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Book Forum: Anxiety/Stress   |    
Concise Guide to Anxiety Disorders
PETER P. ROY-BYRNE, M.D.
Am J Psychiatry 2004;161:1727-a-1728. doi:10.1176/appi.ajp.161.9.1727-a
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By Eric Hollander, M.D., and Daphne Simeon, M.D. Arlington, Va., American Psychiatric Publishing, 2003, 252 pp., $27.95 (paper).

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This compact, pocket-sized review of the anxiety disorders, written by two experts with both research and clinical expertise, has a soothing, lime-green cover, a simple, succinct expositional style, a familiar organization (sequential chapters on epidemiology, diagnosis, course, biological theories, psychological theories, somatic treatments, and psychotherapy treatments), and a wealth of surprisingly up-to-date and comprehensive information about each of the major anxiety disorders (panic, generalized anxiety disorder, social phobia, specific phobia, seasonal affective disorder, obsessive-compulsive disorder [OCD], and posttraumatic stress disorder [PTSD]). In reviewing this kind of "concise guide," gauging both the depth and comprehensiveness of information is most important. The book stands up well to this kind of evaluation.

This book covers most of the important yet often overlooked facts and issues for each of the seven chapter-related topics cited above. For epidemiology, it includes sufficient information on both axis I and axis II comorbid disorders, the status of agoraphobia without panic, the debate on the nosologic validity of generalized anxiety disorder, differences between compulsive personality and OCD, and the continually puzzling nature of comorbid depression in PTSD (i.e., is it really major depression or a severity marker of PTSD?). The diagnostic chapter contains tables for the differential diagnosis of each disorder and does a nice job of showing how OCD is rather distinct from the other disorders and yet still deserves to be part of the anxiety disorders category. Similarly, it mentions the controversial status of PTSD as both an anxiety and a dissociative disorder.

The chapter on biological theories is the most comprehensive, applying the same organization to reviews of each specific disorder so the reader can easily synthesize findings across the disorders and discern some homologies in pathophysiology. The chapter on psychological theories contains a nice summary of psychoanalytic theories for each disorder with a fair-minded suggestion that, despite the lack of empirical data, these theories are likely still relevant for understanding selected patients. This chapter also covers the more empirically based and evidence-supported cognitive behavior theories. The chapter on pharmacological treatment is surprisingly comprehensive and up-to-date. For example, the use of prazosin to treat PTSD-related nightmares is included, along with augmentation strategies for OCD. The chapter on psychotherapies mentions the controversial status of eye movement desensitization and reprocessing as a treatment for PTSD. A final chapter on selecting treatments provides a reasonable review of the data on combination cognitive behavior therapy and pharmacotherapy for the different disorders.

There are relatively few shortcomings to quibble about. The chapter on the course of illness in anxiety disorders is a bit short and contains selective citations of only some outcome studies rather than a true synthesis of the much larger number. The differential diagnosis section could have mentioned the recent appreciation of high-functioning autism and Asperger’s syndrome as mimics of social anxiety as well as the fact that adult attention deficit hyperactivity disorder can often masquerade as generalized anxiety disorder. Medication augmentation could have been discussed for more disorders than just OCD. However, these are relatively minor issues in what is, on balance, an excellent volume and piece of work.

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