Fleet R P, Dupuis G, Marchand A, Burelle D, Beitman B D
Institut de Cardiologie de Montréal, Québec.
Can J Cardiol. 1994 Oct;10(8):827-34.
To examine the association among panic disorder, atypical chest pain and coronary artery disease (CAD). This article's purpose is to inform cardiologists of the prevalence of psychiatric disorders, primarily panic disorder, among patients consulting for chest pain. Panic disorder is described. Treatment modalities are summarized, and social, financial and medical consequences of nondetection are underlined.
PSYCHLIT and MEDLINE searches under panic disorder and chest pain-related headings were conducted.
The search covered January 1973 to June 1993. Thirty-eight articles were studied.
Panic disorder is present in 30% or more of chest pain patients with no or minimal CAD and may coexist with CAD. Panic disorder may often be unrecognized by physicians. Left untreated, risk for disease progression may be augmented, and social vocational disability as well as medical costs may increase.
Physicians should attend to the panic symptomatology and, when in doubt, refer possible panic patients with or without CAD to a mental health professional for assessment and treatment. Future panic prevalence studies in cardiology patients should be prospective, attempt to increase sample size and use randomized protocols where experimenters are blind to chest pain and medical diagnoses. Studies should also focus on CAD patients with atypical chest pain refractory to optimal cardiac therapy.
研究惊恐障碍、非典型胸痛与冠状动脉疾病（CAD）之间的关联。本文旨在告知心脏病专家，在因胸痛前来就诊的患者中，精神障碍（主要是惊恐障碍）的患病率情况。对惊恐障碍进行了描述。总结了治疗方式，并强调了未被识别出该疾病所带来的社会、经济和医疗后果。
在惊恐障碍和胸痛相关主题下进行了PSYCHLIT和MEDLINE检索。
检索涵盖1973年1月至1993年6月。共研究了38篇文章。
在无CAD或CAD轻微的胸痛患者中，30%或更多存在惊恐障碍，且惊恐障碍可能与CAD共存。医生可能常常未识别出惊恐障碍。若不进行治疗，疾病进展的风险可能增加，社会职业残疾以及医疗费用也可能上升。
医生应关注惊恐症状，如有疑问，应将可能患有惊恐障碍的CAD患者或无CAD患者转介给心理健康专业人员进行评估和治疗。未来针对心脏病患者的惊恐障碍患病率研究应具有前瞻性，尝试增加样本量，并采用实验者对胸痛和医学诊断不知情的随机方案。研究还应聚焦于对最佳心脏治疗无效的非典型胸痛的CAD患者。
