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Anxiety disorders are associated with a significantly increased risk of suicidal behaviours.
Rates of suicide and suicide attempts are reported as being ten times higher in people with anxiety disorders than in the general population.
If there is any immediate and imminent danger to either the patient or the safety of others, then it may be necessary to call the police for assistance on 111.
If you require immediate assessment due to concerns around risk and safety as below:
  • Serious suicidal intent – is actively suicidal, has a current suicide plan or is at risk of self–harm
  • Psychotic symptoms
  • Severe self-neglect 
  • Is a risk to others
CONTACT:
  • EBOP: 0800 7774545 or during business hours on 07 306 0154
  • WBOP: 0800 800508 or during business hours 07 579 8329
  • WBOP over 65s: MHSOP – 07 579 8335 (8-5pm). Ask to speak to Intake After Hours (as above).
If the patient requires compulsory assessment then they will need the Mental Health Act 1992. If this is needed, then contact the Duty Authorised Officer using the 0800 numbers above and they will provide the necessary forms.
Referral to mental health services for assessment/admission may also be indicated for severely ill patients who:
  • lack adequate support outside of a hospital setting
  • have complicated psychiatric or general medical conditions
  • carry significant risk to themselves or others and cannot be managed safely outside a hospital setting.
The Adult Community Mental Health Service has a triage intake process that can be found here and which uses a triage scale that takes into account risk assessments. This may be of value to reference when considering a referral into their service.

Background

  • Anxiety is normal but becomes a disorder when it is of greater intensity or duration than would be normally expected and if it leads to impairment or disability.
  • Anxiety disorders are the most frequently seen mental disorders in primary care, followed by depression.
  • Anxiety disorders are usually more common in women however individual disorders differ in their gender distribution e.g. obsessive compulsive disorder is almost as common in men as women.
  • Older adults are less likely to be affected by anxiety disorders because they often can adapt more quickly to cope with stressful tasks.

Assessment

  1. Clinical Presentation

      • Anticipatory anxiety and worry – worry may be excessive and last six months or more
      • Restlessness or nervousness
      • Being easily fatigued
      • Sleep disturbance
      • Poor concentration
      • Irritability
      • Palpitations
      • Hyperventilation
      • Sweating
      • Flushing
      • Muscle tension
      • Lightheadedness
      • Dizziness
      • Epigastric discomfort
      • Nature, frequency and intensity of symptom
      • Rate of onset – gradual or rapid
      • Recent stressful life events and lack of social support
      • Situations that trigger or exacerbate symptoms , including first occurrence
      • Avoidance and ritualised behaviours
      • Personal and family history of anxiety disorders
      • Chronic or severe physical illness
      • Concurrent substance abuse or withdrawal
      • Any self-medication
      • Cultural or other individual characteristics that may be important in subsequent care
      • Always ask about any suicidal ideation and intent
      • Full blood count
      • Thyroid function tests
      • ECG if prominent cardiac symptoms
      • Urea and electrolytes
  2. Scoring Tools

    • These scoring tools can be used as guides to detect and assess the severity of anxiety but must be used alongside a fuller clinical assessment and should not be used to determine the need for treatment.
    • Best Practice also has links to GAD-7 and Kessler 10 listed in the forms menu.
  3. Medical disorders Psychiatric disorders
    • Endocrine and metabolic causes:  hyperthyroidism and hypothyroidism, hypoglycaemia, diabetes, menopause.
    • Gastrointestinal causes: peptic ulcers, irritable bowel  syndrome.
    • Cardiopulmonary causes: asthma, COPD, pulmonary embolism, arrhythmia.
    • Neurological causes: temporal lobe epilepsy, migraine.
    • Others: UTI in elderly, anaemia, adverse effects of medications, excessive stimulant intake including caffeine and nicotine, excessive alcohol intake or withdrawal.

     

    • Substance abuse
    • Depressive disorders
    • Psychotic or delusional disorders
    • Eating disorders
    • Personality disorders – schizoid personality disorder, OCD personality disorder
    • Somatisation disorder
    • Impulse control disorder
    • Hypochondriasis
    • Body dysmorphic disorder
  4. Determine Type of Anxiety
    • There are a wide range of anxiety disorders and presentation can vary.
    • The following algorithm can be used to determine which anxiety disorder is most likely 

      What are patients symptoms?

