한국형 범불안장애 약물치료 알고리듬 2009 (III) : 공존질환의 치료
Korean Medication Algorithm Project for Generalized Anxiety Disorder 2009 (III) : Treatment Strategy for Comorbid Conditions
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참고문헌
초록
ObjectivesZZThis study investigated the consensus about treatment strategies for comorbid conditions in generalized anxiety disorder (GAD). MethodsZZThe executive committee of the Korean Medication Algorithm Project for GAD developed questionnaires about treatment strategies for patients with panic disorder based on guidelines or algorithms and clinical trial studies previously published in foreign countries. This study analyzed the treatment strategies for comorbid conditions in GAD. Fifty-five (65%) of 84 experts on a committee reviewing GADs responded to the questionnaires. We classified the consensus of expert opinions into three categories (first-line, second-line, and third-line treatment strategies) and identified the treatment of choice according using a χ2 test and 95% confidence interval. ResultsZZThe consensus about treatment strategies in the case of GAD with comorbid depression recommended a selective serotonin reuptake inhibitor (SSRI) and a serotonin norepinephrine reuptake inhibitor (SNRI) as the first-line drug treatment. An SSRI, an SNRI and a benzodiazepine (e.g. alprazolam, clonazepam) are recommended in GAD patients with other comorbid anxiety disorders. ConclusionZZThis study provided information about the consensus among Korean experts with regard to treatment strategies for comorbid conditions of GAD.
Abstract
ObjectivesZZThis study investigated the consensus about treatment strategies for comorbid conditions in generalized anxiety disorder (GAD). MethodsZZThe executive committee of the Korean Medication Algorithm Project for GAD developed questionnaires about treatment strategies for patients with panic disorder based on guidelines or algorithms and clinical trial studies previously published in foreign countries. This study analyzed the treatment strategies for comorbid conditions in GAD. Fifty-five (65%) of 84 experts on a committee reviewing GADs responded to the questionnaires. We classified the consensus of expert opinions into three categories (first-line, second-line, and third-line treatment strategies) and identified the treatment of choice according using a χ2 test and 95% confidence interval. ResultsZZThe consensus about treatment strategies in the case of GAD with comorbid depression recommended a selective serotonin reuptake inhibitor (SSRI) and a serotonin norepinephrine reuptake inhibitor (SNRI) as the first-line drug treatment. An SSRI, an SNRI and a benzodiazepine (e.g. alprazolam, clonazepam) are recommended in GAD patients with other comorbid anxiety disorders. ConclusionZZThis study provided information about the consensus among Korean experts with regard to treatment strategies for comorbid conditions of GAD.
참고문헌 (21)
- American Psychiatric Association, "Diagnostic and Statistical Manual of Mental Disorders" (2004), American Psychiatry Association
- American Psychiatric Association, "Diagnostic and statistical manual of mental disorders" (1980), American Psychiatry Association
- Ninan PT, "Generalized anxiety disorder: diagnosis, neurobiology, and treatment", Psychopharmacol Bull, 35, pp.65~76 (2001)
- American Psychiatric Association, "Diagnostic and statistical manual of mental disorders" (1994), American Psychiatry Association
- Goodman WK, "Selecting pharmacotherapy for generalized anxiety disorder", J Clin Psychiatry, 65(Suppl 13), pp.8~13 (2004)
- Kessler RC, "The effects of co-morbidity on the onset and persistence of generalized anxiety disorder in the ICPE surveys", Psychol M, 32, pp.1213~1225 (2002), International Consortium in Psychiatric Epidemiology
- Judd LL, "Comorbidity as a fundamental feature of generalized anxiety disorders: results from the National Comorbidity Study (NCS)", Acta Psychiatr Scand Suppl, 393, pp.6~11 (1998)
- Noyes R Jr, "Comorbidity in generalized anxiety disorder", Psychiatr Clin North Am, 24, pp.41~55 (2001)
- Wittchen HU, "Lifetime risk of depression", Br J Psychiatry Suppl, 26, pp.16~22 (1994)
- Bakish D, "The patient with comorbid depression and anxiety: the unmet need", J Clin Psychiatry, 60(Suppl 6), pp.20~24 (1999)
- Nutt D, "Generalized anxiety disorder: A comorbid disease", Eur Neuropsychopharmacol, 16(Suppl 2), pp.109~118 (2006)
- "General Anxiety Disorder (GAD) Algorithm: Online Flowchart"[URL]
- Canadian Psychiatric Association, "Clinical practice guidelines. Managementof anxiety disorders", Can J Psychiatry, 51, pp.9S~91S (2006)
- "Clinical guideline 22, Management of anxiety (panic disorder, with or without agoraphobia, and GAD) in adults in primary, secondary and community care"[URL]
- Baldwin DS, "Evidence-based guidelines for the pharmacological treatment of anxiety disorders: recommendations from the British Association for Psychopharmacology", J Psychopharmacol, 19, pp.567~596 (2005)
- Bandelow B, "World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the pharmacological treatment of anxiety, obsessive-compulsive and posttraumatic stress disorders", World J Biol Psychiatry, 3, pp.171~199 (2002), World Federation of Societies of Biological Psychiatry Task Force on Treatment Guidelines for Anxiety, obsessive-Compulsive and Posttraumatic Stress Disorders
- Woolf SH, "Practice guidelines, a new reality in medicine. II. Methods of developing guidelines", Arch Intern Med, 152, pp.946~952 (1992)
- Maier W, "Generalized anxiety disorder (ICD-10) in primary care from a crosscultural perspective: a valid diagnostic entity?", Acta Psychiatr Scand, 101, pp.29~36 (2000)
- Davidson JR, "A psychopharmacological treatment algorithm for generalized anxiety disorder (GAD)", J Psychopharmacol, 24, pp.3~26 (2010)
- Lauer D, "Generalized anxiety disorder with comorbidity. Treatment with pregabalin", Nervenarzt, 77, pp.1363~1367 (2006)
- Posternak MA, "Assessing the risks and benefits of benzodiazepines for anxiety disorders in patients with a history of substance abuse or dependence", Am J Addict, 10, pp.48~68 (2001)
