scholarly journals The German Guidelines for the treatment of anxiety disorders: first revision

2021 ◽  
Author(s):  
Borwin Bandelow ◽  
Antonia M. Werner ◽  
Ina Kopp ◽  
Sebastian Rudolf ◽  
Jörg Wiltink ◽  
...  
Keyword(s):  
Anxiety Disorders ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Psychological Treatment ◽  
Behavioral Therapy ◽  
Treatment Plan ◽  
Individual Treatment ◽  
Level Of Evidence ◽  
Randomized Controlled Studies ◽  
Noradrenaline Reuptake ◽  
Virtual Reality Exposure

AbstractStarting in 2019, the 2014 German Guidelines for Anxiety Disorders (Bandelow et al. Eur Arch Psychiatry Clin Neurosci 265:363–373, 2015) have been revised by a consensus group consisting of 35 experts representing the 29 leading German specialist societies and patient self-help organizations. While the first version of the guideline was based on 403 randomized controlled studies (RCTs), 92 additional RCTs have been included in this revision. According to the consensus committee, anxiety disorders should be treated with psychotherapy, pharmacological drugs, or their combination. Cognitive behavioral therapy (CBT) was regarded as the psychological treatment with the highest level of evidence. Psychodynamic therapy (PDT) was recommended when CBT was not effective or unavailable or when PDT was preferred by the patient informed about more effective alternatives. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-noradrenaline reuptake inhibitors (SNRIs) are recommended as first-line drugs for anxiety disorders. Medications should be continued for 6–12 months after remission. When either medications or psychotherapy were not effective, treatment should be switched to the other approach or to their combination. For patients non-responsive to standard treatments, a number of alternative strategies have been suggested. An individual treatment plan should consider efficacy, side effects, costs and the preference of the patient. Changes in the revision include recommendations regarding virtual reality exposure therapy, Internet interventions and systemic therapy. The recommendations are not only applicable for Germany but may also be helpful for developing treatment plans in all other countries.

scholarly journals Treatment of anxiety disorders

2017 ◽  
Vol 19 (2) ◽  
pp. 93-107 ◽  
Keyword(s):  
Anxiety Disorder ◽  
Anxiety Disorders ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Burden Of Illness ◽  
Behavioral Therapy ◽  
Treatment Plan ◽  
Treatment Options ◽  
Level Of Evidence ◽  
Randomized Controlled Studies ◽  
Meta Analyses

Anxiety disorders (generalized anxiety disorder, panic disorder/agoraphobia, social anxiety disorder, and others) are the most prevalent psychiatric disorders, and are associated with a high burden of illness. Anxiety disorders are often underrecognized and undertreated in primary care. Treatment is indicated when a patient shows marked distress or suffers from complications resulting from the disorder. The treatment recommendations given in this article are based on guidelines, meta-analyses, and systematic reviews of randomized controlled studies. Anxiety disorders should be treated with psychological therapy, pharmacotherapy, or a combination of both. Cognitive behavioral therapy can be regarded as the psychotherapy with the highest level of evidence. First-line drugs are the selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors. Benzodiazepines are not recommended for routine use. Other treatment options include pregabalin, tricyclic antidepressants, buspirone, moclobemide, and others. After remission, medications should be continued for 6 to 12 months. When developing a treatment plan, efficacy, adverse effects, interactions, costs, and the preference of the patient should be considered.

Onco-specific sleep disorders and fatigue: tactics of psychological test and cognitive behavioral therapy

2021 ◽  
Vol LIII (3) ◽  
pp. 51-63
Author(s):  
Aleksey I. Melehin
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Sleep Disorders ◽  
Cancer Patients ◽  
Behavioral Therapy ◽  
Treatment Plan ◽  
Cognitive Behavioral ◽  
Individual Treatment ◽  
Team Approach ◽  
Oncological Patient ◽  
Psychological Assistance

