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

认知行为疗法与药物疗法联合治疗惊恐障碍（PD）合并广场恐怖症疗效显著。然而，关于联合治疗的最有利药物的研究很少。本研究的目的是检查哪种药物联合治疗最能改善广场恐怖症的恐慌障碍症状。门诊患者于2008年10月至2011年3月期间招募，并被分配到昭和大学医院接受药物治疗。药物治疗师可以自由地为患者选择药物。我们采用惊恐障碍严重程度量表（PDSS）、汉密尔顿焦虑评定量表（HRSA）、整体功能评估量表（GAF）、医院焦虑抑郁量表（HADS）、广场恐惧认知问卷（ACQ）、身体感觉问卷（BSQ）、临床整体印象(CGI)-严重程度与改善进行评估。评估药物治疗前（前测）和治疗后（抗议：12周）的结果，并进行10次认知行为团体治疗（CBGT）。41例患者的PDSS从测试前到测试后显著改善，PDSS是主要的结果测量指标。在治疗后，临时使用苯二氮卓类药物比常规使用更能显著改善所有量表。我们认为暂时使用苯二氮卓类药物对联合治疗的破坏性最小，而定期使用苯二氮卓类药物会干扰对额叶皮质起作用的CBT。相比之下，使用抗抑郁药、抗精神病药和情绪稳定剂对本研究的结果影响不大。服用SSRI的PD患者对惊恐障碍典型认知的改变比未服用SSRI的PD患者更快，而定期和暂时使用苯二氮卓类药物的PD患者对惊恐障碍典型认知的改善同时得到改善。综上所述，我们的临床试验结果支持该联合疗法对惊恐障碍伴广场恐怖症有效。SSRI和单剂量苯二氮卓类药物被推荐用于联合治疗。SSRI可以更快地改变惊恐障碍的典型认知。在CBGT治疗后，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。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