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惊恐障碍和广泛性焦虑障碍的临床标志物:症状重叠、病程及结局各异

Clinical Markers of Panic and Generalized Anxiety Disorder: Overlapping Symptoms, Different Course and Outcome.

作者信息

Caldiroli Alice, Colzani Lia, Capuzzi Enrico, Quitadamo Cecilia, La Tegola Davide, Surace Teresa, Russo Stefania, Capetti Mauro, Leo Silvia, Tringali Agnese, Marcatili Matteo, Zanelli Quarantini Francesco, Colmegna Fabrizia, Dakanalis Antonios, Buoli Massimiliano, Clerici Massimo

机构信息

Department of Mental Health and Addiction, Fondazione IRCCS San Gerardo dei Tintori, Via G.B. Pergolesi 33, 20900 Monza, Italy.

Department of Medicine and Surgery, University of Milan Bicocca, Via Cadore 38, 20900 Monza, Italy.

出版信息

J Pers Med. 2023 Mar 9;13(3):491. doi: 10.3390/jpm13030491.

Abstract

Generalized Anxiety Disorder (GAD) and Panic Disorder (PD) share underlying neurobiological mechanisms and several clinical features which, with medical comorbidities, may increase misdiagnosis and delay proper treatment. The aim of the study was to evaluate the association between clinical/socio-demographic markers and GAD/PD diagnosis. Outpatients (N = 290) with PD or GAD were identified in mental health services in Monza and Milan (Italy). Descriptive analyses and a binary logistic regression model were performed. Post-onset psychiatric ( = 0.05) and medical ( = 0.02) multiple co-morbidities were associated with GAD; treatment with selective serotonin reuptake inhibitors (SSRIs) was associated with PD, while GAD diagnosis was associated with treatment with atypical antipsychotics or GABAergic drugs ( = 0.03), as well as psychodynamic psychotherapy ( < 0.01). Discontinuation of the last pharmacological treatment was associated with GAD diagnosis rather than the PD one ( = 0.02). GAD patients may have a worse prognosis than PD patients because of more frequent multiple co-morbidities, relapses and poorer treatment compliance. The different treatment approaches were consistent with the available literature, while the association between GAD and psychodynamic psychotherapy is an original finding of our study. Further studies on larger samples are necessary to better characterize clinical factors associated with GAD or PD.

摘要

广泛性焦虑障碍(GAD)和惊恐障碍(PD)具有共同的潜在神经生物学机制和一些临床特征,这些特征与医学合并症一起,可能会增加误诊并延误适当治疗。本研究的目的是评估临床/社会人口统计学指标与GAD/PD诊断之间的关联。在意大利蒙扎和米兰的心理健康服务机构中识别出患有PD或GAD的门诊患者(N = 290)。进行了描述性分析和二元逻辑回归模型。发病后的精神科(P = 0.05)和医学(P = 0.02)多种合并症与GAD相关;选择性5-羟色胺再摄取抑制剂(SSRI)治疗与PD相关,而GAD诊断与非典型抗精神病药物或GABA能药物治疗相关(P = 0.03),以及与心理动力心理治疗相关(P < 0.01)。停用最后一种药物治疗与GAD诊断相关,而非PD诊断(P = 0.02)。由于更频繁的多种合并症、复发和较差的治疗依从性,GAD患者的预后可能比PD患者更差。不同的治疗方法与现有文献一致,而GAD与心理动力心理治疗之间的关联是我们研究的一项原始发现。有必要对更大样本进行进一步研究,以更好地描述与GAD或PD相关的临床因素。

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