惊恐障碍的综合治疗特点

Characteristics of combined therapy for panic disorder

目的:目前对于惊恐障碍中认知行为疗法结合药物疗法的综合治疗正在成为一个热点,而国内对此的研究和临床应用的重视程度均不够。为此作者对此方面最近几年的研究进行述评,力图澄清对综合治疗效用的认识,并展望未来的研究方向。资料来源:应用计算机在ProQuestPsychologyJournals数据库检索1993-01/2006-03期间关于惊恐障碍的文章,检索词包括“panicdisor-der,combinedtreatment,cognitive-behavioraltherapy,medicinetreatment”,并限定语言种类为英语。同时在中国全文期刊数据库中检索1993-01/2006-03期间内关于惊恐障碍的文章,检索词包括“综合治疗、惊恐障碍、认知行为治疗、药物治疗”。限定语言种类为中文。同时手工查阅相关内容书籍若干。资料选择:对资料进行初审,选择与惊恐障碍、惊恐障碍的生理及心理机制、惊恐障碍其药物治疗和认知行为治疗、普通焦虑障碍相关的文献。纳入标准:详细阐述惊恐障碍药物和认知行为综合治疗作用的文献。排除重复性研究。资料提炼:共收集文献30篇,与本文密切相关20篇,排除7篇重复性研究,选择13篇用以综述。资料综合:对惊恐障碍的药物治疗和认知行为治疗的单独作用与综合作用进行对比,在此基础上探讨综合治疗的作用和前景。同时探讨综合治疗中的缺陷。目前还没有完全让人信服的证据说明综合治疗的效果显著优于单独治疗。比较肯定的是在综合治疗中认知行为治疗可以帮助患者停止使用苯二氮类药物而不增加其复发危险。维持期过后综合治疗的脱落和复发高于单独的认知行为治疗。未来对于惊恐障碍综合治疗的研究方向应当包括:有关药物治疗对认知行为治疗的内在影响研究、关于认知行为治疗对药物治疗的干预研究、对影响综合治疗的其他因素的研究。结论:惊恐障碍所具有的生理学病因和社会-心理问题决定了采用综合治疗是一个必然趋势,对惊恐障碍综合治疗研究进展的关注也必然具有其不可忽视的理论与应用价值。

OBJECTIVE： At present, combined therapy of cognitive behavior therapy and drug therapy in the treatment of panic disorder is a hot issue, while there is few documents available in domestic study and little attention paid to the clinical application. This article reviewed the studies published in recent years on this aspect, so as to clarify the efficacy of combined treatment and figure out the clue for future improvement of combined treatment strategies. DATA SOURCES： An overall retrieval of English articles about panic disorder between January 1993 and March 2006 was conducted in Pro- Quest Psychology Journals database with the key words of ＂panic disorder, combined treatment ,cognitive-behavioral therapy,medicine treatment＂. Meanwhile, CNKI database was searched for Chinese relevant articles between January 1993 and March 2006 with the key words of ＂panic disorder,combined treatment ,cognitive-behavioral therapy,mediclne treatment＂. Relevant books were looked for manually in library. STUDY SELECTION： Data were checked in the first trial, and literatures associated with panic disorder, the physical and psychological mechanism of panic disorder and cognitive behavioral therapy and drug therapy on panic disorder as well as papers related to ordinary anxiety disorder were collected. Inclusion criteria： literatures detailed in combined treatment of cognitive behavioral therapy and drug therapy on panic disorder. Repetitive studies were excluded. DATA EXTRACTION： A total of 30 literatures were collected, 20 out which were in close relation to this article, and 7 repetitive studies were excluded, Thirteen literatures were selected for review, DATA SYNTHESIS： The effects of single treatment and combined treatment of cognitive behavioral therapy and drug therapy on panic disorder were compared, based on which the effects and prospects of combined treatment were probed into, Meanwhile defeet of combined therapy was also investigated. By now, few convincible evidence was found in proofing the effects of combined therapy is superior to single treatment, while it was confirmed that cognitive behavioral treatment in combined therapy could prevent increasing recurrence owing to benzodiazepine. After maintaining period, the shedding and recurrence of combined therapy were higher than single cognitive behavioral therapy. Researches on combined therapy of panic disorder in future mainly includes： studies on internal influence of drug therapy on cognitive behavioral therapy, researches about the intervention of cognitive behavior therapy on drug therapy and investigations of other influencing factors of combined therapy. CONCLUSION： Combined therapy is an inexorable trend in the treatment of panie disorder due to the physiological reasons and social-psychological problems. Attention on research development of combined therapy on panic disorder has its innegligible theoretic and application value.