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成人广泛性焦虑障碍的治疗方法

Authors
Michelle Craske, PhD
Alexander Bystritsky, MD, PhD
Section Editor
Murray B Stein, MD, MPH
Deputy Editor
Richard Hermann, MD
Translators
邓学军, 主任医师，教授

引言

广泛性焦虑障碍(generalized anxiety disorder, GAD)的特征是多数时间存在难以控制的过度担心和焦虑，并导致显著的痛苦和功能受损。

GAD是一种相对常见的疾病，最常于成年期起病，呈慢性病程[1-4]。GAD可导致患者角色功能显著受损、生活质量降低、医疗保健费用很高[5,6]。通过认知行为治疗(cognitive behavioral therapy, CBT)、药物治疗或二者联合可有效治疗GAD[7]。

本专题将对选择治疗GAD的方法进行介绍。有关GAD治疗药物的疗效、给药方法及副作用的信息将单独介绍。有关治疗GAD的CBT组成部分、疗效及实施的信息也将单独介绍。GAD的流行病学、发病机制、临床表现、病程和诊断也将单独介绍。 (参见“广泛性焦虑障碍的药物治疗”和“广泛性焦虑障碍的心理治疗”和“广泛性焦虑障碍：流行病学、发病机制、临床表现、病程、评估和诊断”)

新诊断的患者

需进行治疗的患者 — 一旦患者诊断为GAD，下一步是根据临床评估的严重程度、痛苦或功能受损的程度及患者偏好，确定是否需对GAD进行治疗。对于更轻微亚型的GAD患者，如果症状未显著干扰功能，最初选择放弃治疗可能是合理的。每6个月对患者进行临床随访的重要性在于监测GAD的病程，确定症状是否恶化和/或妨碍功能—如果存在这些指征，建议之后进行治疗。 (参见“广泛性焦虑障碍：流行病学、发病机制、临床表现、病程、评估和诊断”，关于‘评估’一节)

选择CBT与药物 — 对于多数新诊断为GAD且需治疗的患者，我们推荐初始治疗选用一种5-HT能抗抑郁药和/或CBT，而不是其他干预。5-HT能抗抑郁药和CBT是研究最充分且已证实对GAD有效的治疗[8,9]。

                     

