HT (TCA) (MAOI) A (TCA) (RIMA)

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1 (WFSBP) Borwin Bandelow, Josef Zohar, Eric Hollander, Siegfried Kasper, Hans - J urgen M oller, WFSBP Task Force on treatment Guidelines for Anxiety, Obsessive - Compulsive and Posttraumatic Stress Disorders, 5 - HT (TCA) SSRI,,, (MAOI),, SSRI, SSRI, MAOI SSRI 5 - HT 5 - CBT DBPC GAD SAD OCD PTSD MAOI RIMA SSNRI SSRI TCA A 5 - HT 5 - HT : HT HT (SSNRI) 314 A (RIMA) 315 (MAOI) HT 1A Department of Psychiatry and Psychotherapy, University of G ottingen, Germany ; Division of Psychiatry, chaim - Sheba Medical Center, Tel - Hashomer, Ramat Gan, israel ; Department of Psychiatry, The Mount Sinai School of Medicine, New York, NY, USA ; Department of General Psychia2 try, University of Vienna, austria ; Department of Psychiatry and Psychotherapy, Ludwig - Maximilians - University, Munich, Germany ; WFSBP Task Force on Treatment Guidelines for Anxiety, Obsessive - Compulsive and Posttraumatic Stress Disorders

2 HT (TCA) (MAOI) A (TCA) (RIMA) ( GAD) HT (SSNRI) HT (TCA) GAD GAD 413 ( ) HT A (RIMA) (MAOI) (OCD) HT OCD OCD OCD 416 (PTSD) HT (TCA) (MAOI) PTSD PTSD ,,,, (DBPC),,, ( GCP), ( ),,, MEDLINE ( ISI) (SCI) ( ) ( APA1998 ; Ballenger 1998a, b ; Ballenger1999 ; NIH1992) 1, ( Uhlenhuth 1999)

3 (Brady Lydiard1995) (Weissman 1989), 1/ 3 (DuPont 1996), 2 : CBT =, SSRI = 5 - HT, SSNRI = 5 - HT 1 6 (APA1998) CBT A SSRIs (Ballenger 1998a) : 2 SSRIs, SSNRI, TCA ( (Ballenger 2001) CBT ) 1 SSRIs 12 ( (Ballenger 1998b) ), 2 ( CBT SSRIs/ ) (1997) CBT, CBT SSRIs 12 (AACAP1998) - 18 ( ) B : SSRIs, CBT B1 1 (Ballenger 2000) B2 1 B3 1 [ C 218 % 317 % 414 % D Z E -, TCA = 3 (Narrow 2002) 1211 % 319 % 316 %, (Sartorius 1996) (Bandelow 1995 ; Cowley 1997) , % ( Kessler 1994 ; Regier 1993),, (Narrow 2002), ( 3) 211 % (Regier 1993) ( GABA) - - (HPA) (Charney (Bandelow2002) 5 - HT - Bremner1999 ; Connor Davidson1998 ; Gorman 2000 ; Jetty ( Klerman 1991), 2001 ; Li 2001 ; Nutt 1998 ; Schneier 2000 ; Stein2000 ;

4 van Amerigen 2000) 114 4,, (Bande2 low2002) 4 ICD - 10 (WHO1991) DSM - IV (APA1994), 14 (DSM - IV 13 ) 4 10, 30-45, / 3, SSRI, 75 % ( ) 1/ 2,, TCA (, 3-5 ) ( ), ( ), 213 ( 2),,,,,,, (OCD),,,, TCA,,, ICD - 10 DSM - IV,,,,, 212,, , 4-6 ( 8-12 ),,,, ( SSRI TCA,

