A balance between fear and relaxation is normal. However, mental dispositions and the continuous influence of environmental stimuli can disrupt this balance. A failure in therapy can often conceal unvoiced fears.
This article is based on the lecture "State of the Art: Treating Anxiety Disorders" by Christian Albus, MD, director of the Clinic and Polyclinic for Psychosomatics and Psychotherapy, University Hospital Cologne, Germany, at the 128th conference of the German Society of Internal Medicine.
Hidden Fears
Poor compliance often has a simple cause: the patients are scared. They are afraid of bad news, for example through further investigations. Taking tablets regularly reminds them over and over of their threatening problem. Those affected rarely speak about these delicate issues of their own volition, said Albus. But latent fears are no trivial issue, as cardiologic investigations have proven.
Cardiac Prognosis
A third of those affected by acute coronary syndrome (ACS) subsequently suffer from long-term anxiety disorders. The fear that they will relive their experiences overshadows their zest for life. As a result, signs of clinical depression can be detected in 50% of patients with ACS. Posttraumatic stress disorders have even been observedin up to 30% of patients. Fear also exacerbates the prognosis. Patients suffering from heart attack and subsequent cardiac failure demonstrate a significant correlation between stress and increased mortality.
