Anxiety Disorders

Van Ameringen M, Allgulander C, Bandelow B, Greist JH, Hollander E, Montgomery SA, Nutt DJ, Okasha A, Pollack MH, Stein DJ, Swinson RP, Anonymous00174. · Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada. · CNS Spectr. · Pubmed #14767397 No free full text.

Abstract: What is the best approach for treating patients with social phobia (social anxiety disorder) over the long term? Social phobia is the most common anxiety disorder, with reported prevalence rates of up to 18.7%. Social phobia is characterized by a marked and persistent fear of being observed or evaluated by others in social performance or interaction situations and is associated with physical, cognitive, and behavioral (ie, avoidance) symptoms. The onset of social phobia typically occurs in childhood or adolescence and the clinical course, if left untreated, is usually chronic, unremitting, and associated with significant functional impairment. Social phobia exhibits a high degree of comorbidity with other psychiatric disorders, including mood disorders, anxiety disorders, and substance abuse/dependence. Few people with social phobia seek professional help despite the existence of beneficial treatment approaches. The efficacy, tolerability, and safety of the selective serotonin reuptake inhibitors (SSRIs), evidenced in randomized clinical trials, support these agents as first-line treatment. The benzodiazepine clonazepam and certain monoamine oxidase inhibitors (representing both reversible and nonreversible inhibitors) may also be of benefit. Treatment of social phobia may need to be continued for several months to consolidate response and achieve full remission. The SSRIs have shown benefit in long-term treatment trials, while long-term treatment data from clinical studies of clonazepam are limited but support the drug's efficacy. There is also evidence for the effectiveness of exposure-based strategies of cognitive-behavioral therapy, and controlled studies suggest that the effects of treatment are generally maintained at long-term follow-up. In light of the chronicity and disability associated with social phobia, as well as the high relapse rate after short-term therapy, it is recommended that effective treatment be continued for at least 12 months.

Stein DJ, Bandelow B, Hollander E, Nutt DJ, Okasha A, Pollack MH, Swinson RP, Zohar J, Anonymous00173. · Medical Research Council Research Unit on Anxiety Disorder, University of Stellenbosch, Cape Town, Tygerberg, South Africa. · CNS Spectr. · Pubmed #14767396 No free full text.

Abstract: Posttraumatic stress disorder (PTSD) is a common and disabling condition. In addition to combat-related PTSD, the disorder occurs in civilians exposed to severe traumatic events, with the community prevalence rate for the combined populations reaching as high as 12%. If left untreated, PTSD may continue for years after the stressor event, resulting in severe functional and emotional impairment and a dramatic reduction in quality of life, with negative economic consequences for both the sufferer and society as a whole. Although PTSD is often overlooked, diagnosis is relatively straightforward once a triggering stressor event and the triad of persistent symptoms-reexperiencing the traumatic event, avoiding stimuli associated with the trauma, and hyperarousal have been identified. However, comorbid conditions of anxiety and depression frequently hamper accurate diagnosis. Treatment for PTSD includes psychotherapy and pharmacotherapy. The latter includes selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants, and monoamine oxidase inhibitors. Only SSRIs have been proven effective and safe in long-term randomized controlled trials. Current guidelines from the Expert Consensus Panel for PTSD recommend treatment of chronic PTSD for a minimum of 12-24 months.

Pollack MH, Allgulander C, Bandelow B, Cassano GB, Greist JH, Hollander E, Nutt DJ, Okasha A, Swinson RP, Anonymous00172. · Division of Psychiatry, Huddinge University Hospital, Stockholm, Sweden. · CNS Spectr. · Pubmed #14767395 No free full text.

Abstract: What are the symptoms of panic disorder and how is the disorder most effectively treated? One of the most commonly encountered anxiety disorders in the primary care setting, panic disorder is a chronic and debilitating illness. The core symptoms are recurrent panic attacks coupled with anticipatory anxiety and phobic avoidance, which together impair the patient's professional, social, and familial functioning. Patients with panic disorder have medically unexplained symptoms that lead to overutilization of healthcare services. Panic disorder is often comorbid with agoraphobia and major depression, and patients may be at increased risk of cardiovascular disease and, possibly, suicide. Research into the optimal treatment of this disorder has been undertaken in the past 2 decades, and numerous randomized, controlled trials have been published. Selective serotonin reuptake inhibitors have emerged as the most favorable treatment, as they have a beneficial side-effect profile, are relatively safe (even if taken in overdose), and do not produce physical dependency. High-potency benzodiazepines, reversible monoamine oxidase inhibitors, and tricyclic antidepressants have also shown antipanic efficacy. In addition, cognitive-behavioral therapy has demonstrated efficacy in the acute and long-term treatment of panic disorder. An integrated treatment approach that combines pharmacotherapy with cognitive-behavioral therapy may provide the best treatment. Long-term efficacy and ease of use are important considerations in treatment selection, as maintenance treatment is recommended for at least 12-24 months, and in some cases, indefinitely.

