Pre-existing Medical Conditions
There is a variety of pre-existing medical conditions that may cause anxiety in MRI patients. The one with which most technologists may already be familiar the thyroid disorders hypothyroidism and hyperthyroidism, which are both linked with anxiety and mood swings74.Hyperthyroidism is caused by an overproduction of the thyroid hormones thyroxine and triiodothyronine, has also been linked to panic attacks and can be caused by a variety of medical conditions, e.g., Graves’ disease, a common immune disorder75,76. Hypothyroidism is caused by the underproduction of the same thyroid hormones that cause hyperthyroidism although its symptoms are usually associated with fatigue and depression; it can also cause anxiety and is commonly experienced in conjunction with depression77. It should be noted that two hormones work together to regulate the thyroid: thyrotropin-releasing hormone (TRH) produced by the hypothalamus and thyroid-stimulating hormone (TSH) produced by the anterior pituitary gland. Consequently, when you are performing a pituitary MRI, these patients may be more likely to experience anxiety78.
Hint: Patients scheduled for a pituitary MRI exam may be more likely to experience anxiety.
People with heart diseases, such as coronary artery disease (CAD), and those who have experience an acute cardiac syndrome (ACS), event such as a heart attack may also experience anxiety. A study showed that 20–30% of people who have had a heart attack have anxiety due to having had a near-death experience79. Other heart diseases that may cause patient anxiety include heart failure, ranging from 13% to 20% depending on disease progression79. Those with advanced heart failure who require a pacemaker are the most susceptible to anxiety and technologists who perform MRIs on patients with pacemakers should take this into consideration as it is possible that not only is the MRI causing anxiety, but the fact that they have a pacemaker may be adding to their anxiety.
Hint: Cardiac MRI patients and those with pacemakers may experience more anxiety.
Most technologists have seen the question “Are you a diabetic?” on the MRI screening questionnaire. If you are like me, then you might assume the patient may have kidney issues, thus requiring a blood test to determine their glomerular filtration rate (GFR) before being able to administer a contrast agent. Or, better yet, the possibility of them having a low blood sugar or glucose event and knowing where the orange juice is located. It never occurred to me that diabetes causes anxiety, yet studies have linked diabetes with anxiety80. The possible reasons range from the stress of managing this disease to physiological causes such as glucose levels. Regardless the reasons, having knowledge of the additional implications of diabetes is helpful.
Respiratory diseases, such as asthma, emphysema, and chronic obstruction pulmonary disease (COPD), all have a common symptom: shortness of breath. Shortness of breath, or dyspnea, is the leading cause of anxiety among people who suffer from respiratory diseases, which can then cause a panic attack81.
Irritable bowel syndrome (IBS) is a digestive disorder with symptoms such as stomach pain, dizziness, and insomnia82. Over 60% of people who suffer from IBS also suffer from some form of mental disorder with generalized anxiety disorder being the leading condition82. The exact reasons why anxiety and IBS are linked have not been determined but the link is undeniable, making this pre-existing condition one we as technologists should know.
Lastly, drug and alcohol use, abuse, and withdrawal can cause anxiety. There have been occasions when setting up a patient for their exam that I’ve asked them if there was anything else I could get them to make them more comfortable. Their reply would be “Yes, how about a drink to help me calm down?” While that may seem like a good way to get them to relax (and it initially does relax them as it increases the level of the relaxation response neurotransmitter GABA), it eventually does just the opposite once the alcohol wears off and can induce a panic attack83,84. Although the exact number of patients who use alcohol to help them relax is unknown, about 7% of Americans suffer from alcohol-related anxiety83. When it comes to anxiety, patients may employ a variety of self-medicating techniques to get through an MRI exam. Therefore, if you smell alcohol on a patient while getting them ready for an exam, then it may be because they had a drink to calm down or they are alcoholic and may experience more anxiety if they had not drunk. The reason alcohol use and withdrawal causes anxiety is that it reduces the level of serotonin and affects the levels other neurotransmitters in the body associated with anxiety83.
Hint: If alcoholism is listed on a patient’s diagnosis list, then they may suffer from anxiety.
Illicit drug use and abuse has been linked to causing anxiety and panic attacks85. In many American states, marijuana is not considered an illicit drug and is probably the second most consumed drug in America, and therefore is worth mentioning. Although marijuana has not been linked to causing anxiety, it can exacerbate underlying anxiety issues depending on the strain consumed and can cause symptoms similar to panic attacks85. Drugs that suppress the central nervous system or “downers,” such as alprazolam (Xanax) and lorazepam (Ativan), are considered the “big guns” when prescribed to patients with severe MRI anxiety. While they are very effective in helping patients relax (sometimes a bit too much in my opinion as I’ve had drooling patients on these drugs and unable to follow simple commands), when abused and/or the patient has withdrawal symptoms, they can cause panic attacks and anxiety. Stimulants, such as cocaine, methamphetamines, mephedrone or bath salts, and MDMA or ecstasy, increase the uptake of serotonin and eventually lowering this mood-enhancing neurotransmitter along with others, and may cause anxiety and/or panic attacks85.