Consider Anxiety in Cases of Pediatric Chest Pain. (Two Small Studies)

Article excerpt

AUSTIN, TEX. -- Children who present with chest pain rarely have cardiac problems and are more likely to have a diagnosable anxiety disorder, Dr. Joshua D. Lipsitz reported at the annual conference of the Anxiety Disorders Association of America.

"If you have chest pain as an adult, there is a reasonable suspicion that there might be something wrong with your heart," said Dr. Lipsitz, a clinical psychologist at Columbia-Presbyterian Medical Center, New York. But a pediatric cardiologist of his acquaintance has found only one or two children with genuine heart problems among the hundreds he has evaluated for chest pain.

Somatizing--expressing emotional distress in somatic symptoms--is the most common presentation of psychopathology in children, said Dr. Lipsitz, who described two small studies he and his colleagues recently conducted.

The first, a pilot diagnostic study, involved interviews with 22 children, aged 7-18 years (mean 12.5 years, 55% female), who were seen in a pediatric cardiology clinic for chest pain. Each child and his or her parent was interviewed using the Anxiety Disorders Interview Schedule (ADIS). Panic disorder was the most common anxiety disorder in these children, found in 8 of the 22 (36%).

"Kids would call it chest pain, but when you ask them to describe it, it was an array of four or more symptoms that come on [in waves] and recurred enough times to meet the criteria for panic disorder," said Dr. Lipsitz.

Other common DSM-IV diagnoses in this group included generalized anxiety disorder in five children, social phobia in three children, specific phobia in three children, and obsessive-compulsive disorder in two children.

Overall, 12 of the children (55%) had a diagnosable anxiety disorder, and 7 (32%) had two or more anxiety disorders. Anxiety disorders were more prevalent in girls and in older children. …