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Tunnell NC, Corner SE, Roque AD, Kroll JL, Ritz T, Meuret AE. Biobehavioral approach to distinguishing panic symptoms from medical illness. Front Psychiatry 2024; 15:1296569. [PMID: 38779550 PMCID: PMC11109415 DOI: 10.3389/fpsyt.2024.1296569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 03/19/2024] [Indexed: 05/25/2024] Open
Abstract
Panic disorder is a common psychiatric diagnosis characterized by acute, distressing somatic symptoms that mimic medically-relevant symptoms. As a result, individuals with panic disorder overutilize personal and healthcare resources in an attempt to diagnose and treat physical symptoms that are often medically benign. A biobehavioral perspective on these symptoms is needed that integrates psychological and medical knowledge to avoid costly treatments and prolonged suffering. This narrative review examines six common somatic symptoms of panic attacks (non-cardiac chest pain, palpitations, dyspnea, dizziness, abdominal distress, and paresthesia), identified in the literature as the most severe, prevalent, or critical for differential diagnosis in somatic illness, including long COVID. We review somatic illnesses that are commonly comorbid or produce panic-like symptoms, their relevant risk factors, characteristics that assist in distinguishing them from panic, and treatment approaches that are typical for these conditions. Additionally, this review discusses key factors, including cultural considerations, to assist healthcare professionals in differentiating benign from medically relevant symptoms in panic sufferers.
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Affiliation(s)
- Natalie C. Tunnell
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
- Department of Psychiatry & Behavioral Sciences, The University of Kansas Medical Center, Kansas City, KS, United States
| | - Sarah E. Corner
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
| | - Andres D. Roque
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
- Primary Care Department, Miami VA Healthcare System, Miami, FL, United States
| | - Juliet L. Kroll
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Thomas Ritz
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
| | - Alicia E. Meuret
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
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Wang C, Chudzicka-Czupała A, Tee ML, Núñez ML, Tripp C, Fardin MA, Habib HA, Tran BX, Adamus K, Anlacan J, García MEA, Grabowski D, Hussain S, Hoang MT, Hetnał M, Le XT, Ma W, Pham HQ, Reyes PWC, Shirazi M, Tan Y, Tee CA, Xu L, Xu Z, Vu GT, Zhou D, Chan NA, Kuruchittham V, McIntyre RS, Ho CSH, Ho R, Sears SF. A chain mediation model on COVID-19 symptoms and mental health outcomes in Americans, Asians and Europeans. Sci Rep 2021; 11:6481. [PMID: 33742072 PMCID: PMC7979938 DOI: 10.1038/s41598-021-85943-7] [Citation(s) in RCA: 131] [Impact Index Per Article: 43.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 03/03/2021] [Indexed: 01/31/2023] Open
Abstract
The novel Coronavirus-2019 (COVID-19) was declared a pandemic by the World Health Organization (WHO) in March 2020, impacting the lifestyles, economy, physical and mental health of individuals globally. This study aimed to test the model triggered by physical symptoms resembling COVID-19 infection, in which the need for health information and perceived impact of the pandemic mediated the path sequentially, leading to adverse mental health outcomes. A cross-sectional research design with chain mediation model involving 4612 participants from participating 8 countries selected via a respondent-driven sampling strategy was used. Participants completed online questionnaires on physical symptoms, the need for health information, the Impact of Event Scale-Revised (IES-R) questionnaire and Depression, Anxiety and Stress Scale (DASS-21). The results showed that Poland and the Philippines were the two countries with the highest levels of anxiety, depression and stress; conversely, Vietnam had the lowest mean scores in these areas. Chain mediation model showed the need for health information, and the perceived impact of the pandemic were sequential mediators between physical symptoms resembling COVID-19 infection (predictor) and consequent mental health status (outcome). Excessive and contradictory health information might increase the perceived impact of the pandemic. Rapid COVID-19 testing should be implemented to minimize the psychological burden associated with physical symptoms, whilst public mental health interventions could target adverse mental outcomes associated with the pandemic.
