Department of Psychiatry, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, Netherlands; GGZ inGeest, Amsterdam, Netherlands.
Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA.
Lancet. 2021 Mar 6;397(10277):914-927. doi: 10.1016/S0140-6736(21)00359-7. Epub 2021 Feb 11.
Anxiety disorders form the most common group of mental disorders and generally start before or in early adulthood. Core features include excessive fear and anxiety or avoidance of perceived threats that are persistent and impairing. Anxiety disorders involve dysfunction in brain circuits that respond to danger. Risk for anxiety disorders is influenced by genetic factors, environmental factors, and their epigenetic relations. Anxiety disorders are often comorbid with one another and with other mental disorders, especially depression, as well as with somatic disorders. Such comorbidity generally signifies more severe symptoms, greater clinical burden, and greater treatment difficulty. Reducing the large burden of disease from anxiety disorders in individuals and worldwide can be best achieved by timely, accurate disease detection and adequate treatment administration, scaling up of treatments when needed. Evidence-based psychotherapy (particularly cognitive behavioural therapy) and psychoactive medications (particularly serotonergic compounds) are both effective, facilitating patients' choices in therapeutic decisions. Although promising, no enduring preventive measures are available, and, along with frequent therapy resistance, clinical needs remain unaddressed. Ongoing research efforts tackle these problems, and future efforts should seek individualised, more effective approaches for treatment with precision medicine.
焦虑障碍是最常见的一类精神障碍,通常在成年前或早期开始。核心特征包括对持续存在且造成损害的感知威胁的过度恐惧、焦虑或回避。焦虑障碍涉及到对危险做出反应的大脑回路功能障碍。焦虑障碍的风险受遗传因素、环境因素及其表观遗传关系的影响。焦虑障碍通常与其他精神障碍(尤其是抑郁症)以及躯体障碍共病。这种共病通常意味着更严重的症状、更大的临床负担和更大的治疗难度。通过及时、准确的疾病检测和适当的治疗管理,以及在需要时扩大治疗范围,可以最大限度地减少个体和全球范围内焦虑障碍带来的巨大疾病负担。循证心理治疗(尤其是认知行为疗法)和精神药物(尤其是 5-羟色胺能化合物)都有效,为患者在治疗决策中提供了选择。虽然有希望,但目前还没有持久的预防措施,加上经常出现的治疗抵抗,临床需求仍未得到满足。正在进行的研究努力解决这些问题,未来的努力应该寻求个体化、更有效的精准医学治疗方法。