1
|
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.
Collapse
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
| |
Collapse
|
2
|
Parsons EM, Hiserodt M, Otto MW. Initial assessment of the feasibility and efficacy of a scalable digital CBT for generalized anxiety and associated health behaviors in a cardiovascular disease population. Contemp Clin Trials 2023; 124:107018. [PMID: 36414206 PMCID: PMC10132350 DOI: 10.1016/j.cct.2022.107018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 11/15/2022] [Accepted: 11/17/2022] [Indexed: 11/21/2022]
Abstract
Generalized anxiety disorder (GAD) is a significant yet modifiable risk factor for worse cardiovascular disease (CVD) outcomes. The treatment of GAD in an accessible manner represents an unmet need in CVD, given that patients with CVD experience numerous barriers to in-person treatment engagement. This paper presents the rationale and design for an investigation of a strategy to enhance care for patients with CVD by introducing a scalable, affordable, and system-friendly digital intervention that targets a prominent modifiable risk factor (generalized anxiety and associated worry) for negative health behaviors in CVD. In the context of a randomized clinical trial design, we describe an experimental medicine approach for evaluating the degree to which a digital cognitive behavior therapy (dCBT), relative to a waitlist control group, engages anxiety and worry outcomes in a sample of 90 adults who have experienced an acute CVD event and who have comorbid GAD symptoms. We also investigate the degree to which dCBT leads to greater changes in GAD symptoms compared to the control condition and whether reductions in these symptoms are associated with corresponding reductions in cardiac anxiety and cardiac health behaviors (including smoking, physical activity, heart-healthy diet, and medication adherence). We propose that by targeting GAD symptoms in CVD in a way that does not tax ongoing medical care provision, we have the potential to improve the uptake of effective care and address both GAD and associated health behaviors.
Collapse
Affiliation(s)
- E Marie Parsons
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA.
| | - Michele Hiserodt
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Michael W Otto
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| |
Collapse
|
3
|
Henningsen P, Laugwitz KL. [Functional cardiovascular symptoms]. Dtsch Med Wochenschr 2022; 147:604-612. [PMID: 35545069 DOI: 10.1055/a-1554-1706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This review provides an update on the diagnosis, differential diagnosis and management of functional cardiovascular symptoms. Typical heart-related symptoms like non-cardiac chest pain and palpitations are frequently complemented by other symptoms like dyspnea, sweating, trembling, dizziness and also further somatic symptoms like pain and fatigue. Functional cardiac symptoms are frequent, with rates of up to 30 % in chest pain units. The differential diagnosis comprises gastrointestinal disorders like gastro-esophageal reflux disease and also mental disorders, particularly panic and other anxiety disorders. Successful management depends on an attitude of realizing and confirming the reality and seriousness of the symptoms despite the absence of a clear structural organic cause. Good cooperation with psychotherapists is helpful for stepped care strategies that start with supportive communication with the patient and biopsychosocial self-help activities, leading, if necessary, to formal psychotherapy.
Collapse
|
4
|
Miyazaki S, Kanbara K, Kunikata J, Tobiume A, Hayashino S, Namba T, Matsumoto I, Takagi Y, Minamino T. Heartbeat tracking task performance, an indicator of interoceptive accuracy, is associated with improvement of exercise tolerance in patients undergoing home-based cardiac rehabilitation. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2022; 3:296-306. [PMID: 36713013 PMCID: PMC9707934 DOI: 10.1093/ehjdh/ztac008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/16/2021] [Accepted: 02/08/2022] [Indexed: 02/01/2023]
Abstract
Aims Interoception is the sensing function of physiological conditions and is crucial in self-regulation and decision-making. We examined the association of heartbeat tracking task performance, an indicator of interoceptive accuracy, with the degree of improvement in exercise tolerance in patients undergoing home-based cardiac rehabilitation. Methods and results Participants underwent baseline peak oxygen uptake (VO2) measurements and a heartbeat tracking task. The heartbeat tracking task score varies between 0 and 1, with higher scores indicating a better heartbeat perception. After 6 months of home-based exercise training, peak VO2 was measured again, and the percentage change (%Δ peak VO2) relative to the peak VO2 at baseline was calculated. Univariate regression analysis was performed to examine the association between %Δ peak VO2 and the heartbeat tracking task score. Multiple regression analysis was performed to determine the predictors of %Δ peak VO2. Of 120 participants, 100 patients (age 65.9 ± 11.9 years; 86% male) were included. There was a significant positive association between %Δ peak VO2 and the heartbeat tracking task score at baseline (R 2 = 0.236, P < 0.001). In multiple regression analysis, the percentage of measured peak VO2 to the predicted value (%predicted peak VO2) (β = -0.248, P = 0.002), exercise adherence (β = 0.364, P < 0.001), and heartbeat tracking task score at baseline (β = 0.372, P < 0.001) were significantly associated with %Δ peak VO2. Conclusions Heartbeat tracking task performance, an indicator of interoceptive accuracy, at baseline is associated with the degree of improvement in exercise tolerance.
