This document discusses the relationship between personality, stress, and cardiovascular disease. It summarizes several studies that found higher levels of depression, neuroticism, and Type D personality among patients with coronary artery disease compared to healthy controls. Type D personality, characterized by negative affectivity and social inhibition, was found to be more common in patients with coronary artery disease. Stress is identified as a common factor linking depression and cardiovascular disease. The document also discusses the role of context and interpersonal relationships in health, suggesting cardiovascular health and function occurs within social environments and interactions with others.

1. Psychocardiology
The importance of the "hearts in interaction"
Olivera Vukovic

2. ‘Water used by firemen’

3. Mental & physical health – the
role of stress
Psychiatriki, 2009

4. Evolutionary Origins & Functions
of the Stress

5. “Mental stress & Health”
Pubmed

6. The Better Angels of Our Nature
Why Violence Has Declined?
Society, Science, and Death

7. Evolutionary Psychology

8. Dove Hawk
HPG-output (testosterone)  
HPA-output (cortisol or corticosterone)  
Neurosympathetic (NE)  
Parasympathetic (HRV)  
Hippocampus (MR mRNA) No response 
ALLOSTATIC LOAD
Anxiety disorders
Violence/impulse control disorders
Hypertension, CHD
Melancholic depression Atypical depression
Psychotic states/insomnia Chronic fatigue states/hypersomnia
Hypertension, Sudden death Metabolic syndrome (sy X)
Infection Inflammation/autoimmune disease
Differences between the neuroendocrine
responses to acute threat
Korte, et al. 2005

10. 60
70
80
90
100
110
120
130
140
150
160
Neuroticism Extraversion Openness Agreeableness Conscientiousness
Personaity & CVD –
preliminary results
** ** **

11. “The literature review on which this chapter
is based was originally conducted in the
context of the Psychocardiology Status
Conference.
Between 1998 and 2002, the members of
this panel wrote comprehensive reviews of
psychosocial aspects of CHD and met
several times a year to discuss and peer
review their work (Jordan, Barde, & Zeiher,
2001)”.

12. ‘Coronary-prone personality’
Johan Denollet (1996)Helen Flanders Dunbar (1935) Howard Rosenman & Meyer Friedman
(1974)

13. Type D Personality
Negative Affectivity Social Inhibition
Definition
tendency to experience negative emotions
across time/situations
tendency to inhibit emotions and behaviors
in social interaction
Manifestation
unhappy, tends to worry;
easily irritated;
closed and reserved;
tends to keep others at distance
Assessment DS14 subscale (7 items; ≥ 10 cut-off) DS14 subscale (7 items; ≥10 cut-off)
Sample items
“I often feel unhappy”
“I often find myself worrying about something”
“I am often irritated”
“I am a closed kind of person”
“I often feel inhibited in social interactions”
“I find it hard to start a conversation”
Pedersen & Denollet, 2006

14. Old wines, new bottles
Stress
Personality
Heart
 Depression vs. Negative affectivity
 Stable personality traits vs. Current state
 Interpersonal Communication Context

15. Relationship between depression and
coronary heart disease
Olivera Vukovic1, Dušica Lecic-Toševski2, Jelena Stepanovic3
1 Institute of psychiatry, CCS 2 Institute for mental health; 3Institute of cardiovascular diseases
UVOD: Klinička depresija ne dovodi isključivo do gubitka zadovoljstva u svakodnevnim aktivnostima već komplikuje, a najverovatnije
predstavlja i faktor rizika za razvoj koronarne bolesti (KB). Predloženo je više mehanizama kojima se tumači priroda medjuodnosa ova
dva poremećaja. Cilj studije bio je da se ispita nivo depresivnosti i učestalost tipa D ličnosti kod pacijenata sa dijagnozom stabilne
koronarne bolesti u odnosu na kontrolnu grupu zdravih ispitanika.
• grupa 1 = 36 subjekata sa dijagnozom stabilne KB
muškarci 18 (50%); starost 55,34 (SD 7,32)
• grupa 2 = 30 zdravih subjekata
muškarci 24 (80%); starost 52,10 (SD 6,86)
REZULTATI I DISKUSIJA:
Instrumenti procene:
• Skala depresije, anksioznosti i stresa (DASS)
• D14 upitnik (DS14):
METOD:
0
20
40
60
80
non Tip D Tip D
grupa 1 grupa 2
Na osnovu iznetih rezultata pokazano je da su negativne emocije udružene sa KB. Stres predstavlja
zajednički imenitelj depresije i KB, te pretpostavljamo da udruženost ova dva poremećaja posreduje,
izmedju ostalih i specifična konstelacija ličnosti, tzv. ličnost sklona distresu (tip D ličnosti).
**
U grupi 1, prosečna vrednost subskale depresivnost DASS skale je statistički značajno viša u odnosu na srednju vrednost u grupi 2 (17,34±8,50 nasuprot 8,80±5,83;
p<0.01). Potvrdjeno je da postoji različita učestalost tipa D ličnosti u ispitivanim grupama. Naime, 24 (66,73%) ispitanika grupe 1 zadovoljava kriterijume za tip D
ličnosti, dok je u grupi 2 učestalost tipa D bila statistički značajno manja 12 (40.0%) (χ2[1]=4,69; p<0.05). U obe ispitivane grupe, vrednosti DASS i DS-14 visoko
koreliraju (u grupi 1 r=.746; p<0.01; u grupi 2 r=.761; p<0.01).

