Generalized anxiety disorder differential diagnosis
The differential diagnosis in generalized anxiety disorder is similar to that of panic disorder. It is important to rule out drug-induced conditions. The mental status examination should take in consideration the possibility of schizophrenia, obsessive-compulsive disorder, major depressive disorder, and both specific and social phobias.
- Bipolar disorder
- Panic disorder- anxiety is only in regards to having a panic attack
- Post-traumatic stress disorder- presence of flashbacks, hyper-arousal, and hyper-vigilance
- Social phobia- anxiety only occurs in regards to social situations
- Obsessive-compulsive disorder- presence of obsessions and compulsions
- Separation anxiety disorder- anxiety occurs in response to being away from home or family
- Anorexia nervosa- anxiety occurs in response to potentially gaining weight
- Somatization disorder- multiple physical complaints
- Hypochondriasis- anxiety in regards to developing a specific disease
- Schizophrenia- presence of psychotic symptoms such as hallucinations and delusions
- Major depressive disorder- criteria requires two weeks of specific symptoms
- Medications- in particular stimulants such as methylphenidate, pseudoephedrine, and other decongestants or appetite suppressants
- Drug abuse- particularly stimulants and hallucinogenics such as cocaine, caffeine, amphetamines, and PCP
- Drug withdrawal- particularly alcohol withdrawal, benzodiazepine withdrawal, and opiate withdrawal.
- Hyperthyroidism- presence of an elevated TSH on laboratory findings
Differentiating generalized anxiety disorder from other diseases
|Disease||Prominent clinical features||Investigations|
|Hyperthyroidism||The main symptoms include:|
|Essential hypertension||Most patients with hypertension are asymptomatic at the time of diagnosis. Common symptoms are listed below:||JNC 7 recommends the following routine laboratory tests before initiation of therapy for hypertension:|
|Generalized anxiety disorder||According to DSM V, the following criteria should be present to fit the diagnosis of generalized anxiety disorder:
|Menopause||The perimenopausal symptoms are caused by an overall drop, as well as dramatic but erratic fluctuations, in the levels of estrogens, progestin, and testosterone. Some of these symptoms such as formication etc may be associated with the hormone withdrawal process.
|Opioid withdrawal disorder||According to DSM V, the following criteria should be present to fit the diagnosis of opioid withdrawal:
|Pheochromocytoma||The hallmark symptoms of a pheochromocytoma are those of sympathetic nervous system hyperactivity, symptoms usually subside in less than one hour and they may include:
Please note that not all patients with pheochromocytoma experience all classical symptoms.
|Diagnostic lab findings associated with pheochromocytoma include:|
|Social phobia||The main symptoms include:||
|OCD||The main symptoms include:||
|PTSD||The main symptoms include:
|Somatoform disorders||The main symptoms include:
|Depression||The main symptoms include:
|Substance-or drug-induced anxiety disorder||The main symptoms include:
|CNS-depressant withdrawal||The main symptoms include:
|Anorexia nervosa||The main symptoms include:
- Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.
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- Wolitzky-Taylor KB, Castriotta N, Lenze EJ, Stanley MA, Craske MG (2010). "Anxiety disorders in older adults: a comprehensive review". Depress Anxiety. 27 (2): 190–211. doi:10.1002/da.20653. PMID 20099273.
- Smith JP, Book SW (2010). "Comorbidity of generalized anxiety disorder and alcohol use disorders among individuals seeking outpatient substance abuse treatment". Addict Behav. 35 (1): 42–5. doi:10.1016/j.addbeh.2009.07.002. PMC 2763929. PMID 19733441.
- Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE (2005). "Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication". Arch Gen Psychiatry. 62 (6): 617–27. doi:10.1001/archpsyc.62.6.617. PMC 2847357. PMID 15939839. Review in: Evid Based Ment Health. 2006 Feb;9(1):27
- Keeton CP, Kolos AC, Walkup JT (2009). "Pediatric generalized anxiety disorder: epidemiology, diagnosis, and management". Paediatr Drugs. 11 (3): 171–83. doi:10.2165/00148581-200911030-00003. PMID 19445546.