Refractory to Treatment

If despite over 3 months of medication treatment and/or psychotherapy, your patient has had less than 50% drop in GAD-7 score, then criteria are met for refractory axniety.

Any of the following present?

1. Non-adherence to medication
2. Undiagnosed medical condition
3. Another psychiatric condition or issue such as:
   • Psychosis?
   • Bipolar?
     •  MDQ 
   • Alcohol / substance use issues?
     • Consider asking questions from the  AUDIT-C 
     • For drug use ask  "How many times in the past year have you used an illegal drug or used a prescription medication for non-medical reasons?" (response of 1 or greater is considered positive)
       • if positive response consider asking questions from the DAST-10
   • Domestic violence? Consider using the 4-item HITS
   • Past history of abuse/trauma?
   • Sexual identity or orientation issues?
   • Any other  psychosocial stressors? (e.g. relationship, work, school, finances)