5 ),, TCA ( PAS; Bandelow 1999), Hamilton ( SSRIs SSNRIs), ( HAM - A ; Hamilton 1959), Liebowitz TCAs (LSAS; Liebowitz 1987), Yale - Brown ( Y- BOCS; Goodman, 1989a), 2-4 ( PTSD (CAPS; Blake, 1995) 6, ) 2,,, (CGI; NIMH 1976), TCAs 216, 5 TCA = ; SSRI = 5 - HT, ; SSNRI = 5 - HT/ ; SAD =,, TCA 2-6 ;, (, SAD), ( ) ;, ( SSRI 2-6 ; ),, SSNRI 2-6 ;,,, ( ), ;, ( ) ; 2-6 ;, Hollon (1999) Klein (1998, 2000) SAD ;, 2-6 ; ;,, ; ; ( ) SSRIs ( ) 3 : (Price 1996 ; Stahl, 1997), 2-4 (,, ( ),, Bezchlibnyk - Bulter Jeffries 2001) HT, SSRIs, 311 (TCA) HT/ (SSNRI) TCA,, SSNRI ( ), ( ),, 2-4

6 , 314 A (RIMA) 2, ( IMCTGMSP1997 ; Stein 2002), (Ver2 318 siani 1992) 4 (Schneier 2, 1998) 5 ( ), 315 (MAOI) MAOI ( ) MAOI 319,,,,,,,, 316 ( ) ( ) 3110,, ( ), ( , 8 ), (Bradwejn1993 ; Liv2 ingston1994 ; Nelson Chouinard1999 ; Rickels 1990 ; Schweizer, 3, 1990b ; Shader Greenblatt1993 ; Smith Landry1990), (Schweizer 1998),,, 2,,, (Rickels1982),,,, ( ),, (Otto 1993 ; Spiegel1999), ( Goddard 2001),, (FuruKawa 2002), 3112 ( ), DSM ICD HT 1A, 4-7 (Rickels 1990), 5 - HT 1A ( ), 5,,, 3111,,, 3113,, ( ) kava

7 , 7 OCD = PTSD = ( ) : HT 2 Bystritsky 1999 ; : A 015-2mg DeMaritinis 1996 ; B mg Papp 2000 : SSRIs A 20-60mg 2 / 5 - HT 2 / 5 - HT 3 Carpenter 1999 B mg 5 - HT 3 ondansetron Schneier 1996 A mg A 20-40mg ( ) Keck 1993 ; B mg Primeau 1990 : TCA A mg A mg Woodman Noyes1994 Rocca 1997 SSNRI A 115-8mg A 1-4mg A 5-20mg B1 2-8mg MAOI B mg SSNRI B mg SNRI Reboxetine B1 4-8mg NASSA B2 45mg RIMA C mg A mg SSRI A 20-50mg TCA A mg Azapirone C 15-60mg : A 5-15mg B mg SSRI A mg A 20-50mg A mg MAOI A 45-90mg RIMA C mg : B mg B , 600mg SSRI B mg B mg TCA A mg SSRI A 20-80mg A mg A mg B mg B mg : MAOI C 45-90mg : B1 3mg B mg B1 715mg B1 5mg L - B2 8-16mg B2 5-15mg B mg PTSD SSRIs B mg B mg B mg B mg TCA B mg B mg : MAOI B mg B mg SSRI Bouwer Stein1998 SSRI Gorman 1987 ; van Ameringen 1993 OCD SSRI Marazziti 2001 SSRI + Pallanti SSRI Ravizza 1996 SSRI + Jenike 1991 ; Markovitz 1990 SSRI + Agid Lerer1999 ; Atmaca 2002 ; Bogetto 2000 Francobandiera2001 ; Kawahara 2000 : Koran 2000 ; Marazziti Pallanti1999 ; Mohr 2002 ; Pfanner 2000 ; Ravizza 1996 ; Saxena 1996 ; Stein 1997 ; Weiss 1999 SSRI, Blier Bergeron1996 +L - Rasmussen Rasmussen1984 SSRI + Fitzgerald 1999 ; OCD Leonard 1994 PTSD SSRI Marshall 1998 SSRI Davidson 1998 Marmar 1996 Lipper 1986 Fesler1991 PTSD SSNRI Hamner Frueh1998

