各种焦虑障碍的治疗详解.ppt

* Efficacy in PD seen with SSRI’s, TCA, BZD, MAOI SNRI (Ven) Preliminary evidence to support the use of mirtazapine antipsychotics Negative results with gabapentin and moclobemide but may be helpful in some subgroups Not useful: Buspirone, trazodone, propranolol, CBZ Pharmacotherapy should be initiated with low doses (usually ? MDD start dose) to minimize early side effects, such as anxiogenosis with AD or sedation with BZD, doses gradually increased to therapeutic levels Effect: 6-8 weeks, gains may accrue 6-12 months Treatment continued 8-12 months * * RCT of early BZD use following trauma; not beneficial Propranolol given right after trauma decreased severity of PTSD Sxs and decreased likelihood of developing subsequent PTSD * * * GAD Diagnosis (DSM-IV) DSM-IV is the currently accepted criteria for diagnosing GAD. In order to be diagnosed with GAD, patients must have experienced excessive anxiety and uncontrollable worry for at least six months about numerous events or activities.1 In addition, patients must exhibit at least three of the following symptoms: restlessness (keyed up feeling), fatigue, difficulty concentrating (mind going blank), irritability, muscle tension and sleep disturbance (difficulty falling asleep or staying asleep, or restless, unsatisfying sleep).1,2 References 1. Connor KM, Davidson JRT. Generalized anxiety disorder: Neurobiological and pharmacotherapeutic perspectives. Biol Psychiatry 1998;44:1286-1294. 2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR. Published by American Psychiatric Press Inc., 2000. * One may achieve remission as early as 2 weeks. However, GAD is a chronic disorder requiring longer-term therapy to achieve and maintain remission. Haskins et al compared the efficacy of venlafaxine XR at doses of 75 mg, 150 mg or 225 mg daily to that of placebo in 377 outpatients with GAD. By the end of the study period, all the venlafaxine groups had significantly great