Clinical study
Panic disorder in emergency department chest pain patients: Prevalence, comorbidity, suicidal ideation, and physician recognition**

https://doi.org/10.1016/S0002-9343(96)00224-0Get rights and content

Abstract

Purpose

To establish the prevalence of panic disorder in emergency department (ED) chest pain patients; compare psychological distress and recent suicidal ideation in panic and non-panic disorder patients; assess psychiatric and cardiac comorbidity; and examine physician recognition of this disorder.

Design

Cross-sectional survey (for psychiatric data). Prospective evaluation of patient discharge diagnoses and physician recognition of panic disorder.

Setting

The ambulatory ED of a major teaching hospital specializing in cardiac care located in Montreal, Canada.

Subjects

Four hundred and forty-one consenting, consecutive patients consulting the ED with a chief complaint of chest pain.

Primary Outcome Measure

Psychiatric diagnoses (AXIS I). Psychological and pain test scores, discharge diagnoses, and cardiac history.

Results

Approximately 25% (108/441) of chest pain patients met DSM-III-R criteria for panic disorder. Panic disorder patients displayed significantly higher panic-agoraphobia, anxiety, depression, and pain scores than non-panic disorder patients (P <0.01). Twenty-five percent of panic disorder patients had thoughts of killing themselves in the week preceding their ED visit compared with 5% of the patients without this disorder (P = 0.0001) even when controlling for co-existing major depression. Fifty-seven percent (62/108) panic disorder patients also met criteria for one or more current AXIS I disorder. Although 44% (47/108) of the panic disorder patients had a prior documented history of coronary artery disease (CAD), 80% had atypical or nonanginal chest pain and 75% were discharged with a “noncardiac pain” diagnosis. Ninety-eight percent of the panic patients were not recognized by attending ED cardiologists.

Conclusions

Panic disorder is a significantly distressful condition highly prevalent in ED chest pain patients that is rarely recognized by physicians. Nonrecognition may lead to mismanagement of a significant group of distressed patients with or without coronary artery disease.

References (58)

  • CarterC et al.

    Panic disorder and chest pain in the coronary care unit

    Psychosomatics

    (1992)
  • CarterC et al.

    Panic disorder and chest pain: a study of cardiac stress scintigraphy patients

    Am J Cardiol

    (1994)
  • ChamblessDL et al.

    The mobility inventory for agoraphobia

    Behav Res Ther

    (1985)
  • MelzackR

    The short-form McGill Pain Questionnaire

    Pain

    (1987)
  • MurabitoJM et al.

    Risk of coronary heart disease in subjects with chest discomfort: the Framingham Heart Study

    Am J Med

    (1990)
  • ShubC

    Stable angina pectoris: 1. Clinical patterns

  • KarlsonBW et al.

    Patients admitted to the emergency room with symptoms indicative of acute myocardial infarction

    J Intern Med

    (1991)
  • LeeTH et al.

    Acute chest pain in the emergency room. Identification and examination of low-risk patients

    Arch Intern Med

    (1985)
  • GoldmanL et al.

    A computer-derived protocol to aid in the diagnosis of emergency room patients with acute chest pain

    N Engl J Med

    (1982)
  • OckeneJS et al.

    Unexplained chest pain in patients with normal coronary arteriograms

    N Engl J Med

    (1980)
  • OslerW
  • DaCostaJM

    On irritable heart: a clinical study of a form of functional cardiac disorder and its consequences

    Am J Med Sci

    (1871)
  • WoodPW

    Da Costa's syndrome (or effort syndrome)

    Br Med J

    (1941)
  • RichterJE et al.

    Unexplained chest pain: differential diagnosis of chest pain with normal cardiac studies

  • KesslerRC 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)
  • KaterndahlDA

    Factors associated with persons with panic attacks seeking medical care

    Fam Med

    (1990)
  • KatonWJ et al.

    Panic disorder: relationship to high medical utilization

    Am J Med

    (1992)
  • NarrowWE et al.

    Use of services by persons with mental and addictive disorders: Findings from the National Institute of Mental Health Epidemiologic Catchment Area Program

    Arch Gen Psychiatry

    (1993)
  • WeissmanMM

    The hidden patient: unrecognized panic disorder

    J Clin Psychiatry

    (1990)
  • Cited by (0)

    **

    Supported by le Fonds de la recherche en santé du Québec et le Conseil québécois de recherche sociale, Grant 930702-104.

    View full text