Myocardial bridging as one of the causes of atypical chest pain in young women.

INTRODUCTION: Myocardial bridging is congenital anomaly which usually has benign prognosis but there are also reports suggesting that it can be associated with ischemic clinical syndromes presenting with chest pain. Coronary computed tomography angiography is a well-established method for detecting myocardial bridging. However, clinical significance of this anomaly still remains unclear. METHODS: We studied 977 patients who presented with recurrent typical or atypical chest pain in outpatient clinic. All patients have undergone detailed clinical examination, ECG stress testing and coronary computed tomography angiography. RESULTS: Highest positive prediction for having myocardial bridging was for patients presenting with atypical chest pain with negative ECG stress test and who were younger women. CONCLUSION: Coronary computed tomography angiography may be preferable method for evaluation of chest pain in younger women presenting with atypical chest pain.

Increase of frequency of post-traumatic stress disorder in disabled war veterans during prolonged stay in a rehabilitation hospital.

AIM: To explore possible causative factors in the development of post-traumatic stress disorder (PTSD) in disabled Croatian war veterans. METHOD: The sample comprised 42 disabled Croatian war veterans, aged 19 to 44 years, accommodated in the VaraZdinske Toplice Rehabilitation Hospital for the purpose of long-term physical rehabilitation. Manifestation of PTSD symptoms (Mississippi Scale for Combat-Related Post-Traumatic Stress Disorder) and anxiety levels (Spilberger's State Trait Anxiety Inventory) were tested in 1994 and 1999. RESULTS: Patients with PTSD symptoms had significantly higher anxiety levels then patients without PTSD symptoms. The percentage of patients manifesting PTSD increased from 19% in 1994 to 41% in 1999. Over the same period, the anxiety levels decreased in the patients with PTSD. CONCLUSION: Anxiety and PTSD seem to share common etiologic grounds. Nevertheless, staying in the same homogenous group for a substantial period of time, in combination with inadequate social support and deficient psychological care, may contribute to the development of the PTSD symptomatology.

Countertransference and empathic problems in therapists/helpers working with psychotraumatized persons.

Countertransference in therapists working with patients with posttraumatic stress disorder (PTSD) differs from countertransference in other psychotherapeutical settings. In this article we discuss the specificities of counter- transference in treating PTSD patients and its relation to empathy. The most difficult countertransference problems occur in treating multiply traumatized patients. Countertransference may occur towards an event (e.g., war), patients who have killed people, as well as to colleagues who avoid treating PTSD patients, or towards a supervisor who avoids, either directly or indirectly, supervision of therapists working with PTSD patients. Our recommendation for the prevention of problems in treating PTSD patients include : 1) careful selection of the therapist or helper, both in the personality structure and training; 2) prevention by debriefing and team work and peer supervision; and 3) education - theoretical, practical, and therapeutical.