Clinical Presentation Worry about: –health –job and finances –competence –acceptance –family, friends, relationships –minor matters Unexplained physical symptoms

2 Most Patients with GAD do NOT Present with Anxiety as the Primary Complaint (part of the reason for under-diagnosis) Based on sample of n=17,739; 5.3% with GAD (DSM-IV) Wittchen et al. J Clin Psychiatry. 2002;63(suppl 8):24-34 Only 13% had anxiety as primary complaint

GAD in Primary Care Often under-diagnosed or significant time lag before correct diagnosis Often available effective treatments are not used due to lack of knowledge!

Patients † with lifetime prevalence* of GAD will commonly report other disorders Kessler RC, et al. Psychological Med. 2002; 32: 1213–1225. Patients † with GAD reporting other lifetime disorder (%) Substance use disorders Anxiety disorders Mood disorders *The lifetime prevalence was defined as the proportion of individuals who have manifested GAD at least once in their lifetime. † Subset of population with GAD (based on surveys in four countries).

GAD often precedes the development of other psychiatric disorders Kessler RC, et al. Psychological Med. 2002; 32: 1213–1225. Anxiety disorders Mood disorders Substance use disorders Patients* in whom GAD precedes comorbid condition (%) *Subset of population with GAD (based on surveys in four countries).

GAD is associated with increased primary and secondary care visits 67% 39% GP visits Referrals by GP Number of referrals ** **p<0.001 vs comparison group N=3340 in each group. Frequency in the year IMS Mediplus Database German GP Analysis. Data on file, Pfizer Ltd PGB026: GAD German GP Database. GAD in German GP database Number of visits

Patients with GAD Are high users of emergency services At a high risk of suicide attempts Are at risk of substance misuse

Patients with GAD report greater work impairment than patients with MDD Wittchen HU, et al. Int Clin Psychopharmacol. 2000; 15: 319–328. This study is based on data from the German National Health Interview & Examination Survey. *95% confidence intervals. MDD, major depressive disorder.

Improving detection and diagnosis of GAD Become familiar with symptoms and Signs of GAD Assess level of disability to decide on threshold for RX Ask about long standing anxiety symptoms when patients present with depression and or unexplained physical symptoms

Scales for Dx. Anxiety D/O HADS BAI HAM-A

GAD-7 for scoring symptom severity in GAD Cut points of 5, 10 and 15 represent mild, moderate and severe anxiety Spitzer RL et al. Arch Intern Med 2006; 166: 10-17