Bandelow Borwin, Michaelis Sophie, Wedekind Dirk
Department of Psychiatry and Psychotherapy, University Medical Center, Gottingen, Germany.
Dialogues Clin Neurosci. 2017 Jun;19(2):93-107. doi: 10.31887/DCNS.2017.19.2/bbandelow.
Anxiety disorders (generalized anxiety disorder, panic disorder/agoraphobia, social anxiety disorder, and others) are the most prevalent psychiatric disorders, and are associated with a high burden of illness. Anxiety disorders are often underrecognized and undertreated in primary care. Treatment is indicated when a patient shows marked distress or suffers from complications resulting from the disorder. The treatment recommendations given in this article are based on guidelines, meta-analyses, and systematic reviews of randomized controlled studies. Anxiety disorders should be treated with psychological therapy, pharmacotherapy, or a combination of both. Cognitive behavioral therapy can be regarded as the psychotherapy with the highest level of evidence. First-line drugs are the selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors. Benzodiazepines are not recommended for routine use. Other treatment options include pregabalin, tricyclic antidepressants, buspirone, moclobemide, and others. After remission, medications should be continued for 6 to 12 months. When developing a treatment plan, efficacy, adverse effects, interactions, costs, and the preference of the patient should be considered.
焦虑症（广泛性焦虑症、惊恐障碍/广场恐惧症、社交焦虑症等）是最常见的精神障碍，且与高疾病负担相关。焦虑症在初级保健中常常未得到充分认识和治疗。当患者表现出明显痛苦或患有该疾病导致的并发症时，需进行治疗。本文给出的治疗建议基于指南、荟萃分析以及对随机对照研究的系统评价。焦虑症应采用心理治疗、药物治疗或两者结合的方式进行治疗。认知行为疗法可被视为证据水平最高的心理治疗方法。一线药物是选择性5-羟色胺再摄取抑制剂和5-羟色胺-去甲肾上腺素再摄取抑制剂。不建议常规使用苯二氮䓬类药物。其他治疗选择包括普瑞巴林、三环类抗抑郁药、丁螺环酮、吗氯贝胺等。缓解后，药物应持续使用6至12个月。制定治疗方案时，应考虑疗效、不良反应、相互作用、成本以及患者的偏好。
