Managing generalised anxiety disorder

Abstract

Anxiety heightens our awareness of potential threats and produces physiological and mental changes that help us tackle dangers. However, people with generalised anxiety disorder (GAD) are abnormally sensitive to potential threats, distorting their views about risks. Most people with GAD recognise that their fears are unrealistic, excessive and inappropriate. Nevertheless, GAD can still compromise work performance, relationships and leisure activities, and worsen outcomes for concurrent physical and psychological diseases. Typically, people with GAD do not seek help for anxiety—so nurses need to remain alert for the condition. Implementing the National Institute for Health and Care Excellence's (NICE) approach to GAD management can help improve screening, diagnosis and treatment. A range of evidence-based interventions is effective in the treatment of GAD, including cognitive behavioural therapy (CBT) or applied relaxation. NICE notes that ‘there is no evidence’ that individual high-intensity psychological intervention or drugs is more effective than the other approach. NICE suggests that sertaline should be the first-line drug for GAD followed by other antidepressants if this fails. NICE recommends benzodiazepines only for short-term treatment during crises. Pregabalin, which offers an alternative for people with GAD who cannot tolerate antidepressants, shows similar efficacy to other agents. Remaining alert for GAD's symptoms, offering tailored treatment and sympathetic follow-up and counselling can improve the prospects for people with this often-underestimated, under-recognised and under-treated condition.