Panic in the emergency room.

OBJECTIVE This paper examines the relation between coronary artery disease (CAD) and panic disorder (PD), discusses the implications of this relation to the general medical system, and suggests future assessment and intervention strategies for emergency departments. METHOD We reviewed the literature on CAD and PD using Medline and PsycINFO. RESULTS PD is more expensive to our nonpsychiatric, general medical system than any other psychiatric condition. The main reason for PD patients' continued use of general medicine for their psychological symptoms is that their PD remains undiagnosed. In the emergency room (ER), PD patients with chest pain have their PD go undiagnosed about 98% of the time. By having ERs implement specific assessment and intervention strategies for patients presenting with chest pain, the savings to the general medical system could be substantial. CONCLUSIONS By improving recognition of PD in the ER, there is the potential to generate large savings in general medical care. With the availability of empirically supported or effective psychological and pharmacologic treatments for PD, appropriately diagnosing and subsequently treating patients with PD may prevent them from experiencing many years of disability and higher rates of fatal coronary events.