Chavira Denise A, Stein Murray B, Golinelli Daniela, Sherbourne Cathy D, Craske Michelle G, Sullivan Greer, Bystritsky Alexander, Roy-Byrne Peter P
Department of Psychiatry, University of California, San Diego, CA 92037, USA.
J Nerv Ment Dis. 2009 Oct;197(10):715-21. doi: 10.1097/NMD.0b013e3181b97d4d.
This study's aim was to prospectively examine and identify a model of demographic, clinical, and attitudinal variables that impact improvement among patients with panic disorder. Subjects were 232 primary care patients meeting criteria for DSM-IV panic disorder. Eligible patients were randomly assigned to a collaborative care intervention or to treatment as usual. Assessments occurred at 3-month intervals during the course of 1 year. In final multivariate logistic regression models, patients with higher anxiety sensitivity and higher neuroticism scores at baseline were less likely to show clinical improvement (using a criterion of 20 or less on the Anxiety Sensitivity Index) at 3 months. Those who were non-white, had higher anxiety sensitivity, and higher overall phobic avoidance at baseline were less likely to show clinical improvement at 12 months. A greater understanding of these predictors may help clinicians identify who is at greatest risk for persistent panic-related symptoms and to plan the intensity of interventions accordingly.
本研究的目的是前瞻性地检查并确定一个由人口统计学、临床和态度变量组成的模型，该模型会影响惊恐障碍患者的病情改善情况。研究对象为232名符合《精神疾病诊断与统计手册》第四版（DSM-IV）惊恐障碍标准的初级保健患者。符合条件的患者被随机分配至协作护理干预组或常规治疗组。在1年的时间里，每隔3个月进行一次评估。在最终的多变量逻辑回归模型中，基线时焦虑敏感性较高和神经质得分较高的患者在3个月时临床改善的可能性较小（使用焦虑敏感性指数20分及以下作为标准）。那些非白人、基线时焦虑敏感性较高且总体恐惧回避程度较高的患者在12个月时临床改善的可能性较小。对这些预测因素有更深入的了解可能有助于临床医生确定谁最有可能出现持续性惊恐相关症状，并据此规划干预措施的强度。
