Differentiating between generalized anxiety disorder (GAD) and panic disorder (PD) in a primary care setting involves understanding their distinct symptom presentations and diagnostic approaches NICE CG113.
- Generalized Anxiety Disorder (GAD): GAD is characterized by persistent, excessive, and difficult-to-control worry about a variety of events or activities, rather than specific situations NICE CG113. For a diagnosis of GAD, symptoms must typically be present for at least six months NICE CKS. Patients with GAD may frequently attend primary care, presenting with chronic physical health problems or seeking reassurance about various somatic symptoms, particularly older individuals or those from minority ethnic groups NICE CG113. The 2-item Generalized Anxiety Disorder scale (GAD-2) or GAD-7 can be used as screening and monitoring tools to assess feelings of anxiety and the ability to control worry NICE CG113,NICE CKS.
- Panic Disorder (PD): In contrast, panic disorder is defined by recurrent, unexpected panic attacks, which are sudden episodes of intense fear or discomfort that peak within minutes NICE CG113. It is important to note that a single panic attack does not necessarily constitute panic disorder; the diagnosis requires recurrent attacks and persistent concern about having more attacks or their consequences NICE CG113. Patients experiencing panic attacks may present to Accident & Emergency (A&E) services, often with symptoms mimicking acute physical problems like chest pain NICE CG113. In such cases, panic disorder is more likely if coronary artery disease is absent, or if the person is female or relatively young NICE CG113. Unlike GAD, there is insufficient evidence to recommend a well-validated, self-reporting screening instrument specifically for panic disorder, so diagnosis relies heavily on strong consultation skills to elicit necessary information, including personal history and any self-medication NICE CG113.
Both conditions are common in primary care and can co-exist with other conditions, particularly depression NICE CG113. When comorbidities are present, the primary disorder – the one that is more severe and whose treatment is more likely to improve overall functioning – should be addressed first NICE CKS. Drawing up a timeline of symptom development can help clarify the sequencing and priorities of co-occurring problems NICE CG113. Primary care clinicians should be alert to the common clinical situation of comorbidity, especially panic disorder with depression and substance misuse NICE CG113. Valente 1996 and Roy-Byrne & Wagner 2004 highlight the importance of primary care in the diagnosis and management of both conditions.