| History: Individuals report a high level of apprehension and fear that has been present for at least 6 months. Individuals cannot control their worrying. In addition to anxiety, at least three of the following symptoms are reported: restlessness, becoming easily fatigued, difficulty with concentration, irritability, muscle tension, and disturbed sleep. At least some of these symptoms have occurred numerous times in the past 6 months. Many individuals say they have felt nervous all their lives. The individual may report use of caffeine, nicotine, over-the-counter medications (e.g., antihistamines), prescription medications (e.g., blood pressure medications, thyroid medications, or antispasmodic drugs), or street drugs such as cocaine or amphetamines. Physical exam: A physical examination, including a thorough medical history, is necessary in the initial evaluation of patients with anxiety. History should include assessment of any changes in behavior and mood as well as neurological symptoms including headaches, dizziness, disorientation, confusion, and syncope. Physical symptoms of anxiety disorders may include trembling, cold and sweaty hands, pale or flushed skin, an elevated heart rate, rapid breathing, and/or high blood pressure. Evaluation must include assessment for any signs of underlying medical conditions commonly associated with anxiety. Tests: Routine diagnostic testing is not usually necessary to establish this diagnosis, but may be required in some individuals to determine the presence of underlying medical conditions. Personality tests such as the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) may be helpful in determining whether or not there is an associated personality disorder. Self-rated scales such as the Beck Anxiety Scale and the State-Trait Anxiety Inventory may be useful in monitoring response to therapy.
Further psychological evaluation may be necessary. The diagnosis of GAD cannot be made until other medical and psychiatric conditions as well as alcohol and substance abuse have been excluded. Generalized anxiety disorder is not diagnosed if symptoms occur only during another mood disorder or a psychotic episode. |
Source: Medical Disability Advisor