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El tratamiento de los trastornos de ansiedad: un legado de William Sargant

Published online by Cambridge University Press:  12 May 2020

M. G. Gelder*
Affiliation:
Departamento Universitario de Psiquiatría, Hospital Warneford, OxfordOX3 7JX, Reino Unido
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Resumen

En 1962, William Sargant y sus colaboradores describieron el valor terapéutico de la fenelzina, un inhibidor de la monoamino oxidasa (IMAO), en los trastornos de ansiedad crónicos y, en el mismo año, Klein y Fink comunicaron el tratamiento de condiciones similares con imipramina, un antidepresivo tricíclico. La investigación posterior ha confirmado estos resultados y ha demostrado la variedad de productos similares que son efectivos en los trastornos de ansiedad. En la época de estas observaciones originales sobre el tratamiento farmacológico de la ansiedad, no había tratamientos psicológicos de valor probado, pero en los años que han transcurrido se han hecho muchos progresos en el desarrollo de los procedimientos conductuales y cognitivos. Se revisan los progresos al determinar el modo de acción de estos tratamientos farmacológicos y psicológicos, y se consideran las implicaciones de los resultados en relación con la investigación sobre las causas de los trastornos de ansiedad y con el tratamiento de los pacientes.

Type
Artículo original
Copyright
Copyright © European Psychiatric Association 1998

