Clinical Focus | SORT Criteria17 | Assessment and Treatment Approach |
---|---|---|
Screening and Assessment | B | Four anxiety disorder questions: ADD |
A | Two depression questions | |
A | Alcohol screen: AUDIT-C | |
C | Pain: one question | |
B | Suicide evaluation: thoughts, plan, intent, reasons for living | |
B | Bipolar disorder: MDQ good specificity, poor sensitivity | |
Severity of Anxiety | A | GAD-7: symptom severity |
B | OASIS: functional impairment plus global symptoms | |
Treatment History | C | Specify response: little, moderate, a lot |
Engaging the Patient-Brief Intervention | B | Expectations for outcome: 0–10 |
B | Expectation for role in outcome: 0–10 | |
C | Use these and MI techniques | |
C | Help patient weight positives/negatives | |
Education and Skills | C | Focus on avoidance: make list of avoided activities |
C | Cognitive restructuring to help with exposure | |
C | Breathing techniques to help with exposure | |
C | Exposure (easiest to hardest) over 8–12 weeks | |
Initial Medication | A | SSRI/SNRI: start low and go slow, but go |
B | Benzodiazepines: if >4 times per week, keep taking for 12 weeks, then taper slowly | |
B | Benzodiazepines: may use as monotherapy in select cases | |
Treatment Resistant Anxiety | C | Add another antidepressant or benzodiazepine |
B | Consider in rare cases adding atypical neuroleptic | |
Medication Discontinuation | C | After 1 year of therapy |
C | Depending on comorbid psych and medical illness, avoidance, ongoing stress |
ADD, Anxiety Depression Detector; AUDIT-C, Alcohol Use Disorder Identification Test; MDQ, Mood Disorders Questionairre; GAD, generalized anxiety disorder; OASIS, Overall Anxiety Severity and Impairment Scale; MI, motivational interviewing; SSRI, selective serotonin reuptake inhibitor; SNRI, serotonin-norepinephrine reuptake inhibitor.