Sažetak
Apstrakt
Uvod/Cilj. Bol u grudima koji nije srčanog porekla često liči na anginozni i kada se ne pronađu medicinski uzroci, bolesnici se upućuju psihijatru radi dalje procene. Cilj istraživanja bilo je utvrđivanje psiholoških karakteristike bolesnika sa bolom u grudima bez koronarnog uzroka, razlika u poređenju sa koronarnim bolesnicima i prediktivnih vrednosti parametara za bol bez koronarnog uzroka. Metode. Konsekutivno je bilo regrutovano 40 bolesnika bez dijagnoze srčane bolesti (BDSB grupa) sa simptomima bola u grudima, koji su upoređeni sa 45 koronarnih bolesnika (K grupa). Za postavljanje dijagnoze psihijatrijske bolesti korišćen je Mini-internacionalni neuropsihijatrijski intervju (MINI), za procenu psiholoških simptoma Upitnik liste simptoma-90-revidirani (SCL-90R upitnik), za procenu izloženost životnim događajima Holmas Rahe skala, a za procenu nivoa anksioznosti i depresivnosti Bek–ov upitnika za anksioznost i Bek-ov upitnik za depresivnost . Statistička analiza rađena je pomoću SPPS 17, a korišćeni su Student-ov t-test i χ2 test za utvrđivanje razlike između parametara u grupama. ANOVA je upotrebljena radi određivanja parametara koji su povezani sa bolom u grudima bez koronarnog uzroka. Rezultati. Bolesnici u BDSB grupi bili su mlađi (33,40 ± 5,43 vs 48,37 ± 6,43, p < 0,001), anksiozniji (20,47 ± 11,93 vs 9,63 ± 3,86, p < 0,001), više izloženi životnim događajima (102,03 ± 52,22 vs 46,5 ± 55,08, p < 0,001) i imali su viši nivo distresa (41,37 ± 7,70 vs 29,37 ± 5,67, p < 0,001), dok su koronarni bolesnici bili više depresivni i hostilni. Regresiona analiza je pokazala da porast skora anksioznosti za 1 poen, znači 25% veću šansu da subjekt pripada BDSB grupi [odds ratio (OR) = 1,25; 95% interval poverenja (IP): 1,10–1,41] i porast skora životnih događaja znači 2% veću šansu da bolesnik pripada BDSB grupi (OR = 1,02; 95% IP: 1,01–1,03). Mlađi ispitanici imali su veću šansu da pripadaju BDSB grupi (OR = 0,58, 95% CI: 0,42–0,80). Zaključak. Bolesnici BDSB grupe nisu imali udruženi psihijatrijski poremećaj, ali su imali viši nivo distresa, izloženost životnim događajima i umereni nivo anksioznosti. Psihološka pomoć mladim ljudima sa bolom u grudima bez srčanog uzroka, mogla bi biti korisna u cilju prevencije mogućih psihijatrijskih poremećaja.
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REFERENCES
Campbell KA, Madva EN, Villegas AC, Beale EE, Beach SR, Wasfy JH,et al. Non cardiac chest pain: A review for the con-sultation liaison psychiatrist. Psychosomatics 2017; 58(3): 252–65.
Webster R, Norman P, Goodacre S, Thompson AR, McEachan RR. Illnessrepresentations, psychological distress and non-cardiac chest pain in patientsattending an emergency department. Psy-chol Health 2014; 29(11):1265–82.
Marks EM, Chambers JB, Russell V, Bryan L, Hunter MS. The rapid access chestpain clinic: unmet distress and disability. QJM 2014; 107(6):429–34.
Remes-Troche JM. How to Diagnose and Treat Functional Chest Pain. Curr TreatOptions Gastroenterol 2016; 14(4):429–43
Chambers JB, Marks EM, Hunter MS. The head says yes but the heart says no:what is non-cardiac chest pain and how is it ma-naged? Heart 2015; 101(15):1240–9.
Brauser D. Anxiety may increase cardiovascular events, death in heart disease patients. Available from:
https://www.medscape.org/viewarticle/725294
World Health Organization. The ICD-10 Classification for men-tal and behavioural disorders. Diagnostic criteria for research. Geneva; World Health Organization; 1993.
Manuel DG, Perez R, Sanmartin C, Taljaard M, Hennessy D, Wilson K,et al. Measuring Burden of Unhealthy Behaviours Using a Multivariable Predictive Approach: Life Expectancy Lost in Canada Attributable to Smoking, Alcohol, Physical Inactivity, and Diet. PLoS Med 2016; 13(8): e1002082.
Pinninti NR, Madison H, Musser E, Rissmiller D. MINI Interna-tional Neuropsychiatric Schedule: clinical utility and patient ac¬ceptance. Eur Psychiatry 2003; 18(7): 361–4.
