Allgulander Christer, Bandelow Borwin, Hollander Eric, Montgomery Stuart A, Nutt David J, Okasha Ahmed, Pollack Mark H, Stein Dan J, Swinson Richard P
Department of Psychiatry, Harvard University School of Medicine, Boston, Massachusetts, USA.
CNS Spectr. 2003 Aug;8(8 Suppl 1):53-61. doi: 10.1017/s1092852900006945.
What are the current recommendations for the long-term treatment of generalized anxiety disorder (GAD)? GAD is a common disorder with a lifetime prevalence of 4% to 7% in the general population. GAD is characterized by excessive, uncontrollable worry or anxiety about a number of events or activities that the individual experiences on more days than not over a 6-month period. Onset of GAD symptoms usually occurs during an individual's early twenties; however, high rates of GAD have also been seen in children and adolescents. The clinical course of GAD is often chronic, with 40% of patients reporting illness lasting >5 years. GAD is associated with pronounced functional impairment, resulting in decreased vocational function and reduced quality of life. Patients with GAD tend to be high users of outpatient medical care, which contributes significantly to healthcare costs. Currently, benzodiazepines and buspirone are prescribed frequently to treat GAD. Although both show efficacy in acute treatment trials, few long-term studies have been performed. Benzodiazepines are not recommended for long-term treatment of GAD, due to associated development of tolerance, psychomotor impairment, cognitive and memory changes, physical dependence, and a withdrawal reaction on discontinuation. The antidepressant venlafaxine extended-release (XR) has received approval for the treatment of GAD in the United States and many other countries. Venlafaxine XR has demonstrated efficacy over placebo in two randomized treatment trials of 6 months' duration as well as in other acute trials. Paroxetine is the first of the selective serotonin reuptake inhibitors (SSRIs) to receive US approval for the treatment of GAD. Paroxetine demonstrated superiority to placebo in short-term trials, and investigations into the use of other SSRIs are ongoing. This suggests that other SSRIs, and serotonin and noradrenaline reuptake inhibitors, are likely to be effective in the treatment of GAD. Of the psychological therapies, cognitive-behavioral therapy (CBT) shows the greatest benefit in treating GAD patients. Treatment gains after a 12-week course of CBT may be maintained for up to 1 year. Currently, no guidelines exist for the long-term treatment of GAD.
目前对于广泛性焦虑障碍（GAD）的长期治疗有哪些建议？GAD是一种常见疾病，在普通人群中的终生患病率为4%至7%。GAD的特征是对个体在6个月内多数日子里经历的许多事件或活动过度、无法控制地担忧或焦虑。GAD症状通常在个体二十出头时出现；然而，在儿童和青少年中也发现了较高的GAD发病率。GAD的临床病程往往是慢性的，40%的患者报告疾病持续时间超过5年。GAD与明显的功能损害相关，导致职业功能下降和生活质量降低。GAD患者往往频繁使用门诊医疗服务，这对医疗费用有显著影响。目前，苯二氮䓬类药物和丁螺环酮常用于治疗GAD。虽然两者在急性治疗试验中均显示出疗效，但很少有长期研究。由于存在耐受性、精神运动损害、认知和记忆改变、身体依赖以及停药时的戒断反应，不建议将苯二氮䓬类药物用于GAD的长期治疗。抗抑郁药文拉法辛缓释剂（XR）在美国和许多其他国家已获批用于治疗GAD。在两项为期6个月的随机治疗试验以及其他急性试验中，文拉法辛XR已证明优于安慰剂。帕罗西汀是首个获得美国批准用于治疗GAD的选择性5-羟色胺再摄取抑制剂（SSRI）。帕罗西汀在短期试验中显示出优于安慰剂的效果，对其他SSRI的使用研究正在进行中。这表明其他SSRI以及5-羟色胺和去甲肾上腺素再摄取抑制剂可能对治疗GAD有效。在心理治疗中，认知行为疗法（CBT）在治疗GAD患者方面显示出最大益处。经过12周CBT疗程后的治疗效果可能维持长达1年。目前，尚无GAD长期治疗的指南。
