Appendix A: Case Definitions for Neuropsychiatric Syndromes in Systemic Lupus Erythematosus
Anxiety Disorder
Anticipation of danger or misfortune accompanied by apprehension, dysphoria, or tension. Includes generalized anxiety, panic disorder, panic attacks, and obsessive-compulsive disorders.
NB: In most SLE patients, anxiety is a secondary stress reaction and not a direct manifestation of NPSLE.
Diagnostic criteria:
Both of the following:
A. Prominent anxiety, panic disorder, panic attacks, or obsessions or compulsions.
B Disturbance causes clinically significant distress or impaired social, occupational, or other important functioning.
Exclusions:
- Adjustment disorder with anxiety (e.g., maladaptive response to stress of having SLE
- Substance- or drug-induced anxiety
- Anxiety occurring exclusively during the course of an acute confusional state, a mood disorder, or psychosis
Associations:
- Metabolic disorders; e.g., hyperthyroidism, pheochromocytoma
- Marked psychosocial stress
- Corticosteroid use
Ascertainment:
- Standardized instruments, e.g., Hospital Anxiety and Depression Scale when indicated
- History from patients and/or others
Record:
- Basic descriptors
- Type of anxiety
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