anxiety disorders

Anxiety Disorders Anxiety Disorders. Edited by E. J. L. Griez, C. Faravelli, D. Nutt and D. Zohar. Copyright © 2001 John Wiley & Sons Ltd Print ISBN 0-471-97893-6 Electronic ISBN 0-470-84643-7 Anxiety Disorders An Introduction to Clinical Management and Research Edited by Eric J.L. Griez Department of Psychiatry and Neuropsychology, University of Maastricht, The Netherlands Carlo Faravelli Department of Neurology and Psychiatry, Florence University Medical School, Italy David Nutt Psychopharmacology Unit, School of Medical Sciences, University of Bristol, UK and Joseph Zohar Department of Psychiatry and Anxiety Clinic, Sheba Medical Center, Tel Hashomer, University of Tel Aviv, Sackler Faculty of Medicine, Israel JOHN WILEY & SONS, LTD Chichester · New York · Weinham · Brisbane · Singapore · Toronto Anxiety Disorders. Edited by E. J. L. Griez, C. Faravelli, D. Nutt and D. Zohar. Copyright © 2001 John Wiley & Sons Ltd Print ISBN 0-471-97893-6 Electronic ISBN 0-470-84643-7 Copyright © 2001 by John Wiley & Sons, Ltd., Baffins Lane, Chichester, West Sussex PO19 1UD, UK National 01243 779777 International (+44) 1243 779777 e-mail (for orders and customer service enquiries): cs-books @wiley.co.uk Visit our Home Page on: http://www.wiley.co.uk or http://www.wiley.com All Rights Reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, scanning or otherwise, except under the terms of the Copyright, Designs and Patents Act 1988 or under the terms of a licence issued by the Copyright Licensing Agency Ltd, 90 Tottenham Court Road, London W1P 0LP, UK, without the permission in writing of the publisher. Other Wiley Editorial Offices John Wiley & Sons, Inc., 605 Third Avenue, New York, NY 10158-0012, USA WILEY-VCH Verlag GmbH, Pappelallee 3, D-69469 Weinheim, Germany John Wiley & Sons Australia Ltd., 33 Park Road, Milton Queensland 4064, Australia John Wiley & Sons (Asia) Pte Ltd, 2 Clementi Loop  02-01, Jin Xing Distripark, Singapore 129809 John Wiley & Sons (Canada) Ltd, 22 Worcester Road, Rexdale, Ontario M9W 1L1, Canada Library of Congress Cataloging-in-Publication Data Anxiety disorders: an introduction to clinical management and research / edited by E.J.L. Griez . . . [et al.]. p. cm. Includes bibliographical references and index. ISBN 0-471-97873-6 (alk. paper) 1. Anxiety. 2. Phobias. 3. Obsessive–compulsive disorder. 4. Anxiety—Research. 5. Phobias—Research. 6. Obsessive–compulsive disorder—Research . I. Griez, E.J.L. RC531.E94 2001 616.8522—dc21 00–069333 British Library Cataloguing in Publication data A catalogue record for this book is available from the British Library ISBN 0-471-97873-6 Typeset in 10/12pt Baskerville from the author’s disks by Vision Typesetting, Manchester Printed and bound in Great Britain by Biddles Ltd, Guildford and King’s Lynn This book is printed on acid-free paper responsibly manufactured from sustainable forestry, in which at least two trees are planted for each one used for paper production. Anxiety Disorders. Edited by E. J. L. Griez, C. Faravelli, D. Nutt and D. Zohar. Copyright © 2001 John Wiley & Sons Ltd Print ISBN 0-471-97893-6 Electronic ISBN 0-470-84643-7 Contents List of contributors vii Preface xi E.J.L. Griez Introduction: Current Concepts in Anxiety xv D. Klein PART I EPIDEMIOLOGY AND GENETICS 1 1 Epidemiology of Anxiety Disorders 3 T. Overbeek, E. Vermetten and E.J.L. Griez 2 Genetics of Anxiety Disorders: Part I 25 M.C. Cavallini and L. Bellodi 3 Genetics of Anxiety Disorders: Part II 41 B. de Brettes and J.P. Le´pine PART II NOSOLOGY AND TREATMENT OF ANXIETY DISORDERS 51 4 Panic Disorder: Clinical Course, Morbidity and Comorbidity 53 C. Faravelli and A. Paionni 5 Panic Disorder: Pathogenesis and Treatment 81 C. Faravelli, V. Ricca and E. Truglia 6 Specific Phobias 105 H. Merckelbach and P. Muris 7 Social Phobia 137 C. Faravelli, T. Zucchi, A. Perone, R. Salmoria and B. Viviani 8 Obsessive-compulsive Disorder: Diagnostic Considerations and an Epidemiological Update 157 Y. Sasson, M. Chopra, R. Amiaz, I. Iancu