Excerpt

The National Institute for Clinical Excellence has commissioned the National Collaborating Centre for Primary Care to develop a clinical guideline on the management of generalised anxiety disorder and panic disorder (with or without agoraphobia) in adults in primary and secondary care and in the community for use in the NHS in England and Wales. This follows referral of the topic by the Department of Health and Welsh Assembly Government. Post-traumatic stress disorder and obsessive–compulsive disorder are excluded from this scope, but will be the subject of another guideline being prepared by the National Collaborating Centre for Mental Health. The guideline will provide recommendations for good practice that are based on the best available evidence of clinical and cost effectiveness.

Contents

• 1. Key priorities for implementation
  • General management
  • Step 1: Recognition and diagnosis of panic disorder and generalised anxiety disorder
  • Step 2: Offer treatment in primary care
  • Step 3: Review and offer alternative treatment
  • Step 4: Review and offer referral from primary care
  • Step 5: Care in specialist mental health services
  • Monitoring
• 2. Panic disorder and generalised anxiety disorder
  • 2.1 Introduction
  • 2.2 Panic disorder and generalised anxiety disorder
• 3. Guideline development methods
  • 3.1 Introduction
  • 3.2 Using guidelines
  • 3.3 Responsibility and support for the guideline
  • 3.4 Scope of the guideline
  • 3.5 Key clinical questions
  • 3.6 Evidence identification
  • 3.7 Evidence grading
  • 3.8 Health economic review and analysis
  • 3.9 Derivation and grading of recommendations
  • 3.10 Update of evidence searches
  • 3.11 Guideline review
• 4. Diagnosis and decision making
  • 4.1 Recognition and diagnosis of panic disorder and generalised anxiety disorder
  • 4.2 Screening tools
• 5. Introduction to evidence review of interventions
  • 5.1 Presentation of recommendations and evidence statements
  • 5.2 The nature of evidence considered
  • 5.3 Medication issues
• 6. Care of individuals with panic disorder
  • Recommendations: care of people with panic disorder
• 7. Interventions for panic disorder
  • 7.1 Pharmacological compared with psychological compared with combination interventions for panic disorder
  • 7.2 Combination compared with pharmacological interventions for panic disorder
  • 7.3 Combination compared with psychological interventions for panic disorder
  • 7.4 Pharmacological compared with psychological interventions for panic disorder
  • 7.5 Pharmacological interventions for panic disorder
  • 7.6 Psychological interventions for panic disorder
  • 7.7 Other interventions for panic disorder
• 8. Care of individuals with generalised anxiety disorder
  • Recommendations: care of people with generalised anxiety disorder
• 9. Interventions for generalised anxiety disorder
  • 9.1 Pharmacological compared with psychological compared with combined interventions for GAD
  • 9.2 Pharmacological compared with psychological interventions for GAD
  • 9.3 Pharmacological interventions for GAD
  • 9.4 Psychological interventions for GAD
  • 9.5 Other interventions for GAD
• 10. Other relevant evidence
  • 10.1 Relevant evidence not specifically about GAD or panic disorder
• 11. Audit criteria & quality framework
  • 11.1 Audit criteria
  • 11.2 Quality and outcome framework
• 12. Research issues
  • Which Interventions?
  • What other interventions may be effective?
  • What are the characteristics of the disorders?
• 13. References
• Evidence Tables Appendices: Panic disorder
  • Appendix 1 Pharmacological compared with psychological compared with combination interventions for panic disorder
  • Appendix 2 Combination compared with pharmacological interventions for panic disorder
  • Appendix 3 Pharmacological interventions for panic disorder
  • Appendix 4 Psychological interventions for panic disorder
• Evidence Tables Appendices: Generalised anxiety disorder
  • Appendix 5 Pharmacological compared with psychological compared with combined interventions for GAD
  • Appendix 6 Pharmacological compared with psychological interventions for GAD
  • Appendix 7 Pharmacological interventions compared with pharmacological interventions
  • Appendix 8 Pharmacological interventions compared with placebo (and other eg withdrawal)
  • Appendix 9 Psychological interventions compared with psychological interventions
  • Appendix 10 Psychological Interventions
  • Appendix 11 Other interventions for GAD
• Other Appendices
  • Appendix 12 Health economics
  • Appendix 13 CSM Working Group on SSRIs
  • Appendix 14 Diagnostic criteria
  • Appendix 15 Selected glossary
  • Appendix 16 Guideline development group
  • Appendix 17 Scope
  • Appendix 18 Key clinical questions
  • Appendix 19 Literature searches
  • Appendix 20 Interventions identified
  • Appendix 21 Related NICE guidance
  • Appendix 22 Costs of CBT and self help treatments

This work is undertaken by ScHARR, University of Sheffield which received funding from the Royal College of General Practitioners on behalf of the National Institute for Clinical Excellence. The views expressed in this Publication are those of the authors and not necessarily those of either the Royal College of General Practitioners or the National Institute for Clinical Excellence.

Suggested citation:

McIntosh A, Cohen A, Turnbull N, Esmonde L, Dennis P, Eatock J, Feetam C, Hague J, Hughes I, Kelly J, Kosky N, Lear G, Owens L, Ratcliffe J, Salkovskis P (2004) Clinical Guidelines and Evidence Review for Panic Disorder and Generalised Anxiety Disorder Sheffield: University of Sheffield/London: National Collaborating Centre for Primary Care