Questionnaire/history: Chronic, excessive worry which is not related to particular circumstances, and symptoms of physiological arousal such as restlessness, insomnia and muscle tension? DSM-V diagnostic criteria fulfilled? ICD-10 diagnostic criteria fulfilled? Number, severity and duration of symptoms? Degree of distress and functional impairment? Past medical history? - Mental health disorders? Current medication? Past experience of and response to treatment? Drug allergies? Examination: Risk of self-harm or harming others? GAD-7 Management: Step 1: Provided material about the nature of GAD and its treatment options? Step 2: without marked functional impairment + not improved following step 1 intervention? Individual non-facilitated self-help (written or electronic materials to work through systematically over a period of at least 6 weeks) with minimal therapist contact (eg occasional short telephone calls of no more than 5 minutes if required)? Individual guided self-help (written or electronic material supported by a trained partitioner who facilitates the programme and reviews progress and outcome (5-7 weekly or fortnightly F2F or telephone sessions (20-30 min)? Psychoeducational groups (6 weekly 2 hours sessions)? Step 3: marked functional impairment or no improvement following step 2 interventions? Individual high-intensity psychological intervention such as CBT or applied relaxation or drug guided by the person’s preference? (Note: drug treatment: 1st line treatment with a (SSRI (sertraline, paroxetine, escitalopram) or SNRI (duloxetine, venlafaxine) or pregabalin of SSRIs or SNRIs contraindicated) Step 4: severe anxiety and marked functional impairment and/or no improvement following step 3 or at risk of self-harm, self-neglect, significant comorbidity (substance misuse, personality disorder, complex physical problem) or at risk of suicide? Referral to mental health team (same day if high risk of suicide)? Advised: - Sleep hygiene (eg going to bed and waking up at the same time each day, eliminating alcohol after 6 pm, avoiding caffeine after 3 pm, getting out of bed if unable to fall asleep to avoid negative associations with the sleep environment - Regular exercise - Review if new medication started within 2 weeks and again at 4, 6 and 12 week and if medication to be continued at 8 to 12 weeks intervals Resource(s): Clinical Effectiveness (CE) Southwark NICE CKS: Generalised anxiety disorder Information for patients/carer(s): NICE: Treating generalised anxiety disorder and panic disorder in adults. Information for the public Royal College of Psychiatrists: Anxiety, panic and phobias