Investigations
1st investigations to order
clinical diagnosis
Test
Perform a thorough history and examination.
No investigations confirm a diagnosis of generalised anxiety disorder (GAD), and results are generally normal, if no co-existing physical health problems or substance misuse issues exist.
GAD is defined by the Diagnostic and Statistical Manual of mental disorders, fifth edition, text revision (DSM-5-TR) criteria as at least 6 months of excessive anxiety and worry about several events or activities, which causes distress or impairment.[1] The worry is not confined to features of another mental health disorder, a result of substance misuse, or related only to a physical health condition. At least three of the following key symptoms are present most of the time in adults to make a diagnosis of GAD: restlessness or sense of feeling 'on edge' (nervousness), being easily fatigued, poor concentration, irritability, muscle tension, or sleep disturbance (only one key symptom is required in children).[1]
Result
meets clinical criteria for GAD; rule out physical health conditions, other mental disorders, and medications or substances as a primary cause
Investigations to consider
thyroid function tests
Test
Order thyroid function tests for patients with anxiety plus symptoms suggestive of thyroid disease (such as unexplained weight loss, exophthalmos, or goitre) or a woman with anxiety and a family history of thyroid disease.
Increased thyroxine or decreased thyroid-stimulating hormone suggests overactive thyroid or excessive thyroid replacement.
Result
normal thyroid-stimulating hormone and thyroxine
urine drug screen
Test
Undertake a urine drug screen if there is a strong suspicion of substance misuse, such as a patient with a history of alcohol or other drug misuse.
The test may miss cocaine, which is rapidly metabolised and excreted.
Result
negative for stimulants
24-hour urine test for catecholamines, metanephrines, normetanephrines, and creatinine
Test
If severe hypertension and/or tachycardia exists with anxiety, this test is recommended to rule out phaeochromocytoma. This is a rare clinical situation.
Increased levels of urine catecholamines, metanephrines, and normetanephrines suggest phaeochromocytoma. If acute kidney injury is present, creatinine levels may be raised.
Result
normal
pulmonary function tests
Test
Order pulmonary function tests if pulmonary disease is suspected as a cause for shortness of breath. Anxiety symptoms frequently co-occur in people with chronic respiratory disorder.
Pulmonary function tests may show reactive airway disease or emphysema.
Result
normal FEV₁
ECG
Test
Order an ECG for patients with abnormal cardiac auscultation, symptoms or risk factors for cardiac disease, syncope, or a strong family history of cardiac disease.
The presence of arrhythmias, evidence of old or new ischaemic changes, or the presence of conduction defects suggests underlying cardiac pathology.
Result
normal sinus rhythm
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