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The definition of treatment resistance in anxiety disorders: a Delphi method‐based consensus guideline

The definition of treatment resistance in anxiety disorders: a Delphi method‐based consensus guideline
The definition of treatment resistance in anxiety disorders: a Delphi method‐based consensus guideline
Anxiety disorders are very prevalent and often persistent mental disorders, with a considerable rate of treatment resistance which requires regulatory clinical trials of innovative therapeutic interventions. However, an explicit definition of treatment-resistant anxiety disorders (TR-AD) informing such trials is currently lacking. We used a Delphi method-based consensus approach to provide internationally agreed, consistent and clinically useful operational criteria for TR-AD in adults. Following a summary of the current state of knowledge based on international guidelines and an available systematic review, a survey of free-text responses to a 29-item questionnaire on relevant aspects of TR-AD, and an online consensus meeting, a panel of 36 multidisciplinary international experts and stakeholders voted anonymously on written statements in three survey rounds. Consensus was defined as ≥75% of the panel agreeing with a statement. The panel agreed on a set of 14 recommendations for the definition of TR-AD, providing detailed operational criteria for resistance to pharmacological and/or psychotherapeutic treatment, as well as a potential staging model. The panel also evaluated further aspects regarding epidemiological subgroups, comorbidities and biographical factors, the terminology of TR-AD vs. “difficult-to-treat” anxiety disorders, preferences and attitudes of persons with these disorders, and future research directions. This Delphi method-based consensus on operational criteria for TR-AD is expected to serve as a systematic, consistent and practical clinical guideline to aid in designing future mechanistic studies and facilitate clinical trials for regulatory purposes. This effort could ultimately lead to the development of more effective evidence-based stepped-care treatment algorithms for patients with anxiety disorders.
Anxiety disorders, agoraphobia, consensus guideline, evidence-based care, generalized anxiety disorder, operational criteria, panic disorder, social anxiety disorder, treatment resistance
2051-5545
113-123
Domschke, Katharina
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Seuling, Patrik D.
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Schiele, Miriam A.
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Bokma, Wicher A.
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Broich, Karl
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Burkauskas, Julius
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Fagan, Harry
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Latas, Milan
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Lidbetter, Nicky
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Stein, Dan J.
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Stein, Murray B.
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Van ameringen, Michael
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Van der wee, Nic
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Zwanzger, Peter
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Baldwin, David S.
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Domschke, Katharina
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Seuling, Patrik D.
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Batelaan, Neeltje M.
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Bokma, Wicher A.
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Broich, Karl
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Burkauskas, Julius
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Masdrakis, Vasilios
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Nardi, Antonio E.
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Pallanti, Stefano
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Pilling, Steve
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Simons, Gemma
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Srivastava, Shrikant
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Stein, Dan J.
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Stein, Murray B.
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Van ameringen, Michael
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Van balkom, Anton J.L.M.
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Van der wee, Nic
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Zwanzger, Peter
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Baldwin, David S.
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Domschke, Katharina, Seuling, Patrik D., Schiele, Miriam A., Bandelow, Borwin, Batelaan, Neeltje M., Bokma, Wicher A., Branchi, Igor, Broich, Karl, Burkauskas, Julius, Davies, Simon J.C., Dell'osso, Bernardo, Fagan, Harry, Fineberg, Naomi A., Furukawa, Toshi A., Hofmann, Stefan G., Hood, Sean, Huneke, Nathan T.M., Latas, Milan, Lidbetter, Nicky, Masdrakis, Vasilios, Mcallister‐williams, R. Hamish, Nardi, Antonio E., Pallanti, Stefano, Penninx, Brenda W.J.H., Perna, Giampaolo, Pilling, Steve, Pini, Stefano, Reif, Andreas, Seedat, Soraya, Simons, Gemma, Srivastava, Shrikant, Steibliene˙, Vesta, Stein, Dan J., Stein, Murray B., Van ameringen, Michael, Van balkom, Anton J.L.M., Van der wee, Nic, Zwanzger, Peter and Baldwin, David S. (2024) The definition of treatment resistance in anxiety disorders: a Delphi method‐based consensus guideline. World Psychiatry, 23 (1), 113-123. (doi:10.1002/wps.21177).

