New guidelines say that asymptomatic adults between the ages of 19 and 64, including those who are pregnant or postpartum, should be screened for anxiety disorders using questionnaires and other screening tools.
A task force announced last fall that it would recommend screening for anxiety disorders, but waited for public comment before making a final recommendation. In October, the group recommended screening for anxiety disorders for children ages 8 to 18.
The group, an independent panel of physicians and other experts appointed by the Department of Health and Human Services to evaluate care for prevention and early detection, is evaluating the benefits and risks of anxiety screening for people with anxiety. It said it did not find enough evidence to evaluate. 65 years of age or older.
Previous guidelines from the Task Force recommended screening for depression but not for anxiety disorders. Anxiety disorders are estimated to affect approximately 19 percent of US adults in the past year and affect 31 percent at some point in their lives. data shows. Experts say the new advice could help clinicians assess, diagnose and treat anxiety disorders earlier, resulting in improved outcomes for patients.
“Many patients who come to primary care may be experiencing symptoms but don’t bring them up,” he said, often due to the stigma surrounding mental health issues. . Michael Silverstein, Vice-Chair of the Task Force. “This means it is important to find patients and relieve their burden early, rather than waiting to see a doctor with signs and symptoms.”
Michael Albert, Chief of Internal Medicine, Johns Hopkins University Community Physician’s Office, said the recommendations would address existing shortfalls in mental health resources, including improved loan relief and insurance reimbursement for students entering mental health professions. He said he hopes that this will be the basis for Companies for Mental Health Care — Enabling better access to mental health care.
“I applaud the USPSTF’s recommendations,” he said. “We hope to see big changes at the national level in what is needed to increase access to the services that patients need.”
The task force strengthened previous recommendations to screen for depression among the same adult population.
“potential bottleneck”
Despite the increased workload and demand for medical and mental health professionals, many primary care clinicians already evaluate patients for anxiety disorders on a case-by-case basis. The new recommendations will only make it standard practice across the adult patient population.
Many people have undiagnosed anxiety disorders. Anxiety disorders include generalized anxiety, separation anxiety, social anxiety, and phobias.
Screening them would almost certainly increase the number of people diagnosed and treated, putting pressure on an already overburdened mental health system.
“There are many professionals who are already pushing themselves to the limit to serve people with anxiety disorders and depression that have become persistent and chronic and require more effort and energy. There are potential bottlenecks at first,” he said. Lynn Bufka, Associate Chair of the Practice Change Division of the American Psychological Association. “If some of these people had received help sooner, they might not have needed so much care.”
“If people can begin to transition sooner to the level of care that meets their needs, it will be beneficial to the balance within the system in the long run.” Bufka said.
Many people with undiagnosed anxiety disorders may be unaware of their symptoms, which experts say can come in many forms, from physical symptoms to physical symptoms. It is said that there is
“People who suffer from gastrointestinal disease, pain, and sleep problems are often unaware that underlying anxiety problems may be contributing,” he said. Natalie Dattiloclinical psychologist at Brigham and Women’s Hospital, and lecturer at Harvard Medical School.
“I have met people who have struggled with anxiety for too long and have come to accept it as who they are,” Dattilo said. These patients “don’t understand how their anxiety prevents them from acting and how much their lives are limited as a result.”
In making its recommendations, the Task Force considered research on a number of scales that can be used to screen for anxiety disorders.
1 screening toolFor example, ask the patient to rate potential anxiety symptoms over the past two weeks. At that time, how often did you feel “tensed, anxious, irritable”, “I was so restless that it was difficult to sit still”, or “I was afraid that something terrible would happen” . Experts say such questionnaires could be provided to patients as part of a form they complete before their primary care visit.
Primary care physicians can prescribe medications such as selective serotonin reuptake inhibitors (SSRIs), but patients who want or need non-pharmacological therapies such as psychotherapy or talking therapy should seek help from social workers, counselors, You will be referred to a therapist, including a therapist. psychologist.
Psychiatrists will take over medication management when the severity of the illness is too complex for the primary care physician to manage with medication, he said. Petros LevounisPresident of the American Psychiatric Association.
Mental health professionals say that once patients test positive for anxiety disorders, they should also be evaluated for often comorbid depression and suicide risk.
The task force also considered suicide risk, but said there was not enough evidence to assess the benefits and risks of suicide screening, instead calling for more research to help make that determination.
Limitations of Anxiety Testing
Some therapists expressed concern about overreliance on drugs, as frontline primary care physicians are only capable of prescribing drugs rather than providing psychotherapy.
“The drugs are effective, but when you stop taking the drugs, the symptoms are likely to return,” he said. erlanger turnerAssociate Professor of Psychology, Pepperdine University.
Turner also said she was concerned about the possible overdiagnosis of anxiety disorders in communities of color. Racism and discrimination can cause higher levels of anxiety at certain points, he said.
“We want you to realize that just because you have these issues, such as feeling irritable or worrying frequently, doesn’t mean you have an anxiety disorder per se. is,” he says. “We want to recognize that anxiety is normal and that there is a continuum from mild to severe symptoms.”
In the editorial accompanying their recommendations, the authors argued that anxiety is a symptom, not a disorder, and that it is associated with various stress-inducing situations and related mental health conditions such as depression and post-traumatic stress disorder. , or may arise from physical health conditions. such as thyroid disease.
“Adoption of these new anxiety screening recommendations should provide a catalyst and opportunity for primary care clinicians to become more familiar with diagnosing and treating anxiety disorders, which may require additional training. potential,” the researchers wrote. “Anxiety disorders can cause distress and disability, and proper recognition and treatment can be life-changing and, in some cases, life-saving.”
