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Terapia a largo plazo del trastorno de ansiedad generalizada

Published online by Cambridge University Press:  12 May 2020

F. Rouillon
F. Rouillon*
Affiliation:
Departamento de Psiquiatría, Hospital Albert Chenevier, 40, rué de Mesly, 94010Creteil, Francia
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Resumen

El trastorno de ansiedad generalizada (TAG) es una alteración común (prevalencia vital: 5,1%) recurrente que anuncia a menudo otros trastornos psiquiátricos, notablemente la depresión. Como, por definición, es un trastorno que progresa durante meses, el tratamiento se debe diseñar a largo plazo. Y, sin embargo, se han realizado pocos estudios más allá de las 6-8 semanas clásicas que caracterizan la fase de tratamiento agudo. Esto es especialmente cierto de los ansiolíticos, pero también de los antidepresivos, con excepción de la paroxetina y la venlafaxina, que son los únicos medicamentos aprobados en esta indicación en los países occidentales. La eficacia de la psicoterapia, notablemente la relajación y la terapia cognitivo-conductual, está establecida en el tratamiento del TAG, pero sus indicaciones preferidas y posible combinación con los antidepresivos están aún por especificar. Se necesitarán todavía estudios a largo plazo, por no decir a muy largo plazo, del TAG, lo mismo que de la depresión, en el futuro para mejorar su tratamiento y especificar las modalidades terapéuticas (tratamiento de combinación, duración óptima, terapia continua o intermitente, elección de técnicas o agentes psicoterapéuticos…). El tratamiento temprano y adecuadamente prolongado no sólo debe conducir a periodos de remisión más numerosos, sino también a una disminución de la frecuencia de las comorbilidades, sean depresivas, adictivas o de otra naturaleza, y debe reducir también el impacto social del TAG.

Keywords

TAGFarmacoterapiaTratamiento psicosocialLargo plazo
Type
Artículo original
Information
European Psychiatry (Ed. Española) , Volume 11 , Issue 4 , May 2004 , pp. 247 - 252
Copyright
Copyright © European Psychiatric Association 2004

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References

Bibliografía

Allgulander, C., Hackett, D., Salinas, E., Venlafaxine extended-ralease (ER) in the treatment of generalizad anxiety disorder. Twenty-four week placebo controlled dose ranging study. Brit J Psychiatry 2001; 179:15-22.CrossRefGoogle Scholar
Allgulander, C., Hirschfeld, R.M., Nutt, D.J., Long-term treatment strategies in anxiety disorders. Psychopharmacol Bull 2002;36(Suppl 2):79-92.Google ScholarPubMed
Ballenger, J.C., Clinical guideslines for establishing remission in patients with depresssion and anxiety. J Clin Psychiatry 1999; 60(Suppl 22):29-34.Google Scholar
Ballenger, J.C., Davidson, J.R., Lecrubier, Y., Nutt, D.J., Borkovec, T.D., Rickels, K., et al. Consensus statement on generalizad anxiety disorder from the International Consensus Group on Depression and Anxiety. J Clin Psychiatry 2001;62(Suppl 11):53–8.Google Scholar
Barlow, DH., Anxiety and its disorders. New York: Guiford Press; 1988.Google Scholar
Barlow, D.H., Cohen, A.S., Waddell, M.T., Vermilyea, B.B., Kosco, J.S., Blanchard, E.B., et al. Panic and generalizad anxiety disorders: natu- ra and treatment. Behav Ther 1984;15:431–49.CrossRefGoogle Scholar
Barlow, D.H., Rapee, R., Brown, T.A., Behavioral treatment of generalizad anxiety disorder. Behav Ther 1992;23:551–70.CrossRefGoogle Scholar
Beck, A.T., Hemery, G., Anxiety disorders and phobias: a cognitive perspective. New York: Basic Books; 1985.Google Scholar
Blowers, C., Cobb, J., Mathews, A., Generalized anxiety: a controlled treatment study. Behav Res Ther 1987;25(6):493-502.CrossRefGoogle Scholar
