Anxiety Mood.
2024 Oct;20(2):72-81. 10.24986/anxmod.2024.20.2.006.
Korean Guidelines for the Treatment of Generalized Anxiety Disorder 2024 Part III: Strategies for Insufficient Treatment Response and Comorbidities
- Affiliations
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- 1Department of Psychiatry, Yonsei University Wonju College of Medicine, Wonju, Korea
- 2Department of Psychiatry, Yonsei University College of Medicine, Seoul, Korea
- 3Department of Psychiatry, CHA Ilsan Medical Center, CHA University, Ilsan, Korea
- 4Department of Psychiatry, Pusan National University School of Medicine, Busan, Korea
- 5Division of Psychiatry, Health Screening and Promotion Center, Asan Medical Center, Seoul, Korea
- 6Department of Psychiatry, College of Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
- 7Department of Psychiatry, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
- 8Department of Psychiatry, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, College of Medicine, Uijeongbu, Korea
- 9Suh Hosuk Yonsei Psychiatry Clinic for Healthy Mind, Seoul, Korea
- KMID: 2561320
- DOI: http://doi.org/10.24986/anxmod.2024.20.2.006
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 an-alyzed 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 psycho- therapy 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 anti- psychotics 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 benzodi-azepines, 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 comorbidi-ties. 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 strate-gies in these complex cases.
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