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Make the Diagnosis: Generalized Anxiety or Panic Disorder

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Prior Probability

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Anxiety symptoms are ubiquitous. Generalized anxiety (GAD) and panic disorders are much less common. The community lifetime prevalence of GAD is 5.1%, and for panic disorder it is 3.5%. Over a 12-month period, about 3.1% of patients in the community will develop GAD and 2.3% will develop a panic disorder.1

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Generalized Anxiety Prior Probability
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Population for Whom Generalized Anxiety and Panic Disorder Should Be Considered

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Many patients present to their primary care clinician with somatic complaints, leading to costly diagnostic testing to rule out underlying pathologic illness. Among patients who present with a specific concern of anxiety, 22% may have GAD.2,3 Generalized anxiety disorder should be considered when patients seem excessively worried and have trouble controlling their worry, with somatic symptoms such as restlessness, easy fatigability, irritability, difficulty concentrating, muscle tension, or sleep disturbance. Panic disorder should be considered when patients have unexpected and unprovoked attacks of fear that occur repeatedly.

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Assessing the Likelihood of Generalized Anxiety or Panic Disorder

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The best measures for assessing the likelihood of these disorders are through patient self-report, prompted by clinician administered questionnaires (see Table 95-1) and clinical assessment. The Generalized Anxiety Disorder Scale 7 Item (GAD-7) evaluates symptoms during the prior 2 weeks and asks about the presence of 7 different symptoms that are self-assessed as not at all present, present for several days, present for more than half the days, or present nearly every day.4 The Patient Health Questionnaire (PHQ) panic module includes only 5 questions (the fifth question has 11 subitems), although if the answer to the first question is "no," the remaining questions 2-5 may be skipped. The PHQ can be completed by patients with low literacy and requires < 1 minute for completion.5 These questionnaires are available online (www.phqscreeners.com).

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Table 95-1.Useful Findings for Diagnosing Generalized Anxiety or Panic Disorders

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