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The Autonomic Nervous System Questionnaire and the Brief Patient Health Questionnaire as screening instruments for panic disorder in Finnish primary care

Published online by Cambridge University Press:  15 April 2020

V. Tilli ,
K. Suominen  and
H. Karlsson
V. Tilli*
Affiliation:
Department of Psychiatry, University of Helsinki, Helsinki, Finland, Mäntytie 19, 02880Veikkola, Finland
K. Suominen
Affiliation:
Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland, P.O.Box 800, 00029HUS, Finland
H. Karlsson
Affiliation:
Department of Clinical Medicine, Institute of Clinical Medicine, University of Turku, Lemminkäisenkatu 1, 20014Turku, Finland
*
*Corresponding author. Tel.: +358 41 545 8575. E-mail address:[email protected] (V. Tilli).
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Abstract

Purpose

As panic disorder often remains unrecognized in the health care system, some screening methods have been developed to enhance its recognition. The aim of this study was to test and compare the Autonomic Nervous System Questionnaire (ANS) and the Brief Patient Health Questionnaire (BPHQ) in primary care.

Subjects and methods

A total sample of 211 primary care outpatients was studied. The Structured Clinical Interview for DSM-IV was the criterion standard for the presence of panic disorder. Indices of diagnostic utility for both screening methods were calculated and compared.

Results

The AUC (area under the ROC curve) was 0.885 for the ANS and 0.877 for the BPHQ. At the optimal cut-off level, the ANS had the sensitivity of 0.88 and specificity of 0.77; the BPHQ had the sensitivity of 0.79 and the specificity of 0.87. There was not any statistically significant difference between the screens.

Conclusions

Both screening methods can be recommended both for clinical practice and research use. In busy primary care practice, the BPHQ may be more useful, as it can be used together with the depression module of the BPHQ.

Keywords

Panic disorderPsychometry and assessments in psychiatryDSMTests
Type
Original article
Information
European Psychiatry , Volume 28 , Issue 7 , September 2013 , pp. 442 - 447
Copyright
Copyright © European Psychiatric Association

