Anxiety and mood (대한불안의학회지)

Korean Academy of Anxiety Disorders (대한불안의학회)
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Korean Guidelines for the Treatment of Generalized Anxiety Disorder 2024 Part III: Strategies for Insufficient Treatment Response and Comorbidities

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

  • June-ho Seo (Department of Psychiatry, Yonsei University Wonju College of Medicine) ;
  • Chun Il Park (Department of Psychiatry, Yonsei University College of Medicine) ;
  • Min-Kyoung Kim (Department of Psychiatry, CHA Ilsan Medical Center, CHA University) ;
  • Eunsoo Moon (Department of Psychiatry, Pusan National University School of Medicine) ;
  • Myung Hee Ahn (Division of Psychiatry, Health Screening and Promotion Center, Asan Medical Center) ;
  • Hyeon-Ah Lee (Department of Psychiatry, College of Medicine, Soonchunhyang University Cheonan Hospital) ;
  • Yoon Young Chang (Department of Psychiatry, Sanggye Paik Hospital, Inje University College of Medicine) ;
  • Won Kim (Department of Psychiatry, Sanggye Paik Hospital, Inje University College of Medicine) ;
  • Kyoung-Uk Lee (Department of Psychiatry, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, College of Medicine) ;
  • Ho-Suk Suh (Suh Hosuk Yonsei Psychiatry Clinic for Healthy Mind)
  • 서준호 (연세대학교 원주의과대학 정신건강의학교실) ;
  • 박천일 (연세대학교 의과대학 정신과학교실) ;
  • 김민경 (차의과학대학교 정신건강의학교실) ;
  • 문은수 (부산대학교 의과대학 정신건강의학교실) ;
  • 안명희 (서울아산병원 건강의학과) ;
  • 이현아 (순천향대학교 의과대학 정신건강의학교실) ;
  • 장윤영 (인제대학교 의과대학 정신건강의학교실) ;
  • 김원 (인제대학교 의과대학 정신건강의학교실) ;
  • 이경욱 (가톨릭대학교 의과대학 정신건강의학교실) ;
  • 서호석 (서호석연세정신건강의학과)
  • Received : 2024.10.03
  • Accepted : 2024.10.23
  • Published : 2024.10.30
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Abstract

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.

Keywords

References

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