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Am J Psychiatry 1992; 149:944-946
Copyright © 1992 by American Psychiatric Association
Brief treatment of emergency room patients with panic attacks
RP Swinson, C Soulios, BJ Cox and K Kuch
Anxiety Disorders Clinic, Clarke Institute of Psychiatry, Toronto, ON, Canada.
OBJECTIVE: Most research on treatment for panic disorder has involved
chronic forms of the illness. To determine the efficacy of early
intervention, the authors examined the effects of treatment for patients
with panic attacks who were seen in the emergency room, which is the first
point of contact with the health delivery system for many persons with
panic attacks. METHOD: The subjects were 33 patients with panic attacks
seen in two emergency rooms. The presence of panic attacks was confirmed
with a modified version of the Structured Clinical Interview for DSM-III-R;
approximately 40% of the patients met the DSM-III-R criteria for panic
disorder with agoraphobia. The patients were randomly assigned to groups
receiving reassurance (N = 16) or exposure instruction (N = 17). Scores on
the Fear Questionnaire agoraphobia subscale, Mobility Inventory, and Beck
Depression Inventory and the frequency of panic attacks were determined at
baseline, 3 months, and 6 months. RESULTS: The subjects who received
exposure instruction significantly improved over the 6-month period on
depression, avoidance, and panic frequency. The reassurance subjects did
not improve on any measure and eventually reported more agoraphobic
avoidance. CONCLUSIONS: These results suggest that early intervention with
exposure instruction may reduce the long-term consequences of panic
attacks. The exposure instruction was of value even though the subjects had
relatively low levels of avoidance at the outset of the study.
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