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Two-year follow-up status of emergency department patients with chest pain: Was it panic disorder?

Published online by Cambridge University Press:  21 May 2015

Richard P. Fleet ,
Kim L. Lavoie ,
Jean-Pierre Martel ,
Gilles Dupuis ,
André Marchand  and
Bernard D. Beitman
Richard P. Fleet*
Affiliation:
Research Center, Montreal Heart Institute, Montréal, Que. Department of Psychiatry, Sacré-Coeur Hospital, Montréal Department of Psychology, University of Quebec at Montreal, Montréal
Kim L. Lavoie
Affiliation:
Research Center, Montreal Heart Institute, Montréal, Que. Department of Psychiatry, Sacré-Coeur Hospital, Montréal Department of Psychology, Concordia University, Montréal
Jean-Pierre Martel
Affiliation:
Department of Psychology, University of Quebec at Montreal, Montréal
Gilles Dupuis
Affiliation:
Department of Psychology, University of Quebec at Montreal, Montréal
André Marchand
Affiliation:
Department of Psychology, University of Quebec at Montreal, Montréal
Bernard D. Beitman
Affiliation:
Department of Psychiatry and Neurology, University of Missouri–Columbia, Columbia, Missouri
*
Research Center, Montreal Heart Institute, 5000 Belanger St., Montréal QC H1T 1C8; 514 376-3330 x3654; fax 514 376-1355, rfleet@videotron.ca

Abstract

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Objectives:

We previously reported that 25% (108/441) of consecutive patients presenting to the emergency department (ED) of the Montreal Heart Institute with a chief complaint of chest pain suffered from panic disorder (PD). The purpose of the present study was to re-examine these patients (with and without PD) 2 years after their initial ED visit to determine their psychiatric and psychosocial status.

Methods:

An interviewer, who was kept blind to patients’ initial medical and psychiatric diagnoses, attempted to contact all patients who participated in the initial study by phone. Patients who completed the phone interview were sent a battery of psychological questionnaires by mail.

Results:

A total of 301 (70%) patients completed the phone interview, and 228 (52%) patients completed the self-report questionnaires. Participants and non-participants did not differ with respect to age, gender, initial self-report scores, or initial cardiac or psychiatric diagnoses. At follow-up, significantly (p < 0.05) more PD+ than non-PD (PD–) patients reported: 1) chest pains in the last month (57% vs. 31%); 2) one or more ED consultations in the past year for chest pain (40% vs. 14%); 3) one or more hospitalizations in the past year (31% vs. 11%); and 4) perceiving their general health as “poor” (22% vs. 9%). PD+ patients displayed a significant (p < 0.05) worsening of their panic symptoms, agoraphobic avoidance, depression, and trait anxiety, and reported significantly (p < 0.05) greater suicidal ideation compared to PD– patients (32% vs. 9%). Of all PD+ patients, only 22% (18/82) reported receiving some form of mental health treatment for their symptoms.

Conclusions:

Unrecognized and untreated PD has a chronic and disabling course. Greater efforts should be made to screen for PD in patients complaining of chest pain in EDs.

Keywords

panic disorderchest painemergency departmentoutcome
Type
EM Advances • Innovations en MU
Information
Canadian Journal of Emergency Medicine , Volume 5 , Issue 4 , July 2003 , pp. 247 - 254
Copyright
Copyright © Canadian Association of Emergency Physicians 2003

