Korean Medication Algorithm Project for Generalized Anxiety Disorder 2009 (I) : Initial Treatment Strategy / 신경정신의학

OBJECTIVES: This study investigated the consensus about treatment strategies for the initial treatment of generalized anxiety disorder (GAD). This issue represents one of the subjects addressed by the Korean Medication Algorithm Project for GAD in Korea. METHODS: The executive committee of the Korean Medication Algorithm Project for GAD, supported by The Korean Association of Anxiety Disorders, developed questionnaires about treatment strategies for patients with GAD, based on guidelines or algorithms and clinical trial studies previously published in foreign countries, especially by the International Psychopharmacology Algorithm Project, the National Institute for Clinical Excellence, and the Canadian Psychiatric Association. Fifty-five (64%) of 86 experts on a committee reviewing GAD in Korea responded to the questionnaires. We classified the consensus of expert opinions into three categories (first-line, second-line, and third-line treatment strategies) and identified the treatment of choice according using a Chi-square test and a 95% confidence interval. RESULTS: For the initial treatment of GAD, antidepressant monotherapy and the combination of antidepressants and benzodiazepines as anxiolytics were recommended as the first line strategies. Escitalopram, paroxetine CR and venlafaxine XR were selected as first-line antidepressant treatments, and alprazolam, clonazepam and lorazepam were the preferred benzodiazepines. The mean starting doses and mean maximum doses of the drugs were 7.55+/-3.09 mg and 24.91+/-8.14 mg for escitalopram, 12.57+/-2.83 mg and 44.76+/-15.00 mg for paroxetine CR, and 46.81+/-16.74 mg and 223.32+/-60.64 mg for venlafaxine XR. CONCLUSION: These results, which reflect recent studies and clinical experiences, may provide guidelines for the initial.

Korean Medication Algorithm Project for Generalized Anxiety Disorder 2009 (III) : Treatment Strategy for Comorbid Conditions / 신경정신의학

OBJECTIVES: This study investigated the consensus about treatment strategies for comorbid conditions in generalized anxiety disorder (GAD). METHODS: The executive committee of the Korean Medication Algorithm Project for GAD developed questionnaires about treatment strategies for patients with panic disorder based on guidelines or algorithms and clinical trial studies previously published in foreign countries. This study analyzed the treatment strategies for comorbid conditions in GAD. Fifty-five (65%) of 84 experts on a committee reviewing GADs responded to the questionnaires. We classified the consensus of expert opinions into three categories (first-line, second-line, and third-line treatment strategies) and identified the treatment of choice according using a chi2 test and 95% confidence interval. RESULTS: The consensus about treatment strategies in the case of GAD with comorbid depression recommended a selective serotonin reuptake inhibitor (SSRI) and a serotonin norepinephrine reuptake inhibitor (SNRI) as the first-line drug treatment. An SSRI, an SNRI and a benzodiazepine (e.g. alprazolam, clonazepam) are recommended in GAD patients with other comorbid anxiety disorders. CONCLUSION: This study provided information about the consensus among Korean experts with regard to treatment strategies for comorbid conditions of GAD.