Roy-Byrne Peter
Professor of Psychiatry, University of Washington School of Medicine, Harborview Medical Center, Seattle, Washington, USA; Founding Partner, Psychiatric Medicine Associates, Seattle, Wash-ington, USA.
Dialogues Clin Neurosci. 2015 Jun;17(2):191-206. doi: 10.31887/DCNS.2015.17.2/proybyrne.
A sizable proportion of psychiatric patients will seek clinical evaluation and treatment for anxiety symptoms reportedly refractory to treatment. This apparent lack of response is either due to "pseudo-resistance" (a failure to have received and adhered to a recognized and effective treatment or treatments for their condition) or to true "treatment resistance." Pseudo-resistance can be due to clinician errors in selecting and delivering an appropriate treatment effectively, or to patient nonadherence to a course of treatment. True treatment resistance can be due to unrecognized exogenous anxiogenic factors (eg, caffeine overuse, sleep deprivation, use of alcohol or marijuana) or an incorrect diagnosis (eg, atypical bipolar illness, occult substance abuse, attention deficit-hyperactivity disorder). Once the above factors are eliminated, treatment should focus on combining effective medications and cognitive behavioral therapy, combining several medications (augmentation), or employing novel medications or psychotherapies not typically indicated as first-line evidence-based anxiety treatments.
据报道，相当一部分精神科患者会因焦虑症状寻求临床评估和治疗，而这些症状据说是难治性的。这种明显的无反应情况要么是由于“假性抵抗”（未能接受并坚持针对其病情的公认有效治疗方法），要么是由于真正的“治疗抵抗”。假性抵抗可能是由于临床医生在有效选择和提供适当治疗方面的失误，或者是患者不坚持治疗过程。真正的治疗抵抗可能是由于未被识别的外源性致焦虑因素（如咖啡因过度使用、睡眠剥夺、酒精或大麻使用）或错误诊断（如非典型双相情感障碍、隐匿性物质滥用、注意力缺陷多动障碍）。一旦消除上述因素，治疗应侧重于联合使用有效药物和认知行为疗法、联合使用几种药物（增效），或采用通常不被视为一线循证焦虑治疗方法的新型药物或心理疗法。
