Anxiety differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Vindhya BellamKonda, M.B.B.S [2]

Overview

Anxiety must be differentiated from other diseases that cause anxiety such as major depressive disorder, bipolar disorder, atypical psychosis, schizophrenia, other medical and neurologic conditions.

Differential diagnosis

Anxiety must be differentiated from the causes listed below:

Psychiatric	Cardinal features
Major depressive disorder	DSM major depressive disorder (MDD) diagnostic criteria require the occurrence of one or more major depressive episodes. Symptoms of a major depressive episode include the following: Depressed mood Anhedonia (diminished loss of interest or pleasure in almost all activities) Significant weight or appetite disturbance Sleep disturbance Psychomotor agitation or retardation (a speeding or slowing of muscle movement) Loss of energy or fatigue Feelings of worthlessness Diminished ability to think, concentrate and make decisions Recurrent thoughts of death, dying or suicide Longstanding interpersonal rejection ideation (ie. others would be better off without me); specific suicide plan; suicide attempt. The DSM states either a depressed mood or anhedonia must be present. In addition to the above DSM criteria for a major depressive episode, the episode must: Be at least two weeks long Cause significant distress or severely impact social, occupational or other important life areas Not be precipitated by drug use Not meet the criteria for another mental disorder like schizophrenia or bipolar disorder Not be better explained by bereavement (such as the loss experienced after a death)
Bipolar I disorder	Bipolar I disorder- A person affected by bipolar I disorder has had at least one manic episode in his/her life, and also suffer from episodes of depression, there is an alternating pattern of mania and depression. Manic episode is characterized by: A period od abnormally elevated or irritable mood and increased goal directed activity,lasting atleats one week and present most of the day, nearly every day. During the period of mood disturbance and increased energy /activity, three (or more) of the following symptoms ( four if the mood is only irritable) are present to a significant degree and represent a noticeable change from usual behavior: Grandiosity Decreased need for sleep More talkative than usual or pressure to keep talking Flight of ideas Distractability Increase in goal directed activity excessive involvement in activities that have dire consequences(e.g. engaging in excessive buying, sexual activity) The mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning the episode is not attributable to the physiological effects of a substance depressive episodes of bipolar disorder are similar to clinical depression.]]
Atypical psychosis	[[The term atypical psychosis has not been included in DSM-V, but was liste in DSM-III-R under the heading psychosis Not otherwise specified( examples include: postpartum psychosis, psychosis with unusual features, psychosis with confusing clinical features that make a more definite diagnosis impossible]]
Schizophrenia	[[A.Two (or more) of the following , each present for a significant portion of time during a 1-month period(or less if successfully treated). Atleast one of these must be delusions, hallucinations, disorganized speech. Apart from these symptoms, grossly disorganized or catatonic behavior and negative symptoms (e.g.Avolition) are present B. Significant functional impairment in all aspects of life. C. Continuous signs of the disturbance persist at least 6 months D. Schizoaffective, depressive and bipolar disorder with psychotic features have been ruled out. E. The disturbance is not attributable to the physiological effects of a substance or another medical condition.]]
Substance abuse	Substance abuse, including alcohol and prescription drugs, can induce symptomatology which resembles mental illness. This can occur both in the intoxicated state and also during the withdrawal state. Signs and symptoms depend on the substance being used
Cognitive disorders	Cognitive disorders predominantly affect cognitive skills, such as learning, memory,thinking, executive functioning, problem solving. It includes delirium and mild and major neurocognitive disorder ( formerly called as dementia)

Mediacl condition	cardinal features
Myocardial infarction	Chest pain,tightness/ squeezing sensation in the chest/arms that may radiate to jaw, neck, back. Nausea, abdominal pain,shortness of breath, fatigue, diaphoresis, dizziness/lightheadedness
Angina pectoris
Hyperthyroidism	Anxiety, palpitation, tremors, heat intolerance, sweating and weight loss inspite of good appetite
Carcinoid	Cutaneous flushing, telaniectasias, diarrhea, wheezing and cardiac lesions
Hypoglycemia	anxiety, sweating, palpitations, weakness, tremor, altered mental status
Hyperventilation	Dyspnea, chest pain, palpitations, parasthesias, dizziness, anxiety, diaphoresis, tachycardia, tachpnea, sense of impending doom

References

LastName, FirstName (2013). Desk reference to the diagnostic criteria from DSM-5. Washington, DC: American Psychiatric Publishing. ISBN 978-0-89042-556-5.