Exploring Integrated and Collaborative Care

Michelle Riba, MD, MS, DFAPA, FAPM

Psychiatric Times, Vol 38, Issue 2, Volume 02,

Understanding and developing treatments for the cardiovascular system and how it relates to psychosocial distress and the nervous system are keys to the future of psychiatry.

SPECIAL REPORT: PSYCHOCARDIOLOGY

The past 20 years have seen a burgeoning interest in the interface between psychiatry and cardiology—psychocardiology. More fellows are seeking training in this subspecialty. Increasing numbers of consultation-liaison faculty are finding careers in working collaboratively with colleagues in cardiology, cardiac surgery, cardiac transplantation, psychology, nursing, social work, pharmacy, and many other disciplines. It has been exciting to see the development of guidelines and pathways to provide integrated and collaborative psychocardiology care in areas such as heart failure, pulmonary artery hypertension, arrhythmias, vascular diseases, and myocardial infarction and to seek earlier intervention that can make sustained behavioral changes and prevent disease, such as in diet, exercise, nicotine use, substance use, stress modification, sleep, etc.

We are seeing these changes in patients across the life cycle. Our colleagues in other medical disciplines are trying to understand and frame this goal from the lens of a public health mandate because depression, cardiovascular diseases, and diabetes are leading causes for global health disabilities.1 At the Academy of Consultation-Liaison Psychiatry, special interest groups in psychocardiology have been well attended, and there are more sessions on psychocardiology topics at our annual meetings and articles in the prestigious journal Psychosomatics.

In 2012, I coedited the book Psychiatry and Heart Disease: The Mind, Brain and Heart. Lawson Wulsin, MD, wrote: “The current need…follows from the profusion of research…showing how the cardiovascular system and psychological distress are each intimately linked to the central, peripheral, and autonomic nervous systems, the immune system, and limbic-hypothalamic-pituitary-adrenal-gonadotropic axis.”2 One only has to look at the significance and severity of coronavirus disease 2019 on the cardiovascular system and on mental health to appreciate the relevance of psychocardiology.

Many topics fall within the psychocardiology domain. For this Special Report, we have chosen a few of the many important topics and issues, with key leaders presenting information in clinically useful and helpful ways. Understanding the underlying mechanisms of and developing effective treatments/interventions for the cardiovascular system as it relates to psychosocial distress and the nervous system in a bidirectional manner are key.

My sincere appreciation to our wonderful contributors of this special series.

Dr Riba is professor in the Department of Psychiatry and director of the Consultation-Liaison Psychiatry fellowship at the University of Michigan in Ann Arbor; she also is deputy editor in chief emeritus of Psychiatric Times™.

References

1. GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1789-1858.

2. Riba M, Wulsin L, Rubenfire M, Ravindranath D, eds. Psychiatry and Heart Disease: The Mind, Brain and Heart. Wiley-Blackwell; 2012. ❒

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