Anxiety Disorders: An Introduction to Clinical Management and Research

383 Pages·2001·1.96 MB·English

by  Griez E.J.L.

AnxietyDisorders.EditedbyE.J.L.Griez,C.Faravelli,D.NuttandD.Zohar.
Copyright©2001JohnWiley&SonsLtd
PrintISBN0-471-97893-6ElectronicISBN0-470-84643-7
Anxiety Disorders
AnxietyDisorders.EditedbyE.J.L.Griez,C.Faravelli,D.NuttandD.Zohar.
Copyright©2001JohnWiley&SonsLtd
PrintISBN0-471-97893-6ElectronicISBN0-470-84643-7
Anxiety Disorders
An Introduction to Clinical
Management and Research
Editedby
Eric J.L. Griez
DepartmentofPsychiatryandNeuropsychology,
UniversityofMaastricht,TheNetherlands
Carlo Faravelli
DepartmentofNeurologyandPsychiatry,
FlorenceUniversityMedicalSchool,Italy
David Nutt
PsychopharmacologyUnit,SchoolofMedicalSciences,
UniversityofBristol,UK
and
Joseph Zohar
DepartmentofPsychiatryandAnxietyClinic,
ShebaMedicalCenter,TelHashomer,
UniversityofTelAviv,SacklerFacultyofMedicine,Israel
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AnxietyDisorders.EditedbyE.J.L.Griez,C.Faravelli,D.NuttandD.Zohar.
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LibraryofCongressCataloging-in-PublicationData
Anxietydisorders:anintroductiontoclinical
managementandresearch/editedbyE.J.L.Griez...[etal.].
p. cm.
Includesbibliographicalreferencesandindex.
ISBN0-471-97873-6(alk.paper)
1.Anxiety.2.Phobias.3.Obsessive–compulsivedisorder.4.Anxiety—Research.
5.Phobias—Research.6.Obsessive–compulsivedisorder—Research.I.Griez,E.J.L.
RC531.E94 2001
616.85(cid:1)22—dc21 00–069333
BritishLibraryCataloguinginPublicationdata
AcataloguerecordforthisbookisavailablefromtheBritishLibrary
ISBN0-471-97873-6
Typesetin10/12ptBaskervillefromtheauthor’sdisksbyVisionTypesetting,Manchester
PrintedandboundinGreatBritainbyBiddlesLtd,GuildfordandKing’sLynn
Thisbookisprintedonacid-freepaperresponsiblymanufacturedfromsustainableforestry,inwhichat
leasttwotreesareplantedforeachoneusedforpaperproduction.
AnxietyDisorders.EditedbyE.J.L.Griez,C.Faravelli,D.NuttandD.Zohar.
Copyright©2001JohnWiley&SonsLtd
PrintISBN0-471-97893-6ElectronicISBN0-470-84643-7
Contents
Listofcontributors vii
Preface xi
E.J.L.Griez
Introduction:CurrentConceptsinAnxiety xv
D.Klein
PARTI EPIDEMIOLOGYANDGENETICS 1
1 EpidemiologyofAnxietyDisorders 3
T.Overbeek,E.VermettenandE.J.L.Griez
2 GeneticsofAnxietyDisorders:PartI 25
M.C.CavalliniandL.Bellodi
3 GeneticsofAnxietyDisorders:PartII 41
B.deBrettesandJ.P.L´epine
PARTII NOSOLOGYANDTREATMENTOFANXIETY
DISORDERS 51
4 PanicDisorder:ClinicalCourse,Morbidityand
Comorbidity 53
C.FaravelliandA.Paionni
5 PanicDisorder:PathogenesisandTreatment 81
C.Faravelli,V.RiccaandE.Truglia
6 SpecificPhobias 105
H.MerckelbachandP.Muris
7 SocialPhobia 137
C.Faravelli,T.Zucchi,A.Perone,R.SalmoriaandB.Viviani
