Beruflich Dokumente
Kultur Dokumente
AVAILABLEEFFECTIVETREATMENTS
FORPANICDISORDERANDAGORAPHOBIA
ANDSATISFACTIONWITHTREATMENT
B.Bandelow,P.D.Dr.,Dipl.Psych.,
ConsultantPsychiatrist,K.Sievert,Dr.M.Rthemeyer,G.Hajak,P.D.Dr.,ConsultantPsychiatrist,L.Adler,Dr.,Consultant
Psychiatrist,andE.Rther,Prof.Dr.,Gttingen,Germany.
Correspondence:
PDDr.B.Bandelow,Dept.ofPsychiatry,TheUniversityofGttingen,Germany
Abstract
Inordertocomparethecurrentstateoftreatmentofpanicdisorderandagoraphobia(PDA)withtherecommendationsderivedfrom
controlledstudies,100PDApatientsand103physicians,psychologistsandpsychotherapistswereinterviewedbymeansofstructured
interviewsaboutthepsychologicalandpsychopharmacologicaltreatmentsusedinpanicdisorder.Bothinvestigationsrevealedthat
psychologicalandpharmacologicaltreatmentmodalitieswithprovenefficacyarebeingunderutilized(e.g.cognitivebehaviortherapy,
exposuretherapy,tricyclicantidepressants,benzodiazepinesorselectiveserotoninreuptakeinhibitors).Ontheotherhand,methods
whoseefficacyhasnotbeenprovenarebeingwidelyapplied.Theretrospectiveinterviewswiththepatientsrevealedthattheyweremost
satisfiedwithtreatmentsthathavebeenproveneffectiveincontrolledstudies.Reasonsfortheinadequateuseofproventreatment
modalitiescouldbeinsufficientknowledge,ideologicalissuesorthefactthat40percentofthehealthprofessionalsdidnotaccepttheterm
"panicdisorder"asdefinedbyDSMIII.Treatmentofpanicdisordermightbeimprovedifmoreheedweretakenoftheresultsofclinical
studies.
Keywords:PanicDisorderAgoraphobiaDrugtreatment,Psychologicaltreatment
Introduction
Patientswithpanicdisorderwithorwithoutagoraphobia(PDA)asdefinedbyDSMIIIRcanbeeffectivelytreatedwithpsychologicaland
psychopharmacologicaltreatmentmodalities.Foranoverview,all77PDAstudiesthatcouldbetracedbycomputeraidedliteraturesearch
wereevaluated(updateofstudy[2]).InTable1andTable2,theresultsofcontrolledstudiesarelisted.Asummaryoftheseresultsis
presentedinTable3.Asplacebotreatmentsareusuallyhighlyeffectiveinpanicdisorder[1],onlystudiesshouldbetakenintoaccountthat
usedadrugplacebo,a"psychologicalplacebo"ora"waitinglist"conditionasacontrolgroup.Treatmentsthathaveproveneffectivein
suchcomparisonsinclude:benzodiazepines(e.g.alprazolam[1]),tricyclicantidepressants(e.g.imipramine[7]orclomipramine[12]),
irreversibleMAOinhibitors(e.g.phenelzine[22]),andserotoninreuptakeinhibitors(e.g.fluvoxamine[4]orparoxetine[19]).Aconsensus
conferenceoftheNationalInstituteofMentalHealthhasrecommendedthesedrugsfortreatmentofPDA[17].Neurolepticsarebeing
widelyappliedinanxietydisordersinEurope,thoughtheirefficacyhasnotbeenshowninPDAtrials.Treatmentstudieswithbetablockers
haveshownconflictingresultsinsummary,convincingproofofefficacyismissing.Propranololwasnotbetterthanplaceboandless
effectivethanalprazolam[16].Inanotherstudy,itwaslesseffectivethandiazepam[18].Herbalpreparationsorhomoeopathicformulations
havenotbeeninvestigated.
