Diagnostik und Therapie der Generalisierten Angststörung (GAS)

1. Einleitung

Die Generalisierte Angststörung (GAS) stellt mit einer geschätzten Lebenszeitprävalenz von bis zu 5 % eine wichtige psychiatrische Störung dar. Der Verlauf ist eher chronisch, eine hohe Komorbidität mit anderen Angsterkrankungen bzw. Depressionen ist charakteristisch. Es besteht eine zum Teil erhebliche psychosoziale Beeinträchtigung der Patienten mit einer hohen Inanspruchnahme des primärärztlichen Versorgungssystems. Neben einer geringen Zahl adäquat diagnostizierter Patienten ist charakteristisch, dass die meisten nicht sachgerecht therapiert werden. Mittlerweile stehen zahlreiche zugelassene Medikamente wie Paroxetin, Venlafaxin, Buspiron und Opipramol sowie andere zur Verfügung, die neben der Kurzzeittherapie auch in der Langzeittherapie mit Erfolg eingesetzt werden können.

Literatur

• 1 Roy-Byrne P P, Wagner A. Primary care perspectives on generalized anxiety disorder.  J Clin Psychiatry. 2004;  65 Suppl 13 20-26
• 2 Carter R M, Wittchen H U, Pfister H, Kessler R C. One-year prevalence of subthreshold and threshold DSM-IV generalized anxiety disorder in a nationally representative sample. Depress Anxiety.  2001;  13 (2) 78-88
• 3 Wittchen H U, Kessler R C, Beesdo K, Krause P, Hofler M, Hoyer J. Generalized anxiety and depression in primary care: prevalence, recognition, and management.  J Clin Psychiatry. 2002;  63 Suppl 8 24-34
• 4 Stein M B, Heimberg R G. Well-being and life satisfaction in generalized anxiety disorder: comparison to major depressive disorder in a community sample.  J Affect Disord. 2004 Apr;  79 (1 - 3) 161-166
• 5 Hunt C, Slade T, Andrews G. Generalized Anxiety Disorder and major depressive disorder comorbidity in the National Survey of Mental Health and Well-Being.  Depress Anxiety. 2004;  20 (1) 23-31
• 6 Yonkers K A, Bruce S E, Dyck I R, Keller M B. Chronicity, relapse, and illness - course of panic disorder, social phobia, and generalized anxiety disorder: findings in men and women from 8 years of follow-up.  Depress Anxiety. 2003;  17 (3) 173-179
• 7 Allgulander C, Bandelow B, Hollander E, Montgomery S A, Nutt D J, Okasha A, Pollack M H, Stein D J, Swinson R P. , World Council of Anxiety . WCA recommendations for the long-term treatment of generalized anxiety disorder.  CNS Spectr. 2003 Aug;  8 (8 Suppl 1) 53-61
• 8 Baldwin D S, Polkinghorn C. Evidence-based pharmacotherapy of Generalized Anxiety Disorder.  Int J Neuropsychopharmacol. 2005;  8 293-302
• 9 Goodman W K. Selecting pharmacotherapy for generalized anxiety disorder.  J Clin Psychiatry.. 2004;  65 Suppl 13 8-13
• 10 Boerner R J. Pharmakotherapie der Angststörungen. In: Möller HJ (Hrsg). Therapie psychiatrischer Erkrankungen. 3. Aufl. Stuttgart, New York: Thieme 2005 im Druck
• 11 Stocchi F, Nordera G, Jokinen R H, Lepola U M, Hewett K, Bryson H, Iyengar M K. , Paroxetine Generalized Anxiety Disorder Study Team . Efficacy and tolerability of paroxetine for the long-term treatment of generalized anxiety disorder.  J Clin Psychiatry. 2003 Mar;  64 (3) 250-258
• 12 Allgulander C, Dahl A A, Austin C, Morris P L, Sogaard J A, Fayyad R, Kutcher S P, Clary C M. Efficacy of sertraline in a 12-week trial for generalized anxiety disorder.  Am J Psychiatry. 2004 Sep;  161 (9) 1642-1649
• 13 Davidson J R, Bose A, Korotzer A, Zheng H. Escitalopram in the treatment of generalized anxiety disorder: double-blind, placebo controlled, flexible-dose study.  Depress Anxiety. 2004;  19 (4) 234-240
• 14 Allgulander C, Hackett D, Salinas E. Venlafaxine extended release (ER) in the treatment of generalised anxiety disorder: twenty-four-week placebo-controlled dose-ranging study.  Br J Psychiatry. 2001 Aug/2002 Feb;  179/180 181-185 - 186
• 15 Katz I R, Reynolds 3rd C F, Alexopoulos G S, Hackett D. Venlafaxine ER as a treatment for generalized anxiety disorder in older adults: pooled analysis of five randomized placebo-controlled clinical trials.  J Am Geriatr Soc. 2002 Jan;  50 (1) 18-25
