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7 Medical Illnesses That May Present as Anxiety

7 Medical Illnesses That May Present as Anxiety


  • Patients with anxiety disorders, such as generalized anxiety disorder (GAD), panic disorder, and phobias, as well as PTSD, report a higher rate of certain medical illnesses than are observed in the general population. Anxiety disorders are associated with an increased incidence of any number of medical illnesses, including those presented in this partial list.
  • Anxiety disorders are associated with an increased incidence of cardiovascular disease, frequent panic attacks, and worse cardiac outcomes. PTSD is linked to increased risk of cardiovascular disease, increased rates of re-hospitalization, and decreased adherence to treatment regimens. Cardiac illnesses such as angina, arrhythmias, cardiac tamponade, congestive heart failure (left sided), myocardial infarction, or valvular disease may present as anxiety.

  • Neuroendocrine systems can be affected by anxiety by creating excessive sympathetic activation and disruption of the hypothalamic-pituitary-adrenal axis—predisposing patients to increased health risks. Some medical disorders that may present as anxiety include Cushing disease, diabetes mellitus, parathyroid disease (hyperparathyroidism, pseudo-hyperparathyroidism), pancreatic tumors, pheochromocytoma, pituitary disease, and thyroid disease (hyperthyroidism, hypothyroidism, thyroiditis).


  • Patients with primary anxiety disorders are more likely to suffer from GI, respiratory, cardiac, and neurological disorders, even after adjusting for confounding factors such as sex, depression, and substance use disorders. Among patients with panic disorder, GAD, and PTSD, rates of irritable bowel syndrome are much higher than in those with no psychiatric diagnoses. GI issues might include gastroesophageal reflux disease, irritable bowel syndrome, peptic ulcer disease, and others.


  • Anxiety can create an alteration in inflammatory response. Polyarteritis nodosa, rheumatoid arthritis, systemic lupus erythematous, temporal arteritis, and other inflammatory conditions may present as anxiety.

  • Metabolic issues might include hyperkalemia, hyperthermia, hypoglycemia, hyponatremia, hypoxia, porphyria, or substance ingestion/overdose. Biologically, acute anxiety may be the first sign of exacerbation of an underlying illness, an undiagnosed medical condition, or substance intoxication or withdrawal. To aid in diagnosis, the patient examination includes a detailed history; focused physical examination; complete review of medications; collateral information; and diagnostic testing, such as toxicology screens.

  • Primary anxiety disorders, particularly panic disorder, can be comorbid with seizure disorder. Social anxiety disorder and panic attacks are often seen in patients with Parkinson disease [see reference 8 here]. Other illnesses, such as akathisia, cerebral trauma and/or post-concussive syndrome, cerebrovascular disease, cerebral syphilis, encephalopathy, Huntington disease, mass lesions, migraines, multiple sclerosis, seizure disorders, subarachnoid hemorrhage, vertigo, and others may present as anxiety.

  • Anxiety can be camouflaged as somatic symptoms to mimic a medical illness, especially in the primary care setting. Some of the somatic expressions of anxiety include tachycardia, palpitations, sweating, flushing, dry mouth, dizziness, tremor, muscle tension, headaches, and fatigue. These symptoms could present as a “false alarm” because of an underlying anxiety disorder or a somatoform disorder. Respiratory conditions that may present as anxiety might include asthma, chronic obstructive pulmonary disease, pneumothorax, pulmonary edema, pulmonary embolism, sleep apnea, obstructive/non-obstructive, and others.

  • Treatment modalities should be discussed with the patient to ensure autonomy, minimize the subjective feeling of losing control, increase adherence, and ultimately strengthen the therapeutic alliance. Collaboration with other treatment teams is essential in reducing health care utilization. For more information, see the Psychiatric Times article, Managing Anxiety in the Medically Ill, on which this slideshow is based. To view a PDF, of this slideshow, click here.

To view a PDF, of this slideshow, click here.

Comments

Nothing about MTHFR gene mutation?

Long-standing difficult or impossible to treat anxiety and refractory depression symptoms can be attributed to this metabolic condition. Alas, the UK neither recognises nor tests for it as yet, and it should be one of the first investigations when a patient has long-standing conditions and a family history of anxiety and depression.

Marianne @

My understanding is these medical conditions can be a result of toxic stress

Tanya @

Don't forget Hashimoto's Thyroiditis causing psychiatric symptoms that can look like anxiety and/or bipolar disorder

Gail @

Great slide.
Perhaps the reason why patients diagnosed with Anxiety have an increased risk of having these disorders is because they were misdiagnosed as having an Anxiety disorder in the first place which has likely confounded the results?

m @

I have to add, that I've had depression and anxiety all of my life, and as a 55 y/o Nurse Practitioner, I just discovered I have ADHD--inattentive type, all of my life as well.

Here I always just thought I was just treatment resistant to antidepressants.

