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Comparing Two Brief Psychological Interventions to Usual Care in Panic Disorder Patients Presenting to the Emergency Department with Chest Pain

Published online by Cambridge University Press:  20 September 2011

Marie-Josée Lessard ,
André Marchand ,
Marie-Ève Pelland ,
Geneviève Belleville ,
Alain Vadeboncoeur ,
Jean-Marc Chauny ,
Julien Poitras ,
Gilles Dupuis ,
Richard Fleet  and
Guillaume Foldes-Busque
...Show all authors
Marie-Josée Lessard
Affiliation:
University of Quebec at Montreal, Canada
André Marchand*
Affiliation:
University of Quebec at Montreal, Canada
Marie-Ève Pelland
Affiliation:
University of Quebec at Montreal, Canada
Geneviève Belleville
Affiliation:
University of Quebec at Montreal, Canada
Alain Vadeboncoeur
Affiliation:
Montreal Heart Institute, Canada
Jean-Marc Chauny
Affiliation:
Sacré-Coeur Hospital, Montreal, Canada
Julien Poitras
Affiliation:
Hôtel-Dieu de Lévis Hospital, Quebec, Canada
Gilles Dupuis
Affiliation:
University of Quebec at Montreal, Canada
Richard Fleet
Affiliation:
Hôtel-Dieu de Lévis Hospital, Quebec, Canada
Guillaume Foldes-Busque
Affiliation:
Hôtel-Dieu de Lévis Hospital, Quebec, Canada
Kim L. Lavoie
Affiliation:
University of Quebec at Montreal, Montreal Heart Institute and Sacré-Coeur Hospital, Montreal, Canada
*
Reprint requests to André Marchand, Department of Psychology, University of Quebec at Montreal, Quebec, CanadaH3C 3P8. E-mail: marchand.andre@uqam.ca
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Abstract

Background: Panic disorder (PD) is a common, often unrecognized condition among patients presenting with chest pain to the emergency departments (ED). Nevertheless, psychological treatment is rarely initiated. We are unaware of studies that evaluated the efficacy of brief cognitive-behavioural therapy (CBT) for this population. Aim: Evaluate the efficacy of two brief CBT interventions in PD patients presenting to the ED with chest pain. Method: Fifty-eight PD patients were assigned to either a 1-session CBT-based panic management intervention (PMI) (n = 24), a 7-session CBT intervention (n = 19), or a usual-care control condition (n = 15). A structured diagnostic interview and self-reported questionnaires were administered at pre-test, post-test, 3- and 6-month follow-ups. Results: Statistical analysis showed significant reduction in PD severity following both interventions compared to usual care control condition, but with neither showing superiority compared to the other. Conclusions: CBT-based interventions as brief as a single session initiated within 2 weeks after an ED visit for chest pain appear to be effective for PD. Given the high prevalence of PD in emergency care settings, greater efforts should be made to implement these interventions in the ED and/or primary care setting.