Borison, R.L., Albrecht, J.W., Diamond, B.I., Efficacy and safety of a putative anxiolytic agent: ipsapirone. Psychopharmacol Bull 1990;26:207–10.Google ScholarPubMed
Borkovec, T.D., Costello, E., Efficacy of applied relaxation and cognitive-behavioral therapy in the treatment of generalized anxiety disorder. J Consult Clin Psychol 1993;61(4):611–9.CrossRefGoogle ScholarPubMed
Borkovec, T.D., Mathews, AM., Treatment of nonphobic anxiety disorders: a comparison of nondirective cognitive and desensitization therapy. J Consult Clin Psychol 1988;56(6):877-84.CrossRefGoogle ScholarPubMed
Borkovec, T.D., Mathews, A.M., Chambers, A., Ebrahimi, S., Lytle, R., Nelson, R., The effects of relaxation training with cognitive or nondirective therapy and the role of relaxation-induced anxiety in the treatment of anxiety generalized anxiety. J Consult Clin Psychol 1987;55:833–83.CrossRefGoogle ScholarPubMed
Borkovec, T.D., Whisman, M., Psychosocial treatment for GAD. In: Mavissakalian, M., Prien, R.F., editors. Long-term treatment for anxiety disorders. Washington (DC): American Psychiatric Press; 1996. p. 171–99.Google Scholar
Borkovec, T.D., Ruscio, A.M., Psychotherapy for generalized anxiety disorder. J Clin Psychiatry 2001;62(Suppl 11):43–5.Google ScholarPubMed
Boyer, P., Mahe, V., Hackett, D., et al. Efficacy of venlafaxine ER in social adjustment in patients with GAD. Presented at the 13th Annual Meeting of the ECNP Congress, Munich, 9-13 September 2000. 2000.Google Scholar
Boyer, W.F., Feighner, J.P., A placebo controlled double blind multicenter trial of two doses of ipsapirone versus diazepam in generalized anxiety disorders. Int Clin Psychopharmacol 1993;8:173–6.CrossRefGoogle Scholar
Buttler, G., Cullington, A., Hibert, G., Klimes, I., Gelder, M., Anxiety managment for persistent generalized anxiety. Brit J Psychiatry 1987;151:535–42.CrossRefGoogle Scholar
Butler, G., Fennel, M., Robson, P., Gelder, M., Comparison of behaviour therapy in the treatment of generalized anxiety disorder. J Consult Clin Psychol 1991;59(1):167–75.CrossRefGoogle ScholarPubMed
Cohn, J.B., Wilcox, C.S., Long-term comparison of alprazolam loraze- pam and placebo in patients with anxiety disorder. Psychopharmacotherapy 1984;4:93–8.CrossRefGoogle Scholar
Cutler, N.R., Sramek, J.J., Hesselink, JMK, Krol, A., Roeschen, J., Rickels, K., et al. A double blind placebo controlled study comparing the efficacy and safety of ipsapirone versus lorazepam in patients with generalized anxiety disorder: a prospective multicenter trial. J Clin Psychophammacol 1993;13:429–37.Google ScholarPubMed
Davidson, JRT, Dupont, R.L., Hedges, D., Haskins, J.T., Efficacy, satety and tolerability of venlafaxine extended release and buspirone in outpatients with generalized anxiety disorder. J Clin Psychiatry 1999;60:528–35.CrossRefGoogle Scholar
Dugas, M.J., La Douceur, R., Treatment of GAD targeting intolerance of uncertainty in two types of worry. Behav Modif 2000;24:635–7.CrossRefGoogle Scholar
Durham, R.C., Chambers, J.A., McDonald, R.R., Power, K.G., Major, K., Does cognitive-behavioral therapy influence the long-term outcome of generalized anxiety disorder? An 18-14 years follow-up of two clinical trials. Psychol Med 2003;33:499-509.CrossRefGoogle Scholar
Durham, R.L., Murphy, T., Allan, T., Richard, K., Treliving, L.R., Fenton, G.W., Cognitive therapy analytic psychotherapy and anxiety management training for generalized anxiety disorder. Brit J Psychiatry 1994;165:315–23.CrossRefGoogle Scholar
Enkelmann, R., Alprazolam versus buspirone in the treatment of outpatients with generalized anxiety disorder. Psychopharmacology 1991;105:428–32.CrossRefGoogle ScholarPubMed
