Approach to managing anxiety disorders in patients with comorbid physical health conditions:
Begin with a comprehensive assessment that includes a timeline to understand the onset and priority of anxiety symptoms relative to physical health problems, facilitating an effective, individualized intervention plan.
Recognize that anxiety symptoms may overlap or be confused with physical health symptoms; consider anxiety disorders especially in patients frequently attending primary care with somatic complaints or chronic physical illness.
Communicate the diagnosis of anxiety disorder early to help patients understand their condition and engage in treatment promptly.
Manage the primary disorder first if there is comorbid depression or another anxiety disorder, prioritizing the condition that is more severe or likely to improve overall functioning.
Ensure optimal management of all comorbid physical health conditions alongside anxiety treatment.
Offer stepped care interventions starting with education, active monitoring, and low-intensity psychological interventions such as guided or non-facilitated self-help based on patient preference.
For patients with marked functional impairment or inadequate response to initial interventions, offer high-intensity psychological therapies (e.g., CBT) or pharmacological treatments, considering patient preference and clinical judgment.
Be vigilant for increased risk of relapse, self-harm, or suicide, especially in those with complex physical comorbidities, and consider referral to specialist mental health services when anxiety is severe, treatment-refractory, or complicated by significant physical health problems.
Maintain effective communication between primary care and specialist services to coordinate care for both anxiety and physical health conditions.
Advise on general health measures such as sleep hygiene and regular exercise, which can improve anxiety symptoms and overall health.