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Deutsch CK, Patnaik PP, Greco FA. Is There a Characteristic Autonomic Response During Outbursts of Combative Behavior in Dementia Patients? J Alzheimers Dis Rep 2021; 5:389-394. [PMID: 34189410 PMCID: PMC8203282 DOI: 10.3233/adr-210007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We sought to determine whether skin conductance level could warn of outbursts of combative behavior in dementia patients by using a wristband device. Two outbursts were captured and are reported here. Although no physiologic parameter measured by the wristband gave advance warning, there is a common pattern of parasympathetic withdrawal (increased heart rate) followed approximately 30 seconds later by sympathetic activation (increased skin conductance). In the literature, a similar pattern occurs in psychogenic non-epileptic seizures. We hypothesize that similar autonomic responses reflect similarities in pathophysiology and that physical activity may partially account for the time course of skin conductance.
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Affiliation(s)
- Curtis K Deutsch
- Eunice Kennedy Shriver Center, Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
| | - Pooja P Patnaik
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Frank A Greco
- VA Bedford Healthcare System, Medical Research Service, Bedford, MA, USA
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Meuret AE, Tunnell N, Roque A. Anxiety Disorders and Medical Comorbidity: Treatment Implications. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1191:237-261. [PMID: 32002933 DOI: 10.1007/978-981-32-9705-0_15] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Anxiety disorders are debilitating psychological disorders characterized by a wide range of cognitive and somatic symptoms. Anxiety sufferers have a higher lifetime prevalence of various medical problems. Chronic medical conditions furthermore increase the likelihood of psychiatric disorders and overall dysfunction. Lifetime rates of cardiovascular, respiratory, gastrointestinal, and other medical problems are disproportionately high in anxiety and panic/fear sufferers. The heightened comorbidity is not surprising as many symptoms of anxiety and panic/fear mimic symptoms of medical conditions. Panic disorder specifically is strongly linked to medical conditions due to its salient somatic symptoms, such as dyspnea, dizziness, numbness, chest pain, and heart palpitations, all of which can signal danger and deterioration for chronic disease sufferers. This chapter identifies shared correlates of medical illness and anxiety disorders and evidence for misinterpretation of symptoms as medically relevant and offers an analysis of implications for treatment of both types of conditions. We will concentrate on medical conditions with high associations for anxiety and panic by aspects of symptomatology, specifically neurological disorders (fibromyalgia, epilepsy, cerebral palsy), diabetes, gastrointestinal illness (irritable bowel syndrome, gastroesophageal reflux disease), and cardiovascular and respiratory illnesses (asthma).
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Affiliation(s)
- Alicia E Meuret
- Department of Psychology, Southern Methodist University, Dallas, TX, USA.
| | - Natalie Tunnell
- Department of Psychology, Southern Methodist University, Dallas, TX, USA
| | - Andres Roque
- Department of Psychology, Southern Methodist University, Dallas, TX, USA
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Alijaniha F, Noorbala A, Afsharypuor S, Naseri M, Fallahi F, Mosaddegh M, Faghih Zadeh S, Sadrai S. Relationship Between Palpitation and Mental Health. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e22615. [PMID: 27247790 PMCID: PMC4884607 DOI: 10.5812/ircmj.22615] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Revised: 09/10/2014] [Accepted: 09/29/2014] [Indexed: 11/16/2022]
Abstract
Background: ‘Palpitation’ is one of the most common complaints in patients referring to cardiologists. In modern medicine era, these patients suffer from much distress and some cases are known to be difficult to treat. Although the clinician’s first duty is obviously to search for an organic basis for this symptom, the diagnostic evaluation is frequently unrevealing. However, clinical experience suggests that psychiatric causes are relatively common. Objectives: This research aimed to screen for mental disorders in patients complaining of palpitation and healthy persons in order to perform a preliminary comparison between them. Patients and Methods: This is a case-control study to screen mental disorders. The target population consisted of adult volunteers with benign palpitation and their matched healthy persons. They were referred during a 10-month-period to the cardiology outpatient’s clinic of Mostafa Khomeini hospital in Tehran, Iran. Sampling was accidental and eventually 110 participants comprised the sample size. The measuring tool was GHQ-28 (28-item general health questionnaire) and the main variable was the questionnaire score obtained from the Likert scoring method. Results: Comparing two groups showed that the number of participants with the scores more than cut-off point in palpitation group was significantly more than healthy person group (85.4% vs. 43.6% with P < 0.001). Also the total score of GHQ-28 and scores of its subscale (somatization, anxiety, and social dysfunction) in patients complaining of palpitation were significantly more than those of the healthy participants (34.2 vs. 25.7, 8.9 vs. 6.4, 9.4 vs. 6.4, and 12.3 vs. 10.8, respectively with P < 0.001, P = 0.001, P < 0.001, and P < 0.007, respectively). Conclusions: Palpitation is the most common symptom in psychiatric disorders such as anxiety and somatization disorders. According to the results of this study, psychiatric causes have an important role in Iranian patients complaining of palpitations (benign form). Considering this fact may lead to a more effective treatment of benign palpitations.
