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Sung SC, Lim L, Lim SH, Finkelstein EA, Chin SLH, Annathurai A, Chakraborty B, Strauman TJ, Pollack MH, Ong MEH. Protocol for a multi-site randomized controlled trial of a stepped-care intervention for emergency department patients with panic-related anxiety. BMC Psychiatry 2022; 22:795. [PMID: 36527018 PMCID: PMC9756520 DOI: 10.1186/s12888-022-04387-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/11/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Approximately 40% of Emergency Department (ED) patients with chest pain meet diagnostic criteria for panic-related anxiety, but only 1-2% are correctly diagnosed and appropriately managed in the ED. A stepped-care model, which focuses on providing evidence-based interventions in a resource-efficient manner, is the state-of-the art for treating panic disorder patients in medical settings such as primary care. Stepped-care has yet to be tested in the ED setting, which is the first point of contact with the healthcare system for most patients with panic symptoms. METHODS This multi-site randomized controlled trial (RCT) aims to evaluate the clinical, patient-centred, and economic effectiveness of a stepped-care intervention in a sample of 212 patients with panic-related anxiety presenting to the ED of Singapore's largest public healthcare group. Participants will be randomly assigned to either: 1) an enhanced care arm consisting of a stepped-care intervention for panic-related anxiety; or 2) a control arm consisting of screening for panic attacks and panic disorder. Screening will be followed by baseline assessments and blocked randomization in a 1:1 ratio. Masked follow-up assessments will be conducted at 1, 3, 6, and 12 months. Clinical outcomes will be panic symptom severity and rates of panic disorder. Patient-centred outcomes will be health-related quality of life, daily functioning, psychiatric comorbidity, and health services utilization. Economic effectiveness outcomes will be the incremental cost-effectiveness ratio of the stepped-care intervention relative to screening alone. DISCUSSION This trial will examine the impact of early intervention for patients with panic-related anxiety in the ED setting. The results will be used to propose a clinically-meaningful and cost-effective model of care for ED patients with panic-related anxiety. TRIAL REGISTRATION ClinicalTrials.gov NCT03632356. Retrospectively registered 15 August 2018.
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Affiliation(s)
- Sharon C. Sung
- grid.428397.30000 0004 0385 0924Duke-NUS Medical School Singapore, 8 College Road, Singapore, 169857 Singapore
| | - Leslie Lim
- grid.163555.10000 0000 9486 5048Singapore General Hospital, Outram Road, Singapore, 169608 Singapore
| | - Swee Han Lim
- grid.163555.10000 0000 9486 5048Singapore General Hospital, Outram Road, Singapore, 169608 Singapore
| | - Eric A. Finkelstein
- grid.428397.30000 0004 0385 0924Duke-NUS Medical School Singapore, 8 College Road, Singapore, 169857 Singapore
| | - Steven Lim Hoon Chin
- grid.413815.a0000 0004 0469 9373Changi General Hospital, 2 Simei Street 3, Singapore, 529889 Singapore
| | - Annitha Annathurai
- grid.508163.90000 0004 7665 4668Sengkang General Hospital, 110 Sengkang E Way, Singapore, 544886 Singapore
| | - Bibhas Chakraborty
- grid.428397.30000 0004 0385 0924Duke-NUS Medical School Singapore, 8 College Road, Singapore, 169857 Singapore ,grid.4280.e0000 0001 2180 6431National University of Singapore, 6 Science Drive 2, Singapore, 117546 Singapore ,grid.26009.3d0000 0004 1936 7961Duke University, 2424 Erwin Road, Suite 1102, Durham, NC 27710 USA
| | - Timothy J. Strauman
- grid.189509.c0000000100241216Duke University Medical Center, 10 Duke Medicine Cir, Durham, NC 27710 USA
| | - Mark H. Pollack
