Behringer Tiffany, Rollman Bruce L, Herbeck-Belnap Bea, Houck Patricia R, Mazumdar Sati, Schwarz Eleanor Bimla
Division of General Internal Medicine, Center for Research on Health Care (Drs Rollman, Herbeck-Belnap, and Schwarz); Department of Psychiatry (Ms Houck); and Departments of Epidemiology and Obstetrics and Gynecology (Dr Schwarz), University of Pittsburgh School of Medicine (Ms Behringer); and Department of Biostatistics, University of Pittsburgh Graduate School of Public Health (Dr Mazumdar), Pittsburgh, Pennsylvania.
Prim Care Companion CNS Disord. 2011;13(2). doi: 10.4088/PCC.10m01028.
To examine the impact of physician counseling on perceived risks, benefits, and likelihood of use of anxiolytic pharmacotherapy during pregnancy among women with a history of anxiety.
We surveyed 96 nonpregnant women, aged 21-45 years, with panic disorder and/or generalized anxiety disorder (DSM-IV criteria) recruited by their family physicians to participate in an anxiety treatment trial from 7 primary care practices in Pittsburgh, Pennsylvania. Trained research assistants telephoned study participants to assess sociodemographics, psychiatric history, comorbidities, and anxiety severity. Respondents were asked to assess risks, benefits, and likelihood of taking a prescribed anxiolytic during pregnancy using 3 Likert scales at baseline. Respondents were then asked to indicate whether their perceptions would change with (1) a US Food and Drug Administration (FDA) warning reporting a 5% chance of birth defects with use and (2) physician counseling that the medication was safe during pregnancy despite the warning. Data were collected from January 1, 2005, through December 30, 2007.
In this study, 46% (44/96) of respondents had generalized anxiety disorder, 14% (14/96) had panic disorder, and 40% (38/96) had both generalized anxiety disorder and panic disorder. The mean baseline Hamilton Anxiety Rating Scale score was 25.6 (SD = 8.4). Respondents were less likely to perceive risk if counseled by their primary care physicians that medication use was safe despite FDA warning. They also saw more benefit in use and reported being more likely to take anxiolytic medications during pregnancy if counseled that doing so was safe. Age, ethnicity, and severity of anxiety did not modify the effect of physician counseling. However, college educated women were less likely to be reassured by primary care physician counseling (P = .05) that anxiolytic use during pregnancy was safe.
Women with anxiety disorders are often hesitant to use anxiolytic medications during pregnancy. Physician counseling may change some women's perceptions of risk and decisions regarding use during pregnancy.
Clinicaltrials.gov Identifier: NCT00158327.
探讨医生咨询对有焦虑病史的孕妇在孕期使用抗焦虑药物的感知风险、益处及用药可能性的影响。
我们对96名年龄在21 - 45岁、患有惊恐障碍和/或广泛性焦虑障碍（符合《精神疾病诊断与统计手册》第四版标准）的非孕妇进行了调查，这些患者由其家庭医生招募，来自宾夕法尼亚州匹兹堡7家初级保健机构参与一项焦虑治疗试验。经过培训的研究助理通过电话评估研究参与者的社会人口统计学特征、精神病史、合并症及焦虑严重程度。在基线时，要求受访者使用3个李克特量表评估孕期服用处方抗焦虑药物的风险、益处及可能性。然后要求受访者指出他们的看法是否会因以下情况而改变：（1）美国食品药品监督管理局（FDA）发布的警告，即使用该药物有5%的出生缺陷几率；（2）医生告知尽管有警告，但该药物在孕期是安全的。数据收集时间为2005年1月1日至2007年12月30日。
在本研究中，46%（44/96）的受访者患有广泛性焦虑障碍，14%（14/96）患有惊恐障碍，40%（38/96）既患有广泛性焦虑障碍又患有惊恐障碍。汉密尔顿焦虑量表基线平均得分为25.6（标准差 = 8.4）。如果初级保健医生告知尽管有FDA警告但用药是安全的，受访者感知风险的可能性较小。如果被告知用药安全，他们也认为用药益处更大，并表示在孕期更有可能服用抗焦虑药物。年龄、种族和焦虑严重程度并未改变医生咨询的效果。然而，受过大学教育的女性不太可能因初级保健医生关于孕期使用抗焦虑药物安全的咨询而安心（P = 0.05）。
患有焦虑症的女性在孕期通常对使用抗焦虑药物犹豫不决。医生咨询可能会改变一些女性对风险的认知以及孕期用药的决定。
Clinicaltrials.gov标识符：NCT00158327。
