Differential Diagnosis of Anxiety Disorders
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Questions and Answers

What is the primary goal of taking a history of present illness in anxiety disorders?

To determine whether DSM-5 diagnostic criteria for a specific anxiety disorder are met, and to rule out alternative explanations.

What medical conditions can be associated with anxiety?

Hyperthyroidism, caffeinism, migraine, asthma, diabetes, chronic pain/illness, lead intoxication, hypoglycemic episodes, hypoxia, pheochromocytoma, central nervous system disorders, cardiac arrhythmias, cardiac valvular disease, systemic lupus erythematosus, allergic reactions, and dysmenorrhea.

Why is laboratory testing not routine in the evaluation of a suspected anxiety disorder?

Because it is not necessary in most cases, but can be completed if suggested by signs and symptoms of a medical condition.

What is the importance of noting somatic symptoms in anxious youths?

<p>To ensure that the somatic symptoms are not falsely attributed to adverse effects of medication treatment.</p> Signup and view all the answers

What medications can cause anxiety?

<p>Bronchodilators, nasal decongestants and other sympathomimetics, antihistamines, steroids, dietary supplements, stimulants, antidepressants, antipsychotics, and withdrawal from benzodiazepines.</p> Signup and view all the answers

Why is medication reconciliation important in the evaluation of anxiety disorders?

<p>To identify potential contributors to anxiety symptoms.</p> Signup and view all the answers

What environmental etiologies can cause anxiety?

<p>Exposure to organophosphates and ingestion of metals (eg, lead, arsenic).</p> Signup and view all the answers

What substances can cause anxiety?

<p>Licit and illicit substances including marijuana, cocaine, anabolic steroids, hallucinogens, phencyclidine, and withdrawal from nicotine, alcohol, and caffeine.</p> Signup and view all the answers

What is the recommendation regarding the use of olanzapine or aripiprazole in treating children and adolescents with Anorexia Nervosa?

<p>Weak recommendation for their use in specific contexts, with careful monitoring and consultation with specialists.</p> Signup and view all the answers

What is the minimum dose of olanzapine or aripiprazole that should be initiated in children and adolescents with Anorexia Nervosa?

<p>0.625-1.25 mg for olanzapine and 0.5-1.0 mg for aripiprazole.</p> Signup and view all the answers

Why is informed consent crucial when using olanzapine or aripiprazole in treating children and adolescents with Anorexia Nervosa?

<p>To ensure the young person or their substitute decision maker is aware of the risk of side effects.</p> Signup and view all the answers

What is the evidence-base supporting the use of olanzapine and aripiprazole in treating children and adolescents with Anorexia Nervosa?

<p>Scant and of poor quality.</p> Signup and view all the answers

What is the primary outcome measured in research trials examining the use of olanzapine in children and adolescents with Anorexia Nervosa?

<p>Weight gain.</p> Signup and view all the answers

What is a common limitation of open trials and case series examining the use of olanzapine in children and adolescents with Anorexia Nervosa?

<p>Patient attrition and reported adverse effects.</p> Signup and view all the answers

Who should ideally be involved in the consultation and monitoring of children and adolescents with Anorexia Nervosa receiving olanzapine or aripiprazole?

<p>Trained specialists in Child and Adolescent Psychiatry or Pediatrics with expertise in eating disorders.</p> Signup and view all the answers

What is the target dose range in research trials examining the use of olanzapine in children and adolescents with Anorexia Nervosa?

<p>Modest.</p> Signup and view all the answers

What is the modest benefit of aripiprazole in adolescents with Anorexia Nervosa?

<p>Aripiprazole showed some modest benefit in adolescents with Anorexia Nervosa.</p> Signup and view all the answers

What are some additional promising medications that require more research for eating disorder treatment?

<p>Selective Serotonin Reuptake Inhibitors (fluoxetine), Risperidone, Quetiapine, Atypical Antipsychotics, and Mirtazapine.</p> Signup and view all the answers

What medications are not recommended for the treatment of primary eating disorder symptoms?

<p>Selective Norepinephrine Reuptake Inhibitors, Mood Stabilizers, and Buproprion.</p> Signup and view all the answers

Why is Buproprion not recommended for use in eating disorders?

