Noncardiac chest pain in the emergency department: the role of cardiac history, anxiety or depression and Type D personality

Reflection impulsivity in patients with panic disorder

BACKGROUND

Individuals with panic disorder (PD) often exhibit a proclivity to conclude that an imminent catastrophe looms, drawing such conclusions from limited physical information. Reflection impulsivity, characterized by decision-making without adequate information, likely affects this bias. This study examines the relationship between reflection impulsivity and self-report impulsive features in individuals with PD.

METHODS

Fifty patients with PD and 50 healthy controls (HC) participated to this study. Reflection impulsivity was assessed using the Information Sampling Task (IST), while trait impulsivity was measured using the Barratt Impulsiveness Scale (BIS). Participants also completed the Beck Anxiety Inventory, Panic and Agoraphobia Scale (P&A), and Anxiety Sensitivity Index-3 (ASI-3).

RESULTS

Individuals with PD exhibited higher reflection impulsivity compared to HC. Increased reflection impulsivity correlated positively with PD severity as assessed by the P&A and cognitive concerns measured by ASI-3. No significant correlations were found with physical or social concerns. PD patients had higher BIS scores than HC. Higher trait impulsivity was linked to recurrent emergency department visits among PD patients.

DISCUSSION

The findings of this study reveal the notion of increased impulsivity among individuals with PD and its relationship with cognitive concerns, as well as recurrent visits to the emergency department stemming from panic attacks.

Cognitive-behavioural therapy reduces psychological distress in younger patients with cardiac disease: a randomized trial

AIMS

To test whether usual outpatient cardiac rehabilitation (CR) supplemented by a cognitive-behavioural therapy (CBT) intervention may reduce anxiety and depression compared with usual CR.

METHODS AND RESULTS

In this multicentre randomized controlled trial, 147 cardiac patients (67% men, mean age 54 years, 92% with coronary artery disease) with psychological distress defined as a hospital anxiety and depression scale (HADS) anxiety or depression score ≥8 were randomized to five sessions of group CBT plus usual CR (intervention, n = 74) or CR alone (control, n = 73). Patients with severe distress or a psychiatric diagnosis were excluded. The intervention was delivered by cardiac nurses with CBT training and supervised by a psychologist. A reference, non-randomized group (background, n = 41) of consecutive patients without psychological distress receiving usual CR was included to explore the effect of time on HADS score. The primary outcome, total HADS score after 3 months, improved more in the intervention than in the control group [the mean total HADS score improved by 8.0 (standard deviation 5.6) vs. 4.1 (standard deviation 7.8), P < 0.001]. Significant between-group differences were maintained after 6 months. Compared with the control group, the intervention group also had greater adherence to CR (P = 0.003), more improvement in the heart-related quality of life (HeartQoL) at 6 months (P < 0.01), and a significant reduction in cardiac readmissions at 12 months (P < 0.01). The background group had no significant change in HADS score over time.

CONCLUSION

Brief CBT provided by cardiac nurses in relation to CR reduced anxiety and depression scores, improved HeartQoL and adherence to CR, and reduced cardiovascular readmissions. The programme is simple and may be implemented by CR nurses.

Taking Heart: Cardiac Symptoms and Nightmares Differentiate Nightmare Proneness and Psychological Distress among Young Adults

Introduction  Nightmare proneness, a trait-like disposition to experience frequent nightmares, has been strongly related to psychological distress. The aim of the present study was to examine if cardiac symptoms and hypothetically-related variables, nightmares, and perceived physical health could be used to differentiate nightmare proneness and psychological distress. Materials and Methods  In the present cross-sectional study, 254 young adults completed measures of nightmare proneness, psychological distress, cardiac symptoms, nonspecific and posttraumatic nightmares, nightmare distress, health behaviors, perceptions of physical health, perceived stress, Type-D personality, sleep fragmentation, and dream recall. Results  After controlling for psychological distress, nightmare proneness remained significantly correlated with nightmares, nightmare distress, cardiac symptoms, sleep fragmentation, physical health, perceived stress, and Type-D personality. After controlling for nightmare proneness, distress remained correlated with perceived stress and Type-D personality. Regression analyses indicated that after accounting for all variables, nightmare distress, physical health, and nightmare proneness predicted cardiac symptoms. Posttraumatic nightmares, sleep fragmentation, distress, perceived stress, Type-D personality, and chest pain predicted nightmare proneness. Conclusion  Nightmare proneness and psychological distress can be considered separate constructs. The findings were consistent with those of previous research and supported the theoretical propositions that nightmare proneness includes hyperarousal, vulnerability to stressors, and concretization, a mental process in which vague internal states are made more concrete.

