Anxiety and Panic Disorders

Warning

Introduction

It is normal and common to worry at times: anxiety is often temporary and can follow a specific, stressful event. Anxiety disorders however describe situations in which these feelings become intense and persistent, and interfere with daily life. 

Anxiety disorders include:

  • Generalised Anxiety Disorder (GAD)
  • Social Anxiety Disorder
  • Panic Disorder
  • Specific Phobias

Mild to moderate anxiety disorders can be managed in primary care. 

You may have contact with patients in hospital who have well managed comorbid anxiety disorders or in whom admission has caused them an exacerbation of their anxiety. 

Signs and symptoms

Psychological - feeling tense or ‘on edge’, excessive worry, restlessness, irritability, difficulty concentrating, avoidance of feared situations

Physical - palpitations, sweating, chest pains, difficulty breathing, dizziness, nausea, headache, muscle aches/tension

Assessment

  • Consider psychological stressors
  • Ask about drug and alcohol use (incl. caffeine)
  • Complete physical examination and investigations to rule out other causes e.g. thyrotoxicosis, respiratory or cardiac issues, alcohol or substance misuse
  • Consider other mental disorders e.g. agitated depression, psychosis, obsessive-compulsive or related disorders (OCD)

Treatment

In general, management follows a stepped care approach with psychoeducation, self-help and psychological interventions for mild and moderate anxiety disorders and consideration of medication, in addition to these interventions, for severe symptoms. 

  • Psychoeducation
  • Relaxation techniques
  • Psychological therapies e.g. cognitive behavioural therapy
  • Medications e.g. selective serotonin reuptake inhibitors (SSRIs) 

Severity can be assessed using the GAD-7 tool (link below) which is quick and easy to complete. Scores: 0-5 mild, 6-10 moderate, 11-15 moderately severe, 15-21 severe anxiety.

More information on management can be found in NICE guidance linked to below.

Last reviewed: 21/02/2024

Next review date: 21/08/2024

Author(s): Medical Education Fellow, NHS Lothian.

Author email(s): mypsych@ggc.scot.nhs.uk.

Reviewer name(s): Medical Education Fellow, NHS Lothian.