IMPROVING CARE FOR PANIC DISORDER IN PRIMARY CARE

Summary

Principal Investigator: M B Stein
Abstract: With the rise of managed care, the primary care setting is assuming increasing importance as a site for the detection and treatment of all mental health problems. In this setting, panic disorder is prevalent, poorly recognized, and inadequately treated. Because it is both disabling and often masquerades as a variety of other medical conditions, it increases both direct (physician visits and unnecessary testing) and indirect (disability days) costs. This is a multi-institutional collaborative research project designed to implement an intervention to identify and treat panic disorder in the primary care setting and to study the clinical and cost effectiveness of this intervention over a one-year period. Three sites (UCSD, UCLA, UW) will screen and identify patients in a university primary care clinic who suffer from panic disorder and test an innovative model of service delivery for panic disorder in this setting. Patients will be randomized to receive either care as usual from their primary care physician or collaborative care (CC). CC employs a combination of cognitive-behavioral psychotherapy (delivered in six sessions over eight weeks by a behavioral health specialist [BHS]), expert pharmacotherapy (guided by a psychiatrist's recommendations relayed by the BHS to the prescribing primary care physician), and disease management elements (education and activation of patient and provider and more careful monitoring and sustained follow-up over the next year via phone contact). It is hypothesized that CC will have superior clinical effectiveness (measured in terms of symptom reduction, quality of life, and functioning). It is also hypothesized that although direct health care costs will be higher for CC than for usual care, indirect costs will be lower and cost-effectiveness analysis will support the adoption of CC as a preferred model of care.
Funding Period: 1999-07-01 - 2004-06-30
more information: NIH RePORT

Top Publications

  1. ncbi Correlates of alcohol use among anxious and depressed primary care patients
    Joanna J Arch
    Department of Psychology, University of California, Los Angeles, 90095 1563, USA
    Gen Hosp Psychiatry 28:37-42. 2006
  2. pmc Disorder-specific impact of coordinated anxiety learning and management treatment for anxiety disorders in primary care
    Michelle G Craske
    Department of Psychology, University of California at Los Angeles, Los Angeles, CA 90095 1563, USA
    Arch Gen Psychiatry 68:378-88. 2011
  3. pmc Quality of and patient satisfaction with primary health care for anxiety disorders
    Murray B Stein
    Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093 0855, USA
    J Clin Psychiatry 72:970-6. 2011
  4. pmc Psychometrics of a brief measure of anxiety to detect severity and impairment: the Overall Anxiety Severity and Impairment Scale (OASIS)
    Sonya B Norman
    Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, Mail Code 0603 La Jolla, CA 92037 0603, USA
    J Psychiatr Res 45:262-8. 2011
  5. pmc Predictors of clinical improvement in a randomized effectiveness trial for primary care patients with panic disorder
    Denise A Chavira
    Department of Psychiatry, University of California, San Diego, CA 92037, USA
    J Nerv Ment Dis 197:715-21. 2009
  6. pmc Brief intervention for anxiety in primary care patients
    Peter Roy-Byrne
    Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Harborview Center for Healthcare Improvement for Addictions, Mental Illness and Medically Vulnerable Populations, Seattle, USA
    J Am Board Fam Med 22:175-86. 2009
  7. ncbi Relationships among pain, anxiety, and depression in primary care
    Adrienne J Means-Christensen
    Department of Psychology, Radford University, Radford, Virginia, USA
    Depress Anxiety 25:593-600. 2008
  8. ncbi Adherence to treatment among economically disadvantaged patients with panic disorder
    Snigdha Mukherjee
    South Central Mental Illness Research, Education and Clinical Center, North Little Rock, Arkansas, USA
    Psychiatr Serv 57:1745-50. 2006
  9. ncbi CBT intensity and outcome for panic disorder in a primary care setting
    Michelle G Craske
    University of California, Los Angeles, Los Angeles, CA 90095 1563, USA
    Behav Ther 37:112-9. 2006
  10. ncbi Poverty and response to treatment among panic disorder patients in primary care
    Peter Roy-Byrne
    Department of Psychiatry and Behavioral Science, University of Washington School of Medicine at Harborview Medical Center, 326 9th Ave, Seattle, WA 98104, USA
    Am J Psychiatry 163:1419-25. 2006

