eMedicine Specialties > Psychiatry > Adult

Phobic Disorders: Differential Diagnoses & Workup

Author: Adrian Preda, MD, Health Sciences Associate Professor of Psychiatry and Human Behavior, University of California Irvine School of Medicine
Coauthor(s): Ronald C Albucher, MD, Chief Medical Officer, Westside Community Services; Consulting Staff, California Pacific Medical Center
Contributor Information and Disclosures

Updated: Jul 10, 2008

Differential Diagnoses

Alcoholism
Panic Disorder
Angina Pectoris
Personality Disorders
Anxiety Disorders
Pheochromocytoma
Depression
Posttraumatic Stress Disorder
Hyperparathyroidism
Schizophrenia
Hyperthyroidism
Somatoform Disorders
Hypoglycemia
Stimulants
Hypothyroidism
Ventricular Premature Complexes
Mitral Valve Prolapse

Other Problems to Be Considered

Depersonalization disorder
Seizure
Vertigo
Vestibular dysfunction

Workup

Laboratory Studies

To rule out anxiety secondary to medical conditions, the following tests are helpful:

  • Thyroid function tests - Hypothyroidism or hyperthyroidism 
  • Fasting glucose - Hypoglycemia
  • Calcium - Hyperparathyroidism
  • Electrocardiogram and cardiac enzyme tests - Myocardial infarct
  • 24-hour urine for 5-hydroxyindoleacetic acid (5-HIAA) - Pheochromocytoma

A drug screen is helpful to rule out substance-induced anxiety. 

Imaging Studies

  • Imaging studies are limited to presentations where medical illness, such as a seizure disorder, is suspected.
    • Head CT scan - Suspected intracranial abnormality
    • MRI - Intracranial abnormality
    • Echocardiogram - Mitral valve prolapse

Other Tests

  • ECG may be used to exclude arrhythmia.
  • EEG may be used to exclude seizure disorder because these conditions may mimic anxiety.
  • Provocation studies with carbon dioxide, sodium lactate, or yohimbine, as well as positron emission tomography (PET) studies, are reserved for research purposes at this point.

More on Phobic Disorders

Overview: Phobic Disorders
Differential Diagnoses & Workup: Phobic Disorders
Treatment & Medication: Phobic Disorders
Follow-up: Phobic Disorders
References
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References

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  2. Mathew SJ, Coplan JD, Gorman JM. Neurobiological mechanisms of social anxiety disorder. Am J Psychiatry. 2001;158:1558–1567. [Full Text].

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Further Reading

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Keywords

phobic disorders, anxiety disorders, phobias, social phobia, social anxiety disorder, agoraphobia, panic, phobic neurosis, fear, mood disorders

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Contributor Information and Disclosures

Author

Adrian Preda, MD, Health Sciences Associate Professor of Psychiatry and Human Behavior, University of California Irvine School of Medicine
Adrian Preda, MD is a member of the following medical societies: International Congress of Schizophrenia Research, Schizophrenia International Research Society, and Society of Biological Psychiatry
Disclosure: Nothing to disclose.

Coauthor(s)

Ronald C Albucher, MD, Chief Medical Officer, Westside Community Services; Consulting Staff, California Pacific Medical Center
Ronald C Albucher, MD is a member of the following medical societies: American Psychiatric Association
Disclosure: Nothing to disclose.

Medical Editor

Mohammed A Memon, MD, Medical Director of Geriatric Psychiatry, Department of Psychiatry, Spartanburg Regional Hospital System
Mohammed A Memon, MD is a member of the following medical societies: American Association for Geriatric Psychiatry, American Medical Association, and American Psychiatric Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Iqbal Ahmed, MBBS, Professor, Department of Psychiatry, John A Burns School of Medicine, University of Hawaii
Iqbal Ahmed, MBBS is a member of the following medical societies: Academy of Psychosomatic Medicine, American Association for Geriatric Psychiatry, American Neuropsychiatric Association, and American Psychiatric Association
Disclosure: Nothing to disclose.

CME Editor

Harold H Harsch, MD, Program Director of Geropsychiatry, Department of Geriatrics/Gerontology, Associate Professor, Department of Psychiatry and Department of Medicine, Froedtert Hospital, Medical College of Wisconsin
Harold H Harsch, MD is a member of the following medical societies: American Psychiatric Association
Disclosure: lilly Honoraria Speaking and teaching; Forest Labs Honoraria Speaking and teaching; AstraZeneca Honoraria Speaking and teaching; Pfizer Grant/research funds Speaking and teaching; Northstar Grant/research funds Research; Novartis Grant/research funds research; Pfizer  Speaking and teaching; Sanofi-avetis Grant/research funds research; Otsuke Grant/research funds reseach; GlaxoSmithKline Grant/research funds research

Chief Editor

Stephen Soreff, MD, President of Education Initiatives, Nottingham, NH; Faculty, Metropolitan College of Boston University, Boston, MA
Stephen Soreff, MD is a member of the following medical societies: American College of Mental Health Administration and American Psychosomatic Society
Disclosure: Nothing to disclose.

 
 
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