Long-term outcome of panic disorder with agoraphobia treated by exposure
Long-term outcome of panic disorder with agoraphobia treated by exposure
复制标题
DOI：
10.1017/s0033291701003592
复制
发表时间：
2001-07-01
影响因子：
6.9
通讯作者：
Belluardo, P
中科院分区：
文献类型：
--
作者：
Fava, GA;Rafanelli, C;Belluardo, P
背景资料。关于恐慌症的长期结果研究很少超过两年的随访。本研究的目的是评估根据标准化方案治疗的惊恐障碍伴广场恐怖症患者的长期随访情况。一组连续的200名符合DSM-IV惊恐障碍伴广场恐怖症标准的患者在门诊接受了基于暴露作业的行为方法的治疗。经过12个疗程的心理治疗后，1名患者和36名患者恢复了恐慌状态，132名患者获得了随访。进行了2年至14年(中位数为8年)的随访。采用生存分析方法描述患者的临床病程。132名患者中有31名(23%)在随访期间的某个时间内惊恐障碍复发。估计两年后仍处于缓解状态的患者的累积百分比为93(.)1。5年后82(.)4。78(.)8在7年后，62(.)1在10年后，这些概率随着年龄的增加而增加，在没有人格障碍的情况下，治疗前抑郁情绪的高水平，暴露后残留的广场恐怖症回避，以及同时使用苯二氮卓类和抗抑郁药物。研究结果表明，暴露治疗可以为大多数惊恐障碍和广场恐惧症患者提供持久的缓解。暴露疗法的目标应该是消除残留的和亚临床的广场恐惧症回避，而不仅仅是恐慌症发作。
Background. There is a paucity of long-term outcome studies of panic disorder that exceed a 2-year follow-up. The aim of the study was to evaluate the long-term follow-up of patients with panic disorder with agoraphobia treated according to a standardized protocol.Methods. A consecutive series of 200 patients satisfying the DSM-IV criteria for panic disorder with agoraphobia was treated in an out-patient clinic with behavioural methods based on exposure homework. One hu nd red and thirty-six patients became panic free after 12 sessions of psychotherapy and 132 were available for follow-up. A 2- to 14-year (median = 8 years) follow-up was performed. Survival analysis was employed to characterize the clinical course of patients.Results. Thirty-one of the 132 patients (23 %) had a relapse of panic disorder at some time during follow-up. The estimated cumulative percentage of patients remaining in remission was 93(.)1 after 2 years. 82(.)4 after 5 years. 78(.)8 after 7 years and 62(.)1 after 10 years Such probabilities increased with younger age, and in the absence of a personality disorder, of high pre-treatment levels of depressed mood, of residual agoraphobic avoidance after exposure, and of concurrent use of benzodiazepines and antidepressant drugs.Conclusions. The findings suggest that exposure treatment can provide lasting relief to the majority of patients with panic disorder and agoraphobia. Disappearance of residual and subclinical agoraphobic avoidance, and not simply of panic attacks, should be the aim of exposure therapy.