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The waiting game

GP urged to ask about social anxiety

GPs should use a two-part questionnaire to ask patients about their feelings of anxiety in order to identify those who require treatment, says draft guidance from NICE.

The draft guideline says GPs should use the two-item Generalized Anxiety Disorder scale (GAD-2) in patients showing symptoms of social anxiety and those who have recently experienced a traumatic event.

Published this month, the guidance recommends cognitive behavioural therapy as the first-line treatment. It also says patients who decline CBT should be offered supported self-help or an antidepressant - fluvoxamine1 or escitalopram - after the reasons for declining CBT have been discussed.

GPs should also consider offering patients with anxiety disorders home visits, or appointments outside of normal hours, the draft guidance recommends.

The guidance says: ‘Be alert to possible anxiety disorders (particularly in people with a past history of an anxiety disorder, possible somatic symptoms of an anxiety disorder or in those who have experienced a recent traumatic event).

‘Consider asking the person about their feelings of anxiety and their ability to stop or control worry, using the two-item Generalized Anxiety Disorder scale.’

Professor Mark Baker, director of the Centre for Clinical Practice at NICE, said: ‘We hope that the development of NICE guidance in this area will help ensure that those affected by this disorder receive the best possible support.’

Readers' comments (5)

  • Another inadequate screening tool, to identify another pseudo-illness that warrants another medication......or a wait of at least 6 weeks to even speak to somebody about CBT, let alone get it!

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  • Tosh!

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  • I was really surprised to see social anxiety here as a problem for GPs to ask about, more so that medication would be so quickly resorted to by a health professional who likely would know little about the condition such as ME/chronic fatigue and Asperger Syndrome.

    As a nurse, I always found it very difficult to be in any place where people wanted to 'small chat', having avoided parties, pubs etc all my life. When I became a practice nurse it was even more difficult attending meetings, so I would escape and linger in the foyer (pretending to admire the fishtank) to avoid social interactions.

    After a meeting one afternoon trying to make a quick escape, a young female GP I worked with followed me out and asked me if I had social anxiety. I had never heard of the term but it made me reflect on it and it explained how I felt exactly and enabled me to start dealing with it.

    That particular GP was unique, but sadly took her own life a little later, but generally, other GPs I have come across have been dismissive of other real life affecting conditions such as ME and Aspergers and it scares me. One dismissing my child with suspected Aspergers as "not another new fangled syndome" and another giving him a PDQ-9 form and telling him to "get a life".

    I don't know about "pseudo-illness" or "tosh" unless one just looks at illness as a physiological malfunction with a diagnostic test, but "illness" truly is what actually does prevent people from functioning and can be more disabling than many other diseases and so needs specialist understanding.

    I do wish those who make these recommendations would realise that GPs are not all the all rounders who know all, or assume all have the emotional intelligence to see beyond their original medical training.

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  • I am a hospital doctor and I suffer from Social Anxiety. It becomes next to impossible for me to deal with people in hospital . I need help , but I have no courage to tell my GP about it. Any help ??

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  • To the person above. I mostly got over my social anxiety via a friend who was patient and helped me to feel more condident in social situations. My anxiety was from always not feeling good enough and those places highly intelligent people furnished were not my people, after all, my dad was an unsilled work in a cotton mill and never had a conversation with me as a child.
    Anonymous above, I think it takes practice and also a change in direction of how you view yourself and CBT I think could help. If you can afford it, a good counsellor or psychotherapist might help if you can pay privately and bypass your GP if you don't feel comfortable.

    Still, if you have a good GP it might still be worth giving them a chance first.

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