Am J Psychiatry：高剂量抗抑郁药联合CBT治疗老年广泛性焦虑障碍

　　广泛性焦虑障碍在老年人群中十分常见，可对患者的健康及认知功能造成损害。尽管使用抗抑郁药治疗广泛性焦虑障碍是有效的，但许多老年患者要求进行强化治疗。此外，医学界对老年患者的维持治疗方案的了解仍十分有限。

　　近期《美国精神病学杂志》（The American Journal of Psychiatry）网络版登载的一篇研究的结果显示，高剂量抗抑郁药联合CBT可在短期内缓解病人忧虑情绪，连续用药可预防其复发。但研究者同时也指出，对许多患者来说，单纯使用CBT即可起到持续的缓解作用。

　　研究对老年广泛性焦虑障碍治疗的有效方案进行了演示，对序贯疗法联合药物及认知行为疗法（CBT）是否会增强对老年广泛性焦虑障碍患者的治疗效果及是否可防止焦虑障碍复发进行了评估。

　　共有73名年龄不小于60岁的广泛性焦虑障碍患者参与研究。参与者来自于三家不同的诊所。此次研究为开放性研究，首先，参与者接受了为期12周的艾司西酞普兰治疗。随后被随机指分配加入四种不同治疗方案：艾司西酞普兰（10-20mg/d）加模块化CBT16周，艾司西酞普兰维持治疗28周；艾司西酞普兰单独治疗，艾司西酞普兰维持治疗；艾司西酞普兰加CBT，接安慰剂；及艾司西酞普兰单独治疗，接安慰剂。

　　研究发现，高剂量艾司西酞普兰联合CBT与艾司西酞普兰单独疗法相比，增强了宾州忧虑问卷的响应率，但未增加汉密尔顿焦虑量表响应率。与安慰剂相比，艾司西酞普兰和CBT均可有效预防广泛性焦虑障碍的复发。

Antidepressant Medication Augmented With Cognitive-Behavioral Therapy for Generalized Anxiety Disorder in Older Adults
Objective 
Generalized anxiety disorder is common among older adults and leads to diminished health and cognitive functioning. Although antidepressant medications are efficacious, many elderly individuals require augmentation treatment. Furthermore, little is known about maintenance strategies for older people. The authors examined whether sequenced treatment combining pharmacotherapy and cognitive-behavioral therapy (CBT) boosts response and prevents relapse in older adults with generalized anxiety disorder.
Method 
Participants were individuals at least 60 years of age with generalized anxiety disorder (N=73) who were recruited from outpatient clinics at three sites. Participants received 12 weeks of open-label escitalopram and were then randomly assigned to one of four conditions: 16 weeks of escitalopram (10–20 mg/day) plus modular CBT, followed by 28 weeks of maintenance escitalopram; escitalopram alone, followed by maintenance escitalopram; escitalopram plus CBT, followed by pill placebo; and escitalopram alone, followed by placebo.
Results 
Escitalopram augmented with CBT increased response rates on the Penn State Worry Questionnaire but not on the Hamilton Anxiety Rating Scale compared with escitalopram alone. Both escitalopram and CBT prevented relapse compared with placebo.
Conclusions 
This study demonstrates effective strategies for treatment of generalized anxiety disorder in older adults. The sequence of antidepressant medication augmented with CBT leads to worry reduction in the short-term. Continued medication prevents relapse, but for many individuals, CBT would allow sustained remission without requiring long-term pharmacotherapy.