Process - Physician - Fraser Health Authority

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Considering Medication forAnxiety Disorders?For some people, medication is an important part of their anxiety disorder treatment. Sometimes,medications that were originally developed for other conditions can be very effective in treatinganxiety. Anti-depressants, anti-seizure medications, and even anti-psychotic medications can bevery useful treatments for anxiety.How you take your anti-anxiety medication is very important.• Sometimes when you first start a medication it can actually make you feel worse temporarily.Some anti-depressants can cause an initial rise in anxiety, which will go down overtime. Thisis especially true if you start at a dose that is too high or try to increase the dose too quickly.• “Start at low doses and go slow” is the best motto when treating anxiety.• The full benefits of a medication can take up to 8-12 weeks to be fully effective.• Generally, side effects go down and benefits increase over time. It is usually better to bepatient when trying a medication rather than quickly switching to a new one if there is noimmediate improvement.• Ask questions about your medication if you are not sure what to expect.Don’t stop your medication without discussing it with your doctor.• While most anti-anxiety medications are not addictive, it is not safe to stop them “cold turkey.”• If you quickly stop the anti-anxiety medications that are in the benzodiazepine group (Ativan,Clonazepam etc) you can have increased anxiety, insomnia and infrequently, seizures.• If you quickly stop anti-depressant medications you can get uncomfortable symptoms likeelectric shock sensations, dizziness and increased anxiety.• If you decide to stop your medication, it is usually best to taper off it slowly over at least fourweeks and use other coping strategies such as relaxation and try to avoid stimulants likecaffeine.What if my doctor recommends a benzodiazepine?• There are a group of medications called benzodiazepines that can usually be identified byhaving “pam” at the last part of their generic name.• Some common ones are Lorazepam (Ativan) and Clonazepam (Rivotril).• These are effective medications for treating anxiety disorders especially for short-termdistress. Their use does require careful planning as they can cause sedation, cognitiveimpairment and it is possible to become dependent on them.• Usually the use of these medications is limited to short-term use and regular rather than “asneeded”dosing.• If you start finding that these medications are no longer effective or you need higher doses toget the same effect, it is time to talk about other options with your doctor.Patient Empowerment Anxiety Manual VIHA.March.2010 85
Resources for Self-HelpOnline Resources:Anxiety Disorders Association of Canada (ADAC) www.anxietycanada.caAnxiety Disorders of America (ADAA) www.adaa.orgAnxiety Disorders Association of BC (ADABC) www.anxietybc.comBC Partners “Anxiety Disorders Toolkit” www.heretohelp.bc.caFreedom from Fear (FFF) www.freadomfromfear.comCanadian Mental <strong>Health</strong> Association (CMHA) www.cmha.caCMHA BC Division www.cmha.bc.caNational Institute of Mental <strong>Health</strong> www.nimh.nih.gov/publicat/anxiety.cfmClinical Research Unit for Anxiety and Depression (CRUFAD) www.crufad.comThe Anxiety Panic Internet resource (tAPir) www.algy.com/anxietyChangeways Programs www.changeways.comBooks:The Anxiety and Phobia Workbook by Edmund Bourne (1995)The Assertiveness Workbook: How to express your ideas and stand up for yourself at workand in relationships by Randy Paterson (2000)Don’t Panic: Taking Control of Anxiety Attacks by Reid Wilson (1996)Mind Over Mood: Change How You Feel by Changing the Way You Think by DennisGreenberger & Christine Padesky (1995)When Perfect Isn’t Good Enough: Strategies for Coping with Perfectionism by Martin Anthony& Richard Swinson (1998)Patient Empowerment Anxiety Manual VIHA.March.2010 86
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SteppedCareLevel 1PSP Mental Health
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Fold back this page before administ
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CBISCOGNITIVE BEHAVIOURAL INTERPERS
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Table of ContentsINTRODUCTION. . .
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IntroductionThe following modules h
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TipsTeachingSelling Strategies• E
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Flow ChartsThis module contains flo
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Patient NeedsTryThe Circle of Depre
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AnxiousSymptomsTryOverwhelmedChaoti
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Assessment ModuleThe Assessment Mod
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5 Energy levela. How would you rate
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15 Phobiasa. Any unrealistic or exc
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21 CAGEHow many drinks might you ha
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DIAGNOSTIC SCREENING WORKSHEET (CON
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Problem List Action PlanACTIVATIONR
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Self-Assessment QuestionnaireName:
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Self-Assessment ProfilePleaser: Hig
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Self-Assessment ProfileOver-Thinker
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Understanding Depression- Frequentl
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Depression: System-Wide CrashDepres
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Activation ModuleThe Activation Mod
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Depression’s Energy BudgetEvery d
Page 45 and 46: Small GoalsThe concentration, fatig
Page 47 and 48: Problem SolvingDepression can make
Page 49 and 50: Chunk the DayStrategies that give p
Page 51 and 52: Appreciation Exercise“Good for Me
Page 53 and 54: The Circle of DepressionCognitive-b
Page 55 and 56: Common Thinking ErrorsThe situation
Page 57 and 58: THOUGHT CHANGE PROCESS (CONTINUED)T
Page 59 and 60: Thought StoppingDepression often ma
Page 61 and 62: Good Guilt / Bad GuiltA world witho
Page 63 and 64: Setting LimitsMost of us like to be
Page 65 and 66: Is Anger a Problem for You?Tom arri
Page 67 and 68: Stress ResponseIntroduction to Rela
Page 69 and 70: Variation - Box BreathingABDOMINAL
Page 71 and 72: Body ScanPurpose• Body scan is a
Page 73 and 74: Stress BustersPurpose• Shorter te
Page 75 and 76: MindfulnessPurpose• Mindfulness i
Page 77 and 78: BreathMINDFULNESS MEDITATION (CONTI
Page 79 and 80: Healthy Habits for SleepingDepressi
Page 81 and 82: IT’S TRUE: YOU ARE WHAT YOU EAT!