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References

Andersch, S, Hetta, JA 15-year follow-up study of patients with panic disorder. Eur Psychiatry 2003;18:401–408.CrossRefGoogle ScholarPubMed
Andersson, G, Bergstrom, J, Buhrman, M, Carlbring, P, Hollandare, F, Kaldo, V, et al.Development of a new approach to guided self-help via the internet: the Swedish experience. J Tech Hum Serv 2008;26:161–181.CrossRefGoogle Scholar
Batelaan, NM, de Graaf, R, Spijker, JThe course of panic attacks in individuals with panic disorder and subtreshold panic disorder: a population-based study. J Affect Disord 2009;121:30–38.CrossRefGoogle Scholar
Batelaan, NM, de Graaf, R, Van Balkom, A, Vollebergh, W, Beekman, AThresholds for health and thresholds for illness: panic disorder versus subtreshold panic disorder. Psychol Med 2007;37:247–256.CrossRefGoogle Scholar
Becker, S, Al, ZK, Al, FEScreening for somatization and depression in Saudi Arabia: a validation study of the PHQ in primary care. Int J Psychiatry Med 2002;32:271–283.CrossRefGoogle ScholarPubMed
Buist-Bouwmann, MA, De Graaf, R, Vollebergh, WA, Alonso, J, Bruffaerts, R, Ormel, JFunctional disability of mental disorders and comparison with physical disorders: a study among the general population of six European countries. Acta Psychiatr Scand 2006;113:492–500.CrossRefGoogle Scholar
Bystritsky, A, Kerwin, L, Niv, N, Natoli, JL, Abrahami, N, Klap, R, et al.Clinical and subtreshold panic disorder. Depress Anxiety 2010;27:381–389.CrossRefGoogle Scholar
Carpiniello, B, Baita, A, Carta, MG, Sitzia, R, Macciardi, AM, Murgia, S, et al.Clinical and psychosocial outcome of patients affected by panic disorder with or without agoraphobia: results from a naturalistic follow-up study. Eur Psychiatry 2002;17:394–398.CrossRefGoogle ScholarPubMed
Corapcioglu, A, Uzuner, GAdaptation of revised Brief PHQ (Brief-PHQ-r) for diagnosis of depression, panic disorder and somatoform disorder in primary health care settings. Int J Psychiatry Clin Pract 2004;8:11–18.CrossRefGoogle Scholar
Cramer, V, Torgersen, S, Kringlen, EQuality of life and anxiety disorders: a population study. J Nerv Ment Dis 2005;193:196–202.CrossRefGoogle ScholarPubMed
Craske, MG, Rose, RD, Lang, A, Welch, SS, Campbell-Sills, L, Sullivan, G, et al.Computer-assisted delivery of cognitive behavioural therapy for anxiety disorders in primary-care settings. Depress Anxiety 2009;26:235–242.CrossRefGoogle ScholarPubMed
Diez-Quevedo, C, Rangil, T, Sanchez-Planell, L, Kroenke, K, Spitzer, RLValidation and utility of the patient health questionnaire in diagnosing mental disorders in 1003 general hospital Spanish inpatients. Psychosom Med 2001;63:679–686.CrossRefGoogle ScholarPubMed
Fava, GA, Rafanelli, C, Grandi, S, Conti, S, Ruini, C, Mangelli, L, et al.Long-term outcome of panic disorder with agoraphobia treated by exposure. Psychol Med 2001;31:891–898.CrossRefGoogle ScholarPubMed
Fernandez, A, Haro, JM, Martinez-Alonso, M, Demyttenaere, K, Brugha, TS, Autonell, J, et al.Treatment adequacy for anxiety and depressive disorders in six European countries. Br J Psychiatry 2007;190:172–173.CrossRefGoogle ScholarPubMed
Furukawa, TA, Watanabe, N, Churchill, RCombined psychotherapy plus antidepressants for panic disorder with or without agoraphobia. Cochrane Database Syst Rev 2007;1:CD004364.Google Scholar
Goodwin, RD, Faravelli, C, Rosi, S, Cosci, F, Truglia, E, de Graaf, R, et al.The epidemiology of panic disorder and agoraphobia in Europe. Eur Neuropsychopharmacol 2005;15:435–443.CrossRefGoogle ScholarPubMed
Greenberg, PE, Sisitsky, T, Kessler, RC, Finkelstein, SN, Berndt, ER, Davidson, JR, et al.The economic burden of anxiety disorders in the 1990s. J Clin Psychiatry 1999;60:427–435.CrossRefGoogle ScholarPubMed
Katon, W, VonKorff, M, Lin, EDistressed high utilizers of medical care. DSM-III-R diagnoses and treatment needs. Gen Hosp Psychiatry 1990;12:355–362.CrossRefGoogle ScholarPubMed
Katsching, H, Amering, MThe long-term course of panic disorder and its predictors. J Clin Psychopharmacol 1998;18(Suppl. 2):6–11.CrossRefGoogle Scholar
Kessler, RC, Greenberg, PE, Mickelson, KD, Meneades, LM, Wang, PSThe effects of chronic medical conditions on work loss and work cutback. J Occup Environ Med 2001;43:218–225.CrossRefGoogle ScholarPubMed
Kouzis, AC, Eaton, WWPsychopathology and the initiation of disability payments. Psychiatr Serv 2000;51:908–913.CrossRefGoogle ScholarPubMed
Kroenke, K, Spitzer, RL, Williams, JB, Monahan, PO, Lowe, BAnxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med 2007;146:317–325.CrossRefGoogle Scholar
Leon, AC, Olfson, M, Portera, LService utilization and expenditures for the treatment of panic disorder. Gen Hosp Psychiatry 1997;19:82–88.CrossRefGoogle ScholarPubMed
Lepine, JPThe epidemiology of anxiety disorders: prevalence and societal costs. J Clin Psychiatry 2002;63(Suppl. 14):4–8.Google ScholarPubMed
Love, B, Grafe, K, Zipfel, S, Spitzer, RL, Herrmann-Lingen, C, Witte, S, et al.Detecting panic disorder in medical and psychosomatic outpatients: comparative validation of the Hospital Anxiety and Depression Scale, the Patient Health Questionnaire, a screening question, and physicians’ diagnosis. J Psychosom Res 2003;55:515–519.Google Scholar
Marcks, BA, Weisberg, RB, Keller, MBPsychiatric treatment received by primary care patients with panic disorder with and without agoraphobia. Psychiatr Serv 2009;60:823–830.CrossRefGoogle ScholarPubMed