      • Characteristic symptoms develop following a stressful event or situation of an exceptionally threatening or catastrophic nature, in which both of the following were present:
        • The person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others.
        • The person's response involved intense fear, helplessness, or horror.
      • Can affect people of all ages.
      • Symptoms include:
        • Re-experiencing of traumatic event:
          • flashbacks
          • repetitive nightmares.
        • Intense psychological distress and/or physiological reactivity at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
        • Avoidance of reminders of trauma, indicated by three (or more) of the following:
          • efforts to avoid thoughts, feelings, or conversations associated with the trauma
          • efforts to avoid activities, places, or people that arouse recollections of the trauma
          • inability to recall an important aspect of the trauma
          • markedly diminished interest or participation in significant activities
          • feeling of detachment or estrangement from others
          • restricted range of effect, eg unable to have loving feelings
          • sense of foreshortened future.
        • Hyperarousal state:
          • irritable
          • overly alert
          • difficulty falling or staying asleep
          • difficulty concentrating
            • anger outbursts.
      • Full symptom picture must be present for more than one month.
      • Disturbance causes clinically significant distress or impairment.
      • Prevalence: Up to 30% of those exposed to a major traumatic event may go on to develop PTSD.
      • Recurrent obsessions or compulsions that are excessive or unreasonable, time-consuming and cause marked distress.
      • Obsessions:
        • Recurrent and persistent thoughts, impulses, or images that are intrusive and inappropriate and cause marked anxiety or distress.
        • Person attempts to ignore or suppress them with other thoughts or actions.
        • Person recognises they are a product of their own mind.
        • Common obsessional themes include fear of contamination from:
          • dirt
          • germs
          • viruses
          • bodily fluids
          • chemicals
          • sticky or dangerous substances.
        • Fear of harm, e.g. door locks are not secure.
        • Excessive attention to order or symmetry.
        • Obsession with body or physical symptoms.
        • Religious, sacrilegious, or blasphemous thoughts.
        • Sexual thoughts.
        • Desire to hoard worn-out or useless possessions.
        • Violent or aggressive thoughts.
      • Compulsions:
        • Repetitive behaviours or mental acts that the person feels driven to perform in response to an obsession or rigid self-rules
        • They are aimed at preventing or reducing distress but are not realistic and clearly excessive.
        • Common compulsions include:
          • checking, e.g. gas, taps, locks
          • cleaning, washing
          • repetition of special words or prayers
          • ordering, symmetry, exactness
          • hoarding or collecting
        • Resultant limit to functional ability may cause anxiety and distress.
        • They are time consuming and/or cause functional impairment.
        • Insight is usually retained − at some point during course of disorder, the person recognises and tries to resist obsessions and compulsions.
        • People with OCD are often ashamed and embarrassed by their condition and may find it difficult to discuss their symptoms with healthcare professionals, friends, families, or carers.
      • Prevalence:
        • Lifetime prevalence of around 2.5%.
        • Equally common in men and women.
        • Onset:
          • can develop at any age, but typical onset is in adolescence and early adulthood
          • usually gradual, and severity fluctuates over time.
      • Prognosis:
        • Approximately 90% of people with OCD can expect a moderate-to-marked improvement of their symptoms with optimal treatment.
        • Complete recovery is rare.
      • Generalised Anxiety Disorder is one of the most common anxiety disorders seen in primary care.
      • It is characterised by excessive and inappropriate worrying that causes significant distress or impairment.
      • Recovery from GAD can be less likely than recovery from major depression.
      • Generalised DSM-IV diagnostic criteria for GAD
        1. Excessive anxiety and worry about a number of events or activities, occurring more days than not for at least six months, that are out of proportion to the likelihood or impact of feared events.