Which symptoms are the psychopathological core affecting the manifestation of pseudo-cardiac symptoms and poor sleep quality in young adults? Symptoms of personality disorders versus clinical disorders

Background

Diagnosing and identifying the psychological origin of pseudo-cardiac symptoms and comorbid conditions such as poor sleep quality is very difficult due to its extensive and complex nature. The present study was conducted to determine the contribution of symptoms of personality disorders (PDs) and clinical disorders (CDs; i.e., psychological symptoms measured using the Symptom Checklist-90) to the manifestation of pseudo-cardiac symptoms and poor sleep quality.

Methods

Subjects in this cross-sectional study were 953 (64.3% female; 28.8 ± 6.2 years) community samples in the west of Iran who were selected by convenience sampling. After applying the inclusion criteria, data were collected using the Symptom Checklist-90 (SCL-90-R), the Personality Diagnostic Questionnaire (PDQ-4), and the Scale for Pseudo-Cardiac Symptoms and Poor Sleep Quality (SPSQ). Pearson correlations, factor analytical techniques, and hierarchical regression models were used to examine associations between symptoms of PDs/CDs and outcome factors.

Results

Factor analytical techniques confirmed both the integrated structure of symptoms of PDs and CDs. Both pseudo-cardiac symptoms and poor sleep quality were more strongly associated with symptoms of CDs than PDs. The results of the hierarchical analysis show that the CDs factor alone could explain the total variance of both pseudo-cardiac symptoms (change in R² = 0.215 vs. 0.009; p < 0.001) and poor sleep quality (change in R² = 0.221 vs. 0.001; p < 0.001).

Conclusion

The different capabilities of two unique factors for the symptoms of PDs and CDs were confirmed by factor analytical methods and regression analysis techniques. Although each of the symptoms of PDs and CDs independently contributes to the manifestation of pseudo-cardiac symptoms and poor sleep quality, the CDs factor is the psychopathological core.

How is type D personality associated with the major psychological outcomes in noncardiac chest pain patients?

Noncardiac chest pain (NCCP) may lead many problems on the health-care system. Having type D personality has been shown to adversely affect NCCP patients. This study aimed to determine the psychological comorbidities that type D personality is associated with, in patients with NCCP. The participants of this cross-sectional study were 360 patients diagnosed with NCCP. Patients filled out questionnaires about sociodemographic, behavioral, and clinical factors (severity of pain, somatization, cardiac anxiety, fear of body sensations, depression, and type D personality). Type D personality was more prevalent among female (p < 0.005), and those people having this personality showed lower sleep quality (p = 0.001) and sexual life satisfaction (p < 0.001) and more likely to be smoker (p < 0.001). Type D personality is strongly associated with fear of body sensations (β = 5.92, SE = 1.95, p = 0.003), pain intensity (β = 3.53, SE = 0.98, p < 0.001), depression (β = 2.91, SE = 0.62, p < 0.001), and somatization (β = 1.75, SE = 0.55, p < 0.001). Type D personality and major psychological comorbidities were strongly associated. Physicians should consider that having type D personality can be linked to NCCP in an effort to help patients receive effective psychological consultations.

Determinants of depression in non-cardiac chest pain patients: a cross sectional study

BACKGROUND

Non-cardiac chest pain (NCCP) is a common patient complaint imposing great costs on the healthcare system. It is associated with psychological factors such as depression. The aim of the present study is determining depression predictors in NCCP patients.

METHODS

The participants of this cross-sectional study were 361 NCCP patients. Patients filled out questionnaires concerning their sociodemographic, lifestyle, and clinical factors (severity of pain, type D personality, somatization, cardiac anxiety, fear of body sensations, and depression).

