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Muñoz-Navarro R, Cano-Vindel A, Ruiz-Rodríguez P, Adrián Medrano L, González-Blanch C, Moriana JA, Capafons Bonet A, Dongil-Collado E. Modelo jerárquico de diagnóstico y derivación de los trastornos mentales comunes en centros de atención primaria. Una propuesta a partir del ensayo clínico PsicAP. Ansiedad y Estrés 2017. [DOI: 10.1016/j.anyes.2017.10.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Cano-Vindel A, Muñoz-Navarro R, Wood CM, Limonero JT, Medrano LA, Ruiz-Rodríguez P, Gracia-Gracia I, Dongil-Collado E, Iruarrizaga I, Chacón F, Santolaya F. Transdiagnostic Cognitive Behavioral Therapy Versus Treatment as Usual in Adult Patients With Emotional Disorders in the Primary Care Setting (PsicAP Study): Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2016; 5:e246. [PMID: 28011446 PMCID: PMC5219590 DOI: 10.2196/resprot.6351] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 09/30/2016] [Accepted: 10/22/2016] [Indexed: 12/18/2022] Open
Abstract
Background Demand for primary care (PC) services in Spain exceeds available resources. Part of this strong demand is due to the high prevalence of emotional disorders (EDs)—anxiety, depression, and somatic symptom disorders—and related comorbidities such as pain or chronic illnesses. EDs are often under- or misdiagnosed by general practitioners (GPs) and, consequently, treatment is frequently inadequate. Objective We aim to compare the short- and long-term effectiveness of group-delivered transdiagnostic cognitive behavioral therapy (TD-CBT) versus treatment as usual (TAU) in the treatment of EDs in the PC setting in Spain. We also aim to compare the effect of these treatments on disability, quality of life, cognitive-emotional factors, and treatment satisfaction. Methods Here we present the study design of a two-arm, single-blind, randomized controlled trial (N=1126) to compare TAU to TD-CBT for EDs. TAU will consist primarily of pharmacological treatment and practical advice from the GP while TD-CBT will be administered in seven 90-minute group sessions held over a period ranging from 12 to 14 weeks. Psychological assessments are carried out at baseline (ie, pretreatment); posttreatment; and at 3-, 6-, and 12-month follow-up. The study is conducted in approximately 26 PC centers from the National Health System in Spain. Results This study was initiated in December 2013 and will remain open to new participants until recruitment and follow-up has been completed. We expect all posttreatment evaluations to be completed by December 2017, and follow-up will end in December 2018. Conclusions We expect the TD-CBT group to have better results compared to TAU on all posttreatment measures and that this improvement will be maintained during follow-up. This project could serve as a model for use in other areas or services of the National Health System in Spain and even in other countries. ClinicalTrial International Standard Randomized Controlled Trial Number (ISRCTN): 58437086; http://www.isrctn.com/ISRCTN58437086 (Archived by WebCite at http://www.webcitation.org/6mbYjQSn3)
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Affiliation(s)
- Antonio Cano-Vindel
- PsicAP Research Group, Complutense University of Madrid, Madrid, Spain.,Faculty of Psychology, Complutense University of Madrid, Madrid, Spain
| | - Roger Muñoz-Navarro
- PsicAP Research Group, Complutense University of Madrid, Madrid, Spain.,Faculty of Psychology, University of Valencia, Valencia, Spain
| | - Cristina Mae Wood
- PsicAP Research Group, Complutense University of Madrid, Madrid, Spain.,Faculty of Psychology, Complutense University of Madrid, Madrid, Spain
| | - Joaquín T Limonero
- PsicAP Research Group, Complutense University of Madrid, Madrid, Spain.,Faculty of Psychology, Autonomous University of Barcelona, Barcelona, Spain
| | - Leonardo Adrián Medrano
- PsicAP Research Group, Complutense University of Madrid, Madrid, Spain.,Faculty of Psychology, Universidad Siglo 21, Córdoba, Argentina
| | - Paloma Ruiz-Rodríguez
- PsicAP Research Group, Complutense University of Madrid, Madrid, Spain.,Fuenlabrada Primary Care Center, Health Service of Madrid, Madrid, Spain
| | | | - Esperanza Dongil-Collado
- PsicAP Research Group, Complutense University of Madrid, Madrid, Spain.,Faculty of Psychology, Catholic University of Valencia, Valencia, Spain
| | - Iciar Iruarrizaga
