Stress testing is now recommended for adults under 65


Your primary care provider may ask you about feelings of anxiety as part of a routine checkup, according to new recommendations from an influential health panel.

A recommendation by a US Defense Services Task Force on JAMA, published Tuesday in the Journal of the American Medical Association, stems from concerns. A growing mental health crisis, growing concerns about depression, anxiety and suicide. Although the task force’s recommendations are not binding, the recommendations typically change the way doctors practice medicine in the United States.

The new guidelines state that asymptomatic adults ages 19 to 64, including those who are pregnant and postpartum, should be screened for anxiety disorders using questionnaires and other screening tools.

The task force said it would last fall. They recommend checking for stressBut he waited for public opinion before making the proposal final. In October, the group is also recommended Anxiety screening for children aged 8 to 18 years.

The group, an independent panel of doctors and other experts appointed by the Department of Health and Human Services to evaluate care aimed at prevention or early detection, said it did not find enough evidence to assess the risks and benefits of those stress screenings. 65 and over.

Previous guidelines from the task force recommended screening for depression, but not anxiety disorder — which affected 19 percent of US adults in the past year and is estimated to affect 31 percent at some point in their lives. Data displayS. Experts say the new advice will help clinicians assess, identify and treat anxiety disorders earlier, giving patients a better prognosis.

“There are a lot of patients who come to primary care who have symptoms but don’t develop them,” he says, because of the stigma often associated with mental health issues. Michael SilversteinVice Chairman of the Task Force. “So instead of waiting for people to come to their doctor with signs or symptoms, it’s about finding people earlier and easing the burden.”

The epidemic has pushed America into a mental health crisis.

Michael Albert, chief of internal medicine at Johns Hopkins Community Physicians, said he hopes the recommendation will lay the groundwork for closing the gap in mental health resources — such as loan relief for students entering the mental health professions and better reimbursement from insurance. Companies for Mental Health Care – To improve access to mental health care.

“I appreciate the USPSTF’s suggestion,” he said. “I hope it moves the needle nationally on what needs to be done to increase access to the services that patients need.”

The task force reinforced previous recommendations to investigate depression among this same adult population.

‘disabling capacity’

Despite increasing workloads and demands among medical and mental health professionals, many primary care clinicians assess patients for anxiety disorders on a case-by-case basis. The new recommendation makes it standard practice in the adult patient population.

Many people are living with undiagnosed anxiety disorders, which can include generalized anxiety disorder, separation anxiety, social anxiety, and phobias.

Implementing testing for them will almost certainly increase the number of people diagnosed and treated – creating pressure. It is already overloaded Mental health care system.

“When we have too many professionals in the beginning for people who have anxiety disorders or depression that is persistent and chronic and requires a lot of effort and energy, there can be a barrier,” he said. Lynn BufkaAssociate Chief of Practice Change at the American Psychological Association. “If some of those individuals had gotten help sooner, they wouldn’t have needed long-term care.”

“If we can start changing so that people can get a level of care that meets their needs quickly, in the long run, it will be beneficial to maintain balance in the system.” Bufka said.

Many patients may not be aware of the symptoms of an undiagnosed anxiety disorder, experts say, from physical to somatic symptoms can appear in different ways.

“People who struggle with GI pain, pain or sleep disturbances often don’t make the connection that there may be a stress issue contributing to it.” Natalie DatilloClinical psychologist at Brigham and Women’s Hospital and instructor at Harvard Medical School.

“I’ve met people who have struggled with depression for a long time and they just accept it for who they are,” Datillo said. These patients “didn’t realize the ways their anxiety kept them from doing things and how limited their lives were because of the anxiety.”

In making its recommendation, the task force reviewed research on several scales used to screen for anxiety disorders.

A filter toolFor example, it asks patients to rate potential anxiety symptoms in the past two weeks, such as how often they felt “stressed, anxious, or on edge,” “so restless that it’s hard to sit still,” or “fearful that something bad is going to happen.” According to experts, such questionnaires can be given to patients in the forms they fill out before their primary care visits.

Primary care physicians may prescribe medications such as serotonin reuptake inhibitors or SSRIs, but patients who want or need non-drug treatments such as psychotherapy, or talk therapy are referred to a therapist, which may include a social worker, counselor, and Psychologist.

When the severity of the illness is too complicated for primary care doctors to manage medication, a psychiatrist will manage drug therapy, he said. Petros LevounisPresident of the American Psychiatric Association.

Mental health experts say that after a patient tests positive for an anxiety disorder, the patient should be evaluated for depression and suicidality.

The task force also looked at the risk of suicide, but said there was insufficient evidence to assess the benefits and risks of screening for it, instead calling for more research to make that decision.

Stress filter limits

Some therapists have expressed concern about over-reliance on medication, as front-line primary care physicians are more equipped to prescribe medication than to provide psychotherapy.

“While medications are helpful, there is a high chance that symptoms will return after individuals stop taking the medication,” he said. Erlanger TurnerAssociate Professor of Psychology at Pepperdine University.

Turner said he worries that anxiety disorders may be overdiagnosed in communities of color. He said racism and discrimination can be very stressful at times.

“We want to recognize that just because you have some of these problems — just because you’re angry or anxious a lot — doesn’t necessarily mean you have an anxiety disorder. “We want to know that anxiety is normal and that there is a continuum from mild to severe symptoms.”

In an editorial accompanying the recommendations, they emphasized that anxiety is a symptom of a disorder, not a disorder, that can arise from a variety of stressors, and related mental health conditions, including stress and posttraumatic stress disorder or physical health conditions. such as thyroid disease.

“The adoption of these new anxiety screening recommendations should provide motivation and opportunity for primary care clinicians to feel more comfortable diagnosing and treating anxiety disorders that require additional training,” they wrote. “Anxiety disorders can be distressing and disabling, and proper recognition and treatment can be life-changing and, in some cases, life-saving for patients.”

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