Differential diagnosis of palpitations. Preliminary development of a screening instrument
A. J. Barsky, D. K. Ahern, B. A. Delamater, S. A. Clancy and E. D. Bailey
Department of Psychiatry, Harvard Medical School, Boston, Mass., USA.
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 post-test probability
of.57 in detecting current panic disorder in patients with palpitations.
CONCLUSIONS: A psychometrically sound and brief self-report 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.
