Anxiety Disorders: Screening and Diagnosis

Significance

  • Studies which included a diagnostic interview report a high prevalence of anxiety disorders in PLWH(i)
  • Specific anxiety disorders include the following:
    • panic disorder (10% in PLWH)
    • generalized anxiety disorder (5.6% PLWH)
    • social anxiety disorder (9% PLWH)
    • 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 in PLWH

 

Screening and diagnosis of anxiety

Who?

Consider screening all PLWH recommended at each 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 General 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

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

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

 

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