        2. The worry is pervasive and difficult to control.
        3. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms present for more days than not for the past six months):
          • restlessness or feeling keyed up or on edge
          • being easily fatigued
          • difficulty concentrating or mind going blank
          • irritability
          • muscle tension
          • sleep disturbance (difficulty falling or staying asleep or restless unsatisfying sleep).
        4. The anxiety, worry or physical symptoms cause clinically significant distress or impairment in social, occupational or other important areas of functioning.
      • Specific phobia definition:
        • Marked and persistent fear of a specific object or situation.
        • Person recognises fear as being excessive or irrational.
        • Exposure may lead to extreme distress or panic attack.
        • Often leads to avoidance behaviour, though may be endured with dread.
        • Interferes with normal routine and functioning and/or causes high levels of distress.
        • Sometimes full-blown panic attacks are experienced in response to the phobic stimulus, especially when the person must remain in the situation or believes that escape May be impossible.
        • Fainting may occur with exposure to blood, injection, injury, or medical phobias.
        • Common fears include:
          • animals
          • insects
          • blood
          • injections
          • injury
          • closed spaces
          • water
          • heights
          • storms
          • dental procedures
          • driving
          • flying
          • elevators
          • vomiting
      • Prevalence:
        • Age of onset is usually childhood or mid-20s.
        • Lifetime prevalence rate of 10-11.3%.
      • Social phobia definition:
        • Persistent and marked fear of social or performance situations.
        • Person fears embarrassing themselves or showing anxiety in front of other people.
        • Person recognises their fear is excessive or unreasonable.
        • Exposure to feared situation may lead to anxiety, including panic attacks.
        • Person will avoid situations or experience intense anxiety during them.
        • Avoidance, anxious anticipation or distress interferes with normal routine and functioning.
        • Common situations include:
          • eating in public
          • speaking in public
          • using public toilets
          • social situations where they may say or do something foolish
          • situations where they may blush or appear anxious.
      • Prevalence:
        • Age of onset is usually mid-teens.
        • Lifetime prevalence of 3-13%.
      • Prognosis:
          • chronic disorder that may fluctuate over time.
          • can be difficult to treat.
          • removal of all anxiety is symptoms is unlikely.
      • Agoraphobia − generally occurs with panic disorder.
      • Definition:
        • At least two unexpected (without warning) panic attacks, followed by:
          • worry about having more attacks
          • concern about implications of attacks
          • change in behaviour as a result of attacks.
        • Panic attacks include at least four of the following symptoms and peak within 10 minutes of symptom onset:
          • palpitations, pounding heart, or accelerated heart rate
          • sweating
          • shaking or trembling
          • shortness of breath or smothering sensation
          • choking feeling
          • chest pain or discomfort
          • nausea or abdominal pain
          • feeling dizzy, light-headed, unsteady, or faint
          • depersonalisation or derealisation
          • fear of losing control or going crazy
          • fear of dying
          • numbness or tingling sensation
          • chills or hot flushes.
        • Panic attacks are not due to the direct physiological effects of a substance or a general medical condition.
      • Prevalence:
        • 1-2%
        • More common in female population.
      • Prognosis:
        • Episodic outbreaks with years of intermittent remissions or continual severe symptoms.
        • 6-10 years after treatment:
          • 30% are without symptoms
          • 40-50% are improved but with some symptoms
          • 20-30% have no improvement or slight worsening of symptoms.
      • Agoraphobia commonly occurs concurrently:
        • Anxiety about situations where a panic attack might occur, and it would be difficult or embarrassing to escape, or help might be unavailable.
        • Agoraphobia is rarely diagnosed without panic disorder, and may be a consequence of the severity of a primary panic disorder.

