• R P Fleet, G Dupuis, A Marchand, D Burelle, A Arsenault, and B D Beitman.
• Montreal Heart Institute, Quebec, Canada.
• Am. J. Med. 1996 Oct 1;101(4):371-80.

PurposeTo establish the prevalence of panic disorder in emergency department (ED) chest pain patients; compare psychological distress and recent suicidal ideation in panic and non-panic disorder patients; assess psychiatric and cardiac comorbidity; and examine physician recognition of this disorder.DesignCross-sectional survey (for psychiatric data). Prospective evaluation of patient discharge diagnoses and physician recognition of panic disorder.SettingThe ambulatory ED of a major teaching hospital specializing in cardiac care located in Montreal, Canada.SubjectsFour hundred and forty-one consenting, consecutive patients consulting the ED with a chief complaint of chest pain.Primary Outcome MeasurePsychiatric diagnoses (AXIS I). Psychological and pain test scores, discharge diagnoses, and cardiac history.ResultsApproximately 25% (108/441) of chest pain patients met DSM-III-R criteria for panic disorder. Panic disorder patients displayed significantly higher panic-agoraphobia, anxiety, depression, and pain scores than non-panic disorder patients (P < 0.01). Twenty-five percent of panic disorder patients had thoughts of killing themselves in the week preceding their ED visit compared with 5% of the patients without this disorder (P = 0.0001) even when controlling for co-existing major depression. Fifty-seven percent (62/108) panic disorder patients also met criteria for one or more current AXIS I disorder. Although 44% (47/108) of the panic disorder patients had a prior documented history of coronary artery disease (CAD), 80% had atypical or nonanginal chest pain and 75% were discharged with a "noncardiac pain" diagnosis. Ninety-eight percent of the panic patients were not recognized by attending ED cardiologists.ConclusionsPanic disorder is a significantly distressful condition highly prevalent in ED chest pain patients that is rarely recognized by physicians. Nonrecognition may lead to mismanagement of a significant group of distressed patients with or without coronary artery disease.

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