Differential diagnosis of palpitations. Preliminary development of a screening instrument

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 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 resul…