Psychologicalmethodswithprovenefficacyincludebehavioraltherapieslikeexposureorcognitivetherapy[36].Otherbehavioral
techniqueslikesystematicdesensitization[26]orprogressiverelaxation[11]werelesseffectivethanexposuretherapy[1315].
PsychodynamicpsychotherapywasonlyinvestigatedonceinPDApatients:inthatstudy,acombinationofpsychodynamictherapyand
exposurewassuperiortopurepsychodynamictherapy[10].Otherpsychologicaltherapies,e.g.clientcenteredtherapy[20],autogenic
training[21]orbiofeedback[9]haveneverbeeninvestigatedinPDApatients.
ComparisonsofpsychologicalandpsychopharmacologicaltherapieshavebeendiscussedindetailbyBandelowetal.[2].Thenumberof
suchcomparisonsislow,andtheirresultsareconflicting.Insummary,nomajoradvantageofeithermethodcanbefound.Becauseofthe
lownumbersoffollowupinvestigations,thewidelyheldopinionthatpsychologicaltherapiesaremoreeffectiveatfollowupwhen
comparedtodrugtherapycannotbeproved.Thoughitissometimesemphasizedthatsimultaneousapplicationofpsychopharmacological
drugscouldinhibitpsychologicaltherapy,studieshaveshownthatacombinationofbothmodalitiesseemstobeadvantageous[25].
Tocomparetheresultsofclinicalresearchwiththestateoftreatmentinreality,twointerviewstudieswereconducted:first,amongPDA
patients,andsecond,amonghealthprofessionalstreatingthesepatients.Patientswereaskedwhichtherapeuticmodalitieshadbeen
appliedtothemandwhethertheyfeltthesetreatmentshadbeeneffective.Physicians,psychologistsandpsychotherapiststreatingpanic
patientsintheirdailypracticewereaskedabouttheirtreatmentpreferences.
Study1:PatientInterviews
Methods
OnehundredpatientswithcurrentorremittedDSMIIIRpanicdisorderandoragoraphobiawereaskedtoreportonanydrugand
psychologicaltreatmenttheyreceivedinthecourseoftheirillness.Ninetypatientswereformerorpresentclientsoftheanxietydisorders
unitoftheUniversityofGttingen,Germany.Thesepatientswerecontactedbymailoratavisitintheunit.Moreover,attemptsweremade
toconatactallPDApatientspresentlybeingtreatedintheurbaninpatientunitstreatinganxietypatients.Thus,10additionalpatientswho
werebeingtreatedinpsychiatricorpsychosomatichospitalsatpresentcouldbequestioned.Of207patientscontacted,24werenot
traceable.Eightythreegavetheirconsenttotheinterview.Patientswerequestionedbymeansofastructuredinterviewconcerningthe
pharmacologicalandpsychologicaltreatmentmodalitiestheyhadreceivedduringthecourseoftheillness.Selfapplicabletreatmentssuch
asautogenictrainingwerealsoevaluated.Singleacutetreatmentsofpanicattacks(e.g.emergencytreatmentswithbenzodiazepine
injections)werenotanalyzed.Onlytreatmentsthatwerewellrememberedbythepatientswereevaluated.Treatmentsthatweregiven
eitherinasubclinicaldoseornotlongenoughtobeeffectivewereincluded.Fortricyclicantidepressants(TCAs),selectiveserotonin
inhibitors(SSRIs),andmonoamineoxidaseinhibitors(MAOIs)onlytreatmentswithaminimumdurationoffourweekscontinuousintake
wereevaluated.Forbenzodiazepines,neurolepticsandherbalpreparations,aminimumintakedurationofoneweekwasrequired.Of241
drugtreatmentsreportedbythepatients,28werenotevaluablebecauseofthiscriterion.Forallpsychologicaltreatmentsaminimum
treatmentdurationof8weekswasnecessaryforinclusion.Forinpatienttreatmentinapsychologicaltreatmentunit,aminimumdurationof
4weekswasrequired.Fivepsychologicaltreatmentsoutof103hadtobeexcludedbecauseofinsufficientduration.
