Treating nonspecific anxiety and anxiety disorders in patients with bipolar disorder: a review.
Treating nonspecific anxiety and anxiety disorders in patients with bipolar disorder: a review.
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DOI：
10.4088/jcp.09r05815gre
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发表时间：
2011
期刊：
影响因子：
--
通讯作者：
J. Rakofsky;B. Dunlop
中科院分区：
文献类型：
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作者：
J. Rakofsky;B. Dunlop
目的回顾双相情感障碍患者焦虑治疗的证据。资料来源通过奥维德和美国国立卫生研究院临床试验在线数据库进行了1950年至2009年8月第1周的文献检索。检索词包括焦虑、焦虑障碍、双相情感障碍、惊恐障碍、广泛性焦虑障碍、社交恐惧症、社交焦虑、强迫症、特定恐惧症、创伤后应激障碍和治疗。还检索了已识别文章的参考文献列表。资料选择14项治疗研究，包括双相情感障碍患者的综合征定义的焦虑障碍或非特异性焦虑被选中。资料提取样本量、双相情感障碍亚型、共病焦虑障碍、基线焦虑、治疗干预和结果测量被提取。结果大多数研究集中在治疗双相情感发作时发生的焦虑障碍和非特异性焦虑。综合征定义的焦虑症的研究表明，利培酮单药治疗与安慰剂没有区别，当用于加强锂治疗时，奥氮平上级拉莫三嗪。一项使用开放标签双丙戊酸钠的研究和一项非对照的群体认知行为治疗研究都表明，这些治疗对双相情感障碍伴惊恐障碍患者有一定的益处。非特异性焦虑研究显示双丙戊酸钠、奎替利、奥氮平和奥氮平-氟西汀联合治疗有一定获益。较弱的证据支持使用基于正念的认知疗法，观察性研究表明加巴喷丁和丙戊酸盐的潜在疗效。结论：尽管双丙戊酸钠可能是双相情感障碍焦虑患者的首选情绪稳定剂，但情绪发作期间发生的非特异性焦虑症状可通过治疗情绪障碍得到改善。考虑到躁狂诱导和发作周期的风险降低，建议使用心理治疗、苯二氮卓类药物和某些非典型抗精神病药物治疗目前未发生急性情绪发作的双相情感障碍患者的焦虑症。
OBJECTIVE To review the evidence for treating anxiety in patients with bipolar disorder. DATA SOURCES A literature search from 1950 to week 1 of August 2009 was conducted via OVID and the National Institutes of Health's clinical trials online databases. Search terms included anxiety, anxiety disorders, bipolar disorder, panic disorder, generalized anxiety disorder, social phobia, social anxiety, obsessive compulsive disorder, specific phobia, posttraumatic stress disorder, and treatment. Reference lists of identified articles were also searched. STUDY SELECTION Fourteen treatment studies that included patients with bipolar disorder with either a syndrome-defined anxiety disorder or nonspecific anxiety were selected. DATA EXTRACTION Sample size, bipolar disorder subtype, comorbid anxiety disorders, baseline anxiety, treatment interventions, and outcome measurements were extracted. RESULTS The majority of studies focus on treating anxiety disorders and nonspecific anxiety occurring during bipolar mood episodes. Studies of syndrome-defined anxiety disorders reveal that risperidone monotherapy did not separate from placebo and that olanzapine was superior to lamotrigine when used to augment lithium treatment. A study using open-label divalproex sodium and an uncontrolled study of group cognitive-behavioral therapy both suggest some benefit from these treatments in patients with bipolar disorder with panic disorder. Studies of nonspecific anxiety reveal some benefit for divalproex, quetiapine, olanzapine, and olanzapine-fluoxetine combination. Weaker evidence supports the use of Mindfulness-Based Cognitive Therapy, and observational studies suggest potential efficacy for gabapentin and valproate. CONCLUSIONS Nonspecific anxiety symptoms occurring during a mood episode improve with treatment of the mood disturbance, though divalproex may be the mood stabilizer of choice for anxious patients with bipolar disorder. Given their reduced risk for manic induction and episode cycling, psychotherapy, benzodiazepines, and certain atypical antipsychotics are recommended for treatment of anxiety disorders present in patients with bipolar disorder not currently experiencing an acute mood episode.