Introduction. Sleep disorders are widespread throughout the entire period of treatment of an oncological patient from the moment of diagnosis, and in many patients persist after completion of treatment. The nature of cancer and its treatment expose patients to many potential provoking and/or supportive factors that are atypical for the general population. In addition, sleep disturbance rarely manifests as a separate symptom, but more often occurs together with such symptoms as fatigue, pain, depression and/or cognitive impairment. This complicates the assessment and often requires an individual treatment plan with a team approach. AIM. of the work is to acquaint mental health specialists, oncologists, chemotherapists with the specifics of the examination of cancer-specific insomnia and fatigue, the construction of team treatment tactics, the organization of psychotherapeutic care for cancer patients. Results. The article describes for the first time the specifics of onco-specific insomnia and fatigue. The general predisposing and supporting factors of insomnia characteristic of cancer patients are systematized. The relationship between onco-specific fatigue and sleep disorders is shown. The role of pro-inflammatory cytokines as a common neuroendocrine-immune mechanism underlying the behavioral symptoms of sleep disorders, fatigue, depression and cognitive dysfunction in people with cancer is noted. Due to the limitations of the pharmacological approach, the purpose, forms, modes and approaches of using cognitive behavioral therapy protocols to minimize insomnia and fatigue are described. Based on the data of our foreign colleagues, we have proposed an algorithm for assessing sleep disorders in a patient with an oncological profile. The effectiveness of the standard protocol of cognitive behavioral psychotherapy of insomnia (SCBT-I) in a patient of the oncological profile Lavini Fiorentino is described in detail and shown; as well as the short protocol of CBT of cancer-specific insomnia by Eric Zo et al.; remote protocol of mindfulness enhancement therapy to minimize onco-specific fatigue Z.by Fieke et al. Conclusions. CBT in the framework of complex treatment has a positive effect on the immune system, reducing inflammation mediated through the hypothalamic-pituitary-adrenal axis. Despite the accumulation of evidence confirming the effectiveness of this form of psychological assistance, its availability in Russia remains extremely limited and not fully appreciated.

scholarly journals Trichotillomania: What Do We Know So Far?

2021 ◽  
pp. 1-7
Author(s):  
Daniel Fernandes Melo ◽  
Caren dos Santos Lima ◽  
Bianca Maria Piraccini ◽  
Antonella Tosti
Keyword(s):  
Selective Serotonin Reuptake Inhibitors ◽  
Behavioral Therapy ◽  
Treatment Plan ◽  
Interdisciplinary Approach ◽  
Comprehensive Treatment ◽  
Reversal Training ◽  
Pharmacological Management ◽  
Related Disorder ◽  
Pull Out ◽  
Habit Reversal Training

Trichotillomania is defined as an obsessive-compulsive or related disorder in which patients recurrently pull out hair from any region of their body. The disease affects mainly female patients, who often deny the habit, and it usually presents with a bizarre pattern nonscarring patchy alopecia with short hair and a negative pull test. Trichoscopy can reveal the abnormalities resulting from the stretching and fracture of hair shafts, and biopsy can be necessary if the patient or parents have difficulties in accepting the self-inflicted nature of a trichotillomania diagnosis. Trichotillomania requires a comprehensive treatment plan and interdisciplinary approach. Physicians should always have a nonjudgmental, empathic, and inviting attitude toward the patient. Behavioral therapy has been used with success in the treatment of trichotillomania, but not all patients are willing or able to comply with this treatment strategy. Pharmacotherapy can be necessary, especially in adolescents and adult patients. Options include tricyclic antidepressants, selective serotonin reuptake inhibitors, and glutamate-modulating agents. Glutamate-modulating agents such as N-acetylcysteine are a good first-line option due to significant benefits and low risk of side effects. Physicians must emphasize that the role of psychiatry-dermatology liaison is extremely necessary with concurrent support services for the patient and parents, in case of pediatric patients. In pediatric cases, parents should be advised and thoroughly educated that negative feedback and punishment for hair pulling are not going to produce positive results. Social support is a significant pillar to successful habit reversal training; therefore, physicians must convey the importance of familial support to achieving remission. This is a review article that aims to discuss the literature on trichotillomania, addressing etiology, historical aspects, clinical and trichoscopic features, main variants, differential diagnosis, diagnostic clues, and psychological and pharmacological management.

scholarly journals Psychological Methods of Chronic Non-Specific Pain Treatment

2020 ◽  
Vol 25 (2) ◽  
pp. 12-21
Author(s):  
T. I. Kuzminova ◽  
A. Kh. Mukhametzyanova ◽  
L. V. Magomedkerimova
Keyword(s):  
Chronic Back Pain ◽  
Pain Treatment ◽  
Psychological Treatment ◽  
Behavioral Therapy ◽  
Pain Syndrome ◽  
Relaxation Method ◽  
Psychological State ◽  
Randomized Controlled Studies ◽  
Methods Of Treatment

Psychological treatment methods can be used to reduce the intensity of the pain syndrome, the influence of psychological, social factors, comorbide disorders, and to improve the quality of life in patients with chronic back pain (CPS, i.e. chronical pain syndrome). The methods of assessing the psychological state, the effectiveness of various psychological methods are discussed. It is noted that the effectiveness of cognitive-behavioral therapy, mindfulness (mindfulness therapy), relaxation method and biofeedback is confirmed by the results of randomized controlled studies for CPS. Psychological methods of treatment for pain should be widely used in the management of patients with CPS.

