ANXIETY

Ask the following questions:

1. Is the anxiety intermittent or constant? Intermittent anxiety suggests the possibility of psychomotor epilepsy, a pheochromocytoma, or insulinoma. It is also possible that the patient is suffering from an intermittent cardiac arrhythmia such as paroxysmal supraventricular tachycardia or atrial fibrillation.
2. What is the patient's age? The young or middle-aged patient is more likely to be suffering from a psychiatric disorder, whereas the older patient may be suffering from cerebral arteriosclerosis or some other type of dementia.
3. If there is tachycardia, is it sustained during sleep? Tachycardia that is sustained during sleep would suggest hyperthyroidism, caffeine effects, or other drug effects.
4. Is there associated weight loss? Sustained tachycardia with weight loss makes hyperthyroidism a very likely possibility.

DIAGNOSTIC WORKUP

Patients with intermittent anxiety with long periods of calmness in between should have a wake-and-sleep EEG and possibly a CT scan to rule out a cerebral tumor. A 24-hr urine collection for catecholamines should be done also to rule out a pheochromocytoma. Twenty-four-hr Holter monitoring may be necessary to rule out a paroxysmal cardiac arrhythmia. In difficult cases, a 24-hr EEG or an EEG with nasopharyngeal electrodes inserted may be necessary.

Patients with constant anxiety should have a thyroid profile, a drug screen, and an EKG. If these are not revealing, perhaps 24-hr Holter monitoring may be of some value. With a negative workup, a referral to a psychiatrist is in order. It may be even wiser to consult a psychiatrist before undertaking an expensive workup.

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

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Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2008 Williams & Wilkins.

More About Causes of Fear

• Back to symptom: Fear: Introduction (review 363 causes)
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More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

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