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References

Bibliografía

Andersch, SRosenberg, NKKullingsjo, H Ottosson J-O, Bech, PBruunberg, R.Efficacy and safety of alprazolam, imipramine and placebo in treating panic disorder. A Scandinavian multicenter study. Acta Psychiatr Scancl 1991; 365 (suppl): 18-27.CrossRefGoogle ScholarPubMed
Angst, JDobler-Mikola, ABinder, JThe Zurich Study: a prospective epidemiological study of depressive neurotic and psychosomatic syndromes. Eur Arch Psychiatry Neurol Sci 1984; 234: 13-20.CrossRefGoogle ScholarPubMed
Amtz, Avan den Hout, M.Psychological treatments of panic disorder without agoraphobia: cognitive therapy versus applied relaxation. Behav Res Ther 1996; 34: 113-21.Google Scholar
Beaudry, PFontaine, DChouinard, Get al.Bromazepam, another high potency benzodiazepine for panic attacks. Am J Psychiatry 1984; 141: 464-5.Google ScholarPubMed
Beck, ATLaude, RBohnert, MIdeational components of anxiety neurosis. Arch Gen Psychiatry 1974; 31: 319-25.CrossRefGoogle ScholarPubMed
Beck, ATSokol, LClark, DABerchik, BWright, FFocused cognitive therapy for panic disorder: a crossover design and one year follow-up. Am J Psychiatry 1992; 147: 778-83.Google Scholar
Black, DWWesner, RBowers, WGabel, J.A comparison of fluvoxamine, cognitive therapy and placebo in the treatment of panic disorder. Arch Gen Psychiatry 1993; 50; 44-50.CrossRefGoogle ScholarPubMed
Bradwejn, JKoszycki, D Couetoux du Tertre, A van Megen, MD den Boer, JWestenberg, HAnnable, LThe panicogenic effects of choleocystokinin tetrapeptide are antagonized by L-365, 260, a central choleocystokinin receptor antagonist, in patients with panic disorder. Arch Gen Psychiatry 1994; 51: 486-93.CrossRefGoogle Scholar
Butler, GFennell, MJVRobson, PGelder, MGComparison of behaviour therapy and cognitive behaviour therapy in the treatment of generalized anxiety disorder. J Consult Clin Psychol 1991; 59: 167-75.CrossRefGoogle ScholarPubMed
Cassano, GBPetracca, A Pergugi G et al.Clomipramine for panic disorder: I The first 10 weeks of a long-term comparison with imipramine. J Affect Disord 1988; 14: 123-7.CrossRefGoogle ScholarPubMed
Charney, DSHeninger, GRBreier, ANoradrenergic function in panic anxiety. Arch Gen Psychiatry 1984; 41: 751-83.CrossRefGoogle ScholarPubMed
Charney, DSWoods, SWGoodman, WKet al.Drug treatment of panic disorder: the comparative efficacy of imipramine, alprazolam and trazodone. J Clin Psychiatry 1986; 47; 850-6.Google ScholarPubMed
Charney, DSWoods, SWBenzodiazepine treatment of panic disorder: a comparison of alprazolam and lorazepam. J Clim Psychiatry 989; 50: 418-23.Google Scholar
Clark, DMA cognitive approach to panic. Behav Res Ther 1986; 23: 585-600.Google Scholar
Clark, DMSalkovskis, PMHackmann, AMiddleton, HAnastasiades, PGelder, MGA comparison of cognitive therapy, applied relaxation and imipramine in the treatment of panic disorder. Br J Psychiatr y 1994; 164: 759-69.CrossRefGoogle ScholarPubMed
Clark, DMWells, A.A cognitive model of social phobia. In: Heimberg, RLiebowitz, MHope, DASchneier, FR, eds. Social phobia : diagnosis, assessment and treatment. New York: Guilford Press, 1995.Google Scholar
Cross-National Collaborative Panic Study. Drug treatment of panic disorder: comparative efficacy of alprazolam, imipramine, and placebo. Br J Psychiatry 1992; 160: 191-202.CrossRefGoogle Scholar
Deakin, JW Graeff. Psychology, 5-HT and mechanisms of defence. J Psychopharmacol 1991; 5: 305-15.CrossRefGoogle Scholar
den Boer, JAWestenberg, HGMEffects of a serotonin uptake inhibitor in panic disorder: a double blind comparative study with fluvoxamine and maprotiline. Int J Clin Psychopharmacol 1988; 3: 59-74.CrossRefGoogle Scholar
Dunner, DLIshiki, DAvery, DHet al.Effect of alprazolam and diazepam on anxiety and panic attacks in panic disorder: a controlled study. J Clin Psychiatry 1986; 47: 458-60.Google ScholarPubMed
Durham, RMurphy, TAlian, TRichard, KTreliving, LRFenton, GWCognitive therapy, analytic psychotherapy and anxiety management training for generalized anxiety disorder. Br J Psychiatry 1994; 165: 315-23.CrossRefGoogle Scholar
Durham, RCTurvey, AACognitive therapy vs behaviour therapy in the treatment of chronic generalized anxiety. Behav Res Ther 1987; 25: 229-34.Google Scholar
Fahy, TJO’Rourke, DBrophy, JSchazmann, WSciascia, SThe Galway study of panic disorder: a placebo controlled atrial. J Affect Disord 1992; 25: 63-76.CrossRefGoogle Scholar
Fyer, AJMannuzza, SChapman, TFMartin, LYKlein, DFSpecificity in familial aggregation of phobic disorders. Arch Gen Psychiatry 1995; 52: 564-73.CrossRefGoogle ScholarPubMed
Gelernter, CSUhde, TWCimbolic, PArnkoff, DBVittone, BJTancer, MEBartko, JJCognitive-behavioural and pharmacological treatment of social phobia. Arch Gen Psychiatiy 1991; 48: 938-45.CrossRefGoogle Scholar
Gentil, V Lotufo-Neto, FAndrade, LCordas, TBernik, M Ramos R et al.Clomipramine, a better reference drug for panic/agoraphobia. I Effectiveness comparison with imipramine. J Psychopharmacol 1993; 7: 316-24.‘CrossRefGoogle ScholarPubMed
Gorman, JMAskanazi, JLiebowitz, MRFyer, AJStein, JKinney, JMKlein, DFResponse to hyperventilation in a group of patients with panic disorder. Am J Psychiatry 1984; 141: 857-61.Google Scholar
