Skumin syndrome

Skumin syndrome (Syndroma Skumin), develops in some patients with cardiac valve disease in the postoperative period after implantation of artificial heart valves and manifested by irrational fear, anxiety, depression, sleep disorder, and asthenia.

History of the disorder
Mitral valve replacement is a cardiac surgical procedure in which a patient’s diseased mitral valve is replaced by either a mechanical or bioprosthetic valve. Mitral valve replacement is performed when the valve becomes too tight (mitral valve stenosis) for blood to flow into the left ventricle, or too loose (mitral valve regurgitation) in which case blood can leak back into the left atrium and thereby back into the lung. Mitral valve disease can occur from infection, calcification, inherited collagen disease, or other causes. Since a mitral valve replacement is an open heart surgical procedure, it requires placing the patient on cardiopulmonary bypass.

Skumin syndrome (Russian: Синдро́м Ску́мина) was described by Skumin in 1978 as a cardioprosthetic psychopathological syndrome.

Alain Carpentier – a member of the French Academy of Sciences and the head the Department of Cardiovascular Surgery at the Hôpital Européen Georges-Pompidou in Paris – believed in 2011 that Skumin syndrome develops in a quarter of the patients with an artificial heart valve. It is possible that a similar problem arises in the conduct of operations to implement an artificial heart.

The International news agency «RIA Novosti», operating under the purview of the Russian Ministry of Communications and Mass Media (Russia), wrote about this problem (2014),



"Victor Skumin, our domestic scientist, described cardioprosthetic psychopathologic syndrome, which entered the textbooks as Skumin syndrome. The human mind is constantly fixed on the motor is running. For example, in contrast to prosthetic of teeth, arms or legs, it is not possible to divert attention of human from the sounds of functioning implant in his body. Person is constantly waiting for a suddenly the motor will stop? In the human heart the pain gives signals. Here there is no pain and can not to be. In the future, probably, there will be heart prostheses, imitating his heartbeat. But they will not be hurt, and Skumin syndrome will continue to hang over the human psyche with a heart valve prosthesis."

Skumin's priority on the description of this syndrome and the establishment of effective methods of treatment and rehabilitation of cardiosurgical patients confirmed Nikolai Amosov and Yakov Bendet, Alain Carpentier, and many others. The Higher Attestation Commission under the USSR Council of Ministers awarded him for this research study the degree of Candidate of Sciences (1980).

Etiology and pathogenesis
This syndrome occurs in patients after surgical treatment of heart valves defects. Valvular heart disease is a process involving one or more of the valves of the heart: the aortic and mitral valves on the left and the pulmonary and tricuspid valves on the right. Valve problems may be congenital (inborn) or acquired (due to another cause later in life). Often (depending on the severity) involves valve repair or replacement (insertion of an artificial heart valve).

Mechanical heart valves (MHV) are prosthetics designed to replicate the function of the natural valves of the human heart. MHV are very reliable and allow the patient to live a normal life. Most MHV last for at least 20 to 30 years. There are three major types of mechanical valves - caged-ball, tilting-disk and bileaflet - with many modifications on these designs. All MHV function in the human body creating a unique sound effects and vibration. These phenomena are the causes of the syndrome, believed to be the authors of the Handbook "Clinical Psychiatry". Due to the disruption of the receptor in the area of the implant and due to the cardiac dysrhythmia the attention of the patient focuses on the activities of his own heart. The syndrome, wrote the authors, often occurs when implantation prosthesis of the mitral valve or when replacing a few valves at once.

Signs and symptoms
Skumin syndrome associated with mechanical heart valve implant and manifested by irrational fear, anxiety, depression and sleep disorder. This syndrome is often accompanied by asthenia.

Skumin syndrome has a typical disease pattern. Thinking and behaviour of patients differ specifically. The attention is concentrated on the prosthesis functioning. There appear unusual sensations from a heart when a person fears possible break-down of artificial valves, ball splitting and tearing off a prosthesis. A person is depressed, miserable, alarmed, with a special kind of dismay (how to live with "a piece of iron in the heart", with a prosthesis in the "motor of life"). Patients tend to keep themselves away from petty physical or psycho-emotional tenseness, introducing inadequate self-restrictions in the routine.

They avoid walks, medical physical training and other adequate work, supposing this can prevent early wear of artificial valves. Sleep disorder is typical of 76.6% of the patients. At night they cannot fall asleep because they listen to a heart beat, count the number of extrasystoles, note petty changes in the heart rhythm and melody of the implanted prosthesis. On the contrary, in the daytime, when it is noisy they can have sound sleep. Neurologically a patient has vegetative faults – painfulness in the zones of solar plexus and carotid artery, arterial hypotension. The research registered faults in mental activity of the patients with a prosthesis. It considerably hampers the realization of rehabilitation programmes. Systematic use of special psychotherapeutic and prophylactic measures is required for the correction and prevention of these faults.

Treatment and rehabilitation
The methods and the main principles of such therapy and neuropsychological rehabilitation are described and its efficacy was demonstrated.

Skumin proposed mixture subsequently named after him. Skumin’s mixture (Russian: Миксту́ра Ску́мина) is a medicine with a sedative effect, affecting the central nervous system. It is used to treat Skumin syndrome, light forms of heart failure, anxiety and sleep disorders, and asthenia. The medicine is known to be well tolerated, with no contra-indications, except sensitivity. The formula contains Adonis vernalis, Crataegus, Valerian root, Leonurus cardiaca, Eucalyptus, Peppermint, and Rose hip.

For psychiatric rehabilitation, Skumin improved psychological function by calming the nervous system, enhancing relaxation, increasing body awareness and decreasing general anxiety.

In 1979, Skumin created a special modification of mind control method for psychiatric rehabilitation of cardiosurgical patients. This method is based on autogenic training. Autogenic training is a relaxation technique developed by the psychiatrist Johannes Heinrich Schultz. He emphasized parallels to techniques in yoga and meditation. It is a method for influencing one's autonomic nervous system. The technique involves the daily practice of sessions that last around 15 minutes, usually in the morning, at lunch time, and in the evening. During each session, the practitioner will repeat a set of visualisations that induce a state of relaxation. Each session can be practiced in a position chosen amongst a set of recommended postures.

The technique of the Skumin mind control method (Russian: Психотре́нинг по Ску́мину) involves the use of two standard postures: sitting meditation and lying down meditation. This method includes five psychological exercises: the first is "the relaxation", the second one is "the warming", the third one is "the zero gravity", the fourth one is "the target autosuggestion", and the fifth exercise is "the psychological activation". Each session contain explanation of the theory and practice of each new exercise as it is reached. The therapeutic effect is achieved by the neutralization of traumatic emotional experiences and the progressive reorganization of the psychic structures to include previously unacceptable mental contents, too. This method of psychotherapy has found application in medical practice, in particular in the treatment of phobias, headaches, etc.