Anxiety Initial Assessment

Clinical Presentation

Generalized Anxiety Disorder (GAD)  

In generalized anxiety disorder, the patient experiences persistent and excessive anxiety and worry about various domains, including work and school performance. The patient also had difficulty in controlling almost every day. Symptoms that commonly occur include multiple unexplained bodily symptoms, insomnia, irritability, muscle spasm, restlessness, easy fatigability, and even difficulty concentrating.  

Panic Disorder (PD)  

In panic disorder, the patient experiences recurrent unexpected panic attacks and is persistently concerned or worried about having more panic attacks or the patient changing his/her behavior in maladaptive ways due to panic attacks. It has episodic characteristics. Symptoms of panic disorder include dizziness, chest pain or discomfort, shortness of breath, palpitations or tachycardia, nausea, GI upset, trembling, sweating, hot flushes, and chills.  

Social Anxiety Disorder (SAD)  

In social anxiety disorder, the patient is fearful or anxious about or avoids social interactions and/or performance situations that involve the possibility of being scrutinized. Symptoms of social anxiety disorder include blushing, sweating, palpitations, and fear that is so great that it interferes with normal functioning, relationships, social activities, or there is excessive distress concerning the phobia. 

Anxiety_Initial Assesment

Diagnosis or Diagnostic Criteria

Diagnostic Criteria  

Generalized Anxiety Disorder (GAD)  

GAD as described in DSM-5-TR is excessive anxiety and worrying about a number of events or activities occurring most days for at least 6 months. Patients who have GAD have problems controlling their worries.  

The worrying and anxiety are accompanied by 3 or more of the following 6 symptoms in adults (1 in children) occurring most days for the past 6 months of the disturbance:

• Restlessness or feeling on edge
• Easy fatigability
• Difficulty concentrating or mind going blank
• Irritability
• Muscle tension
• Sleep disturbances include having problems falling or staying asleep or having unsatisfying sleep

Additionally, symptoms cause clinically serious distress or deterioration in social, occupational, or other important areas of functioning. The disturbance is not a physiological effect of any medication, substance abuse or another medical condition. Lastly, signs and symptoms are not suggestive of other mental disorders. 

Panic Disorder (PD)  

PD as described in DSM-5-TR is a recurrent unexpected abrupt surge of intense fear or intense discomfort peaking within minutes, and during which time 4 or more of the following symptoms occur. Note that the abrupt surge can occur from a calm state or anxiety state. 

• Tachycardia or feelings of pounding heart or heart beating fast
• Diaphoresis
• Trembling or shaking
• Shortness of breath or feeling of smothering
• Feelings of choking
• Chest pain or discomfort
• Nausea or abdominal distress
• Feeling dizzy, unsteady, lightheaded, or faint
• Chills or heat sensations
• Paresthesias (ie numbness or tingling sensations)
• Feelings that one’s surroundings are not real or being an observer of oneself (derealization and depersonalization)
• Fear of losing control or “going crazy”
• Fear of dying

There are some observed symptoms that are specific to cultures (eg neck pain, headache, tinnitus, uncontrollable screaming or crying) and should not be included as 1 of the 4 required symptoms states above. At least 1 of the attacks has been followed by any or both persistent worrying of having additional attacks or there is maladaptive change in the behavior relative to the attacks of ≥1 month duration. The disturbance is not a physiological effect of any medication, substance of abuse or another medical condition. Lastly, signs and symptoms are not suggestive of other mental disorders.  

Social Anxiety Disorder (SAD)  

SAD as described in the DSM-5-TR is the marked fear or anxiety of 1 or more social situations that will expose the patient to possible scrutiny like during social interactions, when being observed, or when performing in the presence of an audience. For children, the disturbance is observed when interacting with peers as well as with adults. SAD can be specified as performance only if there exclusively occurs when speaking or performing in public. The patient has fears that the anxiety symptoms will manifest and that others may perceive it negatively that may lead to rejection by others. Social situations almost always trigger fear or anxiety in the patient and are generally avoided or endured with great uneasiness by the patient. There is fear or anxiety than to the actual threat brought by the social situation and to the sociocultural context. The distress lasts for ≥6 months. The symptoms cause clinically serious distress or deterioration in social, occupational, or other important areas of functioning. The disturbance is not a physiological effect of any medication, substance of abuse or another medical condition. The signs and symptoms are not suggestive of other mental disorders. Lastly, it has been ruled out that the anxiety is not due to certain comorbidities (eg Parkinson’s disease, disfigurement due to burns or injury, morbid obesity), or if the patient showed excessive anxiety due to these situations.

Screening

Screening Tools  

Generalized Anxiety Disorder (GAD) 7-item Scale  

The GAD 7-item scale is a quick and useful screening tool for GAD and other anxiety disorders (eg PD, SAD). It may also be used as a monitoring response to treatment. A score of ≥8 is highly suggestive of anxiety disorder. A total score of ≥10 indicates a probable diagnosis of GAD.  

Hospital Anxiety and Depression Scale (HADS) 

HADS is a self-reported 14-item screening test that measures anxiety and depression in hospitalized non-psychiatric patients. A score of 8 to 10 suggests the presence of anxiety disorder. A score of ≥11 indicates probable mood disorder.  

Clinical Global Impression Scales  

The clinical global impression scales may be used to measure illness severity and treatment progress during consultation.  

Mini-International Neuropsychiatric Interview (M.I.N.I.)  

The mini-International Neuropsychiatric Interview is used as part of the clinical assessment of patients at risk of depression and anxiety.