The definition of treatment resistance in anxiety disorders: a Delphi method-based consensus guideline,World Psychiatry

当前位置： X-MOL 学术 › World Psychiatry › 论文详情

Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)

The definition of treatment resistance in anxiety disorders: a Delphi method-based consensus guideline
World Psychiatry ( IF 60.5 ) Pub Date : 2024-01-12 , DOI: 10.1002/wps.21177
Katharina Domschke ₁ , Patrik D Seuling ₁ , Miriam A Schiele ₁ , Borwin Bandelow ₂ , Neeltje M Batelaan ₃ , Wicher A Bokma ₃ , Igor Branchi ₄ , Karl Broich ₅ , Julius Burkauskas ₆ , Simon J C Davies _{7,

8} , Bernardo Dell'Osso _{9,

10} , Harry Fagan _{11,

12} , Naomi A Fineberg ₁₃ , Toshi A Furukawa ₁₄ , Stefan G Hofmann ₁₅ , Sean Hood ₁₆ , Nathan T M Huneke _{11,

12} , Milan Latas _{17,

18} , Nicky Lidbetter ₁₉ , Vasilios Masdrakis ₂₀ , R Hamish McAllister-Williams _{21,

22} , Antonio E Nardi ₂₃ , Stefano Pallanti _{24,

25} , Brenda W J H Penninx ₃ , Giampaolo Perna ₂₆ , Steve Pilling ₂₇ , Stefano Pini ₂₈ , Andreas Reif _{29,

30} , Soraya Seedat ₃₁ , Gemma Simons _{11,

32} , Shrikant Srivastava ₃₃ , Vesta Steibliene ₃₄ , Dan J Stein ₃₅ , Murray B Stein ₃₆ , Michael van Ameringen ₃₇ , Anton J L M van Balkom ₃ , Nic van der Wee _{38,

39} , Peter Zwanzger _{40,

41} , David S Baldwin _{11,

12,

35}

Affiliation

Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Department of Psychiatry and Psychotherapy, University Medical Center, Göttingen, Germany.
Department of Psychiatry and Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, The Netherlands.
Center for Behavioral Sciences and Mental Health, Istituto Superiore di Sanità, Rome, Italy.
Federal Institute for Drugs and Medical Devices, Bonn, Germany.
Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga, Lithuania.
Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
Centre for Addiction and Mental Health, Toronto, ON, Canada.
Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy.
Department of Mental Health and Addictions, ASST Fatebenefratelli-Sacco, Milan, Italy.
Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
Southern Health NHS Foundation Trust, Southampton, UK.
University of Hertfordshire & Hertfordshire Partnership, University NHS Foundation Trust, Hatfield, UK.
Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan.
Department of Clinical Psychology, Philipps University Marburg, Marburg, Germany.
Division of Psychiatry, Medical School, University of Western Australia, Perth, WA, Australia.
Clinic for Psychiatry, University Clinical Center of Serbia, Belgrade, Serbia.
Belgrade University School of Medicine, Belgrade, Serbia.
Anxiety UK, Manchester, UK.
First Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
Translational and Clinical Research Institute, Newcastle University, Newcastle, UK.
Cumbria, Northumberland, Tyne & Wear NHS Foundation Trust, Newcastle, UK.
Panic & Respiration Laboratory, Institute of Psychiatry, Medical School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
Institute of Neuroscience, Florence, Italy.
Albert Einstein College of Medicine, New York, NY, USA.
Department of Biological Sciences, Humanitas University, Milan, Italy.
Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational & Health Psychology, University College London, London, UK.
University of Pisa School of Medicine, Pisa, Italy.
Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University Frankfurt, Frankfurt am Main, Germany.
Fraunhofer Institute for Translational Medicine and Pharmacology, Frankfurt am Main, Germany.
Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Solent NHS Trust, Southampton, UK.
Geriatric Mental Health, King George's Medical University, Lucknow, India.
Neuroscience Institute and Clinic of Psychiatry, Faculty of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania.
South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa.
Department of Psychiatry and School of Public Health, University of California San Diego, San Diego, CA, USA.
Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands.
Leiden Institute for Brain and Cognition, Leiden, The Netherlands.
Clinical Center for Psychiatry, Psychotherapy and Psychosomatic Medicine, Kbo-Inn-Salzach Hospital, Wasserburg am Inn, Germany.
Department of Psychiatry and Psychotherapy, Ludwigs-Maximilians-University Munich, Munich, Germany.

Anxiety disorders are very prevalent and often persistent mental disorders, with a considerable rate of treatment resistance which requires regulatory clinical trials of innovative therapeutic interventions. However, an explicit definition of treatment-resistant anxiety disorders (TR-AD) informing such trials is currently lacking. We used a Delphi method-based consensus approach to provide internationally agreed, consistent and clinically useful operational criteria for TR-AD in adults. Following a summary of the current state of knowledge based on international guidelines and an available systematic review, a survey of free-text responses to a 29-item questionnaire on relevant aspects of TR-AD, and an online consensus meeting, a panel of 36 multidisciplinary international experts and stakeholders voted anonymously on written statements in three survey rounds. Consensus was defined as ≥75% of the panel agreeing with a statement. The panel agreed on a set of 14 recommendations for the definition of TR-AD, providing detailed operational criteria for resistance to pharmacological and/or psychotherapeutic treatment, as well as a potential staging model. The panel also evaluated further aspects regarding epidemiological subgroups, comorbidities and biographical factors, the terminology of TR-AD vs. “difficult-to-treat” anxiety disorders, preferences and attitudes of persons with these disorders, and future research directions. This Delphi method-based consensus on operational criteria for TR-AD is expected to serve as a systematic, consistent and practical clinical guideline to aid in designing future mechanistic studies and facilitate clinical trials for regulatory purposes. This effort could ultimately lead to the development of more effective evidence-based stepped-care treatment algorithms for patients with anxiety disorders.

中文翻译：

焦虑症治疗抵抗的定义：基于 Delphi 方法的共识指南

焦虑症非常普遍，而且往往是持续性的精神障碍，具有相当大的治疗耐药率，这需要对创新治疗干预进行监管临床试验。然而，目前缺乏对难治性焦虑症（TR-AD）的明确定义，为此类试验提供信息。我们使用基于 Delphi 方法的共识方法为成人 TR-AD 提供国际公认的、一致且临床有用的操作标准。在根据国际指南和可用的系统评价总结了当前知识状况，对关于 TR-AD 相关方面的 29 项问卷的自由文本回答进行了调查，并举行了在线共识会议，一个由 36 名多学科国际专家和利益相关者组成的小组在三轮调查中对书面声明进行了匿名投票。共识被定义为 ≥75% 的专家组同意某项声明。该小组就 TR-AD 定义的 14 项建议达成一致，为药物和/或心理治疗耐药性提供了详细的操作标准，以及潜在的分期模型。该小组还评估了有关流行病学亚组、合并症和传记因素、TR-AD 与“难以治疗”焦虑症的术语、患有这些疾病的人的偏好和态度以及未来研究方向的进一步方面。这种基于 Delphi 方法的 TR-AD 操作标准共识有望作为系统、一致和实用的临床指南，以帮助设计未来的机制研究并促进用于监管目的的临床试验。这项工作最终可能导致为焦虑症患者开发更有效的循证阶梯式护理治疗算法。

更新日期：2024-01-17

点击分享查看原文

点击收藏

公开下载

阅读更多本刊新发论文本刊介绍/投稿指南