WEBSITE OF THE WEEK
On the Royal College of Psychiatrists’ website, cognitive behavioural therapy (CBT) is dealt with so efficiently that most GPs who only know the basics should find this information will increase their knowledge. There is little doubt that this type of approach can help in many instances of phobias and phobic anxiety, and is surely preferable to anxiolytics or antidepressants.
Other methods of treating phobias are also mentioned, so this is a rounded look at the method. The sad thing is that although everyone agrees that CBT is a preferred treatment, it is very expensive.
Why go there: excellent summary of CBT.
Downside: there should be a version for GPs.
Information from: Royal College of Psychiatrists.
There seems to be no happy medium when it comes to information on phobias for medical professionals. The material is either totally superficial, it or goes into too much fine-print detail. This article veers towards the latter. The difficulty of finding decent, simple, GP-orientated information surprises me, and rather suggests that the problem of phobias is not taken seriously enough to warrant some decent presentations.
One thing this detailed account does give is a useful list of differential diagnoses. The pitfalls can be many and varied, and I clearly remember a case where everyone from hospital consultants to myself, thought a patient was having panic attacks, when eventually the cause of his symptoms proved to be an insulinoma. So I was pleased to see hypoglycaemia on the differential list here. There is a list of screening tests that can help exclude medical conditions.
Why go there: all you need to know.
Downside: drug treatment seems too heavily weighted.
Information from: E-Medicine Address: www.emedicine.com/med/topic1821.htm
POST TRAUMATIC STRESS DISORDER
I’m sure it is not true to say that post-traumatic stress disorder (PTSD) has become a fashionable diagnosis, but it was not a problem that many practitioners of my generation encountered until their later years in the profession. This article relates to PTSD following road accidents. Given that such incidents are much more common than fighting in a war or being involved in a terrorist incident, it makes them an important area for GPs. Probably the most useful element of this site is the table listing the diagnostic criteria for PTSD. There is also a link to a patient hand-out that may prove useful for patients involved in a traffic accident.
The data relate to the USA, where there are over 3 million road accidents a year — and I thought our driving in the UK was bad.
Why go there: we need to know about this.
Downside: could be briefer.
Information from: American Academy of Family Physicians.
This is probably the best UK site for patients with phobias, and certainly covers the field well.
Agoraphobia, social phobias, panic attacks, PTSD and all the usual suspects are here, plus some less common ones such as body dysmorphic disorder, emetophobia and erythrophobia.
Each condition is covered along the same lines — there is a description of the condition, a do-it-yourself self-diagnosis guide, and more details in the form of National Phobics Society publications or links to relevant websites.
Lastly there is a ‘personal experiences’ section where fellow sufferers talk about their situations.
Training packages are also on offer, but they cost up to £500 a day.
To get the most out of this site, you have to become a member of the charity, and that costs £16.80 a year for a patient and £21 for a professional.
Why go there: good place for patients to start.
Downside: can cost money.
Information from: National Phobics Society Address: www.phobics-society.org.uk/
- Dr Barnard is a former GP in Fareham, Hampshire