Chest pain without coronary artery disease: An exploratory comparison with panic disorder

Recent reports have indicated similarities between patients with persistent chest pain of nonorganic origin and patients with panic disorder. In order to explore this association further, we administered a structured interview and three self-report measures (State-Trait Inventory, Beck Depression Inventory, and SCL90-R) to three subject groups: (1) a sample with persistent chest pain (CP; n=14) who had been screened and found to have normal coronary arteries, (2) a sample of patients with panic disorder (PD; n=14), and (3) a sample of matched normals (n=14). CP patients were considered to be free of coronary artery disease (CAD) following normal cardiac catheterization and/or normal thallium stress tests and were not diagnosed initially with panic disorder. PD patients were diagnosed with a standardized psychiatric interview and were free of organic causes of panic. Using an exploratory data analytic approach, the results indicated that both CP and PD samples reported increased levels of state and trait anxiety (p <.0001), depression (p <.01), and somatization (p <.0001) compared with normals. CP patients differed from PD patients in their less frequent use of anxiolytic medication (p <.01) and lower levels of reported panic anxiety and phobic avoidance (p <.0001). These data suggest that persistent chest pain in the absence of CAD shares some features with panic disorder, yet differs from panic in key ways as well. The results are discussed in light of the role of anxiety in contributing to symptom labeling.This research was supported by Grant 86G-491 from the American Heart Association, Texas Affiliate, to J.G.B. H.T. is the recipient of USPHS Research Career Development Award K04-HL-0122246.     

Assessing the relationship of Type A beliefs to cardiovascular disease risk and psychosocial distress

Investigators have begun to take a multimodal approach to the assessment and treatment of psychosocial risk factors for cardiovascular disease (CVD). For instance, cognitive responses have become the focus of contemporary research along with continued examination of overt Type A behaviors. Price (1982) has outlined a set of beliefs purportedly associated with Type A behavior and subsequent CVD risk. The current study examines the validity of this belief set as represented by a newly developed measure, the Type A Cognitive Questionnaire (TACQ). Subjects were 221 employed adults participating in a worksite CVD risk reduction program. They completed the TACQ as part of a pretreatment CVD risk screening protocol. As hypothesized, TACQ scores were significantly associated with Type A behavior, hostility, physiological mediators of CVD, and psychosocial distress. Discussion addresses continued refinement of the Type A belief construct.     

How and when to correct for juror hindsight bias in mental health malpractice litigation: Some preliminary observations

This article examines the hindsight bias in the context of mental health malpractice litigation, analyzes various legal mechanisms for dealing with the bias, and discusses whether the law should strive for debiasing in all mental health malpractice cases.     

Hugs or shrugs: Parental and peer influence on continuity of involvement in sport by female adolescents

The study was designed to examine the influence of significant others (mothers, fathers, and male and female peers) on continuing involvement in sport by adolescent females. Survey data were collected from 376 girls using a forced-choice, self-administered questionnaire. Maintenance of involvement was measured by the proportion of possible years in which the respondents were involved in physical activity within each of three participation contexts (intramural, interschool, and community sport). Several indicators of significant other influence were used. The degree to which involvement in physical activity is maintained is positively related to the source, amount and type of influence received from significant others, and varied by the participation context. Overall, the socializing influence of significant others was able to account for 11% of the variance in intramural activity, 20% of the variance in interschool sport, and 10% of the variance in community-based activity.This study was funded by a grant from Fitness Canada.     

Frequency analysis of electromyographically measured covert speech behavior

Eleven subjects were asked to silently read slides of the letters “P” and “T,” and to view meaningless control slides similarly as they were presented visually. One-eighth-second electromyographic excerpts were sampled from the baseline and response periods. The data were then transformed into the frequency domain for inferential analyses. The mean power spectral frequencies for the response period were significantly lower than those for the base-line in the overall analysis. There were, however, no significant changes from baseline as a function of kind of stimulus (T, P, or Control) or muscle activated (lips or tongue). It was concluded that there was a generalized responding, not unique to the processing of the specific stimuli studied. Frequency analysis of EMG measures of covert behavior holds some promise of yielding unique information not available through traditional analysis procedures, but more sensitive methods than those used here would be required to demonstrate this.