불안 증과 우울증은 구별하기 어렵다 두 증상을 구별 하지 않고도 약물을 소신 있게 처방하는 방법 > 임상 응용 정보

불안 증과 우울증은 구별하기 어렵다 두 증상을 구별 하지 않고도 약물을 소신 있게 처방하는 방법

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불안 증과 우울증은 구별하기 어렵다 
 
두 증상을 구별 하지 않고도  
 
약물을 소신 있게 처방하는 방법</TD></TR>
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불안 증과 우울증 그리고 
이로 인한 정신 신체 증을 지닌 환자들이 많다
일 반의를 찾는 모든 환자의 20%에 해당된다
 
지금까지는 
불안 증이냐 우울증이냐를 일단 구별 하고난후 후
항 불안 약을 처방하거나
항 우울 제를 처방하려고 했다
 
 
 
<IMG src="/_dimg/1%20정신병.bmp">
 
그러나 불안 증과 우울증을 
구별하기가 어려운 경우가 많다
 
때문에 향불안약이던 항 우울 제를 구별 사용하기가 어렵다
 
 
다행히도 간단하게 진단해보고
향 정신 약을 소신 있게 처방할 수 있는 
놀라운 지침이 발표되었다
 
 
이는 독일 하이델베르그 의대와 미국 컬럼비아 의대와
위싱톤 의대 연구 팀의 협동 연구 결과이며 
미국 내과학 회지를 통해 발표한 내용이다

 
 
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7 가지 질문 (GAD-7) 에서 
 
8점 이상 맞으면</TD></TR>
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불안증인 지 우울증인지 구별하기 어려운 환자는 
아래 질문 표를 통해 8점 이상 맞는 자들은
불안 증으로 진단하고
 
항 불안 약이든 항우울제든 처방하면 된다
 
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지난 2 주간</TD>
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없음</TD>
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5-6일 
정도</TD>
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매일 반나절
정도</TD>
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매일 
하루 종일</TD></TR>
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점수 </TD>
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0</TD>
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1</TD>
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2</TD>
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3</TD></TR>
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1) 신경질 불안감 여부</TD>
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 </TD>
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 </TD>
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2) 걱정 억제 불가</TD>
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 </TD>
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 </TD>
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 </TD>
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3) 매사에 걱정 </TD>
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 </TD>
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4) relax 하기 어렵다 </TD>
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 </TD>
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 </TD>
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 </TD>
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5) 안 절 부절</TD>
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 </TD>
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 </TD>
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6) 쉽게 화냄 </TD>
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 </TD>
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7) 7) 큰일 날 것처럼 
무 섭다 </TD>
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 </TD>
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 </TD>
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   합계 </TD>
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 </TD>
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 </TD>
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 </TD></TR></TBODY></TABLE></TD></TR>
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불안 증에   왜 항우울제를 사용 하나</TD></TR>
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  상술한 진단 표(GAD-7) 에 의해 
  불안 증으로 진단되었다 할지라도
  모든 불안 증은 우울증과 합병되어 있기 때문이다
 
   따라서 항 불안 약을 사용하든 
항우울제를 사용하든 치료가 된다
 
 
 
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불안 증은 거의 우울증을 합병하고 있다</TD></TR>
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정상인 </TD>
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전반적 불안 증</TD>
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대인 공포증</TD>
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상해공포증</TD></TR>
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불안 증 정도</TD>
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3</TD>
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13</TD>
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13</TD>
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12</TD></TR>
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우울 증 합병</TD>
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3</TD>
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13</TD>
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12</TD>
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12</TD></TR>
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신체 증 합병</TD>
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6</TD>
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14</TD>
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13</TD>
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12</TD></TR></TBODY></TABLE>
 
 
 불안 증 정도가 증가 함에 따라  
 
신체증상 및 기타 불안 증상이 아래 표처럼 증가한다 
 
<IMG src="/_dimg/3%20불안증%20합병.bmp">  [그림] 불안 증 심해지면 정신 신체 증 합병도 증가</TD></TR>
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 4 가지 종류의 불안 증도
 
치료 법에는 차이가 없다 </TD></TR>
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불안 증상 종류도 구별 할 필요 없다
 
일 반의들이 경험하는 불안 증은 4가지다
 
 
-통상적인 불안 증과
 
-대인 공포증과 
 
-성폭력으로 인한 상해 불안 증과
 
-공황공포증이다
 
 
그러나 이들 간에는 불안 증의 정도에 차이가 없다
 따라서 약물을 구별하여 사용할 필요가 없다

 
 
<IMG src="/_dimg/4%20불안%20우울.bmp"> </TD></TR>
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치료 받지 못하고 있는 자들</TD></TR>
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GAD-7 질문 표를 사용하여 8점 이상을 맞은 
 
이른바 약물 요법이 필요한 자 1,059명 중 
 
40% 이상이 약물 요법을 처방 받지 못하고 있다는 점이 문제다</TD></TR>
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근거</TD>
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6 March 2007 Annals of Internla Medicine Volume 146 Issue 5 Pages 317-325
Anxiety Disorders in Primary Care: Prevalence, Impairment, Comorbidity, and 
Detection  Kurt Kroenke, MD; Robert L. Spitzer, MD; Janet B.W. Williams, DSW; 
Patrick O. Monahan, PhD; and Bernd Löwe, MD, PhD 
From Regenstrief Institute for Health Care and Indiana University, Indianapolis,;
New York State Psychiatric Institute and Columbia University, New York;
University of Heidelberg, Heidelberg, Germany</TD></TR></TBODY></TABLE>