The diagnosis of heart failure can have a significant psychological impact on the patient and can result in:

• Avoidance behavior.
• Fears
• Social inhibition and isolation.
• Physical inhibition (particularly due to fear of carrying out efforts and activities).
• Depression.
• Sleeping disorders.
• Decreased libido and sexual problems.

Patients with Type D (“distressed”) personality are particularly at risk.

These psychological consequences can:

• Further reduce the quality of life.
• Compromise patient care and compliance, especially in cases of impaired cognitive function or low literacy.

Rapid identification of these psychological impacts is therefore essential in order to direct the patient towards appropriate help.

In the specific case of cardiomyopathies caused by drug addiction (alcohol, cocaine, etc.), targeted referral to detoxification treatment is of course indicated.

In addition, smoking cessation guidance through a tobaccologist is an essential part of optimizing lifestyle in heart failure.

In conversation with the patient:

• Confirm the presence of physical complaints.
• Normalizing processing and difficulties with it :
  • Don't minimize.
  • Don't laugh it off or make fun of it.
  • Also remain who you are as a person, as a doctor.
  • assess whether or not a treatment is appropriate.
• Explain how processing and coping can be difficult.
• Lower the threshold.
• Assessment of adequate or inadequate processing.
• Check the willingness to undergo therapy.
• Offer therapy or support if signs of psychological difficulties appear.

• Mental Health Services (MHS)
  • Psychotherapy for serious psychological difficulties.
  • Long waiting list.
  • Possible management of associated social difficulties.
  • Suitable for financially limited patients.
• Primary Care Psychology
  • Government-funded psychologists.
  • Need medical referral by GP/specialist.
  • Regional variations.
  • Reasonable waiting time.
  • Psychological counseling or short-term assistance (8 sessions/year).
  • Costs payable by the patient.
• Psychotherapy by independent psychologists.
  • Longer-term therapeutic monitoring possible.
  • Limited reimbursement linked to health insurance.
  • Higher costs for the patient
• Multidisciplinary cardiac rehabilitation psychotherapy.

• Cooperation.
• Processing.
• Psychoeduction.
• Structuring.
• Regulation of emotions.

A psychologist can specifically support in:

• The process of adaptation and learning to manage the disease (adaptation, coping).
• Learn anxiety and stress management techniques.
• Adjust lifestyle (in particular by quitting smoking and drug addiction (alcohol, drugs)).
• Managing relational and sexual tensions through couple conversations in particular.

Some patients continue to struggle with persistent feelings of depression or anxiety, which may require a referral to a psychiatrist. A psychiatrist can prescribe medication or other treatment if necessary.

Note: The psychiatrist should take into account the risk of hyponatremia linked to certain antidepressants such as selective serotonin reuptake inhibitors (SSRIs). Sodium levels should therefore be monitored during treatment with an SSRI.