Academic journal article Advances in Mental Health

Evaluation of an Ultra-Brief Psycho-Education and Referral Intervention Provided to Patients Presenting to a Hospital Emergency Department with Symptoms of Panic Attack

Academic journal article Advances in Mental Health

Evaluation of an Ultra-Brief Psycho-Education and Referral Intervention Provided to Patients Presenting to a Hospital Emergency Department with Symptoms of Panic Attack

Article excerpt

Panic Disorder (PD) is one of the most common anxiety disorders in Australia with a 12-month prevalence rate of 2.6% (Australian Bureau of Statistics, 2008). The defining characteristic of PD is recurrent panic attacks (PA). PA are accompanied by a range of physical symptoms such as dizziness, shortness of breath and chest pain (American Psychiatric Association [APA], 2013). These physical symptoms mimic those of a variety of life-threatening medical conditions including heart attack, leading many individuals to seek consultation at hospital emergency departments (ED; Dyckman, Rosenbaum, Hartmeyer, & Walter, 1999; Huffman & Pollack, 2003; Lynch & Galbraith, 2003; Marchand et al., 2012). The nature of the ED, however, restricts the ability of ED staff to assess, diagnose, and adequately treat patients with panic attacks (Kunen, Niederhauser, Smith, Morris, & Marx, 2005). One potential strategy to assist ED staff in managing panickers is the provision of ultra-brief psycho-education and referral. This study evaluated the use of such a strategy for improving the care of patients presenting to ED with symptoms of PA.

Patients with panic are likely to have recurrent panic-related ED presentations. Buccelletti et al. (2013) found that approximately 77% of patients presenting to EDs with panic symptoms went on to have further panic-related presentations. Studies suggest the prevalence of panickers within the ED to be between 17% and 37% of all those admitted (Barsky, Delamater, & Orav, 1999; Bass & Wade, 1984; Belleville, Foldes-Busque, & Marchand, 2010; Fleet et al., 1998). These recurrent visits might be partly explained by the low rates of mental health treatment that patients access via the ED. Not surprisingly, the high rate of ED presentations and subsequent diagnostic tests equate to considerable costs for the public medical system. Rees, Richards, and Smith (1998) found medical utilisation costs over 12 months to be approximately 11 times higher in a PD group compared to a non-anxious cohort.

Given the busy nature of the ED, it is not feasible for medical staff to engage in time-consuming interventions for psychiatric disorders and evidence suggests patients are rarely given referrals to mental health professionals (Hamer & McCallin, 2006; Ross, Walker, Norton, & Neufel, 1988; Swinson, Cox, & Woszczyna, 1992a). Instead, this setting provides an opportunity to provide ultra-brief intervention, specifically by referring patients to mental health care. Psycho-education is another example of a brief intervention that could be administered in the ED to support patients with panic.

Psycho-education entails providing an individual with specific information regarding their condition and available treatment or management options. Psycho-education interventions with PD patients were related to faster responses to treatment (Dannon, Iancu, & Grunhaus, 2002) and a reduction in medical service utilisation (Rollman et al., 2005). A limited body of research indicates that brief interventions administered in the ED to patients presenting with panic attacks can be successful in improving patient outcomes (Swinson et al., 1992b). Current research is limited by its reliance on time-consuming and specialist interventions that are impractical for an ED-environment (e.g., lengthy cognitive-behavioural treatment that may only be administered by a trained mental health professional). Further research is required to evaluate the integration and outcomes of ultra-brief interventions in ED settings that may be delivered by existing staff members to help manage PA. Such research will assist in developing practical and evidencebased practices to better manage PA in EDs and successfully assist panickers.

To add to the limited research on the outcomes of ultra-brief interventions in ED settings for PA, this study evaluated a panic information card (PIC) provided to patients who presented to an ED with symptoms of panic attack. …

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