Anxiety Disorders: Description and Etiology
Screening and Assessment
Effective management of anxiety disorders begins with a thorough and comprehensive assessment and an accurate diagnosis. The normal fears and uncertainties associated with cancer are often intense. Frequently not clear is the distinction between normal fears and fears that are more severe and finally reach the criteria for an anxiety disorder (see Table 3 for more information).
Treatment should not be based solely on the definition of the disorder but should be based on consideration for the patient's quality of life. To assess the severity of the anxiety, it is important to understand to what extent the symptoms of anxiety are interfering with activities of daily living. Screening for anxiety could include a brief self-report questionnaire that, if a defined cutoff score is exceeded, could then be followed by a more thorough clinical interview. A variety of general screening questionnaires have been used for identification of distress. (Refer to the section on Self-report screening instruments in this summary for more information.) Other anxiety-specific self-report questionnaires (e.g., State-Trait Anxiety Inventory) have also been used, and a questionnaire for the assessment of prostate cancer-related anxiety has been developed and validated.[2,15,16]
The following is a list of symptoms designed to distinguish common or normal worry from more serious symptoms of anxiety. When patients are reporting the more serious symptoms, referral to a qualified mental health professional may be warranted.
Table 3. Common Worry versus Anxiety Disordersa
a Adapted from Nicholas.
|Symptoms of Common or Normal Worry||More Serious Symptoms of Anxiety Disorders|
|Worry comes and goes.||Worry seems constant.|
|Has some difficulty in concentrating.||Is unable to concentrate.|
|Is able to "turn off thoughts" most of the time.||Is unable to "turn off thoughts" most of the time.|
|Has occasional trouble falling asleep.||Has trouble falling asleep and/or wakes up early most nights.|
|Has occasional crying spells that seem to provide some relief.||Has frequent crying spells that interfere with daily activities.|
|Fear and apprehension are clearly connected to some upcoming event (e.g., start of treatment, doctor appointment, or receipt of test results).||Fear and apprehension are more "free floating" and seem to be present most of the time.|
|Has few, if any, physical symptoms (e.g., racing heart, dry mouth, shaky hands, or restlessness).||Has many physical symptoms (e.g., racing heart, dry mouth, shaky hands, restlessness, fidgetiness, or feeling keyed up).|
|Has ways to reduce anxiety (e.g., distraction by staying busy).||Has few, if any, ways to reduce anxiety.|
When anxiety is situational (i.e., produced by pain, another underlying medical condition, a hormone-secreting tumor, or a side effect of medication), the prompt treatment of the cause usually leads to immediate control of the symptoms. Some effective coping strategies include encouraging fearful patients to:
- Confront the problem directly.
- Try to view the situation as a problem to be solved or as a challenge.
- Try to obtain complete information.
- Try to be flexible (taking things as they come).
- Think of major events as a series of step-by-step tasks.
- Use resources and support.