מתוך medicontext.co.il
By Anthony J. Brown, MD

NEW YORK (Reuters Health) – Using a brief structured interview, physicians with no formal psychiatric training can reliably diagnose panic disorder in the emergency room (ER) setting, according to a recent report. Furthermore, treatment initiation in the ER setting is tied to better therapy compliance and improvements in symptom severity.

Dr. Lawson Wulsin and colleagues, from the University of Cincinnati in Ohio screened 156 patients who presented to the ER with chest pain. Fifty of the subjects were diagnosed with panic disorder by a research psychiatrist, Dr. Wulsin's group reports in the February issue of the Annals of Emergency Medicine.

Of the patients with panic disorder, 42 had undergone a 5-question structured interview conducted independently by the research psychiatrist and by the ER physician. In 33 of these patients, the psychiatrist and the ER physician were in agreement regarding the presence or absence of panic disorder.

The patients with panic disorder were randomized to begin paroxetine in the ER or to receive usual care by their primary care physician. All of the patients in the paroxetine group initiated treatment, while only six in the usual care group reporting taking any antipanic drugs within 1 month of the ER visit, the authors note.

At 1-month follow-up, more than half of intervention patients were still receiving paroxetine. At 3-month evaluation, more than a third of intervention patients were receiving some type of antipanic medication compared with only two patients in the usual care group. Intervention patients experienced a greater improvement in symptom severity than usual care patients, but the difference was not statistically significant.

"The problem we are trying to address is the under-recognition of panic disorder in chest pain patients," Dr. Wulsin told Reuters Health. "After being instructed on how to perform a brief structured interview, ER physicians made diagnoses that agreed with those of the research psychiatrist about 75% of the time," he added.

"Usual care hardly ever involves any antipanic treatment," Dr. Wulsin pointed out. "Most patients suspected of having panic disorder get referred to a psychiatrist, but very few of these referrals ever actually happen," he said. "The point of the study is that by initiating treatment in the ER you can dramatically increase the frequency with which these patients receive treatment."

Dr. Wulsin noted that "the current findings indicate that it is feasible to efficiently diagnose panic disorder in the ER and initiate treatment." The data are also "suggestive of greater effectiveness when treatment is initiated in the ER," but further studies are needed to establish this, he added.