PSYCHIATRIC-DISORDERS IN MEDICAL OUTPATIENTS COMPLAINING OF PALPITATIONS

Objective: To determine the prevalence of psychiatric disorders in amb ulatory patients undergoing Holter monitoring to evaluate palpitations . Design: Patients referred for 24-hour ambulatory electrocardiographi c (ECG) monitoring were studied with a structured diagnostic interview and self-report questionnaires prior to monitoring. Setting: Holter l aboratory of a large academic medical center. Patients and other parti cipants: One hundred forty-five consecutive patients complaining of pa lpitations and 70 asymptomatic non-patient volunteers. Outcome measure s: 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 de pression was 20.8%. Current prevalence rates showed a similar pattern; the current prevalence of panic disorder was 18.6%. Panic disorder an d somatization disorder symptoms were significantly more prevalent in the palpitation group than in the general medical clinic at the same h ospital. Patients with a psychiatric diagnosis were more likely to rep ort cardiac symptoms during monitoring than were those without psychia tric disorder, and more commonly described their symptoms as ''poundin g'' and reported faintness, lightheadedness, and vertigo. Although car diac histories and ECG results were no more serious, the patients with Psychiatric diagnoses rated their overall health status as significan tly worse. Conclusions: Almost half of palpitation patients referred f or Holter monitoring have a psychiatric disorder. More than a fourth h ave lifetime panic disorder and a fifth have had panic attacks in the month before monitoring.