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CBT-based interventions as brief as a single session initiated within 2 weeks after an ED visit for chest pain appear to be effective for PD. Given the high prevalence of PD in emergency care settings, greater efforts should be made to implement these interventions in the ED and/or primary care setting.

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Objectives:The objective was to demonstrate the derivation and the preliminary validation of a brief screening score to improve recognition of panic-like anxiety in emergency department (ED) patients with unexplained chest pain.Methods: This cross-sectional study included 507 ED patients with unexplained chest pain randomly assigned to the derivation condition (n = 201) or the validation condition (n = 306). The Anxiety Disorders Interview Schedule for DSM-IV (ADIS-IV) acted as the criterion standard for panic diagnosis. Receiver operating characteristic (ROC) curves were used to determine which of the sociodemographic, medical, and questionnaire response variables best predicted the presence of panic-like anxiety in the derivation condition. The selected predictors were entered in a logistic regression analysis to determine variables to be included in the screening score. The predictive validity of the resulting score was evaluated in both conditions. Results:The four-item Panic Screening Score (PSS) identified panic-like anxiety with a sensitivity of 63% (95% confidence interval [CI] = 52% to 73%) and a specificity of 84% (95% CI = 76% to 90%) in the derivation phase. The positive predictive value was 74% (95% CI = 62% to 93%) and the negative predictive value was 76% (95% CI = 68% to 89%). In the validation phase, the sensitivity and specificity were 53% (95% CI = 44% to 62%) and 85% (95% CI = 78% to 89%), respectively. The positive predictive value was 72% (95% CI = 62% to 80%) and the negative predictive value was 71% (95% CI = 65% to 77%).

A brief treatment for panic disorder with agoraphobia (PDA) supported by selfhelp materials may be an alternative choice to standard CBT: this type of program may also help to overcome some of the cost-benefit limitations of standard cognitive behavioural therapy. The aim of this study was to test the efficacy of a brief cognitive behaviour therapy (7 weeks) for PDA, with and without partner involvement, along with a self-study manual. A total of 77 participants meeting DSM-IV criteria of PDA were assigned to one of three treatment conditions: 1) a 14-session standard CBT (n = 26); 2) a 7-session brief cognitive behaviour therapy along with a self-study manual (n = 26); and 3) a 7-session brief cognitive behaviour therapy involving a partner along with a self-study manual (n = 25). Results show a statistically and clinically significant improvement on all outcome measures in the three treatment conditions. Gains were maintained up to 6 months. Both brief CBT conditions were as effective as the standard cognitive behavioural treatment. These results suggest that a brief program, supported by self-help materials, that shortens the time during which the patient suffers from this problem may be a good option for the treatment of panic disorder.

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The aim of this study was to assess the incremental cost-effectiveness ratios (ICERs) of two brief cognitive-behavioral therapy (CBT)Ybased interventions and a pharmacological treatment, compared with usual care, initiated in the emergency department (ED) for individuals with panic disorder (PD) with a chief complaint of noncardiac chest pain. A total of 69 patients were followed up to 6 months. The primary outcome variables were direct and indirect costs of treatment and PD severity. Panic management (PM) had an ICER of $124.05, per the Anxiety Disorders Interview Schedule for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, severity score change (95% confidence interval [CI], $54.63Y$314.57), compared with pharmacotherapy (paroxetine), with an ICER of $213.90 (95% CI, $133.51Y$394.94), and brief CBT, with an ICER of $309.31 (95% CI, $151.27Y$548.28). The pharmacological and CBT interventions were associated with a greater clinical improvement compared with usual care at posttest. PM presented a superior ICER, suggesting that it may be a promising treatment option to implement in EDs.A total of 69 participants were included in the analysis: 54 were in one of the treatment conditions and 15 were in the usual care

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