Psychiatric Disorders in Youth with Medically Unexplained Chest Pain versus Innocent Heart Murmur

Abstract

Objective To examine prevalence of DSM-IV psychiatric disorders in youth with chest pain compared with a control sample with innocent heart murmur. Study design We assessed youth ages 8–17 years who were evaluated in cardiology settings for medically unexplained chest pain (N=100) or innocent heart murmur (N=80). We conducted semi-structured interviews and assessed medical history, quality of life, and disability. Results Youth with chest pain had a higher prevalence of psychiatric disorders compared with those with murmur (74% vs. 47%, X2 = 13.3; p<.001). Anxiety disorders predominated, although major depression was also more common in the chest pain group (9% vs. 0%; FET; p<.01). Onset of psychiatric disorders generally preceded chest pain. Patterns were similar for boys and girls and for children and adolescents. Chest pain was associated with poorer quality of life and with pain-related disability for youth with comorbid psychiatric disorder. Conclusions In childhood and adolescence, medically unexplained chest pain is associated with a high prevalence of psychiatric disorders. Systematic mental health screening may improve detection and enhance management of these patients.

Anxiety, depression, and behavioural rating scales in children with non-cardiac chest pain

“…Another study in children and adolescents with unexplained chest pain, who presented to paediatric emergency department, showed high rates of psychopathology (27 of 32 children, 84%) using Diagnostic Statistical Manual of Mental Disorders, Fourth Edition and a large percentage of the sample (81%) had anxiety disorder. 21 Finding is also consistent with the result of other study by Lipsitz et al 22 in youngsters with non-cardiac chest pain. They found a higher prevalence of Diagnostic Statistical Manual of Mental Disorders, Fourth Edition, psychiatric disorders in children and adolescents with medically unexplained chest pain compared to a control sample with innocent heart murmur (74% versus 38%), and anxiety was again found most common (70%) in psychiatric disorders.…”

“…Similarly, Lipsitz et al 11 showed that youngsters with non-cardiac chest pain and benign heart murmur had similar mean scores on Child Depression Inventory depressive symptoms, and depression rates (11% of non-cardiac chest pain and 7% of benign heart murmur groups) did not differ across the groups. Another study of Lipsitz et al 22 between children and adolescents with medically unexplained chest pain and innocent heart murmur showed higher prevalence (9% versus 0) of any depression in the chest pain group using Diagnostic Statistical Manual of Mental Disorders, Fourth Edition: Child and Parent version.…”

Annual Research Review: Functional somatic symptoms and associated anxiety and depression – developmental psychopathology in pediatric practice

“…Uncontrolled studies that used a standardized psychiatric interview to assess children and adolescents with unexplained chest pain found that 81% of those presenting to a specialty cardiac clinic and 56% of those presenting to the emergency department met criteria for diagnosis of an anxiety disorder (Lipsitz et al., 2005, 2010). In a subsequent controlled study, psychiatric disorder was significantly more likely in youth presenting with chest pain in a specialty cardiac setting than in controls, with 74% of the chest pain group meeting criteria for a psychiatric disorder, with the most prevalent diagnosis being that of an anxiety disorder (Lipsitz et al., 2012).…”

Relationship between non-cardiac chest pain and internalizing problems in pre-school aged children

“…Tunaoglu et al 14 showed 75% psychiatric disorder and 21% anxiety symptoms in 74 youngsters with noncardiac chest pain in a paediatric cardiology service, based on the Diagnostic Statistical Manual of Mental Disorders, Third Edition-R. Another study in children and adolescents with noncardiac chest pain who were admitted to a paediatric emergency department showed high rates of psychopathology (27 of 32 children, 84%) using the Diagnostic Statistical Manual of Mental Disorders, Fourth Edition, and a large percentage of the sample (81%) had anxiety disorder. 20 Lipsitz et al 21 found a higher prevalence of Diagnostic Statistical Manual of Mental Disorders, Fourth Edition psychiatric disorders in children and adolescents with non-cardiac chest pain than in a control sample with innocent heart murmur (74% versus 38%), and anxiety was again found to be the most common (70%) among psychiatric disorders. Another study by Lipsitz et al showed that youngsters who had been diagnosed several years earlier with non-cardiac chest pain reported more current symptoms of anxiety, anxiety sensitivity, and physiological arousal than children with benign murmurs.…”