ABSTRACT
This chapter presents a case of a 40-year-old schoolteacher who attends his general practitioner surgery with his wife with complaints of feeling constantly fearful and stressed. These feelings have been present on most days and are not limited to specific situations or discrete periods. He is a neatly dressed man with no evidence of self-neglect. He appears to be restless and tense but settles down as the interview progresses. A detailed history and mental state examination are needed to rule out the differential diagnoses are provided. Patients seen in early stages of GAD may respond to counselling offered in primary care. Those with moderate to severe symptoms need cognitive behaviour therapy, which is the first-line treatment. Anxiety management provided by a community mental health nurse is often effective and no other treatment is needed. Selective serotonin reuptake inhibitors such as fluoxetine, paroxetine or citalopram can be useful but may cause paradoxical increase in agitation and reduce patients' concordance with treatment.
