title: Panic Disorder in Patients Presenting to the Emergency Department With Chest Pain: Prevalence and Presenting Symptoms.
abstract: BACKGROUND
  Patients with panic disorder experience symptoms such as palpitations, chest pain, dizziness, and breathlessness. Consequently, they may attend the Emergency Department (ED) to be assessed for possible emergency medical conditions. Recognition of panic disorder within the ED is low. We sought to establish the prevalence of panic disorder in patients presenting for ED investigation of potential acute coronary syndrome. We also sought to characterise the cohort of patients with panic disorder in terms of presenting symptoms, risk factors, medical history and major adverse cardiac events (MACE).
  
  
  METHODS
  This was an observational study of 338 adult patients presenting to the Emergency Department of a tertiary hospital in Australia. Research nurses collected clinical data using a customised case report form. The outcome was panic disorder, assessed using the Mini International Neuropsychiatric Interview.
  
  
  RESULTS
  The average age of participants was 50.2 years and 37.9% were female. Thirty-day MACE occurred in 7.7% of the cohort. The clinical diagnosis of panic disorder was made in 5.6% (95% CI: 3.4-8.6%) of patients. Compared to patients without panic disorder, patients with panic disorder were slightly more likely to report that their pain felt heavy (48.9% and 73.7% respectively, p=0.04). All other reported symptoms were similar in the two groups.
  
  
  CONCLUSIONS
  The prevalence of panic disorder was low in patients presenting to an Australian ED with chest pain. Clinical signs or symptoms that are routinely collected as part of the chest pain workup cannot be used to distinguish patients with and without panic disorder.
authors.affiliation: Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia; School of Medicine, The University of Queensland, Brisbane, Qld, Australia; School of Public Health and Social Work, Queensland University of Technology, Brisbane, Qld, Australia. Electronic address: jaimi.greenslade@health.qld.gov.au.
authors.forename: Jaimi H
authors.initials: JH
authors.lastname: Greenslade
authors.affiliation: Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia.
authors.forename: Tracey
authors.initials: T
authors.lastname: Hawkins
authors.affiliation: School of Medicine, The University of Queensland, Brisbane, Qld, Australia; School of Public Health and Social Work, Queensland University of Technology, Brisbane, Qld, Australia; Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia.
authors.forename: William
authors.initials: W
authors.lastname: Parsonage
authors.affiliation: Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia; School of Medicine, The University of Queensland, Brisbane, Qld, Australia; School of Public Health and Social Work, Queensland University of Technology, Brisbane, Qld, Australia.
authors.forename: Louise
authors.initials: L
authors.lastname: Cullen
mesh_terms: D002637:Chest Pain / Q000150:complications* / Q000175:diagnosis / Q000523:psychology; D000072226:Computed Tomography Angiography; D017023:Coronary Angiography; D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016584:Panic Disorder / Q000453:epidemiology* / Q000209:etiology / Q000523:psychology; D015995:Prevalence; D011793:Queensland / Q000453:epidemiology; D018570:Risk Assessment; D012307:Risk Factors; D062606:Tertiary Care Centers
keywords: Acute coronary syndrome; Emergency medicine; Panic disorder; Prevalence