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Literature review current through: 2017-07 . | This topic last updated: 2016-04-15.
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References
Top
  1. Lieb R, Becker E, Altamura C. The epidemiology of generalized anxiety disorder in Europe. Eur Neuropsychopharmacol 2005; 15:445.
  2. Kessler RC, McGonagle KA, Zhao S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psychiatry 1994; 51:8.
  3. Kessler RC, Berglund P, Demler O, et al. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005; 62:593.
  4. Bruce SE, Yonkers KA, Otto MW, et al. Influence of psychiatric comorbidity on recovery and recurrence in generalized anxiety disorder, social phobia, and panic disorder: a 12-year prospective study. Am J Psychiatry 2005; 162:1179.
  5. Kessler RC, Chiu WT, Demler O, et al. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005; 62:617.
  6. Bereza BG, Machado M, Einarson TR. Systematic review and quality assessment of economic evaluations and quality-of-life studies related to generalized anxiety disorder. Clin Ther 2009; 31:1279.
  7. Stein MB, Sareen J. CLINICAL PRACTICE. Generalized Anxiety Disorder. N Engl J Med 2015; 373:2059.
  8. Hunot V, Churchill R, Silva de Lima M, Teixeira V. Psychological therapies for generalised anxiety disorder. Cochrane Database Syst Rev 2007; :CD001848.
  9. Hendriks GJ, Oude Voshaar RC, Keijsers GP, et al. Cognitive-behavioural therapy for late-life anxiety disorders: a systematic review and meta-analysis. Acta Psychiatr Scand 2008; 117:403.
  10. Mitte K. Meta-analysis of cognitive-behavioral treatments for generalized anxiety disorder: a comparison with pharmacotherapy. Psychol Bull 2005; 131:785.
  11. Weissman MM, Verdeli H, Gameroff MJ, et al. National survey of psychotherapy training in psychiatry, psychology, and social work. Arch Gen Psychiatry 2006; 63:925.
  12. Norton PJ, Price EC. A meta-analytic review of adult cognitive-behavioral treatment outcome across the anxiety disorders. J Nerv Ment Dis 2007; 195:521.
  13. Hofmann SG, Smits JA. Cognitive-behavioral therapy for adult anxiety disorders: a meta-analysis of randomized placebo-controlled trials. J Clin Psychiatry 2008; 69:621.
  14. Mahe V, Balogh A. Long-term pharmacological treatment of generalized anxiety disorder. Int Clin Psychopharmacol 2000; 15:99.
  15. Rickels K, Zaninelli R, McCafferty J, et al. Paroxetine treatment of generalized anxiety disorder: a double-blind, placebo-controlled study. Am J Psychiatry 2003; 160:749.
  16. Stocchi F, Nordera G, Jokinen RH, et al. Efficacy and tolerability of paroxetine for the long-term treatment of generalized anxiety disorder. J Clin Psychiatry 2003; 64:250.
  17. Brawman-Mintzer O, Knapp RG, Rynn M, et al. Sertraline treatment for generalized anxiety disorder: a randomized, double-blind, placebo-controlled study. J Clin Psychiatry 2006; 67:874.
  18. Dahl AA, Ravindran A, Allgulander C, et al. Sertraline in generalized anxiety disorder: efficacy in treating the psychic and somatic anxiety factors. Acta Psychiatr Scand 2005; 111:429.
  19. Davidson JR, Bose A, Korotzer A, Zheng H. Escitalopram in the treatment of generalized anxiety disorder: double-blind, placebo controlled, flexible-dose study. Depress Anxiety 2004; 19:234.
  20. Davidson JR, Bose A, Wang Q. Safety and efficacy of escitalopram in the long-term treatment of generalized anxiety disorder. J Clin Psychiatry 2005; 66:1441.
  21. Goodman WK, Bose A, Wang Q. Treatment of generalized anxiety disorder with escitalopram: pooled results from double-blind, placebo-controlled trials. J Affect Disord 2005; 87:161.
  22. Kapczinski F, Lima MS, Souza JS, Schmitt R. Antidepressants for generalized anxiety disorder. Cochrane Database Syst Rev 2003; :CD003592.
  23. Craske MG, Roy-Byrne P, Stein MB, et al. CBT intensity and outcome for panic disorder in a primary care setting. Behav Ther 2006; 37:112.
  24. Feltner DE, Crockatt JG, Dubovsky SJ, et al. A randomized, double-blind, placebo-controlled, fixed-dose, multicenter study of pregabalin in patients with generalized anxiety disorder. J Clin Psychopharmacol 2003; 23:240.
  25. Kasper S, Herman B, Nivoli G, et al. Efficacy of pregabalin and venlafaxine-XR in generalized anxiety disorder: results of a double-blind, placebo-controlled 8-week trial. Int Clin Psychopharmacol 2009; 24:87.
  26. Montgomery SA, Tobias K, Zornberg GL, et al. Efficacy and safety of pregabalin in the treatment of generalized anxiety disorder: a 6-week, multicenter, randomized, double-blind, placebo-controlled comparison of pregabalin and venlafaxine. J Clin Psychiatry 2006; 67:771.
  27. Pande AC, Crockatt JG, Feltner DE, et al. Pregabalin in generalized anxiety disorder: a placebo-controlled trial. Am J Psychiatry 2003; 160:533.
  28. Pohl RB, Feltner DE, Fieve RR, Pande AC. Efficacy of pregabalin in the treatment of generalized anxiety disorder: double-blind, placebo-controlled comparison of BID versus TID dosing. J Clin Psychopharmacol 2005; 25:151.
  29. Rickels K, Pollack MH, Feltner DE, et al. Pregabalin for treatment of generalized anxiety disorder: a 4-week, multicenter, double-blind, placebo-controlled trial of pregabalin and alprazolam. Arch Gen Psychiatry 2005; 62:1022.
  30. Gelenberg AJ, Lydiard RB, Rudolph RL, et al. Efficacy of venlafaxine extended-release capsules in nondepressed outpatients with generalized anxiety disorder: A 6-month randomized controlled trial. JAMA 2000; 283:3082.
  31. Guaiana G, Barbui C, Cipriani A. Hydroxyzine for generalised anxiety disorder. Cochrane Database Syst Rev 2010; :CD006815.
  32. Davidson JR. Pharmacotherapy of generalized anxiety disorder. J Clin Psychiatry 2001; 62 Suppl 11:46.
  33. Allgulander C, Bandelow B, Hollander E, et al. WCA recommendations for the long-term treatment of generalized anxiety disorder. CNS Spectr 2003; 8:53.
  34. Rickels K, Lucki I, Schweizer E, et al. Psychomotor performance of long-term benzodiazepine users before, during, and after benzodiazepine discontinuation. J Clin Psychopharmacol 1999; 19:107.
  35. Schatzberg AF. New indications for antidepressants. J Clin Psychiatry 2000; 61 Suppl 11:9.
  36. Huh J, Goebert D, Takeshita J, et al. Treatment of generalized anxiety disorder: a comprehensive review of the literature for psychopharmacologic alternatives to newer antidepressants and benzodiazepines. Prim Care Companion CNS Disord 2011; 13.
  37. Gao K, Muzina D, Gajwani P, Calabrese JR. Efficacy of typical and atypical antipsychotics for primary and comorbid anxiety symptoms or disorders: a review. J Clin Psychiatry 2006; 67:1327.
  38. Kreys TJ, Phan SV. A literature review of quetiapine for generalized anxiety disorder. Pharmacotherapy 2015; 35:175.
  39. http://www.accessdata.fda.gov/drugsatfda_docs/label/2011/020639s049s054lbl.pdf (Accessed on March 14, 2016).
  40. Power KG, Simpson RJ, Swanson V, Wallace LA. A controlled comparison of cognitive-behaviour therapy, diazepam, and placebo, alone and in combination, for the treatment of generalised anxiety disorder. J Anxiety Disord 1990; 4:267.
  41. Power KG, Simpson RJ, Swanson V, Wallace LA. Controlled comparison of pharmacological and psychological treatment of generalized anxiety disorder in primary care. Br J Gen Pract 1990; 40:289.
  42. Walkup JT, Albano AM, Piacentini J, et al. Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. N Engl J Med 2008; 359:2753.
  43. Wetherell JL, Petkus AJ, White KS, et al. Antidepressant medication augmented with cognitive-behavioral therapy for generalized anxiety disorder in older adults. Am J Psychiatry 2013; 170:782.