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Affiliation(s)
- Fatemeh Alijaniha
- Department of Traditional Pharmacy, School of Traditional Medicine, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Ahmadali Noorbala
- Psychosomatic Ward, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
- Corresponding Author: Ahmadali Noorbala, Psychosomatic Ward, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, IR Iran. Tel: +98-261192421, Fax: +98-2166930330, E-mail:
| | - Suleiman Afsharypuor
- Faculty of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, IR Iran
| | - Mohsen Naseri
- Traditional Medicine Clinical Trial Research Center, Shahed University, Tehran, IR Iran
| | | | - Mahmood Mosaddegh
- Dean Traditional Medicine and Materia Medica Research Center (TMRC), Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Soghrat Faghih Zadeh
- Department of Biostatistics and Epidemiology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, IR Iran
| | - Sima Sadrai
- Division of Biopharmaceutics and Pharmacokinetics, Department of Pharmaceutics, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, IR Iran
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Wölk J, Sütterlin S, Koch S, Vögele C, Schulz SM. Enhanced cardiac perception predicts impaired performance in the Iowa Gambling Task in patients with panic disorder. Brain Behav 2014; 4:238-46. [PMID: 24683516 PMCID: PMC3967539 DOI: 10.1002/brb3.206] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 11/25/2013] [Accepted: 11/28/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Somatic marker theory predicts that somatic cues serve intuitive decision making; however, cardiovascular symptoms are threat cues for patients with panic disorder (PD). Therefore, enhanced cardiac perception may aid intuitive decision making only in healthy individuals, but impair intuitive decision making in PD patients. METHODS PD patients and age-and sex-matched volunteers without a psychiatric diagnosis (n = 17, respectively) completed the Iowa Gambling Task (IGT) as a measure of intuitive decision making. Interindividual differences in cardiac perception were assessed with a common mental-tracking task. RESULTS In line with our hypothesis, we found a pattern of opposing associations (Fisher's Z = 1.78, P = 0.04) of high cardiac perception with improved IGT-performance in matched control-participants (r = 0.36, n = 14) but impaired IGT-performance in PD patients (r = -0.38, n = 13). CONCLUSION Interoceptive skills, typically assumed to aid intuitive decision making, can have the opposite effect in PD patients who experience interoceptive cues as threatening, and tend to avoid them. This may explain why PD patients frequently have problems with decision making in everyday life. Screening of cardiac perception may help identifying patients who benefit from specifically tailored interventions.
