Çocuklarda Göğüs Ağrısı Anksiyöz Hastalıkların Belirtisi Olabilir Mi ?

Yıl 2017, Cilt: 2 Sayı: 1, 5 - 9, 30.05.2018

Şeyma Kayalı , Derya Özdemir Zeynep Ertekin Uğur Ufuk Işın

Öz

Amaç:

Göğüs ağrısı çocuklarda, ergenlerde yaygın bir şikayettir ve sık acil servis başvurusuyla birlikte ileri testler yapılmasına neden olur. Bu çalışmada, çocuklarda genel anksiyete, kalp odaklı kaygı ve nonkardiyak göğüs ağrısı (NCCP) arasındaki ilişkinin irdelenmesi amaçlanmıştır. Bu değerlendirme ile olası psikolojik rahatsızlığı öngörme ve gereksiz tıbbi testlerden kaçınma sağlanabilecektir.

Yöntem:

Bu prospektif vaka kontrol çalışmasında, göğüs ağrısı şikayetleri ile pediatrik kardiyolojiye başvuran ve tıbbi bir patoloji tespit edilmeyen olgular çalışma grubunu oluştururken (n:73), göğüs ağrısı şikayeti ve sistemik rahatsızlığı bulunmayan olgular ise kontrol grubu olarak belirlendi (n: 26). Her olguya Beck Anksiyete Ölçeği (BAI) yapıldı, göğüs ağrısı olan çalışma grubuna ise ayrıca Kardiyak Anksiyete Ölçeği (CAQ) uygulandı.

Bulgular:

Elli altı hastanın (% 76.7) toplam BAI skoru 22 ve üzerinde idi. Çalışma ve kontrol grubu arasındaki BAI puanları arasında istatistiksel olarak anlamlı fark bulundu (p <0.001). CAQ’nun üç alt ölçeği (korku, dikkat ve kaçınma) genel kaygı ile yüksek korelasyona sahipti. CAQ için Cronbach alfa değeri olan 0.834, iç tutarlılık için tatmin edici bir rakam olarak tespit edildi.

Sonuç:

Bu ön çalışma sonucu, nonkardiyak göğüs ağrılı çocuklarda, anksiyete bozukluklarının öngörülenden daha yaygın olduğunu düşündürmektedir. İdiyopatik göğüs ağrısı olgularının çoğunda da psikolojik bir rahatsızlık olabileceği, bu nedenle göğüs ağrısı bulunan çocukların bir psikiyatriste yönlendirilmesi önerilmektedir. Çalışmamız, çocukluk çağı göğüs ağrılarında, CAQ kullanan ilk çalışma olması nedeniyle de önem taşımaktadır.

Anahtar Kelimeler

Anksiyete, çocuk, adölosan, göğüs ağrısı

Can Chest Pain Be Accepted A Sign of Anxious Disorders in Children ?

Öz

Objective:

Chest pain is a common complaint in children and adolescents, accounting for numerous emergency visits and leading to a wide range of testing. In this study we sought to determine general anxiety, heart-focused anxiety and their relationship among children with non-cardiac chest pain (NCCP). This assessment provides to predict a possible psychological disorder and avoid unnecessary further medical testing.

Method:

In this prospective case-control study, all patients aged 10-18 years old who were referred pediatric

cardiology with a complaint of chest pain and showed no evidence of obvious medical pathology (n:73) were selected for study group. Also cases who had no chest pain or cardiac disease were accepted as control group (n:26). Each case was interviewed with using Beck Anxiety Inventory (BAI) and patients with chest pain were also interviewed with Cardiac Anxiety Questionnaire (CAQ).

Results:

Fifty-six patients (76.7%) had high BAI scores with a total score of 22 and above. Statistically significant difference was found between BAI scores of study group and control group (p< 0.001). CAQ’s all three subscales (fear, attention and avoidance) were highly correlated with indicators of general anxiety. Cronbach’s alpha for CAQ was 0.834, indicating satisfactory internal consistency.

Conclusion:

The results of this preliminary study suggest that anxiety disorders are more common than predicted in children with NCCP. We believe that most idiopathic chest pain cases have an underlying psychological disorder especially anxious disorder therefore referring to a psychiatrist is suggested. Our study also should take a worthy of particular attention because of being the first study that use CAQ in pediatric clinical practice.

