history control tooltip
divider handle tooltip
Generalised anxiety disorder
Short Text
Introduction
This pathway covers the management of GAD in adults in primary, secondary and community care.
GAD is a common disorder of which the central feature is excessive worry about a number of different events associated with heightened tension. It can exist in isolation but more commonly occurs with other anxiety and depressive disorders. The guideline covers both 'pure' GAD, in which no comorbidities are present, and GAD comorbid with other anxiety and depressive disorders in which GAD is the primary diagnosis.
GAD varies in severity and complexity, and can follow chronic or remitting courses. Where possible, the goal of an intervention should be complete relief of symptoms (remission), which is associated with better functioning and a lower likelihood of relapse.
Source guidance
The NICE guidance that was used to create the pathway.
Anxiety. NICE clinical guideline 113 (2011)
Quality standards
Quality statements
Effective interventions library
Successful effective interventions library details
Implementation
Commissioning
These resources include support for commissioners to plan for costs and savings of guidance implementation and meeting quality standards where they apply.
These resources will help to inform discussions with providers about the development of services and may include measurement and action planning tools.
Education and learning
NICE produces resources for individual practitioners, teams and those with a role in education to help improve and assess users' knowledge of relevant NICE guidance and its application in practice.
Service improvement and audit
These resources provide help with planning ahead for NICE guidance, understanding where you are now, and conducting improvement initiatives.
Pathway information
Information for the public
NICE produces information for the public that summarises, in plain English, the recommendations that NICE makes to healthcare and other professionals.
NICE has written information for the public explaining its guidance on generalised anxiety disorder and panic disorder in adults.
NICE has also produced a Guide to self-help resources for generalised anxiety disorder for people with generalised anxiety disorder, their families and carers.
Patient-centred care
Patients and healthcare professionals have rights and responsibilities as set out in the NHS Constitution for England – all NICE guidance is written to reflect these. Treatment and care should take into account individual needs and preferences. People should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals. If someone does not have the capacity to make decisions, healthcare professionals should follow the Department of Health's advice on consent, the code of practice that accompanies the Mental Capacity Act and the supplementary code of practice on deprivation of liberty safeguards. In Wales, healthcare professionals should follow advice on consent from the Welsh Government.
If the person is under 16, healthcare professionals should follow the guidelines in Seeking consent: working with children. If a young person is moving between paediatric and adult services their care should be planned and managed according to the best practice guidance described in the Department of Health's Transition: getting it right for young people.
Updates to this pathway
12 February 2013 Minor maintenance updates
Supporting information
Glossary
Cognitive behavioural therapy
Generalised anxiety disorder
A self-administered intervention intended to treat GAD involving written or electronic self-help materials (usually a book or workbook). It is similar to individual guided self-help but usually with minimal therapist contact, for example an occasional short telephone call of no more than 5 minutes.
Non-steroidal anti-inflammatory drugs
Serotonin–noradrenaline reuptake inhibitor
Selective serotonin reuptake inhibitor
All known and suspected presentations of GAD
All known and suspected presentations of GAD
Identification
Identification
Identification
Identify and communicate the diagnosis of GAD as early as possible to help people understand the disorder and start effective treatment promptly.
Consider the diagnosis of GAD in people presenting with anxiety or significant worry, and in people who attend primary care frequently who:
- have a chronic physical health problem or
- do not have a physical health problem but are seeking reassurance about somatic symptoms (particularly older people and people from minority ethnic groups) or
- are repeatedly worrying about a wide range of different issues.
For people seeking reassurance about a chronic physical health problem or somatic symptoms and/or repeated worrying, consider with them whether some of their symptoms may be due to GAD.
Source guidance
Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/source-guidance-nodeAssessment
Assessment
Assessment
Conduct a comprehensive assessment that does not rely solely on the number, severity and duration of symptoms, but also considers the degree of distress and functional impairment.
Consider how the following factors might have affected the development, course and severity of the person's GAD:
- any comorbid depressive disorder or other anxiety disorder
- any comorbid substance misuse
- any comorbid medical condition
- a history of mental health disorders
- past experience of, and response to, treatments.
People with GAD and a comorbid depressive or other anxiety disorder
Treat the primary disorder first (that is, the one that is more severe and in which it is more likely that treatment will improve overall functioning).
People with GAD who misuse substances
Be aware that:
- substance misuse can be a complication of GAD
- non-harmful substance use should not be a contraindication to the treatment of GAD
- harmful and dependent substance misuse should be treated first as this may lead to significant improvement in the symptoms of GAD.
Source guidance
Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/source-guidance-nodeEducation and active monitoring
Education and active monitoring
Education and active monitoring
Provide the person with education about the nature of GAD and the options for treatment, including information for the public on Treating generalised anxiety disorder and panic disorder in adults. (The guide to self-help resource for generalised anxiety disorder for people with GAD, their families and carers may also be helpful.)
Actively monitor the person's symptoms and functioning.
Discuss the use of over-the-counter medications and preparations, and explain the potential for interactions with other prescribed and over-the-counter medications and the lack of evidence to support their safe use.
Source guidance
Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/source-guidance-nodeStep 2: Diagnosed GAD that has not improved after step 1 interventions
View the 'Step 2: Diagnosed GAD that has not improved after step 1 interventions' pathPaths in this pathway
- Step 1: All known and suspected presentations of GAD
- Step 2: Diagnosed GAD that has not improved after step 1 interventions
- Step 3: GAD with marked functional impairment or that has not improved after step 2 interventions
Pathway created: March 2012 Last updated: February 2013
Copyright © 2013 National Institute for Health and Care Excellence. All Rights Reserved.