Record type: Article

Abstract

Anxiety disorders are very prevalent and often persistent mental disorders, with a considerable rate of treatment resistance which requires regulatory clinical trials of innovative therapeutic interventions. However, an explicit definition of treatment-resistant anxiety disorders (TR-AD) informing such trials is currently lacking. We used a Delphi method-based consensus approach to provide internationally agreed, consistent and clinically useful operational criteria for TR-AD in adults. Following a summary of the current state of knowledge based on international guidelines and an available systematic review, a survey of free-text responses to a 29-item questionnaire on relevant aspects of TR-AD, and an online consensus meeting, a panel of 36 multidisciplinary international experts and stakeholders voted anonymously on written statements in three survey rounds. Consensus was defined as ≥75% of the panel agreeing with a statement. The panel agreed on a set of 14 recommendations for the definition of TR-AD, providing detailed operational criteria for resistance to pharmacological and/or psychotherapeutic treatment, as well as a potential staging model. The panel also evaluated further aspects regarding epidemiological subgroups, comorbidities and biographical factors, the terminology of TR-AD vs. “difficult-to-treat” anxiety disorders, preferences and attitudes of persons with these disorders, and future research directions. This Delphi method-based consensus on operational criteria for TR-AD is expected to serve as a systematic, consistent and practical clinical guideline to aid in designing future mechanistic studies and facilitate clinical trials for regulatory purposes. This effort could ultimately lead to the development of more effective evidence-based stepped-care treatment algorithms for patients with anxiety disorders.

Text
Domschke et al_DELPHI TR-AD_revised manuscript_KD-DSB-210923 - Accepted Manuscript
Restricted to Repository staff only until 12 January 2025.
Available under License University of Southampton Accepted Manuscript Licence.
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e-pub ahead of print date: 12 January 2024
Published date: February 2024
Additional Information: Publisher Copyright: © 2024 World Psychiatric Association. © 2024 World Psychiatric Association.
Keywords: Anxiety disorders, agoraphobia, consensus guideline, evidence-based care, generalized anxiety disorder, operational criteria, panic disorder, social anxiety disorder, treatment resistance

Identifiers

Local EPrints ID: 488252
URI: http://eprints.soton.ac.uk/id/eprint/488252
DOI: doi:10.1002/wps.21177
ISSN: 2051-5545
PURE UUID: 8a58ca37-76df-4d8c-9b80-64dc0d0782ce
ORCID for Gemma Simons: ORCID iD orcid.org/0000-0003-2454-5948
ORCID for David S. Baldwin: ORCID iD orcid.org/0000-0003-3343-0907

Catalogue record

Date deposited: 19 Mar 2024 17:38
Last modified: 02 May 2024 01:55

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Contributors

Author: Katharina Domschke
Author: Patrik D. Seuling
Author: Miriam A. Schiele
Author: Borwin Bandelow
Author: Neeltje M. Batelaan
Author: Wicher A. Bokma
Author: Igor Branchi
Author: Karl Broich
Author: Julius Burkauskas
Author: Simon J.C. Davies
Author: Bernardo Dell'osso
Author: Harry Fagan
Author: Naomi A. Fineberg
Author: Toshi A. Furukawa
Author: Stefan G. Hofmann
Author: Sean Hood
Author: Nathan T.M. Huneke
Author: Milan Latas
Author: Nicky Lidbetter
Author: Vasilios Masdrakis
Author: R. Hamish Mcallister‐williams
Author: Antonio E. Nardi
Author: Stefano Pallanti
Author: Brenda W.J.H. Penninx
Author: Giampaolo Perna
Author: Steve Pilling
Author: Stefano Pini
Author: Andreas Reif
Author: Soraya Seedat
Author: Gemma Simons ORCID iD
Author: Shrikant Srivastava
Author: Vesta Steibliene˙
Author: Dan J. Stein
Author: Murray B. Stein
Author: Michael Van ameringen
Author: Anton J.L.M. Van balkom
Author: Nic Van der wee
Author: Peter Zwanzger
Author: David S. Baldwin ORCID iD

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