Clinical Manual of Anxiety Disorders

by Stein, Dan J.

• ISBN13: 9781585620760
• ISBN10: 1585620769
• Edition: 1st
• Format: Paperback
• Copyright: 2004-03-01
• Publisher: AMERICAN PSYCHIATRIC PUBLISHING INC

Summary

Anxiety disorders are among the most prevalent, persistent, disabling, and costly psychiatric disorders, yet they are often underdiagnosed and undertreated. Fortunately, there have been major advances in understanding and treating these conditions in recent years; this is one of the most exciting areas in modern medicine. This clinical manual has earned its place in the literature as one of just a few volumes that covers all of the major anxiety disorders and presents integrated contributions from both psychopharmacologists and psychotherapists-all in one compact work written for busy clinicians. Though concepts of anxiety have long enjoyed a central position in philosophical and psychoanalytic theories, empirical research on anxiety disorders has a relatively short history. Here, 16 experts discuss advances in diagnosis, assessment (including relevant rating scales), pharmacotherapy, and psychotherapy. This volume begins by reviewing recent important diagnostic, epidemiological, neurobiological, and treatment findings-all of which have significant implications for clinicians. Subsequent chapters cover Panic disorder and agoraphobia-Laboratory studies of fear have significantly advanced our understanding of the neurocircuitry and neurochemistry of panic. Furthermore, panic disorder is now readily treated with both medications and psychotherapy. Specific phobia-Viewed for many years as mild and even trivial, this common disorder is now recognized for its very real associated distress and impairment. Exposure therapy is the treatment mainstay, though pharmacotherapy should be considered particularly when there is comorbidity. Social phobia(or social anxiety disorder)-In the past few years, the first FDA-approved medications for this disorder have been made available. Cognitive-behavioral therapy is also effective for the treatment of this underdiagnosed and undertreated condition. Obsessive-compulsive disorder (OCD)-OCD was the first disorder where it was shown that both specific medications and cognitive-behavioral techniques resulted in normalization of activity in particular brain structures. It is now possible to provide patients with integrated treatment approaches. Posttraumatic stress disorder (PTSD)-Once viewed as a normal reaction to trauma, PTSD is increasingly understood as a pathological response, characterized by specific psychobiological dysfunctions. Again, there have been exciting advances in the treatment of this disorder, with the release of the first FDA-approved agents for PTSD. Generalized anxiety disorder (GAD)-For a number of years GAD was thought of as a residual disorder occasionally seen in combination with more primary conditions. Nowadays, we know that GAD is an independent condition that is prevalent, persistent, and disabling. Busy residents and psychiatrists in active clinical practice, psychologists, primary care practitioners, and other mental health professionals will find this clinical manual-with its integrated approach of both pharmacotherapy and psychotherapy-a valuable tool in their everyday practices.

Author Biography

Dan J. Stein, M.D., Ph.D., is Director of the MRC Research Unit on Anxiety and Stress Disorders in the Department of Psychiatry at the University of Stellenbosch in Cape Town, South Africa.

