Janet P. Realini

Factors affecting the threshold for seeking care: the Panic Attack Care-Seeking Threshold (PACT) Study.

Background: This study was conducted to explore the phenomenon of seeking medical care for panic attacks and to identify factors associated with seeking care. Methods: A community sample of adults was screened using the Structured Clinical Interview of the Diagnostic and Statistical Manual of Mental Disorders, 3rd edition. Subjects who had experienced panic attacks participated in a structured interview concerning their health care access and utilization, panic characteristics, comorbidity, illness attitudes and perceptions, and family characteristics. Results: Forty-one percent of the subjects had not sought medical care for their panic attacks. Having to get someone to drive (RR [relative risk] = 1.8; P = 0.0026), inability to work because of panic (RR = 1.6; P = 0.0054), and a high treatment experience score on the Illness Attitude Scales (RR = 1.5; P = 0.034) independently predicted seeking care. Seeking support was also significantly associated with seeking care (t = –4.05; P = 0.0001). Care seekers tended to have more severe symptoms, stronger symptom perceptions, and more bodily preoccupation and to abuse drugs more frequently. Seeking care was not influenced by sex, race or ethnicity, stress, psychiatric comorbidity, family function, social support, or access to health care. Conclusions: Nearly one-half of persons with panic attacks do not seek care for their attacks. Those who seek care differ from those who do not in ways that have important implications for the understanding of this illness.

Relationship between substance abuse and panic attacks.

This study was done to determine the strength of association between substance abuse and panic states, including subsyndromal panic, its temporal relationship, and self-medication for panic using abusable substances. A community-based sample was screened for panic using DSM-III-R criteria. Panic and matched control groups participated in a structured interview concerning the presence of substance abuse, use of substances to treat panic symptoms, and the age-of-onset of panic and substance abuse. Of 97 individuals with panic, 39% had abused at least one substance. None of the panic disorder-subsyndromal panic differences reached significance. Only 10% of subjects reported using alcohol and 6% reported ever using illicit drugs to treat their panic. The majority (63%) of those abusing alcohol reported that alcohol use began prior to onset of panic, and the majority (59%) of those abusing illicit drugs reported that drug use began first. This study documents the panic-substance abuse relationship even in those with subsyndromal panic. Substance abuse began prior to onset of panic and substances were used to self-medicate for panic attacks by only a few subjects.

Comorbid psychiatric disorders in subjects with panic attacks

Several psychiatric disorders are associated with panic disorder (PD), although the nature of their relationships is unknown. The purpose of this study was to a) document comorbid associations with both PD and infrequent panic (IP), and b) investigate the nature of the relationships among these disorders. This community-based study included 97 adults who met DSM-III-R criteria for panic attacks compared with 97 matched controls. Psychiatric comorbidity was assessed using the SCID and SCL-90. Subjects with either PD or IP had higher rates of psychiatric comorbidity than controls. PD differed from IP only in its higher rate of phobic avoidance. Factor analysis found three factors: PD with phobic avoidance; substance abuse; major depression with obsessive compulsive disorder, social and simple phobias. Only phobic avoidance began secondary to panic onset. In conclusion, this study supports the PD-agoraphobia DSM-IV grouping while lending support to the common diathesis hypothesis for anxiety and affective disorders.

Oral contraceptives and venous thromboembolism: a case-control study designed to minimize detection bias.

Background: Previous epidemiologic studies of venous thromboembolism and oral contraceptive use are susceptible to bias in the detection of venous thromboembolic events. This case-control study uses a unique design to minimize the influence of detection bias. Methods: Nonpredisposed women younger than the age of 40 years who underwent pulmonary angiography, lower extremity venography, or lower extremity duplex Doppler sonography at a large urban hospital were classified into a case group or control group based on results of their diagnostic studies. Medical records were reviewed for a history of current oral contraceptive use. Results: Fifty-seven women met the study criteria during the 11-year study period. Seven of 9 women in the case group and 17 of 48 women in the control group were currently using oral contraceptives (odds ratio 6.38; 95 percent confidence limits 1.19, 34.2). Conclusions: The association previously noted between venous thromboembolism and oral contraceptive use is not due to bias in the detection of venous thromboembolic events.

The Evaluation And Treatment Of Urinary Incontinence In Women: A Primary Care Approach

Background: Urinary incontinence, the involuntary loss of urine severe enough to have adverse social or hygienic consequences, is a major clinical problem and a significant cause of disability and dependency. At least 10 million adults in the US suffer from urinary incontinence, including an estimated 15 to 30 percent of community-dwelling older persons. In spite of its high rate of occurrence, fewer than one-half of women with regular urinary incontinence seek medical help for their problem, either because of embarrassment or the perception that their symptoms are normal. Methods: MEDLINE files were searched from 1970 to 1990 using the key words “incontinence,” “prevalence,” and “diagnosis” and for specific nonsurgical treatments. Only articles pertaining to adult women were chosen. Results and Conclusions: Urinary incontinence frequently can be diagnosed accurately by family physicians using basic tests in the office. Many women experience improvement of incontinence with properly employed behavioral and pharmacologic therapy. Other women benefit from referral for specialized evaluation and consideration for surgical therapy.

Oral-contraceptive use and the risk of breast cancer

To the Editor: The study on oral-contraceptive use and the risk of breast cancer from the Centers for Disease Control (CDC) and the National Institute of Child Health and Human Development (Aug. 14 issue)1 seems to be reassuring for oral-contraceptive users. But, as stated in the editorial by Shapiro in the same issue,2 there are some weak points that need further elucidation. We have found a highly increased risk of breast cancer among young (teenage) oral-contraceptive users in southern Sweden.3 From incidence figures for Sweden, an increase in premenopausal breast cancer can be seen to have started in about 1975,…