Anxiety Disorders in Adults: A Clinical Guide
http://www.100md.com
《新英格兰医药杂志》
The prevailing system for the diagnosis of anxiety disorders in the United States derives from the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), published by the American Psychiatric Association in 1980. DSM-III broke with the past in discarding the notion of "neurosis" in favor of an avowedly descriptive and atheoretical approach. Nowhere was the effect of this change greater than in the category of anxiety disorders, which had been classically considered to be neuroses.
The current incarnation of the manual, DSM-IV-TR (Text Revision), serves as the point of reference for this book by Vladan Starcevic, an associate professor of psychiatry at the University of Sydney. His intent is to present a "real world" guide to the diagnosis, understanding, and treatment of the anxiety disorders. After a brief conceptual overview, the book devotes a chapter to each of the major anxiety diagnoses (panic, generalized anxiety, social anxiety, specific phobias, obsessive-compulsive disorder, and post-traumatic stress disorder). Each chapter is then organized into sections on clinical features, relationship to other disorders, assessment, epidemiology, course, etiology and pathogenesis, biologic and psychological models, and treatment.
The result is a remarkably accessible book that conveys a great deal of clinically useful information. Although expository elegance is not his strength, Starcevic more than compensates for this limitation by focusing on the areas he feels are important, explaining them in comprehensible terms and repeating them if he wants them to stick. He uses many tables to underscore key facts and concepts, and he generally omits the kind of esoterica that only specialists find compelling. This gives the reader the gratifying sense that the book was written to edify rather than to dazzle. Its didactic authority is reinforced by the clear impression one gets that the author has the clinical experience to back up his assertions. His acknowledgment of the kinds of problems often encountered in the translation of textbook recommendations into actual treatment is consistently reassuring.
A detailed examination of the historical origins of contemporary approaches to anxiety is not included, nor is a close consideration of current theoretical and diagnostic issues. The attention given to neurobiologic research on anxiety has an obligatory quality, reflecting either the author's lack of enthusiasm or his judgment that these findings are of less immediate clinical relevance than are others. In contrast, Starcevic's discussions of psychological models and therapies are animated and clear, a major strength of the book. One topic that would have benefited from closer treatment is the increasing tendency among clinicians to diagnose post-traumatic stress disorder in patients with borderline personality disorder, an issue that is particularly challenging for practitioners.
Anxiety disorders are highly prevalent in the general population as well as in general medical practice. Ironically, though, medical students learn little about them, because the typical required psychiatry clerkship is on an inpatient service, and anxiety disorders do not usually necessitate hospitalization. Accessible as it is, this book deserves a wide readership among those who are going to take care of patients with anxiety disorders, and experienced clinicians will find it to be an engaging review.
Lawrence H. Price, M.D.
Butler Hospital
Providence, RI 02806
lawrence_price_md@brown.edu(Vladan Starcevic. 424 pp.)
The current incarnation of the manual, DSM-IV-TR (Text Revision), serves as the point of reference for this book by Vladan Starcevic, an associate professor of psychiatry at the University of Sydney. His intent is to present a "real world" guide to the diagnosis, understanding, and treatment of the anxiety disorders. After a brief conceptual overview, the book devotes a chapter to each of the major anxiety diagnoses (panic, generalized anxiety, social anxiety, specific phobias, obsessive-compulsive disorder, and post-traumatic stress disorder). Each chapter is then organized into sections on clinical features, relationship to other disorders, assessment, epidemiology, course, etiology and pathogenesis, biologic and psychological models, and treatment.
The result is a remarkably accessible book that conveys a great deal of clinically useful information. Although expository elegance is not his strength, Starcevic more than compensates for this limitation by focusing on the areas he feels are important, explaining them in comprehensible terms and repeating them if he wants them to stick. He uses many tables to underscore key facts and concepts, and he generally omits the kind of esoterica that only specialists find compelling. This gives the reader the gratifying sense that the book was written to edify rather than to dazzle. Its didactic authority is reinforced by the clear impression one gets that the author has the clinical experience to back up his assertions. His acknowledgment of the kinds of problems often encountered in the translation of textbook recommendations into actual treatment is consistently reassuring.
A detailed examination of the historical origins of contemporary approaches to anxiety is not included, nor is a close consideration of current theoretical and diagnostic issues. The attention given to neurobiologic research on anxiety has an obligatory quality, reflecting either the author's lack of enthusiasm or his judgment that these findings are of less immediate clinical relevance than are others. In contrast, Starcevic's discussions of psychological models and therapies are animated and clear, a major strength of the book. One topic that would have benefited from closer treatment is the increasing tendency among clinicians to diagnose post-traumatic stress disorder in patients with borderline personality disorder, an issue that is particularly challenging for practitioners.
Anxiety disorders are highly prevalent in the general population as well as in general medical practice. Ironically, though, medical students learn little about them, because the typical required psychiatry clerkship is on an inpatient service, and anxiety disorders do not usually necessitate hospitalization. Accessible as it is, this book deserves a wide readership among those who are going to take care of patients with anxiety disorders, and experienced clinicians will find it to be an engaging review.
Lawrence H. Price, M.D.
Butler Hospital
Providence, RI 02806
lawrence_price_md@brown.edu(Vladan Starcevic. 424 pp.)