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Hamel S, Denis I, Turcotte S, Fleet R, Archambault P, Dionne CE, Foldes-Busque G. Anxiety disorders in patients with noncardiac chest pain: association with health-related quality of life and chest pain severity. Health Qual Life Outcomes 2022; 20:7. [PMID: 35012545 PMCID: PMC8751105 DOI: 10.1186/s12955-021-01912-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 12/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with noncardiac chest pain (NCCP) report more severe symptoms and lowered health-related quality of life when they present with comorbid panic disorder (PD). Although generalized anxiety disorder (GAD) is the second most common psychiatric disorder in these patients, its impact on NCCP and health-related quality of life remains understudied. This study describes and prospectively compares patients with NCCP with or without PD or GAD in terms of (1) NCCP severity; and (2) the physical and mental components of health-related quality of life. METHODS A total of 915 patients with NCCP were consecutively recruited in two emergency departments. The presence of comorbid PD or GAD was assessed at baseline with the Anxiety Disorder Schedule for DSM-IV. NCCP severity at baseline and at the six-month follow-up was assessed with a structured telephone interview, and the patients completed the 12-item Short-Form Health Survey Version 2 (SF-12v2) to assess health-related quality of life at both time points. RESULTS Average NCCP severity decreased between baseline and the six-month follow-up (p < .001) and was higher in the patients with comorbid PD or GAD (p < .001) at both time points compared to those with NCCP only. However, average NCCP severity did not differ between patients with PD and those with GAD (p = 0.901). The physical component of quality of life improved over time (p = 0.016) and was significantly lower in the subset of patients with PD with or without comorbid GAD compared to the other groups (p < .001). A significant time x group interaction was found for the mental component of quality of life (p = 0.0499). GAD with or without comorbid PD was associated with a lower mental quality of life, and this effect increased at the six-month follow-up. CONCLUSIONS Comorbid PD or GAD are prospectively associated with increased chest pain severity and lowered health-related quality of life in patients with NCCP. PD appears to be mainly associated with the physical component of quality of life, while GAD has a greater association with the mental component. Knowledge of these differences could help in the management of patients with NCCP and these comorbidities.
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Affiliation(s)
- Stéphanie Hamel
- School of Psychology, Université Laval, Pavillon Félix-Antoine-Savard, 2325 rue des Bibliothèques, Quebec, QC G1V 0A6 Canada
- Research Centre of the Centre Hospitalier Affilié Universitaire de Lévis of the Centre Intégré de Santé Et de Services Sociaux de Chaudière-Appalaches, 143 Rue Wolfe, Lévis, QC G6V 3Z1 Canada
| | - Isabelle Denis
- School of Psychology, Université Laval, Pavillon Félix-Antoine-Savard, 2325 rue des Bibliothèques, Quebec, QC G1V 0A6 Canada
- Research Centre of the Centre Hospitalier Affilié Universitaire de Lévis of the Centre Intégré de Santé Et de Services Sociaux de Chaudière-Appalaches, 143 Rue Wolfe, Lévis, QC G6V 3Z1 Canada
- Centre de Recherche Universitaire Sur Les Jeunes Et Les Familles (CRUJeF), 2915 avenue du Bourg-Royal, Quebec, QC G1C 3S2 Canada
| | - Stéphane Turcotte
- Research Centre of the Centre Hospitalier Affilié Universitaire de Lévis of the Centre Intégré de Santé Et de Services Sociaux de Chaudière-Appalaches, 143 Rue Wolfe, Lévis, QC G6V 3Z1 Canada
| | - Richard Fleet
- Research Centre of the Centre Hospitalier Affilié Universitaire de Lévis of the Centre Intégré de Santé Et de Services Sociaux de Chaudière-Appalaches, 143 Rue Wolfe, Lévis, QC G6V 3Z1 Canada
- Department of Family and Emergency Medicine, Université Laval, Pavillon Ferdinand-Vandry, 1050 Avenue de la Médecine, Quebec, QC G1V 0A6 Canada
| | - Patrick Archambault
- Research Centre of the Centre Hospitalier Affilié Universitaire de Lévis of the Centre Intégré de Santé Et de Services Sociaux de Chaudière-Appalaches, 143 Rue Wolfe, Lévis, QC G6V 3Z1 Canada