Gorman, JMLiebowitz, MRFyer, AJGoetz, DCampeas, RB Fyer MR et al.An open trial of fluoxetine in the treatment of panic attacks. J Clin Psychopharmacol 1987; 7: 329-32.Google ScholarPubMed
Hoehn-Saric, RMcLeod, DRZimmerlin, WDDifferential effects of alprazolam and imipramine in generalized anxiety disorder: somatic versus psychic symptoms. J Clin Psychiatry 1988; 49: 293-301.Google Scholar
Kahn, RJMcNair, DMLipman, RSCovi, LRickels, 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
Katzelnick, DJKoback, KAGreist, JHJefferson, JWMantle, JMSerlin, RCSertraline for social phobia: a double blind placebo controlled crossover study. Am J Psychiatry 1995; 152: 1368-71.Google ScholarPubMed
Kendler, KNeale, M Kessler R et al.Generalized anxiety disorder in women: a population based twin study. Arch Gen Psychiatry 1992; 49: 267-72.CrossRefGoogle ScholarPubMed
Klein, DFFink, MPsychiatric reaction patterns to imipramine. Am J Psychiatry 1962; 119: 432-8.CrossRefGoogle ScholarPubMed
Klerman, GLOver View of the cross-national collaborative panic study. Arch Gen Psychiatry 1988; 45: 407-12.CrossRefGoogle Scholar
Liebowitz, MRFyer, AJGorman, JMDillon, DDavies, S Stein JM et al.Specificity of lactate infusions in social phobia versus panic disorders. Am J Psychiatry 1985; 142: 947-50.Google ScholarPubMed
Liebowitz, MRSchneier, FCampeas, RHollander, EHatterer, JFyer A et al.Phenelzine vs atenolol in social phobia. A placebo controlled comparison. Arch Gen Psychiatry 1992; 49: 290-300.CrossRefGoogle ScholarPubMed
Margraf, JSchneider, S. Outcome and active ingredients of cognitive behavioural treatments for panic disorder. Paper present at the Annual Conference of Association for Advancement of Behaviour Therapy, New York 1991.Google Scholar
Marks, IMGelder, MGDifferent ages of onset of varieties of phobia. Br J Psychiatry 1966; 123: 218-21.Google ScholarPubMed
Noyes, R Jr, Anderson, DJClancy, Jet al.Diazepam and propanolol in panic disorder and agoraphobia. Arch Gen Psychiatry 1984; 41: 287-92.CrossRefGoogle ScholarPubMed
Nutt, DJGlue, PLawson, CWilson, SFlumazenil provocation of panic attacks. Arch Gen Psychiatry 1990; 47: 917-25.CrossRefGoogle ScholarPubMed
Ottaviani, RBeck, ATCognitive aspects of panic disorders. J Anxiety Disord 1987; 1: 15-28.CrossRefGoogle Scholar
Öst, LGWestling, B.Applied relaxation vs cognitive therapy in the treament of panic disorder. Behav Res Ther 1995; 33; 145-58.Google Scholar
Pitts, FNMcClure, JN.Lactate metabolism in anxiety neurosis. New Engl J Med 1967; 277; 1328-36.CrossRefGoogle ScholarPubMed
Power, KGJerrom, DWASimpson, RJMitchell, MJSwanson, VA controlled comparison of cognitivebehaviour therapy, diazepam and placebo in the management of generalised anxiety disorder. Behav Psychother 1989; 17: 1-4.CrossRefGoogle Scholar
Power, KGSimpson, RJSwanson, VWallace, LA Feistner ATC, Sharp, DA controlled comparison of cognitive behaviour therapy, diazepam, and placebo, alone and in combination for the treatment of generalized anxiety disorder. J Anxiety Disord 1990; 4: 267-93.CrossRefGoogle Scholar
Rapee, RMattick, RMurrell, ECognitive mediation in the affective component of spontaneous panic attacks. J Behav Ther Exp Psychiatry 1986; 17: 245-53.CrossRefGoogle ScholarPubMed
Rickels, KDowning, RSchweizer, EHassman, HAntidepressants for the treatment of generalized anxiety disorder. Arch Gen Psychiatry 1993; 50: 884-95.CrossRefGoogle ScholarPubMed
Sargant, WDaily, PTreatment of anxiety States by antidepressant drugs. Br Med J 1962; 1: 6-9.CrossRefGoogle ScholarPubMed
Sargant, WAim and method in treatment: twenty years of British and American psychiatry. J Ment Sci 1957; 103: 699-709.CrossRefGoogle ScholarPubMed
Schweizer, ERickels, KWeiss, SZavodnick, SMaintenance drug treatment of panic disorder. Arch Gen Psychiatry 1993; 50: 51-60.CrossRefGoogle ScholarPubMed
Sheehan, DVBallenger, JJacobsen, GTreatment of endogenous anxiety with phobic, hysterical and hypochondriacal symptoms. Arch Gen Psychiatry 1980; 37: 51-9.CrossRefGoogle ScholarPubMed
Tesar, GERosenbaum, JFPollack, MHet al.Clonazepam vs alprazolam in the treatment of panic disorder: interim analysis of data from a prospective double-blind placebo-controlled trial. J Clin Psychiatry 1984; 48 (suppl 11): 16-9.Google Scholar
Van der Molen, GM van den Hout, MAVroemen, JLousberg, HGriez, E. Cognitive determinants of lactate- induced anxiety. Behav Res Ther 1986; 24: 67780.CrossRefGoogle Scholar
van Vliet, IM den Boer, JAWestenberg, HGMPsychopharmacological treatment of social phobia: a double blind placebo controlled study with fluvoxamine. Psychopharmacology 1994; 115: 128-34.CrossRefGoogle ScholarPubMed
Versiani, MNardi, AEMundim, FDAlves, ABLiebowitz, MRAmrein, RPharmacotherapy of social phobia. A controlled study with moclobemide and phenelzine. Br J Psychiatry 1992; 161: 353-60.CrossRefGoogle ScholarPubMed
Woods, SWCharney, DSGoodman, WKHeninger, GRCarbon dioxide-induced anxiety. Arch Gen Psychiatry 1988; 45: 43-52.Google ScholarPubMed
Zitrin, CMKlein, DFWoerner, MGet al.Treatment of phobias I: Comparison of imipramine hydrochloride and placebo. Arch Gen Psychiatry 1983; 40: 125-38.CrossRefGoogle ScholarPubMed