Generalized Anxiety Disorder

Posted on Apr 1, 2015 in Awards & Honors, Editorial, Illustration, what's new

Generalized Anxiety Disorder

This illustration was created for a May 2015 AFP article reviewing the diagnosis and management of GAD and PD in the primary care setting. While GAD and PD can develop among children and adolescents, diagnosis and care for these younger populations requires special considerations beyond the scope of this review.

Generalized anxiety disorder (GAD) and panic disorder (PD) are among the most common mental disorders in the United States. Frequently encountered by primary care physicians, both GAD and PD can negatively impact a patient’s quality of life and disrupt important activities of daily living. Evidence suggests that missed- and misdiagnosis of GAD and PD are high, with symptoms frequently ascribed to physical causes. The diagnosis of GAD and PD requires a broad differential and caution to identify confounding variables and co-morbid conditions. Screening and monitoring tools can be used to help make the diagnosis and monitor response to therapy. The GAD-7 and the Severity Measure for Panic Disorder are both available without cost. Successful outcomes may require a combination of treatment modalities tailored to the individual patient. Treatment frequently includes medications such as selective serotonin reuptake inhibitors (SSRIs) and/or psychotherapy, both of which are highly effective. Among psychotherapeutic treatments, cognitive behavioral therapy (CBT) has been studied widely and has an extensive evidence base. Benzodiazepines are effective in reducing symptoms of anxiety, but their use is limited by risk of abuse and side effect profiles. Physical activity can reduce symptoms for both GAD and PD. A number of complementary and alternative treatments are frequently used; however, evidence is limited for most. Several commonly used botanicals and supplements can potentiate serotonin syndrome when used in combination with antidepressants. Medication should be continued for 12 months to prevent relapse.

Caitlin2PRINTGeneralized anxiety disorder (GAD) and panic disorder (PD) are among the most common mental disorders in the United States (US). Frequently encountered by primary care physicians, the hallmark feature of GAD is excessive, out-of-control worries; for PD, it is recurrent and unexpected panic attacks. Both GAD and PD can negatively impact a patient’s quality of life and disrupt important activities of daily living. Missed- and misdiagnosis of GAD and PD are high, with symptoms frequently ascribed to physical causes.