Essential Assessment Questions for Anxiety
When evaluating a patient presenting with anxiety, use the GAD-7 scale as your primary screening tool, then systematically assess for safety concerns, symptom severity, functional impairment, risk factors, and medical causes. 1
Initial Screening Questions
Start with the GAD-7 (Generalized Anxiety Disorder-7) scale, which asks patients to rate how often over the past 2 weeks they have experienced:
- Feeling nervous, anxious, or on edge
- Cannot stop or control worrying
- Worrying too much about different things
- Trouble relaxing
- Being so restless that it's hard to sit still
- Becoming easily annoyed or irritable
- Feeling afraid as if something awful might happen
Each item is rated: 0 (not at all), 1 (several days), 2 (more than half the days), 3 (nearly every day) 2, 1
Scoring interpretation:
- 0-4: None/mild symptoms
- 5-9: Moderate symptoms
- 10-14: Moderate to severe symptoms
- 15-21: Severe symptoms 2
Critical Safety Assessment (Ask First)
Immediately assess risk of harm to self or others - if present, refer for emergency psychiatric evaluation 2, 1
Also screen for:
- Psychosis
- Severe agitation
- Confusion or delirium
These require urgent psychiatric referral 1, 2
Symptom Characterization Questions
Physical manifestations:
- Panic attacks (abrupt surges of intense fear)
- Trembling or shaking
- Sweating
- Rapid breathing (tachypnea)
- Racing heart or palpitations
- Sweaty palms 2, 1
Cognitive patterns:
- Key distinction: GAD patients don't just worry about their presenting problem - they have excessive worries about multiple areas of life beyond the immediate concern 2, 1, 2
- Are worries disproportionate to actual risk?
- Can the patient control the worrying?
- Does worry extend to non-medical topics? 1
Functional Impairment Assessment
Determine impact on:
Ask: "How much do these problems interfere with your ability to function?" 2
Risk Factor History
Personal psychiatric history:
- Prior anxiety disorder diagnosis or treatment
- Other comorbid psychiatric disorders (especially mood disorders)
- Response to previous treatments 2
Family history:
- Familial history of anxiety disorders 2
Substance use:
- Current alcohol or substance use/abuse
- History of alcohol or substance use/abuse 2
Medical factors:
- Presence of other chronic illnesses 2
Medical Causes to Rule Out
Ask about and evaluate:
- Uncontrolled pain
- Fatigue
- Infection
- Electrolyte imbalances
- Delirium
- Medication side effects
- Substance withdrawal 2, 1
Associated Symptoms
Screen for:
- Sleep disturbances
- Fatigue
- Irritability
- Concentration difficulties 2
Comorbid Anxiety Disorders
Consider screening for:
- Panic disorder
- Social phobia/social anxiety disorder
- Specific phobias
- Agoraphobia
- Obsessive-compulsive disorder
- Post-traumatic stress disorder 2
Duration and Chronicity
- When did symptoms begin?
- How long have symptoms been present?
- Is this a new episode or recurrent/chronic pattern? 2
Clinical Pitfalls to Avoid
Don't miss that anxiety may present as "concerns" or "fears" rather than classic anxiety symptoms - patients may describe excessive worry about recurrence, multiple symptoms, or areas unrelated to their presenting problem 2, 1, 2
Don't overlook substance-induced anxiety - systematically ask about psychoactive substance use and withdrawal 3
Don't assume cancer-related worry is normal - in GAD, the worry is disproportionate to actual risk and extends beyond the medical situation 2, 1
Action Based on Severity
Mild (GAD-7: 0-4): Supportive care, education, active monitoring 2
Moderate (GAD-7: 5-9): Consider low-intensity interventions (self-help, group therapy), evaluate for pharmacotherapy 2
Moderate-severe to severe (GAD-7: 10-21): Refer for diagnostic assessment to confirm anxiety disorder diagnosis before initiating treatment; consider individual psychotherapy and/or pharmacotherapy 2, 1