Sung Sharon C, Rush A John, Earnest Arul, Lim Leslie E C, Pek Maeve P P, Choi Joen M F, Ng Magdalene P K, Ong Marcus E H
SUNG: Office of Clinical Sciences, Duke-National University of Singapore (NUS) Medical School, Singapore RUSH: Office of Clinical Sciences, Duke-NUS Medical School EARNEST: Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University & Office of Clinical Sciences, Duke-NUS Medical School, Singapore LIM: Department of Psychiatry, Singapore General Hospital & Office of Clinical Sciences, Duke-NUS Medical School, Singapore PEK: Department of Emergency Medicine, Singapore General Hospital, Singapore CHOI: Office of Clinical Sciences, Duke-NUS Medical School, Singapore NG: Office of Clinical Sciences, Duke-NUS Medical School, Singapore ONG: Department of Emergency Medicine, Singapore General Hospital & Office of Clinical Sciences and Programme in Health Systems & Services Research, Duke-NUS Medical School, Singapore.
J Psychiatr Pract. 2018 Jan;24(1):32-44. doi: 10.1097/PRA.0000000000000283.
Patients with panic-related anxiety often initially present to the emergency department (ED) complaining of respiratory or cardiac symptoms, but rates of detection of panic symptoms by ED physicians remain low. This study was undertaken to evaluate the relevance of panic attacks and panic disorder in ED patients who present with cardiopulmonary symptoms and to determine whether a brief symptom-based tool could be constructed to assist in rapid recognition of panic-related anxiety in the ED setting.
English-speaking adult ED patients with a chief complaint of palpitations, chest pain, dizziness, or difficulty breathing were evaluated for the presence of panic attacks and panic disorder with the Structured Clinical Interview for DSM-IV Axis I Disorders. Participants completed self-report measures to assess panic-related symptoms, comorbid psychiatric conditions, health-related disability, and health service use.
In this sample (N=200), 23.5% had panic attacks and 23.0% had panic disorder. Both groups reported higher rates of panic attack symptoms, greater psychiatric comorbidity, greater health-related disability, and higher rates of ED and mental health service use compared with those without either condition. A brief 7-item tool consisting of panic symptoms identified patients with panic attacks or panic disorder with 85% accuracy (area under the curve=0.90, sensitivity=82%, specificity=88%).
Patients with panic attacks or panic disorder commonly present to the ED, but often go unrecognized. A brief 7-item clinician rating scale accurately identifies these patients among those ED patients presenting with cardiopulmonary complaints.
患有惊恐相关焦虑症的患者最初常因呼吸或心脏症状前往急诊科（ED）就诊，但急诊科医生对惊恐症状的检出率仍然较低。本研究旨在评估惊恐发作和惊恐障碍在出现心肺症状的急诊科患者中的相关性，并确定是否可以构建一种基于症状的简短工具，以协助在急诊科环境中快速识别惊恐相关焦虑症。
以英语为母语、主诉为心悸、胸痛、头晕或呼吸困难的成年急诊科患者，采用《精神疾病诊断与统计手册》第四版轴I障碍的结构化临床访谈，评估其是否存在惊恐发作和惊恐障碍。参与者完成自我报告测量，以评估惊恐相关症状、共病精神疾病状况、与健康相关的残疾以及医疗服务使用情况。
在这个样本（N = 200）中，23.5%的患者有惊恐发作，23.0%的患者有惊恐障碍。与没有这两种情况的患者相比，两组患者的惊恐发作症状发生率更高、精神疾病共病情况更严重、与健康相关的残疾程度更高，以及急诊科和心理健康服务的使用率更高。一个由7项惊恐症状组成的简短工具识别惊恐发作或惊恐障碍患者的准确率为85%（曲线下面积 = 0.90，敏感性 = 82%，特异性 = 88%）。
患有惊恐发作或惊恐障碍的患者常前往急诊科就诊，但往往未被识别。一个由7项组成的简短临床医生评分量表能够在那些因心肺症状就诊的急诊科患者中准确识别出这些患者。