Feighner, J.B., Buspirone in the long-term treatment of generalized anxiety disorder. J Clin Psychiatry 1987;48(Suppl 12):3-6.Google ScholarPubMed
Feighner, J.B., Cohn, J.B., Analysis of individual symptoms in generalized anxiety: a pooled multistudy double blind evaluation of buspirone. Neuropsychobiology 1989;21:124–30.CrossRefGoogle ScholarPubMed
Ferreri, M., Hantouche, E., Billardon, M., Advantages of hydroxyzine in generalized anxiety disorder: a double blind controlled versus placebo study. L’Encephale 1994;20:785–91.Google Scholar
Figueira, M.L., Alprazolam ER in the treatment of generalized anxiety: a multicentre controlled study with bromazepam. Hum Psychopharmacol Clin Exp 1999;14:171–7.3.0.CO;2-7>CrossRefGoogle Scholar
Fisher, P.L., Durham, R.C., Recovery rates in generalized anxiety disorder following psychological therapy: an analysis of clinically significant change in the STAI-T across outcome studies since 1990. Psychol Med 1999;29:1425–34.CrossRefGoogle ScholarPubMed
Floyd, M., McKendree-Smith, N., Stump, J., Scogin, F., Bowman, D., Two-year follow-up of self examination therapy for generalized anxiety disorder. J Anxiety Disord 2002;16(4):369–75.CrossRefGoogle ScholarPubMed
Gelenberg, A.J., Lydiard, R.B., Rudolph, R.L., Aguiar, L., Haskins, J.T., Salinas, E., Efficacy of venlafaxine extended-release capsules in non depressed outpatients with generalized anxiety disorder. A 6 month randomized controlled trial. JAMA 2000;283:3082–8.CrossRefGoogle Scholar
Goisman, R.M., Warsham, M.G., Keller, M.B., Psychosocial treatment prescriptions for generalized anxiety disorder panic disorder and social phobia 1991-1996. Am J Psychiatry 1999;156(11):1819–21.Google ScholarPubMed
Hedges, D.W., Reimherr, F.W., Strong, R.E., Halls, C.H., Rust, C., An open trial of nefazodone in adult patients with GAD. Psychophammacol Bull 1996;32:671–6.Google Scholar
Hoehn-Saric, R., Me Leod, D.R., Zimmerli, W.D., Differential effects of alprazolam and imipramine in generalized anxiety disorder: somatic versus psychic symptoms. J Clin Psychiatry 1988;49:293-301.Google ScholarPubMed
Kahn, R.J., Me Nair, D.M., Lipman, R.S., Covi, L., Rickels, K., Downing, R., et al. Imipramine and chlordiazepoxide in depressive and anxiety disorders II: efficacy in anxious outpatients. Arch Gen Psychiatry 1986;43:79-85.CrossRefGoogle ScholarPubMed
Katz, I.R., Reynolds, C.F.I., Alexopoulos, G.S., Hackett, D., Venlafaxine (ER) as a treatment for generalized anxiety disorder in older adults: a pooled analysis of 5 randomized placebo controlled clinical trials. J Am Genat Soc 2002;50:18-25.CrossRefGoogle ScholarPubMed
Keller, M.B., Raising the expectations of long term treatment strategies in anxiety disorders. Psychopharmacol Bull 2002;36(Suppl 2): 166–74.Google ScholarPubMed
Kessler, R.C., Me Gonagle, K.A., Zhao, K.A., Nelson, C.R., Hughis, M., Eshlenan, , et al. Lifetime and 12 month prevalence of DSM-III-R psychiatric disorders in the USA: results from the National Comorbidity Survey. Arch Gen Psychiatry 1994;51:8-19.CrossRefGoogle Scholar
Klein, E., Colin, V., Stolk, J., Lennox, R.H., Alprazolam withdrawal in patients with panic disorder and generalizad anxiety disorder: vulnerability and effect of carbamazepine. Am J Psychiatry 1994; 151:1760–6.Google Scholar
Kupfer, D.J., Franek, E., The interaction of drug and psychotherapy in the Long temm treatment of depression. J Affeetive Disord 2001;62:131–7.CrossRefGoogle Scholar
Lader, M., Seotto, J.C., A multicentre double blind comparison of hydroxyzine baspirone and placebo in patients with generalizad anxiety disorder. Psychopharmacology 1998;139:402–6.CrossRefGoogle Scholar
