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Acute procedure anxiety in adults: Course, screening, assessment, and differential diagnosis

Yujuan Choy, MD
Section Editor
Murray B Stein, MD, MPH
Deputy Editor
Richard Hermann, MD


Acute procedure anxiety is an excessive fear of medical, dental, or surgical procedures that results in acute distress or interference with completing necessary procedures. Patients may experience anxiety in anticipation of and/or during many types of procedures, including for screening (eg, mammography), diagnosis (eg, amniocentesis or endoscopy), and treatment (eg, angioplasty or open heart surgery).

Specific phobias are a subset of the varied manifestations of acute procedure anxiety, diagnosed under DSM-5 criteria only when the patient’s fears are specific to the procedure and its immediate effects (eg, fear of suffocation during an MRI) rather than fears not specific to the procedure itself (eg, a fear of the underlying illness that might be diagnosed). Specific phobias related to clinical procedures include blood-injection-injury phobia, dental phobia, and MRI claustrophobia.

This topic addresses the course, screening, assessment, and differential diagnosis of acute procedure anxiety in adults, related to common medical and surgical procedures. The topic includes specific phobias with anxiety related to clinical care. Specific phobias unrelated to clinical care are discussed separately. The epidemiology, clinical manifestations, and treatment of acute procedure anxiety are also discussed separately. (See "Specific phobia in adults: Epidemiology, clinical manifestations, course and diagnosis" and "Psychotherapy for specific phobia in adults" and "Pharmacotherapy for specific phobia in adults" and "Acute procedure anxiety in adults: Epidemiology and clinical presentation" and "Treatment of acute procedure anxiety in adults".)


In most cases of acute procedure anxiety, the anxiety tends to peak prior to the procedure and decrease immediately after the procedure. This pattern has been observed in short, prospective studies of sigmoidoscopy screening for colorectal cancer [1], colposcopy [2], neurosurgery/brain biopsy [3], percutaneous coronary intervention (PTCA) [4], and cardiac surgery [5,6]. However, a study of PTCA that followed patients for a longer period of time after PCTA found anxiety level to be equally high six to eight months post-procedure [7].

The course of specific phobia is discussed separately. (See "Specific phobia in adults: Epidemiology, clinical manifestations, course and diagnosis", section on 'Course'.)


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Literature review current through: Sep 2016. | This topic last updated: Nov 5, 2015.
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  1. Simon AE, Steptoe A, Wardle J. Socioeconomic status differences in coping with a stressful medical procedure. Psychosom Med 2005; 67:270.
  2. Byrom J, Clarke T, Neale J, et al. Can pre-colposcopy sessions reduce anxiety at the time of colposcopy? A prospective randomised study. J Obstet Gynaecol 2002; 22:415.
  3. Pringle AM, Taylor R, Whittle IR. Anxiety and depression in patients with an intracranial neoplasm before and after tumour surgery. Br J Neurosurg 1999; 13:46.
  4. Trotter R, Gallagher R, Donoghue J. Anxiety in patients undergoing percutaneous coronary interventions. Heart Lung 2011; 40:185.
  5. Vingerhoets G. Perioperative anxiety and depression in open-heart surgery. Psychosomatics 1998; 39:30.
  6. Guo P, East L, Arthur A. A preoperative education intervention to reduce anxiety and improve recovery among Chinese cardiac patients: a randomized controlled trial. Int J Nurs Stud 2012; 49:129.
  7. Astin F, Jones K, Thompson DR. Prevalence and patterns of anxiety and depression in patients undergoing elective percutaneous transluminal coronary angioplasty. Heart Lung 2005; 34:393.
  8. Ronis DL, Hansen CH, Antonakos CL. Equivalence of the original and revised dental anxiety scales. J Dent Hyg 1995; 69:270.
  9. Radomsky AS, Rachman S, Thordarson DS, et al. The Claustrophobia Questionnaire. J Anxiety Disord 2001; 15:287.
  10. McIsaac HK, Thordarson DS, Shafran R, et al. Claustrophobia and the magnetic resonance imaging procedure. J Behav Med 1998; 21:255.
  11. Moerman N, van Dam FS, Muller MJ, Oosting H. The Amsterdam Preoperative Anxiety and Information Scale (APAIS). Anesth Analg 1996; 82:445.
  12. Boker A, Brownell L, Donen N. The Amsterdam preoperative anxiety and information scale provides a simple and reliable measure of preoperative anxiety. Can J Anaesth 2002; 49:792.
  13. Nishimori M, Moerman N, Fukuhara S, et al. Translation and validation of the Amsterdam preoperative anxiety and information scale (APAIS) for use in Japan. Qual Life Res 2002; 11:361.
  14. Berth H, Petrowski K, Balck F. The Amsterdam Preoperative Anxiety and Information Scale (APAIS) - the first trial of a German version. Psychosoc Med 2007; 4:Doc01.
  15. Maurice-Szamburski A, Loundou A, Capdevila X, et al. Validation of the French version of the Amsterdam preoperative anxiety and information scale (APAIS). Health Qual Life Outcomes 2013; 11:166.
  16. Mohd Fahmi Z, Lai LL, Loh PS. Validation of the Malay version of the Amsterdam Preoperative Anxiety and Information Scale (APAIS). Med J Malaysia 2015; 70:243.
  17. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington 2013.
  18. Reddy DM, Wasserman SA. Patient anxiety during gynecologic examinations. Behavioral indicators. J Reprod Med 1997; 42:631.
  19. Bölükbaş N, Erbil N, Kahraman AN. Determination of the anxiety level of women who present for mammography. Asian Pac J Cancer Prev 2010; 11:495.
  20. Carlsson S, Aus G, Wessman C, Hugosson J. Anxiety associated with prostate cancer screening with special reference to men with a positive screening test (elevated PSA) - Results from a prospective, population-based, randomised study. Eur J Cancer 2007; 43:2109.
  21. Mitsonis CI, Mitropoulos PA, Dimopoulos NP, et al. Anxiety and depression in cataract surgery: a pilot study in the elderly. Psychol Rep 2006; 99:257.
  22. Lenzen MJ, Gamel CJ, Immink AW. Anxiety and well-being in first-time coronary angioplasty patients and repeaters. Eur J Cardiovasc Nurs 2002; 1:195.
  23. Lenk M, Berth H, Joraschky P, et al. Fear of dental treatment--an underrecognized symptom in people with impaired mental health. Dtsch Arztebl Int 2013; 110:517.