- grid.240684.c0000 0001 0705 3621Rush University Medical Center, 1645 W. Jackson Blvd, Suite 400, Chicago, IL 60612 USA ,grid.476678.c0000 0004 5913 664XSage Therapeutics, 215 First Street, Cambridge, MA 02142 USA
| | - Marcus Eng Hock Ong
- grid.428397.30000 0004 0385 0924Duke-NUS Medical School Singapore, 8 College Road, Singapore, 169857 Singapore ,grid.163555.10000 0000 9486 5048Singapore General Hospital, Outram Road, Singapore, 169608 Singapore
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Tremblay MA, Denis I, Turcotte S, DeGrâce M, Tully PJ, Foldes-Busque G. Cognitive-Behavioral Therapy for Panic Disorder in Patients with Stable Coronary Artery Disease: A Feasibility Study. J Clin Psychol Med Settings 2022; 30:28-42. [PMID: 35543901 PMCID: PMC9093559 DOI: 10.1007/s10880-022-09876-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2022] [Indexed: 11/18/2022]
Abstract
Implementing cognitive-behavioral therapy (CBT), the first-line psychological treatment for panic disorder (PD), may be challenging in patients with comorbid coronary artery disease (CAD).This study aimed at assessing the feasibility and acceptability of a CBT for PD protocol that was adapted to patients suffering from comorbid CAD. It also aimed at evaluating the efficacy of the intervention to reduce PD symptomatology and psychological distress and improve quality of life. This was a single-case experimental design with pre-treatment, post-treatment and 6-month follow-up measures. Patients with PD and stable CAD received 14 to 17 individual, 1-h sessions of an adapted CBT for PD protocol. They completed interviews and questionnaires at pre-treatment, post-treatment and at a 6-month follow-up assessing intervention acceptability, PD symptomatology, psychological distress and quality of life. A total of 6 patients out of 7 completed the intervention and 6-month follow-up, indicating satisfactory feasibility. Acceptability was high (medians of ≥ 8.5 out of 9 and ≥ 80%) both at pre and post treatment. Remission rate was of 83% at post-treatment and 6-month follow-up. The intervention appeared to have positive effects on comorbid anxiety and depression symptoms and quality of life. The intervention appeared feasible and acceptable in patients with comorbid CAD. The effects of the adapted CBT protocol on PD symptoms, psychological distress and quality of life are promising and were maintained at the 6-month follow-up. Further studies should aim at replicating the present results in randomized-controlled trials
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Affiliation(s)
- Marie-Andrée Tremblay
- School of Psychology, Université Laval, 2325 rue des Bibliothèques, Quebec, QC, G1V 0A6, Canada.,Research Center of the Centre intégré de santé et de services sociaux de Chaudière-Appalaches, 143 rue Wolfe, Lévis, QC, G6V 3Z1, Canada
| | - Isabelle Denis
- School of Psychology, Université Laval, 2325 rue des Bibliothèques, Quebec, QC, G1V 0A6, Canada.,Research Center of the Centre intégré de santé et de services sociaux de Chaudière-Appalaches, 143 rue Wolfe, Lévis, QC, G6V 3Z1, Canada
| | - Stéphane Turcotte
- Research Center of the Centre intégré de santé et de services sociaux de Chaudière-Appalaches, 143 rue Wolfe, Lévis, QC, G6V 3Z1, Canada
| | - Michel DeGrâce
- Research Center of the Centre intégré de santé et de services sociaux de Chaudière-Appalaches, 143 rue Wolfe, Lévis, QC, G6V 3Z1, Canada
| | - Phillip J Tully
- Faculty of Health and Medical Sciences, The University of Adelaide, 30 Frome Road, Adelaide, SA, 5000, Australia
| | - Guillaume Foldes-Busque
- School of Psychology, Université Laval, 2325 rue des Bibliothèques, Quebec, QC, G1V 0A6, Canada. .,Research Center of the Centre intégré de santé et de services sociaux de Chaudière-Appalaches, 143 rue Wolfe, Lévis, QC, G6V 3Z1, Canada. .,Research Center of the Quebec Heart and Lung Institute, 2725, chemin Sainte-Foy, Quebec, QC, G1V 4G5, Canada.
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