1. Underdiagnosis of Generalized Anxiety Disorder in Russia: The Results of a Web-based Survey of Psychiatrists
Neznanov N.G.1,2,3, Mosolov S.N.4,3, Martynikhin I.A.2,3
1 - St.Petersburg V.M. Bekhterev Psychoneurological Research Institute, St.Petersburg, Russia
2 - Pavlov First Saint Petersburg State Medical University, St.Petersburg, Russia
3 - Russian Society of Psychiatrists (RSP)
4 – Moscow Research Institute of Psychiatry, Moscow, Russia
Introduction: There is a lack of attention to the diagnosis of Generalized Anxiety Disorder (GAD) in the psychiatrists’ education programs and as a consequence in clinical practice in Russian Federation. 
Objective of this study were to estimate comparative prevalence of the diagnosis of GAD among other anxiety and stress related disorders.
Method: An online survey was conducted. The invitations to survey were sent by to members of the Russian Society of Psychiatrists (RSP). 1015 psychiatrists took part in the survey (about 5% of all Russian psychiatrists). 44% of them worked in outpatient departments, 26% - in inpatient departments, 15% - in somatic services, 15% - researchers and university professors.
To estimate the comparative prevalence of diagnosis the comparison with WPA-WHO Global Survey results [Reed G., at al., 2011] was done. 
Results: 83% of participating psychiatrists have diagnosed GAD at least once during the last year. But only 16% of respondents used this diagnosis at least once a week in their clinical practice (in WPA- WHO survey – 60% of respondents). Most often GAD was diagnosed by psychiatrists in somatic services. Mixed Anxiety and Depressive Disorder was diagnosed 2.5 times more often than GAD (in WPA-WHO survey this difference was only 7%) as well as Adjustment Disorders times (in contrast in WPA-WHO survey it was less often than GAD). Among patients with other diagnoses in average 26% have persistent anxiety, but 84% of respondents never establish the comorbid (second) diagnosis of GAD for these patients.
Only a quarter of participants consider that detachment of GAD from other anxiety disorders is based on the differences of pathogenesis, 61% believe that it was done purely for practical reasons, and 10% - that division of anxiety disorders into several diagnostic categories has no sense because they are different phenomenological presentations of the same pathological process. In the treatment of GAD the first choice was SSRIs (32% of respondents) and SSRIs + benzodiazepine (23%). SNRIs more often were indicated as a second choice, after them respondents chose atypical anxiolytics (hydroxyzine, buspirone), and only after them - pregabalin.
Fig. 1. Percentage of participating psychiatrists indicated that they used ICD-10 diagnostic categories of anxiety and stress related disorders at least once a week in their day-to-day clinical practice. The comparison of RSP and WPA-WHO [Reed G. at al., 2011] survey data
Discussion and conclusions: GAD is underdiagnosed in Russia and it's driven by insufficient awareness of psychiatrists regarding modern concepts of anxiety disorders. As it was common in world psychiatry some decades ago, Russian psychiatrists more likely consider anxiety as a result of other mental disorders (e.g. depression) or stress events than an independent disorder. Increasing attention to GAD diagnosis in the psychiatrists’ education programs may improve its screening and treatment.
References
Reed GM, Mendonça Correia J, Esparza P, Saxena S, Maj M. The WPA-WHO Global Survey of Psychiatrists' Attitudes Towards Mental Disorders Classification. World Psychiatry Jun;10(2):
Copyright © 2017 Neznanov N.G., Mosolov S.N., Martynikhin I.A. –