Matt Kushner

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%.

Fear of psychological treatment and its relation to mental health service avoidance

Les auteurs etudient les relations entre la peur du traitement dune maladie mentale et lhistoire de son propre traitement et/ou le statut du traitement actuel. Lechantillon comprend 32 sujets admis plusieurs fois dans des unites de soins psychologiques et 501 sujets non hospitalises. Les resultats montrent en particulier le lien entre les craintes dun traitement et les decisions de recherche dun tel traitement

Memory deficits in compulsive checkers: Replication and extension in a clinical sample

Thirteen checkers and twelve noncheckers, identified on the basis of their responses to the checking subscale of the Maudsley Obsessional-Compulsive Inventory (MOCI; Rachman and Hodgson, 1980), were recruited from a sample of 99 consecutive admissions to the outpatient department of a community mental health center. Consistent with our previous research with nonclinical samples of college students (Sher et al., 1983, 1984), checkers were found to show deficits in memory, especially recall for recently completed actions, compared to noncheckers. This result demonstrates the replicability of our previous findings across different types of samples and implicates deficits in memory for actions as a potentially important determinant of checking behavior. Assessment of spontaneous imagery associated with the anamnestic process suggested that checkers utilized less imagery, especially visual imagery, when recalling biographical information. Additional measures collected at the time of testing indicated that checkers were more neurotic and reported more psychological distress than noncheckers.

Perceived controllability and the development of posttraumatic stress disorder (PTSD) in crime victims

This study evaluated the association between perception of controllability and the development of posttraumatic stress disorder (PTSD) following criminal assault. Factor analysis of a perceived controllability scale revealed three factors; perceived controllability felt during the assault, expected controllability over future assaults, and perceived controllability over aversive events more generally. Only the latter factor was associated with PTSD symptom severity. The hypothesis that perceived controllability would be negatively associated with assault severity was partially supported. Further analyses showed that the association between controllability and PTSD was not mediated or moderated by assault severity measures. The role of perceived controllability in the development of PTSD is discussed.

Panic attacks without fear: An overview∗☆

Non-fearful panic disorder (NFPD) is a condition that meets DSM III-R criteria for panic disorder but lacks a report of subjective fear or anxiety. Presenting the first comprehensive overview of this issue, the authors describe studies investigating a wide range of apparently overlapping phenomena including NFPD, somatically expressed panic, non-cognitive panic, alexithymic panic, non-clinical panic, and masked anxiety. The review shows that such conditions account for from 20 to 40% of the panic disorder found in various medical populations, and that this group resembles conventional panic disorder in cross-sectional comparisons. We emphasize that a triple-response model of anxiety is consistent with our conclusion that NFPD should be conceptualized as a panic disorder subtype. Finally, we discuss unresolved issues regarding the construct and predictive diagnostic validity of NFPD.

Panic disorder without fear in patients with angiographically normal coronary arteries.

By DSM-III-R criteria, patients may be diagnosed as having panic disorder without reporting the experience of intense fear. However, if such patients do not report subjective fear, they may be less likely to receive a panic diagnosis. The authors studied 32 subjects with angiographically normal coronary arteries who fit panic disorder criteria. A total of 13 (41%) reported no fear during their last major attack. These subjects were contrasted with those who did report fear. Pew differences were found in group demographic data or responses to self-report questionnaires. We conclude that there appear to be few differences between the nonfear panic disorder subjects and those who do report fear. This conclusion awaits further support using challenge tests, medication trials, biological indices, alexithymia inventories, and family studies. The recognition of the existence of this subtype is likely to increase the number of patients receiving the panic disorder diagnosis in cardiology settings, in psychiatric settings, and in research projects using structured clinical interviews.

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.

Late Onset Panic Disorder: Evidence from a Study of Patients with Chest Pain and Normal Cardiac Evaluations

In the context of administering psychiatric diagnostic interviews to cardiology patients with chest pain and no evidence of coronary artery disease, the authors found twenty-seven patients over the age of sixty-five, nine (33%) of whom fit panic disorder criteria. Their mean age of onset was sixty-two (SD = 23 years). Only two patients reported onset of panic disorder earlier than age sixty-two. All nine were widows while the comparison group of non-panic subjects over age sixty-five included only seven of eighteen (40%) who were widows. These findings suggest panic disorder may be prevalent in older patients with chest pain and no evidence of coronary artery disease and that panic disorder may begin later in life.

Frequency of isolated panic attacks and panic disorder in patients with the mitral valve prolapse syndrome

Abstract Panic disorder is a specific form of anxiety disorder that shares several clinical features with the mitral valve prolapse (MVP) syndrome. 1,2 Studies attempting to define the relation between these disorders have produced conflicting results. 3–5 This study prospectively assesses the frequency of isolated panic attacks and panic disorder in patients with the MVP syndrome.

Validating Studies for Panic Disorder in Patients with Angiographically Normal Coronary Arteries

This article describes validating studies for diagnosing panic disorder in some patients with angiographically normal coronary arteries (NCA) and chest pain. Psychiatric interviews of 94 such patients showed that 34% met the diagnostic criteria for panic disorder. Further studies showed that NCA patients with panic disorder were more disabled at 3.5-year follow-up, had more relatives with panic disorder, were more likely to suffer from major depression, and were more likely to respond to 35% CO2 challenge with panic symptoms. Because panic disorder is highly disabling but responds well to psychological and pharmacologic treatments, screening NCA patients in the cardiology population for this disorder is recommended.