8 kava ( ) (Tesar 1991) 2, (Charney Woods1989 ; Schweizer 1990a) 1 (Noyes 1996) 1 (Dunner 1986), (MAOI) A,, (RIMA), 1, ( Sheehen 3114, 5 (Tiller 1999) ( Kruger Dahl1999), (Loerch 1999),,,, ,, hen 1993 ), ( Sheehen 1990 ), (Schweizer Rickels1988) (Sheehan 1993) HT SSRIs (Munjack 1989), (Wade 1997), 1 (Munjack 1989 ; Noyes 1984) (Amore 1999b) DBPC,, DBPC (Black 1993 ; den Boer Westenbery 1990 ; Hoehn - Saric 1993 ; Sandmann 1998) 1 (Bakish 1996) DBPC (Michelson 1998) (Amore DBPC SSNRI 1999a, b ; Bystritsky 1994) DBPC (Pollack 1996), (Bellenger 1998c ; Oehrberg 1995) ( reboxetine ) DBPC (Bakker 1999, Lecrubier 1997) (Schatzberg1999 ; Versiani2000 ; Versiani 2002) DBPC (Londborg 1998 ; Pohl 1998 ; Pollack 1998) (TCA), TCA DBPC 7 (Klein1964 ; Zitrin 1980 ; Zitrin 1983) (CNCPS1992 ; Sheehan 1990 ; Uhlenhuth 1989) ; DBPC (Bandelow 2000 ; Johnston 1988) (Cassano 1988 ; Lecrubier 1997 ; Modigh 1992 ; Wade 1997) Bystritsky 1994 ; Lecrubier Judge1997 ; Wade 1997) 41113,, SSRIs (Andersch 1991 ; Ballenger 1988 ; CNCPS1992 ; Lydiard 1996 ; Noyes 1996 ; Uhlenhuth 1989) DBPC ( Beauclair 1994 ; Dyukova 1992 ; Moroz Rosen2 1980) ( RIMA) (Uhlenhuth 2002) (Sheehan 1990 ; Sheen (Ravaris 1991) DBPC ( ) (Lum 1990) DBPC, (Benjamin 1995) TCAs SSRIs (Amore 1999a ; Bakish 1996 ; Bakker 1999 ;, SSRIs TCAs SSRIs (Boyer1995) TCA (Andersch 1991 ; Charney 1986 ; CNCPS1992 ; Lepola 1990 ; Rizley baum1999 ; Rosenbaum 1997) ; Taylor 1990 ; Uhlenhuth 1989),

9 (Feske Goldstein1997 ; Goldstein 2000) DBPC,,, ( ) ( Hirschmann 2000), (Bandelow 2000), TCAs, TCAs, ( Tiffon 1994) 4 3 SSRI TCA (Ontiveros Fontaine1992), (Lep2 (Cournoyer1986) ola 1998) 48, , 1999a),,, (Balow1997 ; Marks 1993), CBT (Barlow1994 ; Beck 1985 ; Clark1994) ( ) 2 CBT /, (Barlow 2000 ; (Barlow 1989 ; Gould Clum1995 ; Klosko 1990 ; Lidren 1994 ; Margraf 1993 ; Swinson 1995 ; Telch 1993, 1995 ; Williams Falbo1996), Loerch 1999 ; Marks 1983 ; Mavissakalian Michelson1986b ; ( Gould 1993) Shear 1994) (Barlow 2000 ; Beck 1992 ; Klosko 1990 ; Marks 1983, 1993 ; Mavissakalian Michelson1983), (Bakker 1999 ; Black 1993 ; Mavis2 szkalian Michelson1986a ; Michelson 1988 ; Shear 1994), SSRIs,, 3 (Bakker 1999 ; Black 1993 ; Mavissakalian Michelson1986a) 5, (Clark 1994 ; Klosko 1990 ; Marks 1983 ; Sharp 1997 ; Telch 1985), (Marks, 1993),,,, TCAs (Barlow 2000 ; Cottraux SSRI, SSRIs TCA, 1995 ; de Beurs 1995 ; Marks 1993 ; Mavissakalian Michelson1986a ; Oehrberg 1995 ; Stein 2000b ; Telch 1985 ; Zitrin 1980, 1983), 2 (ondansetron) (Marks 1983 ; Sharp 1997),, CBT, 2 CBT ( ), (Mavissakalian 1983 ; Wiborg Dahl1996), 3 CBT 412 ( GAD) (Barlow 2000 ; Marks 1983 ; Sharp 1997), (Hoffart Mar2 tinsen1990) ( Eye Movement Desensitisation and Reprocessing ( EMDR) ), (Lecrubier Judge, 1997) 50, (Amore, Marks 1993) CBT (Clark 1994 ; Cohen 1984 ; Craske 1991 ; (Nadiga, ) , SSRIs TCAs SSRIs, ; MAOI, RIMA,, HT (SS2, NRI) SSNRI (Allgu2, lander 2001 ; Gelenberg 2000 ; Rickels 2000b), prega2