8 Obsessive-compulsiveDisorder:DiagnosticConsiderations
andanEpidemiologicalUpdate 157
Y.Sasson,M.Chopra,R.Amiaz,I.IancuandJ.Zohar
9 Obsessive-compulsiveDisorder:BiologyandTreatment,
aGenerationofProgress 169
I.Lanco,Y.Sasson,N.Nakash,M.ChopraandJ.Zohar
vi ————————————————————————————— CONTENTS
10 GeneralisedAnxietyDisorder 189
N.CaycedoandE.J.L.Griez
11 Post-traumaticSyndromes:ComparativeBiologyand
Psychology 205
W.S.deLoos
12 ThePsychologyofPost-traumaticStressDisorder 223
W.S.deLoos
PARTIII RESEARCHMETHODS 245
SECTIONA METHODSOFEXPERIMENTALPSYCHOLOGY 247
13 LearningPerspectivesonAnxietyDisorders 249
P.Eelen,D.HermansandF.Baeyens
14 CurrentTrendsinCognitiveBehaviourTherapy
forAnxietyDisorders 265
Ph.Fontaine,E.Mollard,S.N.YaoandJ.Cottraux
SECTIONB METHODSOFENVIRONMENTALRESEARCH 287
15 TheExperienceSamplingMethodinStress
andAnxietyResearch 289
M.W.deVries,C.I.M.CaesandP.A.E.G.Delespaul
SECTIONC METHODSOFPHARMACOLOGY 307
16 ThePharmacologyofHumanAnxiety 309
D.J.Nutt
17 ClinicalTestingofAnxiolyticDrugs 325
M.Bourin
SECTIOND METHODSOFEXPERIMENTALPSYCHIATRY 339
18 ACaseStudyofthe35%CO Challenge 341
2
K.Verburg,G.PernaandE.J.L.Griez
19 TheTryptophanDepletionTechniquein
PsychiatricResearch 359
S.V.Argyropoulos,J.K.AbramsandD.J.Nutt
Index 371
EPIDEMIOLOGYOFANXIETYDISORDERS ——————————————— 23
WingateBJ,Hansen-FlaschenJ(1997)Anxietyanddepressioninadvancedlungdisease.Clin
ChestMed18:495–505.
Wittchen HU, Essau CA (1993) Epidemiology of panic disorder: Progress and unresolved
issues.JPsychiatrRes27Suppl1:47–68.
WittchenHU,EssauCA,VonZerssenD,KriegJC,ZaudigM(1992)Lifetimeandsix-month
prevalenceof mental disorders in the Munich Follow-Up Study. Eur Arch Psychiatry Clin
Neurosci241:247–258.
WittchenHU, ReedV,KesslerRC(1998)Therelationshipofagoraphobiaandpanicina
communitysampleofadolescentsandyoungadults.ArchGenPsychiatry55:1017–1024.
Wittchen HU, Zhao S, Kessler RC, Eaton WW (1994) DSM-III-R generalised anxiety
disorderintheNationalComorbiditySurvey.ArchGenPsychiatry51:355–364.
WolfeJ,EricksonDJ,SharkanskyEJ,KingDW,King,LA(1999)Courseandpredictorsof
posttraumaticstressdisorderamongGulfWarveterans:Aprospectiveanalysis.JConsult
ClinPsychol67:520–528.
WoodmanCL,NoyesRJr,BlackDW,SchlosserS,YaglaSJ(1999)A5-yearfollow-upstudyof
generalisedanxietydisorderandpanicdisorder.JNervMentDis187:3–9.
ZandbergenJ, BrightM, PolsH,FernandezI, DeLoofC,GriezEJ(1991)Higherlifetime
prevalenceofrespiratorydiseasesinpanicdisorder?AmJPsychiatry148:1583–1585.
ZaublerTS,KatonW(1998)Panicdisorderinthegeneralmedicalsetting.JPsychosomRes44:
25–42.
ZimmermanM,MattiaJI(1999)Isposttraumaticstressdisorderunderdiagnosedinroutine
clinicalsettings?JNervMentDis187:420–428.
AnxietyDisorders.EditedbyE.J.L.Griez,C.Faravelli,D.NuttandD.Zohar.
