A year after the National Institute for Health & Clinical Excellence (NICE) issued guidance on the management of Generalised Anxiety Disorder (GAD) highlighting that the condition was under-treated and under-detected, a new survey shows that GPs believe that this is still the case.

Results from the survey of 308 GPs commissioned by Pfizer show that GAD continues to be a challenge, with over a third of GPs (38%) admitting they are either somewhat, or not that confident, in diagnosing GAD.1c Furthermore only 49% of GPs feel comfortable distinguishing GAD from other mental health disorders. This is despite the condition being one of the most common psychiatric disorders seen in primary care, affecting approximately 1 in 20 adults in Britain.

In follow up research involving 135 GPs, nearly three quarters (72%) of those surveyed believe GAD is under diagnosed. These findings reflect NICE guidance, issued last year, which states that GP rates of diagnosis and treatment of anxiety disorders are much lower than expected from the prevalence figures, showing there is still a need for improvement.

Dr Henk Parmentier, a GP from South London with a special interest in GAD, commented: “Although common and treatable, GAD can be extremely challenging to diagnose as it manifests in a complex combination of psychological and physical symptoms, in addition to frequent comorbid conditions and so patients rarely present with pure anxiety.”

Patients suffering from GAD can present with a variety of debilitating symptoms. Those of a mental and behavioural nature can include uncontrollable worry, difficulty sleeping and excessive irritability. Physical symptoms may consist of stomach cramps, pain and muscle tension. However, it appears the whole symptom picture is not being relayed to healthcare professionals, with the majority of GAD patients still being diagnosed incorrectly or far too late.

Dr Parmentier added: “There continues to be a stigma associated with mental health conditions such as GAD so many patients emphasise what they perceive to be more ‘credible’ problems, such as somatic symptoms or sleep disorder and fail to mention the debilitating worry that could be the trigger for a correct diagnosis. A patient’s cultural background will also influence the metaphors they choose to describe psychological distress and their mood state. GAD rarely improves by itself and becomes a chronic disabling  condition and so this communication breakdown between patients and their doctors could delay diagnosis and prevent patients getting the help they need.”

NICE guidance helps GPs with a stepped care approach recognising GAD even in patients presenting with a chronic physical health problem. As a first step, NICE propose the following for GPs to consider to aid 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

According to NICE guidance on managing GAD, the goal of intervention should be complete relief of symptoms (remission), which is associated with better functioning and a lower likelihood of relapse, which is a significant concern for this patient population.

The guidance advocates early recognition6c and long-term strategies for managing GAD that establish a clear collaborative treatment plan between the GP and the person with GAD, in addition to a stepwise treatment approach starting with psychological interventions and progressing to drug therapies, where necessary.

January 2011

About the survey

The online survey of 308 GPs from across the UK was conducted in November 2011 by independent research organisation, ICM Direct on behalf of Pfizer. The additional survey of 135 GPs from across the UK was conducted in November 2011 by independent research organisation, ICM Direct on behalf of Pfizer, to determine whether GPs believed diagnosis rates of GAD were low.

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