Cognitive-affective neuroscience of depression and anxiety disorders

153 Pages·2002·1.14 MB·English

by  Dan J Stein

Cognitive-Affective
Neuroscience of Depression
and Anxiety Disorders

Cognitive-Affective
Neuroscience of
Depression and Anxiety
Disorders
Dan J Stein, MD, PhD
Director, MRC Unit on Anxiety Disorders,
Department of Psychiatry, University of
Stellenbosch, Cape Town,
South Africa
and
University of Florida, Gainesville, USA
© 2003 Martin Dunitz Ltd, a member of the Taylor & Francis group
First published in the United Kingdom in 2003
by Martin Dunitz Ltd, Taylor &Francis Group plc, 11 New Fetter Lane, London
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Contents
Acknowledgements vii
Preface ix
1. Introduction 1
2. Major depression 15
3. Generalized anxiety disorder 29
4. Obsessive-compulsive disorder 41
5. Panic disorder 57
6. Post-traumatic stress disorder 69
7. Social anxiety disorder 81
8. Conclusion 93
References 99
Appendix 115
Index 133

Acknowledgements
The support of the Medical Research Council of South Africa is gratefully
acknowledged. Permission of the University of Stellenbosch to reprint
the illustrations is appreciated, with particular thanks to Carol Lochner
for her artistic collaboration. While a range of primary sources were used
to develop the illustrations, the University of Washington Digital
Anatomist Program and Salloway and Colleagues’ volume on the Neu-
ropsychiatry of Limbic and Subcortical Disorders were particularly
helpful. Professor David Nutt provided valuable feedback on an early
draft.
Heather, Gabriella, Joshua, and our new arrival, consistently provided
encouragement and inspiration.

Preface
This volume is to some extent about the diagnosis, evaluation, and treat-
ment of the mood and anxiety disorders mostly commonly seen in
general clinical practice. Chapters are devoted to major depression, gen-
eralized anxiety disorder, obsessive-compulsive disorder, panic disorder,
post-traumatic stress disorder, and social anxiety disorder.
This volume is to a greater extent about the psychobiology of these
conditions. Each chapter highlights the mediating neurocircuitry, and
relates this to the relevant cognitive-affective functions, proximal factors
(e.g. neurotransmitter systems), and distal factors (e.g. the evolutionary
basis) involved in the disorder under discussion.
The volume is, however, ultimately an attempt to develop an integ-
rated conceptual approach to depression and the anxiety disorders.
While it is important for clinicians to keep up to date with clinical issues
and with new data, what excites many psychiatrists is the question of
how best to think about the brain–mind and its psychopathology.
The approach taken here to the brain–mind and to its psychopathol-
ogy draws on current developments in cognitive-affective neuroscience
and evolutionary theory. I hope that this will not only provide practic-
ing clinicians with a novel and thought-provoking perspective on their
patients, but also comprise a useful framework for thinking about appro-
priate management.
Dan J Stein, MD, PhD