Substantial anxiety is common in those facing life-threatening illnesses. It is experienced by at least 25% of cancer patients and 50% of chronic heart failure and chronic obstructive pulmonary disease patients.
Etiologies
- Psychiatric disorders (generalized anxiety disorder, panic disorder, adjustment disorder, acute- or post-traumatic stress disorders, phobias)
- Acute or chronic pain, dyspnea, nausea, or cardiac arrhythmias
- Adverse drug effects: corticosteroids, psychostimulants, some antidepressants
- Drug withdrawal: alcohol, opioids, benzodiazepines, nicotine, clonidine, antidepressants, corticosteroids
- Metabolic: hyperthyroidism and syndromes of adrenergic or serotonergic excess
- Existential and psychosocial concerns about dying, disability, loss, legacy, family, finances, and religion/spirituality
Evaluation
Take a detailed history and perform a physical exam. In particular, ask about:
- prior episodes of other psychiatric disorders
- prior and current treatments by a mental health professional
- the presence of specific trigger situations or thoughts leading to anxiety
- the presence of apprehension, dread, insomnia, and hypervigilance; also physical symptoms, such as diaphoresis, dyspnea, muscle tension, and tremulousness
When anxiety is a prominent and functionally impairing part of a patient’s symptoms the intervention of a professional familiar with psychiatric disorders is necessary. Symptoms that can be confused with anxiety are: agitated delirium and akathisia.
See reference for more information. Adapted from Stoklosa J et al. Anxiety in palliative care – causes and diagnosis. Palliative Care Network of Wisconsin. Fast facts and concepts #186. Internet. Accessed on May 6, 2018.