Anxiety disorders New guideline for treatment

New treatment guideline for the treatment of anxiety disorders

08/05/2014

If anxiety takes on morbid forms, so-called anxiety disorder is mentioned in the professional world. About 15 percent of the population in Germany suffer from this most common form of mental illness every year, reports the German Psychiatric and Psychotherapy, Psychosomatic and Neurological Society (DGPPN) in a recent press release on the newly-presented treatment guidelines for the treatment of anxiety disorders presented today.

Although fear of real threats makes perfect sense, in anxiety disorders, those affected show exaggerated, unrealistic and groundless anxiety - for example, in situations that are not at all dangerous. „The anxiety disorders include panic disorder (sudden anxiety attacks), generalized anxiety disorder (excessive fear of everyday dangers) and social phobia (extreme shyness)“, reports the DGPPPN. With a late diagnosis and missing or inadequate therapy it comes frequently to the chronification of the complaints, often connected with longer sick leave or even early retirements. Also insist „Anxiety disorders increase the risk of comorbidity with other mental illnesses such as depression or addictions“ and „they are also associated with an increased risk of suicide“, according to the DGPPN communication.

Treatment guideline based on the latest scientific findings
The new S3 guideline „Treatment of anxiety disorders“ was presented today in Berlin with the participation of patient representatives and all major specialist societies. In a six-year development process, the experts of the German Society for General Medicine and Family Medicine (DEGAM), the German Society for Psychosomatic Medicine and Medical Psychotherapy (DGPM), the German College of Psychosomatic Medicine (DKPM), the German Association for Behavioral Therapy (DVT), The Society for Anxiety Research (GAF), the German Working Group Self-Help Groups (DAG SHG) and the DGPPN with the support of other professional societies, patient representatives and self-help organizations developed the new treatment guideline. Existing scientific studies on the treatment of psychotherapy, drugs and other forms of therapy have been reviewed by the experts for their evidence.

Anxiety disorders often go undetected
The new treatment guideline is intended to provide guidance on the diagnosis and treatment of anxiety disorders to all occupational groups that treat patients with anxiety disorders, such as primary care physicians, psychiatrists and psychotherapists, psychosomatic medicine and psychotherapists, and psychological psychotherapists. To this day, anxiety disorders „Despite its frequency, it was not recognized in almost half of the cases and therefore not treated properly“, reports the DGPPN. Here, the new S3 guideline presents standards for improving the detection and treatment of anxiety disorders at the various care levels.

Psychotherapy or psychotropic drugs?
In principle, according to the new treatment guideline, patients with anxiety disorders should be offered psychotherapy and / or pharmacotherapy. The patient wishes of a preferred therapy should be taken into account here, which, however, presupposes that the persons concerned are initially informed extensively. „An important role in the information discussion must therefore be in particular the onset of action, sustainability, adverse effects and availability“, reports the DGPPN. The patient representative Jürgen Matzat, who was involved in the procedure, emphasized that the new guideline could only be welcomed from the patient's point of view. Now it depends, however, that the „Doctors orient their practice towards it.“ Lie to him „the freedom of choice and the joint decision of the patient and the practitioner about the therapy to be used, especially in the heart“, stressed Matzat.

Cognitive behavioral therapy for anxiety disorders
For all forms of anxiety disorders, psychotherapeutic cognitive behavioral therapy is recommended according to the new treatment guideline, „their effectiveness has been proven by numerous controlled trials“, reports the DGPPN. In addition, for example „in panic disorder or fear of certain places, places or travel (agoraphobia)“ a guided exposure to anxiety-triggering situations may be appropriate. The affected people deliberately set themselves their fears in order to learn to deal with them. In addition, in recent years, several studies have proven the effectiveness of psychodynamic therapies for panic disorder, generalized anxiety disorder and social phobia, so that this form of therapy can be used if necessary, explains DGPPN. „As additional measures the experts advise to participate in a self-help group, in the panic disorder also to sports (endurance training).“

Benzodiazepines not suitable for the treatment of anxiety disorders
To become pharmacological treatment of anxiety disorders „primarily efficacy and tolerability drugs such as Selective Serotonin Reuptake Inhibitors (SSRIs) and Selective Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)“ recommended, reports the DGPPN. Professor Borwin Bandelow, acting director of the Department of Psychiatry and Psychotherapy at the University of Göttingen, added that drugs such as tricyclic antidepressants or pregabalin can also be prescribed secondarily. In the new treatment guideline, however, will „from the use of benzodiazepines, which are currently very commonly prescribed for anxiety disorders, because of the possibility of dependence development discouraged.“ Patients who previously received benzodiazepines should also discuss this with their doctor in order to avoid unnecessary risks. If the anxiety disorders can not be remedied with the chosen form of therapy, according to the experts, a test of the other form of therapy or a combination of psychotherapy and pharmacotherapy is recommended. (Fp)