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Affiliation(s)
- Cuiyan Wang
- grid.440755.70000 0004 1793 4061Institute of Cognitive Neuroscience, Faculty of Education, Huaibei Normal University, Huaibei, China
| | - Agata Chudzicka-Czupała
- grid.433893.60000 0001 2184 0541Faculty of Psychology, SWPS University of Social Sciences and Humanities, Katowice, Poland
| | - Michael L. Tee
- grid.11159.3d0000 0000 9650 2179University of the Philippines Manila, Manila, Philippines
| | - María Inmaculada López Núñez
- grid.4795.f0000 0001 2157 7667Department of Social, Work and Differential Psychology, Faculty of Psychology, Complutense University of Madrid, Somosaguas Campus, Madrid, Spain
| | - Connor Tripp
- grid.255364.30000 0001 2191 0423Department of Psychology, East Carolina University, Greenville, NC USA
| | - Mohammad A. Fardin
- Department of Psychology, Zahedan Branch, Islamic Azad University, Zahedan, Iran
| | - Hina A. Habib
- grid.266518.e0000 0001 0219 3705Institute of Clinical Psychology, University of Karachi, Karachi, Pakistan
| | - Bach X. Tran
- grid.56046.310000 0004 0642 8489Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, 100000 Vietnam ,grid.21107.350000 0001 2171 9311Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205 USA
| | - Katarzyna Adamus
- grid.433893.60000 0001 2184 0541Faculty of Psychology, SWPS University of Social Sciences and Humanities, Katowice, Poland
| | - Joseph Anlacan
- grid.11159.3d0000 0000 9650 2179University of the Philippines Manila, Manila, Philippines
| | - Marta E. Aparicio García
- grid.4795.f0000 0001 2157 7667Department of Social, Work and Differential Psychology, Faculty of Psychology, Complutense University of Madrid, Somosaguas Campus, Madrid, Spain
| | - Damian Grabowski
- grid.433893.60000 0001 2184 0541Faculty of Psychology, SWPS University of Social Sciences and Humanities, Katowice, Poland
| | | | - Men T. Hoang
- grid.444918.40000 0004 1794 7022Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam
| | - Mateusz Hetnał
- grid.433893.60000 0001 2184 0541Faculty of Psychology, SWPS University of Social Sciences and Humanities, Katowice, Poland
| | - Xuan T. Le
- grid.56046.310000 0004 0642 8489Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Wenfang Ma
- grid.440755.70000 0004 1793 4061Institute of Cognitive Neuroscience, Faculty of Education, Huaibei Normal University, Huaibei, China
| | - Hai Q. Pham
- grid.444918.40000 0004 1794 7022Faculty of Medicine, Duy Tan University, Da Nang, Vietnam
| | - Patrick Wincy C. Reyes
- grid.11159.3d0000 0000 9650 2179University of the Philippines Manila, Manila, Philippines
| | - Mahmoud Shirazi
- grid.412796.f0000 0004 0612 766XDepartment of Psychology, University of Sistan and Baluchestan, Zahedan, Iran
| | - Yilin Tan
- grid.440755.70000 0004 1793 4061Institute of Cognitive Neuroscience, Faculty of Education, Huaibei Normal University, Huaibei, China
| | - Cherica A. Tee
- grid.11159.3d0000 0000 9650 2179University of the Philippines Manila, Manila, Philippines
| | - Linkang Xu
- grid.440755.70000 0004 1793 4061Institute of Cognitive Neuroscience, Faculty of Education, Huaibei Normal University, Huaibei, China
| | - Ziqi Xu
- grid.440755.70000 0004 1793 4061Institute of Cognitive Neuroscience, Faculty of Education, Huaibei Normal University, Huaibei, China
| | - Giang T. Vu
- grid.473736.20000 0004 4659 3737Center of Excellence in Evidence-Based Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Danqing Zhou
- grid.440755.70000 0004 1793 4061Institute of Cognitive Neuroscience, Faculty of Education, Huaibei Normal University, Huaibei, China
| | - Natalie A. Chan
- grid.11835.3e0000 0004 1936 9262Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, UK
| | - Vipat Kuruchittham
- Southeast Asia One Health University Network (SEAOHUN), Chiang Mai, Thailand
| | - Roger S. McIntyre
- grid.17063.330000 0001 2157 2938Mood Disorders Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, Canada
| | - Cyrus S. H. Ho
- grid.4280.e0000 0001 2180 6431Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Roger Ho
- grid.4280.e0000 0001 2180 6431Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore ,grid.4280.e0000 0001 2180 6431Institute of Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, Singapore
| | - Samuel F. Sears
- grid.255364.30000 0001 2191 0423Department of Psychology, East Carolina University, Greenville, NC USA
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Schroeder S, Achenbach S, Martin A. Efficacy of a Psychological Single-Session Intervention in Non-Cardiac Chest Pain. ZEITSCHRIFT FUR PSYCHOLOGIE-JOURNAL OF PSYCHOLOGY 2020. [DOI: 10.1027/2151-2604/a000406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Abstract. Despite medical reassurance, non-cardiac chest pain (NCCP) frequently persists. Psychological interventions seem promising, but single-session interventions (SSI) are under-studied. To analyze the efficacy of a SSI focusing on chest pain perceptions in a randomized controlled trial (RCT), and to identify predictors of pain persistence. Individuals presenting with NCCP to a cardiology unit were randomly assigned to SSI ( N = 54) or treatment as usual ( N = 59). Follow-up assessments were 1 month (FU1) and 6 months (FU2) later. Primary outcome measures were chest pain (German Pain Questionnaire) and chest pain perceptions (IPQ-B, Reassurance Scale). Two by Three ANOVAs revealed significant improvements over time, but against expectation no significant interaction with group. Health concern and cardiac attribution following cardiac testing predicted FU2 chest pain ( p’s ≤ .018). These predictors could serve as markers to identify individuals with a risk for persisting complaints, a group that may benefit from interventions addressing dysfunctional illness perceptions.
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Affiliation(s)
- Stefanie Schroeder
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Germany
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Alexandra Martin
- Department of Clinical Psychology and Psychotherapy, University of Wuppertal, Germany
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