- Department of Family and Emergency Medicine, Université Laval, Pavillon Ferdinand-Vandry, 1050 Avenue de la Médecine, Quebec, QC G1V 0A6 Canada
| | - Clermont E. Dionne
- CHU de Quebec Research Centre, Saint-Sacrement Hospital, 1050, Chemin Sainte-Foy, Quebec, QC G1S 4L8 Canada
| | - Guillaume Foldes-Busque
- School of Psychology, Université Laval, Pavillon Félix-Antoine-Savard, 2325 rue des Bibliothèques, Quebec, QC G1V 0A6 Canada
- Research Centre of the Centre Hospitalier Affilié Universitaire de Lévis of the Centre Intégré de Santé Et de Services Sociaux de Chaudière-Appalaches, 143 Rue Wolfe, Lévis, QC G6V 3Z1 Canada
- Quebec Heart and Lung Institute Research Centre, 2725 chemin Sainte-Foy, Quebec, QC G1V 4G5 Canada
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Fathima FN, Kahn JG, Krishnamachari S, Ekstrand M. Productivity losses among individuals with common mental illness and comorbid cardiovascular disease in rural Karnataka, India. INTERNATIONAL JOURNAL OF NONCOMMUNICABLE DISEASES 2019; 4:86-92. [PMID: 32411923 PMCID: PMC7221215 DOI: 10.4103/jncd.jncd_17_19] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Context Common mental disorders (CMD) and cardiovascular diseases (CVDs) frequently co-occur. Productivity losses due to these diseases are substantial in high-income countries. Similar data from the developing world are lacking. Aims This study aims to quantify productivity losses among individuals with comorbid CMD and CVD in rural Karnataka, India. Settings and Design A cross-sectional study was done among patients with a dual diagnosis of a comorbid CMD and CVD in a district in Karnataka, India. Subjects and Methods Three hundred and three patients were administered the iMTA Productivity Cost Questionnaire to measure losses of productivity at paid work (absenteeism and presenteeism) and unpaid work. Statistical Analysis Used Valuation of productivity losses was done by multiplying the number of days of lost productivity by the standard value of productivity based on the minimum wage for agricultural work. Results Among individuals with dual CMD and CVD, 76% had productivity losses. These losses were higher at unpaid (62%) than at paid work (32%). At paid work, losses due to presenteeism were greater than those due to absenteeism. The total days of productivity loss were 1204, amounting to 14.2% of the available person-days. The total productivity loss among 303 individuals with mental illness and comorbid CVD over a 4-week period amounted to 30.3 INR (0.47 USD) per person per day, representing 9.9% of total potential productivity. Conclusions Productivity losses due to common mental illnesses and CVDs are high. There is a need to conduct more studies in this field.
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Affiliation(s)
- Farah Naaz Fathima
- Department of Community Health, St. John's Medical College, Bengaluru, Karnataka, India
| | - James G Kahn
- Department of Epidemiology and Biostatistics, Global Health Sciences, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California, USA
| | | | - Maria Ekstrand
- Department of Medicine, University of California, San Francisco, California, USA
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Heppell JL, Denis I, Turcotte S, Fleet RP, Dionne CE, Foldes-Busque G. Incidence of panic disorder in patients with non-cardiac chest pain and panic attacks. J Health Psychol 2019; 26:985-994. [DOI: 10.1177/1359105319859062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study documented the 6-month incidence of panic disorder and its predictors in emergency department patients with panic attacks and non-cardiac chest pain. The assessment included a validated structured interview to identify panic attacks and questionnaires measuring the potential predictors of panic disorder. Presence of panic disorder was assessed 6 months later. The incidence of panic disorder was 10.1 percent ( n = 14/138). Anxiety sensitivity was the only significant predictor of the incidence of panic disorder (odds ratio = 1.06; 95% confidence interval = 1.01–1.12). Patients with panic attacks and non-cardiac chest pain are at an elevated risk for panic disorder. This vulnerability appears to increase with anxiety sensitivity.