Management

1. Psychoeducation, Self-Help, and Active Monitoring

  • Education and active monitoring may improve less severe presentations and avoid the need for further intervention.
  • There are a wide range of online resources and interventions for patients with anxiety. 
  • If symptoms are severe initially with marked functional impairment then consider offering either psychological intervention or medication first line.
Intervention Key Links

Lifestyle considerations

  • Sleep hygiene measures
  • Take regular exercise
  • Alcohol and substance misuse
  • Diet and eating behaviours
  • Maintenance of social networks and personal meaningful activities

Active Monitoring/support

  • Restoring natural sleep rhythms
  • Integrating structure to the day
  • Provide information about anxiety
  • Provide follow-up – 2 weeks

 

Self-Management

  • Computerised CBT
  • Physical exercise – Green Prescriptions
  • Social support groups
  • Mindfulness strategies
  • Maori – Whanau Ora model

2. Review

  • Review initially every 1-2 weeks.
  • For patients showing good response to initial interventions then arrange further review as appropriate.
  • For those whose symptoms have not responded adequately consider more intensive psychological intervention or medication.
  • Discuss the patient’s preference for these options as there is no clear evidence that either mode of treatment is better, although the relapse rate may be lower with psychological therapies.

3. Psychological Interventions

  • For people with anxiety disorders whose symptoms have not improved after education and active monitoring, offer the option of psychological interventions.
  • Psychological and drug therapies are equally effective in the treatment of anxiety disorders. However the relapse rate for psychological therapies may be lower.
  • It is recommended that initially, either psychological or drug therapy are used alone as there is no evidence that using them together is more effective.
  • Several factors determine which treatment is chosen; these are the:
    • Patient’s preference and motivation
    • Patient’s response to any previous treatments
    • Availability and cost of psychological therapy
    • Patient’s ability to engage in treatment (e.g. certain cognitive-behavioural therapies may be unsuitable for patients with significant cognitive impairment)
    • Adverse drug effects
    • Onset of efficacy.
    • WBOPPHO and EBPHA Referral to CPO Mental Health for six individual psychology sessions and access to group sessions if appropriate.
    • WBOPPHO have the option of anxiety management groups.
    • NMO PHO Referral to Te Manu Toroa.

4. Pharmacological Interventions

Generalised Anxiety Disorder

SSRI/SNRI

  • First line medication choice.
  • Choice is dependent on potential adverse effects, interactions and patient preference ( see link to Moderate Depression – Pharmacology).
  • Transient increase in anxiety, insomnia and nausea may be associated with SSRIs and may affect compliance. This can be minimised by starting with low doses and slowly increasing to full doses as tolerated.

If transient increase in anxiety is intolerable it may be appropriate to consider prescribing a benzodiazepine for the first few weeks of treatment.

Benzodiazepines (For a very useful overview of this class of medication see nzf.org.nz/nzf_2058)

  • Rapid onset of action and are effective for managing symptoms short term.
  • Minimise somatic symptoms of anxiety, with less effect on the key psychological aspects.
  • Can be used in the first few weeks during initiation of SSRI (see above).
  • Sedation is a common side effect and potential for cognitive impairment and ataxia in older people. These effects are less with short to intermediate acting benzodiazepines such as alprazolam, lorazepam and oxazepam.
  • Avoid in people who have previously demonstrated addictive behaviour. People with chronic pain disorders and severe personality disorders may also be at increased risk of dependency.
  • When discontinuing, the dose should be slowly tapered. Useful table of dose equivalences for withdrawal in NZF.

Buspirone

  • Considered second line as it has no impact on co-existing depression.
  • Advantages over benzodiazepines include lack of withdrawal symptoms and low potential for abuse or physical dependence.
  • Response to treatment may take up to 4 weeks.
  • To minimise dizziness, the most common adverse effect, dosing should be slowly increased from 5mg tid to 15mg tid over 2 weeks.

Tricyclic Anti-depressants

  • Imipramine and clomipramine have been found to be effective in GAD.
  • Considered second line agents as they are less well tolerated and more toxic on overdose than SSRI’s/SNRI.

Antipsychotics

  • Some low potency antipsychotics such as quetiapine (off label indications) in low doses are sometimes used in severe anxiety for their anxiolytic actions.
  • Long-term use should be avoided because of the risk of adverse effects.

 

Post-Traumatic Stress Disorder  
  • SSRI – dose tends to be pushed to the higher end of the therapeutic range, as tolerated by the patient.
  • Antiadrenergics – prazosin or clonidine may improve symptoms including nightmares and flashbacks (unapproved indications) BUT should only be initiated by a mental health specialist or after discussion with a mental health specialist.
Obsessive Compulsive Disorder (OCD)
(First line for this condition should be psychological therapies)
  • SSRI. No individual SSRI has been found to be more effective than the others. Clomipramine can also be used but has been found to be any more effective than SSRI
  • In general these medications lead to improvement in 40-60% of people with OCD.
  • On average OCD patients who receive an adequate trial of one of these agents will experience a 20-40% reduction in their OCD symptoms. Thus, they typically offer amelioration rather than elimination of symptoms.
  • Most fixed dose trials suggest higher doses led to greater response rates and greater mean rates of improvement compared to lower dose, but this is balanced with drop out rates due to side effects.
  • Usually needs an 8-12 week trial with gradual increase of dose during that time before concluding that the drug is ineffective.
  • If good response then should remain on medication for at least 1-2 years.
Specific Phobia and Social Phobia
  • Pharmacotherapy has a limited role in treatment of specific phobias. First line for this condition is CBT which includes exposure treatment. For infrequently encountered phobic stimulus then a benzodiazepine such as lorazepam 0.5-2mg can be taken 30 minutes before encountering the situation.
  • SSRIs are best studied and most commonly prescribed for social phobia. Venlafaxine has also been studied in social anxiety disorder and is effective.
  • Patients should be encouraged to ‘try out’ the medication by engaging in situations that typically result in anxiety and report back about their response.
  • Higher doses result in better outcomes.
  • Monamine oxidase inhibitors  have been used historically the longest but their use is limited by side effects and dietary restrictions.
  • Benzodiazepines, specifically clonazepam, have been shown to be effective in the reduction of social anxiety disorder symptoms. Start with low doses and titrate upwards slowly. Avoid in those with a history of addictions.
Panic Disorder
  • SSRIs  and SNRI reduce frequency of panic attacks, severity of anticipatory anxiety and degree of phobic avoidance.
  • Patients are usually very sensitive to overstimulation effects with SSRIs, treatment should start at low doses.
  • Treatment should be continued for at least one year after symptoms control has been attained.


