Anxiety

Anxiety: Excerpt from Field Guide to Bedside Diagnosis

Differential Overview

❑ Situational/characterologic

❑ Post-traumatic stress disorder

❑ Drugs/withdrawal

❑ Generalized anxiety disorder

❑ Panic disorder

❑ Phobia

❑ Agitated depression

❑ Hypoglycemia

❑ Hyperthyroidism

Diagnostic Approach

Anxiety ranges from a vague sense of uneasiness to one of imminent danger and dread. Thoughts race and concentration is difficult. There is a heightened self-awareness and startle response. Restlessness, bitten fingernails, tremor, tic, and excessive sweating are often noticeable. Sympathetic nervous system activation may cause palpitations, flushing, sweating, or diarrhea. Hyperventilation may occur, with lightheadedness, and circumoral numbness.

Heightened perception and negative interpretation of normal bodily sensations is a common stimulus to visit the physician. Anxiety is frequently somatized to symptoms of chest pain, palpitations, or shortness of breath. Anxiety-related air swallowing (aerophagia) produces belching.

Repression is a defense mechanism, leading to dissociation from awareness and conversion to hysterical symptoms such as paralysis, anesthesia, aphonia, or amnesia. Blocking of one side of a conflict (a common defense mechanism) distorts the perception of reality, causing decision-making to become difficult.

Clinical Findings

Situational/characterologic  The anxiety is usually mild, and it waxes and wanes with the precipitant stressor. This response is heightened in persons who have a character predisposed to anxious reactions by culture or upbringing.

Post-traumatic stress disorder  Survivors of unanticipated tragic events often experience recurrent flashbacks, nightmares, and restlessness. They become socially withdrawn and feel inadequate.

Drugs/withdrawal  Cocaine, amphetamines, hallucinogens, caffeine, ephe-drine, beta-agonists, steroids, and exogenous thyroxine all cause anxiety. Withdrawal of alcohol, drugs of abuse, or nicotine can cause symptoms ranging from anxiety, irritability, and restlessness to paranoia and hallucinations.

Generalized anxiety disorder  Muscle tension, sympathetic hyperactivity, and apprehensive expectation lead to symptoms of chronic diffuse nervousness, insomnia, fatigue, irritability, and multiple somatic complaints.

Panic disorder  Sudden, overwhelming anxiety and sense of impending doom, accompanied by dyspnea, palpitations, or faintness are classic symptoms. Episodes occur unexpectedly, resolve within 20 to 30 minutes, and are often recurrent.

Phobia  Irrational anxiety is attached to an object or situation, leading to avoidance. Common manifestations include fear of open or closed spaces, fear of heights, or fear of public speaking.

Agitated depression  It is characterized by marked restlessness and anxiety, constant worry, preoccupation with negative thoughts, and vegetative signs.

Hypoglycemia  A diabetic develops episodic anxiety, diaphoresis, and confusion alleviated by glucose or food.

Hyperthyroidism  Signs might be subtle, such as fine tremor, tachycardia, lid lag, or slight thyroid enlargement.

Book Source Details

• Book Title: Field Guide to Bedside Diagnosis
• Author(s): David S. Smith
• Year of Publication: 2007
• Copyright Details: Field Guide to Bedside Diagnosis, Copyright © 2007 Lippincott Williams & Wilkins.

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• Back to disease: Panic disorder: Introduction
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Field Guide to Bedside Diagnosis Authors: David S. Smith Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 0-78178-165-5

 » Next page: Anxiety disorder, generalized (Handbook of Diseases)

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