Greist JH, Bandelow B, Hollander E, Marazziti D, Montgomery SA, Nutt DJ, Okasha A, Swinson RP, Zohar J, Anonymous00171. · Healthcare Technology Systems, Inc., Madison, Wisconsin 53717, USA. · CNS Spectr. · Pubmed #14767394 No free full text.

Abstract: What are the latest psychotherapeutic and pharmacotherapeutic treatment recommendations for obsessive-compulsive disorder (OCD)? OCD is a relatively common disorder with a lifetime prevalence of approximately 2% in the general population. It often has an early onset, usually in childhood or adolescence, and frequently becomes chronic and disabling if left untreated. High associated healthcare utilization and costs, and reduced productivity resulting in loss of earning, pose a huge economic burden to OCD patients and their families, employers, and society. OCD is characterized by the presence of obsessions and compulsions that are time-consuming, cause marked distress, or significantly interfere with a person's functioning. Most patients with OCD experience symptoms throughout their lives and benefit from long-term treatment. Both psychotherapy and pharmacotherapy are recommended, either alone or in combination, for the treatment of OCD. Cognitive-behavioral therapy is the psychotherapy of choice. Pharmacologic treatment options include the tricyclic antidepressant clomipramine and the selective serotonin reuptake inhibitors (SSRIs) citalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline. These have all shown benefit in acute treatment trials; clomipramine, fluvoxamine, fluoxetine, and sertraline have also demonstrated benefit in long-term treatment trials (at least 24 weeks), and clomipramine, sertraline, and fluvoxamine have United States Food and Drug Administration approvals for use in children and adolescents. Available treatment guidelines recommend first-line use of an SSRI (ie, fluoxetine, fluvoxamine, paroxetine, sertraline, or citalopram) in preference to clomipramine, due to the latter's less favorable adverse-event profile. Further, pharmacotherapy for a minimum of 1-2 years is recommended before very gradual withdrawal may be considered.

Zohar J, Anonymous00170. · Division of Psychiatry, Chaim Sheba Medical Center, Tel-Hashomer, Israel. · CNS Spectr. · Pubmed #14767393 No free full text.

This publication has no abstract.

Anonymous00100. · No affiliation provided · Aust N Z J Psychiatry. · Pubmed #14636376 No free full text.

Abstract: BACKGROUND: The Royal Australian and New Zealand College of Psychiatrists is co-ordinating the development of clinical practice guidelines (CPGs) in psychiatry, funded under the National Mental Health Strategy (Australia) and the New Zealand Health Funding Authority. METHOD: For these guidelines, the CPG team reviewed the treatment outcome literature, consulted with practitioners and patients and conducted a meta-analysis of recent outcome research. TREATMENT RECOMMENDATIONS: Education for the patient and significant others covering: (i) the nature and course of panic disorder and agoraphobia; (ii) an explanation of the psychopathology of anxiety, panic and agoraphobia; (iii) rationale for the treatment, likelihood of a positive response, and expected time frame. Cognitive behaviour therapy (CBT) is more effective and more cost-effective than medication. Tricyclic antidepressants (TCAs) and serotonin selective reuptake inhibitors are equal in efficacy and both are to be preferred to benzodiazepines. Treatment choice depends on the skill of the clinician and the patient's circumstances. Drug treatment should be complemented by behaviour therapy. If the response to an adequate trial of a first-line treatment is poor, another evidence-based treatment should be used. A second opinion can be useful. The presence of severe agoraphobia is a negative prognostic indicator, whereas comorbid depression, if properly treated, has no consistent effect on outcome.

Buhl Sørensen C, Bøhm Jepsen E, Thomsen PH, Dalsgaard S. · Psychiatric Hospital for Children and Adolescents, Harald Selmers vej 66, 8240 Risskov, Denmark. · Eur Child Adolesc Psychiatry. · Pubmed #12768458 No free full text.

