Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders

Abstract

BackgroundAnxiety and related disorders are among the most common mental disorders, with lifetime prevalence reportedly as high as 31%. Unfortunately, anxiety disorders are under-diagnosed and under-treated.MethodsThese guidelines were developed by Canadian experts in anxiety and related disorders through a consensus process. Data on the epidemiology, diagnosis, and treatment (psychological and pharmacological) were obtained through MEDLINE, PsycINFO, and manual searches (1980–2012). Treatment strategies were rated on strength of evidence, and a clinical recommendation for each intervention was made, based on global impression of efficacy, effectiveness, and side effects, using a modified version of the periodic health examination guidelines.ResultsThese guidelines are presented in 10 sections, including an introduction, principles of diagnosis and management, six sections (Sections 3 through 8) on the specific anxiety-related disorders (panic disorder, agoraphobia, specific phobia, social anxiety disorder, generalized anxiety disorder, obsessive-compulsive disorder, and posttraumatic stress disorder), and two additional sections on special populations (children/adolescents, pregnant/lactating women, and the elderly) and clinical issues in patients with comorbid conditions.ConclusionsAnxiety and related disorders are very common in clinical practice, and frequently comorbid with other psychiatric and medical conditions. Optimal management requires a good understanding of the efficacy and side effect profiles of pharmacological and psychological treatments.

Self-management of mood and/or anxiety disorders through physical activity/exercise

“…at least once a week), highlighting an opportunity for improvement in the care and management of such individuals. Even though physical activity/exercise is usually considered an adjunct therapy to conventional clinical treatment (medication and/or psychotherapy) in most clinical guidelines, [34][35][36] it could also be used as a first-line, low-intensity intervention for mild-to-moderate mood and anxiety disorders, along with other self-management strategies. 6,37,38 Findings from this study show that affected Canadians who were less likely to engage in physical activity/exercise were older, less educated, belonged to the lowest income quintiles and resided in Ontario and the Atlantic provinces compared to those who engaged.…”

Use of pregabalin for therapy of patients with generalised anxiety disorder - pilot investigation: Review of case studies

“…Zbog toge postoji preporuka je da se pacijentima sa generalizovanim anksioznim poremećajem za početak lečenja odredi terapija koja je pokazala efikasnost, a nema neželjena dejstva koja mogu da kompromituju tretman [5,6]. Pored toga, treba da se obrati pažnja na eventualno postojanje komorbidih oboljenja (pre svega depresije), ali i na praktične aspekte -kao što su iskustva sa terapijom, dostupnost terapije i lekara za buduće kontrole, ekonomske mogućnosti pacijenta, preference samog pacijenta i slično.…”

“…Što se tiče farmakoterapije, na osnovu kliničkog iskustva i na osnovu rezultata kliničkih studija, a na bazi potvrđene efikasnosti i najbenignijeg profila neže-ljenih dejstava, preporuka je da se pacijenti sa generalizovanim anksioznim poremećajem tretiraju nekim lekom iz grupe SSRI antidepresiva (citalopram, escitalopram, fluoksetin, paroksetin, sertralin), nekim lekom iz grupe iz grupe SNRI antidepresiva (duloksetin ili venlafaksin) ili pregabalinom, ukoliko ne postoje simptomi komorbidne depresije [5,6,7].…”

Management of panic disorder in primary care

“…Once the diagnosis has been explained to the patient, it is often reasonable to give a hopeful prognosis, outline the available treatments and negotiate a treatment package. Table 2) have been shown to be effective against the symptoms of panic disorder 13,14 and clinical studies have demonstrated high rates of efficacy -up to 80 per cent in some trials using drugs originally developed for depression (antidepressants). Among antidepressants, citalopram, escitalopram, paroxetine, sertraline and certain formulations of venlafaxine are licensed specifically for panic disorder.…”