INTERNATIONAL STUDY OF EXPERT JUDGMENT ON THERAPEUTIC USE OF BENZODIAZEPINES AND OTHER PSYCHOTHERAPEUTIC MEDICATIONS .3. CLINICAL-FEATURES AFFECTING EXPERTS THERAPEUTIC RECOMMENDATIONS IN ANXIETY DISORDERS

Our objective was to assemble expert clinical experience and judgment in the treatment of anxiety and related disorders in a systematic, qua ntitative manner, This article reports on some clinical features apart from diagnosis that may affect choice of strategy in the pharmacother apy of anxiety disorders. A panel of internationally recognized expert s in treating anxiety and depression was constituted by multistage pee r nomination, Ninety percent (66 of 73) completed an extensive questio nnaire, This report focuses on the expert panel's responses to questio ns on therapeutic options, based on multi-part case vignettes of sever al anxiety disorders presenting clinical variations within the same di agnosis. In the presence of higher levels of functional impairment, th e experts more often recommended formal psychosocial procedures for ad justment disorder; medication for agoraphobia, social phobia, obsessiv e-compulsive disorder, and adjustment disorder; and polypharmacy for a goraphobia, Their therapeutic recommendations were not materially affe cted by chronicity in the case of panic disorder, Under the condition of heavy use of alcohol in the case of generalized anxiety disorder, t he experts avoided benzodiazepines in favor of various other medicatio ns, In the presence of a serious cardiac conduction defect in the case of obsessive-compulsive disorder, they less often recommended medicat ion, Those who did recommend medication changed their preference from tricyclic antidepressants (clomipramine) to selective serotonin reupta ke inhibitors, Under the condition of a more severe precipitating even t in the case of adjustment disorder, the experts were more likely to recommend both formal psychosocial intervention and medication. The th erapeutic recommendations of the expert panelists imply that anxiety d isorders generally are serious illnesses that merit vigorous psychosoc ial and pharmacological intervention, often even in the face of clinic al features that increase risk, Their recommendations further Imply th at the benefit/risk ratio of pharmacotherapy is especially favorable i n circumstances of high functional impairment, absent history of heavy alcohol use in generalized anxiety disorder, normal cardiac conductio n in obsessive-compulsive disorder, and severe life stress in adjustme nt disorder, Further development of this methodological approach could provide early information about new therapeutic agents that would inf orm clinical practice and the design of conventional post-marketing st udies,