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Dynamics of the psychological features and clinical symptoms in mitral valve prolapse patients receiving long-term integrative psychotherapy for anxiety disorders

Our research interest in mitral valve prolapse (MVP) patients is far from being accidental. MVP is widespread, affecting between 30.8% and 42.0% of the population (Barlett, Kirtley, & Mangham, 1991; Devereux, Kramer-Fox, & Kligfield, 1989; Scordo, 2007; Stefanadis, & Toutouzas, 2000).Researchers note a pronounced dissociation between numerous subjective complaints of the patients, on the one hand, and the scanty data from objective studies, on the other (Joiner & Cornman, 1986; Scordo, 2007); they also present indications of widespread anxiety disorders (AD) accompanying MVP and the unpleasant inclusion of the formation of "functional MVP" within panic disorder (some authors assert that panic attacks not only may be "triggered" by MVP but may lead to its development: Coplan, Papp, King, & Gorman, 1992; Gorman et al., 1988). There are cases of a significant reduction in the intensity of clinical symptoms after psychotherapy and antidepressant or anxiolytic treatment (Gonzalez et al., 2002; Pariser, Reynolds, Falko, Jones, & Mencer, 1981; Scordo, 2007; Stavrakaki, Williams, Boisjoli, Vlad, & Chasse, 1991); there is even some evidence that such treatment may be symptomatolytic--that is, it may result in the complete disappearance of echo-cardio-graphic MVP indicators in patients suffering from panic disorders (Coplan et al., 1992).Research objectivesThe purpose of the study was to investigate the dynamics of psychological features and clinical symptoms in MVP patients with AD receiving long-term integrative psychotherapy and to investigate the psychological factors of their improvement in mental health as a result of psychotherapy.Research designThirty-two MVP patients with AD attended integrative psychotherapy on request (1 to 2 sessions per week, individual assessments). Among them 18 (56.3%) received psychotherapy in addition to Alprazolam medication (with a fixed dose 1.5 to 4.5 mg per day, with dose titration if necessary depending on the severity of the AD, within periodical treatment).The therapy courses were conducted from 1997 to 2012. The duration of the psychotherapy ranged from 5 months to 2 years. The age of the patients during therapy ranged from 25 to 37 years. Most of the patients were women (28 people; 87.5%).Psychological and clinical examinations of the patients were conducted before and after the therapy courses; the follow-up study was undertaken after 2, 5, and 10 years.The types of AD and their frequency in the MVP patients are presented in Table 1.Table 1. AD in patients with MVP before therapy[Table omitted, see PDF.]Note. *Differences are significant when the data from the follow-up studies are compared with the data of MVP patients examined before therapy (pPhysical examination of the patients revealed a significant (p[Figure omitted, see PDF]Figure 1. Intensity of dysautonomic symptoms in patients with MVP before and after therapy and in the follow-up study. A: chest pain; B: psychogenic gastrointestinal disorders; C: loops of thermal control; D: neurogenic hyperventilation syndrome.Psychotherapy encouraged reductions in the frequency of a considerable number of analyzed vascular disorders and, to a considerable extent, in the frequency of tension-type headaches; differences are highly significant (p