- Tim Kendall, director1, visiting professor2, consultant psychiatrist and medical director3,
- John Cape, head4, visiting professor2,
- Melissa Chan, systematic reviewer1,
- Clare Taylor, editor1
- On behalf of the Guideline Development Group
- 1National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London E1 8AA, UK
- 2University College London (Clinical, Educational and Health Psychology), London WC1E 7HB
- 3Sheffield Health and Social Care NHS Foundation Trust, Sheffield S10 3TH, UK
- 4Psychological Therapies, Camden and Islington NHS Foundation Trust, St Pancras Hospital, London NW1 0PE
- Correspondence to: Tim Kendall
Generalised anxiety disorder affects about 4.4% of the adult population in England.1 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.2 3 Like other anxiety disorders, it is often chronic if untreated,2 and it is associated with substantial disability equivalent to other chronic physical health problems such as arthritis and diabetes.4 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.5 6 7
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.8 Only recommendations for the management of generalised anxiety disorder have been updated, and these are described here.
NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets.
A “stepped care” model is used to organise and integrate the provision of care by general practices and community services and to help in choosing the most effective interventions. With this approach, patients are first offered the least intrusive intervention that might be effective, with a “step up” to more intensive interventions if they do not improve.
Identification, assessment, and initial treatment
Consider a diagnosis of generalised anxiety disorder in people presenting with anxiety or substantial worry and in people who attend …