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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…

Page 2

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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…

Page 3

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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…

Page 4

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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…

Page 5

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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. D
· To facilitate…

Page 6

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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…

Page 7

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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…

Page 8

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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…

Page 9

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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…

Page 10

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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. Evaluate:
­ previous treatments, including effectiveness and concordance…

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