Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB-UFRJ), Brazil.
J Affect Disord. 2011 Mar;129(1-3):219-28. doi: 10.1016/j.jad.2010.08.025. Epub 2010 Sep 21.
Non-remission rates to pharmacotherapy for anxiety disorders are related to higher relapse rates, decreased quality of life and greater functional impairment. Here we sought to investigate the efficacy of cognitive-behavior therapy (CBT) as a next-step strategy in the treatment of patients with anxiety disorders who did not remit after a pharmacological intervention.
We carried out a systematic review in the ISI, Pubmed and PsycINFO/PsychLit databases. Studies that did not use CBT and that did not focus on resistance to drug therapy were excluded. We considered resistant patients who failed to respond (did not fully remit) to an adequate trial of pharmacotherapy and still exhibited residual symptoms of anxiety disorder.
We identified 603 references in our survey, of which 17 were included: eight were on OCD, five on panic disorder, and four on PTSD. No studies were found on social anxiety disorder and generalized anxiety disorder. We observed a lack of standardization of terminology and of definitions of resistance, which makes comparison of results difficult. Finally, all of the identified studies showed benefits from the addition of CBT as a next-step strategy.
A limited number of randomized controlled studies were found.
CBT seems to be a promising next-step strategy for patients with anxiety disorders who did not remit with drug-based therapies. However, further clinical trials with strong methodological designs are needed to definitely establish its efficacy in this population.
焦虑障碍药物治疗的未缓解率与更高的复发率、生活质量下降和功能障碍加重有关。在这里，我们旨在研究认知行为疗法（CBT）作为对药物治疗未缓解的焦虑障碍患者的下一步治疗策略的疗效。
我们在 ISI、Pubmed 和 PsycINFO/PsychLit 数据库中进行了系统评价。排除未使用 CBT 且不专注于药物治疗耐药性的研究。我们将未能对充分的药物治疗试验（未完全缓解）作出反应且仍表现出焦虑障碍残留症状的耐药患者视为研究对象。
我们在调查中发现了 603 篇参考文献，其中 17 篇被纳入：8 篇关于强迫症，5 篇关于惊恐障碍，4 篇关于创伤后应激障碍。没有关于社交焦虑障碍和广泛性焦虑障碍的研究。我们观察到术语和耐药性定义缺乏标准化，这使得结果比较困难。最后，所有确定的研究都表明，将 CBT 作为下一步治疗策略添加后都有获益。
发现的随机对照研究数量有限。
CBT 似乎是一种有前途的治疗策略，可用于对药物治疗无缓解的焦虑障碍患者。然而，需要进一步的具有强方法学设计的临床试验来明确确定其在该人群中的疗效。