References

1.Karlson, BW, Herlitz, J, Pettersson, P, Ekvall, HE, Hjalmarson, A.Patients admitted to the emergency room with symptoms indicative of acute myocardial infarction. J Intern Med 1991;230:251–8.CrossRefGoogle Scholar
2.Kroenke, K, Mangelsdorff, AD.Common symptoms in ambulatory care: incidence, evaluation, therapy, and outcome. Am J Med 1989;86:262–6.CrossRefGoogle ScholarPubMed
3.Lee, TH, Cook, EF, Weisberg, M, Sargent, RK, Wilson, C, Goldman, L.Acute chest pain in the emergency room: identification and examination of low-risk patients. Arch Intern Med 1985; 145:65–9.Google Scholar
4.Lavey, EB, Winkle, RA.Continuing disability of patients with chest pain and normal coronary arteriograms. J Chronic Dis 1979;32:191–6.Google Scholar
5.Papanicolaou, MN, Califf, RM, Hlatky, MA, McKinnis, RA, Harrell, FE Jr, Mark, DB, et al. Prognostic implications of angiographically normal and insignificantly narrowed coronary arteries. Am J Cardiol 1986;58:1181–7.Google Scholar
6.Wielgosz, AT, Fletcher, RH, McCants, CB, McKinnis, RA, Haney, TL, Williams, RB.Unimproved chest pain in patients with minimal or no coronary disease: a behavioural phenomenon. Am Heart J 1984;108:67–72.Google Scholar
7.Ockene, IS, Shay, MJ, Alpert, JS, Weiner, BH, Dalen, JE.Unexplained chest pain in patients with normal coronary arteriograms: a follow-up study of functional status. N Engl J Med 1980;303:1249–52.CrossRefGoogle ScholarPubMed
8.Tueth, MJ.Managing recurrent nonischemic chest pain in the emergency department. Am J Emerg Med 1997;15:170–2.CrossRefGoogle ScholarPubMed
9.Diagnostic and statistical manual of mental disorders, 3rd ed, rev (DSM-III-R). Washington (DC): American Psychiatric Association; 1987.Google Scholar
10.Fleet, RP, Dupuis, G, Marchand, A, Burelle, D, Arsenault, A, Beitman, BD.Panic disorder in emergency department chest pain patients: prevalence, comorbidity, suicidal ideation, and physician recognition. Am J Med 1996;101:371–80.Google Scholar
11.Beitman, BD, Mukerji, V, Lamberti, JW, Schmid, L, DeRosear, L, Kushner, M, et al. Panic disorder in patients with chest pain and angiographically normal coronary arteries. Am J Cardiol 1989; 63:1399–403.Google Scholar
12.Katon, W, Hall, ML, Russo, J, Cormier, L, Hollifield, M, Vitaliano, PP, et al. Chest pain: relationship of psychiatric illness to coronary arteriographic results. Am J Med 1988;84:1–9.Google Scholar
13.Carter, C, Maddock, R, Zoglio, M, Lutrin, C, Jella, S, Amsterdam, E.Panic disorder and chest pain: a study of cardiac stress scintigraphy patients. Am J Cardiol 1994;74:296–8.Google Scholar
14.Kessler, RC, McGonagle, KA, Zhao, S, Nelson, CB, Hughes, M, Eshleman, S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: results from the National Comorbidity Survey. Arch Gen Psychiatry 1994;51:8–19.CrossRefGoogle ScholarPubMed
15.Beitman, BD, Kushner, MG, Basha, I, Lamberti, J, Mukerji, V, Bartels, K.Follow-up status of patients with angiographically normal coronary arteries and panic disorder. JAMA 1991;265: 1545–9.Google Scholar
16.Roy-Byrne, PP, Stein, MB, Russo, J, Mercier, E, Thomas, R, McQuaid, J, et al. Panic disorder in the primary care setting: comorbidity, disability, service utilization, and treatment. J Clin Psychiatry 1999;60:492–9.CrossRefGoogle ScholarPubMed