Patientswereaskedtoindicatetheirsatisfactionwithacertaintherapybyrespondingtothestatement,"thistherapyhasbeenveryhelpful
againstmyfear"ona5pointLikertscale(from0="nottrue"to4="true").Asthescalewasassumedtobeofordinalranklevel,the
centraltendency("mean")oftheseanswerswastakenasa"satisfactionindex".CentraltendencieswerecomparedwithMannWhitneysU
test.StatisticalanalysiswereperformedwiththeStatisticalAnalysisSystem(SAS6.08,SASInstitute,Heidelberg).
Finally,54patientswhohadreceivedbothdrugs(notincludingherbalpreparations)andpsychologicaltreatmentsinthecourseofthe
illnesshadtoindicatewhichkindoftreatmenthadhelpedmostinthecourseoftheillness.Onlyoneanswerwaspossibletothisquestion.
Results
FrequencyofApplicationofTreatments
Fourpercentofthepatientshadnotreceivedanytreatmentsbeforetheinterview.Eightyeightpercentofthepatientshadreceiveddrug
treatmentsinthecourseoftheiranxietydisorder.Alltogether213drugtreatmentswereevaluated.Alistofsubstancegroupsappliedon
thepatientsisshowninTable4.Benzodiazepineswerethemostfrequentlyuseddrugs,followedbytricyclicantidepressantsandherbal
preparations.Amongthebenzodiazepines,diazepam(21%)andlorazepam(13%)wereusedmostfrequently,amongtricyclic
antidepressantsdoxepine(18%)andimipramine(10%).Themostusedneurolepticdrugwasfluspirilene(18%).
ThepercentageofpatientswhoreceivedacertainpsychologicaltreatmentisgiveninTable5.Fiftyeightpercentofthepatientshad
receivedoneoftheindicatedpsychologicaltreatments.Alargenumberofpatients(28%)couldnotindicatethespecificationorschool"of
psychologicaltherapyappliedtothem.Noneofthesepatientsreportedtheapplicationofbehaviortechniqueslikeexposure.
Drugprescriptionbygeneralpractitionersandothernonpsychiatrists
Nonpsychiatrists(generalpractitioners,internistsandothers)showedadifferentprescriptionprofile,asreportedbythepatients.
Benzodiazepines,neuroleptics,andherbalpreparationsweremoreoftenprescribedbynonpsychiatristsascomparedtopsychiatrists,
whereaspsychiatriststendedtousemoretricyclicantidepressants(Table6).
Satisfactionwithtreatments
InFigure1thesatisfactionwiththedifferentdrugsappliedasratedbythepatientsisshown.Benzodiazepines,SSRIsandtricyclic
antidepressantswerethemostfavoredpsychopharmacologicaldrugs.TheSSRIswereonlyusedin7%sothattheresultsmaynotbe
representative.Neurolepticswerenotratedveryhighly,andherbalpreparationsandbetablockerswereassessedaspracticallyineffective.
InTable7thesignificantcomparisonsamongdrugtherapiesaregiven.
Amongpsychologicaltherapies,behaviortherapywaspreferred(Figure2).Satisfactionwiththismethodwassignificantlyhigherthanwith
psychodynamicallyorientedtherapy(p<0.005,U=171,Bonferronicorrection),"unknowntherapy"(p<0.005,U=141)andautogenic
training(p<0.0001,U=158).
StudyII:Interviewswithhealthprofessionals
Method
Inthissurvey,practicingphysicians,psychologistsandpsychotherapistswhotreatpanicdisorderpatientsinthetownofGttingen,
Germany,wereapproached:Generalpractitioners,internistsandothernonpsychiatricphysicians,psychiatrists/neurologists,psychologists
aswellaspsychotherapistswhoareneitherphysiciansnorpsychologists.Gttingen,atownwithapopulationof125.000,hasahigh
concentrationofphysicians,psychologistsandpsychotherapistsduetothepresenceofalargeuniversity.Allmajorpsychological
treatmentmodalities(likepsychoanalysis,clientcenteredpsychotherapyorcognitive/behaviortherapyareavailableandarebeingtaught
byuniversityinstructors.