Psychotherapeutic interventions

2017 ◽  
Author(s):  
Fiammetta Cosci ◽  
Giovanni Andrea Fava
Keyword(s):  
Primary Care ◽  
Anxiety Disorders ◽  
Clinical Judgment ◽  
Primary Care Physicians ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Somatic Symptom ◽  
Treatment Plan ◽  
Unipolar Depression ◽  
Psychotherapeutic Interventions ◽  
Primary Care Settings

Primary care physicians may offer a comprehensive care of patients having psychiatric ailments. Psychological interventions are effective in treating major depressive disorder, anxiety disorders, somatic symptom disorders, and tobacco use disorders in primary care settings. Psychotherapeutic approaches are effective either as an alternative or as an adjunct to pharmacotherapy, with enduring benefits after discontinuation of drug treatment. Psychotherapy also represents a pilot area of intervention to treat withdrawal symptoms and disorders due to the tapering or discontinuation of psychotropic medications, in particular selective serotonin reuptake inhibitors (SSRIs). This chapter illustrates the basic steps to establish routine evidence-based psychotherapy for unipolar depression, anxiety disorders, somatic symptom disorder, and substance use disorders in primary care settings. Some factors should be considered to formulate a proper treatment plan for mental disorders in primary care, including primary care physicians’ clinical judgment, availability of treatment, and patient’s preference.

Anxiety Disorders in Late Life: An Evolving Picture

CNS Spectrums ◽  
2002 ◽  
Vol 7 (11) ◽  
pp. 805-810 ◽  
Author(s):  
Eric J. Lenze ◽  
M. Katherine Shear ◽  
Benoit H. Mulsant ◽  
Charles F. Reynolds
Keyword(s):  
Anxiety Disorders ◽  
Older People ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Behavioral Therapy ◽  
The United States ◽  
Medical Illness ◽  
First Line ◽  
Elderly Age ◽  
Chronic Medical Illness ◽  
Poor Social Support

ABSTRACTAlthough anxiety disorders are the most prevalent group of disorders in the United States, little is known about the efficacy of treatments for these disorders in elderly patients. Anxiety disorders, especially generalized anxiety disorder and phobias, are highly prevalent in older people. Anxiety symptoms and disorders are associated with increased mortality and disability in older people. Risk factors for anxiety disorders include chronic medical illness, disability, low education, low social network, and poor social support. The newer antidepressant medications, in particular the selective serotonin reuptake inhibitors and venlafaxine-extended relief, are recommended as first-line pharmacotherapy of these disorders in elderly. Cognitive-behavioral therapy is recommended as first-line psychotherapy for these disorders. However, these recommendations are based on extrapolation of data from younger adults or retrospective analysis of datasets, the results need to be confirmed with controlled studies in an elderly age group.

Efficacy of Combined Pharmacotherapy and Psychotherapy Versus Monotherapy in the Treatment of Anxiety Disorders

CNS Spectrums ◽  
2006 ◽  
Vol 11 (S12) ◽  
pp. 29-33 ◽  
Author(s):  
Donald W. Black
Keyword(s):  
Anxiety Disorders ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Randomized Clinical Trials ◽  
Behavioral Therapy ◽  
Combined Therapy ◽  
Combined Treatment ◽  
Empirical Support ◽  
The United States ◽  
Compulsive Disorder ◽  
Review Criteria

AbstractAnxiety disorders in the United States are prevalent, widespread, and disabling. These illnesses may account for almost one third of the $148 billion total mental health bill each year. Pharmacologic options include tricyclic antidepressants, monoamine oxidase inhibitors, serotonin norepinephrine reuptake inhibitors, selective serotonin reuptake inhibitors, and anxiolytics. Psychological treatments include cognitive-behavioral therapy (CBT), cognitive therapy, exposure, and ritual prevention therapies. Despite insufficient evidence, many experts recommend combined treatment, generally medication with CBT. A literature review was conducted to examine studies with random assignment, adequate methods and sample sizes, blind assessments, sufficient dosages and durations of treatment, and satisfactory reporting of data, to determine whether combined treatment was superior to monotherapy. Twenty-six randomized clinical trials were identified; nine met review criteria. A review of relevant studies could not confirm the superiority of combined treatment over monotherapy. In one of four studies of obsessive-compulsive disorder, combined treatment produced better results than monotherapy.  There was no evidence of superiority for combined therapy over monotherapy for the treatment of social phobia or generalized anxiety disorder. There were no studies that met review criteria for either specific phobia or posttraumatic stress disorder (PTSD). With panic disorder, there was evidence that combined treatment might actually lead to worse outcome. Combined treatment is commonly recommended, but empirical support is limited. More research is needed. There are few well-designed studies, and little data regarding PTSD and specific phobias.

scholarly journals Introduction—Treatment Resistance: Concepts and Management in Mood and Anxiety Disorders

