Generalised anxiety disorder: Updated guidance

26^th January 2011 - Guidance on managing generalised anxiety disorder (GAD) in adults is being updated for the first time since 2004.

GAD is a common condition with chronic, excessive worry about a number of different events associated with heightened tension. It can vary in its severity and complexity for each person. The National Institute for Health and Clinical Excellence (NICE) says it is important to consider how each patient should be treated individually.

In a statement, Christine Carson, Programme Director for the Centre for Clinical Practice at NICE, says: “Since NICE published guidance on the condition in December 2004, new evidence has emerged about how to manage GAD in adults. Therefore this particular section of the guideline was prioritised for updating. The new recommendations include health professionals considering a diagnosis of GAD in patients presenting with anxiety or significant worry, and in those frequently attending primary care who have a chronic physical health problem, or do not have a physical health problem but are seeking re-assurance about somatic symptoms or are repeatedly worrying about a range of different issues.”

Updated recommendations include:

• Recognition and communication of the diagnosis of GAD should occur as early as possible to help people understand the disorder and start effective treatment promptly
• People with GAD, whose symptoms do not improve with education and active monitoring, should be offered one or more of the following as a first-line intervention, guided by the person’s preference: individual non-facilitated self-help, individual guided self-help or psycho-educational groups
• Patients should not be offered an antipsychotic for the treatment of GAD in primary care
• People with GAD with marked functional impairment or those whose symptoms have not adequately responded to low-intensity psychological interventions such as pure self-help, guided self-help and psycho-educational groups should be offered an individual high-intensity psychological intervention or a pharmacological intervention

An under-recognised condition

Dr Tim Kendall, Director of the National Collaborating Centre for Mental Health, Medical Director and Consultant Psychiatrist, Sheffield Health and Social Care NHS Foundation Trust says: “Generalised anxiety disorder is a very common but under-recognised condition characterised by endless worrying, which results in substantial disability for many sufferers, affecting their capacity to work and to live fulfilled and meaningful lives. Many develop secondary disorders, such as panic and depression, and it’s much more common in people with chronic physical ill-health.”

He continued, “People with GAD will be able to choose from a range of self help interventions, including two psychological treatments and some antidepressants. The guideline emphasises choice and patient preference, and is much clearer that there are some old treatments that just don’t work. This is a really excellent and new piece of work produced with some of our top national clinical experts and really committed service users.”