Treating people with anxiety and stress. A practical guide for primary health care

Mental Health Nursing,  Sep 2000  by Rushforth, David

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Treating people with anxiety and stress. A practical guide for primary health care Wilkinson, G; Moore, B and Moore, P (2000) Oxford, Radcliffe Medical Press ISBN 185775139 6

pp 253

This companion guide on anxiety and stress follows much the same format as the previous title on depression. However, whereas the former book found the balance between continuity and link reading, this text feels as though it has been rushed into print prematurely.

The opening introduction is promising with a disarmingly honest analysis of the imprecise nature of the assessment of anxiety in general practice. At last, a text by a GP which does not see general practice as centre stage for all patients? Alas, this is not so. Rather than explore the issues around who should appropriately engage with service users, we are treated to DSM IV and ICD-10 classifications on pages seven to 10 inclusive.

Subsequent chapters reinforce the medical model approach. Why lead the discussion on treatment interventions with benzodiazepines? What message are the authors giving to trainee GPs and primary nurses - the intended audience for this book?

To be fair, cognitive behaviour therapy is considered at some length, but the coverage of preventative stress-busting strategies remains cursory.

The evidence base is distinctly absent at times, of particular note in the brief summary on the contribution of CPN and other non-medical services. The 20 lines on CPN input refer to empirical intervention studies but do not name the authors.

The book has its merits. The final chapter on self-help brings some semblance of balance to the guide. The authors are careful not to countenance the instinctive urge to reach for the prescription pad, but nor do they view it as the last resort, when other interventions have failed.

When will GPs recognise that there are some aspects of public health where their centralist role is untenable? When will they realise their responsibilities to challenge patient expectations and redirect all but the most acutely distressed to the array of non-medical resources out there in the community?

Copyright Community Psychiatric Nurses Association Sep 2000
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