Page 83 and 84: The Wellness WheelPHYSICALGROWTHSEL
Page 85 and 86: CBISCognitive Behavioural Interpers
Page 87 and 88: FLOW CHARTS……………………
Page 89 and 90: PANIC DISORDER• Anxiety “System
Page 91 and 92: The Many Faces of AnxietyPanic Diso
Page 93 and 94: Medical ConsiderationsMost Common M
Page 95: Anxiety“System-Wide Explosion”A
Page 99 and 100: GAD: Self-Assessment QuestionnaireN
Page 101 and 102: GAD: Self-Assessment ProfileHard Dr
Page 103 and 104: How Anxiety WorksTHOUGHTSBODYFEELIN
Page 105 and 106: Panic CircleEvent (public speaking)
Page 107 and 108: Your Emotional Thermometer• Imagi
Page 109 and 110: Anxiety EquationAnxiety arises out
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Page 113 and 114: Coping CardsAnxious people often ma
Page 115 and 116: Problem SolvingAnxiety is strengthe
Page 117 and 118: Example: Kelly begins by making a l
Page 119 and 120: D.E.S.C. ScriptAssertiveness doesn
Page 121 and 122: Application forPsychiatric Medicati
Page 123 and 124: APPENDIX 2: WOMEN’S MENTAL HEALTH
Page 125 and 126: Pharmacotherapy in the Perinatal Pe
Page 131: FAMILY PHYSICIAN GUIDE | ADDRESSING
Page 134 and 135: Olanzapine (Zyprexa)Tablets, wafers
Page 136 and 137: Consortium forOrganizationalMentalH
Page 138 and 139: 3. Gather details on current andpre
Page 140 and 141: Task Two: ADVISE1. Provide meaning
Page 142 and 143: SUPPORTED SELF‐MANAGEMENT FOR DEP
Page 144 and 145: TABLE OF CONTENTSIntroduction 1What
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INTRODUCTIONTake a moment now to as
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WHAT IS DEPRESSION?The two most com
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WHAT CAUSES DEPRESSION?People becom
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WHAT CAUSES DEPRESSION?ThoughtsEach
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WHAT CAUSES DEPRESSION?EmotionDepre
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WHAT CAUSES DEPRESSION?ActionDepres
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WHAT CAN YOU DO ABOUT DEPRESSION?MI
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MORE ABOUT MEDICATIONMedication is
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ANTIDEPRESSANT SKILLSIn this sectio
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REACTIVATING YOUR LIFEStep 1: Ident
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REACTIVATING YOUR LIFESmall DutiesE
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REACTIVATING YOUR LIFEStep 2: Choos
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REACTIVATING YOUR LIFEStep 3: Set r
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REACTIVATING YOUR LIFEStep 4: Carry
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THINKING REALISTICALLYNegatively di
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THINKING REALISTICALLYStep 1: Learn
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THINKING REALISTICALLYStep 4: Pract
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SOLVING PROBLEMS EFFECTIVELYStep 1:
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REDUCING THE RISK OF RELAPSEPlan ah
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Congratulations! You have now made
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SUGGESTED READINGON DEPRESSION AND
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DIETThe Canada Food GuideGuidelines
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SLEEPStress, anxiety, and depressio
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CAFFEINECaffeine stimulates the sym
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CHALLENGING DEPRESSIVE THOUGHTSSitu
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PROBLEM SOLVINGACTION ADVANTAGES DI
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AnxietyDementiaDementiaBipolar155
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Practice Support ProgramGeneralized
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Montreal Cognitive Assessment(MoCA)
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Serial 7s: Administration: The exam
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Appendix CNAME OF PATIENTStandardiz
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Item 11Scoring WORLD backwards (ins
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Appendix CStandardized Mini Mental
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SCORING THE MOOD DISORDERQUESTIONNA
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FORM 4MENTAL HEALTH ACT[ Sections 2
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CommunityMHSU ReferralFormBounceBac
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REFERRAL FORMMental Health and Subs
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MENTAL HEALTH AFTER HOURSPLEASE LEA
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DOCUMENTATION REQUIRED UPON REFERRA
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Adult Eating Disorders ProgramRefer
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Medical History:Medical causes of l
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Who Are We?This is a specialized pr
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Fraser South Eating Disorders Progr
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Fraser South Eating Disorders Progr
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Fraser East:This program is part of
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Fact SheetPanic Disorder GroupDoes
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Fact SheetGeneralized Anxiety Group
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4 th Floor Sherbrooke Centre Tel (6
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Early Psychosis Intervention Progra
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*Additional Resources*For Informati
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Mental Healthand Addiction… suppo
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Fraser Health Mental Healthand Addi
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ADDICTION SERVICESAddiction Service
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ADDICTION SERVICESYouth Addictions
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ADDICTION SERVICES6. Long-term Resi
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MENTAL HEALTH SERVICESMental Health
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MENTAL HEALTH SERVICESDelta Mental
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MENTAL HEALTH SERVICES4. Community
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MENTAL HEALTH SERVICESMinistry of E
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MENTAL HEALTH SERVICES7. Residentia
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Mental Health & AddictionsHEALTHY L
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Client name: ______________________
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Client name: ______________________
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Taking Wellness to Heart! Metabolic
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Mental Health and Substance Use Rev
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Collaborative Care Process Map-Epis
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Fax the Special Authority Request t
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o o o o o o o • • • o o o o o
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Process - Physician - Fraser Health Authority

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