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Affiliation(s)
- Jenny-Lee Heppell
- Université Laval, Canada
- Research Centre of the Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Canada
| | - Isabelle Denis
- Université Laval, Canada
- Research Centre of the Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Canada
| | - Stéphane Turcotte
- Research Centre of the Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Canada
| | - Richard P Fleet
- Université Laval, Canada
- Research Centre of the Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Canada
| | - Clermont E Dionne
- Université Laval, Canada
- Research Centre of the Québec University Hospital, Canada
| | - Guillaume Foldes-Busque
- Université Laval, Canada
- Research Centre of the Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Canada
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Srinivasan K, Mazur A, Mony PK, Whooley M, Ekstrand ML. Improving mental health through integration with primary care in rural Karnataka: study protocol of a cluster randomized control trial. BMC FAMILY PRACTICE 2018; 19:158. [PMID: 30205830 PMCID: PMC6134696 DOI: 10.1186/s12875-018-0845-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 08/31/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND People who are diagnosed with both mental and chronic medical illness present unique challenges for the health care system. In resource-limited settings, such as rural India, people with depression and anxiety are often under-served, due to both stigma and lack of trained providers and resources. These challenges can lead to complications in the management of chronic disease as well as increased suffering for patients, families and communities. In this study, we evaluate the effects of integrating mental health and chronic disease treatment of patients in primary health care (PHC) settings using a collaborative care model to improve the screening, diagnosis and treatment of depression in rural India. METHODS This study is a multi-level randomized controlled trial among patients with depression or anxiety and co-morbid diabetes, or cardiovascular disease. Aim 1 examines whether patients screened at community health-fairs are more likely to be diagnosed and treated for these co-morbid conditions than patients screened after presenting at PHCs. Aim 2 evaluates the impact of collaborative care compared to usual care in a cluster RCT, randomizing at the level of the PHCs. Intervention arm PHC staff are trained in mental health diagnoses, treatment, and the collaborative care model. The intervention also involves community-based "Healthy Living groups" co-led by Ashas, using cognitive-behavioral strategies to promote healthy behaviors. The primary outcome is severity of common mental disorders, with secondary outcomes being diabetes and cardiovascular risk, staff knowledge and patient perceptions. DISCUSSION If effective, our results will contribute to the field in five ways: 1) expand on implementation research in low resource settings by examining how multiple chronic diseases can be treated using integrated low-cost, evidence-based strategies, 2) build the capacity of PHC staff to diagnose and treat mental illness within their existing clinic structure and strengthen referral linkages; 3) link community members to primary care through community-based health fairs and healthy living groups; 4) increase mental health awareness in the community and reduce mental health stigma; 5) demonstrate the potential for intervention scale-up and sustainability. TRIAL REGISTRATION http://Clinicaltrials.gov : NCT02310932 registered December 8, 2014 URL: https://clinicaltrials.gov/ct2/show/record/NCT02310932 ; Clinical Trials Registry India: CTRI/2018/04/013001 retrospectively registered on April 4, 2018.
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Affiliation(s)
- Krishnamachari Srinivasan
- Division of Mental Health and Neurosciences, St. John’s Research Institute, St. John’s National Academy of Health Sciences, Bangalore, Karnataka India
- Department of Psychiatry, St John’s Medical College Hospital, Bangalore, Karnataka India
| | - Amanda Mazur
- Division of Prevention Sciences, University of California, San Francisco, USA
| | - Prem K. Mony
- Division of Epidemiology and Community Health, St. John’s Medical College and Research Institute, St. John’s National Academy of Health Sciences, Bangalore, India
| | - Mary Whooley
- Division of Cardiology, University of California, San Francisco, USA
- San Francisco Veterans Affairs Medical Center, San Francisco, CA USA
| | - Maria L. Ekstrand
- Division of Mental Health and Neurosciences, St. John’s Research Institute, St. John’s National Academy of Health Sciences, Bangalore, Karnataka India
- Division of Prevention Sciences, University of California, San Francisco, USA
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Prospective Impact of Psychiatric Disorders on Employment Status and Health Care Use in Patients Investigated for Occupational Asthma. J Occup Environ Med 2018; 58:1196-1201. [PMID: 27930478 DOI: 10.1097/jom.0000000000000886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We previously reported high rates (34%) of psychiatric disorders (PSY) in patients evaluated for occupational asthma (OA). We determined the impact of PSY on employment status and health care use 12 to 18 months later. METHODS One hundred ninety-six patients underwent clinical and psychiatric interviews on the day of their OA evaluation. Patients were re-contacted 12to 18 months later to assess employment status and health care use. RESULTS Results indicated that patients with a PSY at baseline were less likely to be employed (adjusted odds ratio = 2.88; 95% confidence interval = 1.29 to 6.44) irrespective of final medical diagnosis (including OA), and had higher rates of emergency visits (35% vs 19%, P = 0.04). CONCLUSION Psychiatric morbidity is common in this population and associated with lower employment rates and greater use of emergency services. Greater efforts should be made to assess and treat PSY in this population.
