Bandelow Borwin, Allgulander Christer, Baldwin David S, Costa Daniel Lucas da Conceição, Denys Damiaan, Dilbaz Nesrin, Domschke Katharina, Hollander Eric, Kasper Siegfried, Möller Hans-Jürgen, Eriksson Elias, Fineberg Naomi A, Hättenschwiler Josef, Kaiya Hisanobu, Karavaeva Tatiana, Katzman Martin A, Kim Yong-Ku, Inoue Takeshi, Lim Leslie, Masdrakis Vasilios, Menchón José M, Miguel Euripedes C, Nardi Antônio E, Pallanti Stefano, Perna Giampaolo, Rujescu Dan, Starcevic Vladan, Stein Dan J, Tsai Shih-Jen, Van Ameringen Michael, Vasileva Anna, Wang Zhen, Zohar Joseph
Department of Psychiatry and Psychotherapy, University Medical Center, Göttingen, Germany.
Department of Medical Sciences, Psychiatry, Uppsala University, Uppsala, Sweden.
World J Biol Psychiatry. 2023 Feb;24(2):118-134. doi: 10.1080/15622975.2022.2086296. Epub 2022 Jul 28.
This is the third version of the guideline of the World Federation of Societies of Biological Psychiatry (WFSBP) Task Force for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Posttraumatic Stress Disorders which was published in 2002 and revised in 2008.
A consensus panel of 34 international experts representing 22 countries developed recommendations based on efficacy and acceptability of the treatments. In this version, not only medications but also psychotherapies and other non-pharmacological interventions were evaluated, applying the same rigorous methods that are standard for the assessment of medication treatments.
The present paper (Part II) contains recommendations based on published randomised controlled trials (RCTs) for the treatment of OCD ( = 291) and PTSD ( = 234) in children, adolescents, and adults. The accompanying paper (Part I) contains the recommendations for the treatment of anxiety disorders.For OCD, first-line treatments are selective serotonin reuptake inhibitors (SSRIs) and cognitive behavioural therapy (CBT). Internet-CBT was also superior to active controls. Several second-line medications are available, including clomipramine. For treatment-resistant cases, several options are available, including augmentation of SSRI treatment with antipsychotics and other drugs.Other non-pharmacological treatments, including repetitive transcranial magnetic stimulation (rTMS), deep brain stimulation (DBS) and others were also evaluated.For PTSD, SSRIs and the SNRI venlafaxine are first-line treatments. CBT is the psychotherapy modality with the best body of evidence. For treatment-unresponsive patients, augmentation of SSRI treatment with antipsychotics may be an option.
OCD and PTSD can be effectively treated with CBT and medications.
这是世界生物精神病学协会联合会（WFSBP）焦虑、强迫及创伤后应激障碍药物治疗工作组指南的第三版，该指南于2002年发布并于2008年修订。
由来自22个国家的34名国际专家组成的共识小组根据治疗的有效性和可接受性制定了建议。在这个版本中，不仅对药物进行了评估，还对心理治疗和其他非药物干预措施进行了评估，采用了与药物治疗评估标准相同的严格方法。
本文（第二部分）包含基于已发表的随机对照试验（RCT）对儿童、青少年和成人强迫症（=291）和创伤后应激障碍（=234）治疗的建议。配套论文（第一部分）包含焦虑症治疗的建议。对于强迫症，一线治疗方法是选择性5-羟色胺再摄取抑制剂（SSRI）和认知行为疗法（CBT）。网络CBT也优于积极对照。有几种二线药物可供选择，包括氯米帕明。对于难治性病例，有几种选择，包括用抗精神病药物和其他药物增强SSRI治疗。还评估了其他非药物治疗方法，包括重复经颅磁刺激（rTMS）、深部脑刺激（DBS）等。对于创伤后应激障碍，SSRI和5-羟色胺去甲肾上腺素再摄取抑制剂（SNRI）文拉法辛是一线治疗方法。CBT是有最佳证据支持的心理治疗方式。对于治疗无反应的患者，用抗精神病药物增强SSRI治疗可能是一种选择。
强迫症和创伤后应激障碍可以通过CBT和药物有效治疗。