and J. Zohar 9 Obsessive-compulsive Disorder: Biology and Treatment, a Generation of Progress 169 I. Lanco, Y. Sasson, N. Nakash, M. Chopra and J. Zohar Anxiety Disorders. Edited by E. J. L. Griez, C. Faravelli, D. Nutt and D. Zohar. Copyright © 2001 John Wiley & Sons Ltd Print ISBN 0-471-97893-6 Electronic ISBN 0-470-84643-7 10 Generalised Anxiety Disorder 189 N. Caycedo and E.J.L. Griez 11 Post-traumatic Syndromes: Comparative Biology and Psychology 205 W.S. de Loos 12 The Psychology of Post-traumatic Stress Disorder 223 W.S. de Loos PART III RESEARCH METHODS 245 SECTION A METHODS OF EXPERIMENTAL PSYCHOLOGY 247 13 Learning Perspectives on Anxiety Disorders 249 P. Eelen, D. Hermans and F. Baeyens 14 Current Trends in Cognitive Behaviour Therapy for Anxiety Disorders 265 Ph. Fontaine, E. Mollard, S.N. Yao and J. Cottraux SECTION B METHODS OF ENVIRONMENTAL RESEARCH 287 15 The Experience Sampling Method in Stress and Anxiety Research 289 M.W. de Vries, C.I.M. Caes and P.A.E.G. Delespaul SECTION C METHODS OF PHARMACOLOGY 307 16 The Pharmacology of Human Anxiety 309 D.J. Nutt 17 Clinical Testing of Anxiolytic Drugs 325 M. Bourin SECTION D METHODS OF EXPERIMENTAL PSYCHIATRY 339 18 A Case Study of the 35% CO 2 Challenge 341 K. Verburg, G. Perna and E.J.L. Griez 19 The Tryptophan Depletion Technique in Psychiatric Research 359 S.V. Argyropoulos, J.K. Abrams and D.J. Nutt Index 371 vi ————————————————————————————— CONTENTS Wingate BJ, Hansen-Flaschen J (1997) Anxiety and depression in advanced lung disease. Clin Chest Med 18: 495–505. Wittchen HU, Essau CA (1993) Epidemiology of panic disorder: Progress and unresolved issues. J Psychiatr Res 27 Suppl 1: 47–68. Wittchen HU, Essau CA, Von Zerssen D, Krieg JC, Zaudig M (1992) Lifetime and six-month prevalence of mental disorders in the Munich Follow-Up Study. Eur Arch Psychiatry Clin Neurosci 241: 247–258. Wittchen HU, Reed V, Kessler RC (1998) The relationship of agoraphobia and panic in a community sample of adolescents and young adults. Arch Gen Psychiatry 55: 1017–1024. Wittchen HU, Zhao S, Kessler RC, Eaton WW (1994) DSM-III-R generalised anxiety disorder in the National Comorbidity Survey. Arch Gen Psychiatry 51: 355–364. Wolfe J, Erickson DJ, Sharkansky EJ, King DW, King, LA (1999) Course and predictors of posttraumatic stress disorder among Gulf War veterans: A prospective analysis. J Consult Clin Psychol 67: 520–528. Woodman CL, Noyes R Jr, Black DW, Schlosser S, Yagla SJ (1999) A 5-year follow-up study of generalised anxiety disorder and panic disorder. J Nerv Ment Dis 187:3–9. Zandbergen J, Bright M, Pols H, Fernandez I, De Loof C, Griez EJ (1991) Higher lifetime prevalence of respiratory diseases in panic disorder? Am J Psychiatry 148: 1583–1585. Zaubler TS, Katon W (1998) Panic disorder in the general medical setting. J Psychosom Res 44: 25–42. Zimmerman M, Mattia JI (1999) Is posttraumatic stress disorder underdiagnosed in routine clinical settings? J Nerv Ment Dis 187: 420–428. EPIDEMIOLOGY OF ANXIETY DISORDERS ——————————————— 23 Contributors J.K. Abrams Psychopharmacology Unit, School of Medicine, University of Bristol, Univer- sity Walk, Bristol BS8 1TD, UK Revital Amiaz Division of Psychiatry, Tel Hashomer and Sackler School of Medicine, Chaim Sheba Medical Center, Tel-Hashomer 52621, Israel Spilios V. Argyopoulos Psychopharmacology Unit, School of Medicine, University of Bristol, University Walk, Bristol BS8 1TD, 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, Via L. Prinetti 27, Milan, Italy Michel Bourin Faculty of Medicine, University of Nantes, 1 rue Gaston Veil, 44035 Nantes Cedex, France Chantal I.M. Caes Centre for Gender and Diversity, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands Maria C. Cavallini Department of Neuroscience, Fondazione Centro San Raffaele del Monte Tabor, Via L. Prinetti 27, Milan, Italy Natalie Caycedo c/o Valencia 133, 08011 Barcelona, Spain Miriam Chopra Division of Psychiatry, Tel Hashomer and Sackler School of Medicine, Chaim Sheba Medical