Acute procedure anxiety in adults: Course, screening, assessment, and differential diagnosis
- Yujuan Choy, MD
Yujuan Choy, MD
- Assistant Clinical Professor of Psychiatry (volunteer faculty)
- University of California, Irvine
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 procedural 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 , colposcopy , neurosurgery/brain biopsy , percutaneous coronary intervention (PTCA) , 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 .
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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- Dental anxiety
- MRI claustrophobia
- Anaesthesia and surgical procedures
- Focus of fear and anxiety
- Understanding of procedure
- Past experience with procedure
- History of acute procedure anxiety
- History of specific fears
- Comorbid anxiety disorders
- Differential diagnosis
- - Generalized anxiety disorder
- - Agoraphobia
- - Panic disorder
- - Adjustment disorder with anxious mood
- - General medical conditions
- SUMMARY AND RECOMMENDATIONS