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Greenslade JH, Hawkins T, Parsonage W, Cullen L. Panic Disorder in Patients Presenting to the Emergency Department With Chest Pain: Prevalence and Presenting Symptoms. Heart Lung Circ 2017; 26:1310-1316. [DOI: 10.1016/j.hlc.2017.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 12/09/2016] [Accepted: 01/04/2017] [Indexed: 10/20/2022]
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Foldes-Busque G, Denis I, Poitras J, Fleet RP, Archambault P, Dionne CE. A closer look at the relationships between panic attacks, emergency department visits and non-cardiac chest pain. J Health Psychol 2017; 24:717-725. [DOI: 10.1177/1359105316683785] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study examined the prevalence of emergency department visits prompted by panic attacks in patients with non-cardiac chest pain. A validated structured telephone interview was used to assess panic attacks and their association with the emergency department consultation in 1327 emergency department patients with non-cardiac chest pain. Patients reported at least one panic attack in the past 6 months in 34.5 per cent (95% confidence interval: 32.0%–37.1%) of cases, and 77.1 per cent (95% confidence interval: 73.0%–80.7%) of patients who reported panic attacks had visited the emergency department with non-cardiac chest pain following a panic attack. These results indicate that panic attacks may explain a significant proportion of emergency department visits for non-cardiac chest pain.
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Affiliation(s)
- Guillaume Foldes-Busque
- Université Laval, Canada
- Research Centre of the University Affiliated Hospital Hôtel-Dieu de Lévis, Canada
| | - Isabelle Denis
- Université Laval, Canada
- Research Centre of the University Affiliated Hospital Hôtel-Dieu de Lévis, Canada
| | - Julien Poitras
- Université Laval, Canada
- Research Centre of the University Affiliated Hospital Hôtel-Dieu de Lévis, Canada
| | - Richard P Fleet
- Université Laval, Canada
- Research Centre of the University Affiliated Hospital Hôtel-Dieu de Lévis, Canada
| | - Patrick Archambault
- Université Laval, Canada
- Research Centre of the University Affiliated Hospital Hôtel-Dieu de Lévis, Canada
| | - Clermont E Dionne
- Université Laval, Canada
- Research Centre of the Québec University Hospital (CHU), Canada
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Al Aseri ZA, Suriya MO, Hassan HA, Hasan M, Sheikh SA, Al Tamimi A, Alshathri M, Khalid N. Reliability and validity of the Hospital Anxiety and Depression Scale in an emergency department in Saudi Arabia: a cross-sectional observational study. BMC Emerg Med 2015; 15:28. [PMID: 26459412 PMCID: PMC4603646 DOI: 10.1186/s12873-015-0051-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 09/21/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Depression and anxiety are prevalent psychiatric comorbidities that are known to have a negative impact on a patient's general prognosis. But screening for these potential comorbidities in a hospital's accident and emergency department has seldom been undertaken, particularly in Saudi Arabia and elsewhere in the Middle East. The Hospital Anxiety and Depression Scale (HADS) has been extensively used to evaluate these psychiatric comorbidities in various clinical settings at all levels of health care services except for the accident and emergency department. This study therefore aimed to assess the reliability and validity of the HADS for anxiety and depression among patients at a hospital accident and emergency department in Saudi Arabia. METHODS This cross-sectional observational study was conducted from January to December 2012. The participants were 257 adult patients (aged 16 years and above) who presented at the accident and emergency department of King Khalid University Hospital, Riyadh, Saudi Arabia, who met our inclusion criteria. We used an Arabic translation of the HADS. We employed factor analysis to determine the underlying factor structure of that instrument in assessing reliability and validity. RESULTS We found the Arabic version of the HADS to be acceptable for 95% of the subjects. We used Cronbach's alpha coefficient to evaluate reliability, and it indicated a significant correlation with both the anxiety (0.73) and depression (0.77) subscales of the HADS, thereby supporting the validity of the instrument. By means of factor analysis, we obtained a two-factor solution according to the two HADS subscales (anxiety and depression), and we observed a statistically significant correlation (r = 0.57; p < 0.0001) between the two subscales. CONCLUSION The HADS can be used effectively in an accident and emergency department as an initial screening instrument for anxiety and depression. It thus has great potential as part of integrated multidisciplinary care.
