ABSTRACT
The importance of psycho-social factors in determining a patient’s response to lung disease has become increasingly recognized over the past two decades. These factors impact both on the quality of life and on the physical health of patients with chronic obstructive pulmonary disease (COPD). This chapter will describe the current definitions of depression, anxiety, and panic. It outlines the problems of diagnosing affective disorders in patients with chronic physical conditions and considers the distinction between mood disorder-induced, related and unrelated to physical disease. It describes attempts to formalize the diagnosis of mood disorders with standardized questionnaires in lieu of the ‘‘gold standard,’’ standardized psychiatrist interview and describes how these factors have influenced estimations of the prevalence of these disorders in COPD. The impact of mood disorders on quality of life will be briefly considered also. Before actually considering affective disorders in COPD, the various hypotheses relating to the interactions between anxiety, panic, hyperventilation, and dyspnea in the general population are explored. Finally, the evidence pertaining to the efficacy of drugs and psychotherapy for concurrent anxiety and depression and the putative role of psychotherapy in pulmonary rehabilitation will be described.