Detail Information

Publications14

  1. ncbi Correlates of alcohol use among anxious and depressed primary care patients
    Joanna J Arch
    Department of Psychology, University of California, Los Angeles, 90095 1563, USA
    Gen Hosp Psychiatry 28:37-42. 2006
    ..The purpose of this study is to determine the patterns of alcohol use for primary care patients with anxiety disorders and/or major depression in three urban university-affiliated outpatient clinics...
  2. pmc Disorder-specific impact of coordinated anxiety learning and management treatment for anxiety disorders in primary care
    Michelle G Craske
    Department of Psychology, University of California at Los Angeles, Los Angeles, CA 90095 1563, USA
    Arch Gen Psychiatry 68:378-88. 2011
    ..Anxiety disorders commonly present in primary care, where evidence-based mental health treatments often are unavailable or suboptimally delivered...
  3. pmc Quality of and patient satisfaction with primary health care for anxiety disorders
    Murray B Stein
    Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093 0855, USA
    J Clin Psychiatry 72:970-6. 2011
    ..Most patients with anxiety disorders receive their care from primary care practitioners (PCPs). The purpose of this study was to evaluate quality of and patient satisfaction with primary health care for anxiety disorders...
  4. pmc Psychometrics of a brief measure of anxiety to detect severity and impairment: the Overall Anxiety Severity and Impairment Scale (OASIS)
    Sonya B Norman
    Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, Mail Code 0603 La Jolla, CA 92037 0603, USA
    J Psychiatr Res 45:262-8. 2011
    ..The availability of cut-scores for a non-clinical sample furthers the utility of this measure for settings where screening or brief assessment of anxiety is needed...
  5. pmc Predictors of clinical improvement in a randomized effectiveness trial for primary care patients with panic disorder
    Denise A Chavira
    Department of Psychiatry, University of California, San Diego, CA 92037, USA
    J Nerv Ment Dis 197:715-21. 2009
    ..A greater understanding of these predictors may help clinicians identify who is at greatest risk for persistent panic-related symptoms and to plan the intensity of interventions accordingly...
  6. pmc Brief intervention for anxiety in primary care patients
    Peter Roy-Byrne
    Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Harborview Center for Healthcare Improvement for Addictions, Mental Illness and Medically Vulnerable Populations, Seattle, USA
    J Am Board Fam Med 22:175-86. 2009
    ....
  7. ncbi Relationships among pain, anxiety, and depression in primary care
    Adrienne J Means-Christensen
    Department of Psychology, Radford University, Radford, Virginia, USA
    Depress Anxiety 25:593-600. 2008
    ..An awareness of these relationships may be particularly important in primary care settings where a patient who presents with reports of pain may have an undiagnosed anxiety or depressive disorder...
  8. ncbi Adherence to treatment among economically disadvantaged patients with panic disorder
    Snigdha Mukherjee
    South Central Mental Illness Research, Education and Clinical Center, North Little Rock, Arkansas, USA
    Psychiatr Serv 57:1745-50. 2006
    ..The purpose of this study was to examine the feelings of disadvantaged patients about and experiences of treatment for anxiety disorders in primary care settings...
  9. ncbi CBT intensity and outcome for panic disorder in a primary care setting
    Michelle G Craske
    University of California, Los Angeles, Los Angeles, CA 90095 1563, USA
    Behav Ther 37:112-9. 2006
    ..The significance of follow-up booster phone contact is discussed as an index of continued self-management of panic and anxiety following acute treatment...
  10. ncbi Poverty and response to treatment among panic disorder patients in primary care
    Peter Roy-Byrne
    Department of Psychiatry and Behavioral Science, University of Washington School of Medicine at Harborview Medical Center, 326 9th Ave, Seattle, WA 98104, USA
    Am J Psychiatry 163:1419-25. 2006
    ....
  11. ncbi Using five questions to screen for five common mental disorders in primary care: diagnostic accuracy of the Anxiety and Depression Detector
    Adrienne J Means-Christensen
    Department of Psychiatry, University of California, San Diego, CA 92093 0985, USA
    Gen Hosp Psychiatry 28:108-18. 2006
    ..However, before patients in primary care can be treated, they must be identified. This study set out to validate a very brief screening instrument for identifying primary care patients with anxiety and depression...
  12. ncbi In search of mixed anxiety-depressive disorder: a primary care study
    Adrienne J Means-Christensen
    Department of Psychiatry, University of California, San Diego, California, USA
    Depress Anxiety 23:183-9. 2006
    ..These data dispute the need for a mixed anxiety-depression category (beyond mood and anxiety syndromes currently in DSM-IV) in future editions of the DSM...
  13. ncbi Incremental cost-effectiveness of a collaborative care intervention for panic disorder
    Wayne Katon
    Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, 98195 6560, USA
    Psychol Med 36:353-63. 2006
    ..This study describes the incremental cost-effectiveness of a combined cognitive behavioral therapy (CBT) and pharmacotherapy intervention for patients with panic disorder versus usual primary-care treatment...
  14. pmc The α-endomannosidase gene (MANEA) is associated with panic disorder and social anxiety disorder
    K P Jensen
    1 Department of Psychiatry, Division of Human Genetics, Yale University School of Medicine, New Haven, CT, USA 2 VA CT Health Care Center, West Haven, CT, USA
    Transl Psychiatry 4:e353. 2014
    ..Using publically available data, we observed a consistent effect on expression in brain tissue. We conclude that pathways involving α-endomannosidase warrant further investigation in relation to anxiety disorders. ..