eMedicine Specialties > Emergency Medicine > Psychosocial

Anxiety: Differential Diagnoses & Workup

Author: Lemeneh Tefera, MD, FAAEM, Attending Physician, Department of Emergency Medicine, Beth Israel Medical Center
Coauthor(s): Lauren Claire Tomao, MD, JD, Resident, Department of Emergency Medicine, Albert Einstein College of Medicine, Beth Israel Medical Center
Contributor Information and Disclosures

Updated: Nov 20, 2008

Differential Diagnoses

Acute Coronary Syndrome
Neoplasms, Brain
Alcohol and Substance Abuse Evaluation
Pneumonia, Bacterial
Congestive Heart Failure and Pulmonary Edema
Pneumothorax, Iatrogenic, Spontaneous and Pneumomediastinum
Costochondritis
Pulmonary Embolism
Depression and Suicide
Schizophrenia
Hyperthyroidism, Thyroid Storm, and Graves Disease
Toxicity, Benzodiazepine
Hyperventilation Syndrome
Toxicity, Narcotics
Hypoglycemia
Toxicity, Sympathomimetic
Mitral Valve Prolapse
Toxicity, Thyroid Hormone
Myocardial Infarction
Withdrawal Syndromes

Other Problems to Be Considered

Neuropathy
Pheochromocytoma
Sinus tachycardia
Brugada syndrome

Workup

Laboratory Studies

The history remains the best tool available to the emergency physician in the evaluation of anxiety. Laboratory tests are rarely needed to affirm the diagnosis.

However, if there is an abnormal physical examination finding, such a goiter or prominent nystagmus, or the clinician suspects a toxic ingestion, laboratory testing can help distinguish anxiety from drug-induced causes and organic illnesses (eg, systemic infection, toxin, electrolyte and endocrine disturbances).

Imaging Studies

  • Imaging studies are not useful in diagnosing anxiety but may be needed to exclude other possibilities in the differential diagnosis.

Other Tests

  • Electrocardiograms are useful for evaluating possible tachydysrhythmia and screening for adverse medication effects such as QT prolongation.

More on Anxiety

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

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  2. Brawman-Mintzer O, Lydiard RB. Biological basis of generalized anxiety disorder. J Clin Psychiatry. 1997;58 Suppl 3:16-25; discussion 26. [Medline].

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  4. Hales RE, Hilty DA, Wise MG. A treatment algorithm for the management of anxiety in primary care practice. J Clin Psychiatry. 1997;58 Suppl 3:76-80. [Medline].

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  6. Huffman JC, Pollack MH. Predicting panic disorder among patients with chest pain: an analysis of the literature. Psychosomatics. May-Jun 2003;44(3):222-36. [Medline].

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  13. Pollack MH, Otto MW. Long-term pharmacological treatment of panic disorder. Psychiatr Ann. 1994;24:291-298.

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Further Reading

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Keywords

anxiety, anxiety disorder, panic attack, panic disorder, generalized anxiety disorder, GAD, phobic disorder, obsessive-compulsive disorder, apprehension, fear, worry, agoraphobia, tension, tremulousness, shaking, insomnia, irritability, restlessness, cold clammy hands, dry mouth, socialphobia, post-traumatic stress disorder, PTSD

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Contributor Information and Disclosures

Author

Lemeneh Tefera, MD, FAAEM, Attending Physician, Department of Emergency Medicine, Beth Israel Medical Center
Lemeneh Tefera, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Lauren Claire Tomao, MD, JD, Resident, Department of Emergency Medicine, Albert Einstein College of Medicine, Beth Israel Medical Center
Lauren Claire Tomao, MD, JD is a member of the following medical societies: American Bar Association
Disclosure: Nothing to disclose.

Medical Editor

Edward Bessman, MD, Chairman, Department of Emergency Medicine, John Hopkins Bayview Medical Center; Assistant Professor, Department of Emergency Medicine, Johns Hopkins University
Edward Bessman, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

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

Managing Editor

Robert Harwood, MD, MPH, FACEP, FAAEM, Program Director, Department of Emergency Medicine, Advocate Christ Medical Center; Assistant Professor, Department of Emergency Medicine, University of Illinois at Chicago College of Medicine
Robert Harwood, MD, MPH, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Council of Emergency Medicine Residency Directors, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Jonathan Adler, MD, Attending Physician, Department of Emergency Medicine, Massachusetts General Hospital; Division of Emergency Medicine, Harvard Medical School
Jonathan Adler, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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