Korean Journal of Psychosomatic Medicine (정신신체의학)

Korean Psychosomatic Society (한국정신신체의학회)
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Clinical Characteristics in Panic Disorder Patients in Emergency Department

공황발작으로 응급실에 내원한 공황장애 환자들의 임상 특징

  • Lee, Chang-Ju (Department of Psychiatry, School of Medicine, Konkuk University) ;
  • Nam, Beom-Woo (Department of Psychiatry, School of Medicine, Konkuk University) ;
  • Sohn, In-Ki (Department of Psychiatry, Keyo Hospital)
  • 이창주 (건국대학교 충주병원 정신건강의학과) ;
  • 남범우 (건국대학교 충주병원 정신건강의학과) ;
  • 손인기 (계요병원 정신건강의학과)
  • Received : 2021.03.31
  • Accepted : 2021.06.17
  • Published : 2021.06.30
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Abstract

Objectives : This study was designed to investigate datas related to panic attack and treatment in emergency room of panic disorder patients who visited emergency room for panic attack. Methods : A retrospective analysis of medical records was conducted on 92 patients with panic disorder who visited Chungju Konkuk university hospital emergency department due to panic attack and had bodily symptoms from 1st January 2010 to 31th December 2019. In addition to demographic characteristics and comorbid disorders, triggering stressors and alcohol consumption were corrected as pre-panic attack datas, bodily symptoms at the time of panic attack were corrected as datas during attack, electrocardiogram trial, consultation with psychiatrist, admission and information of used psychotropic drugs were corrected as post-attack data. Depending on size of data, Chi-square test or Fisher's exact test was used. Collected data was analyzed using R 4.03. Results : Cardiovascular disease was accompanied by 5.4% and depressive disorder was the most common coexisting mental disorder. Among triggering stressors, economic problem/work-related stress was significantly higher in men than women (𝛘2=4.322, p<0.005). The most common physical symptom during attack was circulatory (65.2%), followed by respiratory (57.6%), numbness-paralysis (33.7%), dizziness (19.6%), gastro-intestinal (14.1%) and autonomic symptom (12.0%). Electrocardiogram was taken at higher rate when patients complained circulatory symptom (𝛘2=8.46, p<0.005). The psychotropic drug most commonly used in emergency room was lorazepam, used in 92.1%. Conclusions : The most common bodily symptom during panic attack was circulatory symptom and the most common triggering stressor in men was economic problem/work-related stress. The most commonly used psychotropic for panic attack was lorazepam.

연구목적 본 연구에서는 공황발작을 주소로 응급실에 내원한 공황장애 환자들의 공황발작 관련 데이터와 응급실에서의 처치를 알아보고자 하였다. 방 법 공황발작으로 일 대학병원 응급실에 내원한 공황장애 환자들 중 의무기록에 신체증상이 기재되어 있는 92명을 대상으로 후향적 의무기록 분석을 진행하였다. 인구사회학적 특성 및 공존 질환과 발작 전 데이터로 촉발 스트레스 인자와 음주 유무, 발작 중 데이터로 발작 당시 신체증상, 발작 후 데이터로 심전도 시행 여부와 정신건강의학과 협진 및 입원 여부 그리고 정신작용제 사용에 대한 정보를 조사하였다. 자료의 크기에 따라 카이제곱 검정(Chi-square test) 또는 피셔의 정확검정(Fisher's exact test)을 이용하였다. 수집된 자료는 R 4.03을 이용하여 분석하였다. 결 과 공존 심혈관계 질환이 동반된 경우는 5.4%였고, 공존 정신 질환으로는 92명중 14명에서 동반된 우울장애가 가장 흔했다. 촉발 스트레스 요인 중 남성에서는 여성에 비해 경제적 어려움/직장 관련 스트레스가 유의미하게 많았다(𝛘2=4.322, p<0.005). 발작 시 신체증상으로는 순환기 증상이 65.2%, 호흡기57.6%, 사지 감각기 33.7%, 어지럼19.6%, 소화기 14.1%, 자율신경계 12.0% 순이었다. 순환기 증상이 있을 때 심전도 시행율이 유의미하게 높았다(𝛘2=8.46, p<0.005). 응급실에서 가장 흔히 사용된 정신작용제는 92.1%에서 사용된 로라제팜(lorazepam)이었다. 결 론 본 연구결과, 공황발작 시 가장 흔한 신체증상은 순환기 증상이었고, 남자에게서 가장 흔한 촉발 스트레스 인자는 경제적 어려움/직장 관련 스트레스였다. 공황발작의 처치를 위해 가장 흔히 사용된 정신작용제는 로라제팜(lorazepam)이었다.

