Clinical Manual of Anxiety Disorders

Short books deserve brief reviews—unless they are egregiously bad. This is a brief review because Clinical Manual of Anxiety Disorders is relatively short and it is good—quite good, in fact. The editor is to be commended for assembling many of the “big names” in anxiety disorders and inducing them to produce succinct yet comprehensive overviews following a format that provides remarkable chapter-to-chapter consistency. For each disorder, the discussion fits a template that flows from phenomenology to assessment to pathogenesis to pharmacotherapy to psychotherapy to conclusions and references. As in most books, “reference lag” detracts from the timeliness found in journal articles. Only three of the seven chapters are referenced beyond 2002, and there are only four references from 2003 in the entire book. This may explain why citalopram and escitalopram are mentioned in only some of the chapters.

The book is easy on the eyes, and copyediting has been thorough to the extent that even generic drug names are spelled correctly. Following an introductory chapter, each anxiety disorder is presented in about 20 to 30 fact-filled pages that include not only the obligatory DSM-IV-TR diagnostic criteria but also pathophysiology, neuroanatomy, neurochemistry, and management approaches that include both medications and psychotherapies. Especially appreciated is the balanced and critical presentation of pharmacological outcome data in the chapter on posttraumatic stress disorder. Also, all of the authors place proper emphasis on that often neglected aspect of treatment in these days of medical psychiatry—namely, specific psychotherapies with established effectiveness for anxiety disorders (particularly cognitive behavior therapy in its varied manifestations).

I have a few quibbles with the chapter on panic disorder and agoraphobia because of its lack of current references, its claim for efficacy for gabapentin (the study was negative except for a post hoc subanalysis), use of the term “valproic acid” (the majority of reports were with divalproex), omission of studies on benzodiazepines plus selective serotonin reuptake inhibitors, omission of the 2002 study that failed to confirm a lower relapse rate with longer duration of imipramine maintenance, and no mention of extended-release alprazolam. So much for the necessary nit-picking. Let us get to a conclusion.

Overall, the book gets my seal of approval. It is small enough to digest in easy bites yet large enough to be thoroughly nourishing. Its readership should extend from the greenest of residents to the most seasoned old-timers and include all clinicians (including primary care physicians) who deal with anxiety disorders. Just as I have enjoyed and appreciated reading the book in its current form, so do I look forward to future editions.