Anxiety disorders diagnosis

Barbee JG, McLaulin B. Anxiety disorders diagnosis and pharmacotherapy in the elderly. Psychiatr Ann 1990 20 439-445. 

Hoge, E., Ivkovic, A. and Fricchione, G. (2012) Clinical review. Generalised anxiety disorder diagnosis and treatment. British Medical Journal 345, e7500. 

Anxiety disorders are among the most frequent mental disorders encountered by clinicians. Anxiety disorders often are missed or attributed incorrectly to other medical illnesses, with most patients being treated inadequately. The burden of detection and diagnosis most often falls to primary-care clinicians, to whom most patients present in the context of other complaints. Untreated anxiety disorders may result in increased healthcare utilization, morbidity and mortality, and poorer quality of life. 

In the case of panic disorder, the exclusion criteria specify that only certain types of panic attacks are relevant to this diagnosis (i.e., panic attacks resulting from drugs, other anxiety disorders do not count). One could sim-... 

As you might expect, the diagnostic criteria for panic disorder requires the presence of recurrent panic attacks, but panic attacks alone are not sufficient for the diagnosis of panic disorder. Those with other anxiety disorders, for example, can experience panic attacks when confronted by the situation or object that they fear. 

The differential diagnosis of panic disorder includes other psychiatric illnesses, medical illnesses, and substances that can cause panic attacks. Also included are medical illnesses that cause symptoms resembling panic attacks. It should be mentioned that these other conditions, which are described below, and panic disorder are not necessarily mutually exclusive. In fact, there is a high rate of comorbidity between panic disorder, other anxiety disorders, and mood disorders. Because panic disorder is frequently accompanied by agoraphobia, the differential diagnosis also includes illnesses that are associated with symptoms resembling the avoidance of the agoraphobic patient. 

Primary care physicians are critical to the successful identification of GAD. Characterized by often-vague physical complaints, GAD must be distinguished from medical illnesses and other psychiatric disorders, though the high rate of comorbidity requires that a thorough evaluation for GAD be completed even when another disorder has been identified. GAD warrants particular consideration for those patients with nonspecific physical complaints who nevertheless have an urgent need for relief that has resulted in repeated office visits. The differential diagnosis for GAD includes other anxiety disorders, depression, and a variety of medical conditions and substance-induced syndromes. 

There is something distinctly human about social anxiety. Mark Twain once remarked, Man is the only animal that blushes—or needs to. Although there are other mammalian species with complex social pecking orders, we, as humans, are particularly sensitive to how we are perceived by others. This sensitivity, when marked by a fear of evaluation by others, can become maladaptive. If that fear is transient and leads to little or no avoidance of social interactions, then it is considered normal shyness. However, when the social consequences of that fear become more pronounced, then the diagnosis of social phobia, now more commonly referred to as social anxiety disorder, is warranted. 

Psychiatric medications do not currently play a prominent role in the treatment of cocaine-dependent patients (see Table 6.4). Although researchers have labored to find medications to treat cocaine addiction, there have not been any notable breakthroughs. As with other substance use disorders, the presence of a psychiatric disorder for which medication is indicated (i.e., depression, anxiety disorders, bipolar affective disorder, or schizophrenia) should prompt appropriate treatment. Similar to the presence of alcohol intoxication, deferring a diagnosis for a day or two in a new patient with no past history is often the more prudent course. 

These patients will often present with complaints of depressed mood or anxiety. The depression frequently takes the form of dysthymic disorder although these patients are at increased risk for major depressive disorder as well. Anxiety is often a symptom of the personality disorder itself, though comorbid Axis 1 anxiety disorders are occasionally present. Similar to the other personality disorders, there is a differential diagnosis that should be considered in patients who have a Cluster C personality disorder. 

Roerig JL. Diagnosis and management of generalized. Anxiety disorder. J Am Pharm Assoc 1999 39(6) 811-21. 

The diagnosis generalized anxiety disorder, not otherwise specified refers to a free-floating state of anxiety that is not firmly bounded. For example, a person with a diagnosis of generalized anxiety would be differentiated from someone who suffers specifically from panic disorders or from another particular phobia. 

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