Center, Tel-Hashomer 52621, Israel J. Cottraux Hoˆpital Neurologique et Neuro-Chirurgical, Pierre Wertheimer, 59 Boulevard Pinel, Lyon-Montchat 69394, Lyon Cedez 03, France P. Dannon Division of Psychiatry, Tel Hashomer and Sackler School of Medicine, Chaim Sheba Medical Center, Tel-Hashomer 52621, Israel Benoıˆt de Brettes Hoˆpital Fernand Widal, Service de Psychiatrie, 200 rue du Faubourg Saint Denis, 75010 Paris, France Philip A.E.G. Delespaul Department of Psychiatry and Neuropsychology, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands Wolter S. de Loos Psychotrauma Centre, University Medical Centre Utrecht and Central Military Hospital, PO Box 90000, 3509 AA Utrecht, The Netherlands Anxiety Disorders. Edited by E. J. L. Griez, C. Faravelli, D. Nutt and D. Zohar. Copyright © 2001 John Wiley & Sons Ltd Print ISBN 0-471-97893-6 Electronic ISBN 0-470-84643-7 Martin W. deVries Department of Psychiatry and Neuropsychology, Maastricht Univer- sity, PO Box 616, 6200 MD Maastricht, The Netherlands Paul Eelens Department of Psychology, University of Leuven, Tiensestraat 102, 3000 Leyven, Belgium Carlo Faravelli Department of Neurology and Psychiatry, Florence University Medical School, Policlinico Careggi, 50134 Florence, Italy Ph. Fontaine Hoˆpital Neurologique et Neuro-Chirurgical, Pierre Wertheimer, 59 Boule- vard Pinel, Lyon-Montchat 69394, Lyon Cedez 03, France Eric J.L. Griez Department of Psychiatry and Neuropsychology, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands D. Hermans Department of Psychology, University of Leuven, Tiensestraat 102, 3000 Leuven, Belgium Iulian Iancu Division of Psychiatry, Tel Hashomer and Sackler School of Medicine, Chaim Sheba Medical Center, Tel-Hashomer 52621, Israel Donald F. Klein New York State Psychiatry Institute, 1051 Riverside Drive, New York 10032, USA Jean Pierre Le´pine Hoˆpital Fernand Widal, Service de Psychiatrie, 200 rue du Faubourg Saint Denis, 75010 Paris, France Harald Merckelbach Department of Experimental Psychology, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands E. Mollard Hoˆpital Neurologique et Neuro-Chirurgical, Pierre Wertheimer, 59 Boulevard Pinel, Lyon-Montchat 69394, Lyon Cedez 03, France Peter Muris Department of Experimental Psychiatry, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands David J. Nutt Psychopharmacology Unit, School of Medicine, University of Bristol, University Walk, Bristol BS8 1TD, UK Thea Overbeek Department of Psychiatry and Neuropsychology, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands A. Paionni Department of Neurology and Psychiatry, Florence University Medical School, Policlinico Careggi, 50134 Florence, Italy Giampaolo Perna Istituto Scientifico Ospedale San Raffaele, Vita-Salute University, Via Prinetti, 29, 20127 Milan, Italy A. Perone Department of Neurology and Psychiatry, Florence University Medical School, Policlinico Careggi, 50134 Florence, Italy viii —————————————————————————— CONTRIBUTORS V. Ricca Department of Neurology and Psychiatry, Florence University Medical School, Policlinico Careggi, 50134 Florence, Italy R. Salmoria Department of Neurology and Psychiatry, Florence University Medical School, Policlinico Categgi, 50134 Florence, Italy Yehuda Sasson Division of Psychiatry, Tel Hashomer and Sackler School of Medicine, Chaim Sheba Medical Center, Tel-Hashomer 52621, Israel E. Truglia Department of Neurology and Psychiatry, Florence University Medical School, Policlinico Careggi, 50134 Florence, Italy Kees Verburg Mediant, Locatie Helmerzijde, Broekheurnering 1050, PO Box 775, 4500 AT Enschede, The Netherlands Eric Vermetten Department of Psychiatry, Yale University School of Medicine, 47 College Street, Suite 212, New Haven CT 06510, USA B. Viviani Department of Neurology and Psychiatry, Florence University Medical School, Policlinico Careggi, 50134 Florence, Italy S.N. Yao Hoˆpital Neurologique et Neuro-Chirurgical, Pierre Wertheimer, 59 Boulevard Pinel, Lyon-Montchat 69394, Lyon Cedez 03, France Joseph Zohar Chaim