Keywords

Panic disordercognitive behavioural therapybrief CBTchest painemergency departmentefficacy
Type
Empirically Grounded Clinical Interventions
Information
Behavioural and Cognitive Psychotherapy , Volume 40 , Issue 2 , March 2012 , pp. 129 - 147
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2011

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References

Allison, D. B., Gorman, B. S. and Primavera, L. H. (1993). Some of the most common questions asked of statistical consultants: our favorite responses and recommended readings. Genetic, Social, and General Psychology Monographs, 119, 155–185.Google Scholar
American Psychiatric Association (2009). Practice Guideline for the Treatment of Patients With Panic Disorder (2nd ed.). Washington, DC: Author.Google Scholar
Association Américaine de Psychiatrie (2003). Manuel diagnostique et statistique des troubles mentaux (Texte révisé) (4th ed.). Washington, DC: Author.Google Scholar
Bahr, R. (2000). Chest pain centers: moving toward proactive acute coronary care. International Journal of cardiology, 72, 101–110. doi:10.1016/S0167-5273(99)00160-6.CrossRefGoogle ScholarPubMed
Bandelow, B. (1995). Assessing the efficacy of treatments for panic disorder and agoraphobia. II. The Panic and Agoraphobia Scale. International Clinical Psychopharmacology, 10, 73–81.CrossRefGoogle ScholarPubMed
Beitman, B. D., Kushner, M. G., Basha, I., Lamberti, J., Mukerji, V. and Bartels, K. (1991). Follow-up status of patients with angiographically normal coronary arteries and panic disorder. Jama, 265, 1545–1549.CrossRefGoogle ScholarPubMed
Beitman, B. D., Kushner, M., Lamberti, J. W. and Mukerji, V. (1990). Panic disorder without fear in patients with angiographically normal coronary arteries. Journal of Nervous and Mental Disease, 178, 307–312. doi:10.1016/0002-9149(89)91056-4.CrossRefGoogle ScholarPubMed
Beitman, B. D., Mukerji, V., Russell, J. L. and Grafting, M. (1993). Panic disorder in cardiology patients: a review of the Missouri Panic/Cardiology Project. Journal of Psychiatric Research, 27 Suppl 1, 35–46. doi:10.1016/0022-3956(93)90016-U.CrossRefGoogle ScholarPubMed
Belleville, G., Foldes-Busque, G. and Marchand, A. (2010). Characteristics of panic disorder patients consulting an emergency department with noncardiac chest pain. Primary Psychiatry, 17, 35–42.Google Scholar
Boivin, I. and Marchand, A. (1996). Évaluation structurée pour les troubles anxieux pour le DSM-IV. Montréal, Québec: Université du Québec à Montréal.Google Scholar
Brown, T. A. and Barlow, D. H. (1992). Comorbidity among anxiety disorders: implications for treatment and DSM-IV. Journal of Consulting and Clinical Psychology, 60, 835–844. doi:10.1037/0022-006X.60.6.835.CrossRefGoogle ScholarPubMed
Brown, T. A., Di Nardo, P. A. and Barlow, D. H. (1994). Anxiety Disorders Interview Schedule for DSM-IV (ADIS-IV). San Antonio: Psychological Corporation/Graywind Publications Inc.Google Scholar
Carter, C., Maddock, R., Zoglio, M., Lutrin, C., Jella, S. and Amsterdam, E. (1994). Panic disorder and chest pain: a study of cardiac stress scintigraphy patients. American Journal of Cardiology, 74, 296–298. doi:10.1016/0002-9149(94)90381-6.CrossRefGoogle ScholarPubMed
Chambless, D. L., Caputo, G. C., Bright, P. and Gallagher, R. (1984). Assessment of fear of fear in agoraphobics: the body sensations questionnaire and the agoraphobic cognitions questionnaire. Journal of Consulting and Clinical Psychology, 52, 1090–1097. doi:10.1037/0022-006X.52.6.1090.CrossRefGoogle ScholarPubMed
