{"id":3708,"date":"2022-05-03T11:47:20","date_gmt":"2022-05-03T10:47:20","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/anxietypanicphobiasadults\/"},"modified":"2024-10-01T15:08:00","modified_gmt":"2024-10-01T14:08:00","slug":"anxietypanicphobiasadults","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/mentalhealthadult\/anxietypanicphobiasadults\/","title":{"rendered":"Anxiety, Panic and Phobias (Adults)"},"content":{"rendered":"\nAnxiety, Panic and Phobias (Adults)<\/title>\n\n\n\n<p><strong>Description<\/strong><\/p>\n\n\n\n<p>Anxiety is a normal and common part of life: it is often temporary and may be triggered by a specific stressful event.  However it can become persistent and intense, interfering with daily routines and activities.  <\/p>\n\n\n\n<p>Anxiety disorders include phobias, general anxiety, panic or persistent unexplained physical symptoms (see <a href=\"\/refhelp\/guidelines\/Medicallyunexplainedsymptons\" target=\"_blank\" rel=\"noreferrer noopener\">Medically unexplained symptons.aspx<\/a> Medically unexplained symptoms). Mild to moderate anxiety disorders can be managed in Primary Care. Those with severe symptoms or who have not responded to initial management can be referred via SCI Gateway.   <\/p>\n\n\n\n<p>Please note that RefHelp also gives guidance on Stress and Emotional Difficulties <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/stressemotionaldifficulties\/\" data-type=\"URL\" data-id=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/stressemotionaldifficulties\/\" target=\"_blank\" rel=\"noreferrer noopener\">Stress and Emotional Crises.aspx<\/a> and Trauma \/ PTSD <a rel=\"noreferrer noopener\" href=\"\/refhelp\/guidelines\/TraumaPTSDAdults\" target=\"_blank\">Trauma\/PTSD Adults.aspx<\/a> which may be relevant.  <\/p>\n\n\n\n<p>cCBT is ideal for those with mild to moderate anxiety (and those with panic can also be referred).  <\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Please see the Primary Care Management page for further details on Generalised Anxiety Disorder and Panic Disorder. <\/h4>\n\n\n\n<h4 class=\"wp-block-heading\"><span>Locality Services  <\/span><\/h4>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">Who to refer:<\/h4>\n\n\n\n<p>NICE recommends a stepped care approach to Generalised Anxiety Disorder (GAD) \u2013 those who do not respond to initial Primary Care management (levels 1 & 2), or who are significantly functionally impaired. NICE identifies these patients as:<br>Level 3 \u2013 inadequate response to initial approaches or marked functional impairment. Recommend high-intensity psychological intervention (CBT) or drug therapy.<br>Level 4 – Complex treatment-refractory GAD and very marked functional impairment (e.g. self-neglect or a high risk of self-harm). Recommend referral for treatment, both pharmacological and\/or psychological with likely complex input from multi-agency teams.<br>Those with specific phobias, OCD and other anxiety disorders may also need referral.<br>Some patients with moderate to severe panic disorder, not responding to Primary Care management may need referral for CBT or consideration of antidepressant or other therapies.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Who not to refer:<\/h4>\n\n\n\n<p>Those with mild to moderate symptoms, without major impairment \u2013 see Primary Care Management.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">How to refer:<\/h4>\n\n\n\n<p>Please refer via SCI Gateway. A GAD questionnaire is useful <a href=\"\/files\/sites\/2\/Mental-Health-Depression-GAD7-Scoring.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Mental Health – GAD7 Scoring.pdf<\/a> , and an outline of approaches tried to date.<br>Patient leaflets \/ info \u2013 add in<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">GENERALISED ANXIETY DISORDER<\/h4>\n\n\n\n<p>Some patients present with new symptoms of anxiety but have another physical or mental health problem which may need further assessment (agitated depression, alcohol or substance misuse, thyrotoxicosis, rarely psychosis).<br>NICE identifies level 1 approaches for everyone with GAD, and level 2 for those who have not responded to initial discussion and education:<br>Level 1 \u2013 identify, discuss, educate, monitor progress.<br>Level 2 \u2013 for those not responding to above, consider low intensity psychological interventions (self-help, guided self-help and psychoeducational groups).<br>SSRIs may be used for patients with more severe symptoms.<\/p>\n\n\n\n<p>Please see resources for details of services especially Stress Classes\/pages \u2013 link to printable patient resource<\/p>\n\n\n\n<p><strong><a href=\"\/files\/sites\/2\/Mental-Health-Health-in-Mind-Guided-Self-Help-Service-info.