Transcript Beta Blockers - NHS Worcestershire

Beta Blockers
• May be useful in RX of somatic symptoms such as
palpitations, sweating, tremor…
• 20-60mg of Propranalol/day
• Not used much except in certain situations
Antihistamines
• Hydroxizine
• Little long term data
Quetiapine in acute treatment of GAD
randomised double-blind fixed-dose placebo-controlled 8-wk study (LOCF, modified ITT)
Mean baseline HAMA scores: placebo 27.3, QUET 50 mg 26.9, QUET 150 mg 26.6, PAR 20 mg 27.1
Bandelow B et al. Int J Psychiatry Clin Pract 2007; 11: 314-315 (abstract)
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Gabapentin
Tiagabine
Riluzole
Opipramol
Kava Kava
St. John’s Wart
Valerian
Passion flower (Passiflora)
Galphimia Glauca (mexican herb)
Psychological Treatments
• High intensity psychological RX’s delivered by trained supervised
competent staff
• 12-15 weekly hourly sessions
• Equal efficacy to drug RX
• CBT, Applied Relaxation..
• Need to measure outcomes (audio, video taping sessions for
evaluation)
• Caveat availability/accessibility
Cognitive-behaviour therapy in GAD
Study
Interventions
Findings
Butler et al 19911
CBT (4-14 sessions)
Behaviour therapy (BT)
Waiting list
CBT (15/16 measures and BT (4/16)
significantly superior to waiting list, CBT
superior to BT
Barlow et al 19922
Relaxation therapy
Cognitive therapy
CT plus relaxation
Waiting list
Superiority of three interventions over
waiting list on observed case analysis
Borovec and
Costello 19933
Applied relaxation
CBT
Non-directive intervention
At follow-up, relaxation and CBT superior
to non-directive intervention (worsened)
Durham et al 19944
Cognitive therapy
Anxiety management
Analytic psychotherapy
CBT superior to analytic therapy at 6
months, but not superior to anxiety
management
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Butler G et al. J Consult Clin Psychol 1991; 59: 167-175
Barlow DH et al. Behav Ther 1992; 23: 551-570
Borovec TD, Costello E. J Consult Clin Psychol 1993; 61: 611-619
Durham R et al. Br J Psychiatry 1994; 165: 315-323
When to refer to secondary care?
• If you feel diagnosis is uncertain
• If you feel inexperienced to treat
• If 1or 2 treatments have failed (adequate doses for
adequate length of time)
• If there is co-morbidity (depression) and risk of suicide
• If psychological treatments are not available at primary
care
Prediction of response to treatment