驚恐障礙的難治性
一種簡單、基於測量的方法可以補充難治型驚恐障礙臨床指南內容。驚恐障礙嚴重程度量表(PDSS，見下表)，驚恐障礙臨床試驗的一種常見使用結果，也是一種優異的、臨床常見使用的量表[3]。該量表是一個簡短的臨床等級量表，包括7個條目（每一項評分從0到4），分別對不同的驚恐障礙症狀範圍進行抽樣評估。在臨床實驗中，PDSS總分低於4分（包括4分）通常認為症狀緩解，但通常PDSS基線總得分降低50%才會認為出現臨床症狀改善。
PDSS驚恐障礙嚴重程度量表
預後影響
慢性和持續性疾病很有可能增加患上其他併發症的概率，包括後遺症，如廣場恐懼症、重度抑鬱、其他焦慮障礙、藥物濫用以及增加自殺的風險；社會功能受損，如生活質量降低、失業或待業以及與社會隔離。此外，難治型驚恐障礙患者患上慢性免疫疾病或軀體疾病的風險性很高，如心血管和神經退行性疾病。
下一步藥物選擇
2、使用另一種抗抑鬱藥物。
苯二氮卓類藥物與SSRIs、SNRIs和TCAs藥物相比，前者具有長期耐受性，因為其不會導致體重增加或性功能障礙。一般來說，高藥效、短半衰期的苯二氮卓類藥物更可取，因為它們的藥物代謝更好預測，代謝機制更簡單。常規劑量(vs. PRN)就可達到最佳的抗焦慮效果。獲取更多有關劑量和藥物使用的詳細信息，請見表2。
6、其他干預措施。
結論
參考文獻：
1. Batelaan NM, de Graf R, Penninx BW, et al. The 2-year prognosis of panic episodes in the general population. Psychol Med. 2010;40:147-157.
2. Freire RC, Zugliani MM, Garcia RF, Nardi AE. Treatment-resistant panic disorder: a systematic review. Expert Opin Pharmacother. 2016;17:159-168.
3. Shear MK, Brown TA. Barlow DH, et al. Multicenter collaborative panic disorder severity scale. Am J Psychiatry. 1997;154:1571-1575.
4. Cuijpers P, Sijbrandij M, Koole SL, et al. Adding psychotherapy to antidepressant medication in depression and anxiety disorders: a meta-analysis. World Psychiatry. 2014;13:56-67.
5. Barlow DH, Gorman JM, Shear MK, Woods SW. Cognitive-behavioral therapy, imipramine, or their combination for panic disorder: a randomized controlled trial. JAMA. 2000;283:2529-2536.
6. Perna G, Favaron E, Di Bella D, et al. Antipanic efficacy of paroxetine and polymorphism within the promoter of the serotonin transporter gene. Neuropsychopharmacology. 2005;30:2230-2235.
7. Simon NM, Otto MW, Worthington JJ, et al. Next-step strategies for panic disorder refractory to initial pharmacotherapy: a 3-phase randomized clinical trial. J Clin Psychiatry. 2009;70:1563-1570.
8. DuPont RL. Panic disorder and addiction: the clinical issues of comorbidity. Bull Menninger Clin. 1997;61(suppl 2):A54-A65.
9. Patterson B, Van Ameringen M. Augmentation strategies for treatment-resistant anxiety disorders: a systematic review and meta-analysis. Depress Anxiety. 2016;33:728-736.
10. Starcevic V. The reappraisal of benzodiazepines in the treatment of anxiety and related disorders. Expert Rev Neurother. 2014;14:1275-1286.
11. Boutros NN, Ghosh S, Khan A, et al. Anticonvulsant medications for panic disorder: a review and synthesis of the evidence. Int J Psychiatry Clin Pract. 2014;18:2-10.
12. Perna G, Alessandra A, Raffaele B, et al. Is there room for second-generation antipsychotics in the pharmacotherapy of panic disorder? A systematic review based on PRISMA guidelines. Int J Mol Sci. 2016;17:551.
13. Goddard AW, Mahmud W, Medlock C, et al. A controlled trial of quetiapine XR coadministration treatment of SSRI-resistant panic disorder. Ann Gen Psychiatry. 2015;14:26.
14. Andersson G, Cuipers P, Carlbring P, et al. Guided internet-based vs face-to-face cognitive behavior therapy for psychiatric and somatic disorders: a systematic review and meta-analysis. World Psychiatry. 2014;13:288-295.
15. Ori R, Amos R, Bergman H, et al. Augmentation of cognitive and behavioural therapies (CBT) with d-cycloserine for anxiety and related disorders. Cochrane Database Syst Rev. 2015;5:CD007803.
16. Hakamata Y, Lissek S, Bar-Haim Y, et al. Attention bias modification treatment: a meta-analysis toward the establishment of novel treatment for anxiety. Biol Psychiatry. 2010;68:982-990.
閱讀更多 王翼心理 的文章