Clark, D. M. (1986). A cognitive approach to panic. Behaviour Research and Therapy, 24, 461–470. doi:10.1016/0005-7967(86)90011-2.CrossRefGoogle ScholarPubMed
Côté, G., Gauthier, J. G., Laberge, B., Cormier, H. J. and Plamondon, J. (1994). Reduced therapist contact in the cognitive behavioral treatment of panic disorder. Behavior Therapy, 25, 123–145. doi:10.1016/S0005-7894(05)80149-2.CrossRefGoogle Scholar
Cott, A., McCully, J., Goldberg, W. M., Tanser, P. H. and Parkinson, W. (1992). Interdisciplinary treatment of morbidity in benign chest pain. Angiology, 43, 195–202. doi:10.1177/000331979204300304.CrossRefGoogle ScholarPubMed
Dammen, T., Arnesen, H., Ekeberg, O. and Friis, S. (2004). Psychological factors, pain attribution and medical morbidity in chest-pain patients with and without coronary artery disease. General Hospital Psychiatry, 26, 463–469. doi:10.1016/j.genhosppsych.2004.08.004.CrossRefGoogle ScholarPubMed
Dammen, T., Bringager, C. B., Arnesen, H., Ekeberg, O. and Friis, S. (2006). A 1-year follow-up study of chest-pain patients with and without panic disorder. General Hospital Psychiatry, 28, 516–524. doi:10.1016/j.genhosppsych.2006.08.005.CrossRefGoogle ScholarPubMed
Dammen, T., Ekeberg, O., Arnesen, H. and Friis, S. (1999). The detection of panic disorder in chest pain patients. General Hospital Psychiatry, 21, 323–332. doi:S0163834399000377 [pii].CrossRefGoogle ScholarPubMed
Deacon, B. and Abramowitz, J. (2006). A pilot study of two-day cognitive-behavioral therapy for panic disorder. Behavior Research and Therapy, 44, 807–817. doi:10.1016/j.brat.2005.05.008.CrossRefGoogle ScholarPubMed
Di Nardo, P. A., Brown, T. A. and Barlow, D. H. (1994). Anxiety Disorders Interview Schedule for DSM-IV: lifetime version (ADIS-IV-L). San Antonio, TX: Psychological Corporation/Graywind Publications Incorporated.Google Scholar
Dyckman, J. M., Rosenbaum, R. L., Hartmeyer, R. J. and Walter, L. J. (1999). Effects of psychological intervention on panic attack patients in the emergency department. Psychosomatics, 40, 422–427.CrossRefGoogle ScholarPubMed
Eifert, G. H., Thompson, R. N., Zvolensky, M. J., Edwards, K., Frazer, N. L., Haddad, J. W. et al. , (2000). The cardiac anxiety questionnaire: development and preliminary validity. Behaviour Research and Therapy, 38, 1039–1053. doi:10.1016/S0005-7967(99)00132-1.CrossRefGoogle ScholarPubMed
Esler, J. L., Barlow, D. H., Woolard, R. H., Nicholson, R. A., Nash, J. M. and Erogul, M. H. (2003). A brief-cognitive behavioral intervention for patients with noncardiac chest pain. Behavior Therapy, 34, 129–148. doi:10.1016/S0005-7894(03)80009-6.CrossRefGoogle Scholar
Eslick, G. D. (2004). Noncardiac chest pain: epidemiology, natural history, health care seeking, and quality of life. Gastroenterology Clinics of North America, 33, 1–23. doi:10.1016/S0889-8553(03)00125-0.CrossRefGoogle ScholarPubMed
Fifer, S. K., Mathias, S. D., Patrick, D. L., Mazonson, P. D., Lubeck, D. P. and Buesching, D. P. (1994). Untreated anxiety among adult primary care patients in a Health Maintenance Organization. Archives of General Psychiatry, 51, 740–750.CrossRefGoogle Scholar
