Challenges and Opportunities in Diagnosis and Management of Generalized Anxiety Disorder in Primary Care

Abstract

It is known that General Anxiety Disorder (GAD), falling into the category of anxiety disorders with symptoms of anxiety, worry and apparent alertness, displays a fairly constant prevalence in the general population. Its lifelong prevalence in the general population is 5% according to the criteria of DSM and 6.5% according to broader criteria of ICD-10. Among anxiety disorders, GAD patients often consult primary care physicians (PCPs) for their treatment. An international study conducted by the World Health Organization (WHO) found the frequency of GAD in primary health care at 14.9%, 3.7% and 0.9% in Greece, Italy and Turkey respectively. Despite these different figures among countries which are thought to emerge from structural differences of primary health care services, it was found out that the point prevalence of GAD in primary care was much higher (7.9%) than that of the general population. Through reanalysis of WHO's data, it was also shown that 25% of these patients have pure GAD without any comorbidity. In light of this data, it can be concluded that GAD is the most frequent mental disorder after depression in primary care, and that patients favour primary health care services for their treatment. The comorbidity of GAD patients with other psychiatric disorders brings about an increase in the frequency of the health care system use, with longer periods of hospitalization, more frequent use of diagnostic tests and medication, and therefore, a heavy financial burden. This, in turn, implies more serious family problems and prolonged absence from work. There is abundant evidence showing that GAD decreases the quality of life considerably due to invalidity and disability. It is reported that patients complain of physical symptoms more often than psychological, and worry is cited as the main problem for only 13% of GAD patients in primary care. The patients with GAD mostly consult primary care for aches, sleep problems and somatic problems. Somatic complaints of patients usually appear in the form of chronic medical conditions such as chest pain, chronic fatigue syndrome, irritable bowel syndrome and hypertension, diabetes and cardiac diseases. This is an important factor that complicates the accurate diagnosis of patients and also delays their treatment. The period between the time when the first symptoms of GAD appear and the time of the patient's consultation with the family physician or its equivalent can last for up to one year. Furthermore, it can take as