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Panic Disorder

Panic Disorder Index Key Ideas
"SOAP" Outline Signs and Symptoms
Differential Diagnosis Clinical Management of Panic Disorder
Medication "Scorecard" Psychosocial, Healthcare and Economic Effects

Associated Costs and Complications


Topics

  1. Overall Healthcare Costs
  2. Diagnostic Costs and Delays
  3. Psychosocial Effects

Healthcare Costs

  1. Increased primary care visits
    Approximately five to eight times more than patients with no psychiatric illness
  2. Increased specialist referrals
  3. Increased treatment costs but decreased overall healthcare costs after diagnosis
    1. Hospitalization drops from 13 to 0% of total costs
    2. Medical visits drop from 40 to 2% of total costs
  4. Psychiatric care accounted for approximately 66% of costs after diagnosis
  5. Drug costs increased from 10 to 25% of costs after diagnosis
    Salvador-Carulla et al.
    Brit. J. Psychiatry 1995 166(suppl 27): 23-28
  6. Fair to poor rating of overall health (self-report)
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Diagnostic Costs and Delays

  1. Screening instruments for panic disorder are available
    1. These instruments are underused in primary care setting
    2. Diagnosis and effective treatment are delayed
  2. Unnecessary medical tests are performed for a number of complaints:
    1. Irritable bowel syndrome
    2. Labile hypertension
    3. Headaches
    4. Dizziness
    5. Chest pain assessment costs $33 million annually with panic disorder
      Assessment:
      Negative cardiologic workup for chest pain
      Plan:
      Screen for panic disorder and depression

      Beitman et al.
      Am. J. Med. 1992 92(suppl 1A): 7S
      Katon et al.
      JAMA 1991 265: 1545-1549
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Psychosocial Effects

  1. Interference with relationships (spouse and family)
  2. Psychiatric hospitalizations (35%)
  3. Financial dependency (27% receive disability or welfare)
  4. Two or more psychiatric conditions (56%)
  5. Fair to poor emotional health (self-report: 40%)
    Kessler et al.
    Arch. Gen. Psychiatry 1994 51: 8-19
  6. Impact on emotional health similar to severity seen with depression
    Weissman
    J. Clin. Psychiatry 1991 2(suppl): 6-8
  7. Panic disorder and comorbid depression (50-65%) are associated with significant psychosocial problems
    1. The symptoms are more severe
    2. The social function may be subject to greater impairment
    3. Work performance may be subject to greater impairment
    4. Short-term and long term prognoses are worse
    5. Suicide attempts are more frequent
  8. Alcohol abuse is common (40%)
    Elliott
    Primary Psychiatry 1995 52-59
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