Schlosberg A, Shpiz M
Mental Health Center, Beer Ya'acov.
Harefuah. 1993 Feb 15;124(4):193-6, 247-8.
Chest pain is one of the most common complaints in primary care clinics. About 10-30% of patients with chest pain diagnosed as suffering from angina pectoris have normal coronary angiograms. Some of them suffer from psychiatric disorders. We present a 47-year-old man with several risk factors for ischemic heart disease: smoker in the past, obesity, hyperlipidemia and family history of coronary disease. He had complaints typical of anginal syndrome and normal coronary arteriograms. After 1.5 years of unsuccessful medical treatment, he was referred to the psychiatrist in the primary care clinic who diagnosed anxiety and panic disorders with somatization. All cardiac drugs were stopped and psychopharmacological treatment and psychotherapy were started immediately. Within a month he was almost free of symptoms and was treated successfully for a year. Treatment was then stopped and he has remained symptom-free for the past 4 years. We conclude that in such atypical somatic cases, only the collaboration of general practitioner and psychiatrist will lead to quick diagnosis and successful treatment.
胸痛是基层医疗诊所中最常见的主诉之一。在被诊断为患有心绞痛的胸痛患者中，约10% - 30%的人冠状动脉血管造影结果正常。他们中的一些人患有精神疾病。我们介绍一位47岁的男性，他有几个缺血性心脏病的危险因素：既往吸烟、肥胖、高脂血症以及冠心病家族史。他有典型的心绞痛综合征症状，但冠状动脉造影正常。经过1.5年的药物治疗未成功后，他被转诊至基层医疗诊所的精神科医生处，医生诊断为伴有躯体化症状的焦虑和惊恐障碍。所有心脏药物均停用，立即开始心理药物治疗和心理治疗。一个月内他几乎没有症状了，并成功接受了一年的治疗。之后治疗停止，在过去4年里他一直没有症状。我们得出结论，在这种非典型的躯体病例中，只有全科医生和精神科医生合作才能实现快速诊断和成功治疗。
