30 - The treatment of anxiety disorders in primary care  pp. 348-355

The treatment of anxiety disorders in primary care

By Mayumi Okuda, Sharaf S. Khan, Ana Alicia De La Cruz and Carlos Blanco

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Introduction

Anxiety disorders are common in primary care, affecting approximately 10% of patients (Sartorius et al. 1996). During a one-year period, approximately 84% of adults with a probable anxiety disorder receive care in a primary care setting. However, the quality of the care received is often limited. Only 18% receive appropriate pharmacotherapy and 11% appropriate counseling (Young et al. 2001). In university-affiliated primary care practices, the rate of appropriate treatment for anxiety disorders may be higher, around 40%, although the proportion of patients who receive adequate dosage and duration is only around 25%, and the rate of counseling is only 10% (Stein et al. 2004).

This chapter reviews the treatment of anxiety disorders in primary care. Topics explored include medication effectiveness (e.g., sertraline, venlafaxine, pregabalin, herbal medication) and use of psychosocial interventions (e.g., cognitive–behavioral therapy, lifestyle modification therapy). We also describe studies that implement organizational and educational interventions aimed at improving quality of care for anxiety disorders in primary care, such as the collaborative care model. The chapter ends with some considerations about future directions in the treatment of anxiety disorders in primary care.

Pharmacological treatments

At present, selective serotonin reuptake inhibitors (SSRIs) and serotonin–norepinephrine reuptake inhibitors (SNRIs) are considered the first-line pharmacological treatment for anxiety disorders.

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