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==Overview==
==Overview==
[[Anxiety]] must be differentiated from other diseases that cause anxiety such as [[major depressive disorder]], [[bipolar disorder]], atypical [[psychosis]], [[schizophrenia]], other [[Medical|medica]]<nowiki/>l and [[neurologic]] conditions
[[Anxiety]] must be differentiated from other [[diseases]] that cause [[anxiety]] such as [[major depressive disorder]], [[bipolar disorder]], atypical [[psychosis]], [[schizophrenia]], other [[Medical|medica]]<nowiki/>l and [[neurologic]] conditions.


==Differential diagnosis==
==Differential diagnosis==


Anxiety must be differentiated from:<ref name="pmid27797837">{{cite journal |vauthors=Imam T, Finny P, Choo-Kang A, Khan R |title=Phaeochromocytoma presenting as an acute coronary syndrome |journal=BMJ Case Rep |volume=2016 |issue= |pages= |year=2016 |pmid=27797837 |doi=10.1136/bcr-2016-214737 |url=}}</ref><ref name="pmid27735970">{{cite journal |vauthors=Dillon-Naftolin E |title=Identification and Treatment of Generalized Anxiety Disorder in Children in Primary Care |journal=Pediatr Ann |volume=45 |issue=10 |pages=e349–e355 |year=2016 |pmid=27735970 |doi=10.3928/19382359-20160913-01 |url=}}</ref>
[[Anxiety]] must be differentiated from the causes listed  below:  


==Differential diagnosis==
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! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|psychiatric}}
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Psychiatric}}
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Medical}}
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF| Cardinal features}}
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Major depressive disorder]]
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Major depressive disorder]]
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
* Myocardial infarction
DSM [[major depressive disorder]] (MDD) [[diagnostic]] criteria require the occurrence of one or more major depressive episodes. [[Symptoms]] of a [[Major depressive disorder|major depressive]] episode include the following:
*[[Depressed Mood|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|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 (pragmatic) communication disorder|social]], [[Occupational safety and health|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)
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Bipolar I disorder]]
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Bipolar I disorder]]
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
Angina pectoris
[[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 of abnormally elevated or irritable mood and increased goal directed activity,lasting atleast 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 (psychology)|mood]] disturbance is sufficiently severe to cause marked impairment in [[Social (pragmatic) communication disorder|social]] or occupational functioning
** the episode is not attributable to the [[physiological]] effects of a [[substance]]
** [[Depressive]] episodes of [[Bipolar disorder|bipolar]] disorder are similar to [[clinical depression]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Atypical psychosis]]
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Atypical psychosis]]
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
Hyperventilation
The term atypical [[psychosis]] has not been included in DSM-V, but was listed 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
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Schizophrenia]]
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Schizophrenia]]
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*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
* Significant functional impairment in all aspects of life
* Continuous signs of the disturbance persist at least 6 months
* [[Schizoaffective disorders|Schizoaffective]], [[depressive]] and [[bipolar disorder]] with [[psychotic]] features have been ruled out
* The disturbance is not attributable to the [[Physiological|physiologica]]<nowiki/>l effects of a [[substance]] or another [[medical]] condition
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Substance abuse]]
| style="padding: 5px 5px; background: #F5F5F5;" |
[[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
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Cognitive disorder|Cognitive disorders]]
| style="padding: 5px 5px; background: #F5F5F5;" |
[[Cognitive]] [[disorders]] predominantly affect cognitive skills, such as [[learning]], [[memory]], thinking, [[executive functioning]], [[Problem solving|problem]] solving. It includes [[delirium]] and mild and major [[Neurocognitive disorder due to another medical condition|neurocognitive disorde]]<nowiki/>r ( formerly called as [[dementia]])
|-


