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Special Aspects of Generalized Anxiety Disorder Diagnosing Among Russians Psychiatrists: the Results of a Vignette Study

I.A. Мartynikhin 1, N.G. Neznanov 1, 2
1 The First Pavlov State Medical University of St. Petersburg, St. Petersburg, Russia
2 National V.M. Bekhterev Medical Research Center of Psychiatry and Neurology, St. Petersburg, Russia

Absrtact: The official statistics and the results of a previous survey of the Russian Society of Psychiatrists (RSP) show that Russian psychiatrists use diagnoses of anxiety disorders less often than psychiatrists from other countries with largest difference in the frequency of generalized anxiety disorder (GAD). The aim of this study was to evaluate special aspects of the GAD diagnosis in Russia through the vignette methodology.
Methods: 14 clinical vignettes (Cases) were prepared. Each respondent randomly received 5 of them. Psychiatrists were invited to take part in the study through the RSP mailing list. The study involved 409 psychiatrists.
Results: the Case with the pure GAD clinical picture description was recognized by 78 % of respondents. Significantly less respondents established GAD diagnosis in the Cases where GAD symptoms were combined with symptoms of other disorders: 13 % of respondents for a Case of GAD in a patient with remission of paranoid schizophrenia, 18% of respondents for a Case with a combination of GAD and depression, 32 % of respondents for the Case with present clinical features of GAD and one panic attack in the past. The participants' diagnosis decision-making in these and other Cases indicates that much of the respondents do not follow the diagnostic criteria of ICD-10.
Conclusions: The vignette study demonstrated low psychiatrists' agreement in the diagnoses of anxiety disorders and in particular GAD, inaccurate adherence to the ICD-10 diagnostic guidance and reliance on different theoretical concepts (for example, which admit comorbid diagnoses or not). These features of diagnosis can explain the low detectability of GAD in Russia.

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