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Affiliation(s)
- Julian Wölk
- Department of Psychology I, University of Würzburg Würzburg, Germany ; Schön Klinik Roseneck, Hospital of Behavioral Medicine Prien am Chiemsee, Germany
| | - Stefan Sütterlin
- Lillehammer University College, Department of Psychology Lillehammer, Norway ; Research Group on Health Psychology, University of Leuven Leuven, Belgium
| | - Stefan Koch
- Schön Klinik Roseneck, Hospital of Behavioral Medicine Prien am Chiemsee, Germany ; Paracelsus Medical University Salzburg Austria
| | - Claus Vögele
- Research Group on Health Psychology, University of Leuven Leuven, Belgium ; Research Group Self-Regulation and Health, Research Unit INSIDE, University of Luxembourg Luxembourg, Luxembourg
| | - Stefan M Schulz
- Department of Psychology I, University of Würzburg Würzburg, Germany ; Comprehensive Heart Failure Center, University of Würzburg Würzburg, Germany
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Sullivan MD, Ciechanowski PS, Russo JE, Spertus JA, Soine LA, Jordan-Keith K, Caldwell JH. Angina pectoris during daily activities and exercise stress testing: The role of inducible myocardial ischemia and psychological distress. Pain 2008; 139:551-561. [PMID: 18694624 DOI: 10.1016/j.pain.2008.06.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2008] [Revised: 05/21/2008] [Accepted: 06/05/2008] [Indexed: 11/18/2022]
Abstract
Physicians often consider angina pectoris to be synonymous with myocardial ischemia. However, the relationship between angina and myocardial ischemia is highly variable and we have little insight into the sources of this variability. We investigated the relationship of inducible myocardial ischemia on SPECT stress perfusion imaging to angina reported with routine daily activities during the previous four weeks (N=788) and to angina reported during an exercise stress test (N=371) in individuals with confirmed or suspected coronary disease referred for clinical testing. We found that angina experienced during daily life is more strongly and consistently associated with psychological distress and the personal threat associated with angina than with inducible myocardial ischemia. In multivariable models, the presence of any angina during routine activities over the prior month was significantly associated with age, perceived risk of myocardial infarction, and anxiety when compared to those with no reported angina in the past month. Angina during daily life was not significantly associated with inducible myocardial ischemia on stress perfusion imaging in bivariate or multivariable models. In contrast, angina experienced during exercise stress testing was significantly related to image and ECG ischemia, though it was also significantly associated with anxiety. These results suggest that angina frequency over the previous four weeks is more strongly associated with personal threat and psychosocial distress than with inducible myocardial ischemia. These results lend support to angina treatment strategies that aim to reduce threat and distress as well as to reduce myocardial ischemia.
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Affiliation(s)
- Mark D Sullivan
- Department of Psychiatry and Behavioral Sciences, Division of Consultation-Liaison Psychiatry, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356560, Seattle, WA 98195-6560, USA Mid American Heart Institute, University of Missouri, Kansas City, MO, USA Department of Cardiology, VA Puget Sound Health Care System, Seattle, WA, USA Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA Department of Radiology, University of Washington, Seattle, WA, USA
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7
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Joseph PM. Paradoxical ozone associations could be due to methyl nitrite from combustion of methyl ethers or esters in engine fuels. ENVIRONMENT INTERNATIONAL 2007; 33:1090-106. [PMID: 17716731 DOI: 10.1016/j.envint.2007.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2006] [Revised: 07/06/2007] [Accepted: 07/10/2007] [Indexed: 05/16/2023]
Abstract
We review studies of the effects of low ambient ozone concentrations on morbidity that found a negative coefficient for ozone concentration. We call this a Paradoxical Ozone Association (POA). All studies were in regions with methyl ether in gasoline. All but one study carefully controlled for the effects of other criterion pollutants, so the phenomenon cannot be attributed to them. One was in southern California in mid-summer when ozone levels are highest. Because ozone is created by sunlight, the most plausible explanation for a POA would be an ambient pollutant that is rapidly destroyed by sunlight, such as methyl nitrite (MN). A previously published model of engine exhaust chemistry suggested methyl ether in the fuel will create MN in the exhaust. MN is known to be highly toxic, and closely related alkyl nitrites are known to induce respiratory sensitivity in humans. Support for the interpretation comes from many studies, including three linking asthma symptoms to methyl tertiary butyl ether (MTBE) and the observation that a POA has not been seen in regions without ether in gasoline. We also note that studies in southern California show a historical trend from more significant to less significant ozone-health associations. The timing of those changes is consistent with the known timing of the introduction of gasoline oxygenated with MTBE in that region.
