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Biomedical subjects

B D Beitman

Publications and source records attributed to B D Beitman.

At least 55 records · Page 3Linked to original sources
PubMed1989

Atypical angina in patients with coronary artery disease suggests panic disorder.

The occurrence of psychiatric disorders in patients with "medical" problems is not only possible but may be even facilitated by these problems. This article examines the relationship between the type of chest pain and the diagnosis of panic disorder among coronary artery disease (CAD) patients. Forty-nine such cardiology patients were interviewed using a structured instrument. Forty percent of patients with atypical angina met DSM-III-R criteria for current panic disorder while no panic disorder was identified in the typical angina group. This finding should have great implications for the care of CAD patients. At least many of the atypical angina patients could benefit from standard effective treatment for panic disorder. This would likely improve their functioning and decrease the financial burden on them and the health care system.

Adult↗
PubMed1989

Pharmacotherapeutic treatment of panic disorder in patients presenting with chest pain.

While psychiatric populations with panic disorder have been shown to be responsive to several classes of psychoactive medications, there is little evidence that medical patients with panic disorder respond to similar interventions. In this non-blind, eight-week trial of alprazolam in patients presenting with chest pain and found to have panic disorder, 15 of 20 met the single criterion for improvement: a 50 percent or greater reduction in panic frequency. Several other measures were also significantly positive for those who completed the study. Furthermore, these patients reported a marginally significant drop in episodes of chest pain or discomfort. A double-blind, placebo-controlled trial is now required to test the validity of these findings.

Adult↗
PubMed1988

Chest pain: relationship of psychiatric illness to coronary arteriographic results.

Seventy-four patients with chest pain and no prior history of organic heart disease were interviewed with a structured psychiatric interview immediately after coronary arteriography. The majority of patients with both negative and positive coronary angiographies had undergone previous exercise tolerance tests, but the patients with angiographic coronary artery disease were significantly more likely to have had positive results on a treadmill test. Patients with chest pain and negative coronary arteriograms were significantly younger; more likely to be female; more apt to have a higher number of autonomic symptoms (tachycardia, dyspnea, dizziness, and paresthesias) associated with chest pain, and more likely to describe atypical chest pain. Patients with chest pain and normal coronary arteriographic results also had significantly higher psychologic scores on indices of anxiety and depression and were significantly more likely to meet criteria of the Diagnostic and Statistical Manual of Mental Disorders, third edition, for panic disorder (43 percent versus 6.5 percent), major depression (36 percent versus 4 percent), and two or more phobias (36 percent versus 15 percent) than were patients with chest pain and a coronary arteriography study demonstrating coronary artery stenosis.

Age Factors↗
PubMed1988

Panic disorder, cardiology patients, and atypical chest pain.

Although patients with angiographically normal coronary arteries have low mortality, several studies have indicated that their social and work morbidity is high. Panic disorder appears to be a major contributor to the continuing chest pain in this population. There are also many chest pain patients appearing in cardiology clinics who also do not have heart disease but who are not given the opportunity to be evaluated for psychiatric disorders. Among those presenting with atypical or nonanginal chest pain, panic disorder represents a likely etiologic consideration. The fact that such patients do exist in cardiology populations is further substantiated by an open-label trial of alprazolam which demonstrated a positive effect in patients selected from those with atypical chest pain and no heart disease found to fit panic disorder criteria. These findings strongly support the increasing affiliation between cardiology and psychiatry and reinforce the belief that many problems of the heart may be problems of the mind/brain.

Angina Pectoris↗
PubMed1988

Alprazolam in the treatment of cardiology patients with atypical chest pain and panic disorder.

Ten cardiology chest pain patients without clinical evidence of coronary artery disease and with panic disorder were enrolled in an open label trial of alprazolam. Two dropped out at week 3 because of excessive side effects. The eight study completers showed significant decreases in both Hamilton Anxiety and Hamilton Depression scales by week 2 that remained significant by week 8. On the physician's global impression of change since baseline, all completers were rated at least "much improved." Seven experienced a 50% or greater reduction in panic frequency at week 8 compared to baseline. These results suggest that alprazolam is likely to be of benefit to this patient population.

