Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders

Abstract

Background Anxiety and related disorders are among the most common mental disorders, with lifetime prevalence reportedly as high as 31%. Unfortunately, anxiety disorders are under-diagnosed and under-treated. Methods These guidelines were developed by Canadian experts in anxiety and related disorders through a consensus process. Data on the epidemiology, diagnosis, and treatment (psychological and pharmacological) were obtained through MEDLINE, PsycINFO, and manual searches (1980–2012). Treatment strategies were rated on strength of evidence, and a clinical recommendation for each intervention was made, based on global impression of efficacy, effectiveness, and side effects, using a modified version of the periodic health examination guidelines. Results These guidelines are presented in 10 sections, including an introduction, principles of diagnosis and management, six sections (Sections 3 through 8) on the specific anxiety-related disorders (panic disorder, agoraphobia, specific phobia, social anxiety disorder, generalized anxiety disorder, obsessive-compulsive disorder, and posttraumatic stress disorder), and two additional sections on special populations (children/adolescents, pregnant/lactating women, and the elderly) and clinical issues in patients with comorbid conditions. Conclusions Anxiety and related disorders are very common in clinical practice, and frequently comorbid with other psychiatric and medical conditions. Optimal management requires a good understanding of the efficacy and side effect profiles of pharmacological and psychological treatments.

Incidence of and Characteristics Associated With Long-term Benzodiazepine Use in Finland

“…Prescribing guidelines strongly emphasize that BZDR treatment should only be prescribed for a short term (ie, between 4 and 12 weeks, including a discontinuation period). [6][7][8][9][10][11][12][13] Yet, the results of this study suggest that new BZDR users frequently become long-term users; one-third of persons younger than 65 years and about 55% of persons aged 65 years or older were defined as long-term users, and a substantial proportion developed long-term use quickly, without having any gaps in use after initiation. Use of clonazepam, lorazepam, temazepam, and polytherapy at initiation of treatment was associated with long-term treatment when compared with diazepam, whereas an inverse association with long-term treatment was found for alprazolam and zolpidem.…”

Lurasidone as add-on to fluoxetine in obsessive-compulsive disorder with comorbid restrictive anorexia: a case report

“…In accordance with the epidemiological associations, clinical studies also described that AN and OCD share highly similar clinical phenotypes, such as perfectionism, rigidity, obsessive thoughts, persistence, and excessive ritual behaviors (Song et al, 2021). According to the most recent International Guidelines (Katzman et al, 2014;Janardhan Reddy et al, 2017;Riley et al, 2017;Menchon et al, 2019) cognitivebehavioral therapy (CBT) alone is recommended as an initial treatment in patients with mild-to-moderate OCD symptomatology, adding psychopharmacological treatment with selective serotonin reuptake inhibitors (SSRIs) as first-line treatment in more severe OCD. Nevertheless, a substantial percentage of patients still fail to respond to either CBT or SSRIs alone or combined in any meaningful way, or may display residual symptoms in 40-60% of cases, despite the optimization strategy (Skapinakis et al, 2016).…”

Obsessive-Compulsive Disorders

“…The behavioral component of CBT, and exposure and response prevention specifically, is the most common form of evidence-based psychotherapy for OCD. 7,34,35 In this treatment modality, the focus is on systematically reducing and eventually eliminating the compulsive or avoidance behaviors that occur in response to an obsession. Patients and therapists work together to identify and rank the obsessions and associated compulsions according to the level of distress they engender, creating a fear hierarchy.…”