10 balin ( Kasper 2002a), (Davidson 1999), HAM - A, HAM - A CGI , HT DBPC SSRI ( Pollack, (Ballenger 2001) ) (Rynn 2001) (TCA) TCA, (Power 1990) (Hoehn - Saric 1988 ; Rickels 1993) (Davidson SSRI, ; Enkelmann1991 ; Pollack 1997), TCA, ( Feighner 1982 ; Jacobson 1985 ; Rickels 1982 ; Ross Matas1987 ; Strand 1990), (Davidson,, 1999) (Lader Scotto 1998) 41215,, (Elie Lamontagne1984 ; Enkelmann1991 ; Hoehn - Saric 1988 ; Lydiard 1997 ; Moller 2001) (Ansseau 1991 ; Boyer Feighner1993 ; Fontaine 1983 ; Rickels 1993, 1997, 2000a),, ( Elie Lamontagne1984 ; Feighner 1982 ; Jacobson 1985 ; Ross Matas 1987), CBT DBPC ( Ferreri 1994) 413 ( ), HT (Lader Scotto 1998) DBPC SSRI ( Stein 1999 ; van, Vliet 1994) (Allgulander1999 ; Baldwin 1999 ; pregabalin,, ( Kasper 2002a) (Opipramol) (Moller 2001) DBPC, Escitalopram ( ) ( Mahe ( Kobak 2002) Balogh2000) 2 6 (Allgu2 lander 2001 ; Genlenberg 2000) (Harvey Rapee1995) (Borkovec Whisman1996 ; Wells 1997), CBT (Lader Scotto 1998),, CBT SSNRI ( ),,,,, Stein 1998) (Blomhaff 2001 ; Katzelnick 1995 ; van Ameringen 2001), ( Kasper 2002b) ( 7), A (RIMA),

11 ( IMCTGMSP 1997),, ra 1999), (Versiani 1992) 3, (Schneier 1998), (Noyes 1997), RIMAs SS2 berg1995 ; Heiberg 1998) CBT RIs (van der Linden 2000) (MAOI) MAOI ( Liebowitz 1999) ) ( Heimberg 1998 ; Liebowitz 1988 ; Versiani 1992) (Versiani 1992),, (Blomhoff 2001) (Versiani 1988) ,,, (Davidson 1993 ; Munjack 1990) 41315, atenolol ( ) (Liebowitz, 1988 ; Turner 1994), (James Savage1984 ; James 1983) DBPC,, pregabalin (Feltner 2000 ; Pande 1999) DBPC CBT (van Vliet 1997) DBPC,, (Blomhoff 2001), 24 (Walker 2000) 20 DBPC (van Ameringen 2001) (Marks1987) 12, DBPC, (Ben2, 24, jamin 2000) (Hair 2000) 24, 415 (Versiani 1992) SSRI, (van Ameringen 1996) SSRIs 12 (Altamu2, ( Heim2 (Clark Wells 1995) CBT, CBT, ( Heimberg 1998 ;, , SSRIs SSRIs, MAOI,, 2-3 SSRIs, 414,,,