Abstract: The prescription of antidepressants for children and adolescents is a controversial subject, and it has been documented that the practice has increased in the past decade in Denmark, the UK, and the USA. The aim of this study was to survey the indications for and use of antidepressants in child and adolescent psychiatry. Questionnaires were sent to all Danish child and adolescent psychiatric hospitals, out-patient clinics and privately practising psychiatrists treating children and adolescents under the age of 19 years (31 units in all). A 93.5 % response rate for the total of 382 questionnaires in the survey. The antidepressant serotonin selective re-uptake inhibitors (SSRIs) were the most prominently used agents in treating children and adolescents. The extent of their use represents 8 % of the total sample of individuals under the age of 19 years receiving any kind of psychiatric treatment - 0.03 % of the reference population in Denmark. It is only a surprisingly minor group of children and adolescents that are being treated with antidepressants despite the fact that 10 % of youth under the age of 19 are afflicted with diseases like depression, OCD, anxiety disorder and eating disorders.

Anonymous00151, Anonymous00152. · No affiliation provided · Can J Psychiatry. · Pubmed #12371438 No free full text.

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Weine S, Danieli Y, Silove D, Van Ommeren M, Fairbank JA, Saul J, Anonymous00062. · University of Illinois at Chicago, Task Force on International Trauma Training, c/o Stevan M. Weine, M.D., Health Research and Policy Centers, Suite 400, 850 W. Jackson Street, Chicago, IL 60607, USA. · Psychiatry. · Pubmed #12108139 No free full text.

Abstract: OBJECTIVE: To develop consensus-based guidelines for training in mental health and psychosocial interventions for trauma-exposed populations in the international arena. PARTICIPANTS: The Task Force on International Trauma Training of the International Society for Traumatic Stress Studies. EVIDENCE: The Task Force engaged in a 1-year dialogue on the practice of international training, drawing upon field experience, literature review, and consultation with key informants. CONSENSUS PROCESS: This statement was prepared on the basis of shared dialogue, consensus decision making, and a writing process involving all Task Force members. It was then disseminated for review to more than 200 professionals of more than 60 service and academic organizations. Written and oral suggestions from over 80 persons were incorporated and revisions made on the basis of consensus. CONCLUSIONS: The generated guidelines addresses four dimensions: (1) values, (2) contextual challenges in societies during or after conflicts, (3) core curricular elements, and (4) monitoring and evaluation. The guidelines can improve international training.

Anonymous00048. · No affiliation provided · J Pract Nurs. · Pubmed #11930863 No free full text.

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Montgomery D, Anonymous00148. · No affiliation provided · Eur Neuropsychopharmacol. · Pubmed #11788245 No free full text.

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Henningsen P, Rüger U, Schneider W, Anonymous00070. · Psychosomatischen Universitätsklinik Heidelberg. · Versicherungsmedizin. · Pubmed #11554105 No free full text.

Abstract: Guidelines on the medico-legal assessment of patients in the field of psychosomatics and psychotherapy prepared by the "German Society für Psychotherapeutic Medicine" is presented. These guidelines are based on published evidence and on expert consensus among psychotherapists, psychiatrists, judges and social security experts. They give a systematic overview on aspects relevant to the assessment of persons suffering from somatoform disorders, psychological factors in organic diseases and posttraumatic, anxiety, depressive, personality and eating disorders. These aspects are disability, severity, assessment of malingering, of disability and causality.

Enns MW, Swenson JR, McIntyre RS, Swinson RP, Kennedy SH, Anonymous00077. · Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba. · Can J Psychiatry. · Pubmed #11441774 No free full text.

Abstract: BACKGROUND: The Canadian Psychiatric Association and the Canadian Network for Mood and Anxiety Treatments partnered to produce clinical guidelines for psychiatrists for the treatment of depressive disorders. METHODS: A standard guidelines development process was followed. Relevant literature was identified using a computerized Medline search supplemented by review of bibliographies. Operational criteria were used to rate the quality of scientific evidence, and the line of treatment recommendations included consensus clinical opinion. This section, on Axis I, Axis II, and Axis III comorbidity, is 1 of 7 articles that were drafted and reviewed by clinicians. Revised drafts underwent national and international expert peer review. RESULTS: Comorbid depression on Axis I is particularly prevalent in patients with anxiety disorders, substance use disorders, and eating disorders, but it also occurs in patients with schizophrenia, attention-deficit hyperactivity disorder (ADHD), and dementia. Depressive comorbidity has implications for assessment, management, and outcome. The relation between depression and personality disorders is complex. Patient with this comorbidity often require longer, more intense, and multimodal therapies. Depression is also prevalent in medical illnesses, requires careful diagnosis, and responds to standard antidepressant treatments. CONCLUSIONS: Comorbidity can influence the course and outcome of both associated conditions. Depression-specific psychotherapy and/or pharmacotherapy should be considered when comorbid depression is diagnosed.

