Bass C, Wade C, Hand D, Jackson G
Br Med J (Clin Res Ed). 1983 Nov 19;287(6404):1505-8. doi: 10.1136/bmj.287.6404.1505.
The clinical and psychosocial states of 46 patients (26 men and 20 women) who had undergone cardiac catheterisation were examined prospectively. All of the patients had insignificant (less than 50%) coronary lesions and had been told that no limitation of activity was necessary. Twelve months after angiography 19 of the patients continued to complain of chest pain. Twenty one reported phobic symptoms, and 13 were found by standardised clinical interview to have psychiatric morbidity. This had been evident at the time of catheterisation in 28. Twenty three patients had evidence of unexplained breathlessness, 13 were taking psychotropic drugs, 29 were continuing to consult a doctor, and 11 were unable to work because of their symptoms. Patients initially assessed as having high levels of psychiatric morbidity and raised neuroticism scores were more likely to complain of chest pain one year after angiography. The 19 patients with persistent pain also had significantly higher levels of psychiatric and social morbidity at one year than the 27 patients whose chest pain had lessened during the follow up period. Those patients who fail to improve after being told that they have normal or nearly normal coronary arteries tend to be a chronically neurotic and socially maladjusted group in whom psychiatric disorder presents with predominantly somatic symptoms.
对46例接受过心导管插入术的患者（26名男性和20名女性）的临床和心理社会状态进行了前瞻性检查。所有患者的冠状动脉病变均不严重（小于50%），且被告知无需限制活动。血管造影术后12个月，19名患者仍诉说胸痛。21名报告有恐惧症状，经标准化临床访谈发现13名有精神疾病。在导管插入术时，其中28名患者的精神疾病就已明显。23名患者有无法解释的呼吸困难迹象，13名正在服用精神药物，29名仍在继续就医，11名因症状无法工作。最初评估为精神疾病发病率高且神经质得分高的患者，血管造影术后一年更有可能诉说胸痛。19例持续疼痛的患者在一年时的精神和社会疾病水平也显著高于27例在随访期间胸痛减轻的患者。那些被告知冠状动脉正常或接近正常后仍未改善的患者往往是慢性神经质和社会适应不良的群体，其精神障碍主要表现为躯体症状。
