title: Does this patient have generalized anxiety or panic disorder?: The Rational Clinical Examination systematic review.
abstract: OBJECTIVE
  In primary care settings, generalized anxiety disorder (GAD) and panic disorder are common but underrecognized illnesses. Identifying accurate and feasible screening instruments for GAD and panic disorder has the potential to improve detection and facilitate treatment.
  
  
  OBJECTIVE
  To systematically review the accuracy of self-report screening instruments in diagnosing GAD and panic disorder in adults.
  
  
  METHODS
  We searched MEDLINE, PsycINFO, and the Cochrane Library for relevant articles published from 1980 through April 2014.
  
  
  METHODS
  Prospective studies of diagnostic accuracy that compared a self-report screening instrument for GAD or panic disorder with the diagnosis made by a trained clinician using Diagnostic and Statistical Manual of Mental Disorders or International Classification of Diseases criteria.
  
  
  RESULTS
  We screened 3605 titles, excluded 3529, and performed a more detailed review of 76 articles. We identified 9 screening instruments based on 13 articles from 10 unique studies for the detection of GAD and panic disorder in primary care patients Across all studies, diagnostic interviews determined that 257 of 2785 patients assessed had a diagnosis of GAD while 224 of 2637 patients assessed had a diagnosis of panic disorder. The best-performing test for GAD was the Generalized Anxiety Disorder Scale 7 Item (GAD-7), with a positive likelihood ratio of 5.1 (95% CI, 4.3-6.0) and a negative likelihood ratio of 0.13 (95% CI, 0.07-0.25). The best-performing test for panic disorder was the Patient Health Questionnaire, with a positive likelihood ratio of 78 (95% CI, 29-210) and a negative likelihood ratio of 0.20 (95% CI, 0.11-0.37).
  
  
  CONCLUSIONS
  Two screening instruments, the GAD-7 for GAD and the Patient Health Questionnaire for panic disorder, have good performance characteristics and are feasible for use in primary care. However, further validation of these instruments is needed because neither instrument was replicated in more than 1 primary care population.
authors: Department of Psychology, American University, Washington, DC.
authors: Nathaniel R
authors: NR
authors: Herr
authors: Durham Veterans Affairs Evidence-based Synthesis Program (ESP) Center, Durham, North Carolina3Duke University Department of Medicine, Durham, North Carolina.
authors: John W
authors: JW
authors: Williams
authors: Grand River Hospital, Kitchener, Ontario, Canada5Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada.
authors: Sophiya
authors: S
authors: Benjamin
authors: Durham Veterans Affairs Evidence-based Synthesis Program (ESP) Center, Durham, North Carolina3Duke University Department of Medicine, Durham, North Carolina.
authors: Jennifer
authors: J
authors: McDuffie
mesh_terms: D001008:Anxiety Disorders / Q000175:diagnosis*; D006801:Humans; D007406:Interview, Psychological; D016584:Panic Disorder / Q000175:diagnosis*; D011320:Primary Health Care; D011569:Psychiatric Status Rating Scales; D057566:Self Report