• Anxiety disorders in patients with HIV/AIDS. In: Mental health care for people with HIV infection: HIV clinical guidelines for the primary care practitioner. New York (NY): New York State Department of Health; 2006 Mar. p. 1-8. [1 reference]

This is the current release of the guideline.

This guideline updates a previous version: Anxiety disorders in patients with HIV/AIDS. In: Mental health care for people with HIV infection: HIV clinical guidelines for the primary care practitioner. New York (NY): New York State Department of Health; 2001 Mar. p. 59-68.

• Human immunodeficiency virus infection/acquired immune deficiency syndrome (HIV/AIDS)
• Anxiety disorders, including:
  • Panic attacks and disorder
  • Phobias
  • Generalized anxiety disorder
  • Obsessive-compulsive disorder
  • Acute stress disorder
  • Post-traumatic stress disorder
  • Adjustment disorder with anxious mood

Diagnosis
Management
Treatment

Allergy and Immunology
Family Practice
Infectious Diseases
Internal Medicine
Psychiatry
Psychology

Advanced Practice Nurses
Health Care Providers
Physician Assistants
Physicians
Public Health Departments

To provide guidelines for diagnosis and treatment of anxiety disorders in patients with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) in primary care settings

Patients with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) in primary care settings with suspected anxiety disorder

Diagnosis

1. Consideration of signs and symptoms
2. Distinguishing among anxiety disorders and excluding underlying medical conditions such as human immunodeficiency virus (HIV)-related central nervous system disease, endocrinopathies, cardiovascular and other conditions that may cause anxiety
3. Reviewing patients' medication regimens and obtaining a thorough substance use history

Treatment/Management

1. Referring patients who use substances or whose anxiety is persistent or severe and does not respond to standard treatment to mental health professionals
2. Providing psychological support
3. Medications, including benzodiazepines, selective serotonin re-uptake inhibitors (SSRIs), and tricyclic antidepressants

Not stated

Hand-searches of Published Literature (Primary Sources)
Hand-searches of Published Literature (Secondary Sources)
Searches of Electronic Databases

Not stated

Not stated

Expert Consensus (Committee)

Not applicable

Review

Not stated

Expert Consensus

The Human Immunodeficiency Virus (HIV) Guidelines Program works directly with committees composed of HIV Specialists to develop clinical practice guidelines. These specialists represent different disciplines associated with HIV care, including infectious diseases, family medicine, obstetrics and gynecology, among others. Generally, committees meet in person 3 to 4 times per year, and otherwise conduct business through monthly conference calls.

Committees meet to determine priorities of content, review literature, and weigh evidence for a given topic. These discussions are followed by careful deliberation to craft recommendations that can guide HIV primary care practitioners in the delivery of HIV care. Decision making occurs by consensus. When sufficient evidence is unavailable to support a specific recommendation that addresses an important component of HIV care, the group relies on their collective best practice experience to develop the final statement. The text is then drafted by one member, reviewed and modified by the committee, edited by medical writers, and then submitted for peer review.

Not applicable

A formal cost analysis was not performed and published cost analyses were not reviewed.

Peer Review

Not stated

An algorithm is provided in the original guideline document for "Distinguishing Anxiety Disorders."

The type of supporting evidence is not specifically stated for each recommendation.

Appropriate diagnosis and management of anxiety disorders in patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS)

• Benzodiazepines should be used with caution because of the potential for dependence and abuse in some patients.
• The use of tricyclic antidepressants is limited due to their side-effect profile and potential for drug-drug interactions.

Refer to Table 1 in Appendix I (see "Availability of Companion Documents" field) for interactions between HIV-related medications and psychotropic medications: indications and contraindications.

Refer to Table 1 in Appendix I (see "Availability of Companion Documents" field)  for a list of contraindicated drug combinations.

Following the development and dissemination of guidelines, the next crucial steps are adoption and implementation. Once practitioners become familiar with the content of guidelines, they can then consider how to change the ways in which they take care of their patients. This may involve changing systems that are part of the office or clinic in which they practice. Changes may be implemented rapidly, especially when clear outcomes have been demonstrated to result from the new practice such as prescribing new medication regimens. In other cases, such as diagnostic screening, or oral health delivery, however, barriers emerge which prevent effective implementation. Strategies to promote implementation, such as through quality of care monitoring or dissemination of best practices, are listed and illustrated in the companion document to the original guideline (HIV clinical practice guidelines, New York State Department of Health; 2003), which portrays New York's HIV Guidelines Program. The general implementation strategy is outlined below.

