Two-year follow-up status of emergency department patients with chest pain: Was it panic disorder?

Abstract

Objectives:We previously reported that 25% (108/441) of consecutive patients presenting to the emergency department (ED) of the Montreal Heart Institute with a chief complaint of chest pain suffered from panic disorder (PD). The purpose of the present study was to re-examine these patients (with and without PD) 2 years after their initial ED visit to determine their psychiatric and psychosocial status. Methods: An interviewer, who was kept blind to patients' initial medical and psychiatric diagnoses, attempted to contact all patients who participated in the initial study by phone. Patients who completed the phone interview were sent a battery of psychological questionnaires by mail. Results: A total of 301 (70%) patients completed the phone interview, and 228 (52%) patients completed the self-report questionnaires. Participants and non-participants did not differ with respect to age, gender, initial self-report scores, or initial cardiac or psychiatric diagnoses. At follow-up, significantly (p < 0.05) more PD+ than non-PD (PD-) patients reported: 1) chest pains in the last month (57% vs. 31%); 2) one or more ED consultations in the past year for chest pain (40% vs. 14%); 3) one or more hospitalizations in the past year (31% vs. 11%); and 4) perceiving their general health as "poor" (22% vs. 9%). PD+ patients displayed a significant (p < 0.05) worsening of their panic symptoms, agoraphobic avoidance, depression, and trait anxiety, and reported significantly (p < 0.05) greater suicidal ideation compared to PD-patients (32% vs. 9%). Of all PD+ patients, only 22% (18/82) reported receiving some form of mental health treatment for their symptoms. Conclusions: Unrecognized and untreated PD has a chronic and disabling course. Greater efforts should be made to screen for PD in patients complaining of chest pain in EDs. RÉSUMÉ Objectifs :Dans un article antérieur, nous avons signalé que 25 % (108/441) des patients consécu-tifs reçus à l'urgence de l'Institut de cardiologie de Montréal dont la raison de consultation était une douleur thoracique souffraient d'un trouble panique (TP). La présente étude avait comme objectif de réexaminer ces patients (avec et sans TP) deux ans après leur visite initiale à l'urgence afin de déterminer leur statut psychiatrique et psychosocial. Méthodes : Un enquêteur à qui les diagnostics médicaux et psychiatriques initiaux des patients ne furent pas révélés, tenta de contacter par téléphone tous les patients ayant participé à l'étude initiale. Les patients ayant répondu à l'entrevue téléphonique reçurent une batterie de questionnaires psychologiques par la poste.

Norepinephrine transporter variant A457P knock-in mice display key features of human postural orthostatic tachycardia syndrome

“…In summary, the present results in NET A457P mice support the contention that NET dysfunction can produce the POTS phenotype as well as behavioral comorbidities reported in POTS (Barton et al, 2007; Fleet et al, 2003; McCrank et al, 1998; Musselman et al, 1998; Raj et al, 2009). Coupled with the emerging evidence for a more widespread incidence of NET deficiency in POTS, our studies argue for our model as an important tool for the assessment of NET-derived plasticities in heart and brain that contribute to patient phenotypes and might provide a path to the development of improved therapeutics.…”

“…Patients with anxiety complain of heart palpitations and patients with tachycardia disorders have a higher incidence of anxiety (Fleet et al, 2003; McCrank et al, 1998). Activation of the SNS has been associated with depression and patients with major depression are at an increased risk for heart disease (Musselman et al, 1998).…”

A prospective cohort study to refine and validate thePanic Screening Scorefor identifying panic attacks associated with unexplained chest pain in the emergency department

“…28 29 UCP is also associated with significant psychological distress that can become chronic in the absence of targeted interventions. [30][31][32] In fact, 20-40% of patients present a psychiatric disorder at the time of ED consultation 3 6 33-35 and 15% report suicidal ideation. 3 33 34 36 Unfortunately, fewer than 5% of patients are referred to a mental health professional for psychiatric or psychological treatment.…”

“…59 60 Several evidence-based treatment methods for PLA have proven to be effective in patients with UCP 3861–63 Third, given that PLA tends to worsen over time,32 42 64–67 negatively influencing treatment response, early diagnosis improves prognosis 2542 64 66 68–71 Finally, the criterion of acceptability to patients appears to have been met.…”

Incremental Cost-effectiveness of Pharmacotherapy and Two Brief Cognitive-Behavioral Therapies Compared With Usual Care for Panic Disorder and Noncardiac Chest Pain

“…More than half of individuals who consult for chest pain are diagnosed with noncardiac chest pain (NCCP; Eslick and Talley, 2008;Kontos and Jesse, 2000). Despite receiving this diagnosis and a favorable prognosis, most individuals with NCCP continue to experience chest pain; to fear the development of a heart disease; to seek medical care; and to experience social, occupational, and functional impairment (Dammen et al, 2008;Fleet et al, 2003;Gárcia-Campayo et al, 2010;Leise et al, 2010).…”