Follow-up status of patients with angiographically normal coronary arteries and panic disorder
Article Abstract:
About one third of the 500,000 individuals who undergo diagnostic cardiac catheterization each year have normal coronary arteries (NCA), and a good prognosis for long-term survival. Yet half or more of these people continue to believe they have heart disease. They experience chest pain, continue to use heart medications, and have a lowered capacity to carry out daily activities. The cause is not known, and treatment is difficult. It is suggested that panic disorder, which occurs in almost half of patients with NCA, may cause some of these problems. Research indicates that panic disorder causes long-term disability in psychiatric patients. Other research found that psychiatric problems were common among patients with disability after an angiogram. These patients had more chest pain, sought more frequent medical help, and had more social problems. To test this, psychiatric diagnosis, functional status, and self-perceived illness were studied in 72 patients with NCA who had been interviewed immediately after their angiograms. Over a three- to four-year follow-up, patients with panic disorder reported more chest pain, poorer health, less exercise capacity, poorer social adjustment, more symptoms of anxiety, and more psychological distress than those without panic disorder. Panic disorder can be treated effectively with drugs or cognitive-behavioral therapy, but only one patient in five sought psychiatric treatment, and only one in three was taking benzodiazepines (a tranquilizer), antidepressants, or both. They usually resisted psychiatric explanations for their troubles, and their primary care physicians seldom diagnosed panic disorder. Angina (chest pain) specialists also omit panic disorder from the differential diagnosis. Correct diagnosis and treatment of the 50 percent of patients with panic disorder after angiography would effectively reduce illness, thus lowering health costs. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: JAMA, The Journal of the American Medical Association
Subject: Health
ISSN: 0098-7484
Year: 1991
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Disability and physician-assisted suicide
Article Abstract:
Disabled activists are divided on the issue of physician-assisted suicide. Opponents believe physician-assisted suicide would be another way of discriminating against the disabled and would be a violation of the Americans With Disabilities Act. They appear to distrust physicians and believe physician-assisted suicide would be abused. Those in favor believe the disabled have the right to self-determination, including when and how they will die. They trust physicians and do not believe physician-assisted suicide would be abused.
Publication Name: The New England Journal of Medicine
Subject: Health
ISSN: 0028-4793
Year: 1997
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