焦虑障碍治疗药物现状

焦虑障碍是临床上常见的心境障碍之一,多以药物治疗为主。除传统的抗焦虑药物外,目前发现其他精神药物也具有抗焦虑作用。本文就具有抗焦虑作用的药物使用及研究进展作一简要介绍。     

焦虑障碍的药物治疗进展

焦虑障碍是患病率较高的疾病,近年有关其药物治疗研究取得一定突破.多个国家以及国际组织,根据各国临床经验,针对焦虑障碍各种亚型推出了治疗指南和规范化治疗稃序,旨在规范各型焦虑障碍的治疗.我国对焦虑障碍的识别率和治疗率尚处于较低水平.焦虑障碍不仪足精神专科的课题,也是临床各科都面临的基本问题.本文综述焦虑障碍的治疗H标、治疗原则、疗程及治疗药物选择.     

癫痫与焦虑抑郁的研究分析

目的：探讨癫痫与焦虑抑郁的发生原因,了解癫痫患者的生活质量及与焦虑、抑郁情绪的关系,以对癫痫患者采取针对性的心理干预措施提供依据。方法：通过近年来对本院就诊的癫痫患者住院治疗和院外随访进行引起该病原因和药物治疗效果的分析,根据个人情况实施不同的药物和心理治疗,努力提高患者的生存质量。结果：大部分患者给予正确的药物治疗和心理干预可使癫痫症状控制甚至痊愈,焦虑抑郁症状基本痊愈35例,未全面给予心理治疗的痊愈率只有50%～60%。结论：及时正确地诊断患者病情,予以正确的治疗方案,进行正确的心理干预,可使患者病情得到有效控制,生存质量显著提高。     

社交焦虑障碍的药物治疗

社交焦虑障碍(soeial anxiety disorder,SAD)又称社交恐惧症,是常见的焦虑障碍之一。表现为社交或表现性活动(例如．参加聚会,作介绍)明显而特久的恐惧并造成功能障碍．它严重影响人的社会交往和工作生活能力。它是第三大最常见的心理障碍,紧排在重性抑郁症和酒精依赖之后。目前药物治疗被认为最有效的手段之一,经研究证实治疗社交焦虑障碍有效的药物为4类：单胺氧化酶抑制剂、五羟色胺再摄取抑制剂、苯二氮卓类和β-肾上腺素能阻断剂。     

132例老年高血压病焦虑障碍的临床干预

目的 探讨老年高血压病焦虑障碍经抗焦虑治疗后降压的疗效。方法 应用心理测量表HAMA评估132例老年高血压患者，伴有焦虑障碍58例，其中29例在降压基础上用苯二氮Zuo类干预，在治疗6w后再评分以及观察降压效果。结果 伴焦虑障碍的高血压患者，干预后降压效果为86．21％，优于对照组的58．62％。结论 焦虑障碍在老年高血压病患者中的发生率较高，抗焦虑治疗可显著提高降压疗效。     

焦虑障碍心理治疗疗效的循证研究

焦虑障碍是精神科临床的常见病,包括惊恐障碍、广泛性焦虑、强迫症、社交焦虑等。针对焦虑障碍的心理治疗作为近年来越来越受关注的治疗选择,一部分已被临床研究证实有效,其中有相对充分研究支持其疗效的有认知行为治疗、心理动力学治疗等,另外一些疗法的研究也正在探索中。     

护理干预对糖尿病患者情绪障碍的影响

目的探讨护理干预对糖尿病患者情绪障碍的影响。方法于2007年1月-2008年1月期间对在我院住院的57例糖尿病患者进行护理干预,对比分析干预前后患者的情绪状况。结果本组病人焦虑患病率为91．23％,抑郁患病率为92．98％。干预后糖尿病患者SDS评分和SAS评分明显低于干预前,两者比较差异均具有统计学意义（均有P〈0．001）。结论对糖尿病患者进行及时有效的护理干预,有助于控制疾病。     

高血压患者术前焦虑评估与干预效果分析

目的 评估高血压患者的术前焦虑状况,比较药物干预与心理疏导对术前焦虑的干预效果.方法 纳入2019年1月～2020年1月在我院行腹腔镜胆囊切除术(Laparoscopic cholecystectomy,LC)的高血压患者,随机分成药物干预组(36例)与心理疏导组(37例),两组患者均规范降压治疗、术前常规准备,采用焦...     

