Re: Anxiety Disorders Surprisingly Common Yet Often Untreated


"Tim Silva" <Tim.Silva2@xxxxxxxxx> wrote in message
news:1173724246.551741.97250@xxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
thinkanxiety.org - A new study by researchers led by Kurt Kroenke,
M.D., of the Indiana University School of Medicine and the Regenstrief
Institute, Inc. reports that nearly 20 percent of patients seen by
primary care physicians have at least one anxiety disorder. The study
outlines the effectiveness of a new screening tool which can alert
busy primary care physicians to those patients with one or more
anxiety disorders. The study is published in the March 6 issue of the
Annals of Internal Medicine.

There is a real problem with the conclusion, on their web site, that 20% of
patients seen by primary care physicians "have at least one anxiety
disorder." Their study only shows that maybe 20% of the patients in their
data pool score some number of points on their scale. There is no
cross validation, no reliability study, etc.

I do not believe that 20% of regular patients have a clinically significant
anxiety disorder.

The GAD-7, a seven-question, self-administered screening tool,
identifies patients with undiagnosed generalized anxiety disorder,
panic disorder, post traumatic stress disorder or social anxiety
disorder. The new study, which looked at 965 patients in 15 primary
care clinics, found anxiety to be as prevalent as depression, and much
more common than previously thought, in patients who were visiting a
physician for a physical problem or illness.

Any "seven-question ... screening tool" must first pass the Sagan Baloney
Test:
If it smells like baloney, it probably is, and it must prove that it is not.

Seven simple questions cannot, mathematically, identify any complex
characteristic with useful reliability and discrimination. Can't be done.

This leaves a few possibilities. First, and most likely, is that the test
is measuring something trivial. In other words, perhaps the construct can
be better approached just by asking a simple question. Similar to
alcoholism:
Lots of tests purport to measure and "detect" alcoholism, but a simple
question
works better. Just ask, "Do you drink?"

Second, maybe it isn't measuring anything at all. It is only giving a set
of
criteria, which as a group encompass the entire sample. So, if it fails
to achieve identification of a high number of subjects, it has done the
unthinkable. I, personally, am amazed that such a scale would identify
only 20% as having anxiety "disorders," since most people going to their
physician have all sorts of anxiety. And if you ask about anxiety, you
should
get close to 100% agreement. Most questions about anxiety are Barnum
statements.


"Anxiety often manifests as a physical symptom like pain, fatigue, or
inability to sleep, so it is not surprising that one out of five
patients who come to a doctor's office with a physical complaint have
anxiety," said Dr. Kroenke, I.U. School of Medicine professor of
medicine and Regenstrief Institute, Inc. research scientist. Dr.
Kroenke, an internist, is an internationally recognized researcher who
studies physical symptoms, especially pain, and their links to mental
disorders including anxiety and depression.

Dr. Kroenke and colleagues found that even administering the first two
questions of the GAD-7 flagged those patients with possible anxiety
disorders for physician follow-up. These questions ask the patient if
he or she has felt nervous or has been unable to stop or control
worrying over the previous two weeks. Bringing this information to the
physician's attention is important because the doctor may be focused
on the patient's physical complaints and unless prompted by the
patient or test results is unlikely to assess the patient's mental
status. ...cont.

http://www.thinkanxiety.org/article-2996106.htm

Really sort of a meaningless exercise. As it says above, "it is not
surprising" that 20% have symptoms of anxiety. But does this mean that
they have an "anxiety disorder?" Not by a long shot.

Besides, too many symptoms are being called "anxiety" disorders because
there
has come to be a widespread failure to distinguish between anxiety and
arousal
and nervousness and tension. There is, we need to remember, a difference
between
them. Most disorders that are called anxiety are not.

No more rant. Me stop now.

card xii


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