Department of Psychiatry, Yale University School of Medicine, 2 Church Street South, New Haven, CT 06519, USA.
Psychol Med. 2011 May;41(5):1019-28. doi: 10.1017/S0033291710001777. Epub 2010 Sep 14.
This study prospectively examined the natural clinical course of six anxiety disorders over 7 years of follow-up in individuals with personality disorders (PDs) and/or major depressive disorder. Rates of remission, relapse, new episode onset and chronicity of anxiety disorders were examined for specific associations with PDs.
Participants were 499 patients with anxiety disorders in the Collaborative Longitudinal Personality Disorders Study, who were assessed with structured interviews for psychiatric disorders at yearly intervals throughout 7 years of follow-up. These data were used to determine probabilities of changes in disorder status for social phobia (SP), generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), panic disorder and panic disorder with agoraphobia.
Estimated remission rates for anxiety disorders in this study group ranged from 73% to 94%. For those patients who remitted from an anxiety disorder, relapse rates ranged from 34% to 67%. Rates for new episode onsets of anxiety disorders ranged from 3% to 17%. Specific PDs demonstrated associations with remission, relapse, new episode onsets and chronicity of anxiety disorders. Associations were identified between schizotypal PD with course of SP, PTSD and GAD; avoidant PD with course of SP and OCD; obsessive-compulsive PD with course of GAD, OCD, and agoraphobia; and borderline PD with course of OCD, GAD and panic with agoraphobia.
Findings suggest that specific PD diagnoses have negative prognostic significance for the course of anxiety disorders underscoring the importance of assessing and considering PD diagnoses in patients with anxiety disorders.
本研究前瞻性地检查了 7 年随访期间伴有人格障碍（PD）和/或重性抑郁障碍的个体中六种焦虑障碍的自然临床病程。检查了焦虑障碍缓解、复发、新发作和持续性的比率，以确定其与 PD 的特定关联。
共有 499 名焦虑障碍患者参加了协作性纵向人格障碍研究，在 7 年的随访期间，每年通过结构访谈评估一次精神障碍。这些数据用于确定社交恐惧症（SP）、广泛性焦虑症（GAD）、强迫症（OCD）、创伤后应激障碍（PTSD）、惊恐障碍和惊恐障碍伴广场恐怖症的障碍状态变化的概率。
本研究组中焦虑障碍的估计缓解率从 73%到 94%不等。对于那些从焦虑障碍中缓解的患者，复发率从 34%到 67%不等。新发作的焦虑障碍的发生率从 3%到 17%不等。特定的 PD 与焦虑障碍的缓解、复发、新发作和持续性有关。在 SP、PTSD 和 GAD 方面，与精神分裂样 PD 有关；在 SP 和 OCD 方面，与回避型 PD 有关；在 GAD、OCD 和恐惧症方面，与强迫型 PD 有关；在 OCD、GAD 和惊恐伴恐惧症方面，与边缘型 PD 有关。
研究结果表明，特定的 PD 诊断对焦虑障碍的病程有不良预后意义，突出了在焦虑障碍患者中评估和考虑 PD 诊断的重要性。
