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2019, vol. 76, br. 8, str. 772-778
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Psihološke karakteristike bolesnika sa bolom u grudima bez srčanog uzroka
Psychological characteristics in patients with non-cardiac chest pain
aUniverzitet u Nišu, Medicinski fakultet + Klinički centar Niš, Klinika za zaštitu mentalnog zdravlja bVojnomedicinska akademija, Klinika za psihijatriju, Beograd + Univerzitet odbrane, Medicinski fakultet Vojnomedicinske akademije, Beograd cKlinički centar Niš, Klinika za zaštitu mentalnog zdravlja + Univerzitet u Nišu, Medicinski fakultet, Institut za prevenciju, lečenje i rehabilitaciju reumatičkih i kardioloških bolesti 'Niška Banja' - Niška Banja
e-adresa: gordanani@gmail.com
Sažetak
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.
Abstract
Background/Aim. Chest pain of no heart origin resembles angina and when none medical reason is found, the patients are referred to psychiatrist for further assessment. The aim of this reserch was to determine psychological characteristics of the patients with non-coronary chest pain (NCCP), difference compared to the coronary patients and the predictive value of those parameters for NCCP. Methods. Fourty consecutively recruited patients without a diagnose of heart disease (NCCP group) were examined and compared to 45 coronary patients (C group). For psychiatric diagnose, the Mini-International Neuropsychiatric Interview (MINI) was used. Psychological symptoms were assessed by the Symptom Checklist-90-Revised (SCL-90R), exposure to life events was scored by the Holms&Rahe Scale and levels of anxiety and depressiveness by the Back Anxiety Inventory and Back Depression Inventory. The statistical analysis was done by using the software package SPPS17. The Student's-t test and χ2-test were used for estimating more difference between groups while ANOVA determined parameters associated with NCCP. Results. The NCCP patients were younger (33.40 ± 5.43 vs. 48.37 ± 6.43, p < 0.001), more anxious (20.47 ± 11.93 vs. 9.63 ± 3.86, p < 0.001), had more exposure to life events (102.03 ± 52.22 vs. 46.5 ± 55.08, p < 0.001) and were more distressed (41.37 ± 7.70 vs. 29.37 ± 5.67, p < 0.001), while coronary patients were more depressed and hostile. The regression analysis indicated that elevation in anxiety score for 1 point, means 25% of a higher chance [odds ratio (OR) = 1.25; 95% confidence interval (CI): 1.10-1.41] and elevation in the Life events score, means 2% of a higher chance that subject belonged to the NCCP group (OR = 1.02; 95% CI: 1.01-1.03). The younger subjects were more likely to have non-cardiac chest pain (OR = 0.58, 95% CI: 0.42-0.80). Conclusion. The results suggested that the patients with NCCP had none associated psychiatric disorder, but showed higher distress level, more exposure to negative life events and moderate anxiety level. Psychological help could be of a benefit to prevent possible psychiatric issues in young people with non-cardiac chest pain.
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