الفهرس 
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Abstract
Ischemic heart disease (IHD) is the leading cause of death worldwide (Scarborough et al., 2011). It is responsible for up to one third of deaths (Roger et al., 2012). Moreover it will be the most common reason of mortality in the world by the year 2030 (Sniehotta et al., 2005). In Egypt, IHD is the leading cause of death according to world health organization (WHO) (Nobwar et al.,2014).
Over the past 20 years there had been growing evidence of a link between psychiatric disorders and cardiovascular disease. This link has been shown in multiple studies linking psychiatric disorders with an increase in mortality from (IHD) (Collip et al., 2013).
An intriguing relationship between mental illness and CHD appears to exist. A higher prevalence of mental diseases in CHD patients has been demonstrated. Conversely, people suffering from a mental disease seem to have an increased risk of CHD. A common pathophysiological mechanisms may link both diseases (Hert et al., 2018).
The association between mental disorders and CHD is often complicated by comorbid psychiatric conditions (Several mental disorders, including SMI and anxiety disorders, are correlated with comorbid conditions such as obesity, hypertension, dyslipidemia (elevated triglycerides and decreased high-density lipoprotein [HDL] cholesterol), glucose intolerance or insulin resistance, all known to be associated with an increased risk of CHD. These abnormalities are major characteristics of the metabolic syndrome that confers a 3- to 6-fold increased risk of mortality due to CHD (Levine et al., 2014).
The psychosocial and behavioral factors including mood (anxiety, depression and stress), personality traits (type A and type D and hostility) and social support are not only related to the development but also to the progression of cardiovascular disorder. Mood and personality traits are the first two of the five main titles listing the psychological and behavioral risk factors that affect the development of CAD (Perk et al., 2012). The personality traits associated with CAD have been described under the type A and D personality profile (Roest et al., 2010).
Coping strategies as a part of a person’s character assist them to react to different stressful life events. Individuals try to use problem- or emotion-focused strategies to modify the situation, and/or regulate their emotions respectively. Coping strategies are generally divided into adaptive and maladaptive coping strategies. Reactions like rumination, aggression, and passive avoidance have been considered as maladaptive coping strategies, and adaptive coping strategies include learning new skills, seeking help, and venting anger. (Kristofferzon et al., 2004).
Since ACS is a traumatic event, patients have to cope with this occurrence, so some researchers have evaluated the outcomes of coping strategies after ACS and showed patients with maladaptive behavior have more disability (Chung et al., 2008).
Management of psychiatric disorders in patients with Ischemic heart diseases includes Cardiac rehabilitation: It is an essential component of the comprehensive management of cardiac patients, largely to reduce the detrimental emotional, psychosocial, and physical sequale of cardiac events, while setting the pattern for long-term secondary prevention. (West et al., 2012).
Exercise programs: In coronary heart disease patients, aerobic exercise in a group setting appears to have a similar impact on reducing depression to antidepressant medication, those randomized to exercise also having a higher VO2 peak (Blumenthal et al., 2012).
General support: It is likely that general information, advice, and reassurance from a perceived medical authority figure is beneficial. Cognitive behavior therapy (CBT) aims to counteract psychological disorders or problems that arise from dysfunctional thoughts, feelings, and behaviors that develop early in life and can become activated in response to stress( Beck and Dozois 2011).
Pharmacotherapy: Anti-depressant medications, most commonly used are those in the SSRI class, have been demonstrated to improve depression in cardiac patients, particularly those with recurrent or severe depression (Lesperance et al., 2007).
So, we hypothesized that The Personality temperament, character and coping style may affect the severity of IHD. Also the psychiatric comorbidities are more prevalent in IHD.
The aim of the current study was to identify different sociodemographic factors that can be associated with IHD. To identify the personality temperament and character among patients with different groups of ischemic heart diseases. To study the coping style among patients with Coronary artery diseases. To analyze psychiatric morbidities frequency and phenomenology in patients with IHD.
Cases were enrolled from patients attending the cardiology clinics and coronary catheterization unit in cardiology department, Ain shams University Hospitals.
. The catheterization unit is working 6 days per week and serves around 30 to 40 patients per day. The cases diagnosed with IHD were divided into 3 groups; According to the number of vessels affected in the diagnostic angiography to:
1- Patients for conservative medical treatment: Single vessel.
2- Patients for Percutaneous Coronary Intervention (PCI): two vessels.
3-Patients for Coronary artery bypass graft (CABG): three vessels.
• Each group was consisted of 30 patients. All patients fulfilling the inclusion criteria offered to participate in the study until completion of the sample size.
Participants involved in the study was subjected to:
A- A written informed consent obtained from all patients involved in the study and the subjects are given a detailed explanation of the nature and aim of the study.
B- Study proper:
4. Cardiological Assessment was done including cardiological examination and investigations (ECG, echo, diagnostic angiography).
5. Sociodemographic data was collected by self-designed questionnaire according to the psychiatric sheet of the institute of psychiatry Ain Shams University.
6. The cases and controls were assessed using the following measures:
e) General Health questionnaire (GHQ) for screening of psychiatric disorders.
f) Structured Clinical Interview for DSM-IV Axis I Disorders (SCID I) for axis I diagnosis.
g) The Temperament and character Inventory (TCI) to detect the temperament and the character traits for the study sample.
h) Coping processes scale to detect the different coping style in the study sample.
The main findings of this study were:
• The results showed that gender, education level and occupation level were significantly different among group A, B and C and control groups p value (0.10, 0.001, 0.001, 0.001) respectively.
• There was a statically significance difference between the patients groups and the control group as regard the risk factors including hypertension (p value=0.002), Diabetes militias (p value=0.014), known cardiac patient (p value=0.003) and smoking ( p value =0.002).
• Following the screening, SCID was done for diagnosis of psychiatric disorders. And follow up SCID was done one month later. It had been showed statically significance difference between group A, group B, group C and the control as regard psychiatric disorders including anxiety, depression and adjustment disorder with (p value <0.001) and also follow up SCID shows statically significance difference (p value <0.001)
• By using TCI-R the current study demonstrated that there was a statistical significant difference between cases and control regarding the following temperament: reward dependence, Persistence, Self-directedness, Cooperative and Self-transcendence (p value <0.001).
• As regard the coping style between the cardiac cases and the control, our study revealed that helplessness, mental disengagement, seeking out information, turning to religious, emotional discharge, Acceptance, execrate of restrain, denial and positive reinterpretation (p value <0.001) were found to be a statistical significant difference between cardiac patients and the control group.