeorgTitscher
SigmundFreudUniversity
Vienna,Austria
ISBN978-3-662-65321-0 ISBN978-3-662-65322-7 (eBook)
https://doi.org/10.1007/978-3-662-65322-7
#TheEditor(s)(ifapplicable)andTheAuthor(s),underexclusivelicensetoSpringer-VerlagGmbH,DE,partof
SpringerNature2022
Thisworkissubjecttocopyright.AllrightsaresolelyandexclusivelylicensedbythePublisher,whetherthe
wholeorpartofthematerialisconcerned,specificallytherightsoftranslation,reprinting,reuseofillustrations,
recitation,broadcasting,reproductiononmicrofilmsorinanyotherphysicalway,andtransmissionorinformation
storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now
knownorhereafterdeveloped.
Theuseofgeneraldescriptivenames,registerednames,trademarks,servicemarks,etc.inthispublicationdoesnot
imply,evenintheabsenceofaspecificstatement,thatsuchnamesareexemptfromtherelevantprotectivelaws
andregulationsandthereforefreeforgeneraluse.
Thepublisher,theauthors,andtheeditorsaresafetoassumethattheadviceandinformationinthisbookare
believedtobetrueandaccurateatthedateofpublication.Neitherthepublishernortheauthorsortheeditorsgivea
warranty,expressedorimplied,withrespecttothematerialcontainedhereinorforanyerrorsoromissionsthat
mayhavebeenmade.Thepublisherremainsneutralwithregardtojurisdictionalclaimsinpublishedmapsand
institutionalaffiliations.
Coverdesign:deblikBerlin/PhotocreditsCover:#freshidea/stock.adobe.com
This Springer imprint is published by the registered company Springer-Verlag GmbH, DE, part of Springer
Nature.
Theregisteredcompanyaddressis:HeidelbergerPlatz3,14197Berlin,Germany
Preface
Psychocardiology: Psychosomatics at the Heart of Medicine
CardiovasculardiseasesarethemostcommoncausesofdeathinGermanyandworldwide.
Atthesametime,theyarethemostfrequentcausesofillness-relateddisabilityworldwide.
Depression and anxiety disorders follow in second place in the industrialized countries
when counted together (https://www.who.int/healthinfo/global_burden_disease/estimates/
en/index1.html). In terms of incapacity to work (second place), rehabilitation treatments
(secondplace),anddisabilitypensions(firstplace),mentaldisordersareevenfaraheadof
cardiovascular diseases in Germany and Austria. The comorbidity of cardiovascular and
mentalillnessesthusrepresentsanenormouschallengeformedicine,ifonlybecauseofits
quantitativesignificance.However,evenmorethantheircoincidentaloccurrence,thenow
extensivelyresearchedinterrelationshipsbetweenheartdisease,psyche,andsocialenvi-
ronment are of interest for the everyday care of patients as well as for primary and
secondarypreventionapproaches.Thisimprovedunderstandingresultsinadifferentiated,
holistic approach to the patient. In addition to biomedical aspects of the disease, the
psychological and social dimensions of being ill and their significance for recovery or
living with the disease as well as for such important areas as health behavior, treatment
adherence,andqualityoflifeareincreasinglycomingintofocus.
Sincepre-Christiantimes,peoplehavebeenpreoccupiedwiththeconnectionbetween
heartandmind,whichisimmediatelyperceptibleformostpeople.EventheEgyptians,for
exampleintheEbersPapyrus(sixteenthcenturyBC),didnotclearlydistinguishbetween
heartandpsyche.IntheBabylonianEpicofGilgamesh,aman’sheartfillswithjoyinan
erotic encounter.Since then, countlessimages haveaccompanied theheart asa mirror of
the psyche through the millennia and cultures and have made it the “joker of German
poetry” (Reich-Ranicki 1988). The development and course of heart disease have also
alwaysbeenattributedtopsychosocialinfluences,amongothercauses.Inthethirdcentury
BC, theSyriancrownprinceAntiochusfellillwith heartdiseasebecauseofhis unhappy
loveforhisprospectivestepmotherStratonike.“Butasaruleitisnotthecardiologistswho
canhelptheheroesofliterature”(Reich-Ranicki1988).Thecrownprincerecoveredwhen
hisfatherlefthimhisteenagebride.ThebiblicalstoryofAnaniasandSapphiraisdifferent.
