Mitral valve prolapse and panic disorder: Correlation, causation or coincidence?

Abstract

The literature suggests a high incidence of mitral valve prolapse (MVP) in patients with panic disorder (PD). Whether MVP and PD are identical, overlap or are distinct is controversial. Studies suffer from methodological shortcomings and assume a one-to-one correspondence between organic and psychiatric disorders which may preclude complete accounts of the factors operative in the MVP-PD relationship. This study provides a psychological counterbalance by describing psychiatric, personality and psychological-cognitive factors in MVP, comparison and control groups. MVP outpatient echocardiography subjects were compared to both a matched asymptomatic normal (ASN) and a "rule-out MVP" (R/O MVP) group (with parallel MVP procedures but negative MVP findings). Instruments included the Schedule for Affective Disorders and Schizophrenia-Lifetime Version, Modified for the Study of Anxiety Disorders (SADS-LA and SADS-LA-Revised for DSM III-R), Structured Clinical Interview for DSM III-R Personality Disorders, (SCID II), a medical/cardiac history and evaluation, Anxiety Sensitivity Index (ASI), Body Sensations and Agoraphobic Cognitions Questionnaires (BSQ and ACQ), Subjective Cost and Subjective Probability Questionnaires (SCQ and SPQ), and Interpretation Questionnaire. The R/O MVP group had mildly, but nonsignificantly higher rates of DSM III PD, PD symptom constellations, subthreshold PD symptoms and near panic attacks. Both cardiac groups had comparable rates of DSM III-R PD. Thus, findings failed to support a specific relationship between MVP and PD, but demonstrated a significant relationship between cardiac patienthood, PD and PD symptom spectrum. The MVP and R/O MVP groups had comparable elevated prevalences of simple phobia, separation anxiety disorder, affective disorders, noncardiac symptoms, chest pain and avoidant personality disorder in comparison with controls. However, R/O MVP subjects evidenced high rates of somatization disorder, histrionic, dependent and self-defeating personality disorders, general and cardiac symptoms, anxiety sensitivity, agoraphobic cognitions and body sensations sensitization. In addition R/O MVP subjects interpreted events as significantly more catastrophic, more subjectively costly and more likely to befall them than did MVP and control subjects. This suggested that individuals suspected, but not having MVP, although having similar panic, anxiety and affective disorder rates, have a higher prevalence of personality disorders, somatization and cognitive biases, possibly influencing interpretation of cardiac and psychiatric diagnoses. Conversely, cardiac and panic symptomatology may result from anxiety sensitivity, catastrophic response styles and somatic response generalization. In summary, the study failed to support the relationship between MVP, per se, and PD, but delineated the relative contributions of cardiac patienthood, psychiatric, and psychological factors in accounting for their relationship.