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Mismanagement of Panic Disorder in Emergency Departments: Contributors, Costs, and Implications for Integrated Models of Care

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Abstract

Panic disorder (PD) is associated with the rapid onset of fear-related symptomatology, often somatic in nature. As a result, individuals with the disorder often fear that they are experiencing a life-threatening emergency and present in hospital emergency departments (EDs). As the operating heuristics of EDs are geared toward identifying organic causes and allow only brief physician–patient contact, the diagnosis of PD is more often than not overlooked. Those with the disorder go on to incur enormous costs as they seek out an explanation for their symptoms. Efforts to alleviate this problem, including increased physician education and the development of screening instruments, have been largely unsuccessful. The continued misidentification and mismanagement of this disorder argues for greater incorporation of mental health professionals into the ED, allowing collaborative efforts that recognize the relationship between physiological and psychological aspects of panic.

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REFERENCES

  • Adityanjee, Wig, N. N., & Mohan, D. (1987). Non-recording of socio-demographic variables in the emergency room setting. The International Journal of Social Psychiatry, 33(1), 30–32.

    Google Scholar 

  • Aikens, J. E., Wagner, L. I., Lickerman, A. J., Chin, M. H., & Smith, A. (1998). Primary care physician responses to a panic disorder vignette: Diagnostic suspicion and clinical management. International Journal of Psychiatry in Medicine, 28(2), 179–188.

    Google Scholar 

  • Aikens, J. E., Zvolensky, M. J., & Eifert, G. H. (2001). Differential fear of cardiopulmonary sensations in emergency room noncardiac chest pain patients. Journal of Behavioral Medicine, 24(2), 155–167.

    Google Scholar 

  • American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (3rd ed.).Washington,DC: Author.

    Google Scholar 

  • American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (3rd ed., Rev.). Washington, DC: Author.

    Google Scholar 

  • American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.).Washington, DC:Author.

    Google Scholar 

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed. TR). Washington, DC: Author.

    Google Scholar 

  • Ayuso Mateos, J. L., Bayon Perez, C., Santo-Domingo Carrasco, J., & Olivares, D. (1989). Atypical chest pain and panic disorder. Psychotherapy and Psychosomatics, 52 ,92–95.

    Google Scholar 

  • Ballenger, J.C. (1997). Panic disorder in the medical setting. Journal of Clinical Psychiatry, 58(Suppl. 2), 13–17.

    Google Scholar 

  • Ballenger, J. C. (1998). Treatment of panic disorder in the general medical setting. Journal of Psychosomatic Research, 44(1), 5–15.

    Google Scholar 

  • Barlow, D. H. (2002). Anxiety and its disorders: The nature and treatment of anxiety and panic (2nd ed.). New York: Guilford Press.

    Google Scholar 

  • Barsky, A. J., Barnett, M. C., & Cleary, P. D. (1994). Hypochondriasis and panic disorder: Boundary and overlap. Archives of General Psychiatry, 51 ,918–925.

    Google Scholar 

  • Barsky, A. J., Cleary, P. D., Sarnie, M. K., & Ruskin, J. N. (1994). Panic disorder, palpitations, and the awareness of cardiac activity. The Journal of Nervous and Mental Disease, 182(2), 63–71.

    Google Scholar 

  • Barsky, A. J., Delamater, B. A., & Orav, J. E. (1999). Panic disorder patients and their medical care. Psychosomatics, 40(1), 50–56.

    Google Scholar 

  • Barton, G. M. (1983). Psychiatric staff and the emergency department: Roles, responsibilities and reciprocation. Emergency Psychiatry, 6(2), 317–323.

    Google Scholar 

  • Beck, A. T., Steer, R. A., Sanderson, W. C., & Skeie, T. M. (1991). Panic disorder and suicidal ideation and behavior: Discrepant findings in psychiatric outpatients. American Journal of Psychiatry, 148 ,1195–1199.

