关键词: 冠心病, 焦虑, 抑郁, 症状自评量表, 躯体型障碍, 双心医学

Abstract: Background　Anxiety and depression is common among patients with coronary artery disease（CAD），which protracts the course of disease，affecting the treatment and prognosis，with high rate of missed diagnosis.Clinical characteristics of these patients remain unexplored.Objective　To identify the clinical characteristics of CAD patients with anxiety and depression，which can be helpful for early diagnosis.Methods　In this single-center cross-sectional study，a total of 131 patients diagnosed with CAD in Tongji Hospital of Tongji University from March to July 2013 were enrolled.General Information Questionnaire，Beck Depression Inventory（BDI），Beck Anxiety Inventory（BAI），Symptom Checklist 90（SCL-90，composed of 10 dimensions，including somatization，obsessive-compulsive symptoms，interpersonal sensitivity，depression，anxiety，hostility，terror，paranoia，psychosis and other symptoms） were distributed and completed by the patients independently.Results　A total of 131 questionnaires were distributed，and all were recovered，of which 120 were valid，with an effective response rate of 91.6%.Thirty-nine patients（32.5%） were accompanied by anxiety and/or depression，of which 38（31.7%） had anxiety，seven（5.8%） had depression，and six（5.0%） accompanied by both.In somatization dimension，compared to those without anxiety or depression，the CAD patients with anxiety and/or depression complained more “headaches”“faintness or dizziness”“chest pain” “trouble breathing”“numbness or tingling in parts of your body”“ sense of obstruction in your throat”“feeling weak in parts of your body”“heavy feelings in your arms or legs”（P<0.05）．In the dimension of obsessive-compulsive symptoms，the incidence of “unwanted thoughts or ideas that won't leave your head”“feeling difficult in getting things done”“having to check and double check what you do”“difficulty in making decisions”“your mind going blank”“trouble in concentrating”“having to repeat the same actions such as counting，washing”in CAD patients with anxiety and/or depression were higher than those without anxiety and/or depression （P<0.05）．In the dimension of interpersonal sensitivity，the incidence of “ blaming others for perfection”“feeling inferior to others”“feeling very nervous about others” and “feeling uncomfortable about eating or drinking in public”in CAD patients with anxiety and/or depression were higher than those without anxiety or depression（P<0.05）．In the depression dimension，the prevalence of “loss of sexual interest or pleasure”“thoughts of ending life”“crying easily”“blaming yourself”“feeling lonely”“feeling blue”“worrying too much about things”“feeling no interest in things”“feeling hopeless about the future”“feeling everything is difficult”“feeling of worthlessness”in CAD patients with anxiety and depression was higher than those without anxiety and depression （P<0.05）．In anxiety dimension，“nervous or oversensitive”“suddenly scared for no reason”“heart pounding or racing”“feeling tense or keyed up”“feeling so restless you couldn't sit still”“feeling pushed to get things done”were more common in CAD patients with anxiety and/or depression than those CAD patients without anxiety or depression（P<0.05）．In the dimension of terror，CAD patients with anxiety and/or depression had higher incidence of “feeling afraid in open spaces or on the street”“feeling afraid to travel on buses，subways or trains”“having to avoid certain things，places or activities”“feeling uneasy in crowds in shopping malls or theatres”“feeling nervous when you are left alone”“feeling afraid you will faint in public”than those CAD patients without anxiety or depression（P<0.05）．In paranoid dimension，“feeling that most people cannot be trusted”were more prevalent in CAD patients with anxiety and/or depression than that in those without anxiety or depression（P<0.05）．In the psychosis dimension，for CAD patients with anxiety and/or depression，the prevalence of “the idea that someone else can control your thoughts”“feeling lonely even when you are with people”“having thoughts about sex that bother you a lot”“the idea that you should be punished for your sins”“the idea that something serious is wrong with your body”“never feeling close to others personally”were higher than those without anxiety or depression（P<0.05）．About other symptoms，CAD patients with anxiety and/or depression suffered more from “poor appetite”“trouble in falling sleep”“thoughts of death or dying”“awakening in the early morning”and“ restless or disturbed sleep”than those CAD patients without anxiety or depression（P<0.05）．Conclusion　The incidence of CAD patients with comorbid anxiety and depression is high，among whom the somatization disorders are more common and apparent.Besides，the obsessive-compulsive symptoms，interpersonal sensitivity，terror and psychotic symptoms among CAD patients with anxiety and/or depression are marked，as well as sleep disorders.Therefore，the assessment of anxiety and depression should be strengthened in CAD patients with related symptoms.

Key words: Coronary disease, Anxiety, Depression, SCL-90, Somatoform disorders, Psychology-cardiology medicine