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Diagnosis: Anxiety Disorder.

The 1990s was, thankfully, a decade of great advances in the diagnosis and treatment of mental health disorders and far more attention than ever before was given to the development of diagnostic tools for use in busy general medical practices.

Today, there is even a screening questionnaire that covers the five most common mental health disorders encountered by primary care physicians. And, when positive results are obtained on a screening questionnaire evaluation, confirmation can be obtained through brief clinical questions. This 2-step program replaces the time-consuming questioning whereby the physician had to take the patient through long lists of psychiatric symptoms and which, for the most part, was avoided until every other possible cause was ruled out.

Today’s Patient Health Questionnaire screens for depression, anxiety, alcohol abuse, psychosomatic illnesses and eating disorders and is, basically, a self-report version of the previously existing guide for primary care doctors in completing any psychiatric screening examination of their patients. The Patient Health Questionnaire is filled out by the patient and can be evaluated immediately by the physician. It can be used as a general screening tool or each one of its five parts can be used alone if the specific disorder is already suspected.

The Anxiety Disorder Questionnaire.

The Diagnostic and Statistical Manual of Mental Disorders defines ten different anxiety disorders. However, fine-tuned to questions about the two types of anxiety – chronic worry and anxiety attacks – their detection can be a quite simple process. This is then confirmed through clarification of the specific components of the anxiety disorder – the acute onset of such symptoms as palpitations, trembling, chest pain, etc. as opposed to the constant presence of anxiety. Then an indication of the level of severity is provided by questions about avoidance or obsessive/compulsive behaviours.

Using this diagnostic tool, the busy family doctor can, for example, quickly detect the presence of acute anxiety and differentiate a panic attack from a situational anxiety reaction. He/she can determine whether the patient is experiencing chronic worry or reacting to situational stress. And finally he/she can assess the need for referral to a psychiatrist or evaluation by a psychologist through the questions covering behaviour:

This simple system can diagnose, for example, panic disorder with agoraphobia by quickly determining that the patient is experiencing panic attacks, exhibiting phobic avoidance and suffering chronic anxiety.

Stress Reaction.

Acute and chronic reactions to an identifiable source of stress are anxiety disorders which require slightly different screening and confirmation. In such cases the objective is to identify the stressor and determine the level of the problem in terms of whether there is simply a need for social support and short-term therapy and/or medication or whether post-traumatic stress disorder (PTSD) has developed, requiring more intensive treatment.

Sadly studies indicate that as many as 12% of patients in primary care settings have significant PTSD symptoms today. The screening questions here detect the presence of current stresses and any history of more severe exposure to incidents capable of resulting in traumatic stress. The validating questions for this diagnostic tool define the ongoing response to the trauma by determining both physical and emotional reaction to reminders of the event.

Studies show that this two-step method of screening questions and corroborative examination to be effective in detecting mental health disorders at the primary care level. The system is being used either by incorporation into patient self-report checklists used in many general practices today or administered as a separate entity. The screening questions are then reviewed by the physician who follows up with the confirmatory queries.

Copyright Jean Jardine Miller.


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