    Google Scholar 

  • Beitman, B. D., Basha, I., Flaker, G., DeRosear, L., Mukerji, V., & Lamberti, J. (1987). Non-fearful panic disorder: Panic attacks without fear. Behaviour Research and Therapy, 25(6), 487–492.

    Google Scholar 

  • Beitman, B. D., Kushner, M. G., Basha, I., Lamberti, J., Mukerji, V., & Bartels, K. (1991). Follow-up status of patients with angiographically normal coronary arteries and panic disorder. JAMA, 265(12), 1545–1549.

    Google Scholar 

  • Beitman, B.D., Kushner,M., Lamberti, J.W., & Mukerji, V. (1990). Panic disorder without fear in patients with angiographically normal coronary arteries. The Journal of Nervous and Mental Disease, 178(5), 307–312.

    Google Scholar 

  • Beitman, B. D., Mukerji, V., Russell, J. L., & Grafing, M. (1993). Panic disorder in cardiology patients:Areview of the Missouri panic/cardiology project. Journal of Psychiatric Research, 27(Suppl. 1), 35–46.

    Google Scholar 

  • Blount, A. (1998). Introduction to integrated primary care. In A. Blount (Ed.), Integrated primary care: The future of medical and mental health collaboration (pp. 1–43). New York: W. W. Norton.

    Google Scholar 

  • Boyd, J. H. (1986). Use of mental health services for the treatment of panic disorder. American Journal of Psychiatry, 143(12), 1569–1574.

    Google Scholar 

  • Carter, C., Maddock, R., Amsterdam, E., McCormick, S., Waters, C., & Billett, J. (1992). Panic disorder and chest pain in the coronary care unit. Psychosomatics, 33(3), 302–309.

    Google Scholar 

  • Clancy, J., & Noyes, R., Jr. (1976). Anxiety neurosis: A disease for the medical model. Psychosomatics, 17 ,90–93.

    Google Scholar 

  • Craske, M. G., Miller, P. P., Rotunda, R., & Barlow, D. H. (1990). A descriptive report of features of initial unexpected panic attacks in minimal and extensive avoiders. Behaviour Research and Therapy, 28 ,395–400.

    Google Scholar 

  • Dyckman, J.D., Rosenbaum, R. L., Hartmeyer, R. J., & Walter, L. J. (1999). Effects of psychological intervention on panic attack patients in the emergency department. Psychosomatics, 40(5), 422–427.

    Google Scholar 

  • Eaton, W. W., & Kessler, L. G. (1985). Epidemiologic field methods in psychiatry: The NIMH Epidemiologic Catchment Area Program. Orlando, FL: Academic Press.

    Google Scholar 

  • Fleet, R. P., Dupuis,G., Kaczorowski, J., Marchand, A., & Beitman, B. D. (1997). Suicidal ideation in emergency department chest pain patients: Panic disorder as a risk factor. American Journal of Emergency Medicine, 15(4), 345–349.

    Google Scholar 

  • Fleet, R. P., Dupuis, G., Marchand, A., Burelle, D., Arsenault, A., & Beitman, B. D. (1996). Panic disorder in emergency department chest pain patients: Prevalence, comorbidity, suicidal ideation, and physician recognition. The American Journal of Medicine, 101 ,371–380.

    Google Scholar 

  • Fleet, R. P., Dupuis, G., Marchand, A., Burelle, D., & Beitman, B. D. (1997). Detecting panic disorder in emergency department chest pain patients:Avalidated model to improve recognition. Annals of Behavioral Medicine, 19(2), 124–131.

    Google Scholar 

  • Fleet, R. P., Dupuis, G., Marchand, A., Kaczorowski, J., Burelle, D., Arsenault, A., et al. (1998). Panic disorder in coronary artery disease patients with noncardiac chest pain. Journal of Psychosomatic Research, 44(1), 81–90.

