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Anxiety disorder in patients with non-specific chest pain in the emergency setting

¹ Department of Emergency Medicine, School of Medicine, Dokuz Eylul University, Izmir, Turkey
² Department of Psychiatry, School of Medicine, Dokuz Eylul University, Izmir, Turkey

Correspondence to:
Correspondence to:
Dr N S Demiryoguran
Department of Emergency Medicine, School of Medicine, Dokuz Eylul University, 35340, Inciralti, Izmir, Turkey; nesibesonmez{at}yahoo.com

Objectives: Many patients who have been discharged from the emergency department (ED) with a diagnosis of "non-specific chest pain" (NSCP) have anxiety disorder (AD), a commonly missed entity in acute care. The objective of this study was to delineate characteristic properties that could enhance recognition of AD in ED patients admitted with NSCP.

Methods: All patients between 18 and 65 years of age diagnosed with NSCP were enrolled. The Hospital Anxiety and Depression Scale (HADS) anxiety subscale was used as a screening test for AD. The patients with high HADS scores (10) were evaluated by a psychiatrist for AD.

Results: In total, 157 patients were enrolled in the study. HADS scores were found to be "high" (10) in 49 patients (31.2%). Patients with high HADS scores had a higher frequency of associated symptoms (p = 0.004). Dizziness or lightheadedness, chills or hot flushes, and fear of dying were found to have been reported more frequently by patients with high anxiety scores. Of the group with high score, 33 patients (67.3%) were interviewed by a psychiatrist, and 23 (69.7%) of these patients were diagnosed with AD. Associated symptoms were described by 21 patients with AD (91.3%). Of those with AD, 18 (78.3%) had been previously admitted to the ED with chest pain. Atypical chest pain was described by 21 patients (91.3%).

Conclusions: Physicians should always consider AD in patients presenting to the ED with chest pain after ruling out organic aetiology. Patients’ definition of atypical pain, recurrent admissions to ED, and presence of associated symptoms such as dizziness, chills or hot flushes, and fear of dying could aid in considering AD.

Abbreviations: AD, anxiety disorder; CP, chest pain; ED, emergency department; EP, emergency physician; HADS, Hospital Anxiety and Depression Scale; HADS-A, Hospital Anxiety and Depression Scale, anxiety subscale; HADS-D, Hospital Anxiety and Depression Scale, depression subscale; NSCP, non-specific chest pain; PD, panic disorder

Keywords: chest pain; anxiety disorder; emergency medicine

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