Using five questions to screen for five common mental disorders in primary care: diagnostic accuracy of the Anxiety and Depression Detector

Social anxiety disorder

Our understanding of social anxiety disorder (also known as social phobia) has moved from rudimentary awareness that it is not merely shyness to a much more sophisticated appreciation of its prevalence, its chronic and pernicious nature, and its neurobiological underpinnings. Social anxiety disorder is the most common anxiety disorder; it has an early age of onset--by age 11 years in about 50% and by age 20 years in about 80% of individuals--and it is a risk factor for subsequent depressive illness and substance abuse. Functional neuroimaging studies point to increased activity in amygdala and insula in patients with social anxiety disorder, and genetic studies are increasingly focusing on this and other (eg, personality trait neuroticism) core phenotypes to identify risk loci. A range of effective cognitive behavioural and pharmacological treatments for children and adults now exists; the challenges lie in optimum integration and dissemination of these treatments, and learning how to help the 30-40% of patients for whom treatment does not work.

Recent Advances in the Understanding and Treatment of Anxiety Disorders

Anxiety disorders usually are chronic or recurrent disorders characterized by stress sensitivity and a fluctuating course. Both psychopharmacologic and cognitive-behavioral treatments are well-established, evidence-based treatments for panic disorder, social anxiety disorder, generalized anxiety disorder, and obsessive-compulsive disorder. Exposure-based behavioral treatment is well established as evidence-based treatment for specific phobias. Primary care physicians can make a significant impact on patients' lives by identifying and educating about anxiety disorders, directing patients to appropriate self-help resources, choosing evidence-based drug treatment when indicated, and making referrals for specialist care.

Anxiety in primary care

Anxiety disorders are common within primary care (PC) settings and are associated with patient functional impairment, distress, and high utilization of medical care services. Data from PC settings indicate that detection of anxiety disorders is low. Furthermore, adequate psychosocial and pharmacologic treatment of anxiety disorders in accordance with empirically validated guidelines remains low in PC. When patients do receive treatment or referrals from their PC providers, a bias exists for pharmacologic over psychological interventions despite theoretical strengths, empirical evidence, and long-term cost efficiency supporting the use of psychotherapeutic interventions such as cognitive-behavioral therapy (CBT). Objectives of this article include increasing awareness of the prevalence of anxiety disorders in PC, impairment associated with anxiety disorders, issues of detection of anxiety in PC, treatment model and components of CBT, and data supporting the application of CBT to PC to improve patient functioning.

Correlates of alcohol use among anxious and depressed primary care patients

OBJECTIVE

The purpose of this study is to determine the patterns of alcohol use for primary care patients with anxiety disorders and/or major depression in three urban university-affiliated outpatient clinics.

METHOD

A waiting room sample of adults was screened for anxiety disorders and major depression. Six hundred fourteen screened patients were assessed using the Composite International Diagnostic Interview [World Health Organization. Composite International Diagnostic Interview (CIDI) 2.1. Geneva: World Health Organization, 1997] and frequency-quantity alcohol use questions. Adjusted for age and gender, logistic regression analyses were used to determine associations between panic disorder, social phobia, PTSD, major depression and typical heavy (three drinks/two or more times a week) and frequent (four or more times a week) alcohol use.

RESULTS

Of the patients, 6.19% (38/614) reported typical heavy drinking and 8.31% (51/614) reported frequent drinking in the preceding 3 months. PTSD was associated with heavy drinking (adjusted OR = 3.1; 95% CI, 1.3-7.3). Panic disorder was associated with frequent alcohol use (adjusted OR = 2.2; 95% CI, 1.2-4.2) but reduced heavy drinking (adjusted OR = 0.4; 95% CI, 0.2-0.9). There was no significant relationship between alcohol use and the co-occurrence of two or more anxiety and/or mood disorders.

CONCLUSION

In an examination of primary care patients diagnosed, the majority of whom were with at least one anxiety disorder and/or major depression; current heavy and frequent alcohol use was associated with specific individual anxiety disorders and/or major depression.