Keywords

References

  1. Buccelletti F, Ojetti V, Merra G, Carroccia A, Marsiliani D, Mangiola F, Calabro G, Iacomini P, Zuccala G, Franceschi F. Recurrent use of the Emergency Department in patients with anxiety disorder. Eur Rev Med Pharmacol Sci 2013;17:100-106.
  2. Sherbourne CD, Wells KB, Judd LL. Functioning and wellbeing of patients with panic disorder. Am J Psychiatry 1996;153:213-218. https://doi.org/10.1176/ajp.153.2.213
  3. Zane RD, McAfee AT, Sherburne S, Billeter G, Barsky A. Panic disorder and emergency services utilization. Acad Emerg Med 2003;10:1065-1069. https://doi.org/10.1197/S1069-6563(03)00349-X
  4. Kessler RC, Chiu WT, Jin R, Ruscio AM, Shear K, Walters EE. The epidemiology of panic attacks, panic disorder, and agoraphobia in the national comorbidity survey replication. Arch Gen Psychiatry 2006;63:415. https://doi.org/10.1001/archpsyc.63.4.415
  5. Dark T, Flynn HA, Rust G, Kinsell H, Harman JS. Epidemiology of emergency department visits for anxiety in the United States: 2009-2011. Psychiatr Serv 2017;68:238-244. https://doi.org/10.1176/appi.ps.201600148
  6. Lepine JP. The epidemiology of anxiety disorders: prevalence and societal costs. J Clin Psychiatry 2002;63(suppl 14):4-8. https://doi.org/10.4088/JCP.v63n0101
  7. Zun LS. Panic disorder: diagnosis and treatment in emergency medicine. Ann Emerg Med 1997;30:92-96. https://doi.org/10.1016/S0196-0644(97)70117-3
  8. Sung SC, Rush AJ, Earnest A, Lim LEC, Pek MPP, Choi JMF, Ng MPK, Ong MEH. A brief interview to detect panic attacks and panic disorder in emergency department patients with cardiopulmonary complaints. J Psychiatr Pract 2018;24:32-44. https://doi.org/10.1097/PRA.0000000000000283
  9. Fleet RP, Dupuis G, Marchand A, Burelle D, Arsenault A, Beitman BD. Panic disorder in emergency department chest pain patients: prevalence, comorbidity, suicidal ideation, and physician recognition. Am J Med 1996;101:371-380. https://doi.org/10.1016/S0002-9343(96)00224-0
  10. Yingling KW, Wulsin LR, Arnold LM, Rouan GW. Estimated prevalences of panic disorder and depression among consecutive patients seen in an emergency department with acute chest pain. J Gen Intern Med 1993;8:231-235. https://doi.org/10.1007/BF02600087
  11. Katon W, Hall ML, Russo J, Cormier L, Hollifield M, Vitaliano PP, Beitman BD. Chest pain: Relationship of psychiatric illness to coronary arteriographic results. Am J Med 1988;84:1-9.
  12. Lee HJ, Gim MS, Kim SJ, Park SC, Yang JC, Lee KU, Lee SH, Lee SJ, Lim SW, Chae JH, Han SW, Hong JP, Seo HJ. The bodily panic symptoms and predisposing stressors in Korean patients with panic disorder. J Korean Neuropsychiatr Assoc 2019;58:339-345. https://doi.org/10.4306/jknpa.2019.58.4.339
  13. Greenslade JH, Hawkins T, Parsonage W, Cullen L. Panic Disorder in patients presenting to the emergency department with chest pain: prevalence and presenting symptoms. Heart Lung Circ 2017;26:1310-1316. https://doi.org/10.1016/j.hlc.2017.01.001
