Generalized Anxiety Disorder (GAD)

Anxiety disorders are the most prevalent of all psychiatric disorders, with generalized anxiety disorder (GAD) being the most common seen in primary care. Nearly 8% of patients consulting a primary care provider have GAD according to the World Health Organization (WHO). Despite this, it is a diagnosis that can easily be missed. The good news is this condition is responsive to treatment. Patients with GAD are generally managed in the primary care setting, and a range of pharmacologic and nonpharmacologic treatment options are available.

Generalized anxiety disorder (GAD) is characterized by excessive, uncontrollable and often irrational worry, that is, apprehensive expectation about events or activities. This excessive worry often interferes with daily functioning, as individuals with GAD typically anticipate disaster, and are overly concerned about everyday matters such as health issues, money, death, family problems, friendship problems, interpersonal relationship problems, or work difficulties

The main diagnostic criteria of GAD are excessive anxiety and worry that is difficult to control, along with at least 3 from a list of 6 symptoms: restlessness, irritability, difficulty concentrating, muscle tension, sleep disturbances, and being easily fatigued and duration of the disorder for at least 6 months.  Symptoms must be distressing or impairing and not adequately explained by another related disorder.

Screening for GAD can potentially be helpful in improving detection rates in primary care, which can lead to more appropriate treatment and improved patient outcomes. GAD-7 was developed to facilitate the diagnosis. The scale has been shown to be an efficient tool that can screen for likely cases of GAD and can assess symptom severity and assist with the clinical assessment and treatment of GAD.  A link to the assessment tool is included.

The main treatment approaches for GAD include pharmacotherapy or psychotherapy or a combination of both. The often chronic and disabling nature of GAD means that some individuals may fail to respond fully to first-line treatment. Patients may therefore require a sequential trial of treatments.  Psychological therapies are an important first-line option in the management of GAD.

The treatment plan for GAD should account for (1) predominant symptoms, (2) severity of the condition, (3) presence of concomitant medical illness, (4) complications such as substance abuse or the risk of suicide, (5) outcomes of any previous treatments, (6) cost issues, (7) availability of treatment in a given area, and (8) patient preferences.

There are various options for medication management of GAD. Next week’s newsletter will focus on this topic.

GAD is frequently associated with other psychiatric conditions such as other mood or anxiety disorders, somatoform/pain disorders, medically unexplained symptoms, and substance use disorders.  It has also been linked with medical disorders such as heart disease, GI and chronic pain disorders.

Effective management of GAD has the potential to improve quality of life for patients and their families, as well as improve patient productivity and reduce the impact of the condition on health care resources.  The use of appropriate screening tools and providing information to patients with GAD on their condition and its treatment are an important starting point toward increasing recognition and appropriate treatment of GAD.


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