Substance/Medication-Induced Anxiety Disorder

• diagnosed after an individual uses a substance (e.g., a drug of abuse, a medication, or a toxin exposure) that leads to prominent symptoms of panic or anxiety. 
• The symptoms
  • precede the onset of the substance/medication use
  • NOT
    • persist for a substantial period of time (e.g. – about 1 month) after the cessation of acute withdrawal or severe intoxication: 
    • evidence suggesting the existence of an independent nonsubstance/medication-induced anxiety disorder
    • occur exclusively during the course of a delirium. 
• The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. 
• Specify the substance:
  • Alcohol
  • Caffeine
  • Cannabis
  • Phencyclidine
  • Other hallucinogen
  • Inhalant
  • Opioid
  • Sedative, hypnotic, or anxiolytic
  • Amphetamine (or other stimulant)
  • Cocaine
  • Other (or unknown) substance
• Substances/Medications – Panic or anxiety can occur in association with:
  • intoxication :
    • Alcohol
    • Caffeine
    • Cannabis
    • Phencyclidine
    • other hallucinogens, inhalants, and stimulants.
  • withdrawal:
    • Alcohol
    • Opioids
    • Sedatives
    • Hypnotics
    • Anxiolytics
    • stimulants (including cocaine)
  • cause:
    • Anesthetics,Analgesics
    • Sympathomimetics
    • bronchodilators (e.g. – theophylline)
    • anticholinergics
    • antihistamines
    •  antiparkinsonian medications
    • Corticosteroids
    • Antihypertensives
    • Anticonvulsants
    • Heavy metals and toxins
      • Oganophosphate insecticide
      • nerve gases
      • carbon monoxide
      • carbon dioxide
      • volatile substances (e.g. – gasoline, paint)
• Differential Diagnosis
  • Substance intoxication and substance withdrawal
  • Anxiety disorder (i.e. – not induced by a substance/medication)
  • Anxiety disorder due to another medical condition

Delirium