This couple, members of the early Christian community described as “one heart and one
v
vi Preface
soul,” were doomed by embezzlement. When Peter confronts Ananias and notices that
SatanhasfilledAnanias’heart,thelatterceasesitsactivityandAnaniassuddenlydies—as
doeshiswifeSapphiraafewhourslaterwhenshelearnsofherhusband’sdemise.
In a review of psychogenic sudden cardiac death, George Engel (1971) asked to what
extent such “folkloristic” descriptions had always been based on folk wisdom. Reliable
scientificevidenceonheart-mindinteractionswas,however,onlysparselyavailableupto
thattime.Itisonlyresearchoverthelast30–40yearsthathassincefundamentallychanged
this picture. And especially in the last 20 years, the former marginal position of
psychosomatics in cardiology has changed significantly. Whereas in 1998 only three out
of about a thousand presentations at the spring conference of the German Society of
Cardiology dealt with psychosomatic topics in a broader sense, psychosocial issues are
now an accepted part of the spectrum of cardiological publications, congresses, and
training events. And conversely, psychocardiology has also experienced a remarkable
upswing in German-speaking psychosomatics since the late 1990s. The founding of the
working groups on Psychosomatics in Cardiology in the German College of Psychoso-
maticMedicineandCardiologicalPsychosomaticsintheAustrianSocietyofCardiologyin
1997, the Status Conference on Psychocardiology (1998–2002), and the founding of the
workinggrouponPsychosocialCardiologyintheGermanSocietyofCardiologyin2002
mark milestones in the perception and organization of psychocardiology as a relevant
interdisciplinaryfieldofresearchandcare.
Sincethen,psychosomaticissueshavebeenincreasinglyrecognizedasanenrichmentof
cardiologysocietiesandresearchassociations;andinhealthcare,thereisatleastnolackof
verbalacknowledgmentoftheimportanceofpsychosocialfactors.Psychosomaticcontent
can now be found in numerous cardiology guidelines and position papers, and the
standalone position paper of the German Society of Cardiology on psychosocial factors
in cardiology could already be published in its third edition in 2018 (Albus et al. 2019).
Even if these commitments have by no means led to comprehensive psychocardiological
care,psychosomaticshaslongsincegrowntobecome—despitehistoricalreservations—a
fundamentallyrecognisedpartnerofcardiology.
The further development of this partnership is also the subject of this book, which is
nowalreadyavailableinitsthird,carefullyupdatedandexpandededition.Allthreeeditors,
asinternistsorcardiologistsandspecialists inpsychosomatics/psychotherapy,knowboth
the daily routine of somatic cardiology and the particularities of psychotherapeutic work
with cardiac patients. We would like to invite our cardiological and internal medicine
colleaguestobecomemoreintensivelyinvolvedintheencounterwiththeirpatientsandto
experiencetheholisticperspectiveandrelationshipasaprofessionalandpersonalenrich-
ment. To this end, we provide the essential findings of psychocardiological research and
our many years of work at the interface between psychosomatics and cardiology in a
mannerthatisaspracticalaspossible.Contributionsbyotherrenownedauthorscomple-
menttherangeoftopics.
Thisbookisdesignedtohelpinternistsandcardiologists,aswellasfamilyphysicians,
gain an informed and sophisticated approach to the psychological and social aspects of
Preface vii
illnessintheirpatientsandtofamiliarizethemwithkeypsychologicaldiseasepatternsand
their treatment options. At the same time, we want to familiarize our psychotherapeutic
colleagues with the somatic basis of cardiovascular diseases, the fascinating heart-mind
interactions,andtheimpressivetherapeuticpossibilitiesofcardiologyandcardiacsurgery.
Beyond individual therapeutic schools, we would like to make the special features of
counselling and psychotherapeutic work with people suffering from heart disease
understandable. This work very often requires, in addition to a basic understanding of
heartdiseaseanditstreatment,anadaptationofpsychotherapeutictechniques,whichhave,
asarule,beendevelopedandevaluatedonphysicallyhealthypeople.