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Affiliation(s)
- Peter M Joseph
- Department of Radiology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104-4283, USA.
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Hoefman E, Boer KR, van Weert HCPM, Reitsma JB, Koster RW, Bindels PJP. Continuous event recorders did not affect anxiety or quality of life in patients with palpitations. J Clin Epidemiol 2007; 60:1060-6. [PMID: 17884602 DOI: 10.1016/j.jclinepi.2007.01.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2006] [Revised: 12/19/2006] [Accepted: 01/19/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Palpitations can generate feelings of anxiety and decrease quality of life (QoL) due to fear of a cardiac abnormality. Continuous event recorders (CERs) have proven to be successful in diagnosing causes of palpitations but may affect patient QoL and anxiety. The aim is to determine anxiety and health-related (HR)-QoL and evaluate the burden of carrying a CER in general practice populations. STUDY DESIGN AND SETTING Patients (n=244) participated in a randomized trial. One group (n=127) carried a CER during 4 weeks. One hundred and seventeen patients formed the usual care (UC) group. State-Trait Anxiety Inventory (STAI) and the Short Form-36 (SF-36) were administered at study inclusion, after 1, 6 months. RESULTS At baseline, patients reported greater anxiety and lower QoL than healthy populations. The CER group had three times more cardiac diagnoses than the UC group. No differences were found between CER group and UC group at 6 weeks. At 6 months, the UC group showed QoL improvement and less anxiety compared to the CER group. Type of diagnosis had influence, but did not fully explain these differences. CONCLUSION A CER does not negatively influence anxiety or QoL. Better outcomes in the UC group might be attributed to less cardiac diagnosis and more emphasis on psychological well-being.
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Affiliation(s)
- Emmy Hoefman
- Department of General Practice, Academic Medical Center, University of Amsterdam, PO Box 22700, 1100 DE, Amsterdam, The Netherlands.
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Schwenzfeier EM, Rigdon MA, Hill RD, Anderson NS, Seelert KR. Psychological well-being as a predictor of physician medication prescribing practices in primary care. PROFESSIONAL PSYCHOLOGY-RESEARCH AND PRACTICE 2002. [DOI: 10.1037/0735-7028.33.5.478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Ehlers A, Mayou RA, Sprigings DC, Birkhead J. Psychological and perceptual factors associated with arrhythmias and benign palpitations. Psychosom Med 2000; 62:693-702. [PMID: 11020100 DOI: 10.1097/00006842-200009000-00014] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Little is known about how patients who seek medical help for benign palpitations can be distinguished from those with clinically significant arrhythmias. This study tested whether patients with arrhythmia can be distinguished from those who are aware of sinus rhythm or extrasystoles on the basis of sex, prevalence of anxiety disorders, and heartbeat perception. METHODS A consecutive sample of patients referred to a cardiology clinic participated in the study. Patients were diagnosed as having either arrhythmia (N = 62), extrasystoles (N = 75), or awareness of sinus rhythm (N = 47). They were assessed with use of the anxiety disorders and hypochondriasis modules of the Structured Clinical Interview for DSM-IV. Both patients and control subjects (N = 35) answered questionnaires measuring anxiety, fear of bodily sensations, and depression and underwent a heartbeat perception test. The present report focuses on patients who had palpitations but no comorbid cardiovascular disease. RESULTS Patients with awareness of sinus rhythm could be distinguished from those with arrhythmia by several variables: female sex, higher prevalence of panic disorder, poor performance on the heartbeat perception test, report of palpitations when doing the test, higher heart rates, lower levels of physical activity, and (as trends) a greater prevalence of panic attacks, fear of bodily sensations, and depression. In contrast, patients with arrhythmias rarely reported palpitations when doing the test but were more likely to perceive their heartbeats accurately than patients with sinus rhythm and control subjects. Performance on the heartbeat perception test was intermediate in patients with extrasystoles; these patients also had an intermediate prevalence of panic disorder and intermediate depression scores. CONCLUSIONS Measures of panic disorder and a simple heartbeat perception test could complement medical assessment in the diagnosis of patients who seek medical help for palpitations. The results also have implications for the treatment of patients with benign palpitations.
