Assessment
These are the approved guidelines published by the South African Society of Psychiatrists to provide an overview on treatment and management of commonly diagnosed psychiatric illnesses. The guidelines include consensus recommendations, based on peer contribution and using the international evidence based guidelines that are suitable for the local South African health service.
Please note that parts of this guideline may be out of date, an update will be published as soon as it is available.
Particular attention should be paid to the evaluation of symptoms that are chosen as targets for pharmacotherapy and to symptoms that may point to the presence of other psychiatric disorders. It is also useful to determine the severity of GAD symptoms using a scale such as the Hamilton Anxiety Scale.
There are a number of other screening and assessment scales that can be used, including the 7-item GAD scale[7]for screening for GAD and assessing severity, the Generalised Anxiety Disorder Severity Scale (DGSS) which consists of 8 DSM-IV-TR GAD symptoms for the assessment of symptom frequency and intensity[8]and the Daily Assessment of Symptoms-Anxiety (DAS-A) to assess for symptom improvement.[9] It is possible that the situation in GAD mirrors that in depression, where less severe forms of the disorder respond equally well to pharmacotherapy and to psychotherapy.
It is also necessary to rule out the presence of comorbid psychiatric and medical disorders. This includes a thorough physical examination, appropriate laboratory investigation (with attention to thyroid and glucose function), and assessment of current use of prescription or over-the-counter medications.
Mood disorders, such as depression and dysthymia, other anxiety disorders, and alcohol and other substance use disorders are common in patients with GAD. In addition, attention should be paid to the possibility of comorbid somatisation disorder. Children with pervasive anxiety probably deserve specialist evaluation before a diagnosis of GAD is made.