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Panic-Agoraphobic Spectrum and Cardiovascular Disease

Published online by Cambridge University Press:  07 November 2014


Panic disorder occurs frequently with different forms of cardiovascular disease and hypertension. The 13 panic symptoms described in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) often overlap with manifestations of cardiovascular disorders, raising problems in the differential diagnosis. In order to explore in greater detail the phenomenology of panic symptoms in cardiovascular patients, the Structured Clinical Interview for Panic-Agoraphobic Spectrum (SCI-PAS) was administered to 111 patients with hypertension and 29 patients with a recent myocardial infarction.

With regard to the frequency of endorsement of many of the symptoms assessed on the SCI-PAS, more than 40% of the cardiovascular patients who failed to meet the DSM-IV criteria for panic disorder did not significantly differ from the 10% of cardiovascular patients who did fulfill the criteria for panic disorder. A third distinct subgroup comprising 48.6% of the cardiovascular patients reported a significantly smaller number of SCI-PAS symptoms than the other two groups.

These preliminary findings suggest the existence of a relatively large proportion of cardiovascular patients who present with physical and psychological symptoms that are potentially related to panic disorder and that may provoke considerable subjective distress. Further studies are needed to clarify the nature of these symptoms and their potential interference with treatment and symptomatology of cardiovascular disease.

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Copyright © Cambridge University Press 1998

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1.Gorman, JM, Shear, MK, Devereaux, RB, King, DL, Klein, DF. Prevalence of mitral valve prolapse in panic disorder: effect of echocardiographic criteria. Psychosom Med. 1986;48:167171.Google Scholar
2.Katon, W, Roy-Byrne, PP. Panic disorder in the medically ill. J Clin Psychiatry. 1989;50:299302.Google Scholar
3.Skerritt, PW: Anxiety and the heart: a historical review. Psychol Med. 1983;13:1725.Google Scholar
4.Chignon, JM, Lepine, JP, Ades, J. Panic disorder in cardiac outpatients. Am J Psychiatry. 1993;150:780785.Google Scholar
5.Jolley, R, Lydiard, RB, Assey, ME, Usher, BW, Barnwell, WH, Ballenger, JC. Cardiovascular status of panic disorder patients with and without prominent cardiac symptoms. Psychosomatics. 1992;33:8184.CrossRefGoogle ScholarPubMed
6.Simon, G, Ormel, J, VonKorff, M, Barlow, W. Health care costs associated with depressive and anxiety disorders in primary care. Am J Psychiatry. 1995;152:352357.Google Scholar
7.Bass, C, Wade, C. Chest pain with normal coronary arteries: a comparative study of psychiatric and social morbidity. Psychol Med. 1984;14:5161.Google Scholar
8.Beitman, BP, Basha, I, Flaker, G, et al.Atypical or nonanginal chest pain: panic disorder or coronary artery disease? Arch Intern Med. 1987;147:15481552.Google Scholar
9.McNally, RJ. Panic Disorder: A Critical Analysis. New York, NY: Guilford Press; 1994.Google Scholar
10.Kushner, MG, Beitman, BD. Panic attacks without fear: an overview. Behav Res Ther. 1990;28:469479.Google Scholar
11.Beck, JG, Berisford, MA, Taegtmeyer, H, Bennet, A. Panic symptoms in chest pain without coronary artery disease: a comparison with panic disorder. Behav Ther. 1990;21:241252.Google Scholar
12.Cassano, GB, Michelini, S, Shear, MK, Coli, E, Maser, JD, Frank, E. The panic agoraphobic spectrum: a descriptive approach to the assessment and treatment of subtle symptoms. Am J Psychiatry. 1997;154(suppl 6):2738.Google Scholar
13.American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed (DSM-IV). Washington, DC: American Psychiatric Association; 1994.Google Scholar
14.Statistical Package for the Social Sciences. Version 7.0 for Windows 95. Chicago, Ill: SPSS; 1997.Google Scholar
15.Katon, WJ. Chest pain, cardiac disease, and panic disorder. J Clin Psychiatry. 1990;51(suppl):2730.Google Scholar
16.Cormier, L, Katon, W, Russo, J, Hollifield, M, Hall, ML, Vitaliano, PP. Chest pain with negative cardiac diagnostic studies: relationship to psychiatric illness. J Nerv Ment Dis. 1988;176:351358.Google Scholar
17.Robins, LN, Helzer, JE, Croughan, J, Ratcliff, KS. National Institute of Mental Health Diagnostic Interview Schedule: its history, characteristics, and validity. Arch Gen Psychiatry. 1981;38:381389.Google Scholar
18.Sheehan, DV, Ballenger, J, Jacobsen, G. Treatment of endogenous anxiety with phobic, hysterical, and hypochondriacal symptoms. Arch Gen Psychiatry. 1980;37:5159.Google Scholar
19.Katon, W. Panic disorder: epidemiology, diagnosis and treatment in primary care. J Clin Psychiatry. 1986;47(suppl 10):2127.Google Scholar