____________________________________________________________________________ Anxiety Disorders
IDENTIFYING PATIENTS WHO REQUIRE TREATMENT
Generalized Anxiety Disorder • During the past four weeks, have you been bothered by feeling worried, tense, or anxious most of the time? • Are you frequently tense or irritable, or do you have trouble sleeping? If the patient acknowledges in the positive, then follow with the GAD-7 screening tool. Panic Disorder • Do you have sudden, unexpected episodes/spells/ attacks of intense fear or discomfort? If yes, then continue. • Have you had more than one of these attacks? • Does the worst part of these attacks usually peak within several minutes? • Have you ever had one of these attacks and spent the next month or more living in fear of having another attack or worrying about the consequences of the attack? Agoraphobia • Do you avoid certain situations or places where panic attacks have occurred or may occur? Social Anxiety Disorder • Does fear of embarrassment cause you to avoid doing things or speaking to people? • Do you avoid activities where you are, or may be, the center of attention? • Is being embarrassed or looking stupid among your worst fears? Specific Phobia • Do you feel intense anxiety or fear when confronted by certain animals, objects, or situations? • Are you avoiding these animals, objects, or situations because of your fear? • In what ways has this anxiety or fear interfered with your life? • How would you react if you were exposed to the animal, object, or situation right now? • Have you ever fainted or almost fainted around blood, injuries, or needles? Separation Anxiety Disorder • Do you feel anxious, fearful, or upset thinking about separation, or being away from, your (spouse, partner, primary support person)? Positive responses to screening questions is followed by a formal assessment.
The potential chronicity and disability of anxiety disorders indicates that most patients meeting diagnostic criteria should receive psychologic and/or pharmacologic treatment. Treat- ment selection is guided by severity, duration, patient distress and impairment, the presence of depression and other comor- bid disorders, previous treatment response or contraindication, patient preference, provider experience, and treatment avail- ability [3; 126]. However, many patients with anxiety disorder who could benefit do not receive treatment; fewer than one in five receive appropriate medication, improving to one in three for patients with comorbid depression [127]. Treatment quality is improved with accurate diagnosis and regular monitoring. Inadequate dosage and treatment duration were found common in the primary care treatment of patients with panic disorder, but improved outcomes were more likely with enhanced patient education and follow-up contact than with physician education [3; 128]. Worth noting is the con- trast between concerning media reports of medicalization and inappropriate psychotropic prescribing for “normal” anxiety, shyness, or situational stress, and the repeated findings in primary care studies of inadequate or no prescribing and a high level of unmet patient need [3]. General Use Screening Questions Clinical care providers may consider incorporating a simple question format into the routine clinical encounter, asking patients if they have recently felt excessively nervous, anxious, or on edge, and if worrying is ever uncontrollable or otherwise distressing. The DSM-5-TR suggests the following questions for identifying anxiety-related symptoms [2]: During the past two weeks, how much have you been bothered by the following problems: • Feeling nervous, anxious, frightened, worried, or on edge • Feeling panic or being frightened • Avoiding situations that make you anxious A positive history of anxiety symptoms should be explored with screening questions for specific anxiety disorders. Screening for Specific Anxiety Disorders In addition to the general questions suggested for all patients with complaints of anxiety, it is important to inquire regarding disorder-specific symptoms. This will allow for more specialized assessment and diagnosis.
19
EliteLearning.com/Psychology
Powered by FlippingBook