Prevalence of Psychiatric Disorders among Patients Investigated for Occupational Asthma: An Overlooked Differential Diagnosis?
Lavoie KL, et al.
Am J Respir Crit Care Med. 2013 Mar 14.
Up to one third of patients assessed for occupational asthma (OA) do not receive a diagnosis of OA or any other medical disorder. Though several differential diagnoses are considered (e.g., rhinitis, COPD), psychiatric disorders (many with somatic complaints that mimic asthma), are rarely considered or assessed.
OBJECTIVE: To assess the prevalence of psychiatric disorders (mood and anxiety disorders and hypochondriasis), in patients suspected of having OA, and whether psychiatric morbidity increases the risk of not receiving any medical diagnosis.
METHODS: 219 consecutive patients (57% male, mean age 41.8±11.1 years) underwent socio-demographic and medical history interviews on the control or specific inhalation testing day of their OA evaluation. The PRIME-MD was used to assess mood and anxiety disorders, and the Whitley Hypochondriasis Index (WI) was used to assess hypochondriasis.
RESULTS: 26% (n=50) of patients had OA, 25% (n=48) had asthma/work-exacerbated asthma, 14% (n=28) had another inflammatory disorder, 13% (n=26) had a non-inflammatory disorder, and 22% (n=44) did not receive any medical diagnosis. 34% (n=67) of patients had a psychiatric disorder; mood and anxiety disorders affected 29% (n=57) and 24% (n=46) of the sample respectively, and 7% (n=12) had scores on the WI indicating hypochondriasis. Hypochondriasis, but not mood or anxiety disorders, were associated with an increased risk of not receiving any medical diagnosis (adjusted OR=3.92, 95%CI=1.18-13.05, p=.026).
CONCLUSION: Psychiatric morbidity is common in this population, and hypochondriasis may account for a significant proportion of the ‘un-diagnosable’ cases of patients who present for evaluation of OA.
Source: Psychology, University of Quebec at Montreal, Montreal, Canada.
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