Fleet, R. P., Dupuis, G., Marchand, A., Burelle, D., Arsenault, A. and Beitman, B. D. (1996). Panic disorder in emergency department chest pain patients: prevalence, comorbidity, suicidal ideation, and physician recognition. American Journal of Medicine, 101, 371–380. doi:10.1016/S0002-9343(96)00224-0.CrossRefGoogle ScholarPubMed
Fleet, R. P., Lavoie, K. L., Martel, J. P., Dupuis, G., Marchand, A. and Beitman, B. D. (2003). Two-year follow-up status of emergency department patients with chest pain: was it panic disorder? Canadian Journal of Emergency Medicine, 5, 247–254.CrossRefGoogle ScholarPubMed
Fleet, R. P., Martel, J. P., Lavoie, K. L., Dupuis, G. and Beitman, B. D. (2000). Non-fearful panic disorder: a variant of panic in medical patients? Psychosomatics, 41, 311–320.CrossRefGoogle ScholarPubMed
Foldes-Busque, G., Marchand, A., Chauny, J.-M., Poitras, J., Diodati, J., Denis, I. et al. , (in press). Unexplained chest pain in the ED: could it be panic? American Journal of Emergency Medicine. doi:10.1016/j.ajem.2010.02.021.CrossRefGoogle Scholar
Ghosh, A. and Marks, I. M. (1987). Self-treatment of agoraphobia by exposure. Behavior Therapy, 18, 3–16. doi:10.1016/S0005-7894(87)80047-3.CrossRefGoogle Scholar
Goldberg, R., Morris, P., Christian, F., Badger, J., Chabot, S. and Edlund, M. (1990). Panic disorder in cardiac outpatients. Psychosomatics, 31 (2), 168–173.CrossRefGoogle ScholarPubMed
Goodacre, S., Mason, S., Arnold, J. and Angelini, K. (2001). Psychologic morbidity and health-related quality of life of patients assessed in a chest pain observation unit. Annals of emergency medicine, 38, 369–376. doi:10.1067/mem.2001.118010.CrossRefGoogle Scholar
Gould, R. A. and Clum, G. A. (1993). A meta-analysis of self-help treatment approaches. Clinical Psychology Review, 13, 169–186. doi:10.1016/0272-7358(93)90039-O.CrossRefGoogle Scholar
Gould, R. A., Clum, G. A. and Shapiro, D. (1993). The use of bibliotherapy in the treatment of panic: a preliminary investigation. Behavior Therapy, 24, 241–252. doi:10.1016/S0005-7894(05)80266-7.CrossRefGoogle Scholar
Hecker, J. E., Losee, M. C., Fritzler, B. K. and Fink, C. M. (1996). Self-directed versus therapist-directed cognitive-behavioral treatment for panic disorder. Journal of Anxiety Disorders, 10, 253–265. doi:10.1016/0887-6185(96)00010-2.CrossRefGoogle Scholar
Hocaoglu, C., Gulec, M. Y. and Durmus, I. (2008). Psychiatric comorbidity in patients with chest pain without a cardiac etiology. The Israel Journal of Psychiatry and Related Science, 45, 49–54.Google ScholarPubMed
Karlson, B. W., Herlitz, J., Pettersson, P., Ekvall, H. E. and Hjalmarson, A. (1991). Patients admitted to the emergency room with symptoms indicative of acute myocardial infarction. Journal of Internal Medicine, 230, 251–258. doi:10.1111/j.1365-2796.1991.tb00439.x.CrossRefGoogle Scholar
Katerndahl, D. A. (1990). Factors associated with persons with panic attacks seeking medical care. Family Medicine, 22, 462–466.Google ScholarPubMed
Katerndahl, D. A. (2003). Initial care seeking for panic attacks. Psychiatric Services, 54, 1168.CrossRefGoogle ScholarPubMed
Kessler, R. C., Chiu, W. T., Jin, R., Ruscio, A. M., Shear, K. and Walters, E. E. (2006). The epidemiology of panic attacks, panic disorder, and agoraphobia in the National Comorbidity Survey Replication. Archives of General Psychiatry, 63, 415–424. doi:63/4/415 [pii] 10.1001/archpsyc.63.4.415.CrossRefGoogle ScholarPubMed
