Mental Status Exam (MSE) and Anxiety Disorders

Mental Status Exam (MSE)

• Appearance and behavior: may present as well-kempt or disheveled
• Motor activity: may have psychomotor agitation (e.g. hand-wringing, pacing, fidgeting, inability to sit still)
• Speech: may be fast or pressured
• Affect and mood: may describe feelings of anxiety, nervousness, and unease

Anxiety Disorders

• Generalized Anxiety Disorder (GAD): excessive worry about everyday issues and situations almost daily for 6 months or more
• Prevalence: 8-31.2% in primary care, mean age of onset: 30 years
• Risk factors: dysregulation of worry, genetics, female gender, adverse life events
• Diagnosis: by clinical interview (according to DSM-5 criteria), screening tool: GAD-7
• Management: patient education, referral to psychotherapy, psychiatry
• Prognosis: 43% may develop major depression, 20-25% increased risk of suicide

GAD - DSM-5 Diagnostic Criteria

• A. Excessive anxiety and worry, occurring more days than not for at least 6 months, about a number of events or activities
• B. Difficulty controlling the worry
• C. Anxiety and worry associated with 3 or more of the following:
  • Restlessness or feeling keyed up or on edge
  • Being easily fatigued
  • Difficulty concentrating or mind going blank
  • Irritability
  • Muscle tension
  • Sleep disturbance

Other Anxiety Disorders

• Panic Disorder (PD)
• Obsessive Compulsive Disorder (OCD)
• Various phobia-related disorders (e.g. simple phobia, social phobia, agoraphobia)

Considerations

• Trauma- and stressor-related disorders: Stress, Adjustment Disorder, Acute Stress Disorder
• Organic causes of anxiety: endocrine disorders (e.g. Hyperthyroidism, Pheochromocytoma, Hyperparathyroidism), cardiopulmonary disorders (e.g. Heart failure, Arrhythmias, Asthma or COPD), neurologic disorders (e.g. Temporal lobe epilepsy, Transient Ischemic Attacks), medication-related anxiety (e.g. corticosteroids, cocaine, amphetamines, caffeine; withdrawal)

Basic Terminology

• Fear: an emotional, physical, and behavioral response to an immediately recognizable external threat (within normal or typical range)
• Phobia: an excessive fear response to a specific object or situation that is out of proportion to the actual danger, causing significant dysfunction due to avoidance behavior
• Anxiety: a distressing, unpleasant emotional state of nervousness and unease, with causes less clear and timing less tied to a threat (anticipatory, persistent, none identifiable)