Text adapted from: "The adult patient with an anxiety disorder," in Psychiatry in primary care by Alina R. Brotea and Richard Swinson (CAMH, 2019).
The Primary Care Practitioner Role
Anxiety symptoms are extremely common. In the primary care setting, a major task is to determine whether the symptoms are a reaction to a distressing situation, indications of an anxiety or other psychiatric disorder such as depression, or signs of a non-psychiatric condition.
What Is Reasonable to Expect of a Primary Care Practitioner?
- Screen for and establish the specific anxiety disorder diagnosis.
- Develop a treatment plan.
- Be familiar with antidepressants and anxiolytics, as well as psychotropic agents used mainly to augment antidepressants (e.g., antipsychotics, anti-convulsants, mood stabilizers).
- Provide psychoeducation and help patients make an informed treatment choice about medications and psychotherapy.
- Discuss self-help options with patients and support them in using these resources.
- Monitor the patient’s response to treatment
When to Refer to a Specialist
- Following an attempt to treat the patient or earlier if the patient is severely affected by the anxiety disorder
- When an anxious young adult is too fearful to attend school or socialize
- When a patient cannot get to work or maintain usual activities of daily living (e.g., child care, going shopping, hygiene)
- When a patient has multiple comorbid mental disorders (e.g., depression, substance use, suicidality)
- When a patient is being prescribed multiple psychiatric medications
- When a patient is using recreational substances, or over-the-counter medications to alleviate anxiety