Imad Basha

Panic disorder in patients with chest pain and angiographically normal coronary arteries

Although patients with angiographically normal or near normal coronary arteries are at low risk for cardiac disease, several follow-up studies have shown that many continue to report recurrent chest pain associated with social and work dysfunction. Three diagnostic entities have been proposed to explain the morbidity of this group: microvascular angina, esophageal motility disorders and panic disorder. The purpose of this study was to test the hypothesis that panic disorder is found frequently in patients with chest pain who have normal epicardial vessels. Ninety-four subjects with angiographically normal coronary arteries were interviewed according to a structured psychiatric protocol within 24 hours of their catheterizations. Thirty-two (34%) fit Diagnostic and Statistical Manual of Mental Disorders (third edition, revised) criteria for current panic disorder. Because panic disorder can be effectively treated, physicians should consider this diagnosis in this group of patients. Current research findings suggest that panic disorder, microvascular angina and esophageal disorders may each form the basis for chest pain in approximately 25% of these patients. Miscellaneous problems account for the other 25%.

Non-fearful panic disorder: panic attacks without fear.

Abstract Twelve of 38 cardiology patients with chest pain and current panic disorder reported that during their last major panic attack they did not experience intense fear, nor did they experience fear of dying, fear of loss of control or fear of going crazy. Using the DSM-III(R) criteria, they were diagnosed as non-fearful panic disorder (NFPD), and contrasted with the other 26 S s on several descriptive and self-report measures. The NFPD group reported significantly fewer phobias but was no different on reports of depression and several panic attack variables. The NFPD group scored lower on only three of 18 self-report scales. These results suggest that the DSM-III(R) defined NFPD S s resemble those who report the subjective experience of anxiety during their attacks.

Major depression in cardiology chest pain patients without coronary artery disease and with panic disorder

104 patients in a cardiology clinic with atypical or non-anginal chest pain were studied through a structured clinical interview. 43 without coronary artery disease fit diagnostic criteria for panic disorder. 19 (44%) of this group reported a lifetime prevalence of major depression, nine (21%) current and ten (23%) past only. Nine reported that their major depressive episodes had preceded the onset of their panic disorder. On many self-report questionnaire scales the group with a lifetime history of major depression (n = 19) differed significantly from the group with no lifetime history of major depression (n = 24). These differences, however, could be attributed primarily to the group with current major depression. There appears to be a subgroup of panic disorder patients who have current major depression who are more symptomatic than those with panic disorder and past major depression and panic disorder alone. These findings also suggest that the association between panic disorder and depression may remain high outside of psychiatric settings.

ATYPICAL ANGINA IN PATIENTS WITH CORONARY ARTERY DISEASE SUGGESTS PANIC DISORDER

The occurrence of psychiatric disorders in patients with “medical” problems is not only possible but maybe even facilitated by these problems. This article examines the relationship between the type of chest pain and the diagnosis of panic disorder among coronary artery disease (CAD) patients. Forty-nine such cardiology patients were interviewed using a structured instrument. Forty percent of patients with atypical angina met DSM-III-R criteria for current panic disorder while no panic disorder was identified in the typical angina group. This finding should have great implications for the care of CAD patients. At least many of the atypical angina patients could benefit from standard effective treatment for panic disorder. This would likely improve their functioning and decrease the financial burden on them and the health care system.

Panic disorder in patients with angiographically normal coronary arteries: A pilot study

Although persons with angiographically normal arteries have low cardiac morbidity and mortality, continuing chest pain with resulting social and vocational morbidity may occur. Using the hypothesis that the chest pain was related to panic attacks, the authors studied 33 cardiac catheterization patients through a structured interview based on DSM-III and through self-reports of anxiety and depression. One third of this group proved to fit the criteria for panic disorder. These findings suggest that patients with chest pain who are being evaluated by cardiologists and primary care physicians should also be considered for panic disorder.

Panic attack symptoms in patients with chest pain and angiographically normal coronary arteries

Abstract It is often difficult to explain anginal chest pain in patients with angiographically normal coronary arteries and no other obvious heart disease. We reviewed a series of 123 such patients for the characteristics of their chest pain and for other somatic symptoms of panic attacks. Our findings suggest that many of these patients are likely to have panic attacks and should be considered for psychiatric evaluation. A significant number in this group have left-sided, sharp chest pain and palpitations.

Comparing panic disorder uncomplicated and panic disorder with agoraphobia in cardiology patients with atypical or nonanginal chest pain

Abstract Thirty-eight cardiology patients with either atypical or nonanginal chest pain and current panic disorder were divided into two groups, those with agoraphobia ( N = 8) and those without agoraphobia ( N = 30). The agoraphobia group reported marginally longer duration of panic disorder (17.0 ± 21.1 years vs. 3.0 ± 3.2 years) and significantly more panic symptoms (10.6 ± 3 vs. 7.3 ± 2.2) during the last major attack. The agoraphobia group also scored significantly higher on measures of anxiety, depression, phobic avoidance, somatization, interpersonal sensitivity, and psychoticism and also scored higher on three of three global measures of distress. This agoraphobia group differed from previously reported agoraphobics with panic attacks in that they all had current panic disorder, while previously reported groups were categorized according to DSM-III, which required only a history of panic attacks. These findings suggest that patients who have current panic disorder and agoraphobia are more symptomatic. Of interest is the low proportion of agoraphobics compared to nonagoraphobics found in this panic disorder population.

Panic Disorder: A Frequent Occurrence in Patients with Chest Pain and Normal Coronary Arteries:

From 10% to 20% of patients undergoing coronary arteriography for chest pain are subsequently found to have normal coronary arteries. We investigated the prevalence of panic disorder in these patients in a two-stage study. Our results indicate that approximately one third of patients with chest pain and angiographically normal coronary arteries have panic disorder. Proper diagnosis and treatment of these patients with panic disorder may be expected to substantially reduce their psychosocial morbidity.

Panic disorder in cardiology patients with atypical or non-anginal chest pain: A pilot study

Abstract Since chest pain is a characteristic symptom of panic attacks, the authors hypothesized that cardiology patients with atypical or nonanginal chest pain were likely to have panic disorder. In this pilot study, 13 of 30 (43%) of such patients evaluated by a semi-structured interview were positive for panic disorder. Atypical and nonanginal chest pain may serve as potential markers for panic disorder.