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Improving recognition of generalised anxiety disorder.

Generalised anxiety disorder (GAD) has a point prevalence of 4.4% among the adult population in England. It is characterised by a persistent, unfocused sense of threat, associated with symptoms of tension, autonomic hyperactivity and vigilance. It is a chronic relapsing condition, with a remission rate of 38% after five years. Most patients are not recognised in primary care and only a third of those identified by the 2007 household survey in England were receiving treatment. GAD is frequently comorbid with other mental health conditions; it is often difficult to establish a reliable diagnosis. Patients with GAD seldom complain of feeling overanxious and worrying excessively. GPs should be alert to the possibility of GAD when patients express frequent concerns about their health or other matters. NICE recommends a stepped care approach to treatment. The first step is to explain the nature of GAD and discuss treatment options. GPs should then offer one of the following: non-facilitated self-help, guided self-help or psychoeducation group participation. If patients have marked functional impairment or if low-intensity interventions have proved ineffective, a choice of. individual CBT or applied relaxation, or drug treatment (SSRIs) should be offered. Patients should be referred if there is: an inadequate response to high-intensity interventions or drug therapy, severe anxiety with marked functional impairment or a high risk of self-harm or suicide.