Perinatal Generalized Anxiety Disorder: Assessment and Treatment
Perinatal Generalized Anxiety Disorder: Assessment and Treatment
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DOI：
10.1089/jwh.2014.5150
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发表时间：
2015-09-01
影响因子：
3.5
通讯作者：
Swift, Elena
中科院分区：
文献类型：
--
作者：
Misri, Shaila;Abizadeh, Jasmin;Swift, Elena
围产期广泛性焦虑症（GAD）在妊娠期和产后的患病率分别为8.5%-10.5%和4.4%-10.8%。尽管其伴随的功能障碍的病人，这种潜在的衰弱心理健康状况往往诊断不足。本综述将为临床医生及时诊断和适当管理症状提供指导。在围产期人群中诊断广泛性焦虑症的一个重要障碍是难以区分正常与病理性焦虑。由于围产期特异性广泛性焦虑症筛查工具不存在，早期识别，诊断和治疗往往受到影响。由此产生的母亲功能障碍可能会影响母婴联系，并影响儿童的神经发育结果。广泛性焦虑症和抑郁症的共病改变了病程和治疗结果。心理教育是克服否认/污名化和促进成功干预的关键组成部分。治疗策略取决于疾病的严重程度。认知行为疗法（CBT），放松和正念疗法适用于轻度GAD。中度/重度疾病需要单独或联合使用药物治疗和CBT。FDA或加拿大卫生部没有批准在怀孕或产后使用精神药物;只有当治疗的益处超过其风险时，才开始使用标签外药物治疗。SSRIs/SNRIs是焦虑症的一线治疗，因为有数据支持其疗效和总体有利的副作用特征。苯二氮卓类药物是短期治疗的一种选择。虽然对非典型抗精神病药物的研究正在发展，但有些药物可被视为对抗抑郁药或苯二氮卓类药物反应不足的严重表现。一个案例将说明发病，临床过程，并通过怀孕和产后广泛性焦虑症的治疗策略。
Perinatal generalized anxiety disorder (GAD) has a high prevalence of 8.5%-10.5% during pregnancy and 4.4%-10.8% postpartum. Despite its attendant dysfunction in the patient, this potentially debilitating mental health condition is often underdiagnosed. This overview will provide guidance for clinicians in making timely diagnosis and managing symptoms appropriately. A significant barrier to the diagnosis of GAD in the perinatal population is difficulty in distinguishing normal versus pathological worry. Because a perinatal-specific screening tool for GAD is nonexistent, early identification, diagnosis and treatment is often compromised. The resultant maternal dysfunction can potentially impact mother-infant bonding and influence neurodevelopmental outcomes in the children. Comorbid occurrence of GAD and major depressive disorder changes the illness course and its treatment outcome. Psychoeducation is a key component in overcoming denial/stigma and facilitating successful intervention. Treatment strategies are contingent upon illness severity. Cognitive behavior therapy (CBT), relaxation, and mindfulness therapy are indicated for mild GAD. Moderate/severe illness requires pharmacotherapy and CBT, individually or in combination. No psychotropic medications are approved by the FDA or Health Canada in pregnancy or the postpartum; off-label pharmacological treatment is instituted only if the benefit of therapy outweighs its risk. SSRIs/SNRIs are the first-line treatment for anxiety disorders due to data supporting their efficacy and overall favorable side effect profile. Benzodiazepines are an option for short-term treatment. While research on atypical antipsychotics is evolving, some can be considered for severe manifestations where the response to antidepressants or benzodiazepines has been insufficient. A case example will illustrate the onset, clinical course, and treatment strategies of GAD through pregnancy and the postpartum.