One of the most prevalent anxiety conditions seen in primary care is generalized anxiety disorder (GAD). Numerous physical ailments frequently accompany the psychic symptoms of anxiety, which often drive patients to ask for help. In spite of the high incidence of GAD, only 30% of sufferers are diagnosed. Furthermore, very few patients are prescribed medication or referred to a psychiatrist. The key aim is to ensure the early detection and management of these patients. Developing physician education programs may improve the identification of GAD. The use of simple diagnostic tools would also aid the early detection of sufferers. Physicians require more long-term data, including that on the influence of ethnicity and genetics, to assist them to better understand and more effectively manage GAD. By achieving early diagnosis and treatment of GAD, physicians can ensure that a lesser burden is inflicted upon sufferers, thus improving their quality of life.
Anxiety disorders are considered to be the most prevalent of psychiatric disorders, with generalized anxiety disorder (GAD) believed to be one of the most common in the primary care setting (Wittchen et al., 2002). Indeed, GAD is present in nearly one-quarter of patients complaining of an anxiety condition to their primary care physician (PCP) (Wittchen et al., 2002). Regardless of this, many challenges in recognizing and treating GAD patients remain, most especially in primary care. In fact patients suffering with this anxiety disorder are as likely to initially seek out their PCP, than a psychiatrist, for the treatment of numerous associated somatic ailments, such as joint pain, weariness, or weight loss (Shear and Schulberg, 1995). Patients with an anxiety disorder are also more likely than other patient groups to make frequent medical appointments, undergo extensive medical investigations (Katon et al., 1992), present with medical and psychiatric comorbidities (Bowen et al., 2000, Noyes, 2001 and Harter et al., 2003), report poor health, smoke cigarettes, and abuse other substances (Shader and Greenblatt, 1993). Physicians are also missing much of the clinical study data required to make a valid diagnosis of GAD, although a similar situation exists for many of the other mood and anxiety disorders. The name of the disorder may also be misleading—the focus of the condition is the cognitive dysfunction, which Karl Rickels eloquently refers to as an “intolerance of uncertainty.” Perhaps an alternative name would more appropriately emphasize the specific symptoms associated with the disorder. All of these factors, to different degrees, compound the difficulty of the physician's task—that of assuring an accurate diagnosis (Stein, 2001).
GAD was first classified as a distinct disorder relatively recently, in 1980 (American Psychiatric Association, 1980). Previously little distinction was made between GAD and panic disorder (PD)—they were conceptualized as the core components of anxiety neurosis. The realization that GAD and PD are sufficiently different to be considered independently led to their separation in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) ( American Psychiatric Association, 1994). Having evolved from a residual syndrome with several nonspecific features into a more precisely defined condition, GAD is characterized by continual worry and tension about daily life events that are pervasive and uncontrollable, rather than by specific fears. GAD is notable by the duration (≥ 6 months), incidence, and the intensity of apprehension concerning an event being far out of proportion to the actual probability or impact of the experience ( Sanderson and Barlow, 1990, Allgulander, 2001 and Kessler et al., 2001a). The impairment should also be judged as not attributable to medication, another illness, or substance abuse. Further details of the DSM-IV criteria for the diagnosis of GAD are detailed in Table 1. The condition is accompanied by psychic symptoms such as restlessness, poor concentration, or irritability, and somatic symptoms including fatigue, muscle tension, and sleep difficulties ( Allgulander et al., 2003). Indeed, in the PCP's office, this constellation of symptoms can look like the symptoms of numerous other medical conditions. Unfortunately, with only limited time to examine for additional symptoms and minimal acquaintance with psychiatric diagnoses, the PCP will often treat the presenting symptom, but miss the comprehensive diagnosis.
