Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of panic disorder, social anxiety disorder and generalised anxiety disorder

Abstract

Objective: To provide practical clinical guidance for the treatment of adults with panic disorder, social anxiety disorder and generalised anxiety disorder in Australia and New Zealand. Method:Relevant systematic reviews and meta-analyses of clinical trials were identified by searching PsycINFO, Medline, Embase and Cochrane databases. Additional relevant studies were identified from reference lists of identified articles, grey literature and literature known to the working group. Evidence-based and consensus-based recommendations were formulated by synthesising the evidence from efficacy studies, considering effectiveness in routine practice, accessibility and availability of treatment options in Australia and New Zealand, fidelity, acceptability to patients, safety and costs. The draft guidelines were reviewed by expert and clinical advisors, key stakeholders, professional bodies, and specialist groups with interest and expertise in anxiety disorders. Results:The guidelines recommend a pragmatic approach beginning with psychoeducation and advice on lifestyle factors, followed by initial treatment selected in collaboration with the patient from evidence-based options, taking into account symptom severity, patient preference, accessibility and cost. Recommended initial treatment options for all three anxiety disorders are cognitive-behavioural therapy (face-to-face or delivered by computer, tablet or smartphone application), pharmacotherapy (a selective serotonin reuptake inhibitor or serotonin and noradrenaline reuptake inhibitor together with advice about graded exposure to anxiety triggers), or the combination of cognitive-behavioural therapy and pharmacotherapy.

Link-me: Protocol for a randomised controlled trial of a systematic approach to stepped mental health care in primary care

“…Stepped mental health care is both recommended by clinical guidelines [24,62,63] and a focus of current policy direction in Australia [12]. However, tools to guide decisions around which 'step' of care to allocate an individual to are lacking.…”

Anxiety Disorders - Assessment and Management in General Practice

“…Three recently published CPGs on anxiety disorders were reviewed namely, the Australian New Zealand guideline (2018) 2 , the Singapore MOH guideline (2015) 3,4 , and the Canadian guideline (2014) 5 . Useful and new information from these guidelines have been included into this article where relevant.…”

<p>Cognitive Behavioral Therapy for People with Chronic Obstructive Pulmonary Disease: Rapid Review</p>

“…1 For generalized anxiety and depressive disorders, a stepped approach to management is recommended where the least intrusive and most effective intervention (non-pharmacological with or without pharmacotherapy) is devised in collaboration with the patient based on severity of the disorder, previous response to management, availability and patient preference. 1,3 In general, stepped approaches move from least intrusive options (education about the disorder and active monitoring) to low-resource-intensive interventions (individual self-help such as written or electronic self-help materials (bibliotherapy) with no or minimal therapist involvement and psychoeducational groups). Where there is minimal response or symptoms are more severe, high-resource-intensive interventions are considered (therapist facilitated individual CBT, applied relaxation, psychodynamic therapy, non-directive therapies and counselling, or more specialized and complex psychological treatments) with or without pharmacotherapy.…”

“…Where there is minimal response or symptoms are more severe, high-resource-intensive interventions are considered (therapist facilitated individual CBT, applied relaxation, psychodynamic therapy, non-directive therapies and counselling, or more specialized and complex psychological treatments) with or without pharmacotherapy. 1,3 In people living with COPD, anxiety and depression are comorbidities associated with poorer prognosis. 4 In this population, a range of systematic reviews have been published specific to the impact of psychological interventions on psychological (anxiety, depression, quality of life) [5][6][7][8][9][10] or psychological and physical health outcomes.…”