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Affiliation(s)
- Zohair A Al Aseri
- Department of Emergency Medicine (65), College of Medicine, King Khalid University Hospital KSU, PO Box No: 7805, Riyadh, 11472, Kingdom of Saudi Arabia.
| | - M Owais Suriya
- Fellow Community Health, College of Medicine, University of Saskatchewan, 107, Wiggins Road, S7N 5E5, Saskatoon, Canada.
| | - Hosam A Hassan
- Department of Emergency Medicine (65), College of Medicine, King Khalid University Hospital KSU, PO Box No: 7805, Riyadh, 11472, Kingdom of Saudi Arabia.
| | - Mujtaba Hasan
- Department of Emergency Medicine (65), College of Medicine, King Khalid University Hospital KSU, PO Box No: 7805, Riyadh, 11472, Kingdom of Saudi Arabia.
| | - Shaffi Ahmed Sheikh
- Department of Family and Community Medicine, College of Medicine King Khalid University Hospital KSU, PO Box 230155, Riyadh, 11321, Kingdom of Saudi Arabia.
| | - Adel Al Tamimi
- Department of Emergency Medicine (65), College of Medicine, King Khalid University Hospital KSU, PO Box No: 7805, Riyadh, 11472, Kingdom of Saudi Arabia.
| | - Mashhoor Alshathri
- Department of Emergency Medicine (65), College of Medicine, King Khalid University Hospital KSU, PO Box No: 7805, Riyadh, 11472, Kingdom of Saudi Arabia.
| | - Najeeb Khalid
- Cardiff and Vale University Health Board, Cardiff, UK.
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Nonfearful Panic Attacks in Patients With Noncardiac Chest Pain. PSYCHOSOMATICS 2015; 56:513-20. [DOI: 10.1016/j.psym.2014.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 07/21/2014] [Accepted: 07/21/2014] [Indexed: 11/24/2022]
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Schwarz J, Prashad A, Winchester DE. Prevalence and implications of severe anxiety in a prospective cohort of acute chest pain patients. Crit Pathw Cardiol 2015; 14:44-7. [PMID: 25679088 PMCID: PMC4331450 DOI: 10.1097/hpc.0000000000000038] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
Anxiety is a common condition which can manifest with symptoms of chest discomfort. Chest discomfort is one of the most common reasons to seek emergency medical care. We hypothesize that anxiety is highly prevalent, poorly diagnosed, and poorly treated in an acute care environment. We analyzed data from a prospective registry of chest pain patients with low to intermediate likelihood of acute coronary syndrome and coronary artery disease. Scores from the General Anxiety Disorder-7 questionnaire determined the prevalence of anxiety. Differences in presentation, evaluation, and 30-day outcomes were compared for subjects with and without severe anxiety. Of the 151 included subjects, severe anxiety was observed in 15%, moderate 14%, mild 30%, and 41% had no anxiety symptoms. Subjects with severe anxiety had similar baseline characteristics, cardiac risk factors, and symptoms to those without severe anxiety, except for the current use of tobacco (50.0% vs. 18.6%; P = 0.001). Anxiety was self-reported by 54.5% of subjects with severe anxiety and 27.3% were on antianxiety medications. Hospital admission (P = 0.888) and repeated emergency department visits within 30 days (P = 0.554) were not different between the 2 groups. Anxiety is common among patients seeking emergency evaluation of chest pain. Half of patients with severe anxiety were diagnosed and roughly one quarter were medically treated. Cardiac risk factors and symptoms are not different for patients with severe anxiety; these patients warrant a similar evaluation for heart disease as those patients without anxiety.
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Affiliation(s)
- Julio Schwarz
- From the * Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL; and † University of Florida, Gainesville, FL
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Foldes-Busque G, Denis I, Poitras J, Fleet RP, Archambault P, Dionne CE. A prospective cohort study to refine and validate the Panic Screening Score for identifying panic attacks associated with unexplained chest pain in the emergency department. BMJ Open 2013; 3:e003877. [PMID: 24163208 PMCID: PMC3808760 DOI: 10.1136/bmjopen-2013-003877] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Panic-like anxiety (panic attacks with or without panic disorder), a highly treatable condition, is the most prevalent condition associated with unexplained chest pain in the emergency department. Panic-like anxiety may be responsible for a significant portion of the negative consequences of unexplained chest pain, such as functional limitations and chronicity. However, more than 92% of panic-like anxiety cases remain undiagnosed at the time of discharge from the emergency department. The 4-item Panic Screening Score (PSS) questionnaire was derived in order to increase the identification of panic-like anxiety in emergency department patients with unexplained chest pain. METHODS AND ANALYSIS The goals of this prospective cohort study were to (1) refine the PSS; (2) validate the revised version of the PSS; (3) measure the reliability of the revised version of the PSS and (4) assess the acceptability of the instrument among emergency physicians. Eligible and consenting patients will be administered the PSS in a large emergency department. Patients will be contacted by phone for administration of the criterion standard for panic attacks as well as by a standardised interview to collect information for other predictors of panic attacks. Multivariate analysis will be used to refine the PSS. The new version will be prospectively validated in an independent sample and inter-rater agreement will be assessed in 10% of cases. The screening instrument acceptability will be assessed with the Ottawa Acceptability of Decision Rules Instrument. ETHICS AND DISSEMINATION This study protocol has been reviewed and approved by the Alphonse-Desjardins research ethics committee. The results of the study will be presented in scientific conferences and published in peer-reviewed scientific journals. Further dissemination via workshops and a dedicated website is planned.