CNS Spectrums ◽  
2002 ◽  
Vol 9 (S14) ◽  
pp. 5-5
Author(s):  
Mark H. Rapaport
Keyword(s):  
Anxiety Disorders ◽  
Stress Disorder ◽  
Behavioral Therapy ◽  
Combined Treatment ◽  
Treatment Resistance ◽  
Rational Approach ◽  
Individual Treatment ◽  
Therapeutic Approaches ◽  
Important Data ◽  
Mood And Anxiety Disorders

This supplement to CNS Spectrums focuses on exciting emerging data on therapeutic approaches that can help the clinician with difficult-to-treat patients. Over the last decade, there have been tremendous advances in our conceptualization of difficult-to-treat patients, including diagnostic, psychotherapeutic, pharmacotherapeutic, and somatic approaches. A series of articles addressing these advances in the field are presented in this supplement.Edna B. Foa, PhD, has been a leading expert in cognitive-behavioral therapy (CBT) for anxiety disorders for many years. Foa and colleagues provide a thoughtful analysis of the particular components of CBT that may be responsible for its efficacy in anxiety disorders. This article goes beyond simple trials looking at the efficacy of CBT or combined treatment with pharmacotherapy and CBT. Foa and colleagues identify individual treatment and patient factors as well as the interaction between the two, that may influence treatment response. Treatment of posttraumatic stress disorder is used as a model for helping us understand this exciting work.Next, Waguih William IsHak, MD, presents important data about the use of practical and pragmatic treatment paradigms in patients with mood and anxiety disorders. Dr. IsHak emphasizes the importance of standardized structured approaches to facilitate understanding of the breadth of psychopathology present in the patient. The model Dr. IsHak proposes for the evaluation and conceptualization of the patient facilitates the integration of biological factors, psychological factors, and psychosocial variables. His algorithms go beyond merely a technique for assessment and present a rational approach to therapy for patients. These algorithms are limited by existing data, but the steps elaborated within the algorithm are powerful and useful for the clinician. This article serves as a useful guide for both trainees and clinicians with many years in practice.

Treatment of Anxiety Disorders

2021 ◽  
pp. 122-133
Author(s):  
Kirstin Painter ◽  
Maria Scannapieco
Keyword(s):  
Side Effects ◽  
Anxiety Disorders ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Depressive Disorders ◽  
Behavioral Therapy ◽  
Evidence Based ◽  
Promising Practices ◽  
The Core ◽  
Core Components ◽  
Norepinephrine Reuptake

As with depressive disorders, the two most common treatments for anxiety are psychotropic medication and psychotherapy, either individually or in conjunction. Psychotherapy is often the preferred first line of treatment unless the youth is a danger to self or others or is significantly unable to function. This chapter provides an overview of the classes of antianxiety and antidepressant medications (i.e., selective serotonin reuptake inhibitors, serotonin norepinephrine reuptake inhibitors, benzodiazepines) used for treating different anxiety disorders along with brief information on their side effects. Descriptions are provided of the core components of curriculum and non-curriculum evidence-based and promising practices, including child–parent psychotherapy, trauma-focused cognitive-behavioral therapy, and two computerized therapies. The chapter ends by revisiting the case studies from Chapter 7, reviewing the actual outcomes of the cases and posing questions to prompt further discussion.

The Medical Treatment of Obsessive-Compulsive Disorder and Anxiety

CNS Spectrums ◽  
2008 ◽  
Vol 13 (S14) ◽  
pp. 37-46 ◽  
Author(s):  
Borwin Bandelow
Keyword(s):  
Anxiety Disorders ◽  
Obsessive Compulsive Disorder ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Behavioral Therapy ◽  
Treatment Options ◽  
First Line ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
History Of ◽  
Higher Doses

AbstractSelective serotonin reuptake inhibitors (SSRIs) are first-line pharmacotherapy treatments for obsessive-compulsive disorder (OCD). Clomipramine is effective in OCD but associated with more adverse events. Typically, higher doses of antidepressants are required for OCD. Up to 50% of patients do not respond to initial treatment of OCD. Treatment options for nonresponders include augmentation of antidepressants with atypical antipsychotics, among other strategies. First-line treatments for anxiety disorders include SSRIs, serotonin norepinephrine reuptake inhibitors, and pregabalin. Tricyclic antidepressants are equally effective as SSRIs, but are less well tolerated. In treatment-resistant cases, benzodiazepines may be used when the patient does not have a history of dependency and tolerance. Other treatment options include irreversible and reversible monoamine oxidase inhibitors, the atypical antipsychotic quetiapine, and other medications. Cognitive-behavioral therapy has been sufficiently investigated in controlled studies of OCD and anxiety disorders and is recommended alone or in combination with the above medications.

Sign in / Sign up

Export Citation Format

Share Document