Anxiety is a normal physiological response to a threat. Anxiety disorders occur when this normal physiological response is associated with high levels of autonomic arousal, erroneous cognitions and dysfunctional coping strategies. Anxiety disorders are highly prevalent and present commonly to general practice. Anxiety disorders are often comorbid with other psychiatric and medical disorders and may be associated with significant morbidity.
This article describes the diagnosis, assessment and management of anxiety disorders in the general practice setting.
Assessment in patients presenting with anxiety symptoms involves excluding a medical cause, identifying features of specific anxiety disorders as well as other coexisting psychiatric disorders, and assessing the degree of distress. Management options include psychoeducation, psychological treatments (particularly cognitive behaviour therapy) and pharmacological treatments. Patients with
a diagnosis of an anxiety disorder can access Medicare funded psychological care under a number of Australian government initiatives. Selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors are the first line pharmacological agents used to treat anxiety disorders. Regular review is vital to monitor for clinical improvement and more complex presentations may require specialist psychological or psychiatric referral.
Anxiety is a normal human physiological mechanism designed to help the body respond to a threat. The autonomic changes that occur in anxiety are essential to avoid danger and moderate anxiety can actually improve performance. However, when anxiety is associated with very high levels of autonomic arousal, erroneous cognitions including exaggerated threat perceptions and dysfunctional coping strategies, it can result in significant distress and impairment in work, school, family, relationships, and/or activities of daily living. Patients presenting with anxiety symptoms in the general practice setting do not always fit the criteria for a specific anxiety disorder. However, it is important for the general practitioner to know how to assess patients for specific anxiety disorders and the basic principles of management of these disorders. Equally, GPs need strategies to manage patients with distressing anxiety symptoms who do not fulfil the criteria for the diagnosis of a specific anxiety disorder and/or where the anxiety coexists with another mental health disorder (such as depression), substance abuse or medical condition.1
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