Cardiac sarcoidosis resembling panic disorder: a case report

Abstract

BackgroundSarcoidosis is a systemic disease of unknown etiology, in which granulomas develop in various organs, including the skin, lungs, eyes, or heart. It has been reported that patients with sarcoidosis are more likely to develop panic disorder than members of the general population. However, there are many unknown factors concerning the causal relationship between these conditions.Case presentationWe present the case of a 57-year-old woman who appeared to have panic disorder, as she experienced repeated panic attacks induced by transient complete atrioventricular block, associated with cardiac sarcoidosis. Psychotherapy and pharmacotherapy were not effective in the treatment of her panic attacks. However, when we implanted a permanent pacemaker and initiated steroid treatment for cardiac sarcoidosis, panic attacks were ameliorated. Based on these findings, we diagnosed the patient’s symptoms as an anxiety disorder associated with cardiac sarcoidosis, rather than panic disorder.ConclusionsThis report highlights the importance of considering cardiac sarcoidosis in the differential diagnosis of panic disorder. This cardiac disease should be considered especially in patients have a history of cardiac disease (e.g., arrhythmia) and atypical presentations of panic symptoms. Panic disorder is a psychiatric condition that is typically diagnosed after other medical conditions have been excluded. Because the diagnosis of sarcoidosis is difficult in some patients, caution is required. The palpitations and symptoms of heart failure associated with cardiac sarcoidosis can be misdiagnosed as psychiatric symptoms of panic disorder. The condition described in the current case study appears to constitute a physical disease, the diagnosis of which requires significant consideration and caution.

Is it me? The impact of patient–physician interactions on lupus patients’ psychological well-being, cognition and health-care-seeking behaviour

“…SLE is associated with an increased risk of mental health symptoms [ 35–37 ], with estimates of ≈70% of patients having neuropsychiatric manifestations [ 36 ]. Prevalence of depression in SLE is estimated at 30–50% [ 35 , 37 ], and one study found that ≈20–50% of rheumatological patients have psychosocial problems attributable to their disease, which were frequently not discussed with their physician [ 38 ]. Failure to elicit mental health symptoms is therefore of concern, particularly give that many of our participants also felt their mental health was directly damaged by difficult diagnostic journeys and/or negative medical interactions.…”

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