Screening mnemonic for generalized anxiety disorder.

T lifetime prevalence of generalized anxiety disorder (GAD) is between 6% and 10% in the general population; more women than men are aff ected.1 Studies of anxiety disorders in primary care populations have shown that up to 18% of patients suff er from any anxiety disorder, and 7% of patients have GAD. A study of 6370 primary care patients found that 33% of patients reported anxiety symptoms, but these symptoms went undiagnosed and untreated in more than half of all cases.2 Generalized anxiety disorder is associated with functional impairment and increased risk of adverse health outcomes, including cardiovascular disease and suicide.3 Generalized anxiety disorder is also frequently found in conjunction with other psychiatric conditions, including depression, panic disorder, posttraumatic stress disorder, and social phobia.4 Somatic symptoms are common in GAD, and patients diagnosed with GAD visit primary care physicians twice as often as patients with similar medical and socioeconomic backgrounds.4 Patients with GAD are infrequently referred to psychiatrists for management, but are referred to other medical specialists for evaluation of somatic symptoms. One study examining referral patterns for patients with anxiety found that patients with GAD were twice as likely to be treated by gastroenterologists as psychiatrists, likely a refl ection of the somatic symptoms that patients with GAD have.4 Recognition and treatment of GAD will most likely fall to primary care physicians, so it is important that family physicians are able to recognize the disorder. Th e Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSMIV-TR)5 describes GAD criteria as excessive anxiety and worry for 6 months about a number of different activities or events; the person finds it diffi cult to control the worry; the worry is accompanied by three or more of restlessness, fatigue, impaired concentration, irritability, muscle tension, and sleep disturbance. Th ough useful for research purposes, such criteria are cumbersome, and patients rarely complain of anxiety as a presenting symptom. I have devised a mnemonic to remember the core features of GAD based on DSM-IV-TR criteria.