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New NICE guidance on the treatment of generalised anxiety disorder (GAD) and panic disorder (with or without agoraphobia)

In January, the National Institute for Health and Clinical Excellence (NICE) published their new evidence-based clinical guideline on the care and treatment of adults with generalised anxiety disorder (GAD) or panic disorder (with or without agoraphobia).  This guideline updates and replaces their 2004 one (which was itself amended in 2007).  The full 56 page guideline is available as a PDF and in Word format.  It also comes as a 24 page "Quick reference guide" for health professionals, and as a 16 page "Treating generalised anxiety disorder and panic disorder in adults" overview for the general public.  There are a number of other linked documents, including several to help service providers implement these recommendations.  A summary of the on-line resources that are available to help service users with generalised anxiety disorder is due to be made available in March.  

An earlier international consensus statement suggested that it is worth investigating a possible GAD diagnosis if someone answers yes to either of two initial screening questions: 1.) During the past four weeks, have you been bothered by feeling worried, tense, or anxious most of the time?  2.) Are you frequently tense, irritable, and having trouble sleeping?  If I suspect GAD, I often use the GADQ, a simple questionnaire for making a full diagnosis.  As the linked article in the British Medical Journal points out "Generalised anxiety disorder affects about 4.4% of the adult population in England. It is characterised by worry and apprehension. Worries are typically widespread, involving everyday issues and a shifting focus of concern; a person with this disorder finds it difficult to control their worries. Like other anxiety disorders, it is often chronic if untreated, and it is associated with substantial disability equivalent to other chronic physical health problems such as arthritis and diabetes. People with generalised anxiety disorder have high levels of service use (visits to general practitioners and hospital), a consequence of somatic symptoms and worries commonly associated with the disorder and because it commonly coexists with chronic physical health problems. This article summarises the most recent recommendations from the partially updated guideline from the National Institute for Health and Clinical Excellence (NICE) on generalised anxiety disorder and panic disorder (with or without agoraphobia) in adults. Only recommendations for the management of generalised anxiety disorder have been updated ... ".

As one might expect, treatment advice for both GAD and for panic disorder is to follow a stepped care pathway, starting with simple self-help and guided self-help interventions and moving, if needed, to more therapist-intensive strategies.  These latter could involve either psychological or pharmacological interventions (or both in more difficult cases).  Remembering an earlier blog post I wrote - "Generalized anxiety disorder: should applied relaxation be the first line treatment?" - it's interesting to see NICE stating that, when more intensive psychological approaches for GAD are indicated, either applied relaxation or CBT are appropriate interventions.  See both the 24 page "Quick reference guide" for health professionals and the 16 page "Treating generalised anxiety disorder and panic disorder in adults" overview for the general public for fuller details of the recommended stepped care approach in both GAD and in panic disorder.  For various relevant assessement questionnaires and other handouts, see further pages on this website - "GAD and health anxiety" , and "Panic, OCD & depersonalization information & assessment".   

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