How should I approach the management of anxiety disorders in patients with comorbid physical health conditions?

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.