• Statement of purpose and goal to encourage adoption and implementation of guidelines into clinical practice by target audience.
• Define target audience (providers, consumers, support service providers).
  • Are there groups within this audience that need to be identified and approached with different strategies (e.g., HIV Specialists, family practitioners, minority providers, professional groups, rural-based providers)?
• Define implementation methods.
  • What are the best methods to reach these specific groups (e.g., performance measurement consumer materials, media, conferences)?
• Determine appropriate implementation processes.
  • What steps need to be taken to make these activities happen?
  • What necessary processes are internal to the organization (e.g., coordination with colleagues, monitoring of activities)?
  • What necessary processes are external to the organization (e.g., meetings with external groups, conferences)?
  • Are there opinion leaders that can be identified from the target audience that can champion the topic and influence opinion?
• Monitor progress.
  • What is the flow of activities associated with the implementation process and which can be tracked to monitor the process?
• Evaluate.
  • Did the processes and strategies work?
  • Were the guidelines implemented?
  • What could be improved in future endeavors?

Getting Better
Living with Illness

Effectiveness

• Anxiety disorders in patients with HIV/AIDS. In: Mental health care for people with HIV infection: HIV clinical guidelines for the primary care practitioner. New York (NY): New York State Department of Health; 2006 Mar. p. 1-8. [1 reference]

Not applicable: The guideline was not adapted from another source.

2001 Mar (revised 2006 Mar)

New York State Department of Health - State/Local Government Agency [U.S.]

New York State Department of Health

Mental Health Guidelines Committee

Committee Chair: Francine Cournos, MD, Professor of Clinical Psychiatry, Columbia University, New York State Psychiatric Institute - Unit 112, New York, NY

Committee Vice-Chair: Milton L Wainberg, MD, Associate Professor of Clinical Psychiatry, New York State Psychiatric Institute -- Unit 112, New York, NY

AIDS Institute Liaison: L. Jeannine Bookhardt-Murray, MD, Medical Director, Harlem United, New York, NY

AIDS Institute Representatives: Teresa C. Armon, RN, MS, Assistant Bureau Director of Community Support Services, New York State Department of Health, AIDS Institute, Albany, NY; Heather A Duell, LMSW, Director of Mental Health, Bureau of Community and Support Services, New York State Department of Health, AIDS Institute, Albany, NY

Committee Members: Bruce D Agins, MD, MPH, Assistant Professor of Medicine, Cornell University Medical College, New York, New York; Philip A Bialer, MD, Associate Professor of Clinical Psychiatry, Albert Einstein College of Medicine, Chief, Division of Consultation-Liaison Psychiatry, Beth Israel Medical Center, New York, NY; John M Budin, MD, Clinical Instructor in Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY; Mary Ann Cohen, MD, Director, AIDS Psychiatry, Associate Professor of Psychiatry, Mount Sinai Medical Center, New York, NY; Barbara A Conanan, RN, MS, SRO/Homeless Program Director, Saint Vincent's Catholic Medical Centers, Saint Vincent's Manhattan Department of Community Medicine, New York, NY; John AR Grimaldi, Jr, MD, Assistant Professor of Clinical Psychiatry, Sanford Weill-Cornell University Medical College, New York, NY, Chief Psychiatrist, David Rodgers Unit, Center for Special Studies, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, NY; Yiu Kee (Warren) Ng, MD, Director, Special Needs Clinic, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY; Francine Rainone, DO, Director of Community Palliative Care, Montefiore Medical Center, Department of Family Medicine, Bronx, NY

Liaison: James J Satriano, PhD, Director of HIV/AIDS Programs, New York State Office of Mental Health, New York, New York, Assistant Professor of Clinical Psychology, Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY

Not stated

This is the current release of the guideline.

This guideline updates a previous version: Anxiety disorders in patients with HIV/AIDS. In: Mental health care for people with HIV infection: HIV clinical guidelines for the primary care practitioner. New York (NY): New York State Department of Health; 2001 Mar. p. 59-68.

None available

This NGC summary was completed by ECRI on May 5, 2005. It was updated by ECRI on April 13, 2006. This summary was updated by ECRI on November 22, 2006, following the FDA advisory on Effexor (venlafaxine HCl). This summary was updated by ECRI Institute on April 30, 2007, following the FDA advisory on Sedative-hypnotic drug products. This summary was updated by ECRI Institute on November 9, 2007, following the U.S. Food and Drug Administration advisory on Antidepressant drugs.