Differential Diagnosis Of Anxiety Research Articles

Anxiety in the medically ill: nosology and principles of differential diagnosis.

Anxiety and anxiety disorder have been estimated to occur in 5% to 20% of medical inpatients and 4% to 14% of medical outpatients. These estimates do not distinguish between anxiety symptoms and anxiety disorders, nor between the various causes of anxiety in the medically ill. This article reviews the epidemiology, nosology, disorders in the differential diagnosis, and principles of differential diagnosis of anxiety in the medically ill. A widely endorsed nosology for anxiety disorders caused by medical illness and its treatments is a relatively recent development. General guidelines for differentiating between specific diagnoses in the differential diagnosis of anxiety in the medically ill are now provided in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, but, as is often the case, it is easier to describe the distinctions in theory than it is to make them in actual practice.

Anxiety and neurological disorders.

Anxiety disorders occur quite frequently in patients who have neurologic disorders. In fact, several studies show that anxiety disorders occur more frequently than mood disorders in patients with neurologic conditions. Despite high prevalence rates, investigators have neglected the study of anxiety disorders in these patients. Two major reasons for the neglect are the diagnostic hierarchy and exclusion criterion found in Diagnostic and Statistical Manual (DSM)-III-R and DSM-IV. This article discusses problems in the diagnosis of anxiety disorders in patients with neurologic conditions and presents a brief literature review of the relationship between anxiety and neurologic disorders. In addition, the authors describe the differential diagnosis of anxiety in neurologic conditions and treatment options.

Affect traits in differential diagnosis of anxiety, depressive, and schizophrenic disorders using the Multiple Affect Adjective Check List-Revised.

A study of 185 psychiatric patients with anxiety, mood, and schizophrenic disorders and 185 matched nonpatient controls investigated the effectiveness of the affect trait scales of the revised Multiple Affect Adjective Check List (MAACL-R) in differentiating the three disorders. Univariate and multivariate analyses supported the usefulness of the affect in global and specific diagnostic classifications. The strongest discriminant function described a general dysphoria dimension (Depression plus Anxiety minus Positive Affect) which differentiated the anxiety and mood disorder groups from schizophrenic patients and nonpatient controls. A second discriminant function best differentiated the anxiety from mood disorder groups and was defined by relatively higher anxiety and normal sensation seeking scores among anxiety disorders and relatively higher depression and lower sensation seeking among mood disorders. Schizophrenic disorders could not be reliably distinguished from the other groups by negative affect scales, although they scored lower on positive affect than normals. It was concluded that the MAACL-R was valid in making both global and specific diagnostic classifications.

Diagnosis of Anxiety and Depression

The differential diagnosis of anxiety and depression is often difficult as symptoms of generalized anxiety, panic disorder, and depression frequently coexist.

Emotional imagery and the differential diagnosis of anxiety.

Emotional imagery and the differential diagnosis of anxiety.

Clinical presentations of panic-related disorders

Increasing attention to anxiety disorders has highlighted the overlap of symptoms of panic with various medical disorders. The differential diagnosis of anxiety is reviewed. Additionally, the various clinical presentations of anxiety disorders are surveyed.

Emotional imagery and the differential diagnosis of anxiety.

Emotional imagery and the differential diagnosis of anxiety.

The Differential Diagnosis of Anxiety: Psychiatric and Medical Disorders

This article has reviewed clinical and demographic features of the primary anxiety disorders and other psychiatric and medical disorders that often are associated with anxiety symptoms, highlighting differential diagnosis. In summary, phobic disorders (exogenous anxiety) are characterized by anxiety reliably elicited by specific environmental stimuli; the stimuli involved determine which type of phobia is diagnosed. In contrast, panic attacks and generalized anxiety (endogenous anxiety) involve symptoms of anxiety not associated only with specific eliciting stimuli. Panic disorder is differentiated from generalized anxiety disorder by the presence of discrete attacks; both disorders usually have some level of persistent anxiety. Obsessive-compulsive disorder is characterized by recurrent unwanted but irresistible thoughts and the ritualized repetitive acts resulting from these obsessions, in the absence of preexisting psychosis or depression. Finally, posttraumatic stress disorder involves various anxiety (and other) symptoms as a direct result of an obvious stressor. Depressive symptoms are frequently associated with anxiety. It is sometimes impossible to determine which is the primary disorder. Overlap of syndromes probably also occurs with other primary psychiatric disorders, especially somatoform disorders, adjustment disorder with anxious mood, and several personality disorders. Finally, primary anxiety can be confused with several medical syndromes, especially when the medical disorder has not been recognized. Nevertheless, research with patients with pheochromocytoma suggests that medical causes of anxiety may be qualitatively different from primary anxiety disorders, especially the psychic anxiety component. Attention to the clinical and demographic features listed in Table 4, as well as the use of newly-developed structured diagnostic interviews should usually lead to a correct diagnosis, as illustrated by the following examples. The onset of a fear of public speaking in mid-adolescence suggests an uncomplicated social phobia, whereas the onset in the mid-twenties of several social and other situational anxieties in a person with a previous history of panic attacks would be strongly suggestive of the panic-agoraphobia syndrome. The new onset of generalized anxiety symptoms and depression in a 45-year-old patient who has had a previous significant depression would suggest that this person's anxiety is part of, and secondary to, the affective disorder and not a primary anxiety disorder.(ABSTRACT TRUNCATED AT 400 WORDS)

Can you clarify what needs to be considered in the differential diagnosis of anxiety in endocrine disorders (e.g., pheochromocytoma, thyrotoxicosis, caffeinism) versus panic attacks?

Can you clarify what needs to be considered in the differential diagnosis of anxiety in endocrine disorders (e.g., pheochromocytoma, thyrotoxicosis, caffeinism) versus panic attacks?

Differential Diagnosis of Anxiety

Differential Diagnosis of Anxiety

Assessment methods and the differential diagnosis of anxiety.

Anxiety states are commonly encountered, especially in general practice. Some endocrine disorders have features in common with anxiety states, especially thyrotoxicosis and idiopathic hypoglycemia. Functional cardiovascular disorders merge into anxiety states and include a large number of ill-differentiated syndromes. Other causes of anxiety are the drug-associated conditions, such as amphetamine overdose and barbiturate withdrawal. Among neuropsychiatric illnesses, temporal lobe epilepsy and the postconcussional state commonly have anxiety as a prominent syndrome. Psychophysiological technique can be used to assess anxiety levels in a variety of clinical contexts but need cautious interpretation. Anxiety is most easily assessed using rating scales but potential users must be clear as to what they are trying to measure. For clinical anxiety assessed by the physician, the Hamilton Scale is appropriate; for self-assessments linear scales can be adapted.