Diagnosis

• n/a

Investigation

• Assess severity:
  • Social anxiety: Mini social phobia inventory

Management

Acute

• Respiratory alkalosis
• Self-harm and suicide risk

Conservative

• Social anxiety: 1st line individual CBT (not group)
• OCD: local self help and support groups; CBT including Exposure Response Prevention (ERP)
• PTSD: <3mths Watchful waiting; Relaxation >3mths focused CBT / eye movement desensitisation
• Phobia: Behavioural therapy – non collaborative stage-wise desensitization (eg spider)

Medical

• Social / OCD / Panic: 2nd Line SSRI (Sertraline). Monitor 1st week, increased suicide risk. Relapse risk unlike CBT
• PTSD: 2nd line NSRI Mirtazepine (specialists only)
• Severe cases: Intensive CBT + SSRI
• Anxiety 20 to depression, treating depression first

NICE Source: CG31 Obsessive-compulsive disorder and body dysmorphic disorder: treatment, CG113 Generalised anxiety disorder and panic disorder in adults: management, CG26 Post-traumatic stress disorder: management and CG159 Social anxiety disorder: recognition, assessment and treatment. Summary compiled by Dr D P Sheppard MBBS.