Anxiety disorders — KFP-style written assessment

KFP 1 (10 marks)

A 29-year-old teacher presents with six months of constant worry about work performance, difficulty controlling the worry, muscle tension and broken sleep. PHQ-9 is 6; GAD-7 is 8. She drinks five coffees daily. TFTs normal. ^{[1] [16]}

1. Interpret her GAD-7 score — what does it support, what does it not exclude? (2) ^{[2] [3]}
2. Which modifiable contributor deserves a trial before or alongside other treatment, and why? (2) ^[16]
3. Outline NICE's step 1–2 plan for her. (5) ^[1]

Model answers

1. A score of 8 falls below the cut-off of 10 that Cochrane pooling associates with sensitivity 0.64 / specificity 0.91 for GAD — so probability is lowered but not excluded; with six months of uncontrolled worry and somatic tension the clinical story supports GAD assessment regardless. The derivation study's sensitivity 89%/specificity 82% represents best-case; pooled real-world performance is more modest. ^{[2] [3]}
2. Caffeine: systematic review shows a dose-dependent anxiogenic effect in healthy individuals, partly through caffeine-induced insomnia. Five cups daily is a plausible driver; a supervised reduction trial is free, safe and diagnostic. ^[16]
3. Step 1: education about GAD and treatment options plus active monitoring — less severe presentations may improve with this alone. Step 2 if not improved: low-intensity interventions guided by preference — individual non-facilitated self-help (CBT-based materials), individual guided self-help (CBT materials supported by a trained practitioner over 5–7 sessions of 20–30 minutes), or CBT-principled psychoeducational groups. Review with repeat GAD-7 at each contact. ^[1]