General Hospital Psychiatry
Volume 25, Issue 2 , Pages 74-82 , March 2003

A contemporary protocol to assist primary care physicians in the treatment of panic and generalized anxiety disorders

  • Bruce L Rollman, MD, MPH

      Affiliations

    • Corresponding Author InformationCorresponding author. Tel.: +1-412-692-4853; fax: +1-412-692-4838.
    • Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
  • ,
  • Bea Herbeck Belnap, PhD

      Affiliations

    • Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
  • ,
  • Charles F Reynolds, MD

      Affiliations

    • Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
  • ,
  • Herbert C Schulberg, PhD

      Affiliations

    • Department of Psychiatry, Weill Medical College, Cornell University, White Plains, NY, USA
  • ,
  • M.Katherine Shear, MD

      Affiliations

    • Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

References 

  1. Simon G, Ormel J, VonKorff M, Barlow W. Health care costs associated with depressive and anxiety disorders in primary care. Am J Psychiatry. 1995;152:352–357
  2. Schulberg HC, Burns BJ. Mental disorders in primary care (epidemiologic, diagnostic, and treatment research directions). Gen Hosp Psychiatry. 1988;10:79–87
  3. Edlund MJ, Swann AC. The economic and social costs of panic disorder. Hosp Community Psychiatry. 1987;38:1277–1288
  4. Katon W, Von Korff M, Lin E, et al.  Distressed high utilizers of medical care. DSM-III-R diagnoses and treatment needs. Gen Hosp Psychiatry. 1990;12:355–362
  5. Regier DA, Boyd JH, Burke JD, et al.  One-month prevalence of mental disorders in the United States. Based on five Epidemiologic Catchment Area sites. Arch Gen Psychiatry. 1988;45:977–986
  6. Leon AC, Portera L, Weissman MM. The social costs of anxiety disorders. British Journal of Psychiatry 1995;(suppl)27:19–22
  7. Katerndahl DA. Panic attacks and panic disorder. J Fam Practice. 1996;43:275–282
  8. Sherbourne CD, Jackson CA, Meredith LS, Camp P, Wells KB. Prevalence of comorbid anxiety disorders in primary care outpatients. Arch Fam Med. 1996;5:27–34
  9. Shear MK, Schulberg HC. Anxiety disorders in primary care. Bull Menninger Clinic. 1995;59:A73–85
  10. Spitzer RL, Williams JBW, Kroenke K, et al.  Utility of a new procedure for diagnosing mental disorders in primary care (the PRIME-MD 1000 study). JAMA. 1994;272:1749–1756
  11. Katon W, Vitaliano PP, Russo J, Cormier L, Anderson K, Jones M. Panic disorder (epidemiology in primary care). J Fam Practice. 1986;23:233–239
  12. Andersen SM, Harthorn BH. The recognition, diagnosis, and treatment of mental disorders by primary care physicians. Med Care. 1989;27:869–886
  13. Fifer SK, Mathias SD, Patrick DL, Mazonson PD, Lubeck DP, Buesching DP. Untreated anxiety among adult primary care patients in a health maintenance organization. Arch Gen Psychiatry. 1994;51:740–750
  14. Ormel J, Koeter MW, van den Brink W, van de Willige G. Recognition, management, and course of anxiety, and depression in general practice. Arch Gen Psych. 1991;48:700–706
  15. Schulberg HC, McClelland M, Coulehan JL, Block M, Werner G. Psychiatric decision making in family practice. Gen Hosp Psychiatry. 1986;8:1–6
  16. Maier W, Buller R, Philipp M, Heuser I. The Hamilton Anxiety Scale (reliability, validity, and sensitivity to change in anxiety and depressive disorders). J Affect Dis. 1988;14:61–68
  17. Shear M, Brown T, Barlow D, et al.  Multicenter collaborative panic disorder severity scale. Am J Psychiatry. 1997;154:1571–1575
  18. Hales RE, Hilty DA, Wise MG. A treatment algorithm for the management of anxiety in primary care practice. J Clin Psychiatry. 1997;58(suppl 3):76–80
  19. Gorman JR, Coplan J. An algorithm-oriented treatment approach for panic disorders. Primary Psychiatry. 1997;4:16–28
  20. Jobson KO, Davidson JR, Lydiard RB, McCann UD, Pollack MH, Rosenbaum JF. Algorithm for the treatment of panic disorder with agoraphobia. Psychopharmacol Bull. 1995;31:483–485
  21. Sussman N. Toward an understanding of the symptomatology and treatment of generalized anxiety disorder. Primary Psychiatry. 1997;4:68–81
  22. Practice guideline for treatment of patients with panic disorder and related anxiety disorders. Washington, D.C.: American Psychiatric Association, 1998
  23. Depression in primary care. Volume 1, detection and diagnosis; Volume 2, treatment of major depression. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research, 1993
  24. Simon GE, VonKorff M, Rutter C, Wagner E. Randomised trial of monitoring, feedback, and management of care by telephone to improve treatment of depression in primary care. BMJ. 2000;320:550–554
