Managing Anxiety Disorders in Primary Care

by Lee David

Overview

A practical guide to help improve the recognition and treatment of anxiety disorders in primary care.

Making a diagnosis of anxiety can be challenging in primary care, and for this reason many patients remain undiagnosed and untreated.

Patients with undiagnosed anxiety disorders may not receive appropriate treatment and may also undergo unnecessary and costly investigations for their physical symptoms. Anxiety disorders can interfere with the management of patients’ physical health and may be associated with worsening outcomes for coexisting chronic physical disorders. 

However, if the anxiety disorders are correctly identified, patients can be offered effective treatments, including self-help, psychological therapy, and medication, which will in turn help to improve their physical health and wellbeing.

Managing Anxiety Disorders is a practical guide to help those working in primary care to recognize and treat anxiety disorders. Using a consistent approach it provides an overview of the most common anxiety disorders and for each describes how to:

• recognize each disorder
• make the diagnosis
• explain the condition to patients
• manage each disorder, including using simple 10 minute CBT strategies to encourage self-help

It also includes practical case studies to illustrate how different anxiety disorders may present in primary care, and how family physicianss might begin to assess and manage patients with these conditions.

Product Details

ISBN-13:	9781911510390
Publisher:	Scion Publishing Ltd.
Publication date:	09/21/2020
Edition description:	1
Pages:	332
Sales rank:	766,074
Product dimensions:	6.77(w) x 9.60(h) x 0.90(d)

