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School of Health and Related Research (ScHARR), University of Sheffield. Clinical Guidelines for the Management of Anxiety: Management of Anxiety (Panic Disorder, with or without Agoraphobia, and Generalised Anxiety Disorder) in Adults in Primary, Secondary and Community Care [Internet]. London: National Collaborating Centre for Primary Care (UK); 2004 Dec. (NICE Clinical Guidelines, No. 22.)

  • This publication is provided for historical reference only and the information may be out of date.

This publication is provided for historical reference only and the information may be out of date.

Cover of Clinical Guidelines for the Management of Anxiety

Clinical Guidelines for the Management of Anxiety: Management of Anxiety (Panic Disorder, with or without Agoraphobia, and Generalised Anxiety Disorder) in Adults in Primary, Secondary and Community Care [Internet].

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Appendix 18Key clinical questions

The guideline development group identified the following pathway and clinical questions for consideration in the guideline. The pathways and questions were the same for generalised anxiety disorder and panic disorder. GAD is used in this appendix for illustrative purposes.

Presentation to a healthcare professional

Person presents with:

Image appendixes.app18fu1
  • other psychological or physical symptoms
  • worries about social, financial or other issues
  • excessive worry (over and above worries re money, etc.)

The health care professional may ask questions to arrive at a working diagnosis of GAD.

Image appendixes.app18fu2

To confirm diagnosis of GAD

Image appendixes.app18fu3

Screening tools may also be used to arrive at a diagnosis other than GAD

Interventions may be offered at time of working diagnosis.

Interventions may be offered at time of (‘definite’) diagnosis.

Discussion of treatment options

What works for whom, and how is it best delivered.

What pharmacological treatments are effective, not effective, have no evidence available to determine effectiveness.

What psychological treatments are effective, not effective, have no evidence available to determine effectiveness.

Which combinations of treatment are effective.

Which combinations may result in interactions that affect effectiveness, or lead to harm.

What interventions are (may be) harmful.

What self care interventions are effective, not effective or have no evidence available to determine effectiveness.

What factors (predicting, mediating, modulating) help predict efficacy, e.g.

  • duration of symptoms
  • ethnicity
  • gender
  • severity

Which skills are required to deliver specific treatments.

Treatment considerations

Is there a treatment of choice?

What are other acceptable treatments?

Are there timing issues

  • time of treatment from presentation?
  • timing of treatment in ‘illness’?

What is an adequate trial of therapy?

If signs and symptoms reappear what treatment should be considered/offered

  • same
  • different

What follow up should take place?

Outcomes

How do you know you are better.

How does a health care professional know you are better.

What does getting better mean.

  • high end state functioning
  • reduction/removal some/all symptoms

Interventions considered

The complete lists of interventions searched for are listed in Appendix 19.

Copyright © 2004, National Collaborating Centre for Primary Care.
Bookshelf ID: NBK45858

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