Bonham Caroline A, Uhlenhuth Eberhard
Department of Psychiatry, Center for Rural and Community Behavioral Health, University of New Mexico, MSC09 5030, Albuquerque, NM 87131, USA.
Department of Psychiatry, University of New Mexico, MSC09 5030, Albuquerque, NM 87131, USA.
Psychiatry J. 2014;2014:619727. doi: 10.1155/2014/619727. Epub 2014 Mar 2.
Background. Anxiety disorders are associated with considerable disability in the domains of (1) work, (2) social, and (3) family and home interactions. Psychiatric comorbidity is also known to be associated with disability. Methods. Data from the Cross-National Collaborative Panic Study was used to identify rates of comorbid diagnoses, anxiety and depression symptom ratings, and Sheehan disability scale ratings from a clinical sample of 1165 adults with panic disorder. Results. Comorbid diagnoses of agoraphobia, major depression, and social phobia were associated with disability across the three domains of work, social, and family and home interactions. The symptom of agoraphobic avoidance makes the largest contribution to disability but there is no single symptom cluster that entirely predicts impairment and disability. Limitations. The findings about the relative contributions that comorbid diagnoses make to disability only apply to a population with panic disorder. Conclusions. Although panic disorder is not generally considered to be among the serious and persistent mental illnesses, when it is comorbid with other diagnoses, it is associated with considerable impairment. In particular, the presence of agoraphobic avoidance should alert the clinician to the likelihood of important functional impairment. When measuring the functional impact of comorbid anxiety disorders, both the categorical and the dimensional approaches to diagnosis make valuable contributions.
背景。焦虑症在以下三个方面与严重的功能障碍相关：（1）工作，（2）社交，以及（3）家庭和家庭互动。精神疾病共病也与功能障碍有关。方法。来自跨国协作惊恐障碍研究的数据被用于确定共病诊断率、焦虑和抑郁症状评分，以及来自1165名患有惊恐障碍的成年人临床样本的希恩功能障碍量表评分。结果。广场恐惧症（场所恐惧症）、重度抑郁症和社交恐惧症的共病诊断与工作、社交以及家庭和家庭互动这三个领域的功能障碍相关。广场恐惧性回避症状对功能障碍的影响最大，但没有单一的症状群能完全预测功能损害和功能障碍。局限性。关于共病诊断对功能障碍的相对影响的研究结果仅适用于患有惊恐障碍的人群。结论。尽管惊恐障碍通常不被认为是严重且持续的精神疾病之一，但当它与其他诊断共病时，会导致相当严重的功能损害。特别是，广场恐惧性回避的存在应提醒临床医生注意重要功能损害的可能性。在测量共病焦虑症的功能影响时，分类诊断方法和维度诊断方法都有重要作用。
