Generalized anxiety disorder differential diagnosis

Jump to navigation Jump to search
Home logo1.png

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Charmaine Patel, M.D. [2] Irfan Dotani

Overview

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.

Differential Diagnosis

Differentiating generalized anxiety disorder from other diseases

Disease Prominent clinical features Investigations
Hyperthyroidism The main symptoms include:[4]
Essential hypertension Most patients with hypertension are asymptomatic at the time of diagnosis. Common symptoms are listed below:[5] 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:
  1. The presence of sense of apprehension or fear toward certain activities for most of the days for at least 6 months
  2. Difficulty to control the apprehension
  3. Associated restless, fatigue, irritability, difficult concentration, muscle tension or sleep disturbance (only one of these manifestations)
  4. The anxiety or the physical manifestations must affect the social and the daily life of the patient
  5. Exclusion of another medical condition or the effect of another administered substance
  6. Exclusion of another mental disorder causing the symptoms
-
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.
  • B-HCG should always be done first to rule out pregnancy especially in women under the age of 45 years
  • FSH can be measured but it can be falsely normal or low
  • TSH, T3 and T4 to rule out thyroid abnormalities
  • Prolactin can be measured to rule out prolactinoma as a cause of menopause
Opioid withdrawal disorder According to DSM V, the following criteria should be present to fit the diagnosis of opioid withdrawal:[6]
  1. Cessation of (or reduction in) opioid use that has been heavy and prolonged (i.e.,several weeks or longer) or administration of an opioid antagonist after a period of opioid use.
  2. Development of three or more of the following criteria minutes to days after cessation of drug use: dysphoric mood, nausea or vomiting, muscle aches, Lacrimation or rhinorrhea, pupillary dilation, piloerection, or sweating, diarrhea, yawning, fever, and insomnia.
  3. The signs or symptoms mentioned above must cause impairment of the daily functioning of the patient.
  4. The signs or symptoms mentioned above must not be attributed to other medical or mental disorders.
  • Urine drug screen to rule out any other associated drug abuse
  • Routine blood work such as electrolytes and hemoglobin to rule out any associated disease explaining the symptoms
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:
  • Palpitations especially in epinephrine producing tumors.
  • Anxiety often resembling that of a panic attack
  • Sweating
  • Headaches occur in 90 % of patients.
  • Paroxysmal attacks of hypertension but some patients have normal blood pressure.
  • It may be asymptomatic and discovered by incidence screening especially MEN patients.

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:
  • Anxiety or persistent fear is limited to social situations and fear of social scrutiny or embarrassment.
  • Avoidance behavior commonly present.
  • No differentiating tests exist.
OCD The main symptoms include:
  • No differentiating tests exist.
PTSD The main symptoms include:
  • Anxiety is directly related to exposure to reminders of past trauma; patients re-experience symptoms (through flashbacks, nightmares).
  • No differentiating tests exist.
Somatoform disorders The main symptoms include:
  • Anxiety is directly related to specific physical complaints.
  • Thorough medical evaluation shows no basis for physical complaints.
  • No differentiating tests exist.
Depression The main symptoms include:
  • Inability to feel pleasure with an overall sad or irritable mood.
  • No differentiating tests exist.
Substance-or drug-induced anxiety disorder The main symptoms include:
CNS-depressant withdrawal The main symptoms include:
  • Anxiety may occur during withdrawal of a substance (e.g., alcohol, opioids, sedative-hypnotics) with characteristic symptoms such as shakiness (i.e., rapid heart rate, fluctuating blood pressure), and, if delirium is present, mental confusion.
  • Typical signs are tachypnea, tachycardia, and disorientation.
  • Monitoring of vital signs is essential to detect autonomic instability and sometimes delirium.
Anorexia nervosa The main symptoms include:
  • Anxiety is directly related to a fear of gaining weight.
  • Body weight <85% of ideal.
  • No differentiating tests exist.

References

  1. 1.0 1.1 1.2 Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.
  2. Moffitt TE, Harrington H, Caspi A, Kim-Cohen J, Goldberg D, Gregory AM; et al. (2007). "Depression and generalized anxiety disorder: cumulative and sequential comorbidity in a birth cohort followed prospectively to age 32 years". Arch Gen Psychiatry. 64 (6): 651–60. doi:10.1001/archpsyc.64.6.651. PMID 17548747.
  3. 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.
  4. 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.
  5. 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
  6. 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.