Table of Contents

Contributors	xi
1 Introduction	1	(12)
Dan J. Stein, M.D., Ph.D.
Diagnosis	1	(2)
Epidemiology	3	(2)
Pathogenesis	5	(1)
Management	6	(4)
Conclusion	10	(1)
References	10	(3)
2 Panic Disorder and Agoraphobia	13	(30)
Gustavo Kinrys, M.D.
Mark H Pollack, M.D.
Phenomenology	13	(6)
Symptoms	13	(3)
Associated Features	16	(2)
Epidemiology	18	(1)
Assessment	19	(2)
Differential Diagnosis	19	(2)
Assessment Measures	21	(1)
Pathogenesis	21	(4)
Neurochemistry	22	(2)
Neuroanatomy	24	(1)
Pharmacotherapy	25	(7)
Antidepressants	25	(2)
Benzodiazepines	27	(1)
Anticonvulsants	28	(1)
Other Agents	28	(1)
Maintenance Pharmacotherapy	29	(2)
Treatment-Refractory Panic Disorder	31	(1)
Psychotherapy	32	(3)
Cognitive-Behavioral Therapy	32	(2)
Combined Treatments	34	(1)
Psychodynamic Psychotherapies	35	(1)
Conclusion	35	(1)
References	36	(7)
3 Specific Phobia	43	(20)
Bavanisha Vythilingum, M.B.
Dan J. Stein, M.D., Ph.D.
Phenomenology	43	(4)
Symptoms	43	(2)
Associated Features	45	(1)
Epidemiology	46	(1)
Assessment	47	(1)
Pathogenesis	48	(5)
Basic Physiology and Anatomy of Fear	48	(1)
Application to Specific Phobia	49	(1)
Etiological Models	50	(2)
The Role of Disgust	52	(1)
Pharmacotherapy	53	(1)
Psychotherapy	53	(4)
Behavioral Approaches	54	(2)
Cognitive Approaches	56	(1)
Efficacy of Behavioral and Cognitive Treatments	56	(1)
Conclusion	57	(1)
References	57	(6)
4 Social Phobia	63	(24)
Franklin R. Schneier, M.D.
Jane A. Luterek, M.A.
Richard G. Heimberg, Ph.D.
Eduardo Leonardo, M.D., Ph.D.
Phenomenology	63	(3)
Symptoms	63	(2)
Associated Features	65	(1)
Epidemiology	66	(1)
Assessment	66	(4)
Differential Diagnosis	66	(1)
Assessment Measures	67	(3)
Pathogenesis	70	(3)
Biological	70	(1)
Psychosocial	71	(2)
Pharmacotherapy	73	(4)
Selective Serotonin Reuptake Inhibitors	73	(1)
Benzodiazepines	74	(1)
Monoamine Oxidase Inhibitors	75	(1)
β-Adrenergic Blockers	75	(1)
Buspirone	76	(1)
Other Medications	76	(1)
Psychotherapy	77	(3)
Exposure	77	(1)
Cognitive Restructuring	78	(1)
Relaxation Training	79	(1)
Social Skills Training	79	(1)
Conclusion	80	(1)
References	80	(7)
5 Obsessive-Compulsive Disorder	87	(32)
Brian Martis, M.D.
Nancy J. Keuthen, Ph.D.
Kimberly A. Wilson, Ph.D.
Michael Jenike, M.D.
Phenomenology	87	(4)
Symptoms	87	(2)
Associated Features	89	(2)
Epidemiology	91	(1)
Assessment	91	(2)
Differential Diagnosis	93	(1)
Assessment Measures	93	(1)
Pathogenesis	93	(3)
Genetic Epidemiology	94	(1)
Neuroanatomy	95	(1)
Neurochemistry	95	(1)
Management	96	(1)
Pharmacotherapy	97	(6)
Serotonin Reuptake Inhibitors	97	(1)
Partial Response and Treatment Resistance	97	(6)
Psychotherapy	103	(11)
Behavioral Model of Obsessive-Compulsive Disorder	106	(4)
Cognitive Model of Obsessive-Compulsive Disorder	110	(4)
Conclusion	114	(1)
References	115	(4)
6 Posttraumatic Stress Disorder and Acute Stress Disorder	119	(28)
Randall D. Marshall, M.D.
Barbara Rothbaum, Ph.D.
Phenomenology	119	(5)
Symptoms	119	(3)
Associated Features	122	(1)
Acute Stress Disorder	123	(1)
Epidemiology	123	(1)
Assessment	124	(1)
Differential Diagnosis	125	(1)
Assessment Measures	125	(1)
Pathogenesis	125	(3)
Pharmacotherapy	128	(5)
Acute Stress Disorder	128	(1)
Posttraumatic Stress Disorder	128	(5)
Psychotherapy	133	(6)
Early Psychodynamic History	133	(1)
Cognitive-Behavioral Therapy for Acute Stress Disorder	134	(1)
Cognitive-Behavioral Therapy for Posttraumatic Stress Disorder	134	(5)
Conclusion	139	(2)
References	141	(6)
7 Generalized Anxiety Disorder	147	(26)
Jonathan D. Huppert, Ph.D.
Moira Rynn, M.D.
Phenomenology	147	(3)
Symptoms	147	(2)
Associated Features	149	(1)
Epidemiology	149	(1)
Assessment	150	(3)
Differential Diagnosis	150	(2)
Assessment Measures	152	(1)
Pathogenesis	153	(2)
Worry	153	(1)
Somatic Symptoms	154	(1)
Neurobiology	154	(1)
Pharmacotherapy	155	(7)
Antidepressants	155	(3)
Benzodiazepines	158	(1)
Buspirone	159	(2)
Hydroxyzine	161	(1)
Maintenance Pharmacotherapy	162	(1)
Psychotherapy	162	(4)
Psychoeducation	163	(1)
Self-Monitoring	164	(1)
Cognitive Therapy: Restructuring the Worry	164	(1)
Relaxation	164	(1)
Worry Exposure/Stimulus Control	165	(1)
Worry Behavior Prevention	165	(1)
Other Techniques	165	(1)
Conclusion	166	(1)
References	166	(7)
Appendix: Internet Resources	173	(2)
Index	175