Fleet RP, Lavoie KL, Martel JP, Dupuis G, Marchand A, Beitman BD.

Research Center, Montreal Heart Institute, Montreal, Quebec, Canada.

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.

PMID: 17472767 [PubMed – in process]

Batelaan N, Smit F, Graaf RD, Balkom AV, Vollebergh W, Beekman A.

Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands; Department of Psychiatry and Institute for Research in Extramural Medicine, VU-University Medical Centre, Amsterdam, The Netherlands.

BACKGROUND: Data on the societal costs of mental disorders are necessary to inform health policies. METHODS: This study assessed the costs of panic disorder and subthreshold panic disorder, compared these with costs of other mental disorders, and assessed the effects of (psychiatric and somatic) comorbidity and agoraphobia on the costs of panic. Using a large, population-based study in The Netherlands (n=5504), both medical and production costs were estimated from a societal perspective within a one-year timeframe. RESULTS: Annual per capita costs of panic disorder were euro10,269, while subthreshold panic disorder generated euro6384. These costs were higher than those of the other mental disorders studied. About one quarter of the costs could be attributed to comorbidity. Agoraphobia was associated with higher costs. LIMITATIONS: Methodological choices influence cost estimates. In the present study most of these will result in conservative cost estimates. CONCLUSIONS: Panic thus causes substantial societal costs. Given the availability of effective treatment, treatment may not only benefit individual patients, but also have economic returns for society.

PMID: 17466380 [PubMed – as supplied by publisher]