Anxiety and OCD — Initial Treatment Considerations — Clinical Pathway: Outpatient Behavioral Health and Primary Care

Anxiety Disorder and OCD Clinical Pathway — Outpatient Behavioral Health and Primary Care

Initial Treatment Considerations: Psychotherapy, Medications

Select treatment to based on the patient’s clinical presentation, and presence of co-morbidities including SI, other psychiatric diagnoses,
risk factors, and degree of impairment.

Initial Treatment
Severity Behavioral Health (BH) Primary Care (PCP)
Mild
  • Supportive Therapy or Cognitive-Behavioral Therapy (CBT) for anxiety Exposure and Response Prevention (ERP) for OCD
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  • Avoid medications
  • Consider more frequent PCP visits for Supportive Monitoring until BH consultation completed
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  • BH referral as clinically indicated
Moderate
  • Cognitive-Behavioral Therapy (CBT) for anxiety
  • Exposure and Response Prevention (ERP) for OCD
  •  
  • Add Family therapy as clinically indicated
  • Consider 1st line medications
  • Refer to BH for therapeutic interventions
  • Follow-up PCP visit in 6 - 8 weeks for supportive monitoring
  • PCP can consider initiating 1st line medication as clinically indicated
  • PCP visits initially every 2 weeks until stable on medication, then every
    3 months if medication started
  • Refer to BH for consultation as needed
  •  
  • Partner with BH provider
  • Warm hand-off back PCP when treatment program completed
Severe
  • Medication recommended
  • Cognitive-Behavioral Therapy (CBT) for anxiety
  • Exposure and Response Prevention (ERP) for OCD
  •  
  • Add Family therapy as clinically indicated
  •  
  • Referral to IOP or PHP as clinically indicated
  • Refer to BH for therapeutic interventions
  • Acute referral to CRC, ED as needed
  •  
  • PCP can consider initiating 1st line medication as clinically indicated
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  • Follow-up PCP visit in 2 weeks if medications initiated to assess for response
    • Increase as tolerated to clinical response
    • Once stable on medication dose, follow every 2 - 3 months to evaluate clinical response
  • Consult psychiatry if inadequate clinical response or concern for unusual medication side affects
  • Refer to BH for consultation as needed
  •  
  • Partner with BH provider
  • Warm hand-off back PCP when treatment program completed