17. Percentage of distressed CAD patients (n=79), stratified by depressive disorder and Type
D personality
41,2%
12,9%
58,8%
0
10
20
30
40
50
60
70
Depressed Type D Depressed non-Type D Non-Depressed Type D
Distressedpost-MIpatients(%) Type D personality in patients with coronary
artery disease, 2
Vukovic O, et al., Psychiatr Danub, 2014.

18. Health related behaviour
Coping
Acute
stress
reaction CHD
Mental stress test
Personality
Perceived
stress
Mood

19. Psychosom Med 2012;74:766-72.

20. Figure 2. Resting and peak values of heart rate, systolic and diastolic blood pressure, and rate-pressure product in patients who developed myocardial ischemia (positive)
and who did not develop myocardial ischemia (negative) during mental stress (MS) test (math and anger recall). b/min = beats per minute.

22. Blood pressure reactivity from
resting baseline to task
F[2,77]=4,11; p=0,04; partial η2=0,19 F[1,77]= 1,41; p=0,23; η2=0,007
Condition: 1 = Baseline period, 2 = Rest, 3 = Mental arithmetic task, 4 = Anger recall task.
p=0,01
p =0,003
p=0,03
p=0,00
Vukovic O, et al. 2011.

24. Potencijali
 Ljudi poseduju osobine koje se
mogu ostvariti samo u okviru
određjenih sredina, koje mogu
ali i ne moraju biti deo njihove
svakodnevice!!!
 Psihološki kvaliteti nisu
inherentne karakteristike, već
zahtevaju socijalno okruženje da
bi se ispoljili
Kaganova (1998) analogija
Kategorija potencijalno opasnih objekata

25. Contextual cardiology
Interpersonal cardiovasular systems
Health is an interpersonal matter, and heart develops
and functions in interaction with other hearts
Should our understanding, diagnosis, and treatment
of the cardiovascular system be done in the context
of our patients’ interpersonal interactions?
It seems possible that these styles, particularly in the
context of interpersonal relationships, could have a
significant impact on the cardiovascular system.
Pearsall, 2007

26. Health in context
“I ka `olelo no ke ola
I ka `olelo no ka make”
“Our words bring life, our
words cause death”
Smith et al. 2012

27. Broken heart syndrome
First report of tako-tsubo cardiomyopathy -
Takotsubo-like left ventricular (LV)
dysfunction described by Dr Sato (Satoh et
al., 1990.) Increase in the Number of Publications on
MEDLINE Concerning Takotsubo Cardiomyopathy

30. Happy heart syndrome
Patient 1 Birthday party
Patient 2 Son's wedding
Patient 3 Meeting after 50 years with friends from high school
Patient 4 Preparing 50th wedding anniversary (pleasant anticipation)
Patient 5 Positive job interview
Patient 6 Wedding
Patient 7 Favourite driver won race car competition
Patient 8 Becoming grandmother
Patient 9 Surprise farewell celebration
Patient 10 Son's company opening
Patient 11 Favourite rugby team won game
Patient 12 Emotional speaking during a friend's birthday
Patient 13 Celebrating 80th birthday
Patient 14 Winning several jackpots at the casino
Patient 15 Celebration of normal PET-CT scan
Patient 16 Visiting opera with her family
Patient 17 Family party
Patient 18 Unexpected visit from favourite nephew
Patient 19 Grandchildren visiting from London (abroad)
Patient 20 Becoming great grandmother

31. The SAGE Handbook of Personality
and individual differences
Stress and its multiple faces
Dusica Lecic Tosevski2, 3, Olivera Vukovic1,2, Bojana Pejuskovic1,2, Nadja P. Maric1,4
1 School of Medicine, University of Belgrade, Belgrade, Serbia
2 Institute of Mental Health, Belgrade, Serbia
3 Serbian Academy of Sciences and Arts
4 Clinic for Psychiatry, Clinical Center of Serbia, Belgrade, Serbia
Zeigler-Hill, V., & Shackelford, T. K. (in press). The SAGE handbook
of personality and individual differences: Volume 3. Applications
of personality and individual differences. London: SAGE.