Kessler, R. C., McGonagle, K. A., Zhao, S., Nelson, C. B., Hughes, M., Eshleman, S. et al. , (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorder in the United States: results from the National Comorbidity Survey. Archives of General Psychiatry, 51, 8–19.CrossRefGoogle ScholarPubMed
Klimes, I., Mayou, R. A., Pearce, M. J., Coles, L. and Fagg, J. R. (1990). Psychological treatment for atypical non-cardiac chest pain: a controlled evaluation. Psychological Medicine, 20, 605–611. doi:10.1017/S0033291700017116.CrossRefGoogle ScholarPubMed
Kroenke, K. and Mangelsdorff, A. D. (1989). Common symptoms in ambulatory care: incidence, evaluation, therapy, and outcome. American Journal of Medicine, 86, 262–266.CrossRefGoogle ScholarPubMed
Kuijpers, P. M. J. C., Dennollet, J., Wellens, H. J. J., Crijns, H. M. and Honig, A. (2007). Noncardiac chest pain in the emergency department: the role of cardiac history, anxiety or depression and Type D personality. European Journal of Cardiovascular Prevention and Rehabilitation, 14, 273–279. doi:10.1097/HJR.0b013e32801da0fc.CrossRefGoogle ScholarPubMed
Lidren, D. M., Watkins, P. L., Gould, R. A., Clum, G. A., Asterino, M. and Tulloch, H. L. (1994). A comparison of bibliotherapy and group therapy in the treatment of panic disorder. Journal of Consulting and Clinical Psychology, 62, 865–869. doi:10.1037/0022-006X.62.4.865.CrossRefGoogle ScholarPubMed
Ly, N. and McCaig, L. F. (2002). National Hospital Ambulatory Medical Care Survey: 2000 outpatient department summary. Advance Data, 327, 1–27.Google Scholar
Marchand, A. and Boivin, I. (1999). Le trouble panique. In Ladouceur, R., Marchand, A. and Boisvert, J. M. (Eds.), Les troubles anxieux: approche cognitive et comportementale. Montréal, QC: Gaétan Morin.Google Scholar
Marchand, A., Lessard, M.-J. and Pelland, M.-E. (2005). Non-cardiac chest pain and anxiety. Unpublished manuscript, Montreal, QC: University of Quebec at Montreal.Google Scholar
Marchand, A. and Letarte, A. (2004). La peur d'avoir peur: guide de traitement du trouble panique avec agoraphobie. Outremont, QC: Éditions internationales Alain Stanké.Google Scholar
Marchand, A., Roberge, P., Dupuis, G., Contrandriopoulus, A. P., Mainguy, N. and Savard, P. (2000). Évaluation clinique, psychosociale et économique de trois modalités de traitement du trouble panique avec agoraphobie: rapport de recherche présenté au Conseil Québécois de la Recherche Sociale (RS-3166). Montréal, QC: Hôpital Louis-H. Lafontaine, Centre de recherche Fernand-Séguin.Google Scholar
Mathias, S. D., Fifer, S. K., Mazonson, P. D., Lubeck, D. P., Buesching, D. P. and Patrick, D. L. (1994). Necessary but not sufficient: the effect of screening and feedback on outcomes of primary care patients with untreated anxiety. Journal of General Internal Medicine, 9, 606–615. doi:10.1007/BF02600303.CrossRefGoogle Scholar
Mayou, R. A., Bryant, B. M., Sanders, D., Bass, C., Klimes, I. and Forfar, C. (1997). A controlled trial of cognitive behavioural therapy for non-cardiac chest pain. Psychological Medicine, 27, 1021–1031. doi:10.1017/S0033291797005254.CrossRefGoogle ScholarPubMed
McDonald, I. G., Daly, J., Jelinek, V. M., Panetta, F. and Gutman, J. M. (1996). Opening Pandora's box: the unpredictability of reassurance by a normal test result. British Medical Journal, 313, 329–332.CrossRefGoogle ScholarPubMed
