Symptomatic severity of PRIME-MD diagnosed episodes of panic and generalized anxiety disorder in primary care

BACKGROUND: Panic disorder (PD) and generalized anxiety disorder ( GAD) are often unrecognized by primary care physicians (PCPs). The Primary Care Evaluation of Mental Disorders (PRIME-MD) has been used as a case-finding instrument for depression. Yet, little is known on its usefulness as a case-finding tool for anxiety disorders within the context of a clinical trial. OBJECTIVE: To examine the: ( 1) completion rate of the PRIME-MD by patients approached to enroll in a treatment study for PD and GAD; ( 2) distribution of anxiety diagnoses generated; ( 3) severity of PD and GAD episodes thus identified; and ( 4) level of PCPs' agreement with these diagnoses. DESIGN: Cross-sectional interview. PATIENTS: Individuals aged 18 to 64 who presented for care at 4 primary care practices. MEASUREMENTS: The PRIME- MD, Structured Interview Guide for the Hamilton Anxiety Rating Scale (SIGH- A), and the Panic Disorder Severity Scale (PDSS). RESULTS: Of the 6,700 patients who completed the PRIME- MD Patient Questionnaire (PQ), 2,926 (44%) screened positive for an anxiety disorder, and 1,216 (42%) met preliminary study eligibility and consented to the PRIME- MD Anxiety Module. Of these, 619 (51%) had either GAD ( 308), PD ( 94), or both ( 217) disorders. Later, 329 completed a telephone interview. Of these, 59% with GAD and 68% with PD reported moderate or greater levels of anxiety symptoms on the SIGH-A and PDSS, respectively, and PCPs agreed with the PRIME- MD diagnosis for 98% of these patients. CONCLUSIONS: The PRIME- MD can efficiently screen patients for PD and GAD. Although patients thus identified endorse a wide range of anxiety symptoms, PCPs often agree with the diagnosis.