Latas Milan, Starcević Vladan, Trajković Goran
Srp Arh Celok Lek. 2006 Jul-Aug;134(7-8):267-72. doi: 10.2298/sarh0608267l.
Besides numerous studies that examined various aspects of comorbidity in patients with panic disorder and agoraphobia and numerous studies that examined efficacy of different treatment modalities in these patients, there was no study that examined relationship of overall psychiatric comorbidity and treatment of patients with panic disorder and agoraphobia.
The objective of the study was to establish the effect of psychiatric comorbidity on treatment efficiency of patients with panic disorder and agoraphobia.
The sample of the study consisted of 119 patients with primary diagnosis of panic disorder and agoraphobia. The therapy of patients was based on the use of individual integrative model of treatment, which incorporated psycho-pharmaceuticals (benzodiazepines and antidepressants) and cognitive-behavior therapy. Symptom severity was estimated by Panic and Agoraphobia Scale before and after the completion of treatment. Patients with comorbidity and patients without any comorbidity were compared by MANOVA and ANOVA with repeated measures.
The results of the study showed that 91% of patients met diagnostic criteria of comorbid psychiatric disorder and these patients had more severe clinical picture than patients without any comorbid disorder before the treatment. The results also showed that, after the completion of treatment, there was a significant reduction of all analyzed symptoms, that the effects of treatment were significantly better in patients with psychiatric comorbidity and that comorbid psychiatric disorders had no negative effect on the main goals of the treatment.
Based on these results, it may be concluded that: in patients with panic disorder and agoraphobia and comorbid psychiatric disorders, the pharmacotherapy must be based on simultaneous use of antidepressants and benzodiazepines, while standard cognitive-behavior therapy of patients with panic disorder and agoraphobia must be modified in case of the existing comorbid psychiatric disorders.
除了众多研究惊恐障碍和广场恐惧症患者共病的各个方面的研究，以及众多研究这些患者不同治疗方式疗效的研究外，尚无研究探讨惊恐障碍和广场恐惧症患者的总体精神共病与治疗之间的关系。
本研究的目的是确定精神共病对惊恐障碍和广场恐惧症患者治疗效果的影响。
本研究样本包括119例初步诊断为惊恐障碍和广场恐惧症的患者。患者的治疗基于个体综合治疗模式，该模式结合了心理药物（苯二氮䓬类药物和抗抑郁药）和认知行为疗法。在治疗完成前后，通过惊恐和广场恐惧症量表评估症状严重程度。采用多变量方差分析和重复测量方差分析对有共病的患者和无共病的患者进行比较。
研究结果表明，91%的患者符合共病精神障碍的诊断标准，这些患者在治疗前的临床表现比无任何共病障碍的患者更严重。结果还表明，治疗完成后，所有分析症状均显著减轻，有精神共病的患者治疗效果显著更好，共病精神障碍对治疗的主要目标没有负面影响。
基于这些结果，可以得出以下结论：在患有惊恐障碍和广场恐惧症以及共病精神障碍的患者中，药物治疗必须基于同时使用抗抑郁药和苯二氮䓬类药物，而对于患有惊恐障碍和广场恐惧症且存在共病精神障碍的患者，必须对标准的认知行为疗法进行调整。
