Table Of ContentBiological
Basis and
Therapy
of
Neuroses
Editor
Ashoka Jahnavi PrasadD, .Sc., M.B., MRC Psych.
Mental Health Research Institute of Victoria
Royal Park Hospital
Parkville, Victoria, Australia
CRC Press, Inc.
Boca Raton, Florida
Boca Raton London New York
CRC Press is an imprint of the
Taylor & Francis Group, an informa business
First published 1988 by CRC Press
Taylor & Francis Group
6000 Broken Sound Parkway NW, Suite 300
Boca Raton, FL 33487-2742
Reissued 2018 by CRC Press
© 1988 by CRC Press, Inc.
CRC Press is an imprint of Taylor & Francis Group, an Informa business
No claim to original U.S. Government works
This book contains information obtained from authentic and highly regarded sources. Reasonable efforts have been made to publish
reliable data and information, but the author and publisher cannot assume responsibility for the validity of all materials or the
consequences of their use. The authors and publishers have attempted to trace the copyright holders of all material reproduced in this
publication and apologize to copyright holders if permission to publish in this form has not been obtained. If any copyright material has
not been acknowledged please write and let us know so we may rectify in any future reprint.
Except as permitted under U.S. Copyright Law, no part of this book may be reprinted, reproduced, transmitted, or utilized in any form
by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying, microfilming, and recording,
or in any information storage or retrieval system, without written permission from the publishers.
For permission to photocopy or use material electronically from this work, please access www.copyright.com (http://www.copyright.
com/) or contact the Copyright Clearance Center, Inc. (CCC), 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400. CCC is a
not-for-profit organization that provides licenses and registration for a variety of users. For organizations that have been granted a
photocopy license by the CCC, a separate system of payment has been arranged.
Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and
explanation without intent to infringe.
Library of Congress Cataloging-in-Publication Data
Biological basis and therapy of neuroses.
Includes bibliographies and index.
1. Neuroses--Treatment. 2. Biological psychiatry.
I. Prasad, Ashoka Jahnavi. [DNLM: 1. Biological
Psychiatry. 2. Neurotic Disorders--therapy.
WM 170 B615]
RC530.B56 1988 616.85’2 87-27743
ISBN 0-8493-4899-4
Publisher’s Note
The publisher has gone to great lengths to ensure the quality of this reprint but points out that some imperfections in the original copies
may be apparent.
Disclaimer
The publisher has made every effort to trace copyright holders and welcomes correspondence from those they have been unable to
contact.
ISBN 13: 978-1-315-89114-9 (hbk)
ISBN 13: 978-1-351-07024-9 (ebk)
Visit the Taylor & Francis Web site at http://www.taylorandfrancis.com and the
CRC Press Web site at http://www.crcpress.com
PREFACE
Like "hysteria", the term "neurosis" has aroused considerable controversy ever since
its coinage by Cullen (1769) in Edinburgh. His definition was rather wide and included
diverse entities, e.g., epilepsy, apoplexy, asthma, mania, anxiety, etc.
However, it would seem that the concept has not stood the test of time, and has had
varied connotations over different periods. In colloquial usage, it connotes a rather heter-
ogeneous group of seemingly unrelated disorders. The biggest textbook in psychiatry (viz.
Comprehensive Textbook of Psychiatry by Kaplan, Freedman, and Sadock) defines it as
"mental disorder characterised primarily by anxiety which may either be directly experienced
and dominate the clinical picture or be unconsciously controlled and modified by various
psychological mechanisms to produce other subjectively distressing and ego-alien symptoms.
They are not accompanied by gross distortions of reality of severe personality disorganization;
neurotic disorders have no organic basis, are relatively persistent and are treatable."
Paradoxically, it is the term "neurosis" more than perhaps any other which has the
implication of organic basis. Possibly the popular but erroneous belief mentioned earlier
impeded systematic biological research in this area. On careful scrutiny, it becomes obvious
that there is considerable evidence for a biological basis to these hitherto ignored conditions.
To the best of my knowledge, this is the first endeavor to present this information in a
systematic manner. I would consider our efforts successful if this book fulfills the function
of generating further research in this interesting but relatively under-researched area.
Without the help of my colleagues who enthusiastically participated in this venture, this
book would not have seen the light of day. To all of them, I owe a deep sense of gratitude.
Prof. Merton Sandler, a past president of the British Association of Psychophmacology
and a leading authority in this field, provided constant encouragement. I am deeply grateful
to him for writing the foreword. I should like to place on record my sincere appreciation to
CRC Press; its President, Mr. B. J. Starkoff; and Ms. Marsha Baker for their support while
this volume was under preparation. It has been a pleasure collaborating with them. And
last, but certainly not least, I must thank Gillian Cochrane, Anna Stone, and Susan Schiltz
for their secretarial assistance.
