Carter C S, Maddock R J
Department of Psychiatry, University of California at Davis Medical Center, Sacramento 95816.
Int J Psychiatry Med. 1992;22(3):291-8. doi: 10.2190/RGC5-PJK2-7TG5-KL1B.
The objectives of the current study were to evaluate the prevalence of chest pain and related medical utilization in patients with generalized anxiety disorder and to investigate the possible relationship between the occurrence of chest pain in these patients and the episodes of excessive worry which characterize this disorder.
The presence of a history of chest pain in patients with generalized anxiety disorder was investigated in an outpatient psychiatric sample using a structured interview which also assessed related medical utilization and the relationship of chest pain to panic attacks and episodes of excessive worry.
Of fifty sequentially evaluated patients meeting DSM-III R criteria for G.A.D., twenty-four (48%) reported a history of chest pain. Seven of these patients also had a history of panic attacks, however, four of the seven reported that their pain occurred independently of their panic attacks. Sixteen patients with G.A.D. reported that their chest pain episodes were associated with episodes of excess worry. Eleven had sought medical evaluation for their pain. Patients with chest pain and normal coronary arteries are frequently found to have panic disorder. The pattern of utilization of medical care was comparable in this sample of patients with G.A.D. and a group of patients with panic disorder recruited in a similar manner.
These results suggest that in addition to panic disorder, G.A.D. may also be a common diagnosis in chest pain patients with no demonstrable coronary disease. Future studies of coronary artery disease negative patients with chest pain should include assessments for the presence of G.A.D. Our results also suggest that chest pain may be a common symptom in G.A.D. The possibility that chest pain should be included in the diagnostic criteria for this disorder should be the subject of further investigation.
本研究的目的是评估广泛性焦虑症患者胸痛的患病率及相关医疗利用情况，并调查这些患者胸痛的发生与该疾病特征性过度担忧发作之间的可能关系。
在门诊精神科样本中，使用结构化访谈调查广泛性焦虑症患者胸痛病史的存在情况，该访谈还评估了相关医疗利用情况以及胸痛与惊恐发作和过度担忧发作的关系。
在连续评估的50名符合DSM-III-R广泛性焦虑症标准的患者中，24名（48%）报告有胸痛病史。其中7名患者也有惊恐发作史，然而，这7名患者中有4名报告他们的疼痛独立于惊恐发作而发生。16名广泛性焦虑症患者报告他们的胸痛发作与过度担忧发作有关。11名患者因疼痛寻求过医疗评估。胸痛且冠状动脉正常的患者经常被发现患有惊恐障碍。在这个广泛性焦虑症患者样本和以类似方式招募的一组惊恐障碍患者中，医疗护理的利用模式相当。
这些结果表明，除了惊恐障碍外，广泛性焦虑症在无明显冠状动脉疾病的胸痛患者中也可能是一种常见诊断。未来对冠状动脉疾病阴性的胸痛患者的研究应包括对广泛性焦虑症存在情况的评估。我们的结果还表明，胸痛可能是广泛性焦虑症的常见症状。胸痛是否应纳入该疾病诊断标准的可能性应是进一步研究的主题。
