Suggested Pre-Referral Evaluation and Management Guidelines
Rule out medical causes (particularly important for panic attack patients and atypical presentations).It is important to note that we do not treat somatic disorders.
We emphasize integrated pharmacological and cognitive-behavioral treatment (CBT) for specifically diagnosed anxiety disorders. All anxiety disorders can be successfully treated with medication (SSRI) and/or CBT.
If impairment is due to prominent avoidance (phobic) behavior or patient is reluctant to take medication, CBT is a good choice and these patients should be referred. If avoidance behavior is the primary cause of impairment, CBT alone may be preferred over medication.
If medication is indicated and desired by the patient, initiation of an SSRI (citalopram is our preferred generic) at low dose with close follow up (anxiety can initially get worse) is appropriate. We discourage use of benzodiazepines. If rapid symptom control is needed, scheduled use of a long acting agent (e.g. clonazepam) is preferred.
Suggested Additional Test/Management Prior to Specialty Visit
Specific diagnosis is helpful in tailoring treatment. All of the anxiety disorders can be successfully treated without medication (CBT alone), but the type of CBT needed and likelihood of success depends upon the specific diagnosis.
Those with a specific phobia, panic disorder, and OCD might be best served if referred to us before medication is initiated.
For others, initiation of an SSRI, starting low, or in rare cases a benzodiazepine, is appropriate. For example, in panic patients gentle initiation of SSRIs is particularly important; in OCD patients high SSRI doses may be needed and should almost always be supplemented with CBT.
We are happy to consult on any of your anxiety patients to help make these decisions.
Evaluation clinic occurs on Mondays. Patients should plan on 2 to 3 hours for a complete evaluation. Facilitated, rapid access for medication-free patients with panic, OCD, or social anxiety is sometimes available.
We have little capacity to meet urgent care needs.
For Emergent care direct to Psychiatric Emergency Service 734-936-5900
How to Get Results to Consultant
UMHS Patients: Make sure all needed information is posted or scanned in to MiChart
External Patients: Fax referral request form and supporting patient records. Fax: 734-763-5580
Records should be mailed or faxed well in advance of scheduled consultations. If time frame is too short, patients can hand carry outside records.
Clinic Contact Information
Complete electronic referral in MiChart.
Direct the patient to call Psychiatry & Call Center at 734-764-0231 or 1-800-525-5188 to make an appointment.