Panic disorder in emergency department chest pain patients: prevalence, comorbidity, suicidal ideation, and physician recognition.
OBJECTIVE
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.


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


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


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


METHODS
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.
Fleet
R P
RP
Montreal Heart Institute, Quebec, Canada.
Dupuis
G
G
Marchand
A
A
Burelle
D
D
Arsenault
A
A
Beitman
B D
BD
D002637:Chest Pain / Q000523:psychology*; D003327:Coronary Disease / Q000150:complications / Q000523:psychology; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016584:Panic Disorder / Q000175:diagnosis*; D011446:Prospective Studies; D013405:Suicide / Q000523:psychology*