Sheba Medical Center, Division of Psychiatry, Tel Hashomer and Sackler School of Medicine, Tel-Hashomer 52621, Israel T. Zucchi Department of Neurology and Psychiatry, Florence University Medical School, Policlinico Careggi, 50134 Florence, Italy CONTRIBUTORS —————————————————————————— ix Preface There is ample evidence concerning the burden of anxiety disorders. We clinicians 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- matic experiences. In addition to psychic pain, pathological anxiety severely affects the patient’s existence, causing a state of dependence which most often starts in early adulthood and has long-standing consequences, disrupting both family life and professional career. Anxiety disorders, in particular panic attacks, go along with various autonomic disturbances that trigger physical complaints and motivate medi- cal procedures. Therefore, when not properly recognized, anxiety syndromes often induce useless and sometimes expensive complementary investigations, adding un- necessary strain for the patient and costs for the health care system. Finally, there is accumulating evidence that an anxiety disorder, when left untreated, may worsen the prognosis of a coexisting somatic condition. This has been clearly demonstrated in case of cardiac diseases. It certainly holds true in many other instances. Overall, anxiety disorders represent an impressive burden of individual suffering, social impairment and economic costs. However, all too often the patient’s symptoms are not properly interpreted. It has been estimated that in primary care, less than half of the subjects presenting with an anxiety disorder are recognized as having a clinically relevant condition. Only a subset of them will be diagnosed as suffering with an anxiety disorder. And again, only a small part of those with a correct diagnosis of anxiety will be fully informed and offered a state-of-the-art treatment. Yet, the latest decades have witnessed an exponential growth of knowledge in the field of affective disorders, in particular anxiety. Since Klein’s pioneering delineation of the concept of panic, and the subsequent adoption of a more empirically-based nosology of anxiety state, the impetus of research has produced a huge accumulation of data, based on scientific methodology rather than on a theoretical discourse. However, the new, fast-changing situation has produced some drawbacks. As in other fields of medicine, it has become increasingly difficult for the practicing clinician to keep abreast of ongoing developments. This knowledge helps us understand the present paradox: in spite of existing evidence indicating that they could be helped in a very effective way, a substantial proportion of patients with anxiety disorders is neither adequately diagnosed, nor appropriately informed on available treatments. Day-to-day care lags behind scientific evidence, and while knowledge is growing, the gap between theory and practice grows at a still faster rate. More and better continuing medical education programmes will help. Neverthe- less, fast-changing times call for stronger links between research and clinical work. Anxiety Disorders. Edited by E. J. L. Griez, C. Faravelli, D. Nutt and D. Zohar. Copyright © 2001 John Wiley & Sons Ltd Print ISBN 0-471-97893-6 Electronic ISBN 0-470-84643-7 [...]... separation anxiety is a common antecedent of panic disorder has been noted The recent work by Jerome Kagan and associates indicates the frequency of behavioral inhibition in children of patients with anxiety disorders and the possibility that behavioral inhibition may be a precursor of social anxiety disorders This emphasizes the importance of continuity of adult with childhood anxiety disorders Investigation... xiii pertaining to anxiety disorders, as members of the faculty have developed it over the last few years In the future, the board of directors intends to go on inviting leading experts to share their latest findings with the trainees The European Certificate in Anxiety