Summary
Usage Generalized anxiety disorder (GAD) and panic disorder (PD) are among the most common mental disorders in the United States (Locke, Kirst & Shultz, 2015). The Generalized Anxiety Disorder-7 (GAD-7) is a validated diagnostic tool and a symptom severity assessment scale that assists clinicians, typically primary care and mental health settings, with rapid screening for the presence of a clinically significant anxiety disorder, such as GAD, PD, social phobia (SP) & post-traumatic stress disorder (PTSD). GAD-7 can objectively determine initial symptom severity and monitor symptom changes and the effect of treatment over time. Studies suggest 70-90% sensitivity and 80-90% specificity across anxiety disorders. Higher GAD-7 scores correlate with disability and functional impairment in measures to include work productivity and health care utilization (Spitzer, 2006 & Ruiz, 2011). The scale was originally developed and validated based on the DSM-IV criteria. However, since the publication of the DSM-V criteria, the scale remains clinically useful because the differences in GAD diagnostic criteria are minimal.. Summary The Generalized Anxiety Disorder-7 (GAD-7) is a validated diagnostic tool and a symptom severity assessment scale that assists clinicians, typically primary care and mental health settings, with rapid screening for the presence of a clinically significant anxiety disorder, such as GAD, PD, social phobia (SP) & post-traumatic stress disorder (PTSD). GAD-7 is a 7-question assessment. A range of 0-3 points are assigned to each answer. The 8th question assesses global impairment and is not counted in the score (max score of 21 points). Scoring & Recommendations The first 7 questions will answer with one of the following: AnswerPointsNot at all0Several days1More than half the days2Nearly every day3 Result RecommendationScoreNo anxiety disorderN/A< 5 pointsMild anxiety disorderMonitor5-9 pointsStudies suggest a score ≥ 8 in suspected Panic Disorder, Social Phobia or PTSD may be a moderate anxiety disorderNeed for further evaluation and referral for possible clinically significant condition.8-9 pointsModerate anxiety disorder Need for further evaluation and referral for possible clinically significant condition. 10-14 pointsSevere anxiety disorder Need for further evaluation and referral for possible clinically significant condition. Active treatment is likely warranted.> 15 points Additional Considerations The PRO-MIS Emotional Distress - Anxiety - Short Form for Adults and the Severity Measure for Generalized Anxiety Disorder - Adult can aid clinical evaluation of generalized anxiety disorders and monitor treatment effectiveness. The Severity Measure for Panic Disorder - Adult is an assessment scale that can complement the clinical assessment of patients with panic disorder. In a suspected anxiety disorder, medical conditions with similar presentations ought to be excluded, such as:Endocrine conditions: Hyperthyroidism, pheochromocytoma, hyperparathyroidismCardiopulmonary conditions: Arrhythmia, obstructive pulmonary diseasesNeurologic diseases: Temporal lobe epilepsy, TIAOther psychiatric disorders: Major depressive disorder, bipolar disorder, other anxiety disordersSubstance abuse withdrawalMedications: Common ones include albuterol, levothyroxine, decongestants Lifestyles recommendations that may reduce anxiety-related symptoms include:Identifying and removing possible triggersCaffeine: Consider increase sensitivity to caffeine (slow metabolizer) due to genetic polymorphisms in adenosine receptors.Stimulants: Can include medications, supplements or caffeine products ingested in the evening.NicotineDietary triggers: Consider mold sensitivity from food or the environment. Foods such as coffee, peanuts and grains can have high levels of mold. Many other food sensitivities or allergies can also play a role. A food journal and an elimination diet may help sort this out.StressImproving sleep quality and quantityPhysical activity Therapeutic modalities that may reduce anxiety-related symptoms include:Psychotherapy Cognitive behavioral therapySomatic experiencing therapyEye Movement Desensitization and Reprocessing (EMDR)Vagus nerve stimulation Relaxation therapiesMeditation Mindfulness-based stress reduction and breathing techniquesYoga Complementary and alternative medicineBotanicals and supplements (See table 6)AcupunctureMassageSound therapyAromatherapy .