Panic Disorder in Cardiac Outpatients RICHARD GOLDBERG, M.D., PHILIP MORRIS. M.D. FREDERICK CHRISTIAN. M.D., JAMES BADGER,
R.N.,
M.S.
STEVE CHABOT. M.D., MATTHEW EDLUND, M.D.
The prevalence ofand nature ofpanic disorder were im'esti~ated in an amhulatorv cardiolo~y practice. Questionnaires ahout panic symptoms were mailed to 414 patient.;, and possihle or definite panic disorder was found in 104 of the 310 respondents. Interviews with 52 of the 104 patients suhstantiated diagnoses ofpanic disorder,for a prevalence of 9.2% ofthe total sample population of414. Comparison ofpatients ~rouped hy duration ofpanic disorder revealed that lon~-duration panic disorder had its onset hefore a~e 30 and followed a chronic course. Short-duration panic disorder developed at an older age following the appearance of cardiac disease.
ardiac symptoms. including palpitations and atypical chest pain. are a prominent component of panic disorder. 1-.1 While panic disorder is found in from I% to 3% of the general population,4 its many somatic features may result in an increased prevalence in primary care practice.~ Cardiac syndromes have been reported to be manifestations of anxiety for a century.6 Over 50 years ago, the prevalence in cardiology practices of a syndrome likely to have been panic disorder (called da Costa's syndrome and effort syndrome) was estimated to be between 10% and 14%.7.K More recent studies have shown rates of panic disorder among patients with chest pain whose cardiac catheterization revealed nonnal coronary arteries to be between 33% and 43%.Y-'~ Because of the clinical D and economic l4 implications of unrecognized panic disorder along with its potential treatability. we felt it would be
C
Received January 6. 1989; revised May 25. 1989; accepted June 28. 1989. From the Depanmenls of Psychiatry and Cardiology. Rhode Island Hospital. Providence; and the Community Counseling Center. Pawtuckel. Rhode Island. Address reprint requests to Dr. Goldberg. Rhode Island Hospilal. Providence. RI 02903. Copyright © 1990 The Academy of Psychosomatic Medicine.
16M
useful to study the prevalence of panic disorder in an ambulatory cardiology practice.
METHODS The charts of all patients seen at least twice (n=414) between September I, 1985, and August 31. 1986, by a noninvasive cardiologist were reviewed. These patients were sent a panic symptom questionnaire by mail. The questionnaire (available on request), which contained 24 questions. had been modified from the panic disorder screening questionnaire developed by the NIMH Anxiety Disorders Research Section. A total of 310 questionnaires were returned, a response rate of 75%. A total of 104 respondents were classified as having either definite or possible panic attacks and 206 as showing no indication of panic attacks. All patients classified as definitely or possibly suffering from panic attacks were contacted for a semistructured diagnostic psychiatric interview (SCID-Up)l~ to evaluate DSM-lll-R I6 diagnoses of depressive illness or anxiety disorder. Fifty-two interviews were completed. Seventeen patients had moved out of town and could PSYCHOSOMATICS
Goldberg et al.
not be contacted, 27 refused to be interviewed, four did not keep their appointments, and four patients died before the interview could take place. Each patient who was diagnosed as having panic disorder based on the interview was discussed by the research team and the cardiologist to obtain the cardiologist's retrospective opinion regarding the nature and severity of the patient's cardiac symptoms. The cardiologist was asked to classify the patients into those who did and did not have documented heart disease that accounted for their cardiac symptoms. Data were summarized by descriptive statistics (means, standard deviations, and ranges). Comparisons of long-duration and short-duration panic disorder were made with the (-test for continuous data and Fisher's Exact Test for nominal data. Tests were two-tailed. Actual p values are reported for findings that met or approached statistical significance (p
R.N.,
M.S.
STEVE CHABOT. M.D., MATTHEW EDLUND, M.D.
The prevalence ofand nature ofpanic disorder were im'esti~ated in an amhulatorv cardiolo~y practice. Questionnaires ahout panic symptoms were mailed to 414 patient.;, and possihle or definite panic disorder was found in 104 of the 310 respondents. Interviews with 52 of the 104 patients suhstantiated diagnoses ofpanic disorder,for a prevalence of 9.2% ofthe total sample population of414. Comparison ofpatients ~rouped hy duration ofpanic disorder revealed that lon~-duration panic disorder had its onset hefore a~e 30 and followed a chronic course. Short-duration panic disorder developed at an older age following the appearance of cardiac disease.
ardiac symptoms. including palpitations and atypical chest pain. are a prominent component of panic disorder. 1-.1 While panic disorder is found in from I% to 3% of the general population,4 its many somatic features may result in an increased prevalence in primary care practice.~ Cardiac syndromes have been reported to be manifestations of anxiety for a century.6 Over 50 years ago, the prevalence in cardiology practices of a syndrome likely to have been panic disorder (called da Costa's syndrome and effort syndrome) was estimated to be between 10% and 14%.7.K More recent studies have shown rates of panic disorder among patients with chest pain whose cardiac catheterization revealed nonnal coronary arteries to be between 33% and 43%.Y-'~ Because of the clinical D and economic l4 implications of unrecognized panic disorder along with its potential treatability. we felt it would be
C
Received January 6. 1989; revised May 25. 1989; accepted June 28. 1989. From the Depanmenls of Psychiatry and Cardiology. Rhode Island Hospital. Providence; and the Community Counseling Center. Pawtuckel. Rhode Island. Address reprint requests to Dr. Goldberg. Rhode Island Hospilal. Providence. RI 02903. Copyright © 1990 The Academy of Psychosomatic Medicine.
16M
useful to study the prevalence of panic disorder in an ambulatory cardiology practice.
METHODS The charts of all patients seen at least twice (n=414) between September I, 1985, and August 31. 1986, by a noninvasive cardiologist were reviewed. These patients were sent a panic symptom questionnaire by mail. The questionnaire (available on request), which contained 24 questions. had been modified from the panic disorder screening questionnaire developed by the NIMH Anxiety Disorders Research Section. A total of 310 questionnaires were returned, a response rate of 75%. A total of 104 respondents were classified as having either definite or possible panic attacks and 206 as showing no indication of panic attacks. All patients classified as definitely or possibly suffering from panic attacks were contacted for a semistructured diagnostic psychiatric interview (SCID-Up)l~ to evaluate DSM-lll-R I6 diagnoses of depressive illness or anxiety disorder. Fifty-two interviews were completed. Seventeen patients had moved out of town and could PSYCHOSOMATICS
Goldberg et al.
not be contacted, 27 refused to be interviewed, four did not keep their appointments, and four patients died before the interview could take place. Each patient who was diagnosed as having panic disorder based on the interview was discussed by the research team and the cardiologist to obtain the cardiologist's retrospective opinion regarding the nature and severity of the patient's cardiac symptoms. The cardiologist was asked to classify the patients into those who did and did not have documented heart disease that accounted for their cardiac symptoms. Data were summarized by descriptive statistics (means, standard deviations, and ranges). Comparisons of long-duration and short-duration panic disorder were made with the (-test for continuous data and Fisher's Exact Test for nominal data. Tests were two-tailed. Actual p values are reported for findings that met or approached statistical significance (p
