Table Of Content

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 JOHNWILEY&SONS,LTD Chichester·NewYork·Weinham·Brisbane·Singapore·Toronto AnxietyDisorders.EditedbyE.J.L.Griez,C.Faravelli,D.NuttandD.Zohar. Copyright©2001JohnWiley&SonsLtd PrintISBN0-471-97893-6ElectronicISBN0-470-84643-7 Copyright©2001byJohnWiley&Sons,Ltd., BaffinsLane,Chichester, WestSussexPO191UD,UK National 01243779777 International (+44)1243779777 e-mail(forordersandcustomerserviceenquiries):[email protected] VisitourHomePageon:http://www.wiley.co.ukorhttp://www.wiley.com All Rights Reserved.No part of this publicationmay be reproduced, stored in a retrieval system, or transmitted,inanyformorbyanymeans,electronic,mechanical,photocopying,recording,scanningor otherwise,exceptunderthetermsoftheCopyright,DesignsandPatentsAct1988orunderthetermsofa licenceissuedbytheCopyrightLicensingAgencyLtd,90TottenhamCourtRoad,LondonW1P0LP, UK,withoutthepermissioninwritingofthepublisher. OtherWileyEditorialOffices JohnWiley&Sons,Inc.,605ThirdAvenue, NewYork,NY10158-0012,USA WILEY-VCHVerlagGmbH,Pappelallee3, D-69469Weinheim,Germany JohnWiley&SonsAustraliaLtd.,33ParkRoad,Milton Queensland4064,Australia JohnWiley&Sons(Asia)PteLtd,2ClementiLoop(cid:1)02-01, JinXingDistripark,Singapore129809 JohnWiley&Sons(Canada)Ltd,22WorcesterRoad, Rexdale,OntarioM9W1L1,Canada 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.Lépine 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.