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Psychiatric disorders in medical outpatients complaining of palpitations

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Abstract

Objective: To determine the prevalence of psychiatric disorders in ambulatory patients undergoing Holter monitoring to evaluate palpitations.

Design: Patients referred for 24-hour ambulatory electrocardiographic (ECG) monitoring were studied with a structured diagnostic interview and self-report questionnaires prior to monitoring.

Setting: Holter laboratory of a large academic medical center.

Patients and other participants: One hundred forty-five consecutive patients complaining of palpitations and 70 asymptomatic non-patient volunteers.

Outcome measures: DSM-III-R psychiatric diagnoses.

Results: Forty-five percent (44.8% ) of the participants had at least one lifetime anxiety or depressive disorder and 24.8% had at least one current (one month) disorder. The lifetime prevalence of panic disorder was 27.6%, and that of major depression was 20.8%. Current prevalence rates showed a similar pattern; the current prevalence of panic disorder was 18.6%. Panic disorder and somatization disorder symptoms were significantly more prevalent in the palpitation group than in the general medical clinic at the same hospital. Patients with a psychiatric diagnosis were more likely to report cardiac symptoms during monitoring than were those without psychiatric disorder, and more commonly described their symptoms as “pounding” and reported faintness, lightheadedness, and vertigo. Although cardiac histories and ECG results were no more serious, the patients with psychiatric diagnoses rated their overall health status as significantly worse.

Conclusions: Almost half of palpitation patients referred for Holter monitoring have a psychiatric disorder. More than a fourth have lifetime panic disorder and a fifth have had panic attacks in the month before monitoring.

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Author information

Authors and Affiliations

  1. the Department of Psychiatry, Harvard Medical School, USA

    Arthur J. Barsky MD

  2. Department of Health Care Policy, Harvard Medical School, USA

    Paul D. Cleary PhD

  3. Department of Medicine, Harvard Medical School, USA

    Jeremy N. Ruskin MD

  4. the Psychiatry Service, Massachusetts General Hospital, Boston, Massachusetts

    Remy R. Coeytaux BA

  5. the Medical Service and Cardiac Unit, Massachusetts General Hospital, Boston, Massachusetts

    Jeremy N. Ruskin MD

  6. Division of Psychiatry, Brigham and Women’s Hospital, 75 Francis Street, 02115, Boston, MA

    Arthur J. Barsky MD

Authors
  1. Arthur J. Barsky MD
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  2. Paul D. Cleary PhD
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  3. Remy R. Coeytaux BA
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  4. Jeremy N. Ruskin MD
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Additional information

Supported by research grant HI.43216 from the National Heart, Lung, and Blood Institute.

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Barsky, A.J., Cleary, P.D., Coeytaux, R.R. et al. Psychiatric disorders in medical outpatients complaining of palpitations. J Gen Intern Med 9, 306–313 (1994). https://doi.org/10.1007/BF02599176

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