Management of generalised anxiety disorder in adults: Summary of NICE guidance

ArticleinBMJ (online) 342(jan26 1):c7460 · January 2011with27 Reads
DOI: 10.1136/bmj.c7460 · Source: PubMed
    • "In conclusion, the findings of this meta-analysis suggest that duloxetine is a moderately effective pharmacological treatment option for patients with GAD, with the advantage of improvement in overall function and good tolerability. This is consistent with previous and current treatment guideline (Kendall et al., 2011; Bandelow et al., 2012). Drug names: duloxetine (or Cymbalta). "
    [Show abstract] [Hide abstract] ABSTRACT: We carried out a meta-analysis of published randomized, double-blind, placebo-controlled trails to assess the efficacy and tolerability of duloxetine in treating generalized anxiety disorder (GAD). A literature search was conducted using PubMed, ISI Web of Science, Medline, Cochrane Central Register of Controlled Trials databases until October 2014. The search terms used were "anxiety or anxious or generalized anxiety disorder" and "duloxetine or Cymbalta." Meta-analysis was conducted using Revman 5.1. A fixed-effects model was carried out on the response rates, remission rates, and symptom improvement. Risk ratio (RR) and mean difference (MD) were calculated. The overall effect size was calculated with 95% confidence intervals (CIs). Seven studies (n = 2,674) were found eligible for inclusion in analysis. Six studies provided data on response, which showed a significant difference between duloxetine and placebo (n = 1,975, RR = 1.48, 95% CI, 1.34-1.63). Remission rates revealed significant superiority of duloxetine (n = 2,399, RR = 1.60, 95% CI, 1.43-1.80). Change from baseline scores on Hamilton Rating Scale for Anxiety showed a reduction in anxiety symptoms to be significantly efficient for duloxetine (n = 1,135, MD = 3.34, 95% CI, 2.37-4.32). Duloxetine increased statistically Sheehan Disability Scale total score (n = 1,652, MD = 2.84, 95% CI, 2.08-3.60). The discontinuation of the duloxetine was not significantly different from that of the placebo. Duloxetine is moderately effective in treating GAD with improvement in overall function and well tolerability. © 2015 Wiley Publishing Asia Pty Ltd.
    Full-text · Article · Aug 2015
    • "As most somatic problems in this patient group are already dealt with in usual care, the largest effects are likely to be gained by care (programmes) which address psychological problems and which try to strengthen the self-efficacy of patients (mastery) [50]. Although treatment of anxiety and depression has been shown to be effective51525354555657, its effect in preventing persistence of FAs is unclear and needs to be demonstrated in research [58]. In light of the budget problems in many healthcare systems and the high costs of (persisting) FAs not explained by known morbidity, development and testing of interventions to diminish persistence of frequent attendance might be beneficial for these patients and might reduce ex- penditures [6,58]. "
    [Show abstract] [Hide abstract] ABSTRACT: Background: Patients who visit their General Practitioner (GP) very frequently over extended periods of time often have multimorbidity and are costly in primary and specialist healthcare. We investigated the impact of patient-level psychosocial and GP-level factors on the persistence of frequent attendance (FA) in primary care. Methods: Two-year prospective cohort study in 623 incident adult frequent attenders (>90th attendance centile; age and sex-adjusted) in 2009. Information was collected through questionnaires (patients, GPs) and GPs' patient data. We used multilevel, ordinal logistic regression analysis, controlling for somatic illness and demographic factors with FA in 2010 and/or 2011 as the outcome. Results: Other anxiety (odds ratio (OR) 2.00; 95% confidence interval from 1.29 to 3.10) over 3years and the number of life events in 3years (OR 1.06; 1.01-1.10 per event; range of 0 to 12) and, at baseline, panic disorder (OR 5.40; 1.67-17.48), other anxiety (OR 2.78; 1.04-7.46), illness behavior (OR 1.13; 1.05-1.20 per point; 28-point scale) and lack of mastery (OR 1.08; 1.01-1.15 per point; 28-point scale) were associated with persistence of FA. We found no evidence of synergistic effects of somatic, psychological and social problems. We found no strong evidence of effects of GP characteristics. Conclusion: Panic disorder, other anxiety, negative life events, illness behavior and lack of mastery are independently associated with persistence of frequent attendance. Effective intervention at these factors, apart from their intrinsic benefits to these patients, may reduce attendance rates, and healthcare expenditures in primary and specialist care.
    Full-text · Article · Aug 2014
    • "Participants with tricyclic's mainly complained about anticholinergic side effects, participants in the SSRI or SNRI groups reported sexual dysfunction, weight gain and increased nervousness as primary reasons to refuse further pharmacological treatment. However, as the acceptance profile of SSRIs/SNRIs is usually better and side effects are less severe, these drugs are primarily recommended as first line standard treatment of (Kapczinski, et al., 2003; Kendall, et al., 2011). "
    [Show abstract] [Hide abstract] ABSTRACT: Five types of intervention may be of special relevance and in consequence have been included in treatments targeting generalized anxiety disorder (GAD) symptomology: metacognitive therapy targeting both negative and positive metacognitions concerning worrying; fear imagery exposure, based on the avoidance theory of worrying; interventions developed to increase tolerance of uncertainty; relaxation exercises; and finally, treatment modules focusing on negative problem orientation. This chapter first describes the diagnostic procedures most helpful for the preparation of treatment and then the treatment modules. All these modules have been included in manualized treatments, which have been evaluated with regard to their efficacy in a number of RCTs. The chapter presents an overview of the evidence for the efficacy of variations of this cognitive-behavioral treatment (CBT). Applied relaxation is one of the most regularly used components within standard CBTs for GAD. Besides cognitive-behavioral therapy and psychodynamic psychotherapy, pharmacotherapy offers another evidence-based treatment option for GAD.
    Chapter · Apr 2014 · Journal of Psychosomatic Research
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