Video

PUPC Recap—Anxiety Disorders in Primary Care: Recognition, Treatment, and Long-Term Management

Brittany Albright, MD, MPH

Key Highlights

  • Anxiety disorders are among the most common mental health conditions in the United States and can substantially impair quality of life and daily functioning.
  • Primary care clinicians play a frontline role in recognizing anxiety disorders, which may emerge early in life, persist across the lifespan, and often co-occur with depression, OCD, panic disorder, or other psychiatric conditions.
  • Dr Albright highlights practical strategies for screening, diagnosis, patient education, medication selection, and management of treatment-related adverse effects.
  • The presentation underscores the clinical importance of anxiety screening, noting that anxiety disorders are associated with increased risk of suicide attempts and may require urgent attention in some patients.

Brittany Albright, MD, a psychiatrist specializing in general adult psychiatry, obesity medicine, and addiction psychiatry, discusses the recognition, diagnosis, and management of anxiety disorders in primary care. In this video, Dr. Albright emphasizes the high prevalence and functional burden of anxiety disorders, the importance of repeated screening, and the need for evidence-based treatment strategies that include medication management, psychoeducation, and psychotherapy resources.

Additional Resource: https://www.hmpglobalevents.com/pupc 

Transcript

Brittany Albright, MD, MPH: Hi, I'm Dr. Brittany Albright, and I am a psychiatrist specializing in general adult psychiatry, obesity medicine, and addiction psychiatry, based in Charleston, South Carolina, and I own a private practice.

Consultant360: What are some of the key themes of your presentation?

Albright: Our topic is anxiety disorders in primary care: recognition, treatment, and management strategies, and that's exactly what we cover in our learning objectives: how do you recognize, how do you formally diagnose, different anxiety disorders? What evidence-based treatment strategies do we have, especially that one can utilize in the very busy primary care setting? And lastly, how do we manage side effects from a lot of the treatments that we utilize for anxiety disorders? How do you access psychotherapeutic resources for anxiety disorders? Lots to cover on the agenda.

Consultant360: Why is this topic particularly relevant right now?

Albright: The topic of anxiety disorders is particularly relevant because in this country, we're just getting more and more anxious. Unfortunately, anxiety disorders are the number one most common mental health diagnosis in the United States. Often, we focus on depression. We're great at screening for depression, but it's really generalized anxiety disorder, social phobia, panic disorder, post-traumatic stress disorder, and OCD. As a whole, anxiety disorders afflict more Americans than any other mental health condition, and anxiety disorders cause substantial issues with quality of life, with functioning, with being able to get out of the house, with being able to live a full and fulfilled life. So it's our duty to give these patients resources and treatment options.

Consultant360: What are the most important takeaways from your session?

Albright: The most important takeaways from our session include, number one, great screening tools as to how to diagnose anxiety disorders, also clues and hints as to how to just recognize them, even without screening, as you're going through your examination of your patients. Also, a really important key takeaway is that we have a lot of existing treatment options, and they do work. Even though a lot of our medications that are new are not necessarily more effective than our older ones, a lot of the newer medications have more favorable side effect profiles. So, you may have patients with anxiety disorders that gave up on treatments years ago, but it's time to revisit it, because we do have a lot of great treatments now that are more tolerable for our patients.

Consultant360: What gaps in our knowledge do you feel still remain on this topic?

Albright: There are still gaps in our knowledge base on anxiety disorders and just mental health disorders in general. We're still figuring out what causes them, but that's where I revert to the biopsychosocial spiritual model: there's not one cause of an anxiety disorder. They're very heterogeneous, and we think that there's multiple neurotransmitters involved. We think that neurocircuitry, that brain networks, have great implications in this disease process, and then also adverse child experiences, traumatic events, epigenetics, and family history. We have so much yet to discover about anxiety disorders, but one thing we can do now is to reassure patients that their symptoms are real, that we hear them, and that we're there for them. We're going to keep trying different treatment options until we can find our adequate relief for our patients.

Consultant360: Is there any additional information you would like to share?

Albright: One of the most critical reasons we should screen for anxiety disorders, and we should care about anxiety disorders, besides the fact that they're so prevalent and they're so disabling, is that anxiety disorders convey a significantly higher risk of suicide attempts than individuals who don't have an anxiety disorder. So, it truly is a medical emergency for some of our patients.

I do want to leave you with some practical tips here in this brief video: habits of a highly effective anxiety disorder treating clinician. And again, primary care, you are the front line for treating anxiety disorders.

#1: I want you to be troubled by these conditions, to be aware of them, to watch out for them in all of your patients, because they truly lurk everywhere. And the most effective element that you can do is to recognize and diagnose these patients.

#2: Know that these illnesses present earlier in life. Often, in adolescence, is when we first start to pick up on them, but sometimes even earlier than that. Even though they occur early in life, unfortunately, they like to stick around. Anxiety disorders can persist throughout a patient's lifespan, and so early intervention is very important so we can try to break the cycle of anxiety early on.

#3: Anxiety disorders travel in packs. I always remind my patients, yes, you might have several diagnoses in your problem list, but the reality is, all diagnoses are a list of symptoms put together in the DSM. There's so much overlap between anxiety disorders like panic disorder, generalized anxiety disorder, and OCD. So, it's not uncommon for patients to have multiple disorders at once. Depression is another example where it often goes hand in hand with an anxiety disorder.

#4: Look, suspect, screen, repeat. Be proactive. Even if a patient you saw a year ago had no symptoms at that time, reassess them at each visit. They can also pop up at any stage of life.

#5: Knowledge is power. The effective clinician knows the value of psychoeducation and patient self-empowerment. These disorders are challenging to treat, but if we reassure patients, if we validate their feelings, if we offer them solutions, and offer them compassionate education, that can go a long way. As I say all the time, you as their primary care clinician, you are the medicine. You are the treatment. Your empathy goes such a long way.

#6: I want you to carefully navigate the paradox of medications. Medications for anxiety disorders are quite tricky. We have benzodiazepines, we have serotonin-based medications, and we have other medications we use off-label. Know when to use them, know that each class has value, and that it depends on the unique patient circumstances as to which one you should choose.

#7: Last but not least, actually, I would say most importantly, is embrace psychotherapy, and find resources in your community, or virtual, that are cost-effective for your patients, where they can access high-quality psychotherapy. Also, even just providing yourself supportive psychotherapy can go a long way with these patients. So, I wish you all the best on your journey in screening and treating patients with anxiety disorders. Thank you for tuning in!

 

This transcript was edited for clarity.

 

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