<p>Due to the elevated risks of seizures in this population.</p> Signup and view all the answers

What is the current status of research on medications for eating disorder treatment?

<p>More research is needed to determine the efficacy of medications in eating disorder treatment.</p> Signup and view all the answers

What is the significance of researching medications for eating disorder treatment?

<p>To determine their efficacy and make definitive recommendations for treatment.</p> Signup and view all the answers

Study Notes

Differential Diagnosis of Anxiety Disorders

  • The primary goal of the history of present illness is to determine whether DSM-5 diagnostic criteria for a specific anxiety disorder are met and to rule out alternative explanations.
  • Characterization of previous anxiety presentations and response to previous treatments informs current treatment choice.

Medical Conditions Associated with Anxiety

  • Hyperthyroidism, caffeinism, migraine, asthma, diabetes, chronic pain/illness, and lead intoxication are some medical conditions that can present with anxiety symptoms.
  • Other medical conditions associated with anxiety include hypoglycemic episodes, hypoxia, pheochromocytoma, central nervous system disorders, cardiac arrhythmias, cardiac valvular disease, systemic lupus erythematosus, allergic reactions, and dysmenorrhea.

Laboratory Testing

  • Laboratory testing is not routine in the evaluation of a suspected anxiety disorder, but may be completed if suggested by signs and symptoms of a medical condition.
  • Testing may include glucose, thyroid function, and other tests as indicated by the child's primary care practitioner.

Medications and Substances Associated with Anxiety

  • Certain medications can cause anxiety, including bronchodilators, nasal decongestants, sympathomimetics, antihistamines, steroids, dietary supplements, stimulants, antidepressants, antipsychotics, and withdrawal from benzodiazepines.
  • A wide array of licit and illicit substances can cause anxiety, including marijuana, cocaine, anabolic steroids, hallucinogens, phencyclidine, and withdrawal from nicotine, alcohol, and caffeine.
  • Environmental etiologies such as exposure to organophosphates and ingestion of metals (e.g., lead, arsenic) can also be considered.

Mental Conditions with Similar Symptoms

  • ADHD, depression, bipolar disorder, obsessive-compulsive disorder, psychotic disorders, autism spectrum disorder, and learning disorders can present with symptoms similar to anxiety disorders.
  • Differentiating these conditions from anxiety disorders is important for accurate diagnosis and treatment.

Treatment Options for Children and Adolescents with Anorexia Nervosa

  • Olanzapine or aripiprazole may be considered as treatment options for certain populations of children and adolescents with Anorexia Nervosa, but only with careful monitoring.
  • These medications should only be used in specific contexts, under the guidance of trained specialists in Child and Adolescent Psychiatry or Pediatrics with expertise in eating disorders.

Olanzapine

  • Olanzapine has been the most studied psychotropic medication for children and adolescents with Anorexia Nervosa.
  • Only one small double-blind placebo-controlled trial has been published, with no beneficial effect found in 15 subjects who completed the trial.
  • Several open trials and case series have shown mixed results, with some demonstrating benefit (e.g., weight gain), but with common adverse effects and patient attrition.

Aripiprazole

  • Three small poor-quality studies found aripiprazole to have some modest benefit in adolescents with Anorexia Nervosa.
  • Doses should be initiated at 0.5-1.0mg and titrated carefully, with target doses in research trials being modest.

Additional Promising Medications

  • Selective Serotonin Reuptake Inhibitors (e.g., fluoxetine for Bulimia Nervosa) require more research before definitive recommendations can be made.
  • Risperidone and Quetiapine for use in Anorexia Nervosa require more research.
  • Atypical Antipsychotics for use in Avoidant/Restrictive Food Intake Disorder require more research.
  • Mirtazapine use for patients with Anorexia Nervosa requires more research.
  • Selective Norepinephrine Reuptake Inhibitors have no evidence to support their use in eating disorder treatment.
  • Mood Stabilizers have no evidence to support their use in eating disorder treatment.
  • Buproprion is not recommended for use in eating disorders due to the elevated risk of seizures in this population.

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Quiz on determining DSM-5 diagnostic criteria for anxiety disorders and ruling out alternative explanations, including medical conditions that may contribute to anxiety.

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