    Google Scholar 

  • Fleet, R. P., Marchand, A., Dupuis,G., Kaczorowski, J., & Beitman, B. D. (1998). Comparing emergency department and psychiatric setting patients with panic disorder. Psychosomatics, 39(6), 512–518.

    Google Scholar 

  • Fleet, R. P., Martel, J.-P., Lavoie, K. L., Dupuis, G., & Beitman, B. D. (2000). Non-fearful panic disorder: A variant of panic in medical patients? Psychosomatics, 41(4), 311–320.

    Google Scholar 

  • Fontaine, R. (1991). The role of the primary care physician in the treatment of panic disorder. In J. R. Walker, G. R. Norton, & C. A. Ross (Eds.), Panic disorder and agoraphobia: A comprehensive guide for the practitioner (pp. 352–367). Pacific Grove, CA: Brooks/Cole.

    Google Scholar 

  • Friedman, S., Jones, J. C., Chernen, L., & Barlow, D. H. (1992). Suicidal ideation and suicide attempts among patients with panic disorder: A survey of two outpatient clinics. American Journal of Psychiatry, 149 ,680–685.

    Google Scholar 

  • Friedman, S., Paradis, C. M., & Hatch, M. L. (1994). Issues of misdiagnosis in panic disorder with agoraphobia. In S. Friedman (Ed.), Anxiety disorders in African Americans (pp. 128–146). New York: Springer-Verlag.

    Google Scholar 

  • Gater, R., Tansella, M., Korten, A., Tiemens, B. G., Mavreas, V. G., & Olatawura, M. O. (1998). Sex differences in the prevalence and detection of depressive and anxiety disorders in general health care settings: Report from the World Health Organization collaborative study on psychological problems in general health care. Archives of General Psychiatry, 55 ,405–413.

    Google Scholar 

  • Gerdes, T., Yates, W. R., & Clancy, G. (1995). Increasing identi-fication and referral of panic disorder over the past decade. Psychosomatics, 36(5), 480–486.

    Google Scholar 

  • Gold, I., & Baraff, L. J. (1989). Psychiatric screening in the emergency department: Its effect on physician behavior. Annals of Emergency Medicine, 18(8), 875–880.

    Google Scholar 

  • Gold, I., Haughey, L., & Baraff, L. J. (1985). Psychiatric screening in the emergency department: Validation of the General Health Questionnaire. American Journal of Emergency Medicine, 3(5), 419–422.

    Google Scholar 

  • Goldberg, D. P. (1972). The detection of psychiatric illness by questionnaire. Atechnique for the identification and assessment of non-psychotic psychiatric illness. Oxford: Oxford University Press.

    Google Scholar 

  • Goldberg, R. J. (1995). Psychiatry and the practice of medicine: The need to integrate psychiatry into comprehensive medical care. Southern Medical Journal, 88(3), 260–267.

    Google Scholar 

  • Greenberg, P. E., Sisitsky, T., Kesler, R. C., Finkelstein, S. N., Berndt, E. R., Davidson, J. R. T., et al. (1999). The economic burden of anxiety disorders in the 1990s. Journal of Clinical Psychiatry, 60(7), 427–435.

    Google Scholar 

  • Huffman, J. C., & Pollack, M. H. (2003). Predicting panic disorder among patients with chest pain: An analysis of the literature. Psychosomatics, 44(3), 222–236.

    Google Scholar 

  • Johnson, J., Weissman, M. M., & Klerman, G. L. (1990). Panic disorder, comorbidity, and suicide attempts. Archives of General Psychiatry, 47 , 805–808.

    Google Scholar 

  • Johnson, M. R., Gold, P. B., Siemion, L., Magruder, K. M., Frueh, B. C., & Santos, A. B. (2000). Panic disorder in primary care: Patients' attributions of illness causes and willingness to accept psychiatric treatment. International Journal of Psychiatry in Medicine, 30(4), 367–384.

    Google Scholar 

  • Katerndahl, D. A. (1990). Factors associated with persons with panic attacks seeking medical care. Family Medicine, 22(6), 462–466.

