Noncardiac Chest Pain in Children and Adolescents

描述（由申请人提供）：每年，心脏病专家和急诊室都会对数千名儿童和青少年进行胸痛评估。广泛的检测很少发现心脏病的证据，而且大多数病例没有明确的医学病因。然而，胸痛症状通常持续存在，并可能导致功能障碍。在成人中，非心源性胸痛通常与严重但可治疗的精神疾病有关。精神疾病和症状在患有其他类型躯体疾病（反复腹痛、头痛）的青少年中也很常见。迄今为止，还没有研究系统评估患有非心源性胸痛的青少年的精神诊断和症状。申请人对从儿科心脏病学机构招募的患有非心源性胸痛的青少年进行了初步研究。结果表明，精神疾病，尤其是焦虑症和症状，在这一人群中普遍存在。我们现在提出一项对照评估研究，将（n=100）患有非心源性胸痛的青少年与（n=100）患有良性心脏杂音的青少年进行比较。我们将在儿童和青少年就诊后 1 个月内对他们进行评估，并在 6 个月后再次进行评估。使用结构化诊断访谈和一系列评级量表，我们将评估精神病诊断、精神病症状和功能障碍的存在和持续性。我们还将检查心理维度，如生活事件、气质、焦虑敏感性和父母症状，这些可能与儿童和青少年胸痛的发作和持续有关。这项工作的长期目标是提高对非心源性胸痛青少年情绪障碍的认识、理解和治疗。第一项评估研究的信息将为未来调整和测试可能减轻胸痛青少年症状和痛苦的干预措施（例如认知行为疗法）的工作奠定实证基础。

DESCRIPTION (provided by applicant): Every year, thousands of children and adolescents are evaluated by cardiologists and in emergency room settings for complaints of chest pain. Extensive testing rarely detects evidence of cardiac disease and the majority of cases have no clear medical etiology. However, chest pain symptoms often persist and may lead to impairment in functioning. In adults, noncardiac chest pain is often associated with severe but treatable psychiatric disorders. Psychiatric disorders and symptoms are also common in youngsters with other types of somatic complaints (recurrent abdominal pain, headaches). To date no study has systematically assessed psychiatric diagnoses and symptoms in youngsters with noncardiac chest pain. The applicant has conducted preliminary studies of youngsters with noncardiac chest pain, recruited form a pediatric cardiology setting. Results suggest that psychiatric disorders, and especially anxiety disorders and symptoms, are prevalent in this population. We now propose a controlled assessment study, comparing (n=100) youngsters with noncardiac chest pain to (n=100) youngsters with benign heart murmurs. We will evaluate children and adolescents within one month of their visit to the cardiologist and again 6 months later. Using structured diagnostic interviews and a battery of rating scales, we will assess presence and persistence of psychiatric diagnoses, psychiatric symptoms, and functional impairment. We will also examine psychological dimensions such as life events, temperament, anxiety sensitivity, and parental symptoms, which may be associated with the onset and maintenance of chest pain in children and adolescents. The long-term goal of this work is to increase recognition, understanding, and treatment of emotional disorders in youngsters with noncardiac chest pain. Information from this first assessment study will lay an empirical foundation for future work in adapting and testing interventions (e.g., cognitive behavior therapy) that may alleviate symptoms and distress in youngsters with chest pain.