NICE has published an update to its recommendations on the management of anxiety, originally published in December 2004.

The 2004 NICE guidance included the care of adults who have panic disorder (with or without agoraphobia) or generalised anxiety disorder (GAD). This update only covers the recommendations on the management of adults with a diagnosis of GAD.

Generalised anxiety disorder (GAD) is a common condition that can be recognised by chronic, excessive worry about a number of different events associated with heightened tension. GAD can vary in its severity and complexity for each person, and for this reason it is very important to consider how each patient should be treated individually.

Christine Carson, Programme Director for the Centre for Clinical Practice at NICE, said: “Since NICE published guidance on the condition in December 2004, new evidence has emerged about how to manage GAD in adults. Therefore this particular section of the guideline was prioritised for updating. The new recommendations include health professionals considering a diagnosis of GAD in patients presenting with anxiety or significant worry, and in those frequently attending primary care who have a chronic physical health problem, or do not have a physical health problem but are seeking re-assurance about somatic symptoms or are repeatedly worrying about a range of different issues.”

Updated recommendations include:

• Recognition and communication of the diagnosis of GAD should occur as early as possible to help people understand the disorder and start effective treatment promptly.
• For people with GAD whose symptoms do not improve with education and active monitoring, offer one or more of the following as a first-line intervention, guided by the person's preference: individual non-facilitated self-help, individual guided self-help or psycho-educational groups[1].
• Offer an individual high-intensity psychological intervention or a pharmacological intervention to people with GAD with marked functional impairment or those whose symptoms have not adequately responded to low-intensity psychological interventions such as pure self-help, guided self help and psycho-educational groups.
• Do not offer an antipsychotic for the treatment of GAD in primary care.

Dr Tim Kendall, Director of the National Collaborating Centre for Mental Health, Medical Director and Consultant Psychiatrist, Sheffield Health and Social Care NHS Foundation Trust said: “Generalised anxiety disorder is a very common but under-recognised condition characterised by endless worrying, which results in substantial disability for many sufferers, affecting their capacity to work and to live fulfilled and meaningful lives. Many develop secondary disorders, such as panic and depression, and it's much more common in people with chronic physical ill-health. So it is with real pride that we are now announcing the release of new, better and fully updated guidance on the treatment and management of GAD in primary and secondary care. It has been produced through probably the most rigorous evidence analysis worldwide and the recommendations are, as a result, really robust. People with GAD will be able to choose from a range of self help interventions, including two psychological treatments and some antidepressants. The guideline emphasises choice and patient preference, and is much clearer that there are some old treatments that just don't work. This is a really excellent and new piece of work produced with some of our top national clinical experts and really committed service users.”

Professor John Cape, Head of Psychological Therapies, Camden and Islington NHS Foundation Trust, London, Visiting Professor, University College London and Chair of the Guideline Development Group, said: “GAD is the most common mental health disorder in the UK and yet is poorly recognised so two thirds of people with GAD receive no treatment. Effective treatments are available, especially self-help approaches, cognitive behaviour therapy and drug treatments which each can be best for different people. The revised guidance can help more patients receive effective treatment to relieve the incessant uncontrollable worry and anxiety that is the core characteristic of this condition.”

Ends

Notes to Editors

About the guidance

1. The guidance will be available on the NICE website from 26 January, 2011.

About NICE

2. The National Institute for Health and Care Excellence (NICE) is the independent organisation responsible for providing national guidance and standards on the promotion of good health and the prevention and treatment of ill health

3. NICE produces guidance in three areas of health:

• public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
• health technologies - guidance on the use of new and existing medicines, treatments, medical technologies (including devices and diagnostics) and procedures within the NHS
• clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.

4. NICE produces standards for patient care:

• quality standards - these reflect the very best in high quality patient care, to help healthcare practitioners and commissioners of care deliver excellent services
• Quality and Outcomes Framework - NICE develops the clinical and health improvement indicators in the QOF, the Department of Health scheme which rewards GPs for how well they care for patients

5. NICE provides advice and support on putting NICE guidance and standards into practice through its implementation programme, and it collates and accredits high quality health guidance, research and information to help health professionals deliver the best patient care through NHS Evidence.

View the PDF format of this press release.

Footnotes

[1] A psycho-educational group is a specific type of group therapy that focuses on educating clients about their disorders and ways of coping. Many psycho-educational groups consist of members that all share the same diagnosis. In this case, the education tends to focus on coping with that specific disorder.