title: Development of a brief diagnostic screen for panic disorder in primary care.
abstract: OBJECTIVE
  The purpose of this study was to determine the utility of a brief screening tool for panic disorder in the primary care setting.
  
  
  METHODS
  A total of 1476 primary care outpatients in three primary care medical clinics on the West Coast of the United States were studied. Patients completed a brief self-report measure, the five-item Autonomic Nervous System Questionnaire (ANS), while in the waiting room. The presence of DSM-IV panic disorder was subsequently determined in groups of "screen-positive" and "screen-negative" subjects using the Composite International Diagnostic Interview. A subset of patients (N = 511) also completed the 21-item Beck Anxiety Inventory. Indices of diagnostic utility were calculated using receiving operating characteristic analyses to guide the selection of optimal cutoff levels.
  
  
  RESULTS
  The two-question version of the ANS had excellent sensitivity (range = 0.94-1.00 across the three clinic sites) and negative predictive value (0.94-1.00) but low specificity (0.25-0.59) and positive predictive value (range 0.18-0.40). The three- and five-question versions of the ANS had only modestly improved specificity, and this was achieved at the cost of reduced sensitivity and increased respondent burden to complete the questionnaire. The 21-item Beck Anxiety Inventory had maximal clinical utility at a cutoff level of > or =20, but sensitivity was lower than desirable for a screening instrument (0.67).
  
  
  CONCLUSIONS
  The two-question version of the ANS shows promise as a screening instrument for panic disorder in the primary care setting.
authors.affiliation: Department of Psychiatry, University of California, San Diego, La Jolla 92093-0985, USA. mstein@ucsd.edu
authors.forename: M B
authors.initials: MB
authors.lastname: Stein
authors.forename: P P
authors.initials: PP
authors.lastname: Roy-Byrne
authors.forename: J R
authors.initials: JR
authors.lastname: McQuaid
authors.forename: C
authors.initials: C
authors.lastname: Laffaye
authors.forename: J
authors.initials: J
authors.lastname: Russo
authors.forename: M E
authors.initials: ME
authors.lastname: McCahill
authors.forename: W
authors.initials: W
authors.lastname: Katon
authors.forename: M
authors.initials: M
authors.lastname: Craske
authors.forename: A
authors.initials: A
authors.lastname: Bystritsky
authors.forename: C D
authors.initials: CD
authors.lastname: Sherbourne
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016584:Panic Disorder / Q000175:diagnosis*; D011237:Predictive Value of Tests; D011320:Primary Health Care / Q000379:methods* / Q000706:statistics & numerical data; D011569:Psychiatric Status Rating Scales / Q000592:standards*; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires