Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Prog Neuropsychopharmacol Biol Psychiatry. 2016 Oct 3;70:219-26. doi: 10.1016/j.pnpbp.2016.02.001. Epub 2016 Feb 3.
Panic disorder is commonly prevalent in the population, but the treatment response for panic disorder in clinical practice is much less effective than that in our imagination. Increasing evidence suggested existence of a chronic or remitting-relapsing clinical course in panic disorder. In this systematic review, we re-examine the definition of treatment-resistant panic disorder, and present the potential risk factors related to the treatment resistance, including the characteristics of panic disorder, other psychiatric and physical comorbidities, and psychosocial stresses. Furthermore, we summarize the potential pathophysiologies, such as genetic susceptibility, altered brain functioning, brain-derived neurotrophic factor, and long-term inflammation, to explain the treatment resistance. Finally, we conclude the current therapeutic strategies for treating treatment-resistant panic disorder from pharmacological and non-pharmacological views.
惊恐障碍在人群中普遍存在，但惊恐障碍在临床实践中的治疗反应远不如我们想象的那么有效。越来越多的证据表明惊恐障碍存在慢性或缓解-复发的临床病程。在本系统评价中，我们重新审视了治疗抵抗性惊恐障碍的定义，并提出了与治疗抵抗性相关的潜在危险因素，包括惊恐障碍的特征、其他精神和躯体共病、以及心理社会应激等。此外，我们总结了潜在的病理生理学机制，如遗传易感性、大脑功能改变、脑源性神经营养因子和长期炎症，以解释治疗抵抗性。最后，我们从药理学和非药理学的角度总结了治疗治疗抵抗性惊恐障碍的当前治疗策略。
