[page 14 of handout]
Kushner, M.G. and Beitman, B.D. (1990) Panic attacks without fear:
an overview. Behaviour Research and Therapy, 28, 469-479.
A more recent report on the high percentage (25-43%) of patients undergoing cardiac investigations who turn out to have no evidence of coronary disease is Carmin et al. (2003).
See also Fleet et al (1998) below — it is more typical to find cases where cognitions are a part of panic disorder [not included in paper handout]
In the case below it seems likely that being diagnosed as having coronary artery disease predisposes patients to having panic attacks involving fear of heart attacks.
Fleet, RP, Dupuis, G, Marchand, A, Kaczorowski, J, Burelle, D, Arsenault, A, Beitman, BD (1998) Panic disorder in coronary artery disease patients with noncardiac chest pain. Journal of Psychosomatic Research, Vol.44, No.1, Pp.81-90.
- What percentage of coronary artery disease (CAD) patients that present with chest pain, but whose symptoms cannot be fully explained by their cardiac status, suffer from panic disorder (PD)?
How do patients with both CAD and PD compare to patients without CAD and to patients without either PD or CAD in terms of psychological distress?
Four hundred forty-one consecutive walk-in emergency department patients with chest pain underwent a structured psychiatric interview (ADIS-R) and completed psychological scales.
- Fifty-seven percent (250 of 441) of these patients were diagnosed as having noncardiac chest pain and constituted this study's sample,
- A total of 30% (74 of 250) of noncardiac chest pain patients had a documented history of CAD.
- Thirty-four percent (25 of 74) of CAD patients met criteria for PD.
- Patients with both PD and CAD displayed significantly more psychological distress than CAD patients without PD and patients with neither CAD nor PD.
- However, they did not differ from non-CAD patients with PD.
- PD is highly prevalent in patients with CAD that are discharged with noncardiac diagnoses. The psychological distress in these patients appears to be related to the panic syndrome and not to the presence of the cardiac condition.