Montgomery, S., Bullock, T. and Fineberg, N. (1991). Serotonin selectivity for obsessive compulsive and panic disorders. Journal of Psychiatry and Neuroscience, 16 (suppl. 1), 30–35.Google ScholarPubMed
Norell, M., Lythall, D., Coghlan, G., Cheng, A., Kushwaha, S., Swan, J. et al. , (1992). Limited value of the resting electrocardiogram in assessing patients with recent onset chest pain: lessons from a chest pain clinic. British Heart Journal, 67, 53–56. doi:10.1136/hrt.67.1.53.CrossRefGoogle ScholarPubMed
Pauli, P., Marquardt, C., Hartl, L., Nutzinger, D. O., Holzl, R. and Strian, F. (1991). Anxiety induced by cardiac perceptions in patients with panic attacks: a field study. Behaviour Research and Therapy, 29, 137–145. doi:10.1016/0005-7967(91)90042-2.CrossRefGoogle ScholarPubMed
Peski-Oosterbaan, A. S. V., Spinhoven, P., Rood, Y. V., Does, J. W. V., Bruschke, A. V. and Rooijmans, H. G. (1999). Cognitive-behavioral therapy for noncardiac chest pain: a randomized trial. American Journal of Medicine, 106, 424–429.CrossRefGoogle ScholarPubMed
Potts, S. G., Lewin, R., Fox, K. A. and Johnstone, E. C. (1999). Group psychological treatment for chest pain with normal coronary arteries. QJM: An International Journal of Medicine, 92, 81–86. doi:10.1093/qjmed/92.2.81.CrossRefGoogle ScholarPubMed
Reich, J., Warshaw, M., Peterson, L. G., White, K., Keller, M., Lavori, P. et al. , (1993). Comorbidity of panic and major depressive disorder. Journal of Psychiatric Research, 27 (Suppl 1), 23–33. doi:10.1016/0022-3956(93)90015-T.CrossRefGoogle ScholarPubMed
Reiss, S., Peterson, R. A., Gursky, D. M. and McNally, R. J. (1986). Anxiety sensitivity, anxiety frequency and the prediction of fearfulness. Behaviour Research and Therapy, 24, 1–8. doi:10.1016/0005-7967(86)90143-9.CrossRefGoogle ScholarPubMed
Roberge, P. and Marchand, A. (1997). L'échelle d'évaluation de la panique et de l'agoraphobie. Montréal, Québec: Université du Québec à Montréal, Département de psychologie.Google Scholar
Roberge, P., Marchand, A., Cloutier, K., Mainguy, N., Miller, J. M., Bégin, J. et al. , (2005). Healthcare utilization following cognitive-behavioral therapy for panic disorder with agoraphobia. Cognitive Behaviour Therapy, 45, 1–10. doi:10.1080/16506070510008443.Google Scholar
Roy-Byrne, P. P., Stein, M. B., Russo, J., Mercier, E., Thomas, R., McQuaid, J. R. et al. , (1999). Panic disorder in the primary care setting: comorbidity, disability, service utilization, and treatment. Journal of Clinical Psychiatry, 60, 492–499.CrossRefGoogle Scholar
Sanders, D., Bass, C., Mayou, R. A., Goodwin, S., Bryant, B. M. and Tyndel, S. (1997). Non-cardiac chest pain: why was a brief intervention apparently ineffective? Psychological Medicine, 27, 1033–1040. doi:10.1017/S0033291797005266.CrossRefGoogle ScholarPubMed
Schmidt, N. (1999). Panic disorder: cognitive-behavioral and pharmacological treatment strategies. Journal of Clinical Psychological Medicine Settings, 6, 89–111. doi:10.1023/A:1026207414971.CrossRefGoogle Scholar
Simpson, R. J., Kazmierczak, T., Power, K. G. and Sharp, D. M. (1994). Controlled comparison of the characteristics of patients with panic disorder. British Journal of General Practice, 44, 352–356.Google ScholarPubMed
Stephenson, R., Marchand, A. and Brillon, P. (1994). Index de sensibilité à l'anxiété. Montréal, Québec: Université du Québec à Montréal.Google Scholar