and Mood Disorders should stay in tune with the best evidence Eric J.L Griez Chairman of the Board of Directors Anxiety Disorders Edited... Epidemiology and Genetics Anxiety Disorders Edited by E J L Griez, C Faravelli, D Nutt and D Zohar Copyright © 2001 John Wiley & Sons Ltd Print ISBN 0-471-97893-6 Electronic ISBN 0-470-84643-7 ———————————————————————————————— CHAPTER 1 Epidemiology of Anxiety Disorders T Overbeek, E Vermetten, and E.J.L Griez Maastricht University, Maastricht, The Netherlands INTRODUCTION Anxiety disorders have a high... depression (17%) (Kessler et al., 1994) Lifetime prevalence rates for all anxiety disorders lumped together as found in the NCS are 19.2% for men, 30.5% for women (Kessler et al., 1994) There is a strong correlation between socio-economic status and anxiety disorders The one-year prevalence as based on ECA data is 12.6% for all types of anxiety disorders, compared with 14.6% lifetime (Regier et al., 1998) A... 1998) A final important introductory caveat is the issue of comorbidity Comorbidity between disorders quite dramatically complicates the interpretation of many studies Even apart from the considerable comorbidity figures between the anxiety disorders themselves, comorbidity rates between anxiety disorders and depressive disorders are very high (especially panic disorder with agoraphobia, social phobia and... diabetes and dermatological diseases) and anxiety disorders (especially panic disorder, GAD and agoraphobia) (Stoudemire, 1996) In this chapter the epidemiological findings from some large population-based surveys and some smaller but relevant clinical studies will be reviewed, all DSM-IV anxiety disorders arranged by diagnostic category EPIDEMIOLOGY OF ANXIETY DISORDERS ——————————————— 5 PANIC DISORDER... co-existing in time to 60% lifetime Comorbidity rates between, for example, generalised anxiety disorder (GAD) or post-traumatic stress disorder (PTSD) and other psychiatric disorders are even higher, about 80% for GAD and 90% for PTSD lifetime figures In general practice the comorbidity of anxiety disorders and depressive disorders is common, with the happy consequence that the chance of recognition and... al., 1998) Comorbidity Simple phobia is highly comorbid with other disorders; 83.4% of persons with simple phobia reported at least one lifetime comorbid disorder (Magee et al., 1996) The other anxiety disorders and major depression are most frequent Also, specific phobia is frequently diagnosed as a comorbid disorder in other anxiety disorders (Goisman et al., 1998) SOCIAL PHOBIAS In recent years social... among the anxiety disorders GENERALISED ANXIETY DISORDER (GAD) The concept of generalised anxiety disorder is subject to discussion Although the disorder is regarded as prevalent in primary care as well as in specialised settings, because of the high comorbidity rates associated with GAD the controversy is about whether to consider GAD an independent disorder or as a residual or prodrome of other disorders. .. It is shown that panic disorder is common in cardiac, gastrointestinal, respiratory and neurologic disorders SPECIFIC PHOBIAS Specific phobias are the second most common anxiety disorder, after social phobia They are, however, less impressive because they are mostly less incapacitating than other anxiety disorders A specific phobia is defined as a circumscribed, persistent, and unreasonable fear of a particular . anxiety disorders and the possibility that behavioral inhibition may be a precursor of social anxiety disorders. This emphasizes the importance of continuity of adult with childhood anxiety disorders. . Current Concepts in Anxiety xv D. Klein PART I EPIDEMIOLOGY AND GENETICS 1 1 Epidemiology of Anxiety Disorders 3 T. Overbeek, E. Vermetten and E.J.L. Griez 2 Genetics of Anxiety Disorders: Part I. 25 M.C. Cavallini and L. Bellodi 3 Genetics of Anxiety Disorders: Part II 41 B. de Brettes and J.P. Le´pine PART II NOSOLOGY AND TREATMENT OF ANXIETY DISORDERS 51 4 Panic Disorder: Clinical Course,