Screening
Guidelines on screening for panic disorder vary according to country of practice. The US Preventive Services Task Force (USPSTF) recommends screening for anxiety disorders in all children and adolescents ages 8 to 18 years, and all adults between the ages of 19 to 64, including pregnant and postpartum people. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for anxiety disorders in children ages 7 years and younger, and in older adults ages 65 and over.[76][77] The Women’s Preventive Services Initiative (WPSI) in the US recommends primary care screening for anxiety in women and adolescent girls ages ≥13 years, including pregnant and postpartum women. The WPSI states that the optimal screening intervals are unknown, and so clinical judgment should be used to determine frequency.[78]
In contrast, UK guidance from the National Institute for Health and Care Excellence (NICE) does not offer specific guidance on screening for anxiety. NICE states that there is insufficient evidence on which to recommend a well-validated, self-reporting screening instrument for panic disorder, and recommends that consultation skills are relied upon to elicit all necessary information.[69]
The PRIME-MD panic screen contains four "yes or no" questions to assess the presence of panic attacks within the last 4 weeks. Responding "yes" to all 4 questions indicates likely presence of panic disorder. The panic screen also includes 11 somatic and cognitive symptoms, with endorsement of at least 4 of these symptoms indicative of likely panic disorder.[73]
The Panic Disorder Severity Scale (PDSS) is a 7-item measure assessing the frequency, avoidance, degree of distress, and functional impairment of panic attacks. Items are scored on a 0-4 scale, with higher scores indicative of greater panic severity. Among patients with panic disorders without agoraphobia, scores of 0-1 are considered normal, 2-5 borderline ill, 6-9 slightly ill, 10-13 moderately ill, 14-16 markedly ill, and 17+ severely ill.[74]
The GAD-7 is a brief self-report measure for assessing anxiety severity in primary care. In total, 7 items are scored on a 0 to 3 scale, with a cut score of ≥10 indicative of a likely anxiety disorder.[10][75] Although designed as a measure of generalized anxiety, the GAD-7 is sensitive in detecting panic-related symptoms.
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