    Google Scholar 

  • Katerndahl, D. A. (2003). Predictors and outcomes in people told that they have panic attacks. Depression and Anxiety, 17 , 98–100.

    Google Scholar 

  • Katerndahl, D. A., & Realini, J. P. (1995). Where do panic attack sufferers seek care? The Journal of Family Practice, 40(3), 237–243.

    Google Scholar 

  • Katerndahl, D. A., & Realini, J.P. (1997). Use of health care services by persons with panic symptoms. Psychiatric Services, 48(8), 1027–1032.

    Google Scholar 

  • Katon, W. (1984). Panic disorder and somatization: Review of 55 cases. The American Journal of Medicine, 77 ,101–106.

    Google Scholar 

  • Katon, W. (1986). Panic disorder: Epidemiology, diagnosis, and treatment in primary care. Journal of Clinical Psychiatry, 47(Suppl. 10), 21–27.

    Google Scholar 

  • Katon,W. (1996). Panic disorder: Relationship to high medical utilization, unexplained physical symptoms, and medical costs. Journal of Clinical Psychiatry, 57(Suppl. 10), 11–22.

    Google Scholar 

  • Katon, W., Vitaliano, P. P., Russo, J., Cormier, L., Anderson, K., & Jones, M. (1986). Panic disorder: Epidemiology in primary care. Journal of Family Practice, 23(3), 233–239.

    Google Scholar 

  • Katon, W. J., Von Korff, M., & Lin, E. (1992). Panic disorder: Relationship to high medical utilization. The American Journal of Medicine, 92(Suppl. 1A), 7S–11S.

    Google Scholar 

  • Katschnig, H., & Amering,M. (1998).The long term course of panic disorder and its predictors. Journal of Clinical Psychopharmacology, 18(6, Suppl. 2), 6S–11S.

    Google Scholar 

  • Kennedy, B. L., & Schwabb, J. J. (1997). Utilization of medical specialists by anxiety disorder patients. Psychosomatics, 38(2), 109–112.

    Google Scholar 

  • Klein, D. F. (1998). The significance of panic in general medicine. Journal of Psychosomatic Research, 44(1), 17–19.

    Google Scholar 

  • Klein, E., Linn, S., Colin, V., Lang, R., Pollack, S., & Lenox, R. H. (1995). Anxiety disorders among patients in a general emergency service in Israel. Psychiatric Services, 46(5), 488–492.

    Google Scholar 

  • Klerman, G. L., Weissman, M. M., Ouellette, R., Johnson, J., & Greenwald, S. (1991). Panic attacks in the community: Social morbidity and health care utilization. JAMA, 265(6), 742–746.

    Google Scholar 

  • Kroenke, K. (1992). Symptoms in medical patients: An untended field. The American Journal of Medicine, 92(Suppl. 1A), 3S–6S.

    Google Scholar 

  • Kushner, M. G., Beitman, B. D., & Beck, N. C. (1989). Factors predictive of panic disorder in cardiology patients with chest pain and no evidence of coronary artery disease:Across-validation. Journal of Psychosomatic Research, 33(2), 207–215.

    Google Scholar 

  • Lareau, M. W., & Nelson, E. S. (1994). The physician and licensed mental health professional team: Prevalence and feasibility. Family Systems Medicine,12(1), 37–45.

    Google Scholar 

  • Leon, A. C., Olfson, M., & Portera, L. (1997). Service utilization and expenditures for the treatment of panic disorder. General Hospital Psychiatry, 19 , 82–88.

    Google Scholar 

  • Leon, A. C., Olfson, M., Weissman, M. M., Portera, L., Fireman, B. H., Blacklow, R. S., et al. (1996). Brief screens for mental disorders in primary care. Journal of General Internal Medicine, 11 ,426–430.

