背景:虽然尚未批准用于治疗焦虑症(三氟拉嗪除外),但仍在进行标签外,未经批准使用第一代抗精神病药(FGA)和第二代抗精神病药(SGA)治疗焦虑症。已经有关于在焦虑症中使用抗精神病药的系统评价和荟萃分析,其中大部分集中在SGA上。
目的:本综述的具体目的是:(1)评估FGA和SGA在焦虑症中作为传统抗抑郁治疗和其他非抗精神病药物的辅助治疗的有效性的证据;(2)在有效性方面比较抗精神病药物的单一疗法与一线治疗焦虑症,风险,和副作用。审查方案在PROSPERO(CRD42021237436)上注册。
方法:从开始到2020年进行了初步搜索,以确定系统评价和荟萃分析,更新的搜索于2021年8月和2023年1月完成。搜索是在PubMed中进行的,MEDLINE(Ovid),EMBASE(Ovid),APAPsycInfo(Ovid),CINAHL完成(EBSCOhost),和Cochrane图书馆通过手工搜索收录文章的参考文献。使用AMSTAR-2(评估系统评论的计量工具)量表测量评论质量。
结果:原始搜索和更新搜索分别产生1796和3744篇文章,其中45人符合资格。经过最后审查,25篇系统评价和荟萃分析纳入分析。大多数系统评价和荟萃分析通过AMSTAR-2被认为是低质量的,只有一个评价被认为是高质量的。在评估抗精神病药物的单一疗法与焦虑症的一线治疗相比时,由于研究设计有缺陷(例如随机化问题)和研究中的样本量小,证据不足。有有限的证据表明抗精神病药物对焦虑症的疗效,而不是喹硫平对广泛性焦虑症(GAD)。
结论:本综述表明,在使用喹硫平治疗GAD之外,缺乏抗精神病药物治疗焦虑症的高质量研究。尽管对焦虑症可能有效,FGA和SGA可能具有超过其功效的风险和副作用,尽管数据有限。需要对焦虑症中的抗精神病药进行进一步的长期和大规模研究。
Although not approved for the treatment of anxiety disorders (except trifluoperazine) there is ongoing off-label, unapproved use of first-generation antipsychotics (FGAs) and second-generation antipsychotics (SGAs) for anxiety disorders. There have been systematic reviews and meta-analyses on the use of antipsychotics in anxiety disorders, most of which focused on SGAs.
The specific aims of this umbrella
review are to: (1) Evaluate the evidence of efficacy of FGAs and SGAs in anxiety disorders as an adjunctive treatment to traditional antidepressant treatments and other nonantipsychotic medications; (2) Compare monotherapy with antipsychotics to first-line treatments for anxiety disorders in terms of effectiveness, risks, and side effects. The
review protocol is registered on PROSPERO (CRD42021237436).
An initial search was undertaken to identify systematic reviews and meta-analyses from inception until 2020, with an updated search completed August 2021 and January 2023. The searches were conducted in PubMed, MEDLINE (Ovid), EMBASE (Ovid), APA PsycInfo (Ovid), CINAHL Complete (EBSCOhost), and the Cochrane Library through hand searches of references of included articles.
Review quality was measured using the AMSTAR-2 (A MeaSurement Tool to Assess Systematic Reviews) scale.
The original and updated searches yielded 1796 and 3744 articles respectively, of which 45 were eligible. After final
review, 25 systematic reviews and meta-analyses were included in the analysis. Most of the systematic reviews and meta-analyses were deemed low-quality through AMSTAR-2 with only one review being deemed high-quality. In evaluating the monotherapies with antipsychotics compared with first-line treatments for anxiety disorder there was insufficient evidence due to flawed study designs (such as problems with randomization) and small sample sizes within studies. There was limited evidence suggesting efficacy of antipsychotic agents in anxiety disorders other than quetiapine in generalized anxiety disorder (GAD).
This umbrella
review indicates a lack of high-quality studies of antipsychotics in anxiety disorders outside of the use of quetiapine in GAD. Although potentially effective for anxiety disorders, FGAs and SGAs may have risks and side effects that outweigh their efficacy, although there were limited data. Further long-term and larger-scale studies of antipsychotics in anxiety disorders are needed.