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Non-cardiac Chest Pain: A Review for the Consultation-Liaison Psychiatrist

机译：非心胸胸痛：咨询 - 联络精神科医生审查

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Background: Patients presenting with chest pain to general practice or emergency providers represent a unique challenge, as the differential is broad and varies widely in acuity. Importantly, most cases of chest pain in both acute and general practice settings are ultimately found to be non-cardiac in origin, and a substantial proportion of patients experiencing non-cardiac chest pain (NCCP) suffer significant disability. In light of emerging evidence that mental health providers can serve a key role in the care of patients with NCCP, knowledge of the differential diagnosis, psychiatric co-morbidities, and therapeutic techniques for NCCP would be of great use to both consultation liaison (C-L) psychiatrists and other mental health providers. Methods: We reviewed prior published work on (I) the appropriate medical workup of the acute presentation of chest pain, (2) the relevant medical and psychiatric differential diagnosis for chest pain determined to be non-cardiac in origin, (3) the management of related conditions in psychosomatic medicine, and (4) management strategies for patients with NCCP. Results: We identified key differential diagnostic and therapeutic considerations for psychosomatic medicine providers in 3 different clinical contexts: acute care in the emergency department, inpatient C-L psychiatry, and outpatient C-L psychiatry. We also identified several gaps in the literature surrounding the short-term and long-term management of NCCP in patients with psychiatric etiologies or co-morbid psychiatric conditions. Conclusions: Though some approaches to the care of patients with NCCP have been developed, more work is needed to determine the most effective management techniques for this unique and high-morbidity population.
机译：背景：患有胸部疼痛的患者对一般做法或应急供应商代表着独特的挑战，因为差异宽阔，敏锐地差异很大。重要的是，大多数急性和一般练习环境中的胸痛患者最终发现是非心脏的，并且大量比例的患者患有非心胸胸痛（NCCP）患有显着的残疾。鉴于新兴的证据表明，心理健康提供者可以在患有NCCP患者的关键作用中，对NCCP的鉴别诊断，精神病病理和治疗技术的关键作用是对咨询联络（CL）的很大用具精神科医生和其他心理健康提供者。方法：我们审查了先前的公布工作（i）胸痛的急性介绍的适当医疗余量，（2）相关医疗和精神病患者对胸痛的相关性和精神病患者，确定是非心脏的，（3）管理心理学医学中的相关条件，（4）NCCP患者的管理策略。结果：我们在3种不同的临床环境中确定了心身医学提供者的关键差异诊断和治疗考虑：急诊部，住院病，C-L精神病学和门诊C-L精神病学。我们还确定了若干文献中的几个差距，周围患有精神病病因或持续的心理精神病患者的NCCP短期和长期管理。结论：虽然已经开发了一些对NCCP患者的患者进行了一些方法，但需要更多的作品来确定这种独特和高发病率的最有效的管理技术。

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