Noncardiac Chest Pain in Children and Adolescents

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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.