العلاج المسند بالبرهان لاضطراب القلق المتعمم

الملخص EN

Generalized anxiety disorder (gad) is a common anxiety disorder that affects about 5% of adults in primary care.

the essential feature of this condition is chronic anxiety and worry that is out of proportion with life stressors.

it follows a chronic course with exacerbations at times of stress.

drug treatment of gad is based on evidence derived from randomized controlled trials of selective serotonin inhibitors (SSRIS), selective serotonin and noradrenaline inhibitors (SNRIS), the calcium channel modulator drug pregablin and the azapirone buspirone.

among the SSRIS, the strongest evidence for the treatment of gad is for escitalopram, sertraline and paroxetine.

the SNRIS venlafaxine and duloxetine are effective in treating gad.

there is also evidence for the efficacy of the antihistamine hydroxyzine, but excessive sedation limits its use.

other drugs having evidence for efficacy include the antipsychotic quetiapine and several benzodiazepine derivatives.

because of the chronic nature of gad, the use of benzodiazepine derivatives raises issues of tolerance, dependence and withdrawal reactions.

practically, it is advisable to start with an antidepressant and to continue the treatment for 18 months if there was a response.

otherwise, pregablin, buspirone or quetiapine may be added as augmentation, or prescribed as monotherapy.

drug treatment of gad usually involves considering psychological therapies.

counselling or supportive psychotherapy should always be provided.

there is a sound evidence-basee for the use of cognitive behavioural therapy (CBT) in the treatment of gad.

CBT remains effective if provided through the internet.

the choice between drugs and psychotherapy depends on patient preference and treatment availability.

drugs and psychotherapy may be used in combination.