  14. Demiryoguran NS, Karcioglu O, Topacoglu H, Kiyan S, Ozbay D, Onur E, Korkmaz T, Demir OF. Anxiety disorder in patients with non-specific chest pain in the emergency setting. Emerg Med J 2006;23:99-102. https://doi.org/10.1136/emj.2005.025163
  15. Pelland ME, Marchand A, Lessard MJ, Belleville G, Chauny JM, Vadeboncoeur A, Poitras J, Foldes-Busque G, Bacon SL, Lavoie KL. Efficacy of 2 interventions for panic disorder in patients presenting to the ED with chest pain. Am J Emerg Med 2011;29:1051-1061. https://doi.org/10.1016/j.ajem.2010.06.027
  16. Foldes-Busque G, Marchand A, Chauny JM, Poitras J, Diodati J, Denis I, Lessard MJ, Pelland ME, Fleet R. Unexplained chest pain in the ED: could it be panic? Am J Emerg Med 2011;29:743-751. https://doi.org/10.1016/j.ajem.2010.02.021
  17. Klauke B, Deckert J, Reif A, Pauli P, Domschke K. Life events in panic disorder-an update on "candidate stressors". Depress Anxiety 2010;27:716-730. https://doi.org/10.1002/da.20667
  18. Ross CA, Walker JR, Norton GR, Neufeld K. Management of anxiety and panic attacks in immediate care facilities. Gen Hosp Psychiatry 1988;10:129-131. https://doi.org/10.1016/0163-8343(88)90098-9
  19. Chen MH, Tsai SJ. Treatment-resistant panic disorder: clinical significance, concept and management. Prog Neuropsychopharmacol Biol Psychiatry 2016;70:219-226. https://doi.org/10.1016/j.pnpbp.2016.02.001
  20. Uhde TW, Boulenger JP, Roy-Byrne PP, Geraci MF, Vittone BJ, Post RM. Longitudinal course of panic disorder: clinical and biological considerations. Prog Neuropsychopharmacol Biol Psychiatry 1985;9:39-51. https://doi.org/10.1016/0278-5846(85)90178-2
  21. McNally RJ. Panic and posttraumatic stress disorder: implications for culture, risk, and treatment. Cogn Behav Ther 2008;37:131-134. https://doi.org/10.1080/16506070801969120
  22. Fleet RP, Marchand, A, Dupuis G, Kaczorowski J, Beitman BD. Comparing emergency department and psychiatric setting patients with panic disorder. Psychosomatics 1998;39:512-518. https://doi.org/10.1016/S0033-3182(98)71283-6
  23. Lynch P, Galbraith KM. Panic in the emergency room. Can J Psychiatry 2003;48:361-366. https://doi.org/10.1177/070674370304800601
  24. Barzega G, Maina G, Venturello S, Bogetto F. Gender-related differences in the onset of panic disorder. Acta Psychiatr Scand 2001;103:189-195. https://doi.org/10.1034/j.1600-0447.2001.00194.x
  25. Meuret AE, Kroll J, Ritz T. Panic disorder comorbidity with medical conditions and treatment implications. Annu Rev Clin Psychol 2017;13:209-240. https://doi.org/10.1146/annurev-clinpsy-021815-093044
  26. Cox BJ, Swinson RP, Endler NS, Norton GR. The symptom structure of panic attacks. Compr Psychiatry 1994;35:349-353. https://doi.org/10.1016/0010-440X(94)90274-7
  27. Saeed SA, Bruce TJ. Panic disorder: effective treatment options. Am Fam Physician 1998;57:2405-2412