• 16 Montgomery S A, Mahe V, Haudiquet V, Hackett D. Effectiveness of venlafaxine, extended release formulation, in the short-term and long-term treatment of generalized anxiety disorder: results of a survival analysis.  J Clin Psychopharmacol. 2002 Dec;  22 (6) 561-567
• 17 Montgomery S A, Sheehan D V, Meoni P. Characterization of the longitudinal course of improvement in generalized anxiety disorder during long-term treatment with venlafaxine XR.  J Psychiatr Res. 2002;  36 (4) 209-217
• 18 Lenox-Smith A J, Reynolds A. A double-blind, randomised, placebo controlled study of venlafaxine XL in patients with generalised anxiety disorder in primary care.  Br J Gen Pract. 2003 Oct;  53 (495) 772-777
• 19 Hackett D, Haudiquet V, Salinas E. A method for controlling for a high placebo response rate in a comparison of venlafaxine XR and diazepam in the short-term treatment of patients with generalised anxiety disorder.  Eur Psychiatry. 2003 Jun;  18 (4) 182-187
• 20 Boyer P, Mahe V, Hackett D. Social adjustment in generalised anxiety disorder: a long-term placebo-controlled study of venlafaxine extended release.  Eur Psychiatry. 2004 Aug;  19 (5) 272-279
• 21 Guest J F, Russ J, Lenox-Smith A. Cost-effectiveness of venlafaxine XL compared with diazepam in the treatment of generalised anxiety disorder in the United Kingdom. 2005 Jan 29; [Epub ahead of print]
• 22 Davidson J R, DuPont R L, Hedges D, Haskins J T. Efficacy, safety, and tolerability of venlafaxine extended release and buspirone in outpatients with generalized anxiety disorder.  J Clin Psychiatry. 1999 Aug/2000 Jun;  60 (8)/61 (6) 528 - 355-447
• 23 Rickels K, Rynn M. Pharmacotherapy of generalized anxiety disorder.  J Clin Psychiatry. 2002;  63 (Suppl 14) 9-16
• 24 Lader M H, Scoto J C. A comparison of Hydroxyzine, Buspirone and placebo in patients with generalized anxiety.  Psychopharmacol. 1998;  139 402-406
• 25 Llorca P M, Spadone C, Sol O, Danniau A, Bougerol T, Corruble E, Faruch M, Macher J P, Sermet E, Servant D. Efficacy and safety of hydroxyzine in the treatment of generalized anxiety disorder: a 3-month double-blind study.  J Clin Psychiatry. 2002 Nov;  63 (11) 1020-1027
• 26 Pande A C, Crockatt J G, Feltner D E, Janney C A, Smith W T, Weisler R, Londborg P D, Bielski R J, Zimbroff D L, Davidson J R, Liu-Dumaw M. Pregabalin in generalized anxiety disorder: a placebo-controlled trial.  Am J Psychiatry. 2003 Mar;  160 (3) 533-540
• 27 Cutler N R, Sramek J J, Keppel Hesselink J, Krol A, Roeschen J, Rickels K, Schweizer E. 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 Psychopharmacol. 1993 Dec;  13 (6) 429-437
• 28 Dugas M J, Ladouceur R, Leger E, Freeston M H, Langlois F, Provencher M D, Boisvert J M. Group cognitive-behavioral therapy for generalized anxiety disorder: treatment outcome and long-term follow-up.  J Consult Clin Psychol. 2003 Aug;  71 (4) 821-825
• 29 Durham R C, Chambers J A, MacDonald R R, Power K G, Major K. Does cognitive-behavioural therapy influence the long-term outcome of generalized anxiety disorder? An 8 - 14 year follow-up of two clinical trials.  Psychol Med. 2003 Apr;  33 (3) 499-509
• 30 Arntz A. Cognitive therapy versus applied relaxation as treatment of generalized anxiety disorder.  Behav Res Ther. 2003 Jun;  41 (6) 633-646
• 31 Lang A J. Treating generalized anxiety disorder with cognitive-behavioral therapy.  J Clin Psychiatry. 2004;  65 Suppl 13 14-19
• 32 Ladouceur R, Leger E, Dugas M, Freeston M H. Cognitive-behavioral treatment of generalized anxiety disorder (GAD) for older adults.  Int Psychogeriatr. 2004 Jun;  16 (2) 195
• 33 Stanley M A, Hopko D R, Diefenbach G J, Bourland S L, Rodriguez H, Wagener P. Cognitive-behavior therapy for late-life generalized anxiety disorder in primary care: preliminary findings.  Am J Geriatr Psychiatry. 2003 Jan-Feb;  11 (1) 92