Gimeno Carmen, Dorado Marisa Luisa, Roncero Carlos, Szerman Nestor, Vega Pablo, Balanzá-Martínez Vicent, Alvarez F Javier
Unit for Addictive Behaviours, Conselleria de Sanitat, Alicante, Spain.
Sociedad Española de Patología Dual, Madrid, Spain.
Front Psychiatry. 2017 Sep 22;8:173. doi: 10.3389/fpsyt.2017.00173. eCollection 2017.
Patients with alcohol-use disorders (AUDs) have a high prevalence of anxiety disorders (AnxDs). "Co-occurring disorders" refers to the coexistence of an AUD and/or drug related disorders with another non-addictive psychiatric disorder. The aim of this study was to assess the effectiveness of psychopharmacological treatments and psychotherapy in patients with AUD and AnxD and to propose recommendations for the treatment of patients with comorbid AnxDs and AUDs. Randomized clinical trials, meta-analyses, and clinical guidelines were retrieved from PubMed, Embase, and Cochrane databases. Paroxetine was found to be effective in social anxiety patients with alcohol dependence. Selective serotonin reuptake inhibitors (SSRIs), especially sertraline, showed effective results in posttraumatic stress disorder and in comorbid AnxD-AUD. However, SSRIs should be used with caution when patients are actively drinking because they may increase alcohol consumption. Buspirone, gabapentin, and pregabalin were found to be effective in comorbid AnxD-AUD. The treatment of dual AnxDs should start as early as possible. Since AUDs and AnxDs can reinforce each other, treatments targeting both pathologies can be effective. Women suffer from higher levels of stress and AnxDs than men, and they are also more vulnerable to maintaining alcohol consumption levels. Further research is needed in this comorbid patient population, including the study of different types of patients and gender perspectives.
酒精使用障碍（AUDs）患者中焦虑症（AnxDs）的患病率很高。“共病”是指AUD和/或药物相关障碍与另一种非成瘾性精神障碍同时存在。本研究的目的是评估精神药物治疗和心理治疗对患有AUD和AnxD患者的有效性，并为合并AnxDs和AUDs的患者治疗提出建议。从PubMed、Embase和Cochrane数据库中检索随机临床试验、荟萃分析和临床指南。发现帕罗西汀对酒精依赖的社交焦虑患者有效。选择性5-羟色胺再摄取抑制剂（SSRIs），尤其是舍曲林，在创伤后应激障碍和合并AnxD-AUD患者中显示出有效结果。然而，当患者正在积极饮酒时，应谨慎使用SSRIs，因为它们可能会增加酒精摄入量。发现丁螺环酮、加巴喷丁和普瑞巴林对合并AnxD-AUD有效。双重AnxDs的治疗应尽早开始。由于AUDs和AnxDs可相互强化，针对两种病症的治疗可能有效。女性比男性承受更高水平的压力和AnxDs，并且她们在维持酒精消费水平方面也更容易受到影响。在这种合并症患者群体中需要进一步研究，包括对不同类型患者和性别观点的研究。
