A Doody's Core Title for 2018.
Primary care physicians know from experience how many patients come to them needing help with anxiety and related disorders: these disorders have a lifetime prevalence rate of 30%, but they often seem to be present in a much higher proportion of primary care visits.
Time pressure challenges every primary care provider who responds to these disorders. The Primary Care Toolkit for Anxiety and Related Disorders—carefully aligned with the DSM-5—gives you the tools to help you treat your patients promptly and effectively.
Quickly find the information and strategies you need using summaries of diagnostic criteria and pharmacological therapies, severity assessments, treatment summaries, and case studies. Efficiently screen, diagnose, and manage common anxiety and related disorders, using visit-by-visit guides for mild, moderate, and severe disorders.
An accompanying CD puts the best, most effective diagnostic tools at your fingertips, ready to be printed and used by you and your patients: patient self-report forms and questionnaires, symptom checklists, functional impairment assessment scales, and more.
The Primary Care Toolkit helps prepare you for the 7 anxiety and related disorders that primary care physicians see most often:
- Generalized anxiety disorder,
- Panic disorder,
- Social anxiety disorder,
- Obsessive-compulsive disorder,
- Posttraumatic stress disorder,
- Adjustment disorder.
Whether you are a family physician, an ER doctor, a pharmacist, a nurse or nurse practitioner, or a medical student, the information and resources in The Primary Care Toolkit for Anxiety and Related Disorders will add to your clinical primary care knowledge and skills.
About the author
Dr. Bianca Lauria-Horner is an associate professor in the Department of Psychiatry at Dalhousie University and an expert in primary care mental health. She is extensively involved in mental health CME activities and medical training at local, national, and international levels.
Excerpt: Primary Care Toolkit for Anxiety and Related Disorders: Quick, Practical Solutions for Assessment and Management (by (author) Bianca Lauria-Horner)
TOOLKIT OVERVIEW Does This Sound Like You?
It is Friday afternoon at 4:30 p.m.; you are 1 hour behind schedule. A patient who was scheduled for a regular checkup breaks down crying because he or she is at the end of their rope.
Every medical professional knows this feeling well. You feel overwhelmed and helpless, and experience a sense of loss of control. You don’t have the time or energy to help your patient adequately, but you want to carry out your duty to provide care.
Why Was This Toolkit Created?
This toolkit has been designed specifically for primary health care professionals. As a primary care provider, you may ask yourself: why invest time in learning about anxiety and related disorders, aren’t all these conditions more or less managed the same? Anxiety and related disorders are extremely relevant to the primary health care professional as they are among the most common psychiatric conditions, with a lifetime prevalence rate of around 30%. Most patients turn to their primary care provider first for assistance; however, almost one-third of patients will present with other symptoms, such as physical symptoms (e.g., headache, gastrointestinal distress, fatigue) or depression, and if the primary diagnosis is missed, it can lead to a chronic, difficult-to-treat disorder, depression, and/or suicidality. Management specific to anxiety and related disorder subtypes can be quite different depending on the disorder; therefore, early recognition and treatment can alter the course of illness and lead to much better outcomes, early recovery, and improved quality of life for patients.
These factors underscore the need to increase the knowledge and skills of primary care physicians in managing mental illness through education programs. Numerous training programs have been developed to improve the detection and management of mental illness. Despite these efforts, most educational programs do not translate into changes in practice patterns. Although physicians invest a substantial amount of time in continuing medical education (CME) activities, studies have shown a lack of effect of formal CME if these CME initiatives are not associated with enabling or practice-reinforcing strategies. A recent study conducted by Tamburrino et al. suggested that in order for education programs to be effective, family physicians may need to monitor mental illness symptoms closely with the help of protocols and prompts. In addition, physicians best capitalize on professional development that offers distinct, finite opportunities to train for necessary skill sets that can be implemented immediately within the scope of their practice.
However, focusing solely on increasing knowledge and skills is not enough. Barriers that prevent physicians from applying this knowledge need to be taken into account. Studies suggest that one of the top barriers for family physicians in managing mental illness is lack of time. To this end, an educational program that incorporates time-efficient assessment and management strategies would aid in increasing family physicians’ interest and comfort in managing anxiety and related disorders.
How This Toolkit Will Benefit You
As a primary care provider, you probably encounter patients with anxiety and related disorders quite frequently. If you have a busy practice and need access to time efficient, user-friendly strategies and tools, this toolkit is for you. It will guide you through key features of common disorders with the help of case studies. You will work through time-efficient ways to screen, diagnose, and manage common anxiety and related disorders over the course of multiple visits. Some examples of time-efficient assessment and management tools include the following:
- Short screening questionnaires (- Printable patient self-report validated scales.
- Guidelines for pharmacotherapeutic and non-pharmacotherapeutic options.
- Treatment algorithms.
- Visit-by-visit guides.
Particularly complicated or refractory cases will, however, require consultation with or referral to a psychiatric specialist.
As you begin to work through the elements of this toolkit, its benefits will soon become apparent. The toolkit consists of an approach to care that empowers patients and promotes partnership with professionals. Although you will encourage and facilitate the screening, assessment, treatment plan development, monitoring, and management process, the work is shared with your patient, therefore reducing your time involvement while improving patient engagement, compliance, and understanding of the importance of early and timely recovery. This toolkit also has an added bonus of example case studies reflecting real-life practice (e.g., patients presenting to you with somatic symptoms, chronic tension, and comorbid physical disorders, not just obvious psychiatric symptoms).
Guidance on possible choices or actions available to you, combined with disorder-specific treatment strategies, will simplify treatment plan development for your patients, which increases the chances of treatment success. To learn about each disorder, you can follow the diagnosis, treatment, and management of our case study patient. You can progress through the case studies from start to finish, or you can select your own learning path in the Practice Case Study Index, p. xxv. The choice is yours. Well-developed directional strategies such as these empower you to take control.
What You Will Learn by Using This Toolkit
This book includes practical, concise tools that will enhance your ability to detect, assess, and diagnose patients with common anxiety disorders, obsessive-compulsive (OC) and related disorders, and trauma- and stressor-related disorders seen in primary care. You will also:
1. Understand the current treatment strategies that can optimize outcomes for patients with common anxiety, OC and related disorders, and trauma- and stressor-related disorders seen in primary care.
2. Obtain practical approaches for addressing long-term management challenges.
3. Appreciate the importance of functional recovery for patients.
Doody Review: 5 Stars, 100/100 “This is an extremely useful primer on how to approach patients suffering from one of the anxiety disorders, particularly with the screening and diagnostic tools and the guidelines for how to conduct a series of visits to help patients work through their symptoms.”
Vincent F Carr, DO, MSA, FACC, FACP, Uniformed Services University of the Health Sciences