Copyright©2001JohnWiley&SonsLtd
PrintISBN0-471-97893-6ElectronicISBN0-470-84643-7
Contributors
J.K.Abrams PsychopharmacologyUnit,SchoolofMedicine,UniversityofBristol,Univer-
sityWalk,BristolBS81TD,UK
Revital Amiaz Division of Psychiatry, Tel Hashomer and Sackler School of Medicine,
ChaimShebaMedicalCenter,Tel-Hashomer52621,Israel
SpiliosV. Argyopoulos PsychopharmacologyUnit, School of Medicine,Universityof
Bristol,UniversityWalk,BristolBS81TD,UK
F. Baeyens Department of Psychology, University of Leuven, Tiensestraat 102, 3000
Leuven,Belbium
Laura Bellodi Department of Neuroscience, Fondazione Centro San Raffaele del Monte
Tabor,ViaL.Prinetti27,Milan,Italy
Michel Bourin Faculty of Medicine, University of Nantes, 1 rue Gaston Veil, 44035
NantesCedex,France
Chantal I.M. Caes Centre for Gender and Diversity, Maastricht University, PO Box
616,6200MDMaastricht,TheNetherlands
Maria C. Cavallini Department of Neuroscience, Fondazione Centro San Raffaele del
MonteTabor,ViaL.Prinetti27,Milan,Italy
NatalieCaycedo c/oValencia133,08011Barcelona,Spain
MiriamChopra DivisionofPsychiatry,TelHashomerandSacklerSchoolofMedicine,
ChaimShebaMedicalCenter,Tel-Hashomer52621,Israel
J.Cottraux HoˆpitalNeurologiqueetNeuro-Chirurgical,PierreWertheimer,59Boulevard
Pinel,Lyon-Montchat69394,LyonCedez03,France
P.Dannon DivisionofPsychiatry,TelHashomerandSacklerSchoolofMedicine,Chaim
ShebaMedicalCenter,Tel-Hashomer52621,Israel
BenoˆıtdeBrettes HoˆpitalFernandWidal,ServicedePsychiatrie,200rueduFaubourg
SaintDenis,75010Paris,France
Philip A.E.G. Delespaul Department of Psychiatry and Neuropsychology, Maastricht
University,POBox616,6200MDMaastricht,TheNetherlands
WolterS.deLoos PsychotraumaCentre,UniversityMedicalCentreUtrechtandCentral
MilitaryHospital,POBox90000,3509AAUtrecht,TheNetherlands
viii —————————————————————————— CONTRIBUTORS
MartinW.deVries DepartmentofPsychiatryandNeuropsychology,MaastrichtUniver-
sity,POBox616,6200MDMaastricht,TheNetherlands
Paul Eelens Department of Psychology, University of Leuven, Tiensestraat 102, 3000
Leyven,Belgium
Carlo Faravelli Department of Neurology and Psychiatry, Florence University Medical
School,PoliclinicoCareggi,50134Florence,Italy
Ph. Fontaine Hoˆpital Neurologique et Neuro-Chirurgical,Pierre Wertheimer, 59 Boule-
vardPinel,Lyon-Montchat69394,LyonCedez03,France
EricJ.L.Griez DepartmentofPsychiatryandNeuropsychology,MaastrichtUniversity,PO
Box616,6200MDMaastricht,TheNetherlands
D. Hermans Department of Psychology, University of Leuven, Tiensestraat 102, 3000
Leuven,Belgium
IulianIancu DivisionofPsychiatry,TelHashomerandSacklerSchoolofMedicine,Chaim
ShebaMedicalCenter,Tel-Hashomer52621,Israel
DonaldF.Klein NewYorkStatePsychiatryInstitute,1051RiversideDrive,NewYork
10032,USA
Jean Pierre Le´pine Hoˆpital Fernand Widal, Service de Psychiatrie, 200 rue du
FaubourgSaintDenis,75010Paris,France
HaraldMerckelbach Departmentof ExperimentalPsychology,MaastrichtUniversity,
POBox616,6200MDMaastricht,TheNetherlands
E.Mollard HoˆpitalNeurologiqueetNeuro-Chirurgical,PierreWertheimer,59Boulevard
Pinel,Lyon-Montchat69394,LyonCedez03,France
PeterMuris DepartmentofExperimentalPsychiatry,MaastrichtUniversity,POBox616,
6200MDMaastricht,TheNetherlands
David J. Nutt Psychopharmacology Unit, School of Medicine, University of Bristol,
UniversityWalk,BristolBS81TD,UK
TheaOverbeek Departmentof PsychiatryandNeuropsychology,MaastrichtUniversity,
POBox616,6200MDMaastricht,TheNetherlands
A.Paionni DepartmentofNeurologyandPsychiatry,FlorenceUniversityMedicalSchool,
PoliclinicoCareggi,50134Florence,Italy
GiampaoloPerna IstitutoScientificoOspedaleSanRaffaele,Vita-SaluteUniversity,Via
Prinetti,29,20127Milan,Italy
A. Perone Department of Neurology and Psychiatry, Florence UniversityMedical School,
PoliclinicoCareggi,50134Florence,Italy
CONTRIBUTORS —————————————————————————— ix
V. Ricca Department of Neurology and Psychiatry, Florence University Medical School,
PoliclinicoCareggi,50134Florence,Italy