RESULTS

Based on multiple ordinal logistic regression, lack of physical activity (odds ratio [OR], 1.78; 95% confidence interval [CI], 1.09-2.87), sleep quality (OR, 2.98; 95% CI, 1.15-7.69), being a smoker (OR, 1.33; 95% CI, 2.41-4.03), present pain intensity (OR, 1.08; 95% CI, 1.05-1.11), type D personality (OR, 2.43; 95% CI, 1.47- 4.03), and somatization (OR, 1.22; 95% CI, 1.15-1.3) were significant predictors of depression in NCCP patients. Additionally, multiple linear regression showed that being unmarried (β = 1.51, P = 0.008), lack of physical activity (β = 1.22, P = 0.015), sleep quality (β = 2.26, P = 0.022), present pain intensity (β = 0.07, P = 0.045), type D personality (β = 1.87, P < 0.001), somatization (β = 0.45, P < 0.001), and fear of bodily sensation (β = 0.04, P = 0.032) increased significantly depression scores in NCCP patients.

CONCLUSIONS

Physicians should consider the predictors of depression in NCCP patients which can lead to receiving effective psychological consultations and reducing the costs and ineffectual referrals to medical centers.

Type D Personality and Health-Related Quality of Life in Vascular Surgery Patients

BACKGROUND

This study evaluated the association of type D personality and health-related quality of life (HRQoL) and assessed the stability of type D personality in vascular surgery patients during the year after surgery.

METHOD

In a prospective cohort study between 2008 and 2014, 294 patients were assessed with validated questionnaires preoperatively and at 1, 6, and 12 months after surgery. Associations between type D personality, depression, and HRQoL were analyzed by generalized estimating equation models. Type D personality was analyzed in its standard dichotomous form as well as continuous (z) scores of its two components, negative affectivity (NA) and social inhibition (SI), and their interaction term.

RESULTS

Prevalence of type D personality varied between 18% and 25%. However, only 9% of the complete responders were classified as type D personality at all four assessments, whereas one third changed between type D classifications. Continuous scores showed greater stability over time. Dichotomized type D personality measured over time was significantly associated with impaired HRQoL, but this was not the case if measured once at baseline, like in general use. The continuous NA score and depression were also significantly associated with impaired HRQoL over time.

CONCLUSION

Type D personality was not a stable trait over time. Preoperative assessment of type D personality did not predict improvement in HRQoL after vascular surgery. However, the study revealed associations between the NA component of type D personality, depression, and lower HRQoL. This indicates that measures of overall negative affect should be taken into account when assessing HRQoL patient-reported outcomes in vascular surgery patients.

Role of personality in cardiovascular diseases: An issue that needs to be focused too!

This review provides a broad overview of the relationship of personality with cardiovascular diseases (CVDs). There has been a sustained interest over the last half a century on the issue of relationship between personality traits and CVDs. Type A behavior was the initial focus of inquiry as it was observed that individuals who were competitive, hostile, and excessively driven were overrepresented among patients seeking treatment for CVDs and also were prone to develop coronary artery disease/syndrome. However, the research gradually expanded to assess the relationship of cardiac morbidity with various other personality facets. Furthermore, studies found out that negative effects (including anger and hostility) were also associated with adverse cardiovascular outcomes. Subsequently, a new personality entity named as the type D ‘distressed’ personality, which combined negative affectivity and social inhibition. type D personality then became the area of research and was demonstrated to be related with poorer cardiac outcomes. Interestingly, the results of various research studies are not equivocal, and hence, there are several critiques related to the current understanding of the link between personality construct and the risk of development as well as the outcome of CVDs. Furthermore, few personality traits such as optimism, conscientiousness, openness to experience, and curiosity have been found to be protective factors against development of CVDs and therefore are called ‘cardioprotective’ personality traits. A detailed discussion on the various aspects of personality in relation to CVDs along with a critical appraisal has been presented in this review.

The associations between psychological distress and healthcare use in patients with non-cardiac chest pain: does a history of cardiac disease matter?

BACKGROUND

Psychological distress such as somatization, fear of body sensations, cardiac anxiety and depressive symptoms is common among patients with non-cardiac chest pain, and this may lead to increased healthcare use. However, the relationships between the psychological distress variables and healthcare use, and the differences in relation to history of cardiac disease in these patients has not been studied earlier. Therefore, our aim was to explore and model the associations between different variables of psychological distress (i.e. somatization, fear of body sensations, cardiac anxiety, and depressive symptoms) and healthcare use in patients with non-cardiac chest pain in relation to history of cardiac disease.

