title: Recurrent use of the Emergency Department in patients with anxiety disorder.
abstract: OBJECTIVE
  Panic disorder is characterized by the spontaneous and unexpected occurrence of panic attacks. During panic attacks, patients (pts) refer to the Emergency Department (ED). The diagnostic work-up for any panic attack is expensive since symptoms at presentation mimic other diseases such acute coronary syndrome or neurological emergencies. The aim of the present study was to describe a 10 years cohort of pts diagnosed with panic disorder in the ED in terms of ED visit recurrence.
  
  
  METHODS
  Case-control study, in a tertiary care, involving pts presenting to the ED and diagnosed with panic attack according to the International Classification of Diseases 9nt Revision (ICD-9). From January 2001 to Dec 2009 were extracted from the electronic clinical database 469 pts and were divided into "recurrent ED visit" (multiple ED access for panic attack) (N=361) and "no recurrent ED visit" (only one ED access for panic attack in 9 years) (N=108).
  
  
  RESULTS
  At univariate analysis cases and controls differed for male prevalence (p < 0.01), neurological symptoms at presentation (p = 0.02) and history of other psychiatry disorder (p < 0.01). In multivariate analysis independent predictors were male gender, age under 40 year old, palpitations at presentations, 1 or more cardiovascular risk factors and previous other psychiatry conditions.
  
  
  CONCLUSIONS
  Male under 40 years old with palpitations or cardiovascular risk and other psychiatric diseases, have a higher recurrence of panic attacks. General psychiatric evaluation and treatment with benzodiazepine in ED is not useful to prevent recurrences. Identifying those patients at high risk of panic attack and ED visit recurrence might be useful to establish ad-hoc interventions, improve patients' morbidity and save precious resources.
authors: Emergency Department, Catholic University of the Sacred Heart, Rome, Italy.
authors: F
authors: F
authors: Buccelletti
authors: V
authors: V
authors: Ojetti
authors: G
authors: G
authors: Merra
authors: A
authors: A
authors: Carroccia
authors: D
authors: D
authors: Marsiliani
authors: F
authors: F
authors: Mangiola
authors: G
authors: G
authors: Calabrò
authors: P
authors: P
authors: Iacomini
authors: G
authors: G
authors: Zuccalà
authors: F
authors: F
authors: Franceschi
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D015897:Comorbidity; D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004637:Emergency Services, Psychiatric / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D016584:Panic Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D011237:Predictive Value of Tests; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D012008:Recurrence; D012307:Risk Factors; D012384:Rome / Q000453:epidemiology; D012737:Sex Factors; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D013997:Time Factors; D055815:Young Adult