Write a paper on anxiety and generalized anxiety disorder and application of OMM as adjunctive treatment.
o description of the anxiety, management decisions in the clinic of anxiety, and follow up in the outpatient setting (no longer than page)
First reference from DSM V: Generalized anxiety disorder (GAD) is characterized by excessive worry and anxiety that are difficult to control, cause significant distress and impairment, and occur on more days than not for at least six months
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington, VA 2013.
From UpToDate (will cite it myself)
Once a patient has been diagnosed with generalized anxiety disorder (GAD), the next step is to determine, based on clinical assessment of severity, extent of distress or impairment, and patient preference, whether treatment of the disorder is needed. The main objective of treatment is to reduce symptoms of anxiety and thereby improve functioning.
Patients with a mild subtype of GAD whose symptoms do not interfere significantly with functioning may reasonably elect to forgo treatment initially. Clinical follow-up with the patient at least every three months is important to monitor the course of the disorder. If symptoms are worsening or if daily functioning is affected, we recommend treatment.
For individuals with GAD with comorbid substance use disorder, we address both disorders as treating either one individually will leave the individual more vulnerable to relapse from either disorder.
Two main options for treatment of generalized anxiety disorder and chronic anxiety: cognitive behavioral therapy and medication management
In clinical trials, paroxetine [17-19], sertraline [20,21], citalopram, and escitalopram [22,24,25] have been found to be more effective in anxiety reduction than placebo. Uncontrolled trials and our clinical experience suggest other SSRIs (eg, fluoxetine and fluvoxamine) are effective for GAD as well.
o I will cite this one as well
o the common complications/side effects of anxiety treatment (I will cite this entire section as well, but please just summarize). (no longer than page)
We start SSRI and SNRI at the lower end of the recommended dose range in order to avoid initial insomnia, agitation, or other early side effects; in some cases adjunctive therapy is temporarily warranted to manage such side effects (see ‘Adjunctive therapy for early side effects’ below). The dose is increased every three to four days to the therapeutic dose range if tolerated (table 2). Time to onset of clinically meaningful action for an SRI varies by patient, but averages approximately four weeks. We maintain the initial therapeutic dose for four to six weeks to allow time for effect. If the patient does not show a robust response, we increase the SRI in one-week increments until sufficient improvement is seen or the maximum recommended or highest tolerated dose is reached. In individuals who show gradual improvement, we continue to monitor for up to 12 weeks at the maximum tolerated dose.
Common side effects include sexual dysfunction, gastrointestinal abnormalities (nausea and diarrhea), insomnia, sedation, weight gain, dizziness, and sweating.
other medications including benzodiazepines, buspirone, pregabalin, mirtazapine, and TCAs have been studied as initial treatment for GAD [16,23]. These medications have been shown to improve symptoms of anxiety; however, we generally do not use them as first-line treatment due to prominent side effects, risk of dependence, or limited data supporting their use as initial monotherapy.
o brief executive summary of any research on OMT and anxiety/PTSD (references that you can use are attachedcan use as few or as many as needed)
o the model or models of the five Osteopathic models that would be most applicable (in the Five Models of Osteopathy image attachment..the ones I would probably key in on for this paper that are relevant are behavioral, neurological, and whatever else you think works)
how they are applicable,
likely associated comorbid dysfunctions and
o appropriate treatment of likely dysfunction including:
considerations of amount at one time and frequency of using osteopathic medicine for anxiety, according to references
Length: 5 pages
Single Spaced, standard margins
Font Size & Type: 12, Arial
That leaves the bulk of the paper for the Osteopathic OMM considerations as described in the bullet points above. The studies cited should take no more than a page
Pictures, tables and illustrations can be utilized but do not count toward the 5 page length
Reference page at the end of the paper not included in the 5 page length