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Affiliation(s)
- Guillaume Foldes-Busque
- École de psychologie, Faculté des sciences sociales, Université Laval, Québec, Québec, Canada
- Centre de santé et de services sociaux Alphonse-Desjardins, Research Centre of the University-Affiliated Hospital of Lévis, Québec, Québec, Canada
| | - Isabelle Denis
- Centre de santé et de services sociaux Alphonse-Desjardins, Research Centre of the University-Affiliated Hospital of Lévis, Québec, Québec, Canada
| | - Julien Poitras
- Centre de santé et de services sociaux Alphonse-Desjardins, Research Centre of the University-Affiliated Hospital of Lévis, Québec, Québec, Canada
- Department of Family and Emergency Medicine, Faculté de médecine, Université Laval, Québec, Québec, Canada
| | - Richard P Fleet
- Centre de santé et de services sociaux Alphonse-Desjardins, Research Centre of the University-Affiliated Hospital of Lévis, Québec, Québec, Canada
- Department of Family and Emergency Medicine, Faculté de médecine, Université Laval, Québec, Québec, Canada
| | - Patrick Archambault
- Centre de santé et de services sociaux Alphonse-Desjardins, Research Centre of the University-Affiliated Hospital of Lévis, Québec, Québec, Canada
- Department of Family and Emergency Medicine, Faculté de médecine, Université Laval, Québec, Québec, Canada
| | - Clermont E Dionne
- Centre de recherche FRQS du Centre hospitalier universitaire (CHU) de Québec, Hôpital du St-Sacrement, Québec, Québec, Canada
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van Beek MHCT, Oude Voshaar RC, Beek AM, van Zijderveld GA, Visser S, Speckens AEM, Batelaan N, van Balkom AJLM. A brief cognitive-behavioral intervention for treating depression and panic disorder in patients with noncardiac chest pain: a 24-week randomized controlled trial. Depress Anxiety 2013; 30:670-8. [PMID: 23625592 DOI: 10.1002/da.22106] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Revised: 03/01/2013] [Accepted: 03/05/2013] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Most patients with noncardiac chest pain experience anxiety and depressive symptoms. Commonly they are reassured and referred back to primary care, leaving them undiagnosed and untreated. Some small studies have suggested efficacy of 12 cognitive behavioral therapy (CBT) sessions. Our aim was to examine efficacy of brief CBT in reducing anxiety and depressive symptoms in patients with noncardiac chest pain and comorbid panic and/or depressive disorders. METHODS In this 24-week randomized controlled trial comparing CBT (n = 60) versus treatment as usual (TAU, n = 53), we included all adults who presented at the cardiac emergency unit of a university hospital with noncardiac chest pain, scored ≥8 on the hospital anxiety and depression scale (HADS) and were diagnosed with a comorbid panic and/or depressive disorder with the Mini International Neuropsychiatric Interview. CBT consisted of six individual sessions. Main outcome was disease severity assessed with the clinical global inventory (CGI) by a blinded independent rater. RESULTS ANCOVA in the intention-to-treat and completer sample showed that CBT was superior to TAU after 24 weeks in reducing disease severity assessed with CGI (P < .001). Secondary outcomes on anxiety (HADS-anxiety, state trait anxiety inventory (STAI)-trait) and depressive symptoms (Hamilton depression rating scale) were in line with these results except for HADS-depression (P = .10), fear questionnaire (P = .13), and STAI-state (P = .11). CONCLUSIONS Brief CBT significantly reduces anxiety and depressive symptoms in patients with noncardiac chest pain who are diagnosed with panic and/or depressive disorders. Patients presenting with noncardiac chest pain should be screened for psychopathology and if positive, CBT should be considered.