METHODS

In total, 552 patients with non-cardiac chest pain (mean age 64 years, 51% women) responded to the Patient Health Questionnaire-15, Body Sensations Questionnaire, Cardiac Anxiety Questionnaire, Patient Health Questionnaire-9 and one question regarding number of healthcare visits. The relationships between the psychological distress variables and healthcare visits were analysed using Structural Equation Modeling in two models representing patients with or without history of cardiac disease.

RESULTS

A total of 34% of the patients had previous cardiac disease. These patients were older, more males, and reported more comorbidities, psychological distress and healthcare visits. In both models, no direct association between depressive symptoms and healthcare use was found. However, depressive symptoms had an indirect effect on healthcare use, which was mediated by somatization, fear of body sensations, and cardiac anxiety, and this effect was significantly stronger in patients with history of cardiac disease. Additionally, all the direct and indirect effects between depressive symptoms, somatization, fear of body sensations, cardiac anxiety, and healthcare use were significantly stronger in patients with history of cardiac disease.

CONCLUSIONS

In patients with non-cardiac chest pain, in particular those with history of cardiac disease, psychological mechanisms play an important role for seeking healthcare. Development of interventions targeting psychological distress in these patients is warranted. Furthermore, there is also a need of more research to clarify as to whether such interventions should be tailored with regard to history of cardiac disease or not.

Prevalence of mental disorders among depressed coronary patients with and without Type D personality. Results of the multi-center SPIRR-CAD trial

OBJECTIVE

Type D personality, as with formal mental disorders, is linked to increased mortality in coronary heart disease (CHD). Our aim was to determine the prevalence of mental disorders among depressed CHD patients with and without Type D personality.

METHODS

Depressive symptoms (HADS, HAM-D), Type D personality (DS-14) and mental disorders based on DSM-IV (SCID I and II) were assessed. Results were calculated by Kruskal-Wallis tests, Fisher's exact tests and logistic regression analyses.

RESULTS

570 CHD patients were included (age 59.2±9.5years; male 78.9%, HADS-D depression 10.4±2.5; HAM-D 11.3±6.6; Type D 60.1%). 84.8% of patients with Type D personality and 79.3% of non-Type D patients suffered from at least one mental disorder (p=0.092), while 41.8% of Type D positives and 27.8% of Type D negatives had at least two mental disorders (p=0.001). Patients with Type D personality significantly more often had social phobia [odds ratio (95% confidence interval): 3.79 (1.1 to 13.12); p=0.035], dysthymia [1.78 (1.12 to 2.84); p=0.015], compulsive [2.25 (1.04 to 4.86); p=0.038] or avoidant [8.95 (2.08 to 38.49); p=0.003] personality disorder.

CONCLUSIONS

Type D personality among depressed CHD patients is associated with more complex and enduring mental disorders. This implies higher treatment demands.

TRIAL REGISTRATION

ISRCTN 76240576; NCT00705965.

Impact of a Type D Personality on Clinical and Psychometric Properties in a Sample of Turkish Patients With a First Myocardial Infarction

BACKGROUND

Recent studies have shown that a Type D personality is associated with an increased risk of cardiac mortality.

OBJECTIVE

This study aimed to examine the impact of a Type D personality on clinical and psychometric properties in a sample of Turkish patients with a first myocardial infarction (MI).

METHOD

The study included 131 patients who were admitted to the coronary care unit of a hospital. All of the patients underwent a psychiatric assessment within 2 to 6 months after their MI. Psychiatric interviews were conducted using the Structured Clinical Interview for DSM-IV (SCID-I). Patients also completed the Beck Depression Inventory, the Spielberger State-Trait Anxiety Inventory, the Health Anxiety Inventory, and the Type D personality scale.

RESULTS

The patients were divided into 2 groups on the basis of the presence or absence of Type D personality. There was a 38.2% prevalence of Type D personality in the patients with a first MI. Those with this type of personality had a significantly higher frequency of hypertension and stressful life events. The Type D patients also had more psychiatric disorders, including depressive and anxiety disorders, than the non-Type D patients.