Mazzotti, E, Fassone, G, Picardi, A, Sagoni, E, Ramieri, L, Lega, I, et al.The Patient Health Questionnaire (PHQ) for the screening of psychiatric disorders: a validation study versus the Structured Clinical Interview for DSM–IV axis I (SCID I). Ital J Psychopathol 2003;9:235–242.Google Scholar
McQuaid, JR, Stein, MB, McCahill, M, Laffaye, C, Ramel, WUse of brief psychiatric screening measures in a primary care sample. Depress Anxiety 2000;12:21–29.3.0.CO;2-U>CrossRefGoogle Scholar
Means-Christensen, AJ, Sherbourne, CD, Roy-Byrne, PP, Craske, MG, Stein, MBUsing five questions to screen for five common mental disorders in primary care: diagnostic accuracy of the Anxiety and Depression Detector. Gen Hosp Psychiatry 2006;28:108–118.CrossRefGoogle ScholarPubMed
Muntingh, AD, van der Feltz-Cornelis, CM, van Marwijk, HW, Spinhoven, P, Assendelft, WJ, de Waal, MW, et al.Collaborative stepped care for anxiety disorders in primary care: aims and design of a randomized controlled trial. BMC Health Serv Res 2009;9:159, http://www.biomedcentral.com/1472-6963/9/159.CrossRefGoogle Scholar
Otto, MW, Deveney, CCognitive-behavioral therapy and the treatment of panic disorder: efficacy and strategies. J Clin Psychiatry 2005;66(Suppl. 4):28–32.Google ScholarPubMed
Prins, MA, Verhaak, PF, Bensing, JM, van der Meer, KHealth beliefs and perceived need for mental health care of anxiety and depression–the patient's perspective explored. Clin Psychol Rev 2008;28:1038–1058.CrossRefGoogle Scholar
Rollman, BL, Belnap, BH, Mazumdar, S, Houck, PR, Zhu, F, Gardner, W, et al.A randomized trial to improve the quality of treatment for panic and generalized anxiety disorder in primary care. Arch Gen Psychiatry 2005;62:1332–1341.CrossRefGoogle ScholarPubMed
Roy-Byrne, PP, Craske, MG, Stein, MB, Sullivan, G, Bystritsky, A, Katon, W, et al.A randomized effectiveness trial of cognitive-behavioral therapy and medication for primary care panic disorder. Arch Gen Psychiatry 2005;62:290–298.CrossRefGoogle ScholarPubMed
Roy-Byrne, PP, Katon, W, Cowley, DS, Russo, JA randomized effectiveness trial of collaborative care for patients with panic disorder in primary care. Arch Gen Psychiatry 2001;58:869–876.CrossRefGoogle ScholarPubMed
Roy-Byrne, PP, Russo, J, Dugdale, DC, Lessler, D, Cowley, D, Katon, WUndertreatment of panic disorder in primary care: role of patient and physician characteristics. J Am Board Fam Pract 2001;15:443–450.Google Scholar
Roy-Byrne, PP, Stein, MB, Russo, J, Mercier, E, Thomas, R, Mc Quaid, J, et al.Panic disorder in the primary care setting: comorbidity, disability, service utilization, and treatment. J Clin Psychiatry 1999;60:492–499.CrossRefGoogle ScholarPubMed
Seekles, W, van Straten, A, Beekman, A, van Marwijk, H, Cuijpers, PStepped care for depression and anxiety: from primary care to specialized mental health care: a randomised controlled trial testing the effectiveness of a stepped care program among primary care patients with mood or anxiety disorders. BMC Health Serv Res 2009;9:90, http://www.biomedcentral.com/1472-6963/9/90.CrossRefGoogle Scholar
Spitzer, RL, Kroenke, K, Williams, JBValidation and utility of a self-report version of PRIME-MD: The PHQ primary care study. JAMA 1999;282:1737–1744.CrossRefGoogle ScholarPubMed
Spitzer, RL, Williams, JB, Kroenke, K, Linzer, M, deGruy, F.V. 3rd, Hahn, SR, et al.Utility of a new procedure for diagnosing mental disorders in primary care. The PRIME-MD 1000 study. JAMA 1994;272:1749–1756.CrossRefGoogle ScholarPubMed
Stein, MB, Roy-Byrne, PP, Craske, MG, Bystritsky, A, Sullivan, G, Pyne, JM, et al.Functional impairment and health utility of anxiety disorders in primary care outpatients. Med Care 2005;43:1164–1170.CrossRefGoogle Scholar
Stein, MB, Roy-Byrne, PP, McQuaid, JR, Laffaye, C, Russo, J, McCahill, ME, et al.Development of a brief diagnostic screen for panic disorder in primary care. Psychosom Med 1999;61:359–364.CrossRefGoogle ScholarPubMed
Stein, MB, Sherbourne, CD, Craske, MG, Means-Chistensen, A, Bystritsky, A, Katon, W, et al.Quality of care for primary care patients with anxiety disorders. Am J Psychiatry 2004;161:2230–2237.CrossRefGoogle ScholarPubMed
Sullivan, G, Craske, MG, Sherbourne, C, Edlund, MJ, Rose, RD, Golinelli, D, et al.Design of the Coordinated Anxiety Learning and Management (CALM) study: innovations in collaborative care for anxiety disorders. Gen Hosp Psychiatry 2007;29:379–387.CrossRefGoogle ScholarPubMed
Weiller, E, Bisserbe, JC, Maier, W, Lecrubier, YPrevalence and recognition of anxiety syndromes in five European primary care settings. A report of the WHO study on Psychological Problems in General Health Care. Br J Psychiatry Supplement 1998;34:18–23.CrossRefGoogle Scholar
Wittkampf, KA, Baas, KD, van Weert, HC, Lucassen, P, Schene, AHThe psychometric properties of the panic disorder module of the Patient Health Questionnaire (PHQ-PD) in high-risk groups in primary care. J Affect Disord doi: http://dx.doi.org/10.1016/j.jad.2010.10.030 (epub ahead of print) (http://www.elsevier.com/locate/jad).Google Scholar
Young, AS, Klap, R, Sherbourne, CD, Wells, KBThe quality of care for depressive and anxiety disorders in the United States. Arch Gen Psychiatry 2001;58:55–61.CrossRefGoogle ScholarPubMed
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