The earlier cardiological attitude that the psychosomatic approach was nothing but a
superfluousluxurycannowconfidentlyberegardedasoutdated.Butthereservationoften
expressedinthepastbypsychotherapiststhatitisnotpossibletoworksuccessfullywith
heartpatients,whoareoftenolder,comefromlowsocialclasses,showatendencytodeny
and low “psychological mindedness,” has proved to be too short-sighted. However, the
how of a psychosomatic approach to the heart patient has so far—with few exceptions—
hardly been taught in educational curricula for cardiologists and internists and not yet
comprehensively in psychotherapeutic training or continuous education. It cannot, of
course, be learned from a textbook alone. This book cannot therefore replace
psychocardiological training; it is, however, intended to provide a frame of reference
against which both those working primarily somatically and those working primarily
psychotherapeutically can gather their own experiences, classify them, and reflect on
them in in-depth training and continuing education events, supervision, or Balint groups.
Thepsychocardiologicalcurricula described inChap. 9enablethose interestedtodeepen
whattheyhavereadininterprofessionalgroupsandtotryitoutinpractice.Thesecurricula
alsoserveinparticulartopromotediscussionamongtheprofessionsandlearningfromone
another. The interdisciplinary and interprofessional dialogue and the integration of
psychosomatists/psychotherapists in cardiological treatment teams should—similar to
oncology—not only be reserved for rehabilitation facilities (which are also insufficiently
equipped with psychologists). In many cases, cooperation between somatic doctors and
psychotherapistsisusefulorevennecessary,bothintheacute-carehospitalandinthelong-
term outpatient care of patients. Not in all cases can the integration of psychosocial and
somaticaspectsofillness beachievedbythegeneral practitioner alone; inmany cases, it
requiresteamworkbetweendifferentexperts.Inthelast10years,numerouscardiologists
have already acquired additional psychocardiological competencies, and
psychocardiologicalorpsychocardiosurgicalconsultationandliaisonservicesareincreas-
inglybeingestablishedatheartcenters.Ideally,thiscooperationshouldbebasedonmutual
respect,amutualwillingnesstolearn,andaninterestinintegratingtheknowledgegained
inthe variously structured partial relationships into a deeper overallunderstanding ofthe
patients with their physical and psychological components as well as their social living
environment. As a third party in this alliance, the patient can feel competently treated
somatically,butatthesametimealsounderstoodandvalued,whichmakesthenecessary
responsiblecooperationmucheasier,notonlyinovercomingtheacuteillness,butalsoin
viii Preface
regaininghealthandqualityoflife.Asadecisiveprerequisite,italsoensurestheeffective-
ness of somatic treatment and (secondary) prevention. In an interdisciplinary approach,
mental comorbidity can also be recognized much better than before and competently
treatedwithinanoveralltreatmentplan.
Thisbookwaslaunchedin2007asanexperimenttoshowwhetheritispossibletobring
tolifeintheformofatextbookwhathasbeenachievedthroughpersonalrelationshipsand
interfacework.Withitsclaimofinterdisciplinarityandpracticality,itwasnotintended
to replace a textbook on cardiology or psychosomatic medicine. With its intermediate
position,itdeliberatelyrefersthereadertofurtherliteratureforsomespecificquestions.At
thesametime,itattemptstoclosegapsthatpreviouslyexistedbetweenthespecialties.The
great response to the first two editions as well as the extraordinarily positive experiences
with the mutual learning process of cardiologists and psychotherapists in more than
15 psychocardiology courses was an incentive for us to take into account the feedback
receivedandthefurtherdevelopmentofthefieldinthisnewedition.Morethaninprevious
editions, we refer to important current literature findings and guidelines, but without
abandoningthefocusonpractical relevance.WewouldliketothankSpringer-Verlagfor
theopportunitytocontinuethissuccessfulprojectwithanewfaceafterthewithdrawalof
the previous publisher and wish all readers a stimulating read and, above all, many
enrichingexperiencesinpsychocardiologicalwork.
