Managing Anxiety in Practice: Focus on Generalized Anxiety Disorder

MEETING REPORT

Managing Anxiety in Practice: Focus on Generalized Anxiety Disorder

Henk Parmentier

Affiliation: General Practitioner, Croydon, South London, United Kingdom


ABSTRACT

Generalized Anxiety Disorder (GAD) is the second most common anxiety disorder (after phobias) with a lifetime prevalence of approximately 5–10% and a point prevalence in the general population of approximately 2%, depending on gender. Despite its prevalence, only one‐third of patients with GAD are diagnosed by their primary care physician even though they are frequent attenders of primary care clinics. Patients with GAD constitute a diagnostic challenge because they often present with disturbed sleep or medically unexplained symptoms such as pain rather than with anxiety per se. GAD is usually comorbid with other disorders, particularly other psychiatric disorders, and with medical disorders, which presents further diagnostic challenges. GAD itself is a risk factor for the development of subsequent Major Depressive Disorder and may also contribute to an increased risk of or poorer outcomes from medical disorders such as diabetes and cardiovascular disease. GAD exacts a substantial personal, societal and economic burden. Based on a thorough review of the evidence, the World Federation of Societies of Biological Psychiatry has recommended pregabalin, SSRIs and SNRIs as first‐line treatments for GAD. Benzodiazepines are reserved as a second‐line treatment for short‐term use due to concerns about the potential for abuse and dependence. Experts in the management of GAD regard it as an important psychiatric and public health problem that has been somewhat neglected and for which better physician education is needed.

Keywords: Generalised anxiety disorder, diagnosis, treatment
Correspondence: Henk Parmentier, MD, 53 Smitham Bottom Lane Purley, Surrey, CR8 3DF, United Kingdom, Email:
henk.parmentier@gmail.com