抄録
Cardiac neurosis (CN) and neurocirculatory asthenia (NCA) are the most widely used diagnostic terms for non-organic cardiac symptoms in Japan. Although general agreement on these terminology has not been established, NCA is used for the patients indicative of autonomic function disorder whereas CN is used for mere neuroses such as anxiety neurosis or hypochondriasis in our clinic. Recently, DSM-III based criteria for anxiety disorder is gradually accepted in Japan and the relationships among these criteria need to be clarified. The present study was made to investigate the differences of our criteria and DSM-III in reference to epidemiology, reactivity to stress or drug infusion, and pharmacological treatment. Epidemiology : Out of 2461 patients who have visited our clinic from 1984 to 1988,105 patiens had non-organic cardiac symptoms. With our criteria, 50 were diagnosed as NCA and 55 as CN, and 59 were diagnosed as panic disorder (PD) and 46 as others (nonPD) according to DSM-III-R. It was turned out that about a halh of NCA belonged to PD and about the remaining half to CN. This result indicated that our criteria and DSM-III-R based criteria had little in common in diagnosing non-organic cardiac patients. Reactivity to stress : Cardiovascular reactivities to a psychological stress test (mirror drawing test : MDT) were examined in 48 patients. When NCA (n=19) and CN (n=29) were compared, NCA showed greater increases in systolic blood pressure, heart rate and plasma norepinephrine, and a greater decrease in CV_R-R than CN. However, no sinificant differences in those variables were obtained between PD (n=28) and nonPD (n=20).Reactivity to drug infusion : Serial intravenous of isoproterenol and atropine were given to 20 patients. NCA (n=9) showed higher heart rate and lower CV_R-R than CN (n=11) during infusions of each drug. Again, no significant differences were observed between PD (n=11) and nonPD (n=9). Pharmacolcgical treatment : Clinical assessment of effective drugs for non-organic cardiac symptoms was made in 87 patients (NCA=40,CN=47 and PD=51,nonPD=36) who have recieved pharmacotherapy in our clinic. A combination of β-blocker and benzodiazepine (BZD) was effective for 58% of NCA and 26% of CN whereas BZD alone was effective for 30% of NCA and 55% of CN. However, BZD alone or combination with β-blocker were almost equally effective for both PD or nonPD. Present results indicated higher sympathetic and lower parasympathetic reactivity in NCA which might have accounted for higher efficacy rate of β-blocker in pharmacotherapy. It was concluded that our criteria is more focused on the physiological basis and is more useful in selecting pharmacological treatment.
