Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan.
Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan; Department of Psychology, National Chengchi University, Taipei, Taiwan.
J Psychosom Res. 2019 Oct;125:109815. doi: 10.1016/j.jpsychores.2019.109815. Epub 2019 Aug 20.
Ascertaining comorbid illnesses and patterns of medical utilization early in the course of psychiatric illness can help identify patients with panic disorder. We investigated how such cases were diagnosed and the comorbidities associated with newly diagnosed panic disorder in a nationwide database.
We enrolled a large representative cohort of the general population in Taiwan (N = 1000,000) and selected 9759 cases of panic disorder from January 1, 2000 to December 31, 2013. The distribution of the departments in which the cases were identified and the medical utilization 12 months before diagnosis were analyzed. Based on a nested case-control study, four controls were randomly selected for each case and matched for sex, age, and incidence year. Conditional logistic regression was used to explore the factors associated with newly-diagnosed panic disorder such as demographic factors, concomitant medications, and physical and psychiatric comorbidities.
Most (58.5%) cases of panic disorder were diagnosed in the psychiatry department, whereas only 3.7% were identified in the emergency department. Before diagnosis, the patients frequently visited the departments of internal medicine, family practice, and Chinese herbal medicine. A multivariate analysis revealed a higher number of physical and psychiatric comorbidities before diagnosis in the cases compared with the controls, especially depressive disorder and other anxiety disorders.
Individuals with certain comorbidities and patterns of medical utilization are more likely to be diagnosed with panic disorder. We suggest providing more training to general practitioners and emergency physicians for the early diagnosis of panic disorder.
在精神疾病发病早期确定合并症和医疗利用模式，有助于识别出惊恐障碍患者。我们在一个全国性数据库中调查了这种病例是如何诊断的，以及与新诊断的惊恐障碍相关的合并症。
我们纳入了台湾一个具有代表性的 100 万人群的大型队列，并从 2000 年 1 月 1 日至 2013 年 12 月 31 日期间选择了 9759 例惊恐障碍患者。分析了病例识别的科室分布和诊断前 12 个月的医疗利用情况。基于巢式病例对照研究，为每个病例随机选择了 4 名对照，并按性别、年龄和发病年份进行匹配。采用条件 logistic 回归分析探讨与新诊断的惊恐障碍相关的因素，如人口统计学因素、合并用药和躯体及精神合并症。
大多数（58.5%）惊恐障碍病例是在精神科诊断的，而只有 3.7%是在急诊科诊断的。在诊断前，患者经常去内科、家庭医学和中医就诊。多变量分析显示，与对照组相比，病例在诊断前有更多的躯体和精神合并症，尤其是抑郁障碍和其他焦虑障碍。
具有某些合并症和医疗利用模式的个体更有可能被诊断为惊恐障碍。我们建议为全科医生和急诊医生提供更多培训，以实现惊恐障碍的早期诊断。