Keywords: Anxiety, children, adolescent, chest pain

Anahtar Kelimeler

Anxiety, children, adolescent, chest pain

Kaynakça

• 1. Hussain MZ, Ishrat S, Salehuddin M, Mahmood M, Islam MT.Chest pain in children: an update. Mymensingh Med J. 2011; 20:165-70.
• 2. Chun JH, Kim TH, Han MY, Kim NY, Yoon KL. Analysis of clinical characteristics and causes of chest pain in children and adolescents.Korean J Pediatr. 2015;58:440-5.
• 3. Danduran MJ, Earing MG, Sheridan DC, Ewalt LA, Frommelt PC. Chest pain: characteristics of children/adolescents. Pediatr Cardiol. 2008; 29:775–81.
• 4. Lipsitz JD, Masia C, Apfel H, Marans Z, Gur M, Dent H, et al. Noncardiac chest pain and psychopathology in children and adolescents. J Psychosom Res. 2005; 59:185–8.
• 5. Lee JL, Gilleland J, Campbell RM, Simpson P, Johnson GL, Dooley KJ, et al. Health care utilization and psychosocial factors in pediatric noncardiac chest pain. Health Psychol. 2012; 37:817–25.
• 6. Loiselle KA, Lee JL, Gilleland J, Campbell RM, Simpson P, Dooley KJ, et al. Factors associated with healthcare utilization among children with noncardiac chest pain and innocent heart murmurs. J Pediatr Psychol. 2012; 37:817–25.
• 7. Eifert GH. Cardiophobia: A paradigmatic behavioral model of heart-focused anxiety and non-anginal chest pain. Behav Res Ther. 1992;30: 329-45.
• 8. Eifert G H, Hodson, SE, Tracey D R, Seville J L, Gunawardane K. Heart-focused anxiety, illness beliefs, and behavioral impairment: Comparing healthy heart- anxious patients with cardiac and surgical inpatients.J Behav Med. 1996:19; 385-99.
• 9. Eslick GD, Jones M P, Talley N J .Non-cardiac chest pain: Prevalence, risk factors, impact and consulting- A population- based study. Alimentary Pharmacology & Therapeutics 2003;17:1115-24.
• 10. Eifert H, Thompso RN, Zvolesnsky M J, Edwards K, Frazer N L, Haddad J W,Davig J. The Cardiac Anxiety Questionnaire: Development and preliminary validity. Behav Res Ther. 2000;38:1039-53.
• 11. Pelland M, Marchand A, Lessard M, Belleville G, Chauny J, Vadeboncoeur A, et al. Efficacy of 2 interventions for panic disorder in patients presenting to the ED withchest pain Am J Emerg Med 2011;29: 1051-61.
• 12. Van Beek MHCT , Voshaar RCO, Van Deelen FM, Van Balkom A J LM, Pop G, Spekens AEM. The Cardiac Anxiety Questionnaire: Cross-validation among cardiac patients. Int J Psychiatry Med 2012;43: 349-64.
• 13. Israel JI, White KS, Farmer CC, Pardue CM, Gervino EV.Heart-Focused Anxiety in Patients With Noncardiac Chest Pain: Structure and Validity. Assessment 2017;24(1):95-103.
• 14. Beck, AT, Steer R A. (1990). Manual for the Beck Anxiety Inventory. The Psychological Corporation: San Antonio, Tx.
• 15. Friedman KG, Kane DA, Rathod RH, et al. Management of pediatric chest pain using a standardized assessment and management plan. Pediatrics. 2011;128:239-45.
• 16. Sert A, Aypar E, Odabas D, Gokcen C. Clinical characteristics and causes of chest pain in 380 children referred to a paediatric cardiology unit. Cardiol Young. 2013;23:361-7.
• 17. Evangelista JA, Parsons M, Renneburg AK. Chest pain in children: diagnosis through history and physical examination. J Pediatr Health Care 2000;14:3-8.
• 18. McDonnell CJ, White KS, Grady RM. Noncardiac chest pain in children and adolescents: a biopsychosocial conceptualization. Child Psychiatry Hum Dev 2012; 43:1-2.
• 19. Khairandish Z, Jamali L, Haghbin S. Role of anxiety and depression in adolescents with chest pain referred to a cardiology clinic. Cardiol Young. 2017 :125-30.