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惊恐障碍：流行病学、发病机制、临床表现、病程、评估与诊断

Authors
Wayne Katon, MD
Paul Ciechanowski, MD
Section Editor
Murray B Stein, MD, MPH
Deputy Editor
Richard Hermann, MD
Translators
曹庆久, 副主任医师

引言

惊恐发作和惊恐障碍是初级保健患者和精神病患者中的常见问题。随着精神障碍诊断与统计手册(Diagnostic and Statistical Manual of Mental Disorders, DSM)-Ⅳ修订为DSM-5，广场恐惧症的诊断已从惊恐障碍中独立出来[1]。

惊恐发作的患者可能表现为典型的间断发作的强烈恐惧，这种发作突然出现，可持续数分钟至1小时。惊恐发作时患者也常表现出自主神经系统症状，例如胸痛或呼吸急促，这些症状常促使患者前往急诊室就诊。惊恐障碍中的患者会反复出现预期之外的惊恐发作，并持续1个月或更长时间地担心将来再次发作/后果，或存在与惊恐发作有关的显著适应不良性行为改变，例如回避促发惊恐发作的情景。

如果对该病有足够高水平的认识，惊恐发作通常不难诊断。惊恐发作可发生在其他焦虑障碍中。识别并治疗常见的共病(如，广场恐惧症或抑郁)对获得良好的预后也至关重要。在少数情况下，惊恐发作可与其他焦虑障碍同时出现，这使得作出准确的鉴别诊断至关重要。

本专题将讨论惊恐障碍的流行病学、发病机制、临床表现、病程与诊断。广场恐惧症的流行病学、发病机制、临床表现、病程和诊断将单独讨论。惊恐障碍的治疗也将单独讨论。 (参见“Agoraphobia in adults: Epidemiology, pathogenesis, clinical manifestations, course, and diagnosis”和“惊恐障碍的药物治疗”和“惊恐障碍的心理治疗”)

流行病学

在2005年美国的一项全国代表性研究中，美国人群(15-54岁)中惊恐障碍的12个月患病率和终生患病率分别为2.7%和4.7%[2]。一项对13项欧洲研究的系统评价报道，惊恐障碍的12个月患病率为1.8%[3]。在初级保健患者中，惊恐障碍的患病率高达一般人群的约2倍，为4%-8%[4-6]。惊恐发作(可在除惊恐障碍外的其他精神障碍中发生)比惊恐障碍常见得多，高达1/3的人在其一生中某个时间会出现惊恐发作[7-9]。

                            

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Literature review current through: 2017-07 . | This topic last updated: 2017-08-01.
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