I would welcome comments from readers about the contents. If the exercise proves
successful, it would be a tribute to all the contributors. However, I must bear sole respon-
sibility and crave indulgence for any shortcomings which may have crept in inadvertently.
Ashoka Jahnavi Prasad
FOREWORD
Over the past 25 years, we have witnessed a quiet revolution in the theory and practice
of psychiatry. The cult of personality - what we might call divination by introspection -
fights a rear guard action. Slowly and hesitantly, the study of psychopathology has succumbed
to the scientific method, and what is now termed biological psychiatry marches inexorably
forward. But wait! Are there not pockets of resistance? Few would now deny the essential
biological basis of the affective disorders, with their somatic features and biological markers;
and although direct evidence is scanty, the schizophrenic syndromes too march triumphantly
foward on a broad biological front, with the clinical response to neuroleptics as their battle
standard. It is the neuroses which, until very recently, have been stuck in the psychoanalytical
mud! And, as the reader will see in Dr. Prasad's excellent and imaginative compilation,
even this last bastion is beginning to crumble.
Dr. Prasad has recruited a powerful and enthusiastic team of biological psychiatrists to
describe for us this final onslaught. They do not underestimate the obstacles in their path,
but neither do they find them insuperable. Continuous optimism is the watchword, and yet
the story is powerful and compelling. Who can doubt that careful and painstaking application
of the scientific method to the problem of the neuroses will lead to final therapeutic victory.
Prof. Merton Sandler M.D., F.R.C.P., F.R.C. Path., F.R.C.Psych.
Queen Charlotte's Hospital
London, England
THE EDITOR
Ashoka Jahnavi Prasad, M.D., is presently in charge of the Section on Psychophar-
macology at the Mental Health Research Institute of Victoria in Melbourne, Australia. He
also holds Consultant Psychiatrist positions at the Royal Park Hospital and the Prince Henry's
Hospital within the same city, in addition to an academic position with the Department of
Psychological Medicine, Monash University, Clayton, Victoria.
Dr. Prasad graduated in medicine in 1976 from the University of Kanpur, India and after
holding a brief residency position in New Delhi, moved to the Republic of Ireland for a
year before his move to the Royal Edinburgh Hospital in Edinburgh, Scotland, one of the
leading centers for academic psychiatry, where he completed most of his residency in
psychiatry. After obtaining his membership of the Royal College of Psychiatrists, he took
up a research appointment with the University of Leeds in England where he was also briefly
a Tutor in Psychiatry.
Very soon, he was offered the first Kate Stillman Fellowship with the University of
London where he worked for his doctorate under Prof. Merton Sandler, a leader in the field
of psychopharmacology. He then worked as a Consultant Psychiatrist at Whipps Cross and
Claybury Hospitals in London before moving to his present position.
Among other distinctions, Dr. Prasad was the recipient of the Murphy award in 1986 and
was the Catherine Waterman Visiting Professor for 1987. He has also published about 100
scientific papers and abstracts in different journals and sits on the International Editorial
Board of the Journal of Psychiatric Research, a leading journal in the field, and is on the
Board of Assessors of several other journals.
Dr. Prasad has taken an active interest in both postgraduate and undergraduate medical
education, serving as an examiner to several universities, and has lectured widely all over
the world. He has presented papers in over 25 international meetings, many of them as the
Chairperson. He has also written a number of articles on health issues in national papers
and appeared on television.
Apart from psychiatry, Dr. Prasad's other academic interests are medical anthropology
and aviation medicine and he holds postgraduate qualifications in both subjects.
CONTRIBUTORS
Thomas R. E. Barnes, M.B., B.S., M. S. Keshavan, M.B., B.Sc., M.D.,
M.R.C. Psych. M.R.C. Psych., M.N.A.M.S.
Senior Lecturer in Psychiatry Assistant Professor
Charing Cross and Westminster Medical Department of Psychiatry
School Wayne State University
London, England Detroit, Michigan
Gary Bell, B.A., M.B., B.S., M.R.C. Peter F. Liddle, B.M., B.Ch., Ph.D.,
Psych. M.R.C. Psych.
Lecturer in Psychiatry
Senior Lecturer in Psychiatry
University College and Middlesex School
Charing Cross and Westminster Medical
of Medicine
School
London, England
London, England
Jonathan Davidson, M.D.
