Uhlenhuth E H, Balter M B, Ban T A, Yang K
Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque 87131, USA.
J Affect Disord. 1995 Dec 18;35(4):153-62. doi: 10.1016/0165-0327(95)00064-x.
To assemble expert clinical experience and judgement in the treatment of anxiety and related disorders in a systematic, quantitative manner.
A panel of internationally recognized Experts in treating anxiety and depression was constituted by multistage peer nomination. 90% completed a questionnaire. This report focuses on case vignettes of 7 anxiety disorders followed by questions about relevant therapeutic options.
Panelists usually recommended both psychological and pharmacological interventions. Most favored antidepressants, usually tricyclic, for agoraphobia, panic and OCD; beta-blockers for specific social phobia; and benzodiazepines for GAD and adjustment disorder. Some Experts favored polypharmacy, usually an antidepressant and a benzodiazepine. The majority usually advocated pharmacotherapy for 6 months or more. They recommended the same duration of treatment with benzodiazepines and other medications, except for GAD.
The responses of the Expert Panel imply that; (1) most anxiety disorders are serious and merit vigorous, prolonged pharmacotherapy; and (2) antidepressants and benzodiazepines are effective and safe for long-term treatment of these conditions. This outcome contrasts with the widespread apprehension about long-term pharmacotherapy, especially with benzodiazepines, and some regulatory views.
以系统、定量的方式汇总治疗焦虑症及相关障碍的专家临床经验和判断。
通过多阶段同行提名组建了一个国际公认的治疗焦虑症和抑郁症专家小组。90%的专家完成了一份问卷。本报告重点关注7种焦虑症的病例 vignettes，随后是关于相关治疗选择的问题。
小组成员通常推荐心理和药物干预措施。大多数人赞成使用抗抑郁药，通常是三环类药物，用于治疗广场恐惧症、惊恐障碍和强迫症；β受体阻滞剂用于治疗特定社交恐惧症；苯二氮䓬类药物用于治疗广泛性焦虑症和适应障碍。一些专家赞成联合用药，通常是一种抗抑郁药和一种苯二氮䓬类药物。大多数人通常主张药物治疗6个月或更长时间。除广泛性焦虑症外，他们建议苯二氮䓬类药物和其他药物的治疗持续时间相同。
专家小组的回应表明：(1)大多数焦虑症病情严重，值得进行积极、长期的药物治疗；(2)抗抑郁药和苯二氮䓬类药物对这些疾病的长期治疗有效且安全。这一结果与对长期药物治疗，尤其是对苯二氮䓬类药物的广泛担忧以及一些监管观点形成对比。