- PsicAP Research Group, Complutense University of Madrid, Madrid, Spain.,Faculty of Social Work, Complutense University of Madrid, Madrid, Spain
| | - Fernando Chacón
- PsicAP Research Group, Complutense University of Madrid, Madrid, Spain.,Faculty of Psychology, Complutense University of Madrid, Madrid, Spain.,Spanish Association of Psychologists, Madrid, Spain
| | - Francisco Santolaya
- PsicAP Research Group, Complutense University of Madrid, Madrid, Spain.,Spanish Association of Psychologists, Madrid, Spain.,Malva-Rosa Mental Health Service, Valencia, Spain
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Muñoz-Navarro R, Cano-Vindel A, Wood CM, Ruíz-Rodríguez P, Medrano LA, Limonero JT, Tomás-Tomás P, Gracia-Gracia I, Dongil-Collado E, Iruarrizaga MI. The PHQ-PD as a Screening Tool for Panic Disorder in the Primary Care Setting in Spain. PLoS One 2016; 11:e0161145. [PMID: 27525977 PMCID: PMC4985125 DOI: 10.1371/journal.pone.0161145] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 08/01/2016] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Panic disorder is a common anxiety disorder and is highly prevalent in Spanish primary care centres. The use of validated tools can improve the detection of panic disorder in primary care populations, thus enabling referral for specialized treatment. The aim of this study is to determine the accuracy of the Patient Health Questionnaire-Panic Disorder (PHQ-PD) as a screening and diagnostic tool for panic disorder in Spanish primary care centres. METHOD We compared the psychometric properties of the PHQ-PD to the reference standard, the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) interview. General practitioners referred 178 patients who completed the entire PHQ test, including the PHQ-PD, to undergo the SCID-I. The sensitivity, specificity, positive and negative predictive values and positive and negative likelihood ratios of the PHQ-PD were assessed. RESULTS The operating characteristics of the PHQ-PD are moderate. The best cut-off score was 5 (sensitivity .77, specificity .72). Modifications to the questionnaire's algorithms improved test characteristics (sensitivity .77, specificity .72) compared to the original algorithm. The screening question alone yielded the highest sensitivity score (.83). CONCLUSION Although the modified algorithm of the PHQ-PD only yielded moderate results as a diagnostic test for panic disorder, it was better than the original. Using only the first question of the PHQ-PD showed the best psychometric properties (sensitivity). Based on these findings, we suggest the use of the screening questions for screening purposes and the modified algorithm for diagnostic purposes.
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Affiliation(s)
- Roger Muñoz-Navarro
- PsicAP Research Group, Complutense University of Madrid, Madrid, Spain
- Faculty of Psychology, University of Valencia, Valencia, Spain
- * E-mail:
| | - Antonio Cano-Vindel
- PsicAP Research Group, Complutense University of Madrid, Madrid, Spain
- Faculty of Psychology, Complutense University of Madrid, Madrid, Spain
| | - Cristina Mae Wood
- PsicAP Research Group, Complutense University of Madrid, Madrid, Spain
- Faculty of Psychology, Complutense University of Madrid, Madrid, Spain
| | - Paloma Ruíz-Rodríguez
- PsicAP Research Group, Complutense University of Madrid, Madrid, Spain
- Castilla La Nueva Primary Care Center, Health Service of Madrid, Madrid, Spain
| | - Leonardo Adrián Medrano
- PsicAP Research Group, Complutense University of Madrid, Madrid, Spain
- Faculty of Psychology, University Siglo 21, Córdoba, Argentina, Spain
| | - Joaquín T Limonero
- PsicAP Research Group, Complutense University of Madrid, Madrid, Spain
- Stress and Health Research Group, Faculty of Psychology, Autonomous University of Barcelona, Barcelona, Bellaterra, Spain
| | - Patricia Tomás-Tomás
- PsicAP Research Group, Complutense University of Madrid, Madrid, Spain
- Malva-Rosa Primary Care Center, Health Service of Valencia, Valencia, Spain
| | - Irene Gracia-Gracia
- PsicAP Research Group, Complutense University of Madrid, Madrid, Spain
- Faculty of Psychology, Complutense University of Madrid, Madrid, Spain
| | - Esperanza Dongil-Collado
- PsicAP Research Group, Complutense University of Madrid, Madrid, Spain
- Faculty of Psychology, Catholic University of Valencia, Valencia, Spain
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