TherespondentsweresentaquestionnairethatpresentedasymptomdescriptionofpanicdisorderandagoraphobiatakenfromtheDSM
IIIRandtheICD10.Itwasstatedthatthedescribeddisorderwascalledpanicdisorderwith/withoutagoraphobia"accordingtoDSMIII
R/ICD10.Respondentswereaskediftheyhadtreatedsuchpatientsintheiroffice.Onlyonerespondentansweredthathehadnever
treatedpanicpatientsandwasexcludedfromthestudy.Furthermore,therespondentswererequestedtospecifytheirqualificationand
durationoftheeducationinmedicine,psychology,psychiatry,orinpsychologicaltreatments.Theywereaskedtoindicatewhetherthey
acceptedthetermpanicdisorder"asadiagnosticentityandastotheirpreferredpharmacologicalorpsychologicaltherapy.
Results
Of104questionnaires,103wereevaluable.Of103respondents,78(76%)werephysicians,22(21%)psychologists,onepersonwasa
physicianandpsychologistatthesametime,and2wereneitherphysiciansnorpsychologistsbutpsychotherapistsrecognizedbythe
insurancecompanies.Amongthe78physicianswere38psychiatrists(specialistsortrainees).Fiftyfourpercentofthephysicianshada
specialeducationinpsychologicaltherapywhichallphysicianscanacquireinGermanywithoutnecessarilybeingapsychiatrist.On
averageallrespondentshadseen16.5PDApatientsinthepastyear(range10100SD=43,4).Psychiatristsnamedanaverageof17.9
(range5100SD28.1)panicpatientsperyear.Respondentsstatedanaverageof11.3yearsprofessionalexperience(range039SD=
8.4).
Mostphysiciansindicatedthattheypreferredtricyclicantidepressantsinpanicdisordertreatment(Table8).Secondinline,herbal
preparationsarebeingprescribed.Theprescribingpatternsofpsychiatristsandnonpsychiatricphysiciansdifferconsiderably:74%ofthe
psychiatristsusetricyclicantidepressants,whereasonly24%ofthenonpsychiatricphysicianspreferthesedrugs.Herbalpreparations
andhomoeopathicformulationsaremostpopularamongnonpsychiatricphysicians.Psychiatristsusemorebenzodiazepinesthanother
physicians.Selectiveserotoninreuptakeinhibitors,proposedby24%ofthepsychiatrists,areveryrarelyprescribedbynonpsychiatric
physicians(3%).Psychologistsarenotallowedtowriteprescriptions.
ThepreferenceofthepsychologicaltherapistsforthethreemajortherapyschoolsisshowninTable9(asmanypsychotherapistsare
educatedinmorethanonetreatmentmodalityandsometimesapplythesemethodssimultaneously,thepercentagesdonotaddupto
100).Psychologistsclearlyprefercognitive/behaviortherapyoverthetwoothertherapyschools(nodifferentiationwasmadebetween
cognitivetherapyandtraditionalbehaviortherapybecauseacomplexmixtureoftwoisusuallyusedinclinicalpractice).Amongphysicians,
psychoanalysiswasclearlypreferred.
Whenaskedastotheiropinionaboutefficacyproofs,43%oftheprofessionalswhousedpsychodynamictherapyasafirstlinetreatment
forpanicpatientswereconvincedthattheirpreferredmethodhadbeenproveneffectiveincontrolledstudies,whereas89%ofthe
behaviorallyorientedrespondentsthoughtthatcognitivebehaviortherapyhasbeenshowntobeeffectiveinsuchstudies.
