Navarro-Mateu Fernando, Garriga-Puerto Ascensión, Sánchez-Sánchez Juan Antonio
Unidad de Docencia, Servicio Murciano de Salud, Murcia, España.
Aten Primaria. 2010 Feb;42(2):86-94. doi: 10.1016/j.aprim.2009.05.003. Epub 2009 Jul 24.
To analyse the different therapeutic alternatives for Panic Disorders to make it easier to make collaborative treatment decisions between patients and doctors in a Primary Care setting.
Quantitative analysis by a decision tree.
Time period reviewed; 1990-2008 in Med-line, Embase, Cochrane-plus Library and Tripdatabase. Terms used "panic disorder", "psychotherapy" and "drug therapy".
I) A decision tree was prepared with only one therapeutic option in each arm; II) The same procedure with two sequential therapeutic options; III) Sensitivity analysis to test the robustness of the model.
Evidence summary, systematic reviews, meta-analysis and clinical guidelines.
Cognitive-Behavioural Therapy (CBT) obtains the highest usefulness (UME=0.58), followed by the Selective serotonin reuptake inhibitors (SSRI) (UME=0.53) and by the tricyclic antidepressants (UME=0.44). CBT followed by SSRI is the therapeutic sequence with the highest usefulness (0.62). The sensitivity analysis suggests the model is not robust enough.
The CBT in monotherapy or followed by SSRI in a sequential strategy would be the options with the highest usefulness. The results are not robust enough because they can clearly vary with changes in the most important variables in a reasonable range.
分析恐慌症的不同治疗选择，以便在初级保健环境中患者和医生更容易做出联合治疗决策。
通过决策树进行定量分析。
回顾的时间段；1990 - 2008年见于医学在线数据库、荷兰医学文摘数据库、考科蓝图书馆和循证医学数据库。使用的检索词为“恐慌症”、“心理治疗”和“药物治疗”。
I）准备一个决策树，每个分支只有一种治疗选择；II）对两个连续治疗选择采用相同程序；III）进行敏感性分析以测试模型的稳健性。
证据总结、系统评价、荟萃分析和临床指南。
认知行为疗法（CBT）效用最高（效用均值UME = 0.58），其次是选择性5-羟色胺再摄取抑制剂（SSRI）（UME = 0.53）和三环类抗抑郁药（UME = 0.44）。先采用CBT然后使用SSRI是效用最高的治疗顺序（0.62）。敏感性分析表明该模型不够稳健。
单一疗法的CBT或之后采用顺序策略使用SSRI将是效用最高的选择。结果不够稳健，因为在合理范围内随着最重要变量的变化它们可能会明显不同。
