eMedicine Specialties > Psychiatry > Adult
Anxiety Disorders: Differential Diagnoses & Workup
Updated: Oct 26, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Differential Diagnoses
Other Problems to Be Considered
Adult respiratory distress syndrome (ARDS)
AIDS
Thyrotoxicosis
Anxiety disorders have one of the longest differential diagnosis lists of all psychiatric disorders. Anxiety is a nonspecific syndrome and can be due to a variety of medical or psychiatric syndromes. A variety of anxiety symptoms, such as panic, worry, rumination, and obsessions, can present in a variety of psychiatric illnesses including mood disorders, psychotic disorders, personality disorders, somatoform disorders, and cognitive impairment disorders (eg, delirium). Anxiety also can be observed as part of a drug withdrawal or drug intoxication effect.
Other important causes in the differential include medication-induced anxiety (ie, due to epinephrine or other sympathomimetics, theophylline or other neurostimulant bronchodilators, analgesics containing caffeine, corticosteroids, antivirals, others); migraine, seizure disorders, or other CNS-based disorders; and sleep disorders such as restless legs syndrome, sleep apnea, and periodic limb movement. Heroin abuse also should be considered in the differentials.
Workup
Laboratory Studies
- When the index of suspicion for anxiety being produced by a medical disorder is low (lack of physical findings, younger age, typical anxiety disorder presentation), initial lab studies might be limited to the following:
- CBC count
- Chemistry profile
- Thyroid function tests
- Urinalysis
- Urine drug screen
- For presentations with a higher index of suspicion for other medical causes of anxiety (ie, atypical anxiety disorder presentation, older age, specific physical examination abnormalities), more detailed evaluations may be indicated as follows:
- Rule out CNS disorder using electroencephalogram, lumbar puncture, or brain CT scan, as indicated by history and associated clinical findings.
- Rule out cardiac disorder using ECG or treadmill ECG.
- Rule out infectious causes using rapid plasma reagent test, lumbar puncture (CNS infections), or HIV testing.
Imaging Studies
- Diagnostic imaging studies are not indicated in the diagnosis of primary anxiety disorders unless specific general medical conditions need to be ruled out.
- Imaging studies may be helpful, however, to rule out anxiety due to a general medical condition, eg, cephalic CT scan or MRI to evaluate for pathological intracranial processes.
Procedures
- Psychosurgery is used in rare cases of severe treatment-refractory OCD.
- Electroconvulsive therapy is not effective for anxiety disorders but may successfully treat comorbid conditions, such as severe major depression, and is especially indicated when the patient is at high risk for suicide.
More on Anxiety Disorders |
| Overview: Anxiety Disorders |
 Differential Diagnoses & Workup: Anxiety Disorders |
| Treatment & Medication: Anxiety Disorders |
| Follow-up: Anxiety Disorders |
| Multimedia: Anxiety Disorders |
| References |
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References
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Further Reading
Keywords
generalized anxiety disorder, panic disorder, phobia, agoraphobia, obsessive-compulsive disorder, OCD, stress, anxiety neurosis, nervousness, posttraumatic stress disorder, PTSD, substance-induced anxiety disorder, specific phobias, social phobia, adjustment disorder, acute stress disorder
major depression, separation anxiety, substance abuse disorder, recurrent distressing dreams, recurrent distressing nightmares, difficulty staying asleep, exaggerated startle response, hypervigilance, difficulty concentrating, anger outbursts, irritability, difficulty falling asleep, sweaty palms, restlessness
