Psychiatric Consultation/Liaison Service, Canterbury DHB, Christchurch, New Zealand.
Intern Med J. 2012 Apr;42(4):369-73. doi: 10.1111/j.1445-5994.2012.02743.x.
To compare psychological factors in patients presenting to hospital with earthquake-induced stress cardiomyopathy, myocardial infarction (MI) and non-cardiac chest pain. We hypothesised that patients with stress cardiomyopathy and non-cardiac chest pain would be more psychologically vulnerable than those with MI.
Cardiology admitting staff in the week following the September 2010 Christchurch earthquake prospectively identified patients with earthquake-precipitated chest pain. Males were excluded. All consenting women met diagnostic criteria for one of the three conditions. Patients underwent a semistructured interview with a senior clinical psychologist who was blind to the cardiac diagnosis. Premorbid psychological factors, experience of the earthquake and psychological response were assessed using a range of validated tools.
Seventeen women were included in the study, six with stress cardiomyopathy, five with MI and six with non-cardiac chest pain. Earthquake experiences were notably similar across the groups. Patients with non-cardiac chest pain scored high on the hospital anxiety and depression scale, the health anxiety questionnaire, the Eysenck neuroticism scale and the Impact of Event scale. Women with stress cardiomyopathy scored as the most psychologically robust. Depression and extroversion scores were the same across groups.
Our hypothesis was incorrect. Women with non-cardiac chest pain following an earthquake have higher anxiety and neuroticism scores than women with either MI or stress cardiomyopathy. Stress cardiomyopathy following an earthquake is not specific to psychologically vulnerable women. The psychology of natural disaster-induced stress cardiomyopathy may differ from that of sporadic cases.
比较因地震诱发的应激性心肌病、心肌梗死（MI）和非心源性胸痛而住院的患者的心理因素。我们假设应激性心肌病和非心源性胸痛患者比 MI 患者心理上更为脆弱。
2010 年 9 月基督城地震发生后一周内，心脏病学住院医师前瞻性地确定了因地震引发胸痛的患者。排除男性。所有同意的女性均符合三种情况之一的诊断标准。患者与一名资深临床心理学家进行半结构化访谈，该心理学家对心脏诊断情况不知情。使用一系列经过验证的工具评估了发病前的心理因素、对地震的体验和心理反应。
本研究共纳入 17 名女性，其中 6 名患有应激性心肌病，5 名患有 MI，6 名患有非心源性胸痛。各组的地震经历明显相似。非心源性胸痛患者在医院焦虑和抑郁量表、健康焦虑问卷、艾森克神经质量表和事件影响量表上得分较高。应激性心肌病患者的心理状态得分最高。抑郁和外向得分在各组之间相同。
我们的假设是错误的。地震后出现非心源性胸痛的女性比 MI 或应激性心肌病患者的焦虑和神经质评分更高。地震后应激性心肌病并非特定于心理脆弱的女性。自然灾害诱发的应激性心肌病的心理学可能与散发性病例不同。