Stephenson, R., Marchand, A. and Lavallée, M.-C. (1998). Validation du Questionnaire des sensations physiques auprès de la population canadienne-française. Encephale, 24, 415–425.Google Scholar
Stephenson, R., Marchand, A. and Lavallée, M.-C. (1999). French-Canadian adaptation of the Agoraphobic Cognitions Questionnaire: cross-cultural validation and gender diffrences. Scandinavian Journal of Behavior Therapy, 28, 58–69. doi:10.1080/028457199440016.CrossRefGoogle Scholar
Stephenson, R., Marchand, A., Lavallée, M. C. and Brillon, P. (1996). Translation and transcultural validation of the Anxiety Sensitivity Index. Paper presented at the XXVIe Congrès International de Psychologie. Montréal, QC.Google Scholar
Swinson, R. P., Antony, M. M., Bleau, P., Chokka, P., Craven, M. and Fallu, M. (2006). Clinical practice guidelines: management of anxiety disorders. Canadian Journal of Psychiatry, 51 (Suppl.2), 1S–92S.Google Scholar
Swinson, R. P., Soulios, C., Cox, B. J. and Kuch, K. (1992). Brief treatment of emergency room patients with panic attacks. American Journal of Psychiatry, 149, 944–946.Google ScholarPubMed
Weissman, M. M. (1990). The hidden patient: unrecognized panic disorder. Journal of Clinical Psychiatry, 51 Suppl, 5–8.Google ScholarPubMed
White, K. S. and Barlow, D. H. (2004). Panic disorder and agoraphobia. In Barlow, D. H. (Ed.), Anxiety and Its Disorders: the nature and treatment of anxiety and panic (2nd. ed., pp. 328–379). New York: The Guilford Press.Google Scholar
Worthington, J. J. 3rd, Pollack, M. H., Otto, M. W., Gould, R. A., Sabatino, S. A., Goldman, L. et al. , (1997). Panic disorder in emergency ward patients with chest pain. Journal of Nervous and Mental Disease, 185, 274–276. doi:10.1097/00005053-199704000-00009.CrossRefGoogle ScholarPubMed
Wulsin, L. R., Arnold, L. M. and Hillard, J. R. (1991). Axis I disorders in ER patients with atypical chest pain. International Journal of Psychiatry in Medicine, 21, 37–46. doi:10.2190/HFQ4-J41N-6M1E-MBN3.CrossRefGoogle ScholarPubMed
Wulsin, L. R., Liu, T., Storrow, A., Evans, S., Dewan, N. and Hamilton, C. (2002). A randomized, controlled trial of panic disorder treatment initiation in an emergency department chest pain center. Annals of Emergency Medicine, 39, 139–143. doi:10.1067/mem.2002.121484.CrossRefGoogle Scholar
Wulsin, L. R. and Yingling, K. (1991). Psychiatric aspects of chest pain in the emergency department. The Medical Clinics of North America, 75, 1175–1188.CrossRefGoogle ScholarPubMed
Yelin, E., Mathias, S. D., Buesching, D. P., Rowland, C., Calucin, R. Q. and Fifer, S. (1996). The impact on unemployment of an intervention to increase recognition of previously untreated anxiety among primary care physicians. Social Science and Medicine, 42, 1069–1075. doi:10.1016/0277-9536(95)00297-9.CrossRefGoogle ScholarPubMed
Yingling, K. W., Wulsin, L. R., Arnold, L. M. and Rouan, G. W. (1993). Estimated prevalences of panic disorder and depression among consecutive patients seen in an emergency department with acute chest pain. Journal of General Internal Medecine, 8, 231–235. doi:10.1007/BF02600087.Google Scholar
Zane, R. D., McAfee, A. T., Sherburne, S., Billeter, G. and Barsky, A. (2003). Panic disorder and emergency services utilization. Academic Emergency Medicine, 10, 1065–1069. doi:10.1197/S1069-6563(03)00349-X.CrossRefGoogle ScholarPubMed
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