Noncardiac Chest Pain in Children and Adolescents

描述(由申请人提供)：每年，数千名儿童和青少年因胸痛而在急诊室接受心脏病专家的评估。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，胸痛症状往往持续存在，并可能导致功能障碍。在成年人中，非心源性胸痛通常与严重但可治疗的精神疾病有关。精神障碍和症状在有其他类型躯体主诉(反复腹痛、头痛)的青少年中也很常见。到目前为止，还没有研究系统地评估患有非心源性胸痛的年轻人的精神诊断和症状。申请者已经对非心源性胸痛的年轻人进行了初步研究，这些研究是从儿科心脏病学环境中招募的。结果表明，精神障碍，特别是焦虑症和症状，在这一人群中很普遍。我们现在建议进行一项对照评估研究，比较(n=100)患有非心源性胸痛的青少年和(n=100)患有良性心脏杂音的青少年。我们将在儿童和青少年去看心脏病专家的一个月内进行评估，并在6个月后再次进行评估。使用结构化的诊断性访谈和一系列评分表，我们将评估精神诊断、精神症状和功能障碍的存在和持久性。我们还将检查心理维度，如生活事件、气质、焦虑敏感度和父母症状，这些可能与儿童和青少年胸痛的发生和维持有关。这项工作的长期目标是增加对患有非心源性胸痛的青少年情绪障碍的认识、理解和治疗。这项第一次评估研究的信息将为今后适应和测试干预措施(例如认知行为疗法)奠定经验基础，这些干预措施可能会缓解患有胸痛的青少年的症状和痛苦。

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.