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Mental Health- Health in Mind Guided Self Help Service info.pdf<\/a><\/strong><\/p>\n\n\n\n<p><strong><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/GSH-Referral-Form-Edinburgh-April-2021.doc\" data-type=\"link\" data-id=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/GSH-Referral-Form-Edinburgh-April-2021.doc\" target=\"_blank\" rel=\"noreferrer noopener\">Mental Health- GSH Referral Form Edinburgh – April 2020.pdf<\/a><\/strong><\/p>\n\n\n\n<p><strong><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/MH-Anxiet-PP-Midlothian-Referral-Form-May20.pdf\" data-type=\"URL\" data-id=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/MH-Anxiet-PP-Midlothian-Referral-Form-May20.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Mental Health- Midlothian Referral Form May20.pdf<\/a><\/strong><\/p>\n\n\n\n<h4 class=\"wp-block-heading\">PANIC DISORDER.<\/h4>\n\n\n\n<p>NICE emphasises the need for good communication and explanation, and that treatment in Primary Care has advantages over that in secondary care settings. It is crucial to make a clear positive diagnosis and especially important not to overlook physical or mental health co-morbidity. There are no validated screening tools to aid diagnosis.<br>Management approaches with an evidence base:<br>\u00b7 Explanation and helping the patient understand their symptoms is key, supported by written information<br>\u00b7 Self help and support groups<br>\u00b7 Exercise<br>\u00b7 CBT for those with moderate to severe symptoms.<br><strong>To see the range of services offered in Lothian please view the Refhelp section on <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/mentalhealthpsychologyotherservices\/\" data-type=\"URL\" data-id=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/mentalhealthpsychologyotherservices\/\" target=\"_blank\" rel=\"noreferrer noopener\">Psychology Behavioural SERVICES Adult.aspx<\/a><\/strong><br>NICE advises against the use of benzodiazepines, antihistamines or antipsychotics. For those with more severe symptoms, antidepressants may help.<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">Scoring Tools<\/h4>\n\n\n\n<p><strong>GAD-7 Anxiety Severity.<\/strong><br>The GAD-7 score is calculated by assigning scores of 0, 1, 2, and 3, to the response categories of \u201cnot at all,\u201d \u201cseveral days,\u201d \u201cmore than half the days,\u201d and \u201cnearly every day,\u201d respectively. GAD-7 total score for the seven items ranges from 0 to 21.<br>Scores represent: 0-5 mild 6-10 moderate 11-15 moderately severe anxiety 15-21 severe anxie\u200bty<\/p>\n\n\n\n<p><a href=\"\/files\/sites\/2\/Mental-Health-Depression-GAD7-Scoring.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Mental Health – GAD7 Scoring.pdf<\/a><\/p>\n\n\n\n<p><a href=\"http:\/\/www.foundationforpositivementalhealth.com\/positive-mental-training\/\" target=\"_blank\" rel=\"noreferrer noopener\">Foundation for Positive Mental Training<\/a><\/p>\n\n\n\n<p>There are Stress Control Classes available in Edinburgh, East and Mid Lothian for anyone over eighteen wishing to learn how to manage stress more effectively. For further details please see: <a href=\"https:\/\/services.nhslothian.scot\/StressControl\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/services.nhslothian.scot\/StressControl <\/a>Link to Patient Information from Health in Mind Service <\/p>\n\n\n\n<p><a href=\"http:\/\/health-in-mind.org.uk\/services\/guided_self_help\/d7\/\" target=\"_blank\" rel=\"noreferrer noopener\">http:\/\/health-in-mind.org.uk\/services\/guided_self_help\/d7\/<\/a><\/p>\n\n\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Anxiety, Panic and Phobias (Adults) Description Anxiety is a normal and common part of life: it is often temporary and may be triggered by a specific stressful event.  However it can become persistent and intense, interfering with daily routines and activities.  Anxiety disorders include phobias, general anxiety, panic or persistent unexplained physical symptoms (see Medically<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":4125,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[316],"class_list":["post-3708","page","type-page","status-publish","hentry","category-anxietypanicphobiasadults"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/mentalhealthadult\/anxietypanicphobiasadults\/\" rel=\"tag\">Anxiety Panic Phobias (Adults)<\/a>","rttpg_excerpt":"Anxiety, Panic and Phobias (Adults) Description Anxiety is a normal and common part of life: it is often temporary and may be triggered by a specific stressful event.  However it can become persistent and intense, interfering with daily routines and activities.  Anxiety disorders include phobias, general anxiety, panic or persistent unexplained physical symptoms (see Medically","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3708","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=3708"}],"version-history":[{"count":10,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3708\/revisions"}],"predecessor-version":[{"id":21012,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3708\/revisions\/21012"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4125"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=3708"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=3708"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}