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Affiliation(s)
- A Ehlers
- Department of Psychiatry, Oxford University, Warneford Hospital, UK.
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Kroeze S, van den Hout MA. No superior perception of hyperventilatory sensations in panic disorder. Behav Res Ther 1998; 36:285-95. [PMID: 9642848 DOI: 10.1016/s0005-7967(97)10040-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
It has been argued that panic disorder patients may be more skilled at detecting changes in actual physiology than others. The present study investigated if panic patients are better than controls in perceiving sensations produced by light hyperventilation. Twelve panic patients and 28 control subjects underwent a procedure in which they were exposed 12 times to 1 min of light hyperventilation or 1 min of 'placebo' hyperventilation (isocapnia). Differences in sensations reported during real hyperventilation were compared to sensations reported during 'placebo' hyperventilation. Results demonstrated an absence of superior perception of hyperventilatory sensations in panic patients.
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Affiliation(s)
- S Kroeze
- Department of Experimental Abnormal Psychology, Maastricht University, The Netherlands
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12
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Zwietering P, Knottnerus A, Gorgels T, Rinkens P. Occurrence of arrhythmias in general practice. Scand J Prim Health Care 1996; 14:244-50. [PMID: 8956453 DOI: 10.3109/02813439608997092] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To study the occurrence and distribution of arrhythmias in patients with symptoms possibly caused by arrhythmias, in order to support the diagnostic process in general practice. DESIGN From 1989-1991 all patients who consulted their general practitioner with symptoms or signs possibly indicating an arrhythmia had a transtelephonic electrocardiogram, which was sent to the Department of Cardiology for interpretation. SETTING 20 Dutch general practices, serving a population of nearly 50,000 inhabitants. SUBJECTS A total of 868 patients were included in the study. RESULTS An arrhythmia was documented by ECG in 32% of the patients. Of these, 31% clinically more relevant arrhythmias needed medical attention. An incidence of 2.6 arrhythmias per 1000 listed patients was calculated. There was a highly positive correlation between the occurrence of arrhythmias and age. Relatively more arrhythmias were seen in men, in patients with occasional findings, and when there were symptoms that possibly indicated haemodynamic imbalance. CONCLUSION Clinically relevant arrhythmias can be detected in general practice with 12-lead ECG recording in a significant proportion of patients with symptoms and physical findings suggesting an arrhythmia. The distribution of arrhythmias described in this study can help general practitioners in their diagnostic management.
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Affiliation(s)
- P Zwietering
- Department of General Practice, University of Limburg, Maastricht, The Netherlands
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Abstract
PURPOSE To determine: (1) the etiologies of palpitations, (2) the usefulness of diagnostic tests in determining the etiologies of palpitations, and (3) the outcomes of patients with palpitations. PATIENTS AND METHODS One hundred and ninety consecutive patients presenting with a complaint of palpitations at a university medical center were enrolled in this prospective cohort study. Patients underwent a structured clinical interview and psychiatric screening. The charts were abstracted for results of the physical exam and tests ordered by the primary physician. Assignment of an etiology of palpitations was based on strict adherence to predetermined criteria and achieved by consensus of the two physician investigators. One-year follow-up was obtained in 96% of the patients. RESULTS An etiology of palpitations was determined in 84% of the patients. The etiology of palpitations was cardiac in 43%, psychiatric in 31%, miscellaneous in 10%, and unknown in 16%. Forty percent of the etiologies could be determined with the history and physical examination, an electrocardiogram, and/or laboratory data. The 1-year mortality rate was 1.6% (95% confidence interval [CI] 0% to 3.4%) and the 1-year stroke rate was 1.1% (95% CI 0% to 2.6%). Within the first year, 75% of the patients experienced recurrent palpitations. At 1-year follow-up, 89% reported that their health was the same or improved compared to that at enrollment, 19% reported that their work performance was impaired, 12% reported that workdays were missed, and 33% reported accomplishing less than usual work at home. CONCLUSIONS The etiology of palpitations can often be diagnosed with a simple initial evaluation. Psychiatric illness accounts for the etiology in nearly one third of all patients. The short-term prognosis of patients with palpitations is excellent with low rates of death and stroke at 1 year, but there is a high rate of recurrence of symptoms and a moderate impact on productivity.
