An Analysis of Pharmacotherapy Combined Cognitive-Behavioral Group Therapy for Panic Disorder with Agoraphobia

众所周知，认知行为疗法和药物疗法(联合疗法)相结合治疗惊恐障碍(PD)伴广场恐怖症是有效的。然而，关于联合治疗最有利的药物的研究很少。这项研究的目的是检验哪种药物的联合治疗最能改善具有广场恐惧症的惊恐障碍的症状。2008年10月至2011年3月期间招募了一些患者，并分配到昭和大学医院进行药物治疗。药物治疗师可以自由地为患者选择药物。采用惊恐障碍严重度量表(PDSS)、汉密尔顿焦虑量表(HRSA)、总体功能评定量表(GAF)、医院焦虑抑郁量表(HADS)、广场恐怖症认知问卷(ACQ)、躯体感觉问卷(BSQ)、临床总体印象(CGI)-严重程度与改善量表进行评定。在药物治疗联合…之前(前测)和之后(抗议：12周)评估结果接受10次认知行为团体治疗(CBGT)。41名患者在日本人的PDSS测试前后有显著改善，这是主要的结果衡量标准。在治疗后，临时使用苯二氮卓类药物比常规使用更明显地改善了所有的评分。我们认为暂时使用苯二氮卓类药物对联合治疗的干扰最小，而定期使用苯二氮卓类药物会干扰CBT，后者作用于额叶皮质。相反，在这项研究中，使用抗抑郁药、抗精神病药物和情绪稳定剂对结果几乎没有影响。伴有SSRI的帕金森病患者对惊恐障碍的认知改变明显快于无SSRI的患者，而常规和临时使用苯二氮卓类药物的患者对惊恐障碍的认知也有改善。综上所述，我们的临床试验结果支持综合治疗惊恐障碍伴广场恐怖症是有效的。SSRI和单剂量苯二氮卓类药物推荐用于联合治疗。SSRI能更快地改变惊恐障碍的典型认知。在CBGT的后处理中，暂时使用苯二氮卓类药物比常规使用苯二氮卓类药物更有效。较少

It is well known that combination of cognitive-behavioral therapy and pharmacotherapy(the combination therapy) for panic disorder(PD) with agoraphobia is effective. However, there has been little research on the most favorable drug for the combination therapy. The purpose of this study was to examine which drug for the combination therapy is best to improve symptoms of panic disorder with agoraphobia.Out patients were recruited between October 2008 and March 2011 and assigned to pharmacotherapy at Showa university hospital. Pharmacotherapists were free to choose the drug for patients. We used Panic disorder severity scale(PDSS), Hamilton Rating Scale for Anxiety(HRSA), Global Assessment of Functioning Scale(GAF), Hospital Anxiety Depression Scale(HADS), Agoraphobic Cognitions Questionnaire(ACQ), Body Sensations Questionnaire(BSQ), Clinical Global Impression(CGI)-Severity & Improvement for assessment. Outcomes were assessed before(pretest) and after(protest : 12weeks) pharmacotherapy co … More mbined 10 times cognitive-behavioral group therapy(CBGT).Forty-one patients improved significantly from pretest to posttest on PDSS for Japanese, which was primary outcome measure. At posttrearment, all scales improved significantly by Temporary use of benzodiazepines more than Regular use. We supposed that temporary using benzodiazepine is least disruptive to the combination therapy, while regular using benzodiazepine interferes with CBT, which works on frontal cortex. In contrast, using antidepressant, antipsychotic and moodstabilizer had little influence on outcomes in this study. PD with SSRI are changed the typical cognition of panic disorder faster than without SSRI, while both regular and temporary using benzodiazepine improved at the same time.In summary, the results from our clinical trial provide support that the combination therapy is efficacious for panic disorder with agoraphobia. SSRI and a single dose of benzodiazepine are recommended for the combination therapy. SSRI can change the typical cognition of panic disorder faster. Temporary using benzodiazepine is more effective than regular using benzodiazepine at posttreatment of CBGT. Less