17.Reich, J, Warshaw, M, Peterson, LG, White, K, Keller, M, Lavori, P, et al. Comorbidity of panic and major depressive disorder. J Psychiat Res 1993;27 (suppl 1):23–33.CrossRefGoogle ScholarPubMed
18.Brown, TA, Barlow, DH.Comorbidity among anxiety disorders: implications for treatment and DSM-IV. J Consult Clin Psychol 1992;60:835–44.CrossRefGoogle ScholarPubMed
19.Wulsin, LR, Arnold, LM, Hillard, JR.Axis I disorders in ER patients with atypical chest pain. Int J Psychiatry Med 1991;21:37–46.Google Scholar
20.Weissman, MM.The hidden patient: unrecognized panic disorder. J Clin Psychiatry 1990;51 (suppl):5–8.Google ScholarPubMed
21.Diagnostic and statistical manual of mental disorders, 4th ed (DSM-IV). Washington (DC): American Psychiatric Association; 1994.Google Scholar
22.Shear, MK, Maser, JD.Standardized assessment for panic disorder research. A conference report. Arch Gen Psychiatry 1994; 51:346–54.CrossRefGoogle ScholarPubMed
23.Chambless, DL, Caputo, GC, Bright, P, Gallagher, R.Assessment of fear in agoraphobics: the Body Sensations Questionnaire and the Agoraphobic Cognitions Questionnaire. J Consult Clin Psychol 1984;52:1090–7.Google Scholar
24.Chambless, DL, Caputo, GC, Jasin, SE, Gracely, EJ, Williams, C.The Mobility Inventory for Agoraphobia. Behav Res Ther 1985;23:35–44.Google Scholar
25.Spielberger, CD.Manual for the State–Trait Anxiety Inventory (STAI form Y). Palo Alto (CA): Consulting Psychologists Press; 1993.Google Scholar
26.Beck, AT.Depression: clinical, experimental, and theoretical aspects. New York: Harper & Row; 1967.Google Scholar
27.Melzack, R.The short-form McGill Pain Questionnaire. Pain 1987;30:191–7.CrossRefGoogle ScholarPubMed
28.Fleet, RP, Dupuis, G, Marchand, A, Burelle, D, Beitman, BD.Detecting panic disorder in emergency department chest pain patients: a validated model to improve recognition. Ann Behav Med 1997;19:124–31.CrossRefGoogle ScholarPubMed
29.Dammen, T, Ekeberg, O, Arnesen, H, Friis, S.The detection of panic disorder in chest pain patients. Gen Hosp Psychiatry 1999;21:323–32.Google Scholar
30.Schmidt, NB.Panic disorder: cognitive-behavioral and pharmacological treatment strategies. J Clin Psychol Med Settings 1999;6:89–111.Google Scholar
31.Dyckman, JM, Rosenbaum, RL, Hartmeyer, RJ, Walter, LJ.Effects of psychological intervention on panic attack patients in the emergency department. Psychosomatics 1999;40:422–7.CrossRefGoogle ScholarPubMed
32.Zun, LS.Panic disorder: diagnosis and treatment in emergency medicine. Ann Emerg Med 1997;30:92–6.Google Scholar
33.Nutt, DJ.Antidepressants in panic disorder: clinical and preclinical mechanisms. J Clin Psychiatry 1998;59(suppl 8):24–8.Google ScholarPubMed
34.Yeragani, VK, Jampala, VC, Sobelewski, E, Kay, J, Igel, G.Effects of paroxetine on heart period variability in patients with panic disorder: a study of Holter ECG records. Neuropsychobiology 1999;40:124–8.Google Scholar
35.Montgomery, S, Bullock, T, Fineberg, N.Serotonin selectivity for obsessive compulsive and panic disorders. J Psychiatry Neurosci 1991;16 (suppl 1):30–5.Google Scholar
36.Bocola, V, Trecco, MD, Fabbrini, G, Paladini, C, Sollecito, A, Martucci, N.Antipanic effect of fluoxetine measured by CO2 challenge test. Biol Psychiatry 1998;43:612–5.Google Scholar
37.Sheline, YI, Freedland, KE, Carney, RM.How safe are serotonin reuptake inhibitors for depression in patients with coronary heart disease? Am J Med 1997;102:54–9.Google Scholar