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Anxiety

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					Draft Care Pathway - Anxiety

Panic Disorder and generalised anxiety disorder.


Diagnosis

Anxiety is a feeling of unease, such as worry or fear. Many people have anxiety disorders in
Britain, about 1 in 20 adults have generalised anxiety disorder and 1 in 100 have panic
disorder.


Generalised Anxiety Disorder (GAD)

People with GAD have feelings that include feeling constantly edgy, irritable or worried; they
may have difficulty concentrating and have trouble sleeping.


Panic Disorder

People with Panic Disorder often feel panicky or anxious and may make changes to their
lives in order to avoid situations that make them feel this way.

It may take several consultations with your G.P. before a diagnosis is made as the symptoms
can be vague and can be related to other health conditions.

Once a diagnosis has been made you will be offered different levels of care depending on
your need.


Care Options

Your G.P. is likely to be the first person you will see. She/he will ask a number of questions
relating to your personal circumstances, including any medication or other substances you
are taking.

Following this, all of the options for treatment should be discussed with you and a care plan
developed. You should also be offered information about your condition and about any
national and local voluntary groups that can also provide support.


Treatment

Psychological therapies – (talking therapies). Medication and self-help groups have all been
shown to be effective treatments. All of these options should be discussed with you so you
can make a decision as to which is best for you based on your individual preferences and
circumstances.

Psychological Therapy

Cognitive Behavioural Therapy (CBT). Its focus is on helping people to change unhelpful
thoughts and behaviours in order to reduce their distress. If you are offered CBT you should
have the process fully explained to you. [Info on CBT].
Medication

If you and your G.P. decide on medication you should be offered an anti-depressant.
There are a number of different anti-depressants that can help in your treatment. [Info on anti-
depressants].


Your G.P. should discuss with you how it will work and all its potential side effects.

When you and your G.P. decide that it is time to stop your medication it is important that it is
done slowly, with the dosage reduced gradually over a period of time. If you experience any
problems with this you should seek advice from your G.P.


Special issues for women who are pregnant or planning a pregnancy

You should be given information about contraception. Taking medication in pregnancy can
entail risks for the baby but if you stop treatment there is also the risk you could become
seriously unwell again. You will need to have discussions with your Doctor who will advise
you on what the best options are. [Link to information leaflet/website].


Self Help

There are a number of things you can do yourself that can be successful; these can include a
programme of bibliotherapy which was written material based on the principles of CBT.

Access to support groups that are often run by people who have had the experience.

You should continue to see your G.P. or other primary healthcare professional regardless of
the chosen treatment option.

Treatment if you are referred to a specialist Mental Health Service: If you have tried a
number of treatments and don’t feel any better your G.P. should discuss with you whether
you wish to have an appointment with a specialist Mental Health professional such as a
Psychiatrist, Psychiatric Nurse, Psychologist, Occupational Therapist or Social Worker.
Whoever you see will undertake reassessment of your condition to understand the
background to your situation. She/he will also review your medication to ensure that the best
option is available to you.

If your condition is severely affecting how you manage your daily life or that of your family, or
other carers, the mental health professional may suggest providing support during the day,
that could be to attend a day centre or hospital.


Physical Health

When you have a problem such as generalised anxiety or panic disorder it is sometimes
easy to let your physical health slip as well.

You should have your physical health checked by your G.P. and be given advice on how to
lead a healthy lifestyle.
Help for families and carers

If someone in your family has Bipolar disorder healthcare professional should give you
information about the illness and any treatments that can help. You should also be offered
an assessment of your needs. You should also be advised about any support groups for
families and carers.