CONCLUSIONS

Our findings suggest that Type D personality traits may increase the risk of hypertension and the risk of psychiatric morbidity in patients with a first MI. We suggest that this type of personality is a contributor to depression and anxiety disorders. These findings emphasize the importance of screening for Type D personality as both a cardiovascular and psychiatric risk marker in patients who have had an MI.

Psychological distress as a crucial determinant for quality of life in patients with noncardiac chest pain in Central China: A cross-sectional study

Increased psychiatric comorbidity, predominantly anxiety and depressive symptoms, and lower quality of life (QoL) are associated with noncardiac chest pain (NCCP). We aimed to investigate the roles of anxiety and depression in the impaired QoL of NCCP patients in Central China.In this hospital-based cross-sectional study, 200 consecutive patients who complained of chest pain with normal coronary angiography were enrolled in the Department of Cardiology and Gastroenterology, Union Hospital, Wuhan, China. Meanwhile, 100 healthy controls, with age and sex-matched, were recruited. Upper gastrointestinal endoscopy was undergone and a standardized symptom questionnaire was completed in NCCP patients. Levels of anxiety and depression and QoL were assessed using locally translated and validated versions of the Hospital Anxiety and Depression Scale (HADS) and the 36-item Short Form Health Survey (SF-36), respectively.The NCCP patients had poorer physical and mental QoL compared with the controls, and nearly half of them had anxiety (49.7%) and depression (40.1%). Those with anxiety and/or depression had lower physical (PCS) and mental (MCS) component summary score compared with those without anxiety and depression. Increased levels of anxiety and depression were associated with lower PCS (r = -0.469 and -0.523 respectively, P < 0.001) and MCS (r = -0.474 and -0.440, respectively, P < 0.001). The chest pain, heartburn, and anxiety were independent factors influence on both PCS and MCS. Moreover, psychological distress, besides directly acting on the QoL, may also mediate indirectly effects of physical symptoms on both the physical and mental QoL.We demonstrated that anxiety and depression are important determinants for the QoL of NCCP patients. Therefore, interventions should emphasize on identifying and treating the psychological impact in NCCP.

Coping, uncertainty and health-related quality of life as determinants of anxiety and depression on a sample of hospitalized cardiac patients in Southern Italy

OBJECTIVES

Being hospitalized often causes psychological distress and compromises patients' psychological well-being, thereby augmenting the burden of illness. The aim of this paper is to investigate two possible determinants of anxiety and depression among hospitalized cardiac patients, namely uncertainty in illness, and coping strategies, controlling for the perceived health-related quality of life, and distinguishing between borderline and pathological levels of anxiety and depression.

METHODS

Data on anxiety, depression, coping style, uncertainty in illness and self-assessed quality of life concerning 200 cardiac inpatients from a university hospital were collected through validated questionnaires. A biprobit analysis, whose dependent variables are hospital anxiety and depression, was carried out.

RESULTS

Uncertainty in illness has a significant impact on the possibility of crossing the borderline level of both anxiety and depression. The coping strategy of Positive Reappraisal and Growth is inversely and significantly correlated to anxiety and depression, be it borderline or pathological; the Restraint Coping strategy is positively and significantly related to borderline anxiety.

CONCLUSIONS

The reduction of uncertainty in illness and the development of adequate coping strategies should be promoted in order to decrease the patients' risk of crossing the borderline threshold of anxiety and depression.

DS14 is more likely to measure depression rather than a personality disposition in patients with acute coronary syndrome

It has been suggested that Type D Personality is a risk factor for acute coronary syndrome (ACS) and the DS14 has been developed for its assessment. However, some of the items on the DS14 seem to evaluate depressive symptoms rather than personality features. Therefore, the present study aims to verify whether an overlap exists between the constructs of Type D Personality and depression. Three-hundred-and-four consecutive patients who were both presenting their first ACS and had no history of major depression completed the Hospital Anxiety and Depression Scale (HADS) and the DS14 to assess Type D personality at baseline and have been re-evaluated at 1, 2, 4, 6, 9 and 12-month follow-ups. Out of 304 subjects (80.6% males), 40 were diagnosed as depressed. An exploratory factor analysis of HADS and the DS14 in the second month revealed that four out of seven items on the depressive subscale of HADS (HADS-D) and six out of seven items on the Negative Affectivity (NA) subscale of the DS14 segregated on the same factor. Results were verified by a Partial Confirmatory Factor Analysis performed at the twelfth month when most of the patients achieved complete remission from the depressive episode. Temporal stability was poor for NA and Type D Personality and these construct co-vary with HADS-D over time. Our data suggests that NA and depression are overlapping constructs, supporting the idea that the DS14 measures depressed features, rather than a personality disposition.