Table of Contents

Preface xi

Abbreviations xiii

1 Understanding anxiety disorders 1

1.1 Introduction 1

1.2 How common are anxiety disorders? 1

1.3 Co-morbid conditions 3

1.4 Overview of anxiety 3

1.5 The purpose of anxiety - the fight or flight response 5

1.6 CBT model of anxiety 6

1.7 Treatment of anxiety 8

1.8 Summary and key points 8

2 Initial assessment of anxiety disorders 9

2.1 Recognition of anxiety 9

2.2 Communication skills for identifying and managing anxiety 10

2.3 Diagnostic and screening tools for anxiety 11

2.4 Assessment of anxiety 14

2.5 Summary and key points 18

3 Management of anxiety disorders 19

3.1 General principles of management 19

3.2 Self-management for anxiety disorders 22

3.3 Psychological therapies for anxiety disorders 22

3.4 Drug treatment for anxiety disorders 31

3.5 Summary and key points 40

4 10 minute CBT for anxiety 41

4.1 What is 10 minute CBT? 41

4.2 CBT-based communication skills for primary care 41

Case example 4.1: Emma - Using the C8T framework in anxiety 46

4.3 10 minute CBT: cognitive skills and strategies 51

4.4 10 minute CBT: behavioural strategies 60

Case example 4.1: Emma - Discussing values 68

4.5 Other strategies 69

4.6 Summary and key points 73

4.7 Useful self-help online resources 74

5 Generalised anxiety disorder 75

5.1 Introduction 76

5.2 What is GAD? 77

5.3 Epidemiology 78

5.4 Aetiology 78

5.5 CBT model of GAD 78

5.6 Co-morbidity 81

5.7 Course and prognosis of GAD 82

5.8 Presentation of GAD 82

Case example 5.1: Sebastian - How might GAD present? 83

5.9 Management of GAD 84

5.10 Monitoring and follow-up 96

Case example 5.2: Anita - Diagnosis and management of GAD 96

Case example 5.3: Joseph - Diagnosis and management of GAD 98

5.11 Summary and key points 99

5.12 GAD resources 99

6 Panic disorder 101

6.1 Introduction 102

6.2 What is panic disorder? 103

6.3 Epidemiology 104

6.4 Aetiology 104

6.5 CBT model of panic disorder 104

6.6 Co-morbidity 107

6.7 Course and prognosis of panic disorder 107

6.8 Presentation of panic disorder 107

Case example 6.1: Nisha - How might panic disorder present? 108

6.9 Management of panic disorder 109

6.10 Monitoring and follow-up 120

Case example 6.2: Richard - Diagnosis of panic disorder 120

6.11 Summary and key points 122

6.12 Panic disorder resources 122

7 Agoraphobia 123

7.1 Introduction 125

7.2 What is agoraphobia? 125

7.3 Epidemiology 126

7.4 Aetiology 126

7.5 CBT model of agoraphobia 126

7.6 Co-morbidity 126

7.7 Course and prognosis of agoraphobia 128

7.8 Presentation of agoraphobia 128

7.9 Management of agoraphobia 128

Case example 7.1: Sarah - How might agoraphobia present? 129

7.10 Monitoring and follow-up 137

Case example 7.2: Diane - Diagnosis and management of agoraphobia 138

7.11 Summary and key points 139

7.12 Agoraphobia resources 140

8 Specific phobias 141

8.1 Introduction 142

8.2 What are phobias? 142

8.3 Epidemiology 144

8.4 Aetiology 145

8.5 CBT model of phobias 145

8.6 Co-morbidity 147

8.7 Course and prognosis of specific phobias 148

8.8 Presentation of phobias 148

Case example 8.1: Douglas - How might specific phobia present? 149

8.9 Management of phobias 149

8.10 Monitoring and follow-up 158

Case example 8.2: Yasmin - Diagnosis of vomiting phobia 159

8.11 Summary and key points 159

8.12 Phobias resources 160

9 Social anxiety 161

9.1 Introduction 162

9.2 What is social anxiety? 162

9.3 Epidemiology 164

9.4 Aetiology 165

9.5 CBT model of social anxiety 165

9.6 Co-morbidity 167

9.7 Course and prognosis 168

9.8 Presentation of social anxiety 168

Case example 9.1: Khalid - How might social anxiety present? 169

9.9 Management of social anxiety 170

9.10 Monitoring and follow-up 181

Case example 9.2: Claire - Diagnosis and management of social anxiety 181

9.11 Summary and key points 183

9.12 Social anxiety resources 183

10 Obsessive-compulsive disorder 185

10.1 Introduction 186

10.2 What is OCD? 186

10.3 Epidemiology 189

10.4 Aetiology 189

10.5 CBT model of OCD 190

10.6 Co-morbidity 192

10.7 Course and prognosis of OCD 192

10.8 Presentation of OCD 192

Case example 10.1: Angel - How might OCD present? 194

Case example 10.2: Marie - How might OCD present? 195

10.9 Management of OCD 197

10.10 Monitoring and follow-up 208

Case example 10.3: Andrew - Diagnosis and management of OCD 208

10.11 Summary and key points 210

10.12 OCD resources 210

11 Body dysmorphic disorder 211

11.1 Introduction 212

11.2 What is BDD? 213

11.3 Epidemiology 215

11.4 Aetiology 215

11.5 CBT model of BDD 216

11.6 Co-morbidity 218

11.7 Course and prognosis of BDD 219

11.8 Presentation of BDD 219

Case example 11.1: Sinead - How might BDD present? 220

11.9 Management of BDD 222

11.10 Monitoring and follow-up 234

Case example 11.2: Donald - Diagnosis of BDD 234

11.11 Summary and key points 236

11.12 BDD resources 236

12 Post-traumatic stress disorder 237

12.1 Introduction 238

12.2 What is PTSD? 239

12.3 Epidemiology 242

12.4 Aetiology 242

12.5 CBT model of PTSD 244

12.6 Co-morbidity 247

12.7 Course and prognosis of PTSD 247

12.8 Presentation of PTSD 248

Caseexample 12.1: Peter-How might PTSD present? 249

12.9 Management of PTSD 249

12.10 Monitoring and follow-up 261

Case example 12.2: John - Diagnosis and treatment of PTSD 261

12.11 Summary and key points 263

12.12 PTSD resources 264

13 Health anxiety 265

13.1 Introduction 266

13.2 What is health anxiety? 267

13.3 Epidemiology 270

13.4 Aetiology 270

13.5 CBT model of health anxiety 271

13.6 Co-morbidity 274

13.7 Course and prognosis of health anxiety 274

13.8 Presentation of health anxiety 274

Case Example 13.1: Olivia-How might health anxiety present? 275

13.9 Management of health anxiety 277

13.10 Monitoring and follow-up 290

Case example 13.2: Ines - Diagnosis and management of health anxiety 290

13.11 Summary and key points 292

13.12 Health anxiety resources 293

References and further reading 295

Index 309