R.Salmoria DepartmentofNeurologyandPsychiatry,FlorenceUniversityMedicalSchool,
PoliclinicoCateggi,50134Florence,Italy
YehudaSasson Divisionof Psychiatry,Tel Hashomerand SacklerSchool ofMedicine,
ChaimShebaMedicalCenter,Tel-Hashomer52621,Israel
E.Truglia Departmentof NeurologyandPsychiatry,FlorenceUniversityMedicalSchool,
PoliclinicoCareggi,50134Florence,Italy
Kees Verburg Mediant, Locatie Helmerzijde, Broekheurnering 1050, PO Box 775,
4500ATEnschede,TheNetherlands
Eric Vermetten Department of Psychiatry, Yale University School of Medicine, 47
CollegeStreet,Suite212,NewHavenCT06510,USA
B. Viviani Department of Neurology and Psychiatry, Florence University MedicalSchool,
PoliclinicoCareggi,50134Florence,Italy
S.N. Yao Hoˆpital Neurologique et Neuro-Chirurgical, Pierre Wertheimer, 59 Boulevard
Pinel,Lyon-Montchat69394,LyonCedez03,France
JosephZohar ChaimShebaMedicalCenter,DivisionofPsychiatry,TelHashomerand
SacklerSchoolofMedicine,Tel-Hashomer52621,Israel
T. Zucchi Department of Neurology and Psychiatry, Florence University Medical School,
PoliclinicoCareggi,50134Florence,Italy
AnxietyDisorders.EditedbyE.J.L.Griez,C.Faravelli,D.NuttandD.Zohar.
Copyright©2001JohnWiley&SonsLtd
PrintISBN0-471-97893-6ElectronicISBN0-470-84643-7
Preface
Thereisampleevidenceconcerningtheburdenof anxietydisorders.Weclinicians
know the personal distress of those suffering with panic attacks, severe phobias or
obsessive–compulsive disorder, not to mention people living with stigmas of trau-
maticexperiences.Inadditiontopsychicpain,pathologicalanxietyseverelyaffects
thepatient’sexistence,causingastateofdependencewhichmostoftenstartsinearly
adulthood and has long-standing consequences, disrupting both family life and
professional career. Anxiety disorders, in particular panic attacks, go along with
variousautonomicdisturbancesthattriggerphysicalcomplaintsandmotivatemedi-
calprocedures.Therefore,whennotproperlyrecognized,anxietysyndromesoften
induce useless and sometimes expensive complementary investigations, adding un-
necessarystrainforthepatientandcostsforthehealthcaresystem.Finally,thereis
accumulatingevidencethatananxietydisorder,whenleftuntreated,mayworsenthe
prognosisof a coexistingsomatic condition.This has been clearly demonstratedin
caseofcardiacdiseases.Itcertainlyholdstrueinmanyotherinstances.
Overall,anxietydisordersrepresentanimpressiveburdenofindividualsuffering,
socialimpairmentandeconomiccosts.However,alltoooftenthepatient’ssymptoms
arenotproperlyinterpreted.Ithasbeenestimatedthatinprimarycare,lessthanhalf
of the subjects presenting with an anxiety disorder are recognized as having a
clinicallyrelevantcondition.Onlyasubsetofthemwillbediagnosedassufferingwith
ananxietydisorder.Andagain,onlyasmallpartofthosewithacorrectdiagnosisof
anxietywillbefullyinformedandofferedastate-of-the-arttreatment.
Yet,thelatestdecadeshavewitnessedanexponentialgrowthofknowledgeinthe
fieldofaffectivedisorders,inparticularanxiety.SinceKlein’spioneeringdelineation
of the concept of panic, and the subsequent adoption of a more empirically-based
nosologyofanxietystate,theimpetusofresearchhasproducedahugeaccumulation
of data, based on scientific methodology rather than on a theoretical discourse.
However,thenew,fast-changingsituationhasproducedsomedrawbacks.Asinother
fieldsofmedicine,ithasbecomeincreasinglydifficultforthepracticingclinicianto
keep abreast of ongoing developments. This knowledge helps us understand the
presentparadox:inspiteofexistingevidenceindicatingthattheycouldbehelpedina
very effective way, a substantial proportion of patients with anxiety disorders is
neitheradequately diagnosed,nor appropriatelyinformed on available treatments.
Day-to-daycarelagsbehindscientificevidence,andwhileknowledgeisgrowing,the
gapbetweentheoryandpracticegrowsatastillfasterrate.
Moreandbettercontinuingmedicaleducationprogrammeswillhelp.Neverthe-
less, fast-changing times call for stronger links between research and clinical work.