Göttingen,Germany ChristophHerrmann-Lingen
Cologne,Germany ChristianAlbus
Vienna,Austria GeorgTitscher
April2019
References
Reich-RanickiM(1988).DasHerz–derJokerderdeutschenDichtung.In:R.Selbmann
(ed)DasInsel-BuchvomHerzen.Insel-Verlag,Frankfurt/M.,pp283-297.
Engel GL (1971) Sudden and rapid death during psychological stress. Folklore or folk
wisdom?AnnInternMed74:771–782
AlbusC,WallerC,FritzscheK,GunoldH,HaassM,HamannB,KindermannI,KöllnerV,
Leithäuser B, Marx N, Meesmann M, Michal M, Ronel J, Scherer M, Schrader V,
SchwaabB,WeberCS,Herrmann-LingenC(2019)Significanceofpsychosocialfactors
in cardiology: update 2018: Position paper of the German Cardiac Society. Clin Res
Cardiol108:1175–1196.
Contents
1 MainFeaturesofCardiacDiseases. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
ChristianAlbusandMarkusHaass
2 BasicConceptsofPsychosomaticMedicine. . . . . . . . . . . . . . . . . . . . . . . . 41
ChristianAlbus
3 EthicalIssuesinPsychocardiology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
PeterKampits
4 PsychocardiologyAlongtheLifespan. . . . . .. . . . . . . .. . . . . . . . .. . . . . . 59
ChristophHerrmann-Lingen
5 PsychosomaticProblemAreasandComorbiditiesUsingtheExample
ofCoronaryHeartDisease. . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . 63
ChristianAlbus,ChristophHerrmann-Lingen,VolkerKöllner,
RolandvonKänel,andGeorgTitscher
6 OtherImportantClinicalPicturesandInterventionsinCardiology. . . . . . 129
ChristianAlbus,ChristophHerrmann-Lingen,VolkerKöllner,and
GeorgTitscher
7 Diagnostics. . . .. . . . .. . . . .. . . . .. . . . .. . . . .. . . . .. . . . . .. . . . .. . . . 201
ChristianAlbusandChristophHerrmann-Lingen
8 Treatment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219
GeorgTitscher,ChristianAlbus,AnnegretBoll-Klatt,VolkerKöllner,
MaryPrincip,RolandvonKänel,andChristophHerrmann-Lingen
9 PsychocardiologicalTrainingandContinuingEducationCurricula. . . . . 335
GeorgTitscherandChristophHerrmann-Lingen
AddressList. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 345
Index. . . . . . . .. . . . . . .. . . . . . . .. . . . . . .. . . . . . .. . . . . . . .. . . . . . .. . . . . 349
ix
Editors and Authors
About the Editors
Christoph Herrmann-Lingen,MD,isaspecialistininternal
medicine, psychosomatic medicine and psychotherapy. He is
thedirectoroftheDepartmentofPsychosomaticMedicineand
PsychotherapyattheUniversityMedicalCentreGöttingen.
His research interests focus on psychocardiology and
psychodiagnostics in the physically ill. He is a Past President
of the German College of Psychosomatic Medicine
(DKPM) and of the American Psychosomatic Society, a for-
merMemberoftheExecutiveCommitteeoftheAssociationof
Scientific Medical Societies in Germany (AWMF) and is a
co-authorofnationalandinternationalguidelinesandposition
papers. In 2017 he received the Hans Roemer Award for
PsychosomaticResearchoftheDKPM.
Christian Albus, MD, is a specialist in internal medicine,
psychosomatic medicine and psychotherapy. He is the Head
of the Department for Psychosomatics and Psychotherapy at
theUniversityofCologne.
His research focuses on psychosocial aspects and psycho-
logical comorbidity in physical diseases, especially coronary
heart disease and diabetes mellitus. He is an active member
ofnumerousscientificsocietiesandnationalandinternational
guidelinecommittees.In2005and2017hereceivedtheHans
Roemer Award for Psychosomatic Research of the German
College of Psychosomatic Medicine and in 2016 the Interna-
tional Collaboration Award of the International Society of
BehavioralMedicine.Since2011hehasbeenaFellowofthe
EuropeanSocietyofCardiology(FESC).
xi