COPD: The psyche is often underestimated

Anxiety and depressive moods are common in COPD patients. Often, the psychological suffering in this pathology goes unnoticed, with devastating effects.

COPD and the psyche

• The prevalence of mental disorders such as anxiety and depression in COPD is estimated to be between 36 and 40%.
• In addition, feelings of guilt and shame often play a role.
• COPD and psychological comorbidities reinforce each other.
• Less than 44% of people with COPD receive adequate diagnosis, and only one-third receive treatment.
• There are validated screening tools and non-drug treatment options.

In contrast to cystic fibrosis (CF), where psychological care is now an integral part of the therapy in many CF centres, and psychologists are part of the team, psychological symptoms in people with COPD are not yet given sufficient attention. They are not only a burden for those affected, but also have a negative effect on the underlying disease, reinforcing a vicious circle.

What screening tools are available for diagnostics?

There is no lack of suitable diagnostic tools, as Dr Eleonora Volpato from the Università Cattolica del Sacro Cuore in Milan points out. The PRIME-MD (Primary Care Evaluation of Mental Disorders), HADS (Hospital Anxiety and Depression Scale) or, especially for respiratory diseases, the Breathlessness Beliefs Questionnaire are suitable for differentiating between mental stress and genuine mental disorders. They can be collected quickly in everyday clinical practice. In the case of conspicuous screening findings, diagnostic interviews such as the Mini-International Neuropsychiatric Interview (MINI) are the gold standard.

How are psychological symptoms treated in COPD?

There is also good experience in the treatment of psychological symptoms in COPD, especially with non-drug methods. The best evidence exists for cognitive behavioural therapy (CBT). By interweaving thoughts, feelings, physical reactions and behaviour, patients learn to categorise anxiety and depressive moods correctly and to cope better with them.

Pulmonary rehabilitation programmes have also been shown to have a positive effect. Such interdisciplinary interventions includes psychoeducation, physical training and measures for behavioural changes. It not only alleviates anxiety and depression, but also improves COPD symptoms, increases quality of life and reduces hospitalisation rates.

How can patients be actively involved?

Other methods with proven effectiveness on accompanying psychological symptoms in COPD are relaxation exercises such as progressive muscle relaxation (PMR), movement therapies such as Qigong, music therapy, and instructions for self-management. Lhe latter in particular actively involves the patients and aims at behavioural changes such as smoking cessation, physical activity, correct inhalation techniques, and the constructive handling of symptoms.

Conclusion for medical practice

Although good diagnostic and therapeutic options are available, there is still a huge lack of implementation in everyday clinical practice. Dr Volpato and her team therefore advise all treating physicians to:

• Provide information materials on psychological distress in lung disease.
• Introduce routine screening for mental disorders in patients with COPD.
• Use validated screening tools.
• Involve specialists (psychiatrists or psychologists) as needed.