Background:
Psychiatric disorder is underdiagnosed in
primary care practice, often because it is somatized and
the patient reports only physical symptoms. Palpitations are among the symptoms that often are somatized.
Methods:
We studied prospectively 125 consecutive
medical outpatients referred for ambulatory electrocardiographic monitoring to evaluate a chief complaint of
palpitations. They completed an in-person research interview at the time of monitoring and a telephone follow-up interview 3 months later. The referring physicians completed questionnaires about their patients before
receiving the results of the monitoring and again 3 months
later.
Results:
Forty-three patients had clinically significant
cardiac arrhythmias. Twenty-four (29%) of the remaining 82 patients had a current psychiatric disorder, and
20 of these patients (83%) had major depression or panic
disorder. These patients were significantly younger and
more disabled, somatized more, and had more hypochondriacal concerns about their health than did patients who had no psychiatric disorder. Their palpitations were more likely to last longer than 15 minutes,
were accompanied by more ancillary symptoms, and were
described as more intense. At 3-month follow-up, about
90% of the patients in both groups continued to experience palpitations. Symptoms of somatization, hypochondriacal concerns, and impairment of intermediate activities had improved in both groups, but remained higher
in patients with psychiatric disorder than in patients without psychiatric disorder. During the follow-up interval,
patients with psychiatric disorder had more emergency
department visits. The physicians of patients with psychiatric disorder were more likely to ascribe the palpitations to anxiety or depression, and ordered fewer laboratory tests on them, but few patients who had not already
been in psychiatric treatment were referred or started on
psychotropic medication.
Conclusions:
Physicians are aware of a psychiatric component to the clinical presentation of palpitation, but this
observation does not result in psychiatric treatment or
referral in most cases.(Arch Intern Med. 1996;156:1102-1108)