[Anxiety and depression in COPD: a review]

Abstract

Introduction: COPD does not only affect the respiratory function of a patient. It also affects his/her cognitive and affective functions. These effects can be seen particularly in the incidence of anxiety and depressive disorders at different periods during the stage of the illness. This review of the literature suggests some contemporary definitions of these disorders, their link to COPD, and procedures for their assessment during clinical practice.

Background: The neurocognitive functions and the emotional resources of the patient are disturbed by the insidious development of COPD and the disabling effects that follow. The prevalence stands at 50% for anxiety disorders and 33% for depressive disorders. These symptoms deteriorate dyspnoea, reduce the exercise tolerance of patients, intensify the effects of fatigue, increase emotional instability, alter compliance, favor risk behavior in relation to health, and affect communication with caregivers. These symptoms also increase the annual number of exacerbations and hospitalizations. For practical purposes, while a semidirective clinical interview remains the better method to highlight the symptoms, the auto-questionnaire "hospitalization anxiety depression" has proved to be a reliable and sensitive tool.

Viewpoints: In patients who do not suffer from a major depressive or anxiety disorder (from a source external to COPD) anxiety and depressive symptoms reveal a lack of comprehension of the illness, difficulties in adjusting psychologically to the illness, misunderstanding and solitude. Except for serious cases, in which resort to medication is necessary, psychological support is a solution, therapeutic education, acceptance, behavior control through rehabilitation and development of the patient-caregiver relationship and networks.

Conclusion: Anxiety and depressive disorders occur at any time in the life of a patient suffering from COPD. Health professionals should not neglect the signs, thinking them inevitable, attributing them to the personality of the patient, the natural evolution of the illness, or ageing. Therapeutic solutions exist.