Thorpe L, Whitney DK, Kutcher SP, Kennedy SH, Anonymous00076. · Department of Psychiatry, University of Saskatchewan, Regina, Saskatchewan. · Can J Psychiatry. · Pubmed #11441773 No free full text.

Abstract: BACKGROUND: The Canadian Psychiatric Association and the Canadian Network for Mood and Anxiety Treatments partnered to produce clinical guidelines for psychiatrists for the treatment of depressive disorders. METHODS: A standard guidelines development process was followed. Relevant literature was identified using a computerized Medline search supplemented by review of bibliographies. Operational criteria were used to rate the quality of scientific evidence, and the line of treatment recommendations included consensus clinical opinion. This section, "Special Populations," is 1 of 7 articles that were drafted and reviewed by clinicians. Revised drafts underwent national and international expert peer review. RESULTS: This section reports on the prevalence, course, and outcome of depression for specific populations. Psychological, pharmacologic, and other biological treatment options for these populations--children and adolescents, the elderly, women at times of increased risk within the reproductive cycle, and specific ethnocultural groups--are critically evaluated. CONCLUSIONS: Major depressive disorder (MDD) is prevalent across the lifespan. In general, clinical presentations are more similar than different across age, sex, and cultural divides. Although less evidence is available for the efficacy of treatments in these subpopulations than in mid-life patients, comparable rates of response for pharmacotherapies, electroconvulsive therapy (ECT), and, in some cases, evidence-based psychotherapies have been reported.

Segal ZV, Kennedy SH, Cohen NL, Anonymous00075. · Department of Psychiatry and Psychology, University of Toronto, Toronto, Ontario. · Can J Psychiatry. · Pubmed #11441772 No free full text.

Abstract: BACKGROUND: The Canadian Psychiatric Association and the Canadian Network for Mood and Anxiety Treatments partnered to produce clinical guidelines for psychiatrists for the treatment of depressive disorders. METHODS: A standard guidelines development process was followed. Relevant literature was identified using a computerized Medline search supplemented by review of bibliographies. Operational criteria were used to rate the quality of scientific evidence, and the line of treatment recommendations included consensus clinical opinion. This section, "Combining Psychotherapy and Pharmacotherapy," was 1 of 7 articles drafted and reviewed by clinicians. Revised drafts underwent national and international expert peer review. RESULTS: Recommendations are given for the use of combined psychotherapy and pharmacotherapy for the treatment of depressive disorders. Three methods of combined treatment are identified: concurrent treatment (psychotherapy plus pharmacotherapy) for the acute-treatment phase, sequential treatment (adding the other treatment for nonresponders or partial responders to monotherapy in the acute-treatment phase), and crossover treatment (switching to psychotherapy for the maintenance-treatment phase after response to pharmacotherapy in the acute phase). CONCLUSIONS: Combined treatment with psychotherapy and pharmacotherapy is widely used in clinical practice. The recommendations for use of combined treatment are, however, based on only a limited evidence base.

Kennedy SH, Lam RW, Cohen NL, Ravindran AV, Anonymous00074. · Department of Psychiatry, University of Toronto, Toronto, Ontario. · Can J Psychiatry. · Pubmed #11441771 No free full text.

