title: Treatment of panic in chest pain patients from emergency departments: efficacy of different interventions focusing on panic management.
abstract: OBJECTIVE
  The aim was to assess the efficacy of two brief cognitive-behavioral therapy (CBT)-based interventions (7×1-h sessions and 1×2-h session) and a pharmacological treatment (paroxetine), compared to supportive usual care, initiated in the emergency department (ED) for individuals suffering from panic disorder (PD) with a chief complain of noncardiac chest pain (NCCP). We hypothesized that the interventions would be more efficacious than supportive usual care on all outcomes.
  
  
  METHODS
  A 12-month follow-up study of patients who received a diagnosis of NCCP in the ED and who met diagnostic criteria for PD (n=71) was performed. Assessments included several psychological questionnaires and a structured interview. A series of repeated-measures analyses of variances, using a split-plot design, were conducted, as well as planned comparisons to examine the differences.
  
  
  RESULTS
  The seven-session CBT (n=19), one-session panic management (n=24) and pharmacotherapy (n=13) led to greater improvements in PD severity (primary outcome) compared to supportive usual care (n=15) at posttest, and no significant difference was noted between the three active interventions. On the other measures, patients improved in all conditions, and the therapeutic gains were maintained up to 1 year following the visit to the ED.
  
  
  CONCLUSIONS
  These results suggests that early intervention, in particular seven sessions of CBT, one session of PM or pharmacotherapy (generic paroxetine), should be considered for the treatment of PD patients consulting the ED with a discharge diagnosis of NCCP.
authors: Psychology Department, Université du Québec à Montréal, Montreal, Canada. marchand.andre@uqam.ca
authors: André
authors: A
authors: Marchand
authors: Geneviève
authors: G
authors: Belleville
authors: Richard
authors: R
authors: Fleet
authors: Gilles
authors: G
authors: Dupuis
authors: Simon L
authors: SL
authors: Bacon
authors: Julien
authors: J
authors: Poitras
authors: Jean-Marc
authors: JM
authors: Chauny
authors: Alain
authors: A
authors: Vadeboncoeur
authors: Kim L
authors: KL
authors: Lavoie
mesh_terms: D000328:Adult; D002637:Chest Pain / Q000150:complications*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016584:Panic Disorder / Q000150:complications / Q000628:therapy*; D017374:Paroxetine / Q000627:therapeutic use*; D011614:Psychotherapy, Brief / Q000379:methods; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D017374:Paroxetine; D017367:Selective Serotonin Reuptake Inhibitors