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Differential Diagnosis of PalpitationsPreliminary Development of a Screening Instrument
Arthur J. Barsky, MD;
David K. Ahern, PhD;
Beth A. Delamater;
Susan A. Clancy, MA;
E. Duff Bailey, MD
Arch Fam Med. 1997;6(3):241-245.
Abstract
Objective
To develop a self-report screening instrument to assist in the differential diagnosis of medical outpatients complaining of palpitations.
Design
Patients completed self-report questionnaires assessing somatization, cardiac symptoms, and hypochondriacal concerns about health. Principal components analysis was performed to identify a subset of questions that could be used to distinguish patients with palpitations who have panic disorder from those with palpitations who do not have panic disorder.
Patients
Sixty-seven medical outpatients referred for Holter monitoring because of a complaint of palpitations.
Main Outcome Measures
Patients with palpitations were classified into 2 groups, those with and those without current panic disorder (established with a structured, diagnostic interview). The sensitivity, specificity, and posttest probability of the screening instrument were determined.
Results
A reliable, stable, 10-item instrument was derived. It seems to tap diffuse, vague, or generalized somatic complaints and worry about physical illness. With the use of a criterion cutoff score of 21, this instrument had a sensitivity of 0.81, a specificity of 0.80, and a posttest probability of .57 in detecting current panic disorder in patients with palpitations.
Conclusion
A psychometrically sound and brief selfreport instrument was developed to assist in the differential diagnosis of palpitations. It can be used to identify patients whose symptoms are more likely to result from panic disorder and in whom ambulatory monitoring might be deferred.
Author Affiliations
From the Department of Psychiatry, Harvard Medical School (Drs Barsky, Ahern, and Bailey); Division of Psychiatry, Brigham and Women's Hospital (Dr Barsky and Mss Delamater and Clancy); and Psychiatric Service, Massachusetts General Hospital (Drs Ahern and Bailey), Boston, Mass.
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