title: Psychiatric disorders in youth with medically unexplained chest pain versus innocent heart murmur.
abstract: OBJECTIVE
  To examine the prevalence of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition psychiatric disorders in youth with chest pain compared with a control sample with innocent heart murmur.
  
  
  METHODS
  We assessed youth ages 8 to 17 years who were examined 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 youth with murmur (74% versus 47%, χ(2)=13.3; P<.001). Anxiety disorders predominated, although major depression was also more common in the chest pain group (9% versus 0%; Fisher exact tests; 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 co-morbid 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 treatment of these patients.
authors.affiliation: College of Physicians and Surgeons, Columbia University, New York, NY, USA. joshual@bgu.ac.il
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Lipsitz
authors.forename: Daphne T
authors.initials: DT
authors.lastname: Hsu
authors.forename: Howard D
authors.initials: HD
authors.lastname: Apfel
authors.forename: Zvi S
authors.initials: ZS
authors.lastname: Marans
authors.forename: Rubin S
authors.initials: RS
authors.lastname: Cooper
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Albano
authors.forename: Merav
authors.initials: M
authors.lastname: Gur
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001008:Anxiety Disorders / Q000503:physiopathology; D002637:Chest Pain / Q000523:psychology*; D002648:Child; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000503:physiopathology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006337:Heart Murmurs / Q000523:psychology*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000503:physiopathology*; D011788:Quality of Life / Q000523:psychology*; D012307:Risk Factors; D012737:Sex Factors; D011795:Surveys and Questionnaires