Expert Insights in Advanced Psychopharmacology is an ongoing video series featuring members of the Psych Congress Steering Committee and Faculty. The series, which highlights key psychopharmacology topics, is designed to provide mental health clinicians with practical guidance to maximize the effectiveness of treatments.
(Part 4 of 7)
In this video, Psych Congress Steering Committee member Rakesh Jain, MD, MPH, discusses the fourth of 7 habits which clinicians can develop to be highly effective at treating anxiety disorders.
Dr. Jain is Clinical Professor, Department of Psychiatry, Texas Tech University School of Medicine, Austin. He will co-present a session on the 7 habits at Psych Congress 2020, being held virtually Sept. 10-13, 2020, with a preconference on Sept. 9, 2020.
Go to the Expert Insights in Advanced Psychopharmacology page to learn about the other habits.
Read the transcript:
Hello, dear friends and colleagues from Psych Congress family. Welcome back to the Seven Habits of a Highly Effective Anxiety Disorder Treating Clinician. My name is Rakesh Jain, and I'm a proud member of the Steering Committee for Psych Congress.
Today we're going to focus on habit number 4, which is look, suspect, screen, and repeat. This effective clinician who adopts habit number 4 knows to screen proactively for anxiety disorders in all patients and makes no exceptions.
How do we go about doing it? The way to start is to look for core symptoms by proactively asking for specific symptoms to start with. For example, if you're interested in screening for PTSD, ask about a history of trauma or flashbacks.
If you are interested in screening about generalized anxiety disorder, you may want to ask about the predominant symptom focus of uncontrollable worry about several things in their life. This is one approach to take, which can be very helpful, and is quite DSM‑5 based.
I do think this is a very supportive way to look at it, which is to certainly look for core symptoms. If you detect core symptoms of one particular anxiety disorder, accept the fact that others may also coexist. Look for these bubble symptoms if you will.
If you check for PTSD, please be sure to check for panic disorder, for example, or social phobia. If you do meet a patient who has certain symptoms of GAD, certainly make sure you get the diagnosis correct, but you may also want to check for OCD.
Let me go back one slide. You can follow this longitudinally. You can support that by looking for comorbid anxiety disorders along with other conditions.
Let me just share an example with you. We'll use generalized anxiety disorder. The way to go about doing it is to ask exploratory questions first. Only if they're positive, do we move on to a full assessment.
In the case of GAD, exploratory questions may include asking patients if over the last two weeks they have felt things such as feeling nervous, anxious, or on edge, or they have not been able to stop or control their worrying. Very helpful information to ask.
Let me pull the curtains, if I may, on the utilization of screening tools. Very important to remember that it can help in lots of ways. It actually saves us time, helps avoid making incorrect diagnoses or miss comorbidities, and they tend to have very good sensitivity and specificity.
Here is one I would love to introduce you to, and that is the Generalized Anxiety Disorder 7, also known as GAD‑7. Very simple to use, self‑rating scale. As you can see, there are just 7 questions. Each one is on 0, 1, 2, 3 scale. By the way, very easy for you and I to score as well. Remember, this is a screening instrument.
If you have someone who has less than 5, we're in good shape. If it's 5 or more, we do need to be concerned about mild anxiety, moderate anxiety, severe anxiety. A score of 10 or more, there will probably be underlying generalized anxiety disorder, which we will need to obviously confirm through further evaluation.
So, habit number 4: look, suspect, screen, repeat, and we, as clinicians interested in helping our patients, will remember that we do not make exceptions. We do this in all patients. That is a good habit.
All right, folks. Thank you very much for being with me, and I'll look forward to visiting with you in future installments.