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The use of PRIME-MD questionnaire in a rheumatology clinic

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Abstract

Objective: To determine whether the Primary Care Evaluation of Mental Disorders 1-page Brief Patient Health Questionnaire (PRIME-MD 1-page PHQ) can serve as: (1) a diagnostic test for fibromyalgia syndrome (FM), or (2) a questionnaire through which internists can be alerted to otherwise hidden mental disorders in patients attending internal medicine clinics. Method: Two hundred and thirteen consecutive patients attending a rheumatology clinic were given the PRIME-MD 1-page PHQ and seen by a rheumatologist who was blind to the PRIME-MD diagnosis. Results: The PRIME-MD 1-page PHQ pointed to Major Depressive Disorder in 33.3% of FM patients, Other Depressive Disorder in 33.3% of FM patients, and Panic Disorder in 22.2% of FM patients (all of whom also had Major Depressive Disorder), as compared to 13.1, 13.1, and 3.0% respectively in patients with other rheumatic disorders. However, when used as a diagnostic test for FM, the PRIME-MD 1-page PHQ did not have adequate diagnostic value. When all the PRIME-MD 1-page PHQ diagnoses were compiled, however, a trend was observed. Compared to the rates of mental disorders in both the normal population and in primary care practices, the rates found in this rheumatology clinic were higher. Conclusions: The PRIME-MD 1-page PHQ is not an adequate diagnostic test for FM. Because FM is primarily a somatization disorder that draws its symptoms from other current diseases, it may in fact be impossible to diagnose FM based on specific symptoms alone. However, the PRIME-MD 1-page PHQ proved to be a useful diagnostic tool in a rheumatology clinic. It helped to alert the physician to the possibility of an elevated frequency of mental disorders that would otherwise have gone unnoticed and untreated.

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References

  1. Nimnuan C, Hotopt M, Wessely S (2001) Medically unexplained symptoms: an epidemiologic study in seven specialities. J Psychosom Res 51:361–367

    Article  CAS  PubMed  Google Scholar 

  2. Fink P (1992) Surgery and medical treatment in persistent somatising patients. J Psychosom Res 36:439–447

    CAS  PubMed  Google Scholar 

  3. Kroenke K, Spitzer RL, Williams JP, Linzer M (1994) Physical symptoms in primary care. Predictors of psychiatric disorders and functional impairment. Arch Fam Med 3:774–779

    CAS  PubMed  Google Scholar 

  4. Sharpe M (2002) Medically unexplained symptoms and syndromes. Clin Med 2:501–504

    PubMed  Google Scholar 

  5. O’Malley PG, Jackson JL, Santoro J, Tomkins G, et al. (1999) Antidepressant therapy for unexplained symptoms and symptom syndromes. J Fam Pract 48:980–990

    CAS  PubMed  Google Scholar 

  6. Walker EA, Keegan D, Gardner G, Sullivan M, Katon WJ, Bernstein D (1997) Psychosocial factors in fibromyalgia compared with rheumatoid arthritis: I. psychiatric diagnoses and functional disability. Psychosom Med 59:565–571

    CAS  PubMed  Google Scholar 

  7. Hudson JI, Hudson MS, Pliner LF, Goldenberg DL, Pope HG (1985) Fibromyalgia and major affective disorder: a controlled phenomenology and family history study. Am J Psychiatry 142:441–446

    CAS  PubMed  Google Scholar 

  8. Spitzer RL, Williams JBW, Kroenke K, et al. (1994) Utility of a new procedure for diagnosing mental disorders in primary care: The PRIME-MD 1000 Study. J Am Med Assoc 272:1749–1756

    CAS  Google Scholar 

  9. Spitzer RL, Kroenke K, Williams JBW (1999) Validation and utility of a self-report version of PRIME-MD: The PHQ Primary Care Study. J Am Med Assoc 282:1737–1744

    CAS  Google Scholar 

  10. Wolfe F (1999) Silicone related symptoms are common in patients with fibromyalgia: no evidence for a new disease. J Rheumatol 26:1172–1175

    CAS  PubMed  Google Scholar 

  11. Ferrari R, Russell, AS (1997) The whiplash syndrome—common sense revisited. J Rheumatol 24:622–623

    Google Scholar 

  12. Okifuji A, Turk DC, Sherman JJ (2000) Evaluation of the relationship between depression and fibromyalgia syndrome: why aren’t all patients depressed? J Rheumatol 27:212–219

    CAS  PubMed  Google Scholar 

  13. Payne TC, Leavitt F, Garron DC, et al. (1982) Fibrositis and psychologic disturbance. Arthritis Rheum 25:213–217

    CAS  PubMed  Google Scholar 

  14. Alfici S, Sigal M, Landau M (1989) Primary fibromyalgia syndrome—a variant of depressive disorder? Psychother and Psychosom 51:156–161

    CAS  Google Scholar 

  15. Krag NJ, Norregaard J, Larsen JK, Danneskiold-Samsoe B (1994) A blinded, controlled evaluation of anxiety and depressive symptoms in patients with fibromyalgia, as measured by standardized psychometric interview scales. Acta Psychiatr Scand 89:370–375

    CAS  PubMed  Google Scholar 

  16. Maiden NL, Hurst NP, Lochhead A, Carson AJ, Sharpe M (2003) Medically unexplained symptoms in patients referred to a specialist rheumatology service: prevalence and associations. Rheumatology 42:108–112

    CAS  PubMed  Google Scholar 

  17. Myers JK, Weissman MM, Tischler GL et al. (1984) Six-month prevalence of psychiatric disorders in three communities. Arch Gen Psychiatry 41:959–967

    CAS  PubMed  Google Scholar 

  18. Katon W, Sullivan M, Walker E (2001) medical symptoms without identified pathology: relationship to psychiatric disorders, childhood and adult trauma, and personality traits. Ann Intern Med 134:917–925

    CAS  PubMed  Google Scholar 

  19. Simon GE, VonKorff M (1991) Somatization and psychiatric disorder in the NIMH epidemiologic catchment area study. Am J Psychiatr 148:1494–1500

    CAS  PubMed  Google Scholar 

  20. Bridges KW, Goldberg DP (1985) Somatic presentation of DSM III psychiatric disorders in primary care. J Psychosom Res 29:563–569

    CAS  PubMed  Google Scholar 

  21. Kroenke K, Price RK (1993) Symptoms in the community: prevalence, classification, and psychiatric comorbidity. Arch Intern Med 153:2474–2480

    Article  CAS  PubMed  Google Scholar 

  22. Kirmayer LJ, Robbins JM, Dworkind M, Yaffe MJ (1993) Somatization and the recognition of depression and anxiety in primary care. Am J Psychiatry 150:734–741

    CAS  PubMed  Google Scholar 

  23. Walker EA, Roy-Byrne PP, Katon WJ, Li L, Amos D, Jiranek G (1990) Psychiatric illness and irritable bowel syndrome: a comparison with inflammatory bowel disease. Am J Psychiatry 147:1656–1661

    CAS  PubMed  Google Scholar 

  24. Shorter E (1992) From paralysis to fatigue: a history of psychosomatic illness in the modern era.Macmillan, New York

    Google Scholar 

Download references

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Correspondence to A. S. Russell.

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CONFLICT OF INTEREST STATEMENT. Neither author has any conflict of interest in the above.

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Russell, A.S., Hui, B.K. The use of PRIME-MD questionnaire in a rheumatology clinic. Rheumatol Int 25, 292–295 (2005). https://doi.org/10.1007/s00296-004-0548-8

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  • DOI: https://doi.org/10.1007/s00296-004-0548-8

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