anxiety quick reference

anxiety quick reference

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  • Created on: 29-06-10 17:52
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Issue date: December 2004, with amendments April 2007
Quick reference guide (amended)
Anxiety: management of anxiety
(panic disorder, with or without
agoraphobia, and generalised
anxiety disorder) in adults in
primary, secondary and
community care
Amendment of recommendations concerning venlafaxine: April 2007
On 31 May 2006 the MHRA issued revised prescribing advice for venlafaxine*. This
amendment brings the guideline into line with the new advice but does not cover other
areas where new evidence may be available. NICE expects to make a decision on a full
update later in 2007.
The revised sections are marked in italics on pages 6, 8 and 9 of this quick reference guide.
The amendments to the recommendations to take account of the revised prescribing advice
for venlafaxine were developed by the National Collaborating Centre for Mental Health.
*See
www.mhra.gov.uk/home/idcplg?IdcService=SS_GET_PAGE&useSecondary=true&ssDocName=CON2023843&ssTargetNodeId=389
Clinical Guideline 22 (amended)
Developed by the National Collaborating Centre for Primary Care

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Key messages about anxiety disorders
Key messages about anxiety disorders
· Anxiety disorders are
­ common
­ chronic
­ the cause of considerable distress and disability
­ often unrecognised and untreated.
· If left untreated, they are costly to both the individual and society.
· A range of effective interventions is available to treat anxiety disorders, including medication,
psychological therapies and self-help.
· Individuals do get better and remain better.…read more

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Which NICE guideline?
Which NICE guideline?
What are the patient's symptoms?
Low mood or loss of interest, usually accompanied by Enter NICE clinical
one or more of the following: low energy, changes in guideline on
appetite, weight or sleep pattern, poor concentration, Yes depression
feelings of guilt or worthlessness and suicidal ideas? (www.nice.org.…read more

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Key priorities for implementation
Key priorities for implementation
General management
· Shared decision-making between the individual and healthcare professionals should take place
during the process of diagnosis and in all phases of care.
· Patients, and where appropriate, families and carers should be provided with information on
the nature, course and treatment of panic disorder or generalised anxiety disorder, including
information on the use and likely side-effect profile of medication.…read more

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General principles of care ­ all steps
For details of recommendation grading, see page 11.
General principles of care ­ all steps
Shared decision-making and information provision
· Shared decision-making between the individual and healthcare professionals should take place
during diagnosis and all phases of care.…read more

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Management of panic disorder in primary care: Steps 2­4
Management of panic disorder in primary care: S
Step 2: Offer treatment
Following discussion with patient and taking acco
listed in descending order of evidence for the lon
· psychological therapy A or
· pharmacological therapy A or
· self-help A
The chosen treatment option should be available
Psychological therapy Pharmacological therapy
· CBT should be used A Before prescribing, consider: When prescribing
­ It should be delivered by trained and · age D · Offer…read more

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Management of panic disorder in primary care: Steps 2­4 continued
Steps 2­4
t in primary care
ount of patient preference, offer (interventions
ngest duration of effect):
e promptly D
Self-help
· Offer bibliotherapy based on CBT
c disorder, unless otherwise indicated A principles A
re is no improvement after a 12-week course, and if further medication is · Offer information about support groups,
nea or clomipraminea A where available D
eatment is initiated, about: · Discuss the benefits of exercise as part of
ding transient…read more

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Management of generalised anxiety disorder in primary care: Steps 2­4
Management of generalised anxiety disorder in p
Step 2: Offer treatment in primary care
Consider offering: Yes Is immediate management necessary?
· support and information D
· problem solving C
· benzodiazepines A ­ do not use for more than 2­4 weeks
Following discussion with patient and taking acc
· sedative antihistamines A
listed in descending order of evidence for the lon
· self-help D
· psychological therapy A or
· pharmacological therapy A or…read more

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Management of generalised anxiety disorder in primary care: Steps 2­4 continued
primary care: Steps 2­4
No
count of patient preference, offer interventions
ngest duration of effect:
e promptly D
Self-help
· Offer bibliotherapy based on CBT
dicateda A principles A
e is no improvement after a 12-week course, and if a further medication · Consider large-group CBT C
ld be offered D · Offer information about support groups,
ment is initiated, about: where available D
g transient increase in anxiety at the start of treatment)…read more

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Step 5: Care for people with panic disorder and GAD in specialist mental health services
Step 5: Care for people with panic disorder and
generalised anxiety disorder in specialist
mental health services
· Reassess the patient, their environment and their social circumstances.…read more

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