    Google Scholar 

  • Lerner, J. A., Lawton, J. K., Albano, A.M., Mayer,D., Ross, M. S., & Barlow, D.H. (1995, November).Adescriptive study of panickers visiting emergency departments. Poster session presented at the 29th Annual Meeting of the Association for the Advancement of Behavior Therapy, Washington, DC.

  • Markowitz, J. S., Weissman, M. M., Ouellette, R., Lish, J. D., & Klerman, G. L. (1989). Quality of life in panic disorder. Archives of General Psychiatry, 46 , 984–992.

    Google Scholar 

  • Merritt, T. C. (2000). Recognition and acute management of patients with panic attacks in the emergency department. Emergency Medicine Clinics of North America, 18(2), 289–300.

    Google Scholar 

  • Murphy, J. G., Fenichel, G. S., & Jacobson, S. (1983). Psychiatry in the emergency department: Factors associated with treatment and disposition. American Journal of Emergency Medicine, 2(4), 309–314.

    Google Scholar 

  • Neighbors, H. W. (1988). The help seeking behavior of Black Americans: A summary of findings from the National Survey of Black Americans. Journal of the National Medical Association, 80(9), 1009–1012.

    Google Scholar 

  • Nelles, W. B., & Barlow, D. H. (1988). Do children panic? Clinical Psychology Review, 8(4), 359–372.

    Google Scholar 

  • Noyes, R., Reich, J., Clancy, J., & O'Gorman,W. (1986). Reduction in hypochondriasis with treatment of panic disorder. British Journal of Psychiatry, 149 ,631–635.

    Google Scholar 

  • Ollendick, T. H. (1998). Panic disorder in children and adolescents: New developments, new directions. Journal of Clinical Child Psychology, 27(3), 234–245.

    Google Scholar 

  • Ormel, J., van den Brink, W., Koeter, M. W. J., Giel, R., van der Meer, K., van de Willige, G., et al. (1990). Recognition, management, and outcome of psychological disorders in primary care: A naturalistic follow-up study. Psychological Medicine, 20 , 909–923.

    Google Scholar 

  • Paradis, C. M., Friedman, S., Lazar, R.M., Grubea, J., & Kesselman, M. (1992). Use of a structured interview to diagnose anxiety disorders in a minority population. Hospital and Community Psychiatry, 43(1), 61–64.

    Google Scholar 

  • Pollard, C. A., & Lewis, L. M. (1989). Managing panic attacks in emergency patients. The Journal of Emergency Medicine, 7 ,547–552.

    Google Scholar 

  • Reiger, D. A., Myers, J. K., Kramer, M., Robins, L. N., Blazer, D. H., Hough, R. L., et al. (1984). The NIMH Epidemiologic Catchment Area Program: Historical context, major obstacles, and study population characteristics. Archives of General Psychiatry, 41 ,934–941.

    Google Scholar 

  • Robins, L. N., Helzer, J. E., Croughan, J. L., & Ratcliff, K. S. (1981). National Institute of Mental Health Diagnostic Interview Schedule. Its history, characteristics, and validity. Archives of General Psychiatry, 38(4), 381–389.

    Google Scholar 

  • Ross, C. A., Walker, J. R., Norton, G. R., & Neufeld, K. (1988). Management of anxiety and panic attacks in immediate care facilities. General Hospital Psychiatry, 10 ,129–131.

    Google Scholar 

  • Roy-Byrne, P. P., Clary, C. M., Miceli, R. J., Colucci, S. V., Xu, Y., & Grudzinski, A. N. (2001). The effect of selective serotonin reuptake inhibitor treatment of panic disorder on emergency room and laboratory resource utilization. Journal of Clinical Psychiatry, 62(9), 678–682.

    Google Scholar 

  • Roy-Byrne, P. P., & Katon,W. (2000). Anxiety management in the medical setting: Rationale, barriers to diagnosis and treatment, and proposed solutions. In D. I. Mostofsky & D. H. Barlow (Eds.), The management of stress and anxiety in medical disorders (pp. 1–14). Boston: Allyn and Bacon.