5. Review

  • When starting medication for anxiety it is very important to review them after 1-2 weeks to assess effectiveness and possible side effects.
  • Particularly in patients under 30 years old, there may be an increase in suicidal thinking and self-harm in a minority of people on initiation of an SSRI or SNRI.
  • Review for improvement

    Review regularly once diagnosis has been made and treatment initiated.

    Initially within 1-2 weeks. Consider phone review after a week if needed. This can be made by any member of a primary health team, i.e. practice nurse.

    Continue to monitor risk and ask about suicide. In the first few days of treatment with an SSRI an increase in anxiety, restlessness or agitation may occur. This can be distressing and may be associated with increased suicidality.

    Review again after 4 weeks and then ideally every 3 months until decision made to cease treatment.

    Consider using Kessler Score or PhQ-9 to monitor progress 

    If antidepressants have been prescribed then ask about side effects particularly:

    • symptoms of hyponatraemia – dizziness, lethargy, nausea, confusion, cramps, seizures
    • hypertension/ hypotension – if taking venlafaxine
    • mania
    • anti-cholinergic symptoms
    • sedation, insomnia, activation, changes in weight, sexual dysfunction.

    Some side effects can be managed and will decrease with time, i.e. mild nausea and headaches. This information can be given to a patient to help manage their expectations.

    Sexual dysfunction is a common problem with many medications particularly SSRIs.

    The following guide provides a framework for managing antidepressant-induced sexual dysfunction:

    • rule out other causes
    • wait: some patients will improve within six months
    • reduce dose: risk of relapse
    • switch to antidepressant with lower risk of sexual dysfunction (e.g. mirtazapine, moclobemide, bupropion) -NZF switch table
    • add low dose of bupropion or mirtazapine (more evidence for bupropion than mirtazapine). Women are more likely to respond to bupropion than sildenafil or tadalafil.
    • add sildenafil or tadalafil (more effective for men than women)
    • exercise: high drop-out rate.

    The following table details the comparative rates of common side effects amongst the commonly prescribed antidepressants

    Medicine Anticholinergic Agitation/
    insomnia
    GI* Sedation Weight gain Sexual dysfunction QT prolongation

    SSRIs

     

     

     

     

     

     

     

    Citalopram

    0

    +

    +

    0

    +

    +++

    +

    Escitalopram

    0

    +

    +

    0

    +

    +++

    +

    Fluoxetine

    0

    ++

    +

    0

    +

    +++

    +

    Paroxetine

    +

    +

    +

    +

    ++

    ++++

    0/+

    Sertraline

    0

    ++

    ++

    0

    +

    +++

    0/+

     

     

     

     

     

     

     

     

    SNRI/NaSSA

     

     

     

     

     

     

     

    Venlafaxine

    0

    +

    ++

    0/+

    +

    +++

    +

    Mirtazapine

    +

    0

    0

    ++++

    ++++

    +

    +

     

     

     

     

     

     

     

     

    TCAs

     

     

     

     

     

     

     

    Amitriptyline

    ++++

    0

    +

    ++++

    ++++

    ++

    +++

    Clomipramine

    ++++

    +

    +

    ++++

    ++++

    ++

    ++

    Dosulepin (dothiepin)

    +++

    0

    +

    ++++

    ++++

    ++

    +++

    Doxepin

    +++

    0

    0

    +++

    ++++

    ++

    +++

    Imipramine

    +++

    +

    +

    +++

    ++++

    ++

    +++

    Nortriptyline

    ++

    0

    0

    ++

    +

    ++

    +++

     

