232 Anxiety Disorders
a substance, or exposure to a toxin, a su bstance/medication-induced anxiety disorder
should be considered. Certain medications are known to increase anxiety (e.g., corticoste-
roids, estrogens, metoclopramide), and when this is the case, the medication may be the
most likely etiology, although it may be difficult to distinguish whether the anxiety is at-
tributable to the medications or to the medica l illness itself. When a diagnosis of substance-
induced anxiety is being made in relation to recreational or nonprescribed drugs, it may be
useful to obtain a urine or blood drug screen  or other appropriate laboratory evaluation.
Symptoms that occur during or shortly after (i.e., within 4 weeks of) substance intoxication
or withdrawal or after medication use may be  especially indicative of a substance/medi-
cation-induced anxiety disorder, depending on  the type, duration, or amount of the sub-
stance used. If the disturbance is associate d with both another medical condition and
substance use, both diagnoses (i.e., anxiety disorder due to anothe r medical condition and
substance/medication-induced an xiety disorder) can be given. Features such as onset af-
ter age 45 years or the presence of atypical symptoms during a panic attack (e.g., vertigo,
loss of consciousness, loss of bladder or bowe l control, slurred speech, amnesia) suggest
the possibility that another medical condition or  a substance may be causing the panic at-
tack symptoms.
Anxiety disorder (not due to a known medical condition). Anxiety disorder due to an-
other medical condition should be distinguis hed from other anxiety disorders (especially
panic disorder and generalized anxiety disorder). In other anxiety disorders, no specific
and direct causative physiological mechanisms  associated with anot her medical condition