The prevalence of mitral valve prolapse in children with anxiety disorders

Are children with mitral valve prolapse more anxious?

Background

Mitral valve prolapse (MVP) is a common valvular disease in children. Symptoms in children with MVP are not explained by the severity of mitral regurgitation alone. Hence, we sought to correlate symptom status with the incidence of anxiety disorder in this population.

Materials and Methods

Groups were as follows: (a) MVP; n = 115; mean age: 13.5 ± 3.06 years and (b) control; n = 53; mean age: 15.1 ± 13.2. The Screen for Child Anxiety-Related Emotional Disorders (SCAREDs) scale was filled by all participants. The SCARED scores of 25 and above determined a warning for anxiety disorders.

Results

The mean SCARED scale values of MVP and control groups were 29.2 ± 13.08 and 24.9 ± 14.17, respectively (P = 0.065). Although the SCARED scale score was higher among the MVP patients, no significant difference was found between the groups in terms of the mean SCARED score, or the number of participants with a score of 25 or more. While girls with MVP had higher anxiety scores compared to boys with the disorder, there was no difference with respect to SCARED scores in children with MVP and the general population when analyzed separately by gender. Moreover, the SCARED scale score was significantly higher in symptomatic MVP patients than in asymptomatic cases.

Conclusion

Children with MVP did not have higher anxiety scores compared to those without the syndrome. However, MVP patients with higher anxiety scores may benefit from a psychiatric assessment since higher scores correlate with symptoms.

Association between anxiety state and mitral valve disorders: A Taiwanese population-wide observational study

BACKGROUND AND OBJECTIVE

Despite substantial research progress in concurrent diseases, for instance comorbidities involving anxiety state (AS) and mitral valve disorders (MVD), the current measures and care are limited and no consensus about their association has yet been reached. Hence, this study aims to analyze the prevalence and association between AS and MVD among Taiwanese population.

METHODS

We employed phenome-wide association study (PWAS) portal to investigate the association between AS and MVD using claim data of Taiwan's National Health Insurance Research Database (NHIRD) from year 2000 to 2002. Association strength between AS and MVD was analyzed among overall age and gender groups.

RESULTS

We found an overall stronger association between AS and MVD, which was significantly higher in younger age group (OR 15, 95% CI 14.82-16.88) than in the elderly age group (OR 1.99, 95% CI 1.76-2.24). Also, the study reveals a higher incidence of co-occurrence in females than males, particularly in age group of 40-49.

CONCLUSIONS

Based on our results showing considerable strength of association between AS and MVD, this study suggests the necessity of MVD assessment in all patients with AS, particularly in younger females. Moreover, we also propose psychotherapeutic as well as pharmacologic intervention for comorbidity-based pathologies to better the quality care for high-need Taiwanese population.

Does the association between mitral valve prolapse and panic disorder really exist?

OBJECTIVE

Although the possible relationship between panic disorder and mitral valve prolapse (MVP) attracted considerable research interest in the 1980s and 1990s, the reported prevalence of MVP in these patients has been inconsistent and widely variable. Clinical and epidemiologic studies have produced controversial data on possible association or definite causal relationship between these 2 entities. The primary objective of the present review was to summarize the current state of knowledge on the association between panic disorder and MVP, including the influence of diagnostic criteria for MVP on the controversial results.

DATA SOURCES

We searched MEDLINE, LILACS, and EMBASE databases using the keywords panic and mitral. Inclusion criteria were articles concerning the reciprocal association of MVP and panic disorder, published from the earliest dates available through December 2006.

STUDY SELECTION

All relevant articles published in English, Spanish, or Portuguese and reporting original data related to the association of MVP and panic disorder were included. Forty articles fulfilling the criteria for inclusion in this review were identified.

DATA SYNTHESIS

Even though the reported prevalence of MVP in panic disorder varied from 0% to 57%, a significant association between the 2 disorders was documented in 17 of the 40 studies. Such inconsistent results were due to sampling biases in case or control groups, widely different diagnostic criteria for MVP, and lack of reliability of MVP diagnosis. None of the reviewed studies used the current state-of-the-art diagnostic criteria for MVP to evaluate the volunteers. Apparently, the more elaborate the study methodology, the lower the chance to observe a significant relationship between these 2 conditions.

CONCLUSIONS

Published results are insufficient to definitely establish or to exclude an association between MVP and panic disorder. If any relationship does actually exist, it could be said to be infrequent and mainly occur in subjects with minor variants of MVP. To clarify this intriguing issue, future studies should mainly focus on the observed methodological biases and particularly should use the current criteria for MVP as the standard for evaluation.

Cognitive Behavioral Therapy for Anxiety Disorders in Youth

Cognitive-behavioral therapies (CBTs) have been shown to be efficacious for the treatment of anxiety disorders in children and adolescents. Randomized clinical trials indicate that approximately two-thirds of children treated with CBT will be free of their primary diagnosis at posttreatment. Although several CBT treatment packages have been investigated in youth with diverse anxiety disorders, common core components have been identified. A comprehensive assessment, development of a good therapeutic relationship and working alliance, cognitive restructuring, repeated exposure with reduction of avoidance behavior, and skills training comprise the core procedures for the treatment of anxiety disorders in youth.

Pharmacological treatment options for panic disorder in children and adolescents

Although panic disorder usually emerges in early to middle adulthood, adults with panic disorder often retrospectively report that their panic symptoms began in childhood or early adolescence. The majority of these juvenile cases are being misdiagnosed, and/or do not come to clinical attention. Awareness of early-onset panic disorder, as well as a more precise definition of early signs and possible clinical subtypes, can favour timely diagnosis and treatment, reduce clinical impairment and improve the prognosis of these patients. In the context of a multimodal approach, pharmacological treatment can be helpful. This review focuses on the empirical evidence of pharmacotherapy in early-onset panic disorder, including selective serotonin re-uptake inhibitors, benzodiazepines and tricyclics. The data supporting efficacy are still limited, and no controlled studies are available. Practical guidelines for the management of these patients are provided, including treatment of the most frequent psychiatric comorbidities.

Anxiety and medical disorders

Anxiety symptoms and disorders are associated with a range of general medical disorders. This association may be a physiologic consequence of the general medical disorder, a psychologic reaction to the experience of having a medical illness, a side effect of treatment, or a chance occurrence. This article briefly reviews the associations of panic disorder with seizure disorder, Klüver-Bucy syndrome, mitral valve prolapse, and respiratory disorders; of generalized anxiety disorder with chronic obstructive airway disease and cardiovascular and endocrine disorders; of social anxiety disorder with Parkinson's disease; of obsessive-compulsive disorder with striatal disorders; and of posttraumatic stress disorder with head injury and pain. Such associations provide important clues for understanding the neurobiology of anxiety disorders.

Psychiatric morbidity and quality of life in children with malignancies and their parents

Recent improvements in prognosis necessitate considering the emotional responses of children with malignant diseases and of their parents. This prospective study assessed 20 children and adolescents and their 36 parents within 2 weeks of diagnosis and after 1 and 6 months. Fifty-three percent exhibited moderate to severe posttraumatic symptoms right after diagnosis that decreased significantly after 1 month. Children with high-risk disease reported the most severe symptoms. Unexpectedly, children with low-risk disease exhibited more severe symptoms than those with moderate risk. Depressive symptoms decreased significantly during the period, but anxiety symptoms did not. Moreover, quality of life did not change. Twenty percent of parents exhibited posttraumatic symptoms on initial evaluation. Mothers' symptoms did not change, but fathers' symptoms decreased with those of their children. Several procedures and experiences were identified as causes of traumatic stress responses.