     

     

     

     

     

     

     

    MAOIs

     

     

     

     

     

     

     

    Moclobemide (RIMA)

    +

    0

    +

    0/+

    0/+

    0/+

    0/+

    Phenelzine

    +

    +

    +

    ++

    ++

    +++

    0

     

     

     

     

     

     

     

     

    Atypical

     

     

     

     

     

     

     

    Bupropion

    0

    +

    +

    0

    0

    0

    +

     

    It is also important to identify any possibility of serotonin syndrome which is a severe form of serotonin toxicity. The can be mild with tremor and low grade restlessness or present with more severe symptoms as below. This may require supportive management and cessation of the causative agents. If severe the patient may require referral to an emergency department as it can be fatal.

    Features of Serotonin Toxicity (BPAC - 2009)

    Clinical Features Contributing factors

    Abdominal cramps, agitation, diarrhoea, myoclonus, tremulousness, coma, tachycardia, hypotension, disorientation, profuse sweating, hyperpyrexia.

    • Overdosage
    • Drug interaction, especially SSRI + MAOI or SSRI + serotonergic TCA (e.g. clomipramine, amitriptyline, imipramine)
    • Inadequate drug-free interval in changing medications
    • Idiosyncratic reaction

     

    There are several drugs and herbal products that have serotonergic activity and therefore can cause serotonin syndrome when combined or given alone at high doses.

    Drugs that may cause serotonin toxicity (BPAC -2009)

    Class Drugs

    antidepressants

    TCAs (especially clomipramine), MAOIs (including moclobemide), SSRIs, mirtazapine, venlafaxine, St John’s Wort

    opioids

    Tramadol, pethidine, dextromethorphan

    stimulants

    Amphetamines, sibutramine

    5HT1 agonists

    Sumatriptan, naratriptan, zolmitriptan

    others

    Ecstasy, LSD, cocaine. Selegiline, tryptophan, buspirone, lithium, linezolid

     

    For more information on Serotonin syndrome/toxicity – Medsafe Prescriber Update

  • Good response
    • Review every 3 months and consider continuing any medication for a year as the likelihood of relapse is high.
    • Educate for recognition of any future episodes looking for early warning symptoms.
  • Poor response
    • Consider alternative medication if initial response is not effective or providing psychological input if this has not already been accessed.
    • Consider referral to Community Mental Health – 

      Refer to Community Mental Health

      Consider referral for specialist assessment and further treatment if:

      • the patient has severe anxiety with marked functional impairment in conjunction with/or without
        • a risk of self-harm or suicide or
        • significant co-morbidity, e.g. substance misuse, personality disorder or complex physical health problems or
        • self-neglect or
        • an inadequate response to high intensity psychological intervention or drug therapy or a combination of both
      • the diagnosis is unclear and needs further evaluation, for example the diagnosis of obsessive compulsive disorder
      • the patient has limited access to social support.

      The Adult Community Mental Health Service has a Triage Intake Process that can be found here and which uses a triage scale that takes into account risk assessments. This may be of value to reference when considering a referral into their service.

6. Refer to Community Mental Health

  • Consider referral for specialist assessment and further treatment if:
    • the patient has severe anxiety with marked functional impairment in conjunction with/or without
      • a risk of self-harm or suicide or
      • significant co-morbidity, e.g. substance misuse, personality disorder or complex physical health problems or
      • self-neglect or
      • an inadequate response to high intensity psychological intervention or drug therapy or a combination of both
  • the diagnosis is unclear and needs further evaluation, for example the diagnosis of obsessive compulsive disorder
  • the patient has limited access to social support.
  • The Adult Community Mental Health Service has a Triage Intake Process that can be found here and which uses a triage scale that takes into account risk assessments. This may be of value to reference when considering a referral into their service.

 

Information

Disclaimer: These pathways, for the care and management of patients within Bay of Plenty, have been developed jointly by primary and secondary care clinicians. They provide guidance for General Practice teams to diagnose and manage patients suffering from a number of different conditions, and contain patient information resources. The pathways are maps of publicly-funded services accessed by referral from the community, and are strongly evidence based, but are not full clinical guidelines. As the pathways are suggested guidance only, while using them you must exercise your own clinical judgement and pertinent clinical data when treating your patient. This site is intended to be flexible and frequently updated. While every effort has been made to ensure accuracy, all information should be verified.