Acceptanceoftheterm"PanicDisorder"
Ofallrespondents,41(40%)statedthattheywouldnotagreeinusingthetermpanicdisorder"forthedescribedsyndrome(41%ofthe
psychiatrists,23%ofthepsychologists).Therejectionofthetermpanicdisorder"wasparticularlyhigh(73%)in22respondentswith
psychoanalytictraining,comparedto17%ofthe22respondentswithbehaviorallyorientedtraining.
Discussion
Thetreatmentofpatientswithpanicdisorderandagoraphobia(PDA)couldfurtherbeimprovediftheresultsofclinicalstudieswereput
intopractice.Thiswasshowninasurveyamong100patientswithPDAand103healthprofessionalstreatingPDApatients.Differences
betweenthetwosurveyscanbeexplainedbythefactthatthepatientshadtoreportretrospectivelyabouttheirtreatments,whereasthe
healthprofessionalshadtoreportaboutthestateoftheirknowledgetodate.Bothresultsmightbebiased:thepatientsanswersbythe
possibilitythattheydidnotremembertheappliedtreatmentsverywell,andthehealthprofessionalsanswersbythefactthattheyhadthe
chancetoinformthemselvesintheliteraturebeforefillingoutthequestionnaire.Nevertheless,bothsurveyswereconsistentinshowing
thattreatmentmodalitiesforwhichefficacyproofsexistwereunderutilized.Ontheotherhand,treatmentmodalitiesthathaveneverbeen
investigatedinPDApatientsarebeingwidelyapplied.Forexample,nonpsychiatristsproposedherbalandhomoeopathicpreparationsas
afirstlinetreatmentforpanicdisorder.Alowincidenceofadverseeventsisoftenofferedasanargumentfortheuseofthese
preparations.However,thechoiceofdrugtreatmentshouldnotbeguidedbysideeffects,butprimarilybyefficacy.Ifaprescriberputshis
hopeonlyintheplaceboeffect,aneffectivealternativetreatmentmightbewithheldfromthepatient.
InGermanyitiscommontotreatanxietydisorderswithneuroleptics,butproofofefficacyproofsislackingforpanicdisorderpatients.A
consensusconferenceoftheNationalInstituteofMentalHealthdidnotrecommendneurolepticsforpanicdisorder.Nevertheless,onethird
ofthepatientsreportedhavingbeentreatedwithneurolepticsevenonethirdofthepsychiatristsindicatedthattheyuseneurolepticsfor
treatmentofpanicdisorder.
Thoughnoconvincingefficacyproofsexistforbetablockers,theywerenamedby26%ofthepsychiatristsasapossibletreatmentoption.
Ontheotherhand,only6%ofthepatientsindicatedthattheyhadbeentreatedwithbetablockers.
Selectiveserotoninreuptakeinhibitorswereunderrepresentedinbothsurveys.ThepossiblereasonmaybethatSSRIsarerelativelynew
onthemarket.Tricyclicantidepressantswhichareproposedasfirstlinetreatmentintheliteraturehavenotevenbeentriedinhalfofthe
patients.Onlyonequarterofnonpsychiatrists,butthreequartersofthepsychiatristsreportedprescribingthesedrugs.
Halfofthepatients(48%)reportedthattheyhadreceivedbenzodiazepinetreatment.Twiceasmanypsychiatrists(45%)asnon
psychiatrists(22%)reportedprescribingthesedrugs.However,accordingtothestatementsofthepatients,theyhadreceivedevenmore
benzodiazepineprescriptionsfromnonpsychiatrists.Inothercountriesbenzodiazepinesaremorefrequentlyprescribedtopanicpatients,
ascomparablestudiesintheUnitedStates[8]andinCanada[24]haveshown.
Lookingatproposedpsychologicaltherapies,underutilizationofeffectivemethodsisevenmorestriking.Manypatientswereinstructedto
treattheirdisorderwithautogenictraining,thoughnoproofofefficacyisavailableforthistreatmentmodality.Onethirdofthepatients
indicatedtheyhadbeentreatedwithdepthpsychologyorpsychoanalytictherapy.Asstatedabove,thedatabaseforthistreatmentmethod
ispoorinspiteofitswidespreaduse.