Rahul Manchanda, M.B.B.S., M.D.,
Director of Anxiety Disorders Program
M.R.C. Psych., F.R.C.P.(C)
Department of Psychiatry
Assistant Professor
Duke University Medical Center
Department of Psychiatry
Durham, North Carolina
University of Western Ontario
Sanjay Dube, M.B., B.S., M.D. London, Ontario, Canada
Director
Affective Disorders Unit Harold Merskey, D.M.
Lafayette Clinic Professor
Detroit, Michigan Department of Psychiatry
University of Western Ontario
Nigel F. S. Hymas, M.A., M.R.C. London, Ontario, Canada
Psych.
Senior Registrar
Ashoka Prasad, DSc., M.B., M.R.C.
Goodmayes Hospital
Psych.
Ilford, Essex, and
Director of Psychophmacology
Department of Psychological Medicine
Mental Health Research Institute
St. Bartholomew's Hospital
Royal Park Hospital
London, England
Melbourne, Australia
Cornelius Katona, M.A., M.B.,
B.Chir., M.R.C. Psych. Daniel Rogers, M.A., M.R.C., M.R.C.
Senior Lecturer in Psychiatry Psych.
University College and Middlesex School Consultant Neuropsychiatrist
of Medicine Burden Neurological Hospital
London, England Bristol, Avon, England
Natraj Sitaram, M.D. Janet Treasure, Ph.D., M.B.B.S.,
Professor M.R.C.P., M.R.C. Psych.
Department of Psychiatry Lecturer in Psychiatry
Wayne State University Department of Psychiatry
Lafayette Clinic Institute of Psychiatry
Detroit, Michigan London, England
V. K. Yeragani, M.D.
Assistant Professor of Psychiatry
Lafayette Clinic
Wayne State University
Detroit, Michigan
TABLE OF CONTENTS
Chapter l
Neurobiology of Anxiety.. ..............................................................1.
M. S. Keshavan and V. K. Yeragani
Chapter 2
The Biological Status of Neurotic Depression.. .........................................2 3
Sanjay Dube and Natraj Sitaram
Chapter 3
Obsessive-Compulsive Disorder: Its Clinical Neurology and Recent Pharmacological
Studies ..................................................................................4 l
N. Hymas and A. J. Prasad
Chapter 4
Hysteria ................................................................................8.1
R. Manchanda and H. Merskey
Chapter 5
The Biology of Anorexia Nervosa.. ....................................................9. 3
Janet Treasure
Chapter 6
Biological Aspects of Post-Traumatic Stress Disorder.. ................................1 07
Jonathan Davidson
Chapter 7
Epilepsy and Neurosis. .................................................................l 2l
Peter F. Liddle and Thomas R. E. Barnes
Chapter 8
Neurosis and Neurological Disorder.. ..................................................l 45
Daniel Rogers
Chapter 9
Neurotic Disorders Associated with Menstruation, Pregnancy and the Postpartum
Period .................................................................................1. 59
Gary Bell and Cornelius Katona
Index ..................................................................................1.8 7
Chapter 1
NEUROBIOLOGY OF ANXIETY
. . . .
M S Keshavan and V K Yeragani
TABLE OF CONTENTS
I . Nosology of Anxiety States - A Historical Overview ...........................2
I1 . Genetic Factors In Anxiety ......................................................3.
A . Role of Genetic Factors in Anxiety Disorders ............................. 3
B . Are Genetic Factors Specific to Anxiety Disorders? .......................3
C . How are Anxiety Disorders Transmitted? .................................4
I11 . Neuropharmacological and Neurochemical Aspects of Anxiety ...................4
A . Lactate Model ............................................................4.
1. Possible Mechanisms of Lactate-Induced Panic Anxiety ........... 5
2 . Specificity of Lactate-Induced Panic - Methodological Issues .... 6
B . Carbon Dioxide as an Anxiogenic Agent ..................................7
C . Caffeine Model ...........................................................7.
D . Isoproterenol Model ......................................................8.
E . Yohimbine Model ........................................................9.
F . The Benzodiazepine and GABA Receptor Model of Anxiety Disorders . . 10
1. Where in the CNS do Benzodiazepines Act? ..................... 10
2 . Benzodiazepine Antagonists ......................................1 0
3 . Benzodiazepine Endogenous Ligands .............................1 1
G . Opioids and Panic Anxiety ...............................................1 1
IV . Psychophysiological Aspects of Anxiety ........................................1.1
A . A Psychophysiological Model of Anxiety ................................1 2
V . Neurophysiology of Anxiety ....................................................1.2
V1 . Neuroendocrine Aspects of Anxiety Disorders ...................................1 4
V11 . Neurobiology of Anxiety - An Integration .....................................1 4
V11 . Conclusions and New Directions .................................................1 5
Acknowledgments ......................................................................1.6
References ...............................................................................1 6