La Douceur, R., Dugas, M.J., Freeston, M.H., Leger, E., Gagnont, F., Thibodeau, N., Efficacy of a cognitive-behavioral treatment for generalized anxiety disorder: evaluation in a controlled clinical trial. J Consult Clin Psychol 2000;68:957–65.CrossRefGoogle Scholar
Léger, E., La Douceur, R., Dugas, M.J., Freeston, M.H., Cognitive behavioral treatment of generalizad anxiety disorder among adolescents: a case series. J Am Acad Child Adolesc Psychiatry 2003;42(3):327–30.CrossRefGoogle Scholar
Llorca, P.M., Spadone, C., Sol, O., Danniau, A., Bougerol, T., Corruble, E., et al. Efficacy and safety of hydroxyzine in the treatment of generalizad anxiety disorder: a 3 months double blind study. J Clin Psychiatry 2002;63:1020–7.CrossRefGoogle Scholar
Maier, W., Gaensicke, M., Freyberger, H.J., Linz, M., Lecrubier, Y., Generalized anxiety disorder (I.C.D.10) in primary cure from a cross cultural perspective. A valid diagnostic entity? Acta Psychiat Scand 2000;101:29-36.CrossRefGoogle Scholar
Manassis, K., Mendlowitz, S.L., Scapillato, D., Avery, D., Fiksenbauml, L., Freire, M., et al. Group and individual cognitive-behavioral therapy for chilhoud anxiety disorders: a randomized trial. J Am Acad Child Adolesc Pschiatry 2002;41:1423–30.CrossRefGoogle ScholarPubMed
Mohlman, J., Gorenstein, E.E., Kleber, M., De Jesus, M., Gorman, J.M., Papp, L.A., Standard and enhanced cognitive-behavior therapy for latelife generalizad anxiety disorder: two pilot investigations. Am J Geriatr Psychiatry 2003; 11(1):24-32.Google Scholar
Möller, H.J., Volz, H.P., Reimann, I.W., et al. Opipramol for the treatment of generalizad anxiety disorder: a placebo controlled trial including an alprazolam-treatment group. J Clin Psychopharmacol 2001; 21:59-65.CrossRefGoogle Scholar
Montgomery, S.A., Sheehan, D.V., Meoni, P., Haudiquet, V., Hackett, D., Characterization of the longitudinal course of improvement in generalized anxiety disorder during long term treatment with venlafaxi-ne XRJ. Psychiatry Res 2002;36(3):209–17.CrossRefGoogle Scholar
Morselli, P.L., On the therapeutic action of alpidem in anxiety disorders: an overview of European data. Pharmacopsychiatry 1990; 23(Suppl): 129–34.CrossRefGoogle ScholarPubMed
Murphy, S.M., Owen, R., Tyrer, P., Comparative assessment of efficacy and withdrawal symptoms after 6 and 12 weeks treatment with diazepam or buspirone. Br J Psychiatry 1989;154:529–34.CrossRefGoogle ScholarPubMed
Ninan, PT., Dissolving the barden of generalizad anxiety disorder. J Clin Psychiatry 2001;62(Suppl 19):5-10.Google Scholar
Pande, A.C., Crockatt, J.G., Feltner, D.E., Janney, C.A., Smith, W.T., Weisler, R., et al. Pregabalin in generalizad anxiety disorder: a placebocon-trolled trial. Am J Psychiatry 2003;160(3):533–40.CrossRefGoogle Scholar
Pelissolo, A., Andre, C., Chignon, J.M., Dutoit, D., Martin, P., Richard-Berthe, C., et al. Anxiety disorders in private practice psychiatric outpatients: prevatence comorbidity and barden. L’Encephale 2002; 28:510–9.Google Scholar
Pollack, M.H., Zaninelli, R., Godard, A., Me Cafferty, J.P., Bellew, K.M., Burnham, D.B., et al. Paroxetine in the treatment of generalizad anxiety disorder: results of a placebo-controlled flexible dos age trial. J Clin Psychiatry 2001;62:350–7.CrossRefGoogle Scholar
Power, K.G., Simpson, R.J., Swanson, V., Wallace, L.A., (a) Controlled comparison of pharmacological and psychological treatment of generalized anxiety disorder in primary care. Brit J Gen Pract 1990;40:289–94.Google ScholarPubMed
Power, K.G., Simpson, R.J., Swanson, V., Wallace, L.A., Feistner, A.T.C., Sharp, DA., A controlled comparison of cognitive-behaviour therapy diazepam and placebo alone and in combination for the treatment of generalizad anxiety disorder. J Anxiety Disord 1990;4:267–92.CrossRefGoogle Scholar
