Guidelines on Anxiety Dr Jothi Murugan

Prevalence 5-10% 5-10%

C/F Apprehension Apprehension Cued panic attacks Cued panic attacks Irritability Irritability Poor sleeping Poor sleeping Avoidance Avoidance Poor concentration Poor concentration Physical symptoms Physical symptoms

Panic disorder with or without agoraphobia Intermittent episodes of panic or anxiety and taking avoiding action to prevent these feelingsIntermittent episodes of panic or anxiety and taking avoiding action to prevent these feelings

Generalised anxiety disorder Over-arousal Over-arousal irritability irritability poor sleeping poor sleeping worry about several areas most of the time worry about several areas most of the time

Agoraphobia, social phobia or simple phobia Episodes of anxiety triggered by external stimuliEpisodes of anxiety triggered by external stimuli

Recognition and Diagnosis H/o: self medication H/o: self medication cultural characteristics cultural characteristics Associated depression Associated depression Substance abuse Substance abuse Medical h/o :Hyperthyroidism Medical h/o :Hyperthyroidism

Recognition and Diagnosis Minimum tests to exclude physical problems Minimum tests to exclude physical problems Not usually be admitted Not usually be admitted Written info about the condition and support available Written info about the condition and support available

Management of panic disorder in primary care CBT 7-14 hours (4 months) CBT 7-14 hours (4 months) SSRI, if not suitable or no response in 12 weeks imipramine or clomipramine SSRI, if not suitable or no response in 12 weeks imipramine or clomipramine No Benzodiazepines, sedative antihistamines or antipsychotics No Benzodiazepines, sedative antihistamines or antipsychotics

Management of panic disorder in primary care Self help: Exercise, support group, computerised CBT Self help: Exercise, support group, computerised CBT Refer if trial of 2 treatments don’t work Refer if trial of 2 treatments don’t work

Generalised anxiety disorder CBT 6-20 sessions over 4 months CBT 6-20 sessions over 4 months Antidepressant medication: Paroxetine, venlafaxine Antidepressant medication: Paroxetine, venlafaxine self-help self-help Swap treatment after 12 weeks if not beneficial Swap treatment after 12 weeks if not beneficial Betablockers for physcial symptoms Betablockers for physcial symptoms

Generalised anxiety disorder If after two interventions provided and the person still has significant symptoms, referral to specialist mental health services If after two interventions provided and the person still has significant symptoms, referral to specialist mental health services

Phobia Agoraphobia, fear of the market place, multiple phobic symptoms and a generalised high level of anxiety. Agoraphobia, fear of the market place, multiple phobic symptoms and a generalised high level of anxiety. Specific phobias Specific phobias

Phobia management CBT CBT Desensitisation Desensitisation Diazepam 5-10 mg 2 hours prior to dental procedures Diazepam 5-10 mg 2 hours prior to dental procedures

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