阿普唑仑治疗老年人焦虑-抑郁障碍190例分析

190例焦虑－抑郁障碍患者,随机分成2组,即阿普唑仑治疗组和对照组,二组病例治疗前后皆检测MMPI,治疗组可使大部分病人MMPI各临床量表转为正常,结论：阿普唑仑可有效的控制焦虑－抑郁发作,是内科老年人病人首选的抗焦虑药。     

维持性血液透析患者焦虑状况与心理干预对策分析

目的对维持性血液透析患者的焦虑状况进行调查评估与相关因素分析,探索制定实施有效的心理干预对策,提高临床护理质量。方法 50例血液透析患者使用焦虑自评量表（Self-rating Anxiety Scale,SAS）评定主观感受,同时调查相关因素。结果焦虑发生率为88%,其中年龄大、以内瘘进行长期血液透析的患者焦虑评分较高。结论血液透析患者焦虑发生率较高,与年龄、血液通路建立方式相关,与有无烟酒嗜好无关。     

Late-life anxiety disorders

The prevalence, natural course, risk profile, and treatment of anxiety disorders in the elderly are remarkably understudied. Anxiety disorders are less prevalent in the elderly than in younger adults, but rates of subsyndromal anxiety disorders in elderly persons are nearly as high as in their younger cohorts. The most common late-life anxiety disorders are mixed anxiety-depression and generalized anxiety disorder. Though the benzodiazepines are widely used in this population and are considered relatively safe given appropriate dosing and safety monitoring, important liabilities remain with the use of these agents. Antidepressants also are widely used in elderly patients, but there are no randomized controlled anxiety disorder treatment trials in this population. Gabapentin and low-dose atypical antipsychotics are beginning to be used and studies of the atypical antipsychotics are ongoing. Until studies are completed, treatment of late-life anxiety will continue to be guided by extrapolating data from the general adult population. Psychopharmacology Bulletin. 2004;38(Suppl 1): 25-30.     

Tiagabine in anxiety disorders

GABA has been implicated in both the aetiology and treatment of anxiety. Tiagabine is currently the only selective GABA reuptake inhibitor available in US markets; it exerts its action via GAT-1 transporter blockade presynaptically, facilitating GABA neurotransmission. Preclinical studies and current human studies suggest tiagabine possesses anxiolytic properties. The anxiolytic properties of tiagabine have also been suggested in a number of case series, open-label studies and placebo-controlled studies in patients with different anxiety disorders. Throughout these studies, tiagabine has been reasonably tolerated; the most commonly reported adverse events include dizziness, headache and nausea. Tiagabine may be a useful addition to currently available drugs for anxiety; however, the data from small open-label investigations remain to be confirmed in larger controlled studies.     

Genetic epidemiology of anxiety disorders

This chapter reviews the genetic epidemiology of the major subtypes of anxiety disorders including panic disorder, phobic disorders, generalized anxiety disorder, and obsessive-compulsive disorder. Controlled family studies reveal that all of these anxiety subtypes are familial, and twin studies suggest that the familial aggregation is attributable in part to genetic factors. Panic disorder and, its spectrum have the strongest magnitude of familial clustering and genetic underpinnings. Studies of offspring of parents with anxiety disorders an increased risk of mood and anxiety disorders, but there is far less specificity of the manifestations of anxiety in children and young adolescents. Although there has been a plethora of studies designed to identify genes underlying these conditions, to date, no specific genetic loci have been identified and replicated in independent samples.     

