 |
|
A Randomized Effectiveness Trial of Cognitive-Behavioral Therapy and Medication for Primary Care Panic Disorder
Peter P. Roy-Byrne, MD;
Michelle G. Craske, PhD;
Murray B. Stein, MD, MPH;
Greer Sullivan, MD, MSPH;
Alexander Bystritsky, MD;
Wayne Katon, MD;
Daniela Golinelli, PhD;
Cathy D. Sherbourne, PhD
Arch Gen Psychiatry. 2005;62:290-298.
Background Panic disorder is a prevalent, often disabling condition among patients in the primary care setting. Although numerous studies have assessed the effectiveness of treatments for depression in primary care, few such studies have been conducted for panic disorder.
Objective To implement and test the effectiveness of a combined pharmacotherapy and cognitive-behavioral intervention for panic disorder tailored to the primary care setting.
Design Randomized, controlled study comparing intervention to treatment as usual.
Setting Six primary care clinics associated with 3 university medical schools, serving an ethnically and socioeconomically diverse patient population.
Participants Two hundred thirty-two primary care patients meeting DSM-IV criteria for panic disorder. Comorbid mental and physical disorders were permitted, provided these did not contraindicate the treatment to be provided and were not acutely life threatening.
Intervention Patients were randomized to receive either treatment as usual or an intervention consisting of a combination of up to 6 sessions (across 12 weeks) of cognitive-behavioral therapy (CBT) modified for the primary care setting, with up to 6 follow-up telephone contacts during the next 9 months, and algorithm-based pharmacotherapy provided by the primary care physician with guidance from a psychiatrist. Behavioral health specialists, the majority inexperienced in CBT for panic disorder, were trained to deliver the CBT and coordinated overall care, including pharmacotherapy.
Main Outcomes Measures Proportion of subjects remitted (no panic attacks in the past month, minimal anticipatory anxiety, and agoraphobia subscale score <10 on Fear Questionnaire) and responding (Anxiety Sensitivity Index score <20) and change over time in World Health Organization Disability Scale and short form 12 scores.
Results The combined cognitive-behavioral and pharmacotherapeutic intervention resulted in sustained and gradually increasing improvement relative to treatment as usual, with significantly higher rates at all points of both the proportion of subjects remitted (3 months, 20% vs 12%; 12 months, 29% vs 16%) and responding (3 months, 46% vs 27%; 12 months, 63% vs 38%) and significantly greater improvements in World Health Organization Disability Scale (all points) and short form 12 mental health functioning (3 and 6 months) scores. These effects were obtained in spite of similar rates of delivery of guideline-concordant pharmacotherapy to the 2 groups.
Conclusion Delivery of evidence-based CBT and medication using the collaborative care model and a CBT-naïve, midlevel behavioral health specialist is feasible and significantly more effective than usual care for primary care panic disorder.
Author Affiliations: Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine at Harborview Medical Center, Seattle (Dr Roy-Byrne); Department of Psychiatry, University of Washington School of Medicine, Seattle (Dr Katon), Departments of Psychology (Dr Craske) and Psychiatry and Biobehavioral Sciences (Drs Craske and Bystritsky), University of California, Los Angeles; Departments of Psychiatry and Family and Preventive Medicine, University of California, San Diego (Dr Stein); Veterans Affairs South Central Mental Illness Research Education and Clinical Center, Little Rock, Ark (Dr Sullivan); University of Arkansas for Medical Science, Little Rock (Dr Sullivan); the RAND Corporation, Santa Monica, Calif (Drs Golinelli and Sherbourne).
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
L'identification et traitement du trouble panique avec ou sans agoraphobie: Mise a jour
Foldes-Busque et al.
cfp 2007;53:1686-1693.
ABSTRACT
| FULL TEXT
Combat and Peacekeeping Operations in Relation to Prevalence of Mental Disorders and Perceived Need for Mental Health Care: Findings From a Large Representative Sample of Military Personnel
Sareen et al.
Arch Gen Psychiatry 2007;64:843-852.
ABSTRACT
| FULL TEXT
Rural-Urban Differences in Hospitalization Rates of Primary Care Patients With Depression
Rost et al.
Psychiatr. Serv. 2007;58:503-508.
ABSTRACT
| FULL TEXT
Anxiety Disorders: Efficient Screening Is the First Step in Improving Outcomes
Katon and Roy-Byrne
ANN INTERN MED 2007;146:390-392.
FULL TEXT
Measuring the Impact of Medical Research: Moving From Outputs to Outcomes
Weiss
Am. J. Psychiatry 2007;164:206-214.
ABSTRACT
| FULL TEXT
Adherence to Treatment Among Economically Disadvantaged Patients With Panic Disorder
Mukherjee et al.
Psychiatr. Serv. 2006;57:1745-1750.
ABSTRACT
| FULL TEXT
Poverty and Response to Treatment Among Panic Disorder Patients in Primary Care
Roy-Byrne et al.
Am. J. Psychiatry 2006;163:1419-1425.
ABSTRACT
| FULL TEXT
Antidepressant Adherence and Medical Resource Use Among Managed Care Patients With Anxiety Disorders
Stein et al.
Psychiatr. Serv. 2006;57:673-680.
ABSTRACT
| FULL TEXT
The case for psychological treatment centres.
Layard
BMJ 2006;332:1030-1032.
FULL TEXT
Panic disorder
Taylor
BMJ 2006;332:951-955.
FULL TEXT
A Randomized Trial to Improve the Quality of Treatment for Panic and Generalized Anxiety Disorders in Primary Care
Rollman et al.
Arch Gen Psychiatry 2005;62:1332-1341.
ABSTRACT
| FULL TEXT
Coordinated care consisting of cognitive behavioural therapy plus medication improves panic disorder
Kumar
Evid. Based Ment. Health 2005;8:110-110.
FULL TEXT
Evidently...
Lehman
Evid. Based Med. 2005;10:105-105.
FULL TEXT
Other articles noted
Evid. Based Med. 2005;10:127-128.
FULL TEXT
Panic Care in Primary Care
JWatch Psychiatry 2005;2005:8-8.
FULL TEXT
Panic Care in Primary Care
JWatch Women's Health 2005;2005:4-4.
FULL TEXT
|
