Estimated prevalences of panic disorder and depression among consecutive patients seen in an emergency department with acute chest pain.
OBJECTIVE
1) To determine whether the frequencies of panic disorder (PD) and depression (DEP) in an emergency department (ED) population were comparable to those in other primary care groups; 2) to evaluate whether patients without the clinical diagnosis of acute cardiac ischemia (ACI) had higher frequencies of these disorders; and 3) to identify characteristic clinical findings in patients with PD or DEP.


METHODS
An urban teaching hospital ED.


METHODS
Three hundred thirty-four patients with acute chest pain were evaluated prospectively over an eight-week period. The cohort participating (69%-229/334) completed psychiatric screening measures, including the Panic Disorder Self-Rating Scale, the Beck Depression Inventory, and the Zung Self-Rating Anxiety Scale.


RESULTS
A symptom profile consistent with PD was identified in 17.5% of the patients (40/229), DEP in 23.1% (53/229), and either disorder in 35% (80/229). The prevalences of PD were similar in those with and without ACI (19.4% vs 16.6%, respectively, p > 0.05). The likelihoods of one or more ED visits for chest pain in the previous year were significantly greater in those with PD (57.5% vs 36%, p < 0.05) and DEP (54% vs 35%, p < 0.05) than in those without these psychiatric disorders.


CONCLUSIONS
This study suggests that approximately one in three patients presenting to the ED with acute pain has symptoms consistent with a psychiatric disorder. These disorders occur frequently in both those with and those without acute cardiac ischemia, and clinical variables may help identify these frequent ED utilizers.
Department of Internal Medicine, University of Cincinnati College of Medicine, Ohio 45267.
K W
KW
Yingling
L R
LR
Wulsin
L M
LM
Arnold
G W
GW
Rouan
D000208:Acute Disease; D000328:Adult; D000367:Age Factors; D000704:Analysis of Variance; D002637:Chest Pain / Q000175:diagnosis / Q000209:etiology / Q000523:psychology*; D016009:Chi-Square Distribution; D003863:Depression / Q000175:diagnosis* / Q000453:epidemiology; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000175:diagnosis / Q000523:psychology*; D016584:Panic Disorder / Q000175:diagnosis* / Q000453:epidemiology; D015995:Prevalence; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D015203:Reproducibility of Results; D012737:Sex Factors; D011795:Surveys and Questionnaires