Disorder-Specific Impact of Coordinated Anxiety Learning and Management Treatment for Anxiety Disorders in Primary Care
Disorder-Specific Impact of Coordinated Anxiety Learning and Management Treatment for Anxiety Disorders in Primary Care
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DOI：
10.1001/archgenpsychiatry.2011.25
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发表时间：
2011-04-01
影响因子：
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通讯作者：
Roy-Byrne, Peter
中科院分区：
文献类型：
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作者：
Craske, Michelle G.;Stein, Murray B.;Roy-Byrne, Peter
内容：焦虑症通常存在于初级保健中，循证心理健康治疗通常不可用或不理想delivered.Objective：比较焦虑症循证治疗与常规治疗（UC）在初级保健中对主要和共病广泛性焦虑症（GAD）、惊恐障碍（PD）、社交焦虑症（SAD）和创伤后应激障碍（PTSD）的治疗效果。设计：一项随机对照试验，在基线和6个月、12个月和18个月随访评估时比较协调焦虑学习和管理（CALM）干预与UC。参考初级保健样本，1004例患者，主要DSM-IV诊断为GAD（n = 549）、PD（n = 262）、SAD（n = 132）或PTSD（n = 61）（平均[SD]年龄：43.7 [13.7]岁; 70.9%为女性）。80%的参与者完成了18个月的随访。主要结果测量：广泛性焦虑障碍严重程度量表、惊恐障碍严重程度-自我报告量表、社交恐惧量表和PTSD检查表-平民版评分。结果：在6个月时，CALM在主要GAD方面上级UC（-1.61; 95%置信区间[CI]，-2.42至-0.79），12个月（-2.34; -3.22至-1.45）和18个月（-2.37; -3.24至-1.50），6个月（-2.00; -3.55至-0.44）和12个月（-2.71; -4.29至-1.14）时的PD，以及6个月（-7.05; -12.11至-2.00）时的SAD结局。在6个月（-4.26; 95% CI，-7.96至-0.56）、12个月（-8.12，-11.84至-4.40）和18个月（-6.23，-9.90至-2.55）结局时，CALM治疗合并SAD上级UC。效果大小有利于CALM，但没有统计学意义的其他共病disorders.Conclusions：CALM（认知行为疗法和药物治疗药物的建议）是更有效的比UC的主要焦虑症，并在较小程度上，共病焦虑症，目前在初级保健。
Context: Anxiety disorders commonly present in primary care, where evidence-based mental health treatments often are unavailable or suboptimally delivered.Objective: To compare evidence-based treatment for anxiety disorders with usual care (UC) in primary care for principal and comorbid generalized anxiety disorder (GAD), panic disorder (PD), social anxiety disorder (SAD), and posttraumatic stress disorder (PTSD).Design: A randomized controlled trial comparing the Coordinated Anxiety Learning and Management (CALM) intervention with UC at baseline and at 6-, 12-, and 18-month follow-up assessments.Setting: Seventeen US primary care clinics.Patients: Referred primary care sample, 1004 patients, with principal DSM-IV diagnoses of GAD (n = 549), PD (n = 262), SAD (n = 132), or PTSD (n = 61) (mean [SD] age, 43.7 [13.7] years; 70.9% were female). Eighty percent of the participants completed 18-month follow-up.Interventions: CALM (cognitive behavior therapy and pharmacotherapy recommendations) and UC.Main Outcome Measures: Generalized Anxiety Disorder Severity Scale, Panic Disorder Severity-Self-report Scale, Social Phobia Inventory, and PTSD Checklist-Civilian Version scores.Results: CALM was superior to UC for principal GAD at 6-month (-1.61; 95% confidence interval [CI],-2.42 to -0.79), 12-month (-2.34; -3.22 to -1.45), and 18-month (-2.37; -3.24 to -1.50), PD at 6-month (-2.00; -3.55 to-0.44) and 12-month (-2.71; -4.29 to -1.14), and SAD at 6-month (-7.05; -12.11 to -2.00) outcomes. CALM was superior to UC for comorbid SAD at 6-month (-4.26; 95% CI, -7.96 to -0.56), 12-month (-8.12, -11.84 to -4.40), and 18-month (-6.23, -9.90 to -2.55) outcomes. Effect sizes favored CALM but were not statistically significant for other comorbid disorders.Conclusions: CALM (cognitive behavior therapy and pharmacotherapy medication recommendations) is more effective than is UC for principal anxiety disorders and, to a lesser extent, comorbid anxiety disorders that present in primary care.