Abstract: BACKGROUND: The Canadian Psychiatric Association and the Canadian Network for Mood and Anxiety Treatments partnered to produce clinical guidelines for psychiatrists for the treatment of depressive disorders. METHODS: A standard guidelines development process was followed. Relevant literature was identified using a computerized Medline search supplemented by review of bibliographies. Operational criteria were used to rate the quality of scientific evidence, and the line of treatment recommendations included consensus clinical opinion. This section, "Medications and Other Biological Treatments," is 1 of 7 articles that were drafted and reviewed by clinicians. Revised drafts underwent national and international expert peer review. RESULTS: Evidence-based recommendations are presented for 1) choosing an antidepressant, based on efficacy, tolerability, and safety; 2) the optimal use of antidepressants, including augmentation, combination, and switching strategies; 3) maintenance treatment; and 4) electroconvulsive therapy (ECT), light therapy, and additional somatic treatments. Evidence from metaanalyses is presented first, followed by conclusions from randomized controlled trials (RCTs) and, if appropriate, open-label data. CONCLUSIONS: There is significant evidence to support the role of selective serotonin reuptake inhibitors (SSRIs), novel agents, and classic agents in the treatment of major depressive disorder (MDD). There is also evidence to support the use of somatic treatments, including ECT and light therapy, for some patients with MDD. There is limited evidence for the use of specific medications to treat subtypes of MDD. There is emerging evidence to support augmentation and combination strategies for patients previously nonresponsive to medication.

Segal ZV, Whitney DK, Lam RW, Anonymous00073. · Department of Psychiatry and Psychology, University of Toronto, Toronto, Ontario. · Can J Psychiatry. · Pubmed #11441770 No free full text.

Abstract: BACKGROUND: The Canadian Psychiatric Association and the Canadian Network for Mood and Anxiety Treatments partnered to produce clinical guidelines for psychiatrists for the treatment of depressive disorders. METHODS: A standard guidelines development process was followed. Relevant literature was identified using a computerized Medline search supplemented by review of bibliographies. Operational criteria were used to rate the quality of scientific evidence, and the line of treatment recommendations included consensus clinical opinion. This section on "Psychotherapy" is 1 of 7 articles drafted and reviewed by clinicians. Revised drafts underwent national and international expert peer review. RESULTS: Recommendations are given for the use of psychotherapy in the treatment of depressive disorders. Considerable evidence shows that specific, short-term psychotherapies including cognitive-behavioural therapy (CBT) and interpersonal therapy (IPT) are effective acute-phase treatments. There is also evidence that group and marital/couples formats of psychotherapy are effective. There is only limited evidence that psychotherapy is effective for maintenance treatment of depressive disorders. CONCLUSIONS: Psychotherapy is effective in the treatment of depressive disorders. Despite the evidence for effectiveness of specific psychotherapies, there is still limited access to these treatments in the community.

Reesal RT, Lam RW, Anonymous00072. · Centre for Depression and Anxiety, Calgary, Alberta. · Can J Psychiatry. · Pubmed #11441769 No free full text.

Abstract: BACKGROUND: The Canadian Psychiatric Association and the Canadian Network for Mood and Anxiety Treatments partnered to produce clinical guidelines for psychiatrists for the treatment of depressive disorders. METHODS: A standard guidelines development process was followed. Relevant literature was identified using a computerized Medline search supplemented by review of bibliographies. Operational criteria were used to rate the quality of scientific evidence, and the line of treatment recommendations included consensus clinical opinion. This section on "Principles of Management" is 1 of 7 articles drafted and reviewed by clinicians. Revised drafts underwent national and international expert peer review. RESULTS: The principles and goals of psychiatric management with psychotherapy and pharmacotherapy are reviewed. Two phases of treatment, acute and maintenance, are identified. Special topics, including inpatient management, suicide management, and medical-legal issues are also discussed. CONCLUSIONS: These principles of psychiatric management provide a framework for the use of specific treatments for depressive disorders.

Parikh SV, Lam RW, Anonymous00071. · Department of Psychiatry, University of Toronto, Toronto, Ontario. · Can J Psychiatry. · Pubmed #11441768 No free full text.

Abstract: BACKGROUND: The Canadian Psychiatric Association and the Canadian Network for Mood and Anxiety Treatments partnered to produce clinical guidelines for psychiatrists for the treatment of depressive disorders. METHODS: A standard guidelines development process was followed. Relevant literature was identified using a computerized Medline search supplemented by review of bibliographies. Operational criteria were used to rate the quality of scientific evidence, and the line of treatment recommendations included consensus clinical opinion. This section on "Definitions, Prevalence, and Health Burden" was 1 of 7 articles drafted and reviewed by clinicians. Revised drafts underwent national and international expert peer review. RESULTS: The 1-year prevalence rate of major depressive disorder (MDD) in Canada is 3.2% to 4.6%, similar to the rates in other countries. MDD frequently runs a chronic or recurrent course and carries high risks for mortality and morbidity. The significant economic costs and disability associated with depressive illness are reduced by effective treatment. CONCLUSIONS: MDD is a prevalent medical condition that results in a significant health burden in the world. Vigorous efforts to improve diagnosis, treatment, and prevention are indicated to reduce the societal and personal costs of depressive disorders.