12 HT SSRIs (Dannon 2000), DBPC ( Goodman 1989b, 1996 ; Hohagen 1998) (Milanfranchi 1997 ; Mundo 2000), (Hew1ett 1992) DBPC, (Zohar Judge1996) DBPC (Chouinard 1990 ; Kronig 1999) (Bisserbe 1997) (Montgomery 1993 ; Tollefson 1994 ; Zitterl 1999), 41516, (Lopez - Ibor 1996), DBPC (Montgomery 2001), 6 SSRI CBT, CBT ( Greist 1995a ; Mont2 (Hohagen 1998) gomery 1993, 2001) (TCA) DBPC ( 1991 ; DeVeaugh Geiss 1989 ; Thoren 1980) (Milanfranchi 1997) TCA ( Piccinelli 1995) , 1992) (March 1998),,,, ( Fux DBPC (DeVeaugh - Geiss 1992 ; 1996), MAOI DBPC ( 52 ) (Vallejo 1992),, (Romano 2001), (Jenike 1997) DBPC, SSRIs ( Romano 2O01) (Rasmussen 1997) TCA ( Katz 1990) (Pigott 1992) DBPC (Mundo 1998),,,, (McDoug1e 1991) ( 7),, (Marks1994, 1997) (Facorro Gomez Hernandez 1997),,, ( Greist Jefferson1998 ; Mindus 1994) SSRIs (Riddle 1996, 20O1) ( Geller 2001 ; Riddle Flament 1985),, 60mg/ d ( 7),, (Rapoport Inoff - Germain 2000) 41515,, 5 - HT, ( Fallon, (Hoehn - Saric 2000 ; Leonard 1989) 1998 ; Koran 1997) 41518, (Thoren 198O), 5 - HT SSRIs DBPC, SSRI,, (McDougle 1994) SSRIs SSRI, (Mc2 (Abramowitz1997 ; Bisserbe 1997 ; Greist 1995b ; Piccinelli Dougle 200O), 1995 ; Pigott Seay1999 ; Todorov 2000) DBPC,, SSRIs

13 (Bisserbe 1997 ; Milanfranchi 1997 ; Mundo 2000 ; Zohar Judge1996), PTSD, PTSD, (Londborg 2001) ( 7) 416 (PTSD) HT SSRIs PTSD DBPC (Brady ( Foa 2000) PTSD 20O0 ; Davidson 2001b ; Zohar 2002) (Tucker 2001) (Connor 1999 ; van der Kolk 1994) 12, ( Hertzberg 2000),, (TCA) (Davidson 1990), (, TCA, CGI ) (Cahill 1999), ( Kosten CBT (Stein 2000a) 1991) (Frank 1988), PTSD, PTSD (Reist 1989) SSRIs, TCAs, TCAs MAOI,, (MAOI) ( Frank 1988 ; Kosten 1991) 5, (4 ) (Shes2 tatzky 1988) PTSD,,, SSRIs TCAs (Altshuler PTSD 2001 ; Austin Mitchell 1998 ; Emslie Judge2000 ; Ericson, (Braun 1990) 41615, ( Goldstein (Hertzberg 1999) Sundell 1999) (Laegreid 1990), 24,, 28, ( ), (Davidson 2001a) ( Iqbal 2002), 12 DBPC,, 24 DBPC,,, (Shalev l996) (Brom 1989) ( EMDR), PTSD, SSRIs SSRIs, PTSD, 511, SSRIs TCAs,, 1999 ; Misri 2000a, 2000b), (Nordeng 2001 ; Wisner 1999) (Austin Mitchell 1998),

498 2003 17 7 512 SSRIs TCA, SSRIs TCA (Misri 2000b ; Simpson Noble2000 ; Spigset Hagg1998) TCAs ( ) ( Spigset Hagg1998) SSRIs ( ),,, (Spigset Hagg1998),,,,, (

14 SSRIs TCA, SSRIs TCA (Misri 2000b ; Simpson Noble2000 ; Spigset Hagg1998) TCAs ( ) ( Spigset Hagg1998) SSRIs ( ),,, (Spigset Hagg1998),,,,, ( Iqbal 2002 ; Spigset Hagg1998) 513 ( ), SSRIs ( Emslie Judge2000) 514 TCAs, SSRIs SSNRIs, HT 1A 5 - HT 2c 5 - HT HT 3 - Y CRH nitrof1avanoids1 7,,,,,,,,,,,,,,

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