Type D personality in never-depressed patients and the development of major and minor depression after acute coronary syndrome

BACKGROUND

Type D personality (TDP) has been proposed as a risk factor for the development of depressive symptoms after an acute coronary syndrome (ACS). However, contrasting findings emerged about its predicting power on the onset of depression, since an overlap between TDP and depressive symptoms has been proposed. The present study was aimed to verify whether TDP predicts the development of a depressive disorder in the 6 months after the discharge from hospital.

METHODS

Two hundred fifty consecutive patients were recruited, at the Coronary Intensive Care Unit at the University Hospital of Parma, who were both presenting their first ACS and had no history of depression. The presence and the severity of major (MD) and minor (md) depression were evaluated with the Primary Care Evaluation of Mental Disorders (PRIME-MD) and the Hospital Anxiety and Depression Scale (HADS) respectively. Type D Personality was assessed with the DS14, both at baseline and at 1, 2, 4 and 6 month follow ups.

RESULTS

Out of 250 subjects (81.2% males), MD was diagnosed in 12 patients (4.8%) and md in 18 patients (7.2%). At baseline risk factors for a post-ACS depressive disorder were HADS depression scores, whereas TDP, or its subscales, did not showed any effect.

LIMITATION

The small amount of patients with incidence of depression, due to highly selective inclusion criteria, tempers the reliability of our results.

CONCLUSION

Our data suggests that TDP does not predict the development of depressive disorders in never-depressed patients at their first ACS, when the baseline depression severity was controlled.

The impact of perceived stress and perceived control on anxiety and mood disorders in noncardiac chest pain

Chest pain without detectable heart disease, noncardiac chest pain (NCCP), is linked with anxiety and depression. Theory posits stress and perceived control may relate to NCCP. We hypothesized stress would have direct and mediated effects via perceived control on anxiety and mood disorders in NCCP. Patients ( N = 113) completed questionnaires and a structured diagnostic interview. Stress and perceived control were associated with anxiety and mood disorder severity. Perceived control fully mediated the relation between stress and mood disorder severity but not anxiety disorder severity. Results are partially supportive of anxiety-based theories of NCCP.

Comparing Two Brief Psychological Interventions to Usual Care in Panic Disorder Patients Presenting to the Emergency Department with Chest Pain

Background: Panic disorder (PD) is a common, often unrecognized condition among patients presenting with chest pain to the emergency departments (ED). Nevertheless, psychological treatment is rarely initiated. We are unaware of studies that evaluated the efficacy of brief cognitive-behavioural therapy (CBT) for this population. Aim: Evaluate the efficacy of two brief CBT interventions in PD patients presenting to the ED with chest pain. Method: Fifty-eight PD patients were assigned to either a 1-session CBT-based panic management intervention (PMI) (n = 24), a 7-session CBT intervention (n = 19), or a usual-care control condition (n = 15). A structured diagnostic interview and self-reported questionnaires were administered at pre-test, post-test, 3- and 6-month follow-ups. Results: Statistical analysis showed significant reduction in PD severity following both interventions compared to usual care control condition, but with neither showing superiority compared to the other. Conclusions: CBT-based interventions as brief as a single session initiated within 2 weeks after an ED visit for chest pain appear to be effective for PD. Given the high prevalence of PD in emergency care settings, greater efforts should be made to implement these interventions in the ED and/or primary care setting.

Is type-D a stable construct? An examination of type-D personality in patients before and after cardiac surgery

OBJECTIVE

Type-D personality-negative affectivity and social inhibition-are related to poor prognosis in cardiovascular diseases. At present, little is known about type-D personality and its stability before and after cardiac surgery.

