2024 한국형 범불안장애 치료지침 III: 치료 반응이 불충분한 경우 및 공존질환이 존재하는 경우 치료 전략

• Published in: Anxiety and mood Vol. 20; no. 2; pp. 72 - 81
• Main Authors: 서준호, 박천일, 김민경, 문은수, 안명희, 이현아, 장윤영, 김원, 이경욱, 서호석, June-ho Seo, Chun Il Park, Min-Kyoung Kim, Eunsoo Moon, Myung Hee Ahn, Hyeon-Ah Lee, Yoon Young Chang, Won Kim, Kyoung-Uk Lee, Ho-Suk Suh
• Format: Journal Article
• Language: Korean
• Published: 대한불안의학회 01.10.2024
• Subjects: 정신과학
• ISSN: 2586-0151; 2586-0046
• DOI: 10.24986/anxmod.2024.20.2.006

Objective : This study aimed to establish expert consensus on treatment strategies for generalized anxiety disorder (GAD) when treatment response is insufficient and when comorbid conditions are present as part of developing the 2024 Korean guidelines for the treatment of GAD. Methods : The executive committee developed a questionnaire based on existing international and Korean treatment guidelines and academic literature. Sixty-five experts participated in a survey. Responses were analyzed using chi-squared test and 95% confidence intervals to determine the level of consensus. Treatment strategies were categorized into first-line, second-line, and third-line choices. Results : For patients with an insufficient treatment response, combining pharmacotherapy and psychotherapy was the most preferred first-line strategy. Experts recommended switching to or augmenting with a different class of antidepressants, adding benzodiazepines or azapirones, and augmenting with atypical antipsychotics as first-line pharmacotherapy adjustments. Suitable psychotherapies included cognitive behavioral therapy (CBT), mindfulness-based cognitive therapy (MBCT), acceptance and commitment therapy (ACT), and applied relaxation. For patients with comorbid conditions such as depression, other anxiety disorders, or alcohol and substance use disorders, a combination of pharmacotherapy and psychotherapy was also the most preferred first-line treatment. In these cases, the use of antidepressants alone or in combination with benzodiazepines, azapirones, or atypical antipsychotics was recommended. Conclusion : This expert consensus reflects current clinical practices and experiences in Korea, providing valuable insights for clinicians treating GAD patients who have insufficient treatment responses or comorbidities. Findings of this study emphasize the importance of a multimodal treatment approach, including both pharmacotherapy and psychotherapy. They also offer specific recommendations for adjusting treatment strategies in these complex cases.