The Clinical Presentation of Generalized Anxiety in Primary-Care Settings: Practical Concepts of Classification and Management

On the basis of our long-term experience in treating family-practice patients and conducting clinicalresearch with them, we propose a practical clinical nosology that takes into account thesubsyndromal spectrum of generalized anxiety, as well as patterns of illness, particularly for the family-practice setting. We present an alternative proposal of how to conceptualize generalized anxietydisorders clinically into acute anxiety, subacute anxiety, chronic anxiety, and double anxiety. This isfollowed by a discussion of the implications for choosing from among the various anxiolytic treatmentoptions available to the family physician and of the importance of the therapeutic context inwhich treatment is provided. Anxiolytics are not a panacea, but only tools to allow the patient to helphimself or herself. Irrespective of which anxiolytic is chosen, and irrespective of the chronicity of theanxiety, short-term (2 to 6 weeks) anxiolytic therapy—if necessary provided more than once on anintermittent basis—should be the treatment approach of first choice. Data are presented to suggest that50% of all chronically ill patients who have generalized anxiety disorder could benefit from such atreatment approach.