Psychiatric Comorbidity in Patients with Chest Pain without a Cardiac Etiology

By Hocaoglu, Cicek; Gulec, Medine Yazici et al. | The Israel Journal of Psychiatry and Related Sciences, January 1, 2008 | Go to article overview

Psychiatric Comorbidity in Patients with Chest Pain without a Cardiac Etiology


Hocaoglu, Cicek, Gulec, Medine Yazici, Durmus, Ismet, The Israel Journal of Psychiatry and Related Sciences


Abstract: Objective: Throughout the world and among different cultural groups, physical symptoms are the most common expressions of social problems and distress; chest pain is one of the most widely seen, medically unexplained physical symptoms. Most of the time, chest pain cases in which an organic etiology cannot be determined over time and in those presenting with atypical features should be evaluated as a component or an accompanying symptom of various specific psychiatric disorders, primarily such as panic disorder and depression. The aim of this study was to determine the psychiatric comorbidity rate in patients with chest pain without a cardiac etiology. Method: Seventy patients admitted to the cardiology clinic with a complaint of chest pain but without any detectable cardiac etiology were included in the study. All patients were evaluated using a Sociodemographic Data Collection Form and Structured Clinical Interview for DSM-IV. Results: Panic disorder was diagnosed in 47.1% of the non-cardiac chest pain group, depressive disorders in 21.4%, generalized anxiety disorder in 5.7%, anxiety disorders not otherwise specified in 5.7%, obsessive compulsive disorder in 5.7%, and undifferentiated somatoform disorder in 2.9%. Two psychiatric diagnoses were established in 12.9% of the patients and no psychiatric diagnosis in 24.3%. Conclusion: Psychiatric disorder rates are quite high in patients with chest pain that cannot be explained cardiologically. These results show the importance of psychiatric evaluations in patients with non-cardiac chest pain or unexplained chest pain (UCP). In addition, understanding the psychiatric symptom profile of these patients will make an important contribution to the treatment of non-cardiac chest pain.

Introduction

Worldwide and among different cultural groups, bodily symptoms are the most common individual expressions of social problems and emotional distress (1). Chest pain as a bodily symptom unexplained medically is frequently seen in people seeking treatment at first and second step health institutions (2). Over 50% of patients with chest pain are diagnosed by cardiologists with chest pain unrelated to the cardiac system. Non-cardiac or unexplained chest pain (UCP) can be defined as recurrent angina-like or substernal chest pain thought to be unrelated to the heart after a reasonable cardiac evaluation (2-8). Only one-third of patients with chest pain are diagnosed with ischemic heart disease (2). Some 10% to 30% of patients who experienced cardiac catheterization due to angina-like symptoms are found to have normal coronary arteries. In most of these patients, chest pain continues and they frequently come to the emergency department and their heart catheterization is repeated (9). Although the medical prognosis of UCP patients is good, these patients do not function well. The unexplained chest pain is persistent; it causes long-term physical limitations, and negatively affects daily activities (4). Chest pain is persistent in 50% to 70% of UCP patients, and 19% to 51% of the patients experience occupational losses, and 40% to 100% experience functional losses. They are exposed to increased rates of medical interventions, including high rates of hospitalization and inappropriate cardiac drug intake (6, 10, 11). Most of the time, chest pain cases in which an organic etiology cannot be determined over time and those presenting with atypical features should be evaluated as a component or an accompanying symptom of various specific psychiatric disorders, primarily such as panic disorder and depression (2, 12-17).

Worrying about cardiac disease is the most common belief reported by patients with both generalized anxiety disorder and panic disorder. It is not at all surprising to note that most patients admitted with chest pain and palpitation describe physical symptoms of anxiety. Panic is the exact cause of chest pain and palpitation, but this is only one of the various psychological reasons associated with the etiology of these symptoms (3). …

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