Bakker A, van Balkom A J, Spinhoven P, Blaauw B M, van Dyck R
Department of Psychiatry, Vrije Universiteit, Amsterdam, The Netherlands.
J Nerv Ment Dis. 1998 Jul;186(7):414-9. doi: 10.1097/00005053-199807000-00005.
We conducted a meta-analysis to update the knowledge of long-term efficacy of different treatments in panic disorder with or without agoraphobia. Included were 68 studies pertaining to 106 treatment conditions and 1346 patients. Effect sizes Cohen's d were calculated within the treatment conditions at posttest and at follow-up for panic and agoraphobia. A comparison was made between six treatments: high-potency benzodiazepines, antidepressants, psychological panic management, exposure in vivo, antidepressants combined with exposure, and psychological panic management combined with exposure in vivo. The mean (+/- SD) duration of the follow-up period was 62 +/- 89 weeks. In the majority of the studies (84%), follow-up had a naturalistic character. The lack of information about treatments received between posttest and follow-up limits the interpretation of the results. For all conditions, the treatment gains at posttest were maintained during the follow-up period. The mean (+/- SD) d for panic was 1.11 +/- 0.70 at posttest and 1.28 +/- 0.61 at follow-up; for agoraphobia, the mean d at posttest was 1.36 +/- 1.10 and at follow-up it was 1.41 +/- 0.82. Significant differences were found in efficacy on agoraphobic measures at follow-up between the combination of antidepressants and exposure in vivo versus psychological panic management, exposure in vivo, and the combination of psychological panic management and exposure. Overall, the data suggest that different treatment options for panic disorder with or without agoraphobia are effective at both posttest and follow-up. Research on long-term treatment, discontinuation of therapies, and interventions between posttest and follow-up need more attention, for pharmacotherapy as well as psychotherapy.
我们进行了一项荟萃分析，以更新关于不同治疗方法对伴或不伴广场恐怖症的惊恐障碍长期疗效的认识。纳入了68项研究，涉及106种治疗情况和1346名患者。在治疗情况内计算了治疗后和随访时惊恐和广场恐怖症的效应量Cohen's d。对六种治疗方法进行了比较：高效苯二氮䓬类药物、抗抑郁药、心理惊恐管理、现场暴露、抗抑郁药联合暴露以及心理惊恐管理联合现场暴露。随访期的平均（±标准差）时长为62±89周。在大多数研究（84%）中，随访具有自然主义性质。治疗后至随访期间所接受治疗信息的缺乏限制了对结果的解释。对于所有情况，治疗后获得的改善在随访期间得以维持。惊恐的平均（±标准差）d在治疗后为1.11±0.70，随访时为1.28±0.61；对于广场恐怖症，治疗后的平均d为1.36±1.10，随访时为1.41±0.82。在随访时，抗抑郁药与现场暴露联合治疗与心理惊恐管理、现场暴露以及心理惊恐管理与现场暴露联合治疗相比，在广场恐怖症测量指标的疗效上存在显著差异。总体而言，数据表明伴或不伴广场恐怖症的惊恐障碍的不同治疗选择在治疗后和随访时均有效。对于药物治疗和心理治疗，关于长期治疗、治疗中断以及治疗后至随访期间的干预措施的研究需要更多关注。
