Efficacy of 2 interventions for panic disorder in patients presenting to the ED with chest pain.
BACKGROUND
Brief and efficacious interventions for panic disorder (PD) in patients presenting to emergency departments (EDs) for chest pain are essential. This study assessed the effects of 2 interventions for this population: a brief cognitive-behavioral therapy delivered by psychologists, and a 6-month pharmacologic treatment initiated and managed by the ED physician. The relative efficacy of both interventions was also examined.


METHODS
Forty-seven adult patients meeting the diagnostic criteria for PD upon presentation to the ED were assigned to 1 of 3 experimental conditions: a brief cognitive-behavioral therapy (7 sessions), a pharmacologic intervention (paroxetine; 6 months); and a usual care control condition. The primary outcome was severity of PD on Anxiety Disorder Interview Schedule for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and secondary outcomes included measures of PD symptoms, depressive symptoms, and cardiac anxiety. Outcome measures were taken at baseline, postintervention, as well as at 3- and 6-month follow-ups.


RESULTS
Patients receiving either intervention demonstrated significant reductions of PD severity (P = .012), frequency of panic attacks (P = .048), and depressive symptoms (P = .027).


CONCLUSIONS
Taken together, these findings suggest that empirically validated interventions for PD initiated in an ED setting can be feasible and efficacious, and future studies should assess their impact on both the direct (ie, health care utilization) and indirect (ie, lost productivity) costs associated with PD morbidity in this population.
Pelland
Marie-Ève
MÈ
Department of Psychology, Université du Québec à Montréal, Montreal, Quebec, Canada.
Marchand
André
A
Lessard
Marie-Josée
MJ
Belleville
Geneviève
G
Chauny
Jean-Marc
JM
Vadeboncoeur
Alain
A
Poitras
Julien
J
Foldes-Busque
Guillaume
G
Bacon
Simon L
SL
Lavoie
Kim L
KL
D000328:Adult; D002637:Chest Pain / Q000209:etiology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D016584:Panic Disorder / Q000150:complications / Q000188:drug therapy / Q000628:therapy*; D017374:Paroxetine / Q000627:therapeutic use; D011614:Psychotherapy, Brief; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D012720:Severity of Illness Index; D016896:Treatment Outcome
D017374:Paroxetine; D017367:Selective Serotonin Reuptake Inhibitors