Anxiety

Objectives

1. For a patient with multiple unexplained symptoms or behaviours, look for anxiety as a primary or contributing cause.
2. When a patient presents with symptoms of anxiety, clearly distinguish between distress (e.g. fear, nervousness, worry) and an anxiety disorder.
3. In a patient presenting with acute symptoms of panic (e.g., shortness of breath, palpitations, hyperventilation), do not attribute the symptoms to anxiety without first excluding serious medical pathology (e.g., pulmonary embolism, myocardial infarction) from the differential diagnosis, especially in patients with established anxiety disorder.
4. When working up a patient with symptoms of anxiety, and before making the diagnosis of an anxiety disorder,
   • Exclude serious medical pathology
   • Identify:
     • other co-morbid psychiatric conditions
     • abuse
     • substance use
   • Assess the risk of suicide
   • Discuss functional impact with the patient
5. When an anxiety disorder is suspected, assess and classify according to established diagnostic criteria, as treatment will vary according to the classification.
6. In patients with known anxiety disorders, do not assume all new symptoms are attributable to the anxiety disorder.
7. When planning management of anxiety, offer appropriate treatment, which may include one or a combination of the following:
   • Self-management techniques
   • Regular office follow-up
   • Community resources
   • Structured therapies (Cognitive Behavioral Therapy, psychotherapy)
   • Judicious use of pharmacotherapy
   • Referral to other health professionals with ongoing shared care
8. When managing anxiety or an anxiety disorder do not use medication as a sole treatment.
9. When assessing and managing anxiety, discuss the use of alcohol and substances as harmful self-medication.