Hypoglycemia
|}
 
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! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Mediacl condition}}
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF| Cardinal features}}
|-
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Substance abuse]]
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Myocardial infarction]]
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[Chest pain]], tightness/ squeezing sensation in the chest/arms that may radiate to jaw, neck, back. [[Nausea and vomiting|Nausea]], [[abdominal]] [[pain]], [[shortness of breath]], [[fatigue]], [[diaphoresis]], [[dizziness]]/lightheadedness
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Angina pectoris]]
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
Hyperthyroidism
* [[Chest pain]], [[Shortness of breath]], [[Nausea and vomiting|nausea]], [[fatigue]], [[dizziness]], [[sweating]], [[anxiety]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Cognitive disorders]]
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Hyperthyroidism]]
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
Carcinoid
* [[Anxiety]], [[palpitations]], [[tremors]], heat intolerance, [[sweating]] and weight loss in spite of good appetite<ref name="pmid2151080">{{cite journal |vauthors=Horcicka V, Lindusková M, Vykydal M |title=Injury to gastric mucosa due to cortisonoid therapy |journal=Acta Univ Palacki Olomuc Fac Med |volume=126 |issue= |pages=151–5 |year=1990 |pmid=2151080 |doi= |url=}}</ref>
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Carcinoid]]
| style="padding: 5px 5px; background: #F5F5F5;" |


*[[Cutaneous]] [[flushing]], [[telangiectasias]], [[diarrhea]], [[wheezing]] and [[cardiac]] lesions
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Hypoglycemia]]
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[Anxiety]], [[sweating]], [[palpitations]], [[weakness]], [[tremor]], [[altered mental status]]<ref name="pmid19088155">{{cite journal |vauthors=Cryer PE, Axelrod L, Grossman AB, Heller SR, Montori VM, Seaquist ER, Service FJ |title=Evaluation and management of adult hypoglycemic disorders: an Endocrine Society Clinical Practice Guideline |journal=J. Clin. Endocrinol. Metab. |volume=94 |issue=3 |pages=709–28 |year=2009 |pmid=19088155 |doi=10.1210/jc.2008-1410 |url=}}</ref>
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Hyperventilation]]
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[Dyspnea]], [[chest pain]], [[palpitations]], parasthesias, [[dizziness]], [[anxiety]], [[diaphoresis]], [[tachycardia]], [[tachypnea]], sense of impending doom<ref name="pmid3084604">{{cite journal |vauthors=Rapee R |title=Differential response to hyperventilation in panic disorder and generalized anxiety disorder |journal=J Abnorm Psychol |volume=95 |issue=1 |pages=24–8 |year=1986 |pmid=3084604 |doi= |url=}}</ref>
|}
|}


==References==
==References==
<references />
{{cite book | last = LastName | first = FirstName | title = Desk reference to the diagnostic criteria from DSM-5 | publisher = American Psychiatric Publishing | location = Washington, DC | year = 2013 | isbn = 978-0-89042-556-5 }}

Latest revision as of 14:39, 12 December 2017

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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 of abnormally elevated or irritable mood and increased goal directed activity,lasting atleast 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 listed 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
  • 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
  • Significant functional impairment in all aspects of life
  • Continuous signs of the disturbance persist at least 6 months
  • Schizoaffective, depressive and bipolar disorder with psychotic features have been ruled out
  • 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
Angina pectoris
Hyperthyroidism
Carcinoid
Hypoglycemia
Hyperventilation

References

  1. Horcicka V, Lindusková M, Vykydal M (1990). "Injury to gastric mucosa due to cortisonoid therapy". Acta Univ Palacki Olomuc Fac Med. 126: 151–5. PMID 2151080.
  2. Cryer PE, Axelrod L, Grossman AB, Heller SR, Montori VM, Seaquist ER, Service FJ (2009). "Evaluation and management of adult hypoglycemic disorders: an Endocrine Society Clinical Practice Guideline". J. Clin. Endocrinol. Metab. 94 (3): 709–28. doi:10.1210/jc.2008-1410. PMID 19088155.
  3. Rapee R (1986). "Differential response to hyperventilation in panic disorder and generalized anxiety disorder". J Abnorm Psychol. 95 (1): 24–8. PMID 3084604.

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