Holi M. Assessment of psychiatric symptoms using the SCL-90 [dissertation]. Helsinki, Finland: University of Helsinki, Medi-cal Faculty, Department of Psychiatry. 2003.
Fenner E, Michels G. Scl-90-R scoring of stress after myocar-dial infarction. Med Klin (Munich) 2003; 98(1): 7–12. (Ger-man)
Beck AT, Epstein N, Brown G, Steer RA. An inventory for meas¬uring clinical anxiety: psychometric properties. J Consult ClinPsychol 1988; 56(6): 893–7.
Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inven-tory for measuring depression. Arch Gen Psychiatry 1961; 4: 561–71.
Holmes TH, Rahe RH. The Social Readjustment Rating Scale. J Psychosom Res 1967; 11(2): 213–8.
Eslick GD, Talley NJ. Non-cardiac chest pain: predictors of health care seeking, the types of health care professional con-sulted, work absenteeism and interruption of daily activities. Aliment PharmacolTher 2004; 20(8): 909–15.
Ahn S, Song R, Choi SW. Effects of Self-care Health Behaviors on Quality of Life Mediated by Cardiovascular Risk Factors Among Individuals with Coronary Artery Disease: A Structural Equation Modeling Approach. Asian Nurs Res (Ko¬reanSocNursSci) 2016; 10(2): 158–63.
Mourad G, Strömberg A, Jonsbu E, Gustafsson M, Johansson P, Jaarsma T. Guided Internet-delivered cognitive behavioural therapy in patients with non-cardiac chest pain - a pilot ran-domized controlled study. Trials 2016; 17(1): 352.
Spring B, Moller AC, Colangelo LA, Siddique J, Roehrig M, Daviglus ML, et al. Healthy lifestyle change and subclinical atheroscle¬rosis in young adults: Coronary Artery Risk Development in Young Adults (CARDIA) study. Circulation 2014;130(1):10–7.
George N, Abdallah J, Maradey-Romero C, Gerson L, Fass R. Re-view article: the current treatment of non-cardiac chest pain. Aliment PharmacolTher 2016; 43(2): 213–39.
Marks EM, Chambers JB, Russell V, Hunter MS. A novel biopsy¬chosocial, cognitive behavioural, stepped care interven-tion for patients with non-cardiac chest pain. Health PsycholBehav Med 2016; 4(1): 15–28.
Husser D, Bollmann A, Kühne C, Molling J, Klein HU. Evaluation of noncardiac chest pain: Diagnostic approach, coping strate¬gies and quality of life. Eur J Pain 2006; 10(1): 51–5.
Haukkala A, Konttinen H, Laatikainen T, Kawachi I, Uutela A. Hostility, anger control, and anger expression as predictors of cardiovascular disease. Psychosom Med 2010; 72(6): 556–62.
Campbell KA, Madva EN, Villegas AC, Beale EE, Beach SR, Wasfy JH,et al. Non-cardiac Chest Pain: A Review for the Con¬sultation-Liaison Psychiatrist. Psychosomatics 2017; 58(3): 252–65.
Mourad G, Strömberg A, Johansson P, Jaarsma T. Depressive Symp¬toms, Cardiac Anxiety, and Fear of Body Sensations in Patients with Non-Cardiac Chest Pain, and Their Relation to Healthcare-Seeking Behavior: A Cross-Sectional Study. Patient 2016; 9(1): 69–77.
Bjerkeset O, Nordahl HM, Mykletun A, Holmen J, Dahl AA. Anxi¬ety and depression following myocardial infarction: Gender differences in a 5-year prospective study. J Psychosom Res 2005; 58(2): 153–61.
Januzzi JL, Stern TA, Pasternak RC, DeSanctis RW. The influ-ence of anxiety and depression on outcomes of patients with coronary artery disease. Arch Intern Med 2000; 160(13): 1913–21.
Lutfi MF. Anxiety level and cardiac autonomic modulation in coronary artery disease and cardiac syndrome x patients. PLOS One 2017; 12(1): e0170086.
Frieling T. Differential diagnosis "non-cardiac chest pain". Dtsch Med Wochenschr 2015; 140(15): 1166–72. (German)
Bahremand M, Moradi G, Saeidi M, Mohammadi S, Komasi S. Re-ducing Irrational Beliefs and Pain Severity in Patients Suf-fering from Non-Cardiac Chest Pain (NCCP): A Comparison of Re¬laxation Training and Metaphor Therapy. Korean J Pain 2015; 28(2): 88–95.
George N, Abdallah J, Maradey-Romero C, Gerson L, Fass R. Re-view article: the current treatment of non-cardiac chest pain. Aliment PharmacolTher 2016;43(2):213–39.