Anxiety Diagnosis

Diagnostic Criteria

Generalized Anxiety Disorder (GAD)

• Generalized anxiety disorder as described in DSM-5 is an excessive anxiety and worrying about a number of events or activities for at least 6 months
• Patients who have generalized anxiety disorders have problems controlling their worries
• The worrying and anxiety is accompanied by 3 or more of the following 6 symptoms in adults (1 in children) 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 including having problems falling or staying asleep or having unsatisfying sleep
• Symptoms cause clinically serious distress or deterioration in social, occupational, or other important areas of functioning
• Disturbance is not a physiological effect of any medication, substance of abuse or another medical condition
• Signs and symptoms are not suggestive of other mental disorders

Panic Disorder (PD)

• Panic disorder as described in DSM-5 is 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: 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 & depersonalization)
  • Fear of losing control or “going crazy”
  • Fear of dying
• Some observed symptoms 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 stated above
• At least 1 of the attacks has been followed by any or both of persistent worrying of having additional attacks or there is maladaptive change in the behavior relative to the attacks of ≥1 month duration
• Disturbance is not a physiological effect of any medication, substance of abuse or another medical condition
• Signs and symptoms are not suggestive of other mental disorders

Social Anxiety Disorder (SAD)

• Social anxiety disorder as described in DSM-5 is the 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 presence of an audience
  • For children, the disturbance is observed when interacting with peers as well as with adults
• 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 generally avoided or endured with great uneasiness by the patient
• There is greater fear or anxiety than to actual threat brought by the social situation and to the socio-cultural context
• The distress lasts for ≥6 months
• The symptoms cause clinically serious distress or deterioration in social, occupational, or other important areas of functioning
• Disturbance is not a physiological effect of any medication, substance of abuse or another medical condition
• Signs and symptoms are not suggestive of other mental disorders
• It has been ruled out that the anxiety is not due to certain comorbidities (eg Parkinson’s disease, disfigurement due to burns/injury, morbid obesity), or if patient showed excessive anxiety due to these situations

Tools

• Generalized Anxiety Disorder (GAD) 7-item scale
  •  A quick and useful screening tool for generalized anxiety disorder and other anxiety disorders (eg panic disorder, social anxiety disorder)
  • May also be used as a monitoring response to treatment
  • A score of ≥8 is highly suggestive of anxiety disorder
  • Total score of ≥10 indicates a probable diagnosis of generalized anxiety disorder
• Hospital Anxiety and Depression Scale (HADS)
  • A self-reported 14-item screening test that measures anxiety and depression in hospitalized non-psychiatric patients
  • A score of 8-10 suggests presence of anxiety disorder
  • A score of >11 indicates probable mood disorder
• Clinical Global Impression Scales
  • May be used to measure illness severity and treatment progress during consultation
• Mini-International Neuropsychiatric Interview (M.I.N.I.)
  • Used as part of the clinical assessment of patients at risk of depression and anxiety