Schaffer Ayal, McIntosh Diane, Goldstein Benjamin I, Rector Neil A, McIntyre Roger S, Beaulieu Serge, Swinson Richard, Yatham Lakshmi N
Mood and Anxiety Disorders Program, Sunnybrook Health Sciences Centre, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
Ann Clin Psychiatry. 2012 Feb;24(1):6-22.
Comorbid mood and anxiety disorders are commonly seen in clinical practice. The goal of this article is to review the available literature on the epidemiologic, etiologic, clinical, and management aspects of this comorbidity and formulate a set of evidence- and consensus-based recommendations. This article is part of a set of Canadian Network for Mood and Anxiety Treatments (CANMAT) Comorbidity Task Force papers.
We conducted a PubMed search of all English-language articles published between January 1966 and November 2010. The search terms were bipolar disorder and major depressive disorder, cross-referenced with anxiety disorders/symptoms, panic disorder, agoraphobia, generalized anxiety disorder, social phobia, obsessive-compulsive disorder, and posttraumatic stress disorder. Levels of evidence for specific interventions were assigned based on a priori determined criteria, and recommendations were developed by integrating the level of evidence and clinical opinion of the authors.
Comorbid anxiety symptoms and disorders have a significant impact on the clinical presentation and treatment approach for patients with mood disorders. A set of recommendations are provided for the management of bipolar disorder (BD) with comorbid anxiety and major depressive disorder (MDD) with comorbid anxiety with a focus on comorbid posttraumatic stress disorder, use of cognitive-behavioral therapy across mood and anxiety disorders, and youth with mood and anxiety disorders.
Careful attention should be given to correctly identifying anxiety comorbidities in patients with BD or MDD. Consideration of evidence- or consensus-based treatment recommendations for the management of both mood and anxiety symptoms is warranted.
共病的情绪和焦虑障碍在临床实践中很常见。本文的目的是回顾关于这种共病在流行病学、病因学、临床和管理方面的现有文献，并制定一套基于证据和共识的建议。本文是加拿大情绪与焦虑治疗网络（CANMAT）共病特别工作组系列论文的一部分。
我们在PubMed上检索了1966年1月至2010年11月发表的所有英文文章。检索词为双相情感障碍和重度抑郁症，并与焦虑障碍/症状、惊恐障碍、广场恐惧症、广泛性焦虑障碍、社交恐惧症、强迫症和创伤后应激障碍交叉引用。根据预先确定的标准对特定干预措施的证据水平进行赋值，并通过整合证据水平和作者的临床意见来制定建议。
共病的焦虑症状和障碍对情绪障碍患者的临床表现和治疗方法有重大影响。针对伴有共病焦虑的双相情感障碍（BD）和伴有共病焦虑的重度抑郁症（MDD）的管理提供了一套建议，重点关注共病的创伤后应激障碍、跨情绪和焦虑障碍使用认知行为疗法以及患有情绪和焦虑障碍的青少年。
应仔细关注正确识别BD或MDD患者的焦虑共病情况。对于情绪和焦虑症状的管理，考虑基于证据或共识的治疗建议是有必要的。