    Google Scholar 

  • Roy-Byrne, P. P., Katon,W., Cowley, D. S., & Russo, J. (2003).Arandomized effectiveness trial of collaborative care for patients with panic disorder in primary care. Archives of General Psychiatry, 58(9), 869–876.

    Google Scholar 

  • Roy-Byrne, P. P., Katon, W., Cowley, D. S., Russo, J. E., Cohen, E., Michelson, E., et al. (2000). Panic disorder in primary care: Biopsychosocial differences between recognized and unrecognized patients. General Hospital Psychiatry, 22 ,405–411.

    Google Scholar 

  • Roy-Byrne, P. P., Russo, J., Cowley, D. S., & Katon, W. J. (2003). }Panic disorder in public sector primary care: Clinical characteristics and illness severity compared with “mainstream” primary care panic disorder}. Depression and Anxiety, 17 , 51–57.

    Google Scholar 

  • Roy-Byrne, P. P., Stein, M. B., Russo, J., Mercier, E., Thomas, R., McQuaid, J., et al. (1999). Panic disorder in the primary care setting: Comorbidity, disability, service utilization, and treatment. Journal of Clinical Psychiatry, 60(7), 492–499.

    Google Scholar 

  • Salvador-Carulla, L., Seguí, J., Fernández-Cano, P., & Canet, J. (1995). Cost and offset effect in panic disorders. British Journal of Psychiatry, 166(Suppl. 27), 23–28.

    Google Scholar 

  • Schriger, D. L., Gibbons, P. S., Langone, C. A., Lee, S., & Altshuler, L. L. (2001). Enabling the diagnosis of occult psychiatric illness in the emergency department: A randomized, controlled trial of the computerized, self-administered PRIME-MD diagnostic system. Annals of Emergency Medicine, 37(2), 132–140.

    Google Scholar 

  • Segee, P. F., Maguire, L., Ross, J., Malik, M. L., Colket, J., & Davidson, J. R. T. (1999). Demographics, treatment seeking, and diagnoses of anxiety support group participants. Journal of Anxiety Disorders, 13(3), 315–334.

    Google Scholar 

  • Sheikh, J. I., & S alzman, C. (1995). Anxiety in the elderly: Course and treatment. The Psychiatric Clinics of North America, 18(4), 871–883.

    Google Scholar 

  • Shulman, I.D., Cox, B. J., Swinson, R.P., Kuch, K., & Reichman, J.T. (1994). Precipitating events, locations and reactions associated with initial unexpected panic attacks. Behaviour Research and Therapy, 32(1), 17–20.

    Google Scholar 

  • Simpson, R. J., Kazmierczak, T., Power, K. G., & Sharp, D. M. (1994). Controlled comparison of the characteristics of patients with panic disorder. British Journal of General Practice, 44 ,352–356.

    Google Scholar 

  • Spitzer, R. L., Williams, J. B. W., Kroenke, K., Linzer, M., deGruy, F. V., III, Hahn, S. R., et al. (1994). Utility of a new procedure for diagnosing mental disorders in primary care: The PRIMEMD 1000 study. JAMA,272(22), 1749–1756.

    Google Scholar 

  • Swinson, R. P., Soulios,C., Cox, B. J., & Kuch, K. (1992). Brief treatment of emergency room patients with panic attacks. American Journal of Psychiatry, 149(7), 944–946.

    Google Scholar 

  • Stein, M. B., Roy-Byrne, P. P., McQuaid, J. R., Laffaye, C., Russo, J., McCahill, M. E., et al. (1999). Development of a brief diagnostic screen for panic disorder in primary care. Psychosomatic Medicine, 61 ,359–364.

    Google Scholar 

  • Tiemens, B. G., Ormel, J., Jenner, J. A., van der Meer, K., van Os, T. W. D. P., van den Brink, R. H. S., et al. (1999). Training primary-care physicians to recognize, diagnose and manage depression: Does it improve patient outcomes? Psychological Medicine, 29(4), 833–845.