Ballenger JC, Davidson JR, Lecrubier Y, Nutt DJ, Borkovec TD, Rickels K, Stein DJ, Wittchen HU. · Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences, SC 29425-0742, USA. · J Clin Psychiatry. · Pubmed #11414552 No free full text.

Abstract: OBJECTIVE: To provide primary care clinicians with a better understanding of management issues in generalized anxiety disorder (GAD) and guide clinical practice with recommendations on the appropriate treatment strategy. PARTICIPANTS: The 4 members of the International Consensus Group on Depression and Anxiety were James C. Ballenger (chair), Jonathan R.T. Davidson, Yves Lecrubier, and David J. Nutt. Four additional faculty members invited by the chair were Karl Rickels, Hans-Ulrich Wittchen, Dan J. Stein, and Thomas D. Borkovec. EVIDENCE: The consensus statement is based on the 6 review articles that are published in this supplement and the scientific literature relevant to the issues reviewed in these articles. CONSENSUS PROCESS: Group meetings were held over a 2-day period. On day 1, the group discussed the review articles and the chair identified key issues for further debate. On day 2, the group discussed these issues to arrive at a consensus view. After the group meetings, the consensus statement was drafted by the chair and approved by all attendees. CONCLUSIONS: GAD is the most common anxiety disorder in primary care and is highly debilitating. Furthermore, it is frequently comorbid with depression and other anxiety disorders, which exacerbates functional impairment. Antidepressants (serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and nonsedating tricyclic antidepressants) are generally the most appropriate first-line pharmacotherapy for GAD, since they are also effective against comorbid psychiatric disorders and are suitable for long-term use. Cognitive-behavioral therapy is the preferred form of psychotherapy for GAD, although when GAD is comorbid with depression, pharmacotherapy is increasingly indicated.

Montgomery S, Bech P. · No affiliation provided · Eur Neuropsychopharmacol. · Pubmed #10871713 No free full text.

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Anonymous58272. · No affiliation provided · Z Arztl Fortbild Qualitatssich. · Pubmed #10802900 No free full text.

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Ballenger JC, Davidson JR, Lecrubier Y, Nutt DJ, Foa EB, Kessler RC, McFarlane AC, Shalev AY. · Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences, Charleston 29425-0742, USA. · J Clin Psychiatry. · Pubmed #10761680 No free full text.

Abstract: OBJECTIVE: To provide primary care clinicians with a better understanding of management issues in posttraumatic stress disorder (PTSD) and guide clinical practice with recommendations on the appropriate management strategy. PARTICIPANTS: The 4 members of the International Consensus Group on Depression and Anxiety were James C. Ballenger (chair), Jonathan R. T. Davidson, Yves Lecrubier, and David J. Nutt. Other faculty invited by the chair were Edna B. Foa, Ronald C. Kessler, Alexander C. McFarlane, and Arieh Y. Shalev. EVIDENCE: The consensus statement is based on the 6 review articles that are published in this supplement and the scientific literature relevant to the issues reviewed in these articles. CONSENSUS PROCESS: Group meetings were held over a 2-day period. On day 1, the group discussed the review articles and the chair identified key issues for further debate. On day 2, the group discussed these issues to arrive at a consensus view. After the group meetings, the consensus statement was drafted by the chair and approved by all attendees. CONCLUSION: PTSD is often a chronic and recurring condition associated with an increased risk of developing secondary comorbid disorders, such as depression. Selective serotonin reuptake inhibitors are generally the most appropriate choice of first-line medication for PTSD, and effective therapy should be continued for 12 months or longer. The most appropriate psychotherapy is exposure therapy, and it should be continued for 6 months, with follow-up therapy as needed.

Buitrago Ramírez F, Ciurana Misol R, Chocron Bentata L, Fernández Alonso C, García Campayo J, Montón Franco C, Redondo Granado MJ, Tizón García JL. · No affiliation provided · Aten Primaria. · Pubmed #10666930 No free full text.

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Anonymous00020. · No affiliation provided · J Trauma Stress. · Pubmed #11109232 No free full text.

This publication has no abstract.