Factors predictive of panic disorder in cardiology patients with chest pain and no evidence of coronary artery disease: A cross-validation

doi:10.1016/0022-3999(89)90048-2

Journal of Psychosomatic Research

Volume 33, Issue 2, 1989, Pages 207-215

https://doi.org/10.1016/0022-3999(89)90048-2 Get rights and content

Abstract

Recent data indicate that a substantial number of cardiology patients with chest pain and no clinical evidence of coronary artery disease suffer from panic disorder. Discriminant function analysis reveals that a self-report anxiety measure alone, or in conjunction with minimal demographic information, can predict whether such patients have panic disorder. Predictive accuracy ranges from 69 to 76% correct classification, significantly improving upom chance predictions alone. A ‘split-half’ design was used in order to cross-validate predictive equations, and the total sample was also analyzed so as to provide the most stable equation. Clinical and future research implications of these findings are discussed.

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Cited by (19)

Predicting panic disorder among patients with chest pain: An analysis of the literature
2003, Psychosomatics
Citation Excerpt :
Still, the results suggested a significant association between chest pain and anxiety, especially in patients with normal coronary angiograms, that has led to further investigation into the association between panic disorder and chest pain. Since these seminal studies, at least 20 published reports have examined the prevalence of panic disorder in patients with chest pain.25–29,35–51 Three major studies in emergency departments found high rates of panic disorder among patients seeking evaluation of chest pain25,26,35 (Table 1).
As many as 25% of patients with chest pain who come to hospital emergency departments have panic disorder. Rates of panic disorder are even higher among those who present for outpatient evaluation of their chest pain. Unfortunately, panic disorder remains largely undiagnosed and untreated in these settings. The authors reviewed studies published between 1970 and 2001 that addressed the prevalence of panic disorder among persons who seek treatment for chest pain in an emergency department or outpatient cardiology clinic. A meta-analysis of the findings revealed five variables that appear to correlate with higher rates of panic disorder among persons who present with chest pain: 1) absence of coronary artery disease, 2) atypical quality of chest pain, 3) female sex, 4) younger age, and 5) a high level of self-reported anxiety. Further studies of these and other variables associated with panic disorder should aid in the detection of this disabling but treatable cause of chest pain.
Panic disorder and the heart: A cardiology perspective
2000, Journal of Psychosomatic Research
Panic disorder is a common condition that includes symptoms that may masquerade as a primary cardiovascular disorder. In addition, many patients with cardiovascular disease may also have panic disorder. To date, no definitive pathophysiological mechanism for panic disorder has been found; however, there are several hypotheses in the literature. Patients with syndrome X, coronary artery disease and/or palpitations, in addition to panic disorder all present to cardiologists. However, many patients go undiagnosed and ultimately place large costs on the health care system as a result. Panic disorder is a treatable condition, and cardiologists could easily identify patients with panic disorder and initiate appropriate therapy and/or referral.
The detection of panic disorder in chest pain patients
1999, General Hospital Psychiatry
The aims of this study were to 1) develop a detection model for recognizing panic disorder (PD), 2) develop a simple questionnaire as a screening instrument for PD detection, and 3) test in an outpatient cardiological chest pain population a detection model for panic disorder previously described by Fleet et al. [20]. Logistic regression analysis was performed to explore factors predictive of panic disorder and to test the cross-cardiological setting constancy of the Fleet model in 199 chest pain patients without previously known heart disease referred to cardiological outpatient investigation of chest pain. The SCL-90 somatization subscale, Agoraphobia Cognitions Questionnaire, chest pain quality, pain localization, and age were the best predictors of the presence of panic disorder. This model correctly classified 78% of the subjects. The sum-score of a three-item questionnaire correctly classified 74% of the subjects, while the previously described model by Fleet et al. correctly classified 73% of the subjects. A detection model and a screening questionnaire are proposed to improve the recognition of PD in this chest pain population. This study partly supports the cross-setting validity of a previously described detection model.
Chest pain self-management training for patients with coronary artery disease
1994, Journal of Psychosomatic Research
This study was designed to evaluate the efficacy of a brief, structured pain management program to improve control over chest pain episodes in patients diagnosed with coronary artery disease. Twenty-six male veterans who attended the three-session program were compared with twenty-six matched controls. Results indicated significant short-term reductions in self-report of number of chest pain episodes in treated subjects. Self-report of pretreatment daily physical activity level moderated treatment outcome, as individuals reporting lower levels of physical activity derived greater benefit than their high-activity counterparts. These results suggest the potential utility of incorporating chest pain control strategies into comprehensive cardiac rehabilitation programs.
Denial Specific to Friedman's Pathogenic Emotions in Jenkins Activity Survey Type A and Angiography-Referred Males
1992, Psychosomatics
A pilot study of 27 firemen yielded a number of significant positive partial correlations between Type A Scale scores on the Jenkins Activity Survey and the spouse- or friend-reported frequency of items indicative of aggravation, irritation, anger, and impatience (AIAI), while controlling for subject self-reported frequency. A second study then assessed AIAI, depression, and anxiety with identical subjective (self-reported) and objective (spouse- or friend-reported) measures in 100 male angiography patients. Analysis of variance indicated that 1) angiographically normal or subclinical patients are psychologically distressed; 2) denial (as defined by diminished self-report vs. spouse- or friend-report) is specific to AIAI in this population; and 3) denial is observed with about equal intensity in both occluded and nonoccluded groups.
Chest Pain: Cardiac and Non-Cardiac
2022, Handbook of Cardiovascular Behavioral Medicine

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Factors predictive of panic disorder in cardiology patients with chest pain and no evidence of coronary artery disease: A cross-validation

Abstract

Am J Med

Lancet

Am J Med

Am Heart J

J chronic Dis

Am J Cardiol

Behav Res Ther

Chest pain with normal coronary arteries: a comparative study of psychiatric and social morbidity

Psychol Med

Unexplained chest pain in patients with normal coronary arteriograms

N Engl J Med

Chest pain with angiographically insignificant coronary arterial obstruction

Am J Med

Pharmacotherapy of panic disorder

J clin Psychiat