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 clinical research with them, we propose a practical clinical nosology that takes into account the subsyndromal 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 anxiety disorders clinically into acute anxiety, subacute anxiety, chronic anxiety, and double anxiety. This is followed by a discussion of the implications for choosing from among the various anxiolytic treatment options available to the family physician and of the importance of the therapeutic context in which treatment is provided. Anxiolytics are not a panacea, but only tools to allow the patient to help himself or herself. Irrespective of which anxiolytic is chosen, and irrespective of the chronicity of the anxiety, short-term (2 to 6 weeks) anxiolytic therapy--if necessary provided more than once on an intermittent basis--should be the treatment approach of first choice. Data are presented to suggest that 50% of all chronically ill patients who have generalized anxiety disorder could benefit from such a treatment approach.