Course and outcome – Generalised Anxiety Disorder
People with mild Generalised Anxiety Disorder may have their anxiety state precipitated by an adverse life event. They are likely to have mild or intermittent symptoms. They may self-treat and are likely to have either no health care involvement or be under the care of their GP. They usually respond to explanation, reassurance and supportive counselling, particularly if the cause of their anxiety is clear-cut. If medication is required it is likely to be limited to occasional use of benzodiazepines, beta-blockers or a short course of other anxiolytic medication. The illness in the majority of cases is self-limiting. Significant improvement can be expected within a 6-month period with complete resolution after approximately 12 months.
A person with moderate Generalised Anxiety Disorder is likely to have more severe chronic symptoms or frequent episodes of severe anxiety. Management is likely to be achieved by specific referral to an individual member of the community mental health teamwho may either be attached to the GP’s practice or hospital based. This includes counsellors, Community Psychiatric Nurses (CPN), psychologists and occupational therapists. Treatment is likely to be associated with intermittent specialist prescription of regular medication or a recent course of psychological treatment. They almost always respond to appropriate treatment but this may take up to 12 to 18 months to resolve. A small proportion may experience ongoing or recurrent symptoms.
A person with severe Generalised Anxiety Disorder will have severe chronic symptoms to such an extent that they are extremely limited in their social function. Management is likely to be achieved by referral to the community mental health team and will include an assessment by a psychiatrist. People who are severely disabled will be unable to leave their homes and are therefore likely to require assessment by a psychiatrist in their own home. Treatment of people with severe anxiety is likely to be associated with the prescription of regular medication and 2 or more courses of psychological treatment in the last 2 years. In this group of people, the illness tends to be chronic and intractable with a poor response to treatment. However, occasionally some people will respond well to treatments that have not been tried before, for example Cognitive Behavioural Therapy (CBT) or newer antidepressants.
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