Asubstantialnumberofpatientscouldnotindicatethepsychologicaltherapyschoolappliedtothem.Inthesecasespatientswereaskedif
specifictechniqueslikeexposuretofearfulsituationshadbeenperformedduringsessions.Inallcases,patientsdeniedtheuseofsuch
techniquessoitcanbeexcludedthatthesepatientshadbeentreatedwithbehaviortherapy.
InvestigationsintheUSAandCanadaalsoshowedalackofconcordancebetweenresultsofclinicalstudiesandthecurrentstateof
treatment[582324].InGermanyonereasonfortheuncriticaluseofineffectivetreatmentmodalitiesmaybeinsufficientknowledge,the
otheronemaybethatthenewclassificationofanxietydisordersbyDSMIIIorICD10doesnotfindunequivocalacceptance:40%ofthe
healthprofessionalsindicatedthattheywouldnotacceptthetermpanicdisorder"forthedescribedsymptompattern.Acceptanceofthe
modernDSM/ICDclassificationoftheanxietydisordersbyhealthcareprofessionalstreatingthesepatientscouldhelptoimprovethe
acceptanceofresearchresults.
Theresultsofthisretrospectiveinvestigationshouldbeinterpretedwithcautionbecauseanumberoffactorscouldnotbecontrolledinthe
study:properrecollectionofappliedtherapiesbythepatients,adequatedurationanddoseofthedrugs,complianceofdrugintake,
availabilityofpsychologicaltreatments,adequatedurationofpsychologicaltreatments,classificationleveloftherapists,assessment
problemsarisingfromcombinationtreatmentsandmanyotherfactors.Mostoftheinterviewedpatientswereclientsofour
psychopharmacologicalandbehaviorallyorientedanxietydisordersunit.Thismighthaveledtoadistortionofthepicture.Resultsmight
havebeendifferentiftheinterviewshadmostlybeenconductedinaninstitutionapplyingonlypsychologicaltherapy.However,a
comparableinvestigationwasconductedinamainlybehavioraltreatmentinstitutionandshowedalmostthesameresults[24].Moreover,
thestatementsofpatientsconcerningtheefficacyoftreatmentsrevealedthatpatientsappreciatedpreciselythosetreatmentmethodsthat
havebeenshowntobeeffectiveincontrolledstudies.
Anotherreasonwhytheresultsshouldbeinterpretedwithcautionisthefactthatpatientsdonothavethesamepossibilitytojudgethe
risk/benefitratioofcertaintreatmentsashealthprofessionalsdo.Resultsmayhavebeenbiasedinfavoroftreatmentsshowingimmediate
success,suchasbenzodiazepinetreatment,ascomparedtotreatmentswithdelayedefficacy,likepsychologicaltherapies.Longterm
effectssuchaspossibleaddictiontobenzodiazepinesmaynothavebeentakenintoconsideration.
Muchefforthasbeenputintocontrolledstudiesontheefficacyofpanictreatments.Forthebenefitofthepatientsconcerned,theresultsof
theseinvestigationsshouldbeacceptedbyprofessionalstreatingpanicdisorderpatientsinordertoimprovetheoutcomeoftreatment.