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Affiliation(s)
- M H C T van Beek
- Department of Psychiatry, Radboud University Nijmegen Medical Center, 6500 HB Nijmegen, The Netherlands.
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Suicidality and panic in emergency department patients with unexplained chest pain. Gen Hosp Psychiatry 2012; 34:178-84. [PMID: 22285369 DOI: 10.1016/j.genhosppsych.2011.12.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Revised: 11/15/2011] [Accepted: 12/02/2011] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The present study aims to document the problem of suicidality in emergency department (ED) patients with unexplained chest pain and to assess the strength and independence of the relationship between panic and suicidal ideation (SI) in this population. METHOD This cross-sectional study included 572 ED patients with unexplained chest pain. SI, history of suicide attempts, history of SI and the presence of thoughts about how to commit suicide were assessed. Logistic regression analyses were used to quantify the relationship between current SI and panic. RESULTS Approximately 15% [95% confidence interval (CI), 12%-18%] of patients reported current SI, and 33% (95% CI, 29%-37%) reported history of SI. Nearly 19% (95% CI, 16%-22%) of patients had thought about a method to commit suicide, and 33% (95% CI, 29%-37%) had a history of a suicide attempt. Panic attacks were diagnosed in 42% (95% CI, 38%-46%) of patients, and 45% (95% CI, 39%-51%) of those had panic disorder. Panic increased the crude likelihood of current SI [odds ratio (OR)=2.53, 1.4-4.5]. This increase in SI risk remained significant after controlling for confounding factors (OR=1.70, 95% CI, 1.0-2.9). CONCLUSIONS Suicidality and SI were common and often severe in our sample of ED patients with unexplained chest pain.
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Abstract
Over the years Consultation-Liaison (C-L) psychiatry has contributed significantly to the growth of the psychiatry and has brought psychiatry very close to the advances in the medicine. It has also led to changes in the medical education and in the providing comprehensive management to the physically ill. In India, although the General Hospital Psychiatric units were established in 1930s, C-L Psychiatry has never been the main focus of training and research. Hence there is an urgent need to improve C-L Psychiatry services and training to provide best and optimal care to the patients and provide best education to the trainees.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Booth BM, Walton MA, Barry KL, Cunningham RM, Chermack ST, Blow FC. Substance use, depression, and mental health functioning in patients seeking acute medical care in an inner-city ED. J Behav Health Serv Res 2011; 38:358-72. [PMID: 21086057 PMCID: PMC3320727 DOI: 10.1007/s11414-010-9227-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The study investigated the behavioral health of a consecutive sample of 5,641 adult emergency department (ED) patients aged 19 through 60 presenting for medical care in a large, inner-city hospital ED. Twenty-three percent met the criteria for major depression; average mental health functioning, as measured by the mental health component of the SF-12, was half of a standard deviation lower than in the general population; 15% met the criteria for alcohol or drug abuse/dependence in the past year. Comorbidity was high. These behavioral health disorders may complicate treatment and diagnosis of the chief presenting complaint. These findings, coupled with the high rates of these disorders, suggest the importance of screening and either beginning appropriate treatment or offering appropriate referral for such disorders in ED settings.
