Anxiety CPG - Regal Medical Group

CLINICAL
PRACTICE
GUIDELINE
REVIEW
WORKSHEET
Procedure: Generalized Anxiety Disorder
Page#: 1 of 71
Guideline Review Cycle: 2012
Reviewed By: George Orras, Ph.D.
Review Date: November 2012
Committee Approval Date:
PURPOSE:
This guideline provides recommendations for the most appropriate method of diagnosing and
managing Generalized Anxiety Disorder. Following the guideline should result in the best outcome for
most patients. It does not address the treatment of depression, or other anxiety-related disorders such
as panic disorder, obsessive-compulsive disorder, or the treatment of personality disorders. This
guideline is not a substitute for a physicians clinical judgment and may not be appropriate for all
patients.
BACKGROUND:
Both depression and anxiety disorders more commonly present in primary care clinical settings than in
mental health specialty settings. Although the treatment of depression in primary care settings has
received much more attention, anxiety disorders as a group are more common than depression with a
lifetime prevalence of 29% versus 21% for depression. Furthermore, anxiety disorders are often more
chronic, persistent, and less episodic than depressive disorders. The most common anxiety disorders
presenting in primary care clinical settings are panic disorder, generalized anxiety disorder, social
anxiety disorder, and post-traumatic stress disorder, each with an estimated primary care prevalence
of at least 5%. At least half of the people presenting with an anxiety disorder in primary care will have
more than one anxiety disorder, and over 50% of persons with one anxiety disorder have co-morbid
depression. Appropriately treating anxiety will likely have an impact on many depressed patients since
the effective treatment approaches share certain similarities. This is particularly true for those patients
who are the most severely ill, since anxiety with co-morbid depression has more severe symptoms,
greater functional impairment, and a more chronic and persistent course.
FINDINGS:
Appropriately treating anxiety will likely have an impact on many depressed patients since the
effective treatment approaches share certain similarities. This is particularly true for those patients who
are the most severely ill, since anxiety with co-morbid depression has more severe symptoms, greater
functional impairment, and a more chronic and persistent course.

Recommendation:
Heritage Provider Network recommends the adoption of the CALM (Coordinated Anxiety Learning
and Management interventional manual and the GAD 7 tool for assessing generalized anxiety
SOURCES USED:
1. Windstone Behavioral Health, Inc. http://www.windstonebehavioral.com/
ATTACHMENTS:
1. CALM (Coordinated Anxiety Learning and Management interventional manual
2. GAD 7