title: Treatment-refractory anxiety; definition, risk factors, and treatment challenges.
abstract: A sizable proportion of psychiatric patients will seek clinical evaluation and treatment for anxiety symptoms reportedly refractory to treatment. This apparent lack of response is either due to "pseudo-resistance" (a failure to have received and adhered to a recognized and effective treatment or treatments for their condition) or to true "treatment resistance." Pseudo-resistance can be due to clinician errors in selecting and delivering an appropriate treatment effectively, or to patient nonadherence to a course of treatment. True treatment resistance can be due to unrecognized exogenous anxiogenic factors (eg, caffeine overuse, sleep deprivation, use of alcohol or marijuana) or an incorrect diagnosis (eg, atypical bipolar illness, occult substance abuse, attention deficit-hyperactivity disorder). Once the above factors are eliminated, treatment should focus on combining effective medications and cognitive behavioral therapy, combining several medications (augmentation), or employing novel medications or psychotherapies not typically indicated as first-line evidence-based anxiety treatments.
authors.affiliation: Professor of Psychiatry, University of Washington School of Medicine, Harborview Medical Center, Seattle, Washington, USA; Founding Partner, Psychiatric Medicine Associates, Seattle, Wash-ington, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Roy-Byrne
mesh_terms: D014151:Anti-Anxiety Agents / Q000008:administration & dosage*; D001007:Anxiety / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D016206:Databases, Bibliographic / Q000706:statistics & numerical data; D006801:Humans; D016896:Treatment Outcome
chemical_list: D014151:Anti-Anxiety Agents
keywords: CBT; antidepressant; anxiety; benzodiazepine; pseudo-resistance; refractory