Quality statement 3: Pharmacological treatment

Quality statement

People with an anxiety disorder are not prescribed benzodiazepines or antipsychotics unless specifically indicated.

Rationale

NICE guidance provides recommendations on pharmacological therapies for anxiety disorders. Benzodiazepines are associated with tolerance and dependence, and antipsychotics are associated with a number of adverse effects. Therefore they should not be used routinely to treat anxiety disorders.

Healthcare professionals should be aware of circumstances in which benzodiazepines and antipsychotics may be appropriate, such as short-term care and anxiety disorder crises.

Quality measures

Structure

Evidence of local monitoring arrangements to ensure that people with an anxiety disorder are not prescribed a benzodiazepine or an antipsychotic to treat their disorder unless specifically indicated.

Data source: Local data collection.

Process

a) Proportion of people who have an anxiety disorder and are prescribed a benzodiazepine that is not specifically indicated.

Numerator – the number of people in the denominator for whom a benzodiazepine is not specifically indicated.

Denominator – the number of people with an anxiety disorder who are prescribed a benzodiazepine.

b) Proportion of people who have an anxiety disorder and are prescribed an antipsychotic that is not specifically indicated.

Numerator – the number of people in the denominator for whom an antipsychotic is not specifically indicated.

Denominator – the number of people with an anxiety disorder who are prescribed an antipsychotic.

Data source: Local data collection.

Outcome

a) Rates of prescribing benzodiazepines.

b) Rates of prescribing antipsychotics.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers ensure that there are procedures and protocols in place to monitor the prescribing of pharmacological treatment for people with anxiety disorders to ensure that benzodiazepines and antipsychotics are not offered to treat that disorder unless specifically indicated.

Healthcare professionals ensure that people with anxiety disorders are not offered benzodiazepines or antipsychotics to treat that disorder unless specifically indicated.

Commissioners ensure that they monitor rates of prescribing of benzodiazepines and antipsychotics to treat anxiety disorders and only commission services from providers who can demonstrate that they have procedures and protocols in place to monitor this prescribing.

What the quality statement means for service users and carers

People with an anxiety disorder are not offered benzodiazepines (medication used to help people sleep or act as a sedative) or antipsychotics (medication used mainly to treat psychotic conditions such as schizophrenia) for that disorder unless there are specific clinical reasons why these treatments may be of short-term benefit.

Source guidance

  • Obsessive-compulsive disorder and body dysmorphic disorder (NICE clinical guideline 31), recommendations 1.5.3.21, 1.5.3.22, and 1.5.6.21.

  • Generalised anxiety disorder and panic disorder (with or without agoraphobia) in adults (NICE clinical guideline 113), recommendations 1.2.25 (key priority for implementation), 1.4.7 and 1.4.8.

  • Social anxiety disorder (NICE clinical guideline 159), recommendation 1.6.2.

Definitions of terms used in this quality statement

Anxiety disorders

Anxiety disorders are generalised anxiety disorder, social anxiety disorder, post-traumatic stress disorder, panic disorder, obsessive–compulsive disorder and body dysmorphic disorder.