Assessing anxiety in palliative care

Anxiety is characterised by feelings of apprehension, fear and dread, and can manifest as physical symptoms (eg palpitations, nausea, dizziness, breathlessness, tremulousness, sweating, diarrhoea). Anxiety may be episodic, situational, intermittent or continuous, and ranges in severity from mild disquiet to severe disabling states.

Anxiety is common in patients with palliative care needs. Patients face many challenges, which can contribute to new-onset anxiety or exacerbate pre-existing symptoms; this can result in severe distress. Pre-existing anxiety disorders may not have been formally diagnosed but patients may indicate that they have always been ‘a worrier’ or ‘highly strung’. Anxiety can also be the main presentation of medical conditions, drug withdrawal or toxicity (including toxidromes), or disorders of substance use.

A variety of anxiety disorders with specific diagnostic criteria exist, requiring detailed assessment to target treatment. The Psychotropic guidelines provide advice on assessing anxiety. Assessment includes considering differential diagnoses and comorbid conditions (eg depression, suicidal ideation).