Rakel, RE., Long-term buspirone therapy for chronic anxiety: a multicenter international study to determine safety. South Med J 1990; 83(2): 195–8.CrossRefGoogle Scholar
Rickels, K., Case, W.G., Downing, R.W., Winokur, A., Long term diazepam therapy and clinical outcome. JAMA 1983;250:767–71.CrossRefGoogle ScholarPubMed
Rickels, K., Downing, R., Schweizer, E., Hassman, H., Antidepressants for the treatment of generalized anxiety disorder: a placebo controlled comparison of imipramine, trazodone and diazepam. Arch Gen Psychiatry 1993;50:884–95.CrossRefGoogle ScholarPubMed
Rickels, K., Schweizer, E., Canalosi, I., Case, W.G., Chung, H., Long term treatment of anxiety and risk of withdrawal: a prospective comparison of clorazepate and buspirone. Arch Gen Psychiatry 1988;45: 445–50.CrossRefGoogle ScholarPubMed
Rickels, K., Rynn, M., Pharmacotherapy of generalizad anxiety disorder. J Clin Psychiatry 2002;63(Suppl 14):9-16.Google Scholar
Rocca, P., Fonzo, V., Scotta, M., Zanalda, E., Ravizza, L., Paroxetine efficacy in the treatment of GAD. Acta Psychiatr Scand 1997;95(5): 445–50.CrossRefGoogle Scholar
RUPPASG (Research Unit on Pediatric Psychopharmacology Anxiety Study Group). Fluvoxamine for the treatment of anxiety disorders in children and adolescents. Engl J Med 2001 ;344:1279–85.CrossRefGoogle Scholar
Rynn, M.A., Siqueland, L., Rickels, K., Placebo-controlled trial of sertraline in the children with GAD. Am J Psychiatry 2001;158:2008–14.CrossRefGoogle Scholar
Schweizer, E., Rickels, K., The long-term management of generalized anxiety disorder: issues and dilemmas. J Clin Psychiatry 1996; 57(Suppl 7):9-12.Google ScholarPubMed
Shader, R.I., Greenblatt, DJ., Use of benzodiazepines in anxiety disorders. N Engl J Med 1993;328:1398-405.Google ScholarPubMed
Shader, R.I., Greenblatt, D.J., Use of benzodiazepines in anxiety disorders. N Engl J Med 1993;328:1398-405.Google ScholarPubMed
Sheehan, D.V., Raj, A.B., Harnett-Sheehan, K., Soto, S., Knapp, E., The relative efficacy of high-dose buspirone and alprazolamin the treatment of panic disorder: a double-blind placebo-controlled study. Acta Psychiatr Scand 1993;89:1-11.CrossRefGoogle Scholar
Stocchi, F., Nordera, G., Jokinen, R., et al. Efficacy and tolerability of paroxetine for the long-term treatment of generalizad anxiety disorder. J Clin Psychiatry 2003;64:250–8.CrossRefGoogle Scholar
Varia, I., Rauscher, F., Treatment of generalizad anxiety disorder with citalopram. Int Clin Psychopharmacol 2002;17(3):103–7.CrossRefGoogle Scholar
Westen, D., Morrison, K., A multidimensional meta analysis of treatments for depression, panic and generalized anxiety disorder: an empirical examination of the status of empirically supported therapies. J Consult Clin Psychol 2001;69:875–99.CrossRefGoogle ScholarPubMed
Wetherell, J.L., Gatz, M., Craske, M.G., Treatment of generalized anxiety disorder in older adults. J Consult Clin Psychol 2003; 71 (1):31-40.CrossRefGoogle ScholarPubMed
Wittchen, H.U., Kessler, R.C., Pfister, H., Lieb, M., Why do people with anxiety disorders become depressed? A prospective longitudinal community study. Acta Psychiatr Stand 2000;102(Suppl 406): 14-23.CrossRefGoogle Scholar
Yonkers, K.A., Warshaw, M., Massion, A.O., Keller, M.B., Phenomenology and course of generalized anxiety disorder. Br J Psychiatry 1996;168:308–11.CrossRefGoogle Scholar
Yonkers, K.A., Dick, I.R., Warshaw, M., Keller, M.B., Factors predicting the clinical course of generalizad anxiety disorder. Brit J Psychiatry 2000;176:544–9.CrossRefGoogle Scholar