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Brief intervention for anxiety in primary care patients.
To address the difficulty of assessing and managing multiple anxiety disorders in the primary care setting, this article provides a simple, easy-to-learn, unified approach to the diagnosis, care management, and pharmacotherapy of the 4 most common anxiety disorders found in primary care: panic, generalized anxiety disorders, social anxiety disorders, and posttraumatic stress disorder. This evidence-based approach was developed for an ongoing National Institute of Mental Health-funded study designed to improve the delivery of evidence-based medication and psychotherapy treatment to primary care patients with these anxiety disorders. We present a simple, validated method to screen for the 4 major disorders that emphasizes identifying other medical or psychiatric comorbidities that can complicate treatment; an approach for initial education of the patient and discussion about treatment, including provision of some simple cognitive behavioral therapy skills, based on motivational interviewing/brief intervention approaches previously used for substance use disorders; a validated method for monitoring treatment outcome; and an algorithmic approach for the selection of initial medication treatment, the selection of alternative or adjunctive treatments when the initial approach has not produced optimal results, and indications for mental health referral.
J Am Board Fam Med. 2009 Mar-Apr;22(2):175-86. Roy-Byrne P, Veitengruber JP, Bystritsky A, Edlund MJ, Sullivan G, Craske MG, Welch SS, Rose R, Stein MB. Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Harborview Center for Healthcare Improvement for Addictions, Mental Illness and Medically Vulnerable Populations, Seattle, USA. roybyrne@u.washington.edu
In general, there are three types of mental health disorders with which I am concerned. The first category, and probably most common, involves disorders related to fears, anxieties, trauma, and phobias. These almost always related to learned patterns. Something happened in their mind and body fell to adapt appropriately. The second category is personality disorders. Again, this involves a person's ability to adapt and adjust to the unknown. A personality is normally considered one's beliefs, values, and behaviors. Together these are reflected as patterns. Once something happens that is...
In our culture alcohol consumption has often been synonymous with being socially accepted. Somehow we have linked the ingestion of these liquids, which everyone knows contains toxic substances, to our desire to be socially connected. It has always been the baby boomers version of Facebook and Twitter. In fact, decades ago while serving as a young Army officer, it would have been considered an insult not to share a few “cold ones” with the men as a form of celebration. I’m not saying the Generation X and Y’ers are immune to becoming alcoholics. It seems to be a problem that transcends...
Over the past several years too many people have had to cope with the stress of financial difficulties. Very rarely have these situations been the consequence of poor decisions on the part of the affected individuals. Yet, it is so difficult for someone undergoing such stresses and strains to convince themselves that they are not at fault.
In our society many have always placed an emphasis on finding oneself. Generally, this meant realizing a sense of self-identity. In other words, we want to find out who we are. Often this leads us to seek answers from religious or other spiritual...
