An Augmented Provisional Screening Instrument Assessing 5 Additional Common Anxiety-Related Diagnoses in Adult Primary Care Patients

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John P. Houston, MD, PhD; Kurt Kroenke, MD; Jonathan R. Davidson, MD; Lenard A. Adler, MD; Douglas E. Faries, PhD; Jonna Ahl, PhD; Ralph Swindle, PhD; and Paula T. Trzepacz, MD

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Postgraduate Medicine:

Volume 123 No. 5


Clinical Focus

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DOI: 10.3810/pgm.2011.09.2463
Abstract: Patients with nonpsychotic mental health and emotional problems are commonly seen by primary care physicians. The objective of this study was to expand the Provisional Diagnostic Instrument-4 (PDI-4) to include a short self-report screen for 5 common anxiety-related diagnoses: panic attack (PA), social phobia (SP), obsessive-compulsive disorder (OCD), hypochondriasis, and post-traumatic stress disorder (PTSD). Primary care patients (N = 343) were originally evaluated with a self-report screen comprised of 85 Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition symptom-based candidate questions, then interviewed by a trained rater for Structured Clinical Interview Research Version (SCID)/Adult ADHD Clinician Diagnostic Scale version 1.2 (ACDS) assessment and diagnosis. Responses to screening questions were used to calculate sensitivity and specificity for an SCID diagnosis, and to select the optimal cutoffs in symptom frequency for 1 or 2 questions for each additional anxiety-related diagnosis. The PDI-4 Anxiety (PDI-4A) contains 6 items for provisional differential diagnosis of PA, SP, OCD, hypochondriasis, and PTSD in addition to items for the PDI-4. Sensitivities/specificities were: PA, 88%/68%; SP, 57%/70%; OCD, 88%/61%; hypochondriasis, 67%/85%; and PTSD, 71%/72%. Screening for multiple common anxiety diagnoses may be desirable, although limitations may include reduced sensitivity and specificity for selected diagnoses. The PDI-4A may additionally help primary care physicians identify patients with PA, SP, OCD, hypochondriasis, and PTSD.

Keywords: anxiety , hypochondriasis , obsessive-compulsive disorder , post-traumatic stress disorder , panic disorder