Drug
Positive
studies
Alprazolam
Imipramine
Fluvoxamine
Clomipramine
Paroxetine
Adinazolam,clonazepam,lorazepam,diazepam,
sertraline
Amitriptyline,brofaromine,carbamazepine,
citalopram,desipramine,etizolam,inositol,
lofepramine,phenelzine,valproicacid,
zimelidine
Propranolol
Bupropion,clonidine,ibuprofen,
maprotiline,ritanserine,trazodone,verapamil
Buspirone
Negative
studies*
15
15
Table1.Overviewoftheefficacyofdrugsinpanicdisorderandagoraphobia(doubleblindstudies)moreeffectivethanplacebo
oraseffectiveasreferencedrug*notmoreeffectivethanplaceboorlesseffectivethanreferencedrug
Psychologicaltreatment
Cognitivetherapy
Exposuretherapy
Systematicdesensitization
Positivestudies
Negativestudies*
Table2.Efficacyofpsychologicaltreatmentsinpanicdisorderandagoraphobiamoreeffectivethancontrolcondition*no
moreeffectivethancontrolcondition
Drugs
Tricyclicantidepressants(e.g.imipramine,clomipramine)
Serotoninreuptakeinhibitors(e.g.fluvoxamine,citalopram,paroxetine)
Benzodiazepines(e.g.alprazolam)
IrreversibleMAOinhibitors(e.g.phenelzine)
Psychologicaltherapies
Cognitivetherapy
Exposuretherapy(foragoraphobicpatients)
Table3.Overview:treatmentmodalitiesforPDAthathavebeenshowntobeeffectiveincontrolledtrials
Drugs
Benzodiazepines
Tricyclicantidepressants
Herbalpreparations
Neuroleptics
Serotoninreuptakeinhibitors
Betablockers
Tetracyclicantidepressants
IrreversibleMAOinhibitors
Percent
48%
42%
32%
29%
7%
6%
3%
2%
Table4.PercentageofPDApatientswhoreceiveddrugsinthecourseoftheirillness(n=100)
Psychologicaltreatment
Percent
Autogenictraining
43%
Psychodynamictherapy
33%
Unknown
28%
Cognitive/behaviortherapy
20%
Biofeedback
6%
Progressiverelaxation
6%
Hypnosis
4%
Table5.Psychologicaltherapies:frequencyofapplicationinpercent
Benzodiazepines
Tricyclic
antidepressants
Neuroleptics
Herbal
preparations
Total
n
Psychiatrists Non
no
unknown
prescriptions
psychiatrists prescription
77
40.2%
57.1%
2.6%
51
64.7%
31.4%
3.9%
30
33.3%
63.3%
3.3%
37
10.8%
54.9%
35.1%
0.0%
195
40.0%
50.7%
6.7%
2.6%
Table6.Prescriptionofdrugsbypsychiatristsandnonpsychiatrists(generalpractitioners,internists,andothers)
Benzodiazepines
N.S.
N.S. P<0.001(U=167)
SSRI
Tricyclic
antidepressants
Neuroleptics
N.S.
Herbalpreparations
P<0.0001(U=214)
N.S.
P<0.005(U=35)
P<0.005(U=381)
P<0.0001(U=248)
N.S.
Table7.Significanceofcomparisonsbetweendifferentmedications(MannWhitneysUtestBonferronicorrection)
All
physicians
(n=79)
Non
psychiatric
physicians
Psychiatrists
(n=38)
(n=41)
Tricyclicantidepressants
Herbalpreparations
Benzodiazepines
Neuroleptics
Betablockers
Homoeopathicformulations
Serotoninreuptakeinhibitors
Irreversiblemonoamineoxidase
inhibitors
Others
48%
24%
74%
40%
46%
29%
33%
22%
45%
24%
20%
29%
20%
15%
26%
18%
32%
3%
13%
3%
24%
8%
0%
16%
1%
3%
3%
Table8.Percentageofdifferentgroupsofphysicianswhoproposedifferentdruggroups(morethanonechoicepossible)
Psychological
therapy
All
psychological
therapists
All
physicians
Psychiatrists Psychologists
(n=33)
(n=22)
(n=49)
(n=68)
Psychoanalysis
44%
57%
51%
9%
Clientcentered
therapy(Rogerian)
28%
35%
33%
9%
Cognitive/behavior
therapy
28%
4%
6%
64%
Table9.Respondentspracticingpsychologicaltherapies:treatmentmodalityproposedinthefirstline
Figure1.Meansatisfactionwithdrugtherapy,indicatedona5pointscale(from0=notatallhelpfulto4=veryhelpful)
Figure2.Meansatisfactionwithpsychologicaltherapies,indicatedona5pointscale(from0=notatallhelpfulto4=very
helpful)
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