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From the Departments of Psychiatry (M.B.S., J.R.M., C.L.) and Family and Preventive Medicine (M.E.M), University of California, San Diego, La Jolla, California; Department of Psychiatry, University of Washington, Seattle, Washington (P.P.R.-B., J.R., W.K.); University of California, Los Angeles, Los Angeles, California (M.C., A.B.); and RAND, Santa Monica, California (C.D.S.).
Address reprint requests to: Murray B. Stein, MD, Department of Psychiatry (0985), University of California, San Diego, 9500 Gilman Dr., La Jolla, CA 92093-0985. Email: mstein{at}ucsd.edu
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 
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.
Key Words: panic disorder • primary care • general medicine • screening • diagnostic interview • anxiety disorders
Abbreviations: GIM = University of Washington General Internal MedicineClinic; HMC = University of Washington Harborview Medical CenterAdult Medical Clinic; UCSD = University of California, San Diego,Mira Mesa Family Medicine Clinic; NPV = negative predictive value; Se = sensitivity; Sp = specificity; NPV = negativepredictive value; PPV = positive predictive value; ROC =receiver operating characteristic; SDDS-PC = Symptom-DrivenDiagnostic System for Primary Care; PRIME-MD = Primary CareEvaluation of Mental Disorders.
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