It's been a miracle to realize that ADHD meds not only have helped my anxiety and depression, but also my optimism, AND spirituality... positivity affecting my self esteem. I'd have never guessed that treating one (earlier unidentified) psychiatric illness could so profoundly affect my quality of life.

Oddly enough, no Education system, Primary Care of Psychiatrist ever identified it before in me, and it took a friend pointing it out to me, for me to realize it.

It really makes me wonder how much Attention Deficit Inattentive Type is really being missed as diagnoses in the rest of the population.

Ann @

I was diagnosed with ADHD/ADD in 2003. Your question is understandable, it a known state of mind in patiënt that were diagnosed recently. But try not to bother yourself asking why general things be. Now you have the meds that help you to focus, be aware of the need to keep that focus centered to what directly benefits your own circomstances, which is only is what you yourself undertake... Try not to waste the effect of your meds to trivia... ;-)

Arnold @

Quite amazing and glad for you it was picked up. I have also had the same- and 5 years ago-35 years too late- was diagnosed with ADHD- I have not been able to afford the ADD drugs- so continue for now with medaid paid for anti depressants and hope that I can get onto the ADD medications- also only childhood ADHD to age 18 paid for by Medaids here. After that - you're on your own - and adulT ADD OR ADHD is not covered here by any medical aid/health plan at all.
Please advise which ADHD meds you're taking and the dosage. I know we're all different but it would very helpful to know this. Thanks very much

norman @

Good job!
Panic attack patients not only tend asking first for a Cardiologist consultation, but are reluctant to admit their disorder is mental; infections, as Toxoplasmosis, may have a deep impact on mental health, endocrine medications, as corticosteroids, may induce a 'manic-like' state, other conditions do the reverse, a melancholic depression; tricyclic anti-depressants, that have an anti-cholinergic, anti-secretory action, improve non-ulcer dyspepsia symptoms, so do anti-psychotics, some having an anti-nausea effect; Alprazolam was considered, but not formally studied, as adjuvant drug in non-ulcer dyspepsia and tension headache; some people take an Aspirin when in conciliation insomnia; MS patients may have psychiatric symptoms irrespective of drug therapy; hypoxia or hypercapnia is a known cause of Delirium, once called 'Organic Brain Syndrome'.

Patients are lucky that Psychiatry remains a Medical Science, and psychology is not an acceptable alternative and identical source of Diagnosis and Treatment

Jose @

It seems to me the other way around. These are the anxiety symptoms that look like medical illnesses.

Anxiety is a high arousal state. All listed symptoms can be explained by activation of the amygdalae, which in turn stimulate the autonomic nervous system (neurological, cardiac, respiratory, and gastrointestinal components) and hypothalamus ( the endocrine response to stress).

I was a bit surprised seeing "fatigue, dizziness, headaches, palpitations, tremors" listed under "Inflammatory conditions" and practically the same - Automic [sic!] instability, dizziness, fatigue, headaches, palpitations, tachypnea, tremors as Metabolic and then again as Neurologic in the PDF version. I assume these were typos.

Michael @

To "Michael"
Thanks for the attention to detail. We made the correction in slide 3. The overlap in symptoms is indicated in Table 2 on which this slideshow is based: http://www.psychiatrictimes.com/special-reports/managing-anxiety-medical.... Finally, we ask our readers to include name/title/institution with their comments.
Respectfully,
Laurie Martin
Digital Managing Editor
Psychiatric Times

PsychTimes @

Yes, this is true for sure. However, one affects the other and it could be both in an endless cycle. It does not negate the need for counselling or support in both the physical and the psychiatric treatment. Medications can cause symptoms , as well. Treating the person from a whole perspective , with a good assessment of their history helps. Teachingboth their conditions people to manage their chronic illnesses is paramount and providing them with emotional support and education along with positive reinforcement in self determination in their successes towards independence also improves both conditions. None of these illnesses are isolated from anxiety.

Brenda E @

As one of the endocrine based etiologies, let's not forget perimenopause which often has an anxiety component. This is often overlooked as the source of the anxiety and will self correct upon its own physiologic resolution. When treating anxiety remember there are other medication choices besides benzodiazepines so stay away from them unless the patient clearly understands it is for short term use only. I can't tell you how many women have come to me years later still on the high dose medication and most did not realized its insidious effect.

Carol @

Updated
Physical medical exam by a patient's general practitioner is always necessary to rule out hyperthyroidism with a storm, or arrhythmia as many medical deficiencies present with anxiety
In addition child sexual abuse past or current in the patient's life must also be ruled out

dr stella @

I am a dermatologist and I see many patients with somatoform skin symptoms.

Andrew @

Yes, in particular amongst the patient's living with a noticeable skin condition which is uncertain to them as well as their self esteem being affected when the medical condition is arrested but relapses therefore the patient is challenged with denial, anger, resentment for the challenge and recurrent, hence anxiety sets and depressive moods
Thank you for sharing

dr stella @

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