College of Physicians and Surgeons, Columbia University, New York, NY, USA.
J Pediatr. 2012 Feb;160(2):320-4. doi: 10.1016/j.jpeds.2011.07.011. Epub 2011 Aug 24.
To examine the prevalence of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition psychiatric disorders in youth with chest pain compared with a control sample with innocent heart murmur.
We assessed youth ages 8 to 17 years who were examined in cardiology settings for medically unexplained chest pain (n=100) or innocent heart murmur (n=80). We conducted semi-structured interviews and assessed medical history, quality of life, and disability.
Youth with chest pain had a higher prevalence of psychiatric disorders compared with youth with murmur (74% versus 47%, χ(2)=13.3; P<.001). Anxiety disorders predominated, although major depression was also more common in the chest pain group (9% versus 0%; Fisher exact tests; P<.01). Onset of psychiatric disorders generally preceded chest pain. Patterns were similar for boys and girls and for children and adolescents. Chest pain was associated with poorer quality of life and with pain-related disability for youth with co-morbid psychiatric disorder.
In childhood and adolescence, medically unexplained chest pain is associated with a high prevalence of psychiatric disorders. Systematic mental health screening may improve detection and enhance treatment of these patients.
研究与伴有良性心脏杂音的对照组相比，患有胸痛的青年人群中出现《精神障碍诊断与统计手册》第 4 版精神障碍的流行率。
我们评估了在心脏病学环境中接受检查的年龄在 8 至 17 岁之间的患有不明原因胸痛（n=100）或良性心脏杂音（n=80）的青年人群。我们进行了半结构化访谈，并评估了病史、生活质量和残疾情况。
与伴有杂音的青年人群相比，胸痛青年人群的精神障碍患病率更高（74%对 47%，χ(2)=13.3；P<.001）。焦虑障碍更为普遍，尽管胸痛组中重度抑郁症也更为常见（9%对 0%；Fisher 确切检验；P<.01）。精神障碍的发作通常先于胸痛。男孩和女孩、儿童和青少年的模式相似。伴有共病精神障碍的胸痛与青年人群生活质量较差和与疼痛相关的残疾有关。
在儿童和青少年中，医学上无法解释的胸痛与精神障碍的高患病率相关。系统的心理健康筛查可能会提高这些患者的检出率，并增强对他们的治疗。
