Anxiety Disorder Diagnosis and Treatment

Diagnostic Considerations

The American Academy of Child and Adolescent Psychiatry recommends ruling out medical conditions that can mimic or cause anxiety symptoms, such as hyperthyroidism, hypoglycemia, and caffeine excess, before confirming an anxiety disorder diagnosis 2
Laboratory testing should include thyroid function tests and glucose levels if the clinical presentation suggests these conditions, according to the American Academy of Child and Adolescent Psychiatry 2
The clinical presentation of excessive, uncontrollable worry about tasks and timing is characteristic of Generalized Anxiety Disorder (GAD), as noted by the Journal of the American Academy of Child and Adolescent Psychiatry 1, 2

The American Academy of Child and Adolescent Psychiatry suggests assessing for comorbid or alternative psychiatric conditions, including Major Depressive Disorder, Bipolar Disorder, and Personality Disorder features 4
The presence of extreme anger bursts and projection may indicate comorbid mood disorder or personality features, according to the American Academy of Child and Adolescent Psychiatry 4

The American Academy of Child and Adolescent Psychiatry recommends initiating an SSRI as first-line pharmacological treatment for both GAD and panic disorder, with sertraline or paroxetine as specific options 5
Cognitive-behavioral therapy (CBT) is a first-line treatment and should be initiated concurrently with medication, as noted by Praxis Medical Insights 5
The combination of CBT and SSRI is superior to either alone, providing durable skills that may prevent relapse after medication discontinuation, according to Praxis Medical Insights 5

The American Academy of Child and Adolescent Psychiatry recommends scheduling follow-up at 2 weeks, then monthly for the first 3 months, to monitor for worsening anxiety/panic, suicidal ideation, and medication adherence 3
The assessment of response should include reduction in panic attack frequency, improved sleep, decreased worry, and better functional capacity, as noted by Praxis Medical Insights 3