Diagnosing & Managing Anxiety as an NP in Primary Care

Spotting anxiety in your patients can be difficult with so many factors and differential diagnoses to consider. If you’re struggling with this as a primary care NP, that’s where SMNP Reviews can help! 

This video by Brittney Olson, MSN, APRN, FNP-C has some great tips on how to screen for, diagnose, and treat anxiety in primary care. All of the topics discussed in the video are fair game for your NP boards, not to mention they’re things you’ll need to know as a real-deal NP! 

Anxiety Screening Tools NPs Use

In the video, Brittney talks about how anxiety is a normal reaction in certain situations, but when it becomes chronic and interferes with daily life, the patient could be suffering from generalized anxiety disorder (GAD).  

To help you spot cases of GAD, she reviews the “WATCHERS” mnemonic, which is a great way to remember the symptoms of the disorder:

Worry
Anxious
Tension
Concentration
Hyperarousal
Energy loss
Restlessness
Sleep disturbance

Brittney also reviews commonly used anxiety screening tools, including the Generalized Anxiety Disorder 2-Item Scale (GAD-2), and the more comprehensive Generalized Anxiety Disorder 7-Item Scale (GAD-7).

Who should be screened for anxiety? 

The United States Preventive Services Task Force (USPSTF) recommends screening all adults ages 18-64 for anxiety disorders. Brittney notes a good rule is to screen those who have never been screened before, and those who may have risk factors for GAD.  

Diagnosing Anxiety

Of course, when it comes to formally diagnosing someone with GAD, you’ll need to consult the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision (DSM-5-TR), which lays out all the criteria that need to be met. 

According to the DSM-5-TR, for someone to be diagnosed with GAD, their anxiety symptoms must be present on more days than not, for at least six months.    

What are differential diagnoses for anxiety?

GAD can be hard to spot, considering other conditions like panic disorder, obsessive-compulsive disorder, situational anxiety, specific phobias, bipolar disorder, and hyperthyroidism can often present like GAD. Brittney gives you a heads-up on what differential diagnoses to look out for, and shows you how to distinguish them from GAD.  

Treating Anxiety as a Primary Care NP   

When it comes to treatments for GAD, it’s important to include the patient in the decision-making process, since in the end, the best treatment options will be the ones a patient is comfortable with. 

In most cases, treatment for GAD should include psychotherapy and/or medications. Brittney says cognitive behavioral therapy is the preferred psychotherapy for patients with GAD, and some medication options include selective serotonin reuptake inhibitors (SSRIs) like Lexapro, or serotonin and norepinephrine reuptake inhibitors (SNRIs) like Cymbalta. 

💜 Be sure to subscribe to the SMNP YouTube channel, where you’ll find lots of great tips on how to get through NP school, crush your boards, and kickstart your NP career!

For more (free!) content to help you as a real-deal NP, check out these other posts on the blog:

• [Podcast] Ep #99: Mental Health as a New NP
• [Video] Deep Dive Into Understanding Thyroid Disorders with SMNP Reviews
• How I Overcame Anxiety for My AAENP Keynote Presentation