Collapse
Affiliation(s)
| | - Kenji Kanbara
- Psychosomatic Medicine, Department of Clinical Psychology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa Prefecture 761-0793, Japan
| | - Jun Kunikata
- Clinical Research Support Center, Kagawa University Hospital, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa Prefecture 761-0793, Japan
| | - Atsushi Tobiume
- Department of Cardiorenal and Cerebrovascular Medicine, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa Prefecture 761-0793, Japan
| | - Shusei Hayashino
- Rehabilitation Center, KKR Takamatsu Hospital, 4-18 Tenjinmae, Takamatsu City, Kagawa Prefecture 760-0018, Japan
| | - Tsunetatsu Namba
- Department of Cardiology, KKR Takamatsu Hospital, 4-18 Tenjinmae, Takamatsu City, Kagawa Prefecture 760-0018, Japan
| | - Ichiro Matsumoto
- Department of Cardiology, KKR Takamatsu Hospital, 4-18 Tenjinmae, Takamatsu City, Kagawa Prefecture 760-0018, Japan
| | - Yuichiro Takagi
- Department of Cardiology, KKR Takamatsu Hospital, 4-18 Tenjinmae, Takamatsu City, Kagawa Prefecture 760-0018, Japan
| | - Tetsuo Minamino
- Department of Cardiorenal and Cerebrovascular Medicine, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa Prefecture 761-0793, Japan
| |
Collapse
|
5
|
Heshmati R, Jafari E, Salimi Kandeh T, Caltabiano ML. Associations of Spiritual Well-Being and Hope with Health Anxiety Severity in Patients with Advanced Coronary Artery Disease. MEDICINA-LITHUANIA 2021; 57:medicina57101066. [PMID: 34684103 PMCID: PMC8539553 DOI: 10.3390/medicina57101066] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Health anxiety is one of the most common problems in patients with coronary artery disease. The present study tested whether health anxiety severity could be predicted by spiritual well-being and hope in patients with advanced coronary artery disease. Materials and Methods: In a cross-sectional study, 100 patients with advanced coronary artery disease were recruited from hospitals and healthcare centers in Iran. Patients completed self-report scales, including the Spiritual Well-Being Scale, Adult Hope Scale, and Short Health Anxiety Inventory. Hierarchical multiple regression analyses were used to empirically explore the relations among variables. Results: Results indicated that patients who reported higher levels of hope (β = 0.42, p < 0.01) and spiritual well-being (β = 0.20, p < 0.05) reported lower levels of health anxiety. Agency (β = 0.58, p < 0.01) scores were a significant negative predictor of health anxiety severity. Additionally, religious spirituality scores (β = 0.28, p < 0.01) were shown to significantly negatively predict health anxiety level. However, the pathways components of hope and existential spirituality were not significant predictors. Conclusion: The findings of the present study indicate that spiritual well-being and hope could be important factors in determining health anxiety for adults with coronary artery disease, and their role is worthy of further exploration to help improve health anxiety for patients with coronary artery disease.
Collapse
Affiliation(s)
- Rasoul Heshmati
- Department of Psychology, Faculty of Education and Psychology, University of Tabriz, Tabriz 5166, Iran
- Correspondence: (R.H.); (E.J.)
| | - Eisa Jafari
- Department of Psychology, Faculty of Education and Psychology, Payame Noor University, Tehran 4697, Iran;
- Correspondence: (R.H.); (E.J.)
| | - Tahereh Salimi Kandeh
- Department of Psychology, Faculty of Education and Psychology, Payame Noor University, Tehran 4697, Iran;
| | - Marie L. Caltabiano
- Department of Psychology, College of Healthcare Sciences, Division of Tropical Health & Medicine, James Cook University, Cairns 4870, Australia;
| |
Collapse
|