Anxiety in primary care

UCLA Department of Psychology, 405 Hilgard Avenue, Box 951563, Los Angeles, CA 90095-1563, USA.
Current Psychiatry Reports (Impact Factor: 3.24). 09/2006; 8(4):291-7. DOI: 10.1007/s11920-006-0065-4
Source: PubMed


Anxiety disorders are common within primary care (PC) settings and are associated with patient functional impairment, distress, and high utilization of medical care services. Data from PC settings indicate that detection of anxiety disorders is low. Furthermore, adequate psychosocial and pharmacologic treatment of anxiety disorders in accordance with empirically validated guidelines remains low in PC. When patients do receive treatment or referrals from their PC providers, a bias exists for pharmacologic over psychological interventions despite theoretical strengths, empirical evidence, and long-term cost efficiency supporting the use of psychotherapeutic interventions such as cognitive-behavioral therapy (CBT). Objectives of this article include increasing awareness of the prevalence of anxiety disorders in PC, impairment associated with anxiety disorders, issues of detection of anxiety in PC, treatment model and components of CBT, and data supporting the application of CBT to PC to improve patient functioning.

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    • "The goal of the current study was to determine the clinical correlates of frequent telephone healthcare utilization in PD, and to identify potential modifiable risk factors thereof. Based on our clinical observations, preliminary research, [9] [10] and prior findings in the primary care literature [11] [12], we postulated that frequent telephone healthcare utilization in PD would more closely relate to non-motor symptoms – particularly anxiety – than to motor impairment. "
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    ABSTRACT: Patient telephone calls are a major form of unreimbursed healthcare utilization in Parkinson's disease (PD), yet little is known about potential risk factors for frequent calling behavior. Prospective cohort study of 175 non-demented outpatients with PD. Our primary outcome measure was the frequency of patient telephone calls over a three-month period relative to baseline demographics, State-Trait Anxiety Index (STAI) and Beck Anxiety Inventory (BAI) scores, Unified Parkinson's Disease Rating Scale (UPDRS) motor scores, and medication use. Based on the median call rate (1 call/3 months), subjects were dichotomized into frequent (≥2 calls) and infrequent (≤1 call) caller groups. A total of 297 calls were received, of which 264 (89%) were from the frequent caller group (n = 63 subjects), and only 33 (11%) were from the infrequent caller group (n = 112 subjects). Compared with calls from infrequent callers, those from frequent callers more commonly related to somatic symptoms of PD (46.8% vs. 19.4%, p = 0.007). In multivariate logistic regression analysis, independent predictors of frequent calling were: anxiety (STAI ≥55; adjusted OR = 2.62, p = 0.02), sleep disorders (adjusted OR = 2.36, p = 0.02), dyskinesias (adjusted OR = 3.07, p = 0.03), and dopamine agonist use (adjusted OR = 2.27, p = 0.03). Baseline demographics, UPDRS motor scores, and levodopa use were similar in both groups. Frequent patient telephone calls in PD are independently associated with anxiety, sleep disorders, dyskinesias, and dopamine agonist use, with a minority of patients accounting for the majority of calls. Aggressive treatment of these non-motor symptoms and motor complications might potentially reduce the burden of patient telephone calls in PD.
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    • "The patient’s distress increases if he or she cannot be correctly diagnosed, and thus receive adequate treatment or if, after correct diagnosis appropriate treatment is not available in a primary care setting. Such events may mean higher utilization of medical care services (Demertzis and Craske 2006). However, effective psychotherapeutic intervention for primary care patients has been developed (Lang et al 2006). "
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    • "Although anxiety disorders are prevalent, costly, and disruptive to patients' lives, rates of detection and of evidence-based treatment remain low in primary care settings [7]. Surveyed family physicians report that they are much more knowledgeable about effective treatments for depression (88%) compared with panic disorder (17%) and generalized anxiety disorder (13%) [8]. "
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