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Biomedical subjects

W Katon

Publications and source records attributed to W Katon.

150 records · Page 9Linked to original sources
PubMedDate not supplied

Development of a brief diagnostic screen for panic disorder in primary care.

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 > or =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.

Adult↗
PubMedDate not supplied

Pharmacotherapy of panic disorder: proposed guidelines for the family physician.

BACKGROUND: Efforts to improve the recognition and treatment of panic disorder in the primary care setting have not resulted in better outcomes. Studies show that even when physicians recognize panic disorder, they do not treat it adequately. Family physicians need specific diagnostic and treatment guidelines when they encounter a patient who has possible panic disorder. METHODS: Four psychiatrists with expertise in the pharmacotherapy of panic disorder and experience working in the primary care setting reviewed the available treatment literature and developed a consensus treatment algorithm for panic pharmacotherapy in the primary care setting. These proposed guidelines were reviewed for accuracy by 3 additional psychiatric experts and for their applicability to the primary care setting by 2 leading experts on the treatment of mental disorders in primary care. RESULTS: Guidelines for medication selection, dosing, titration, side-effect management, and maintenance treatment are proposed. Modifications for patients already on psychotropic medication are provided, and indications for psychiatric consultation are specified. CONCLUSIONS: Panic disorder is a highly treatable condition, and primary care physicians can deliver effective pharmacotherapy if specific guidelines are carefully followed.

Anti-Anxiety Agents↗
PubMedDate not supplied

Prospective study of the natural history of infectious mononucleosis caused by Epstein-Barr virus.

BACKGROUND: Knowledge regarding the clinical characteristics and natural history of acute infectious mononucleosis is based largely on older, often retrospective, studies without systematic follow-up. Differences in diagnosis, methodology, or treatment between historical and current practice might affect an understanding of this illness. METHODS: Using a prospective case series design, we enrolled 150 persons with an acute illness serologically confirmed as Epstein-Barr virus infection. The goal of the study was to assess symptoms, physical examination findings, laboratory tests, and functional status measures during the acute presentation and 1, 2, and 6 months later. RESULTS: Acutely, infectious mononucleosis was characterized by the symptoms of sore throat and fatigue and substantial functional impairment. Objective physical and laboratory examination findings included pharyngitis and cervical lymphadenopathy, a moderate absolute and atypical lymphocytosis, and mildly elevated transaminase levels. The traditional signs of fever and splenomegaly were relatively uncommon. By 1 month, most symptoms and signs and all laboratory tests had returned to normal. Fatigue, cervical lymphadenopathy, pharyngitis, and functional health status improved more slowly. CONCLUSIONS: In contemporary practice most of the classical illness features of infectious mononucleosis are observed. Symptoms, signs, and poor functioning might be protracted in some patients.

Adolescent↗