Kisely S R
Birmingham Health Authority, Edgbaston, United Kingdom.
Aust N Z J Psychiatry. 1998 Apr;32(2):172-9. doi: 10.3109/00048679809062726.
Psychosocial variables have been identified as important predictors of outcome in patients with chest pain. Most attention has focused on patients with ischaemic heart diseases or those in outpatient settings. This paper compares focuses on inpatients, and compares patients with ischaemic heart disease to those with non-specific chest pain.
A search of the literature on chest pain and psychiatric disorder from 1972 onwards using Medicine, Index Medicus and the bibliographies of retrieved articles.
One-third of patients admitted with acute chest pain have psychiatric disorder as measured by standardised interviews. Patients who have had psychiatric symptoms prior to admission and those with non-specific pain appear to be most at risk of continuing psychiatric morbidity. In patients with ischaemic heart disease, psychiatric symptoms on admission are more strongly related to subsequent social outcome than variables such as severity of infarct or the presence of angina. Psychiatric symptoms may also effect physical morbidity and possibly mortality, although further research is required to clarify the latter finding. In patients with nonspecific pain, further research is indicated to identify aetiological and maintaining factors for continued non-specific pain. There is, however, a strong association with alcohol and cigarette use.
The prediction of outcome requires careful assessment of previous or current psychiatric symptoms in patients admitted with chest pain, irrespective of underlying diagnosis. Early intervention with psychological treatment for patients with non-specific chest pain is indicated; this may also involve help to reduce smoking. There is also further evidence that mortality following myocardial infarction is closely linked to psychiatric disorder, although prior psychiatric disorder may be more important than 'post-infarction' depression. Larger and more methodologically rigorous studies are required to further clarify these findings.
心理社会变量已被确定为胸痛患者预后的重要预测因素。大多数关注集中在缺血性心脏病患者或门诊患者身上。本文重点关注住院患者，并将缺血性心脏病患者与非特异性胸痛患者进行比较。
使用《医学》《医学索引》以及检索文章的参考文献，对1972年以来有关胸痛和精神障碍的文献进行检索。
通过标准化访谈测量，三分之一因急性胸痛入院的患者患有精神障碍。入院前有精神症状的患者以及有非特异性疼痛的患者似乎最易出现持续性精神疾病。在缺血性心脏病患者中，入院时的精神症状与随后的社会结局的关联比梗死严重程度或心绞痛存在等变量更为密切。精神症状也可能影响身体疾病甚至可能影响死亡率，尽管需要进一步研究以阐明后者这一发现。对于有非特异性疼痛的患者，需要进一步研究以确定持续性非特异性疼痛的病因和维持因素。然而，这与饮酒和吸烟有很强的关联。
预后的预测需要仔细评估因胸痛入院患者先前或当前的精神症状，无论其潜在诊断如何。对于非特异性胸痛患者，建议尽早进行心理治疗干预；这可能还包括帮助减少吸烟。还有进一步的证据表明，心肌梗死后的死亡率与精神障碍密切相关，尽管先前的精神障碍可能比“梗死后”抑郁症更重要。需要更大规模且方法更严谨的研究来进一步阐明这些发现。
