psychiatric disorders
Overview of Anxiety Disorders
Diagnosis of Anxiety Disorders
Diagnostic and Statistical Manual of Mental Disorders, 5th edition, Text Revision (DSM-5-TR) criteria Diagnosis of a specific anxiety disorder is based on its characteristic symptoms and signs according to DSM-5-TR. In general, an anxiety disorder may be suspected when the following apply ( Diagnosis references ): Anxiety is very distressing. Anxiety interferes with functioning. Anxiety does not stop spontaneously within a few days. Other causes are not identified. When diagnosing an anxiety disorder, it is important to rule out anxiety attributable to certain medical conditions (eg, asthma, hyperthyroidism), and/or substances or medications ( Diagnosis references ). Furthermore, if present, the clinician needs to assess the extent to which the medical disorder and/or substance is actually implicated in the anxiety. As is true in all psychiatric assessments, a careful history is crucial to accurate diagnosis. If patients meet criteria for an anxiety disorder, and the clinician concludes that the symptoms are best explained by the direct physiologic effects of a medication or illicit drug/substance, the patient is deemed to have asubstance-/medication-induced anxiety disorder.Similarly, if the significant anxiety is deemed to be the direct physiologic result of another medical condition, the patient may be diagnosed withanxiety disorder due to another medical condition. As is true for almost all psychiatric conditions, there are no laboratory tests for anxiety disorders, though laboratory tests may help identify medical conditions associated with the anxiety. Clinical judgment is required before making the diagnosis. In addition to eliciting characteristic symptoms and time course, the clinician must also evaluate whether the clinical situation meets the threshold for causing clinically significant distress and/or dysfunction. The different anxiety disorders can often be distinguished from one another based on the answers to 3 key questions: What situations induce the fear and anxiety? What thoughts are associated with the anxiety? What avoidance strategies are used? Culture influences the expression, conceptualization, and treatment of all psychiatric conditions, including anxiety disorders ( Diagnosis references ). During the psychiatric assessment, it is important to look for ways in which the anxiety symptoms might be affected by the surrounding political, economic, and legal systems, as well as by specific issues related to migrant status, sexual orientation, socioeconomic status, religion, spirituality, and family structures. Patients may feel intimidated, embarrassed, or reluctant to discuss anxiety with anyone, much less physicians, who may appear to belong to a different and potentially more privileged socioeconomic group. Similarly, people who want to be "good patients" might not be upfront about psychiatric issues if they suspect that their clinicians are too busy to address anything other than their most prominent nonpsychiatric medical issue. It is useful for the clinician to consider that different individuals or groups use different words to describe distress. For example, people in many countries use the phrase "thinking too much" rather than describing symptoms that match specific psychiatric criteria for disorders such as major Depressive Disorders , It can also be useful to ask patients what they think is causing their problems. Not all patients believe completely in the medical model, and, if tactfully asked, many patients might reluctantly mention that they (or their relatives) believe their symptoms were induced by a religious or other mystical source (eg, an "evil eye"). Eliciting such information improves the patient-clinician alliance, deepens the understanding of both the patient and the presenting complaints, and improves the likelihood that the patient will be more transparent and adherent going forward. 1.Diagnostic and Statistical Manual of Mental Disorders, 5th edition,Text Revision (DSM-5-TR). American Psychiatric Association Publishing, Washington, DC, pp 215-221. 2.Craske MG, Stein MB: Anxiety.Lancet388:3048-3059, 2016. doi: 10.1016/S0140-6736(16)30381-6 3.Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision (DSM-5-TR), Cultural Concepts of Distress. American Psychiatric Association Publishing, Washington, DC, pp 872-880. 4.Lewis-Fernández R, Aggarwal NK, Lam PC, et al: Feasibility, acceptability and clinical utility of the Cultural Formulation Interview: Mixed-methods results from the DSM-5 international field trial.Br J Psychiatry210(4):290-297, 2017. doi: 10.1192/bjp.bp.116.193862 5.Kaiser BN , Haroz EE, Kohrt BA, et al: "Thinking too much": A systematic review of a common idiom of distress.Soc Sci Med147:170-183, 2015. doi: 10.1016/j.socscimed.2015.10.044 