METHODS

One hundred twenty-six patients recommended for coronary bypass and/or valve surgery were examined at pre-surgery and 6 months post-surgery to investigate the stability of type-D (14-item Type-D Scale) and its relationship to anxiety, depression (Hospital Anxiety and Depression Scale) and quality of life (Short Form 12).

RESULTS

Preoperatively, 26% were assessed to have type-D, while only 11% fulfilled type-D criteria both pre- and post-surgery. Patients were assessed and identified as belonging to one of the four type-D groups: Stable type-D (11%), non-type-D (61%), type-D pre (15%), and type-D post (13%). In comparison to the stable non-type D group, the stable type-D reported more symptoms of anxiety, depression, lower physical quality of life post-surgery, and lower mental quality of life both pre- and post-surgery. When compared to the population at large, stable type-D had more symptoms of depression pre-surgery, and more anxiety as well as lower physical and mental quality of life pre- and post-surgery.

CONCLUSION

Type-D diagnosis changed in nearly 60% of the cases post-surgery. Only those patients with stable type-D exhibited a relationship to emotional distress, such as anxiety and depression and reduced quality of life. Additional research on the critical cut-off scores and stability of type-D as it relates to critical life events would likely enhance our ability to more effectively diagnose and treat patients who are at high risk for insufficient coping.

Use of the hospital anxiety and depression scale (HADS) in a cardiac emergency room: chest pain unit

OBJECTIVE

To determine the prevalence of anxiety and depression in patients complaining of chest pain who seek a chest pain unit attendance.

INTRODUCTION

Patients arriving at a Chest Pain Unit may present psychiatric disorders not identified, isolated or co-morbid to the main illness, which may interfere in the patient prognosis.

METHODOLOGY

Patients were assessed by the 'Hospital Anxiety and Depression Scale' as a screening instrument wile following a systematized protocol to rule out the diagnosis of acute coronary syndrome and other potentially fatal diseases. Patients with 8 or more points in the scale were considered 'probable case' of anxiety or depression.

RESULTS

According to the protocol, 59 (45.4%) of 130 patients studied presented Chest Pain of Determined Cause, and 71 (54.6%) presented Chest Pain of Indefinite Cause. In the former group, in which 43 (33.1%) had acute coronary syndrome, 33.9% were probable anxiety cases and 30.5% depression cases. In the second group, formed by patients without acute coronary syndrome or any clinical conditions involving greater morbidity and mortality risk, 53.5% were probable anxiety cases and 25.4% depression.

CONCLUSION

The high anxiety and depression prevalence observed may indicate the need for early and specialized approach to these disorders. When coronary arterial disease is present, this may decrease complications and shorten hospital stay. When psychiatric disorder appears isolated, is possible to reduce unnecessary repeated visits to emergency room and increase patient's quality of life.

Women and non-cardiac chest pain: gender differences in symptom presentation

A substantial number of individuals evaluated for complaints of chest pain do not suffer from coronary heart disease (CHD). Studies show that many patients who complain of symptoms that might be caused by CHD, such as shortness of breath or chest pain, may actually have an anxiety disorder. Gender differences in how patients present with these symptoms have not been adequately explored. The purpose of this study was to explore possible gender differences in the presentation of patients with CHD-like symptoms. Two groups were examined, one comprising 6,381 individuals self-referred for electron beam tomography (EBT) studies and a subset of these individuals who defined a "low-risk" group based on the absence of risk factors for CHD and low coronary artery calcium (CAC) scores. We explored gender differences in symptom presentation in each group after controlling for relevant variables by using logistic regression models. These analyses showed that women were significantly more likely than men to endorse CHD symptoms that might also be caused by an anxiety disorder. Women in the low risk group reported CHD symptoms also referable to anxiety more often than men, but unlike men did not complain primarily of chest pain. Women were also more likely to have been prescribed antianxiety or antidepressant medication. In previous studies, non-cardiac chest pain has been considered a hallmark of anxiety in individuals seen in medical settings. This study suggests that in individuals with low risk for CHD chest pain was not related to gender, but other anxiety-related symptoms including heart flutter, lightheadedness, nausea, and shortness of breath were more likely to be reported in women than in men.