Differential Diagnoses for Anxiety or Anxious Distress

Immediate Safety Assessment

The American Academy of Child and Adolescent Psychiatry recommends assessing for imminent risk of harm to self or others, and if present, referring immediately for emergency psychiatric evaluation, facilitating a safe environment with one-to-one observation, and initiating harm-reduction interventions 3, 4
Evaluate for psychosis, severe agitation, or delirium requiring urgent intervention, as recommended by the Journal of Clinical Oncology 3

The American Academy of Child and Adolescent Psychiatry states that medical conditions must be excluded before diagnosing a primary anxiety disorder, including endocrine disorders such as hyperthyroidism, hypoglycemia, pheochromocytoma, and diabetes with hypoglycemic episodes 1
The American Academy of Child and Adolescent Psychiatry also recommends considering cardiovascular conditions, respiratory disorders, neurological conditions, metabolic disturbances, chronic conditions, and substance-related causes 1

The American Academy of Child and Adolescent Psychiatry defines Generalized Anxiety Disorder (GAD) as excessive worry about multiple everyday situations or activities, which is the most prevalent anxiety disorder and commonly comorbid with depression 7, 1
The American Academy of Child and Adolescent Psychiatry also defines Panic Disorder, Social Anxiety Disorder, Specific Phobia, Agoraphobia, Separation Anxiety Disorder, Selective Mutism, Post-Traumatic Stress Disorder (PTSD), and Obsessive-Compulsive Disorder, as recommended by the Journal of Clinical Oncology 1, 7

The American Academy of Child and Adolescent Psychiatry recommends using the GAD-7 scale as the primary screening tool, with severity stratification, as recommended by the Journal of Clinical Oncology 2, 6
For mild anxiety (GAD-7: 0-9), provide psychoeducation, active monitoring, self-help resources based on CBT principles, and structured physical activity, as recommended by the Praxis Medical Insights 2
For moderate anxiety (GAD-7: 10-14), refer to educational and support services, and consider low-intensity psychological interventions, as recommended by the Praxis Medical Insights 2
For moderate to severe/severe anxiety (GAD-7: 15-21), implement high-intensity interventions including CBT, behavioral activation, structured physical activity, and consider pharmacotherapy, as recommended by the Praxis Medical Insights 2

The Journal of Clinical Oncology recommends conducting interviews with both the patient and collateral sources, including family members, teachers, and primary care providers, to identify physical symptoms, severity and duration of symptoms, functional impairment, possible stressors, and risk factors 4, 6

The Praxis Medical Insights states that anxiety disorders frequently co-occur with other psychiatric conditions, including depression, other anxiety disorders, and substance use disorders, as recommended by the Journal of Clinical Oncology 6, 7

The American Academy of Child and Adolescent Psychiatry recommends distinguishing clinically significant anxiety from everyday worries and normative developmental fears, as anxiety disorders cause clinically significant disturbance in cognition, emotion regulation, or behavior reflecting dysfunction in psychological, biological, or developmental processes 1, 7

For mild symptoms (GAD-7: 0-9), the Praxis Medical Insights recommends psychoeducation, active monitoring, self-help resources based on CBT principles, and structured physical activity 2
For moderate symptoms (GAD-7: 10-14), the Praxis Medical Insights recommends all interventions for mild symptoms, referral to educational and support services, and low-intensity psychological interventions 2, 5
For moderate to severe/severe symptoms (GAD-7: 15-21), the Praxis Medical Insights recommends Cognitive Behavioral Therapy (CBT) as first-line psychological treatment, SSRIs (sertraline preferred) or SNRIs as first-line pharmacotherapy, and combined CBT plus SSRI for superior outcomes 2, 5

The Praxis Medical Insights recommends assessing treatment response at regular intervals (4 weeks, 8 weeks, and end of treatment) using standardized measures, and altering the treatment course after 8 weeks of treatment with poor improvement despite good adherence 2, 7