  25. Cooper–Patrick L, Powe NR, Jenckes MW, Gonzales JJ, Levine DM, Ford DE. Identification of patient attitudes and preferences regarding treatment of depression. J Gen Intern Med. 1997;12:431–438
  26. Rokke PD, Tomhave JA, Jocic Z. The role of client choice and target selection in self-management therapy for depression in older adults. Psychol Aging. 1999;14:155–169
  27. Stevens T, Katona C, Manela M, Watkin V, Livingston G. Drug treatment of older people with affective disorders in the community (lessons from an attempted clinical trial). Int J Geriatr Psychiatry. 1999;14:467–472
  28. Craske M, Barlow D. Mastery of your anxiety and panic for primary care. (Unpublished workbook) 2000
  29. Craske MG, Barlow DH, O’Leary TA. Mastery of Your Anxiety and Worry, Client Workbook. San Antonio: The Psychological Corporation, Harcort Brace and Company; 1992;
  30. Barlow DH, Craske MG, Cerny JA, Klosko JS. Behavioral treatment of panic disorder. Behav Ther. 1989;20:261–282
  31. Wagner EH, Austin BT, Von Korff M. Organizing care for patients with chronic illness. Milbank Q. 1996;74:511–544
  32. Von Korff M, Gruman J, Schaefer J, Curry SJ, Wagner EH. Collaborative management of chronic illness (essential elements). Ann Intern Med. 1997;127:1097–1102
  33. Noyes R, Garvey MJ, Cook B, Suelzer M. Controlled discontinuation of benzodiazepine treatment for patients with panic disorder. Am J Psychiatry. 1991;148:517–523
  34. Beck AT, Kovacs M, Weissman A. Assessment of suicidal intention (the Scale for Suicide Ideation). J Consult Clin Psychol. 1979;47:343–352
  35. Wagner EH. More than a case manager. Ann Intern Med. 1998;129:654–656
  36. Katon W, Von Korff M, Lin E, Simon G. Rethinking practitioner roles in chronic illness (the specialist, primary care physician, and the practice nurse). Gen Hosp Psychiatry. 2001;23:138–144
  37. Von Korff M, Tiemens B. Individualized stepped care of chronic illness. West J Med. 2000;172:133–137
  38. Grembowski DE, Martin D, Patrick DL, et al.  Managed care, access to mental health specialists, and outcomes among primary care patients with depressive symptoms. J Gen Intern Med. 2002;17:258–269
  39. Anonymous . Single-specialty carve-outs: a threat to integrated care?. Med Net Strategy Rep. 1999;8:1–8
  40. DeBusk R, Miller N, Superko H, Dennis C, Thomas R, Lew H. A case-management system for coronary risk factor modification after acute myocardial infarction. Ann Intern Med. 1994;120:721–729
  41. Rich MW, Beckham V, Wittenberg C, Leven CL, Freedland KE, Carney RM. A multidisciplinary intervention to prevent the readmission of elderly patients with congestive heart failure. N Engl J Med. 1995;333:1190–1195
  42. Aubert R, Herman W, Waters J, et al.  Nurse case management to improve glycemic control in diabetic patients in a health maintenance organization. A randomized controlled trial. Ann Intern Med. 1998;129:605–612
  43. Delaronde S. Using case management to increase antiinflammatory medication use among a managed care population with asthma. J Asthma. 2002;39:55–63
  44. Wasson J, Gaudette C, Whaley F, Sauvigne A, Baribeau P, Welch HG. Telephone care as a substitute for routine clinic follow-up. JAMA. 1992;267:1788–1793
  45. Katzelnick DJ, Simon GE, Pearson SD, et al.  Randomized trial of a depression management program in high utilizers of medical care. Arch Fam Med. 2000;9:345–351
  46. Hunkeler E, Meresman J, Hargreaves W, et al.  Efficacy of nurse telehealth care and peer support in augmenting treatment of depression in primary care. Arch Fam Med. 2000;9:700–708
  47. Roy-Byrne PP, Katon W, Cowley DS, Russo J. A randomized effectiveness trial of collaborative care for patients with panic disorder in primary care. Arch Gen Psychiatry. 2001;58:869–876
  48. Schulberg HC, Bryce C, Chism K, et al.  Managing late-life depression in primary care practice (a case study of the health specialist’s role). Int J Geriatr Psychiatry. 2001;16:577–584
  49. Bruce M, Pearson J. Designing an intervention to prevent suicide (PROSPECT (Prevention of Suicide in Primary Care Elderly:Collaborative Trial)). Dialogues Clin Neurosci. 1999;1:100–112
  50. Pincus HA, Pechura CM, Elinson L, Pettit AR. Depression in primary care (linking clinical and systems strategies). Gen Hosp Psychiatry. 2001;23:311–318
  51. Kroenke K, Spitzer RL, Williams JB. The PHQ-9 (validity of a brief depression severity measure). J Gen Intern Med. 2001;16:606–613

PII: S0163-8343(03)00004-5

doi: 10.1016/S0163-8343(03)00004-5

General Hospital Psychiatry
Volume 25, Issue 2 , Pages 74-82 , March 2003