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.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
3R01MH057835-01A2S1
Application #
6200505
Study Section
Special Emphasis Panel (ZMH1 (02))
Program Officer
Pearson, Jane L
Project Start
1999-07-01
Project End
2003-06-30
Budget Start
1999-12-01
Budget End
2000-06-30
Support Year
1
Fiscal Year
2000
Total Cost
$29,216
Indirect Cost
Name
University of California San Diego
Department
Psychiatry
Type
Schools of Medicine
DUNS #
077758407
City
La Jolla
State
CA
Country
United States
Zip Code
92093
Campbell-Sills, Laura; Roy-Byrne, Peter P; Craske, Michelle G et al. (2016) Improving outcomes for patients with medication-resistant anxiety: effects of collaborative care with cognitive behavioral therapy. Depress Anxiety 33:1099-1106
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Jensen, K P; Stein, M B; Kranzler, H R et al. (2014) The ?-endomannosidase gene (MANEA) is associated with panic disorder and social anxiety disorder. Transl Psychiatry 4:e353
Niles, Andrea N; Sherbourne, Cathy D; Roy-Byrne, Peter P et al. (2013) Anxiety treatment improves physical functioning with oblique scoring of the SF-12 short form health survey. Gen Hosp Psychiatry 35:291-6
Stein, Murray B; Roy-Byrne, Peter P; Craske, Michelle G et al. (2011) Quality of and patient satisfaction with primary health care for anxiety disorders. J Clin Psychiatry 72:970-6
Craske, Michelle G; Stein, Murray B; Sullivan, Greer et al. (2011) Disorder-specific impact of coordinated anxiety learning and management treatment for anxiety disorders in primary care. Arch Gen Psychiatry 68:378-88
Norman, Sonya B; Campbell-Sills, Laura; Hitchcock, Carla A et al. (2011) Psychometrics of a brief measure of anxiety to detect severity and impairment: the Overall Anxiety Severity and Impairment Scale (OASIS). J Psychiatr Res 45:262-8
Chavira, Denise A; Stein, Murray B; Golinelli, Daniela et al. (2009) Predictors of clinical improvement in a randomized effectiveness trial for primary care patients with panic disorder. J Nerv Ment Dis 197:715-21
Roy-Byrne, Peter; Veitengruber, Jason P; Bystritsky, Alexander et al. (2009) Brief intervention for anxiety in primary care patients. J Am Board Fam Med 22:175-86
Means-Christensen, Adrienne J; Roy-Byrne, Peter P; Sherbourne, Cathy D et al. (2008) Relationships among pain, anxiety, and depression in primary care. Depress Anxiety 25:593-600

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