Rogers M P, Warshaw M G, Goisman R M, Goldenberg I, Rodriguez-Villa F, Mallya G, Freeman S A, Keller M B
Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.
Depress Anxiety. 1999;10(1):1-7.
This study explores the potential differences in comorbidity and course between primary generalized anxiety disorder (GAD), which develops before other anxiety disorders, and secondary GAD. As part of the Harvard/Brown Anxiety Research Project (HARP), a naturalistic, long-term, longitudinal study of 711 subjects from a variety of clinic settings with DSM III-R defined anxiety disorders, 210 subjects with GAD were identified. Of these, 78 (37%) had primary GAD, and 84 (40%) had secondary GAD; of the remainder, 28 (13%) had no other anxiety disorder and 20 (10%) developed GAD within a month of another anxiety disorder and were excluded from the analysis. All subjects were comorbid for at least one other anxiety disorder. Primary GAD subjects were more likely to be in episode at intake (90% vs. 77%, P = .04) and less likely than secondary GAD subjects to have current or past agoraphobia without panic disorder (3% vs. 11%, P = .04), social phobia (19% v. 52%, P = .001), simple phobia (14% v. 30%, P = .02), or post traumatic stress disorder (5% vs. 20%, P = .01). Subjects with primary GAD were also less likely to have current or past alcohol use disorders (17% vs. 37%, P = .004) or major depressive disorder (60% vs. 76%, P = .03). There were no significant differences in either treatment approaches or remission rates for primary compared to secondary GAD. Whether GAD first occurs before or after another anxiety disorder, it is similar in terms of prevalence, treatment, and course. The only significant differences between primary and secondary GAD lie in the rates of comorbidity of both other anxiety disorders and non-anxiety disorders, including major depression and substance abuse. These results support the concept of GAD as a valid, separate and distinct entity, whether it occurs primarily or secondarily.
本研究探讨原发性广泛性焦虑障碍（GAD）与继发性广泛性焦虑障碍在共病情况和病程方面的潜在差异。原发性广泛性焦虑障碍先于其他焦虑障碍出现。作为哈佛/布朗焦虑研究项目（HARP）的一部分，该项目对来自各种临床环境、患有DSM III-R定义的焦虑障碍的711名受试者进行了一项自然主义、长期的纵向研究，共识别出210名患有广泛性焦虑障碍的受试者。其中，78名（37%）患有原发性广泛性焦虑障碍，84名（40%）患有继发性广泛性焦虑障碍；其余受试者中，28名（13%）没有其他焦虑障碍，20名（10%）在另一种焦虑障碍出现后一个月内患上广泛性焦虑障碍，被排除在分析之外。所有受试者至少合并有一种其他焦虑障碍。原发性广泛性焦虑障碍受试者在入组时更可能处于发作期（90%对77%，P = 0.04），与继发性广泛性焦虑障碍受试者相比，出现当前或既往无惊恐障碍的广场恐惧症的可能性更小（3%对11%，P = 0.04）、社交恐惧症（19%对52%，P = 0.001）、单纯恐惧症（14%对30%，P = 0.02）或创伤后应激障碍（5%对20%，P = 0.01）。原发性广泛性焦虑障碍受试者出现当前或既往酒精使用障碍（17%对37%，P = 0.004）或重度抑郁症（60%对76%，P = 0.03）的可能性也更小。原发性广泛性焦虑障碍与继发性广泛性焦虑障碍在治疗方法或缓解率方面均无显著差异。无论广泛性焦虑障碍是先于还是后于另一种焦虑障碍出现，其在患病率、治疗和病程方面均相似。原发性和继发性广泛性焦虑障碍之间唯一的显著差异在于其他焦虑障碍和非焦虑障碍（包括重度抑郁症和物质滥用）的共病率。这些结果支持将广泛性焦虑障碍视为一个有效的、独立且独特的实体的概念，无论其是原发性还是继发性出现。
