Influence of psychiatric comorbidity on recovery and recurrence in generalized anxiety disorder, social phobia, and panic disorder: A 12-year prospective study
Influence of psychiatric comorbidity on recovery and recurrence in generalized anxiety disorder, social phobia, and panic disorder: A 12-year prospective study
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DOI：
10.1176/appi.ajp.162.6.1179
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发表时间：
2005-06-01
影响因子：
17.7
通讯作者：
Keller, MB
中科院分区：
文献类型：
--
作者：
Bruce, SE;Yonkers, KA;Keller, MB
目的：作者试图观察焦虑症的长期临床病程超过12年，并检查共病精神障碍对惊恐障碍、广泛性焦虑障碍和社交恐惧症的恢复或复发的影响。数据来自哈佛/布朗焦虑症研究项目，这是一个前瞻性的，自然的，纵向的，一项针对有焦虑症病史或既往病史的成年人的多中心研究。使用标准生存分析方法计算恢复和复发的概率。进行比例风险回归分析与随时间变化的协变量，以确定可能的共病的精神病康复和recurrence.Results预测的风险比：生存分析显示，大多数焦虑症的整体慢性病程。在12年的随访中，社交恐惧症的康复概率最小。此外，前瞻性观察到从摄入焦虑症中恢复的患者在随访期间复发的可能性很高。几个共病的精神疾病，包括抑郁症和酒精和其他物质使用障碍，并由共病的广泛性焦虑症和惊恐障碍与agoraphobi.Conclusions：这些数据描述的焦虑症是阴险的，慢性临床过程中，恢复率低，复发的概率相对较高。特定共病精神障碍的存在显著降低了焦虑症康复的可能性，并增加了其复发的可能性。这些发现增加了对这些疾病的疾病分类和治疗的理解。
Objective: The authors sought to observe the long-term clinical course of anxiety disorders over 12 years and to examine the influence of comorbid psychiatric disorders on recovery from or recurrence of panic disorder, generalized anxiety disorder, and social phobia.Method: Data were drawn from the Harvard/Brown Anxiety Disorders Research Program, a prospective, naturalistic, longitudinal, multicenter study of adults with a current or past history of anxiety disorders. Probabilities of recovery and recurrence were calculated by using standard survival analysis methods. Proportional hazards regression analyses with time-varying covariates were conducted to determine risk ratios for possible comorbid psychiatric predictors of recovery and recurrence.Results: Survival analyses revealed an overall chronic course for the majority of the anxiety disorders. Social phobia had the smallest probability of recovery after 12 years of follow-up. Moreover, patients who had prospectively observed recovery from their intake anxiety disorder had a high probability of recurrence over the follow-up period. The overall clinical course was worsened by several comorbid psychiatric conditions, including major depression and alcohol and other substance use disorders, and by comorbidity of generalized anxiety disorder and panic disorder with agoraphobia.Conclusions: These data depict the anxiety disorders as insidious, with a chronic clinical course, low rates of recovery, and relatively high probabilities of recurrence. The presence of particular comorbid psychiatric disorders significantly lowered the likelihood of recovery from anxiety disorders and increased the likelihood of their recurrence. The findings add to the understanding of the nosology and treatment of these disorders.