Differential diagnosis of palpitations. Preliminary development of a screening instrument

To develop a self-report screening instrument to assist in the differential diagnosis of medical outpatients complaining of palpitations.

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.

Sixty-seven medical outpatients referred for Holter monitoring because of a complaint of palpitations.

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.

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.

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.