Adult↗
PubMed1987

Panic disorder: a frequent occurrence in patients with chest pain and normal coronary arteries.

From 10% to 20% of patients undergoing coronary arteriography for chest pain are subsequently found to have normal coronary arteries. We investigated the prevalence of panic disorder in these patients in a two-stage study. Our results indicate that approximately one third of patients with chest pain and angiographically normal coronary arteries have panic disorder. Proper diagnosis and treatment of these patients with panic disorder may be expected to substantially reduce their psychosocial morbidity.

Adult↗
PubMed1987

Atypical or nonanginal chest pain. Panic disorder or coronary artery disease?

Of 195 patients with atypical or nonanginal chest pain presenting in a cardiology clinic, 104 consented to be evaluated for anxiety disorders using a structured psychiatric interview. Thirty patients had histories of coronary artery disease (CAD). Fifty-nine patients in the sample (16 of those with CAD and 43 of those without CAD) fit diagnostic criteria for panic disorder (PD). Those without CAD and with PD were primarily women (mean age, 43 years) with predominantly nonanginal chest pain. Those patients with both CAD and PD were primarily men (mean age, 54 years) with predominantly atypical angina. Since PD has been shown to be readily responsive to pharmacologic intervention, this diagnosis should be considered in patients with atypical or nonanginal chest pain.

Adolescent↗
PubMed1984

Distorted learning from unusual medical anecdotes.

Doctors are encouraged to look upon each patient as a learning experience ( Wyngaarden , 1979). Case-oriented learning begins in the clinical years of medical school and continues throughout the professional career of the doctor. Clinical cases, or anecdotes, have the potential of producing accurate, relevant and meaningful learning for the clinician even though they are uncontrolled in a scientific sense. However, unusual or atypical cases can also result in erroneous learning which can negatively affect patient care. The purpose of this article is to identify difficulties in this form of subjective learning which can lead to suboptimal doctor practice patterns. Six actual clinical cases are briefly described to illustrate how inaccurate learning distorted subsequent clinical problem-solving by doctors. Suggestions are then made for ameliorating this difficulty.

Anecdotes as Topic↗
PubMed1984

The pharmacotherapy-psychotherapy triangle: psychiatrist, nonmedical psychotherapist, and patient.

Members of the Washington State Psychiatric Association (N = 387) were sent a questionnaire asking about their experience with providing adjunctive medicinal treatment to patients in psychotherapy with someone else. Of the 202 respondents, 63% acknowledged such "therapeutic triangles." Younger psychiatrists, psychiatrists working in clinic and/or public settings, and non-psychoanalytic psychiatrists were more likely to participate in such arrangements. It is estimated that between 7200 and 21,000 U.S. psychiatrists participate in such arrangements, with 72,000-210,000 patients seen each month. More extensive study of all aspects of this phenomenon is urged.

Adult↗
PubMed1983

The demographics of American Psychotherapists: a pilot study.

Of the professional groups from which data are available, psychiatrists, psychologists and social workers do approximately 30 percent of the total number of hours of self-defined psychotherapy while primary care physicians report doing 10 percent. These figures are not truly representative of the actual percentage of psychotherapy being performed by these groups, since at least three other professions (ministry, psychiatric nursing and the counseling profession) are also significantly involved in the delivery of such services. The expansion of psychotherapeutic practice has been accompanied by an increasing ambiguity in the definition of psychotherapy, to the point that the definition appears solely dependent upon the judgement of the participants. The Commission on Psychiatric Therapies of the American Psychiatric Association is attempting to clarify psychotherapeutic practice in regard to decision trees applied to specific diagnostic categories. In order to lead the way to its utilization by all psychotherapists, two further problems need attention: (1) the demography of American psychotherapists and (2) a definition of the basic elements of psychotherapy.

Counseling↗