Medical and substance-induced mimics of anxiety

What it is

Anxiety symptoms are not always a primary anxiety disorder. Anxiety secondary to medical conditions, to substance use, or occurring exclusively during posttraumatic stress disorder has to be distinguished from GAD, and a patient who presents with panic attacks should be screened for medical disorders first.

The medical conditions that give similar symptoms are hyperthyroidism and pheochromocytoma. Beside them stands substance induced anxiety disorder, for example amphetamine abuse or alcohol withdrawal. A careful history will differentiate substance intoxication, notably cocaine or amphetamines, and alcohol withdrawal symptoms.

How it presents

Patients with hyperthyroidism may have typical features of a panic attack as well as other symptoms including weight loss and increased appetite.

A 32 yr woman with palpitation, tremor and weight loss in the last 3 months, who had a URTI 2 weeks back, is set as a choice between Graves disease and De Quervain's. The answer marked for it is Graves disease, and a question mark is left beside De Quervain's and beside the 3 months of weight loss, so the choice is left open.

Subacute thyroiditis, also known as De Quervain's thyroiditis and subacute granulomatous thyroiditis, is thought to occur following viral infection and typically presents with hyperthyroidism.