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2024 한국형 범불안장애 치료지침 III: 치료 반응이 불충분한 경우 및 공존질환이 존재하는 경우 치료 전략

Korean Guidelines for the Treatment of Generalized Anxiety Disorder 2024 Part III: Strategies for Insufficient Treatment Response and Comorbidities

김민경|이현아|서호석|김원|안명희|이경욱|장윤영|문은수|서준호|박천일
대한불안의학회 (Korean Academy of Anxiety Disorders)|2024.10|대한불안의학회지 (Anxiety and Mood)|제20권 제2호|pp. 72-81|DOI 10.24986/anxmod.2024.20.2.006

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키워드

범불안장애Generalized anxiety disorderTreatment guidelinesExpert consensus.치료지침치료 반응 불충분공존질환.Insufficient treatment responseComorbidities
주제분류정신과학

초록

Objective : This study aimed to establish expert consensus on treatment strategies for generalized anxiety disorder (GAD) when treatment response is insufficient and when comorbid conditions are present as part of developing the 2024 Korean guidelines for the treatment of GAD. Methods : The executive committee developed a questionnaire based on existing international and Korean treatment guidelines and academic literature. Sixty-five experts participated in a survey. Responses were analyzed using chi-squared test and 95% confidence intervals to determine the level of consensus. Treatment strategies were categorized into first-line, second-line, and third-line choices. Results : For patients with an insufficient treatment response, combining pharmacotherapy and psychotherapy was the most preferred first-line strategy. Experts recommended switching to or augmenting with a different class of antidepressants, adding benzodiazepines or azapirones, and augmenting with atypical antipsychotics as first-line pharmacotherapy adjustments. Suitable psychotherapies included cognitive behavioral therapy (CBT), mindfulness-based cognitive therapy (MBCT), acceptance and commitment therapy (ACT), and applied relaxation. For patients with comorbid conditions such as depression, other anxiety disorders, or alcohol and substance use disorders, a combination of pharmacotherapy and psychotherapy was also the most preferred first-line treatment. In these cases, the use of antidepressants alone or in combination with benzodiazepines, azapirones, or atypical antipsychotics was recommended. Conclusion : This expert consensus reflects current clinical practices and experiences in Korea, providing valuable insights for clinicians treating GAD patients who have insufficient treatment responses or comorbidities. Findings of this study emphasize the importance of a multimodal treatment approach, including both pharmacotherapy and psychotherapy. They also offer specific recommendations for adjusting treatment strategies in these complex cases. (Anxiety and Mood 2024;20(2):72-81)

Abstract

Objective : This study aimed to establish expert consensus on treatment strategies for generalized anxiety disorder (GAD) when treatment response is insufficient and when comorbid conditions are present as part of developing the 2024 Korean guidelines for the treatment of GAD. Methods : The executive committee developed a questionnaire based on existing international and Korean treatment guidelines and academic literature. Sixty-five experts participated in a survey. Responses were analyzed using chi-squared test and 95% confidence intervals to determine the level of consensus. Treatment strategies were categorized into first-line, second-line, and third-line choices. Results : For patients with an insufficient treatment response, combining pharmacotherapy and psychotherapy was the most preferred first-line strategy. Experts recommended switching to or augmenting with a different class of antidepressants, adding benzodiazepines or azapirones, and augmenting with atypical antipsychotics as first-line pharmacotherapy adjustments. Suitable psychotherapies included cognitive behavioral therapy (CBT), mindfulness-based cognitive therapy (MBCT), acceptance and commitment therapy (ACT), and applied relaxation. For patients with comorbid conditions such as depression, other anxiety disorders, or alcohol and substance use disorders, a combination of pharmacotherapy and psychotherapy was also the most preferred first-line treatment. In these cases, the use of antidepressants alone or in combination with benzodiazepines, azapirones, or atypical antipsychotics was recommended. Conclusion : This expert consensus reflects current clinical practices and experiences in Korea, providing valuable insights for clinicians treating GAD patients who have insufficient treatment responses or comorbidities. Findings of this study emphasize the importance of a multimodal treatment approach, including both pharmacotherapy and psychotherapy. They also offer specific recommendations for adjusting treatment strategies in these complex cases. (Anxiety and Mood 2024;20(2):72-81)

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