NICE guidance - anxiety: management of anxiety (panic disorder, with or without agoraphobia, and generalised anxiety disorder) in adults

NICE have produced guidance concerning the management of anxiety (panic disorder, with or without agoraphobia, and generalised anxiety disorder) in adults in primary, secondary and community care (1).

Generalised anxiety disorder (GAD) is one of a range of anxiety disorders that includes panic disorder (with and without agoraphobia), post-traumatic stress disorder, obsessive-compulsive disorder, social phobia, specific phobias (for example, of spiders) and acute stress disorder.

• anxiety disorders can exist in isolation but more commonly occur with other anxiety and depressive disorders
• NICE guidance covers both 'pure' GAD, in which no comorbidities are present, and the more typical presentation of GAD comorbid with other anxiety and depressive disorders in which GAD is the primary diagnosis (1)

Generalised anxiety disorder (GAD)

• is a common disorder, of which the central feature is excessive worry about a number of different events associated with heightened tension
• a formal diagnosis using the DSM-IV classification system requires two major symptoms (excessive anxiety and worry about a number of events and activities, and difficulty controlling the worry) and three or more additional symptoms from a list of six
• symptoms should be present for at least 6 months and should cause clinically significant distress or impairment in social, occupational or other important areas of functioning

Panic Disorder

• according to the DSM-IV-TR, a fundamental characteristic of panic disorder is
  • the presence of recurring, unforeseen panic attacks followed by at least 1 month of persistent worry about having another panic attack and concern about the consequences of a panic attack, or a significant change in behaviour related to the attacks
  • at least two unexpected panic attacks are necessary for diagnosis and the attacks should not be accounted for by the use of a substance, a general medical condition or another psychological problem. Panic disorder can be diagnosed with or without agoraphobia

Points from this guidance have been summarised in this section. For detailed guidance then consult the full NICE guideline (1).

If the patient has intermittent episodes of panic or anxiety, and taking avoiding then see linked NICE guideline for panic disorder.

Else

If the episodes of anxiety triggered by external stimuli then the patient has agoraphobia, social phobia or simple phobia (not covered by this NICE guideline)

Else

If the patient suffers symptoms of over-arousal, irritability, poor concentration, poor sleeping and worry about several areas most of the time then see linked NICE guidance for generalised anxiety disorder

Reference:

1. NICE (July 2019).management of anxiety (panic disorder, with or without agoraphobia, and generalised anxiety disorder) in adults in primary, secondary and community care