TREATMENT OF PANIC DISORDER--LONG TERM STRATEGIES

这是一项多中心研究的四项相同申请之一， 惊恐障碍（PD）的长期治疗策略。该研究建立 根据我们最初的多中心研究结果， 丙咪嗪，安慰剂，认知行为疗法（CBT），以及他们的 联合治疗不超过轻度 恐旷症 该研究发现，CBT或 单独丙咪嗪与它们的组合一样。 考虑到 因此，开始时， 单一疗法。 此外，根据医疗实践的一般原则， 合理的做法是采用侵入性较小的 行为干预 因此，重要的是要了解什么应该是 在初始治疗后进行。 拟议的赠款解决了这一问题 话题吧 在拟议的研究中，所有受试者最初仅接受CBT。 受试者随后被随机分配到两项急性期后研究之一中， 回复状态。 这些研究涉及两个问题：（1） 对CBT初始疗程有反应的患者， 是否需要保持响应？（2）不回答者 基本上，在CBT的初始课程中， 药物治疗改善反应？ 共336名受试者将 在3年期间从4个研究中心入组。 响应者将 随机分配至维持研究，比较无维持与9个月 持续的CBT。 无应答者将被随机分配至研究 对比帕罗西汀和持续认知行为疗法 除了主 问题，将检查缓解和复发的可能预测因素 以及可能的反应介质。 这项建议的核心是继续维持一个运作良好、 开展当前研究的各研究中心之间开展了富有成效的合作。 这些地点已经有经过培训和认证的评估 治疗人员和严格的监测程序， 这对开展我们提议的研究至关重要。

This is one of four identical applications for a multi-center study of long-term treatment strategies for panic disorder (PD). The study builds upon the findings of our original multi-center study comparing imipramine, placebo, cognitive behavior therapy (CBT), and their combination in the treatment of PD patients with no more than mild agoraphobia. That study found response rates were as high with CBT or imipramine alone as with their combination. Given the added cost of combined treatments, it therefore seems reasonable to begin with monotherapy. Further, following general principles of medical practice, it would be reasonable to initiate treatment with the less invasive behavioral intervention. It is then important to learn what should be done following initial treatment. The proposed grant addresses this subject. In the proposed study, all subjects initially receive CBT alone. Subjects are then randomized in one of two postacute studies, depending on response status. These studies address two questions: (1) among patients who respond to an initial course of CBT, is maintenance therapy required to maintain response?; and (2) among those who fail to respond substantially to an initial course of CBT, will the addition of pharmacotherapy improve response? A total of 336 subjects will be enrolled from 4 sites over a 3 year period. Responders will be randomized to a maintenance study comparing no maintenance with 9 months of continued CBT. Non-responders will be randomized to a study comparing paroxetine with continued CBT. In addition to the main questions, possible predictors of response and relapse will be examined as well as possible mediators of response. Central to this proposal is the continuation of a well-functioning and productive collaboration among the sites conducting the current study. These sites already have in place the trained and certified assessment and treatment personnel and rigorous monitoring procedures that are essential for the conduct of a study such as the one we propose.