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When to Screen?
Patient presents with symptoms of anxiety:
- feels anxious or nervous
- Insomnia
- irritability
- avoidance behaviour
- panic-like symptoms
- excessive worry
High risk symptom presentations:
- Unexplained physical symptoms
- Fatigue
- Substance abuse
- Depression
High risk groups:
- Past history of depression or anxiety
- Family history of depression or anxiety
- Psycho-social adversity, including childhood abuse or neglect
- History of trauma
- Higher users of the medical system
- Chronic medical conditions (e.g. cardiovascular disease, diabetes, chronic pain, neurological disorders)
- Other psychiatric conditions
How to Screen
There are many ways to screen:
1. General screening questions (Katzman et al. 2014)
"During the past two weeks how much have you been bothered by the following problems:
- Feeling nervous, anxious, frightened, worried or on edge
- Feeling panic or being frightened
- Avoiding situations that make you anxious"
Items scored as mild or greater may warrant further assessment
2. Consider using the PHQ-4 questionnaire PHQ-4.pdf
A score of 3 or greater on items 1 and 2 considered positive screen for anxiety
A score of 3 or greater on items 3 and 4 is considered positive screen for depression
(if so consider going to the Ottawa Depression Algorithm)
3. Consider using the GAD-7 questionnaire GAD-7 in other languages |GAD-7.pdf Online on MDcalcScoring instructions
If you have a high suspicion of anxiety, consider simply using the GAD-7, which will allow for screening as well as provide an assessment of severity.