ANXIETY RECONCEPTUALIZED
ANXIETY RECONCEPTUALIZED
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DOI：
10.1016/0010-440x(80)90043-7
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发表时间：
1980-01-01
影响因子：
7.3
通讯作者：
KLEIN, DF
中科院分区：
文献类型：
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作者：
KLEIN, DF
丙咪嗪与焦虑的早期经验1959年，我正在研究神秘新药丙咪嗪的临床效果。人们希望它能像吩噻嗪类药物一样成为治疗精神分裂症的另一种强效药物。然而，它未能减轻精神分裂症的症状，尽管它提高了抑郁的精神分裂症患者的情绪。此外，对严重抑郁症患者的临床试验取得了良好的结果。它既不是最初设想的镇静剂，也不是后来假设的兴奋剂，而是情绪正常化剂。它的作用模式似乎是药物和产生病理状态的心理生理失调之间相互作用的结果。我们想到要在一组极度焦虑的病人身上试用这种新药，这些病人没有表现出妄想或幻觉，但被证明对强化心理治疗和氯丙嗪镇静剂治疗都很难治愈。今天，这些病人会被诊断为广场恐惧症并伴有惊恐发作，尽管在当时的习惯中，他们会被贴上精神分裂症的标签，因为他们有明显的社交障碍和严重的症状，有几个病人自愿参加了丙咪嗪的试点试验，主要是因为任何事情都比毫无起色地被送回家要好。尽管病人和他们的治疗师坚持了很多天，没有取得任何进展，但到了第三周，病房工作人员注意到病人不再经历他们以前的严重焦虑发作。几周后，他们的进步变得无可争议。
EARLY EXPERIENCE WITH IMIPRAMINE AND ANXIETY I N 1959 I was studying the clinical effects of the mysterious new drug imipramine. The hope was that it would be another powerful agent, like the phenothiazines, for the treatment of schizophrenia. It failed, however, to alleviate schizophrenic symptoms although it raised the mood of depressed schizophrenics. Further, clinical trials on patients with severe depression led to excellent results. It was neither a tranquillizer, as initially conceived, nor a stimulant, as later hypothesized, but rather a mood normalizer. Its mode of action seemed the result of an interaction between the medication and the psychophysiological dysregulation that produced the pathological state. It occurred to us to try this new drug with a group of extremely anxious patients who did not evince delusions or hallucinations but who had proven refractory both to intensive psychotherapy and treatment with sedatives OI chlorpromazine. These patients today would be diagnosed as agoraphobic with panic attacks although, in the feckless habit of the time, they were then labeled schizophrenic because they had marked social impairment and severe symptoms.Several patients volunteered for a pilot trial with imipramine, primarily because anything was better than being sent home unimproved. Although both the patients and their therapists insisted for many days that no gains had been made, by the third week the ward staff noticed that patients no longer experienced their former episodes of severe anxiety. After a few more weeks their improvement became indisputable.