Anxiety Disorders: Screening and Diagnosis

Significance

Studies which included a diagnostic interview report a high prevalence of anxiety disorders in persons with HIV⁽ⁱ⁾
Specific anxiety disorders include the following:
- panic disorder (10% in persons with HIV)
- generalised anxiety disorder (5.6% persons with HIV)
- social anxiety disorder (9% persons with HIV)
- post-traumatic stress disorder (PTSD)
Significant disability and poorer HIV treatment outcomes are associated with anxiety
Anxiety disorders are often associated with substance use behavior

Screening and diagnosis of anxiety

Who?

Consider screening all persons with HIV at each routine clinic visit (in view of the high prevalence of anxiety)

Populations at particularly high risk

Positive history of anxiety disorders in family
Anxious personality
Alcohol excess
As part of investigation of cognitive impairment, see Management of Cognitive Impairment
Multiple stressful life events (particular relevance during COVID-19 pandemic)

How to screen?

Generalised Anxiety Disorder-2 (GAD-2) Screening tool⁽ⁱ⁾:
"Over the last 2 weeks, how often have you been bothered by the following problems?"

Feeling nervous, anxious or on edge
Not being able to stop or control worrying

Score each question and calculate sum:

0. Not at all
1. Several days
2. More than half the days
3. Nearly every day

How to diagnose?

If GAD-2 cut-off score of ≥ 3, ask the following questions to diagnose Generalised Anxiety Disorder:

excessive anxiety for more days than not over 6 months
difficulty controlling worry
associated with at least three of these symptoms (restlessness, fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbances)
significant life impairment
not attributable to another substance or medical condition
not being better explained by another medical disorder

Rule out hyperthyroidism, hypoglycemia and hyperadrenocorticism.
Exclude caffeine excess and use of stimulants (such as cocaine, crystal methamphetamine, amphetamines)

Seek expert advice to diagnose panic disorders, social phobia and PTSD

i GAD-2 score is a validated screening tool in persons with HIV, https://www.hiv.uw.edu/page/mental-health-screening/gad-2