Psych Vivas · Consultation-liaison psychiatry
Cardiac psychiatry — structured clinical viva
Fellowship viva covering post-ACS depression, AHA risk framing, SADHART/CREATE/ENRICHD literacy, QTc and bleeding, ACS-PTSD, and beta-blocker myth.
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Target exams
FRANZCPMRCPsychABPNMD-DNB
Prompt
You are the CL psychiatry registrar. Cardiology refers a 67-year-old woman 3 weeks after STEMI (EF 40%, dual antiplatelets, beta-blocker, ACE inhibitor, statin). Issues: suspected post-ACS depression with passive suicidal ideation and rehab refusal; staff asking whether antidepressants prevent reinfarction; request for amitriptyline for sleep; family asking to stop the beta-blocker 'because it causes depression'; nightmares and hypervigilance suggesting ACS-PTSD symptoms; questions about Takotsubo versus her confirmed coronary disease. Discuss epidemiology/prognosis framing, mechanisms, assessment, trial literacy (SADHART, ENRICHD, CREATE, SADHART-CHF contrast), psychotropic safety, PTSD, and disposition.
Interpretation
Reveal interpretationShowHide
Classic CL cardiac psychiatry package: post-ACS depression with suicide risk and rehab refusal, hard-endpoint trial literacy, unsafe TCA request, beta-blocker myth, ACS-PTSD symptoms, and coronary disease already confirmed (not Takotsubo-first). Lead with syndrome clarity, AHA prognosis framing, and named trials.[1][2][4][5]
References9ShowHide
- [1]Lichtman JH, Bigger JT Jr, Blumenthal JA, et al. Depression and coronary heart disease: recommendations for screening, referral, and treatment Circulation, 2008.PMID 18824640
- [2]Lichtman JH, Froelicher ES, Blumenthal JA, et al. Depression as a risk factor for poor prognosis among patients with acute coronary syndrome Circulation, 2014.PMID 24566200
- [3]Frasure-Smith N, Lespérance F, Talajic M Depression following myocardial infarction. Impact on 6-month survival JAMA, 1993.PMID 8411525
- [4]Glassman AH, O'Connor CM, Califf RM, et al. Sertraline treatment of major depression in patients with acute MI or unstable angina (SADHART) JAMA, 2002.PMID 12169073
- [5]Berkman LF, Blumenthal J, Burg M, et al. Effects of treating depression and low perceived social support on clinical events after myocardial infarction (ENRICHD) JAMA, 2003.PMID 12813116
- [6]Lespérance F, Frasure-Smith N, Koszycki D, et al. Effects of citalopram and interpersonal psychotherapy on depression in patients with coronary artery disease (CREATE) JAMA, 2007.PMID 17244833
- [7]O'Connor CM, Jiang W, Kuchibhatla M, et al. Safety and efficacy of sertraline for depression in patients with heart failure (SADHART-CHF) J Am Coll Cardiol, 2010.PMID 20723799
- [8]Edmondson D, Richardson S, Falzon L, et al. Posttraumatic stress disorder prevalence and risk of recurrence in acute coronary syndrome patients PLoS One, 2012.PMID 22745687
- [9]Carney RM, Freedland KE Depression and coronary heart disease Nat Rev Cardiol, 2017.PMID 27853162