Anxiety disorders differential diagnoses

Table 22.1 Anxiety disorders differential diagnoses Chapter 26 Emotionally unstable personality disorder (EUPD)...

Medications that have been used as treatment for anxiety and depression in the postwithdrawal state include antidepressants, benzodia2epines and other anxiolytics, antipsychotics, and lithium. In general, the indications for use of these medications in alcoholic patients are similar to those for use in nonalcoholic patients with psychiatric illness. However, following careful differential diagnosis, the choice of medications should take into account the increased potential for adverse effects when the medications are prescribed to alcoholic patients. For example, adverse effects can result from pharmacodynamic interactions with medical disorders commonly present in alcoholic patients, as well as from pharmacokinetic interactions with medications prescribed to treat these disorders (Sullivan and O Connor 2004). 

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. 

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. 

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. 

FIG. 12-1. Differential diagnosis of various anxiety-related disorders and treatment strategies (see specified figures in this and other chapters). 

Cluster C patients may indeed present for psychotherapy and may improve with that treatment modality alone. However, the therapist should carefully consider the differential diagnosis between avoidant personality disorder and panic disorder or social anxiety disorder, for example, which responds well to SSRI therapy. And the therapist should particularly evaluate the Cluster C patient for obsessional signs and symptoms that may respond well to antiobsessional medication. 

The differential diagnosis of anxiety disorders includes medical and psychiatric illnesses and certain drugs. Family studies show that SAD can be inherited, with a threefold increase in the rate of SAD in relatives of patients. Behavioral inhibition, characterized by wariness, decreased social interaction, and withdrawal, is a genetic trait that may contribute to SAD. " Patients with SAD commonly report having overprotective parents. Parental dysfunction and abuse are potential risk factors for developing SAD. "... 

Differentiating SAD from other anxiety disorders can be difficult. Panic attacks occur in both SAD and panic disorder, but the distinction between the two is the rationale behind fear fear of anxiety symptoms is characteristic of panic disorder, while fear of embarrassment from social interaction typifies SAD. GAD is hkely the diagnosis if anxiety regarding social situations are part of a pattern of worries about multiple fife areas or numerous potential negative outcomes. A majority of SAD patients have a comorbid mood, anxiety, or substance abuse disorder. The SAD typically precedes the development of comorbid disorders, which is associated with increased suicidal ideation. ... 

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