    Google Scholar 

  • Tommasini, N. R., & Federici, C. M. (1993). Recognition of panic disorder in the emergency department. Journal of Emergency Nursing, 18(4), 319-325.

    Google Scholar 

  • Ware, M. R., DeVane, C. L., & Hall, K. L. (1992). Panic disorder: Recognizing and managing the “real thing.” Postgraduate Medicine, 91 ,99–108.

    Google Scholar 

  • Warshaw, M. G., Massion, A. O., Peterson, L. G., Pratt, L. A., & Keller, M. B. (1995). Suicidal behavior in patients with panic disorder: Retrospective and prospective data. Journal of Affective Disorders, 34 ,235–247.

    Google Scholar 

  • Watkins, P. L. (1999). Manualized treatment of panic disorder in a medical setting: Two illustrative case studies. Journal of Clinical Psychology in Medical Settings, 6(4), 353–372.

    Google Scholar 

  • Watkins, P. L., Nock, C., Champion, J., & Lidren, D. M. (1996). Practitioner-patient communication in the presentation of panic symptoms. Mind/Body Medicine, 1(4), 177–191.

    Google Scholar 

  • Weissman, M. M., Klerman, G. L., Markowitz, J. S., & Ouellette, R. (1989). Suicidal ideation and suicide attempts in panic disorder and attacks.The New England Journal of Medicine, 321(18), 1209–1214.

    Google Scholar 

  • Woodruff-Borden, J., Meeks, S., Depp, C., & McNally, N. (2000). Characteristics of self-reported panic among older adults. Poster session presented at the 34th annual meeting of The Association for Advancement of Behavior Therapy, New Orleans.

  • Woodruff-Borden, J., Stanley, M. A., Lister, S.C., & Tabacchi, M. R. (1997). Nonclinical panic and suicidality: Prevalence and psychopathology. Behavior Research and Therapy, 35(2), 109–116.

    Google Scholar 

  • Worthington, J. J., III, 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. The Journal of Nervous and Mental Disease, 185(4), 274–276.

    Google Scholar 

  • Wulsin, L. R., Arnold, L. M., & Hillard, J. R. (1991). Axis I disorders in ER patients with atypical chest pain. International Journal of Psychiatry in Medicine, 21(1), 37–46.

    Google Scholar 

  • Wulsin, L. R., Hillard, J. R., Geier, P., Hissa, D., & Rouan, G. W. (1988). Screening emergency room patients with atypical chest pain for depression and panic disorder. International Journal of Psychiatry in Medicine, 18(4), 315–323.

    Google Scholar 

  • Wulsin, L., Liu, T., Storrow, A., Evans, S., Dewan, N., & Hamilton, C. (2002). A randomized, controlled trial of panic disorder treatment initiation in an emergency department chest pain center. Annals of Emergency Medicine, 39(2), 139–143.

    Google Scholar 

  • Yingling, K. W., Wulsin, L. R., Arnold, L. M., & 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 Medicine, 8 , 231–235.

    Google Scholar 

  • Zaubler, T. S., & Katon, W. (1998). Panic disorder in the general medical setting.Journal of Psychosomatic Research, 44(1), 25–42.

    Google Scholar 

  • Zun, L. S. (1997). Panic disorder: Diagnosis and treatment in emergency medicine. Annals of Emergency Medicine, 30(1), 92–96.

    Google Scholar 

  • Zung, W.W. (1971).Arating instrument for anxiety disorders. Psychosomatics, 12(6), 371–379.

    Google Scholar 

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Harvison, K.W., Woodruff-Borden, J. & Jeffery, S.E. Mismanagement of Panic Disorder in Emergency Departments: Contributors, Costs, and Implications for Integrated Models of Care. Journal of Clinical Psychology in Medical Settings 11, 217–232 (2004). https://doi.org/10.1023/B:JOCS.0000037616.60987.89

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