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Affiliation(s)
- B E Weber
- St. Mary's Hospital, Rochester, New York 14611, USA
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Abstract
OBJECTIVES To assess the characteristics of consecutive patients referred from general practice with the presenting disorder of chest pain or palpitations, and to determine the outcome at six months and three years. SETTING A single consultant teaching hospital cardiac clinic receiving new referrals from a health district. DESIGN 94 consecutive referrals by general practitioners to a cardiac clinic with the presenting disorder of chest pain or palpitations were assessed at first attendance (research interview, cardiologists' ratings, systematic medical case note information), home interview six months later, and by a postal questionnaire at three years. OUTCOME MEASURES Physical and psychological symptoms, limitation of activities, satisfaction with care, and use of health care resources. RESULTS 39 patients were given a cardiac diagnosis and 51 patients were not given a cardiac or other major physical diagnosis. The non-cardiac group was more likely to be young women, and to report other physical symptoms and previous psychiatric problems. The cardiac and non-cardiac groups reported progressive improvement in presenting symptoms and disability at the six months and three year follow up, but little change in mental state. Even so, three quarters of the non-cardiac subjects described continuing limitation of activities, concern about the cause of their symptoms, and dissatisfaction with medical care. CONCLUSIONS A substantial proportion of the consecutive referrals continued to describe symptoms and disability throughout the three years after clinic attendance. Outcome was poor for those who had negative investigations and were reassured that they had no cardiac disorder or other serious physical finding. These results have implications for defining the role of psychological assessment and for the formulation of cost effective clinical measures to (a) minimise disability associated with cardiac disorder; and (b) prevent and treat handicaps in those without major physical diagnoses.
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Affiliation(s)
- R Mayou
- University Department of Psychiatry, Warneford Hospital, Oxford
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Fava GA, Magelli C, Savron G, Conti S, Bartolucci G, Grandi S, Semprini F, Saviotti FM, Belluardo P, Magnani B. Neurocirculatory asthenia: a reassessment using modern psychosomatic criteria. Acta Psychiatr Scand 1994; 89:314-9. [PMID: 8067269 DOI: 10.1111/j.1600-0447.1994.tb01521.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The purpose of this study was to assess the prevalence of mental illness and to evaluate the quality of life of patients with neurocirculatory asthenia. A consecutive series of 80 patients who satisfied the diagnostic criteria developed by Kannel et al. for neurocirculatory asthenia was included in this study. Patients underwent a psychiatric diagnostic research interview and extensive psychometric evaluation, with both observer and self-rated scales for depression, anxiety, phobic symptoms, quality of life and abnormal illness behavior. In 47 patients (59%), a psychiatric diagnosis (mainly an anxiety disorder) antedated the onset of neurocirculatory asthenia, which was thus defined as secondary, also because cardiorespiratory symptoms were part of the mental symptoms. In the remaining 33 patients (41%) neurocirculatory asthenia was the primary disorder. Patients with secondary neurocirculatory asthenia reported significantly higher levels of anxiety, depression, social phobia, abnormal illness behavior and an impaired quality of life compared with patients with primary neurocirculatory asthenia. This latter did not significantly differ in these variables (except for depression) from healthy control subjects matched for sociodemographic variables. At a 1-year follow-up, patients with primary neurocirculatory asthenia had a much better prognosis than those with secondary neurocirculatory asthenia. The results indicate the feasibility of the primary/secondary distinction based on the time of onset of mental and cardiorespiratory symptoms in neurocirculatory asthenia. Since only about one quarter of the patients were found to suffer from decreased energy and fatigue according to specified criteria, the terms neurocirculatory asthenia and effort syndrome should probably be discarded.
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Affiliation(s)
- G A Fava
- Department of Psychology, University of Bologna, Italy
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