Challenge studies in anxiety disorders

In psychiatry, the use of pharmacological challenges in panic disorder is unique in that the clinical phenomenon of central interest (i.e., the panic attack) can be provoked readily and assessed in the clinical laboratory setting. During the past 20 years pharmacological challenge studies have increased our knowledge concerning the neurobiology of panic disorder remarkably and may ultimately result in novel and more causal treatment strategies. Moreover, the differences in sensitivity to certain panicogens such as serotonergic agents, lactate, carbon dioxide and cholecystokinin tetrapeptide are likely to be fruitful in serving as biological markers of subtypes of panic disorders and should be a major focus of research, as the identification of reliable endophenotypes is currently one of the major rate-limiting steps in psychiatric genetic studies.     

The classification of anxiety disorders

A brief outline of some of the diagnostic systems for classifying the anxiety disorders are presented. This includes historical diagnoses, as well as systems of the recent past and those in current use. Some of the research issues and results leading to these diagnostic systems have been considered, as well as the way that a diagnostic system could have adverse effects in limiting research and the understanding of the anxiety disorders and their interplay, one with another. Finally a revised diagnostic system for the anxiety disorders is introduced, which, it is suggested, will overcome some of the serious criticisms of the current diagnostic systems.     

Managing depressive and anxiety disorders with escitalopram

This article reviews escitalopram, the S-stereoisomer of the racemic compound citalopram, and a highly selective and potent member of the selective serotonin re-uptake inhibitor class of antidepressants. Escitalopram has a straightforward pharmacokinetic profile, little effect on hepatic metabolism, and is relatively safe in overdose. Similar to other members of the selective serotonin re-uptake inhibitor class, escitalopram (10-20 mg/day) is a well-tolerated and effective treatment of major depressive disorder. Although relatively few head-to-head comparative studies with other antidepressants have been published, pooled analyses of studies using citalopram as the active comparator suggest a modest advantage for the stereoisomer. This advantage, which is more apparent among patients with greater symptom levels, may be attributable to a greater than predicted potency compared with citalopram, presumably as a result of the greater effect of escitalopram at the allosteric binding site of the serotonin transporter. Results of two published studies versus venlafaxine also suggest better tolerability in the context of comparable efficacy. Escitalopram is also approved for the treatment of generalised anxiety disorder (in the US) and social anxiety disorder and panic disorder (in the EU). Pharmacoeconomic models suggest that the greater drug acquisition cost of this patent-protected compound may be offset by greater efficacy (relative to generic citalopram) and tolerability (compared with extended release venlafaxine).     

Discontinuation symptoms in depression and anxiety disorders

The present overview investigates whether different antidepressants have differing discontinuation symptoms upon treatment cessation, if these symptoms vary between depression and anxiety disorders, and with length of treatment. Data came from two comparative studies of escitalopram in major depressive disorder (MDD) (one vs. venlafaxine XR and one vs. paroxetine), two studies in social anxiety disorder (SAD) (one of which used paroxetine as the active reference), and one study in generalized anxiety disorder (GAD), using paroxetine as an active reference [total number of patients: escitalopram (n=1051); paroxetine (n=336); venlafaxine XR (n=124); placebo (n=239)]. All studies included a defined discontinuation period and used the Discontinuation Emergent Signs and Symptoms (DESS) checklist to record the number of discontinuation symptoms. All three antidepressants showed more discontinuation symptoms compared with placebo (p<0.001). Patients reported significantly fewer discontinuation symptoms with escitalopram than with paroxetine and venlafaxine XR in MDD (p<0.05). Escitalopram showed significantly fewer discontinuation symptoms than paroxetine in SAD (p<0.05) and GAD (p<0.001). For each antidepressant, no differences in discontinuation symptoms were observed between the three indications and there was no evidence for increased symptom incidence with increased length of treatment. Thus, discontinuation profiles differ between antidepressants of the same class and are broadly similar in different disorders. No evidence was seen for a higher discontinuation burden with longer treatment.