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Affiliation(s)
- Brenda M. Booth
- Professor, Division of Health Services Research, Department of Psychiatry, University of Arkansas for Medical Sciences. address: 4301 W. Markham, Slot 755, Little Rock, AR 72205, Phone: (501) 526-8129, Fax: (501) 526-8199,
| | - Maureen A. Walton
- Research Assistant Professor, University of Michigan Department of Psychiatry and National Serious Mental Illness Treatment Research and Evaluation Center (SMITREC), Ann Arbor VA Healthcare System, Department of Veterans Affairs. address: Rachel Upjohn Building, 4250 Plymouth Road, Ann Arbor, MI 48109, Phone: (734) 232-0270, Fax: (734) 998-7992,
| | - Kristin L. Barry
- Research Associate Professor, University of Michigan Department of Psychiatry Addiction Research Center and Associate Director, National Serious Mental Illness Treatment Research and Evaluation Center (SMITREC), Ann Arbor VA Healthcare System, Department of Veterans Affairs. Mailing address: Rachel Upjohn Building, 4250 Plymouth Road, Ann Arbor, MI 48109, Phone: (734) 232-0404, Fax: (734) 615-8739,
| | - Rebecca M. Cunningham
- Assistant Professor, University of Michigan Department of Emergency Medicine. Mailing address: Injury Research Center 300 NIB, Room 2C31G, Ann Arbor, Michigan 48109-0437, Phone: (734) 615-3704, Fax: 734-936-2706,
| | - Stephen T. Chermack
- Associate Professor, University of Michigan Department of Psychiatry, and Chief, Substance Abuse Clinic, Ann Arbor VA Healthcare System. Mailing address: Psychiatry Service (116C), VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, Phone: (734) 845-3908, Fax: (734) 845-3235,
| | - Frederic C. Blow
- Director, National Serious Mental Illness Treatment Research and Evaluation Center (SMITREC), Ann Arbor VA Healthcare System, Department of Veterans Affairs, and Associate Professor and Research Associate Professor, Department of Psychiatry, University of Michigan. Mailing address: Department of Veterans Affairs, Health Services Research and Development, Serious Mental Illness Treatment Research and Evaluation Center (SMITREC), PO Box 130170, Ann Arbor, MI 48113-0170, Phone: 734-761-2210, Fax: 734-761-2617,
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Foldes-Busque G, Marchand A, Chauny JM, Poitras J, Diodati J, Denis I, Lessard MJ, Pelland MÈ, Fleet R. Unexplained chest pain in the ED: could it be panic? Am J Emerg Med 2010; 29:743-51. [PMID: 20825891 DOI: 10.1016/j.ajem.2010.02.021] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Accepted: 02/23/2010] [Indexed: 10/19/2022] Open
Abstract
PURPOSE This study aimed at (1) establishing the prevalence of paniclike anxiety in emergency department (ED) patients with unexplained chest pain (UCP); (2) describing and comparing the sociodemographic, medical, and psychiatric characteristics of UCP patients with and without paniclike anxiety; and (3) measuring the rate of identification of panic in this population. BASIC PROCEDURE A structured interview, the Anxiety Disorders Interview Schedule for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, was administered to identify paniclike anxiety and evaluate patients' psychiatric status. Anxious and depressive symptoms were evaluated with self-report questionnaires. Medical information was extracted from patients' medical records. MAIN FINDINGS The prevalence of paniclike anxiety was 44% (95% CI, 40%-48%) in the sample (n = 771). Psychiatric disorders were more common in panic patients (63.4% vs 20.1%), as were suicidal thoughts (21.3% vs 11.3%). Emergency physician diagnosed only 7.4% of panic cases. PRINCIPAL CONCLUSIONS Paniclike anxiety is common in ED patients with UCP, and this condition is rarely diagnosed in this population.
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Eken C, Oktay C, Bacanli A, Gulen B, Koparan C, Ugras SS, Cete Y. Anxiety and depressive disorders in patients presenting with chest pain to the emergency department: a comparison between cardiac and non-cardiac origin. J Emerg Med 2008; 39:144-50. [PMID: 18722737 DOI: 10.1016/j.jemermed.2007.11.087] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2006] [Revised: 11/17/2007] [Accepted: 11/19/2007] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to determine the prevalence of anxiety and depressive disorders in patients presenting with chest pain to the Emergency Department (ED) and determine if there is a relationship between these and cardiac vs. non-cardiac chest pain. METHODS This prospective cross-sectional study was performed in an urban tertiary care hospital between March and October 2005. Consecutive patients presenting with chest pain were enrolled in the study. The prevalence of anxiety and depressive disorders in patients with chest pain were determined by using the Hospital Anxiety and Depression Scale. RESULTS A total of 324 patients presented to the ED with chest pain during the study period. The mean age of the patients studied was 50.5 +/- 14 years; 67% were men and 33% were women. Of the 324 study patients, 194 (59.9%) patients were diagnosed with non-cardiac chest pain, 16 (4.9%) with stable angina, 84 (25.9%) with unstable angina, and 30 (9.3%) with acute myocardial infarction. No statistically significant differences were determined between patients with cardiac and non-cardiac chest pain both for anxiety (40% vs. 38.1%, respectively; p = 0.737) and depressive disorders (52.3% vs. 52.1%, respectively; p = 0.965). CONCLUSION Anxiety and depressive disorders are common among patients presenting with chest pain to the ED. However, the prevalence of anxiety and depressive disorders is similar between patients with chest pain of cardiac and non-cardiac origin. Chest pain should not be attributed to an anxiety or depressive disorder before organic etiologies are excluded.
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Affiliation(s)
- Cenker Eken
- Department of Emergency Medicine, Akdeniz University Medical Faculty, Antalya, Turkey.
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