Screening Tools for Anxiety Disorders

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At present, screening tools for anxiety disorders have been developed to recognize anxiety as a broad syndrome, examining somatic symptoms (racing heart, lightheadedness) or cognitive symptoms (tendency to worry, intensity of worry). Other tools have been used to screen for single, distinct disorders, such as phobias or panic disorder. To date, no clear screening tool or symptom-severity measure has emerged for use in primary care settings, although newer instruments may be useful for primary care physicians. The Generalized Anxiety Disorder 7 (GAD-7) scale was developed and validated

Box 47-3 Diagnostic Criteria for Generalized Anxiety Disorder

Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities.

A. The person finds it difficult to control the worry.

B. The anxiety and worry are associated with three (or more) of the following six symptoms:

1. Restlessness and feeling keyed up or on edge

2. Being easily fatigued

3. Difficulty concentrating or mind going blank

4. Irritability

5. Muscle tension

6. Sleep disturbance

C. The focus of the anxiety and worry is not confined to features of an Axis I disorder, e.g., the anxiety or worry is not about having a Panic Attack.

D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The disturbance is not due to the direct physiological effects of a substance or a general medical condition.

From American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed, text revision. Washington, DC, APA, 2000.

Box 47-4 Diagnostic Criteria for Panic Attack

A discrete period of intense fear or discomfort, in which four (or more) of the following symptoms developed abruptly and reached a peak within 10 minutes:

1. Palpitations, pounding heart, or accelerated heart rate

2. Sweating

3. Trembling or shaking

4. Sensations of shortness of breath or smothering

5. Feeling of choking

6. Chest pain or discomfort

7. Nausea or abdominal distress

8. Feeling dizzy, unsteady, lightheaded, or faint

9. Derealization (feelings of unreality) or depersonalization (being detached from oneself)

10. Fear of losing control or going crazy

11. Fear of dying

12. Paresthesias (numbness or tingling sensations)

13. Chills or hot flushes

From the American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed, text revision. Washington, DC, APA, 2000.

Box 47-5 Diagnostic Criteria for Panic Disorder without Agoraphobia

1. Recurrent and unexpected panic attacks

2. At least one of the attacks has been followed by 1 month (or more) of one (or more) of the following:

(a) Persistent concern having additional attacks

(b) Worry about the implications of the attack or its consequences (e.g., losing control, having a heart attack, "going crazy")

(c) A significant change in behavior related to the attacks

B. Absence of Agoraphobia.

C. The Panic Attacks are not due to the direct physiological effects of a substance or a general medical condition.

D. The Panic Attacks are not better accounted for by another mental disorder.

From the American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th ed, text revision. Washington, DC, APA, 2000.

in primary care clinics and is a brief, seven-item self-report screening tool for GAD (Spitzer et al., 2006). The GAD-7 helps identify probable cases of GAD and measure symptom severity. A score of 10 or greater represents a reasonable cutoff point for identifying patients with GAD, and cutoffs of 5, 10, and 15 correlate to mild, moderate, and severe levels of anxiety. An extended version of the PHQ includes five questions for panic disorder (Spitzer et al., 1999), but its utility as a stand-alone tool is currently unclear. The Overall Anxiety Severity and Impairment Scale (OASIS) is a five-item continuous measure that can be used across anxiety disorders, with multiple anxiety disorders, and with subthreshold anxiety symptoms. OASIS can be used to measure the severity of anxiety symptoms, but it was not developed as a diagnostic tool for any specific disorder (Norman et al., 2006).

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Anxiety and Panic Attacks

Anxiety and Panic Attacks

Suffering from Anxiety or Panic Attacks? Discover The Secrets to Stop Attacks in Their Tracks! Your heart is racing so fast and you don’t know why, at least not at first. Then your chest tightens and you feel like you are having a heart attack. All of a sudden, you start sweating and getting jittery.

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