Psychiatric Clinics of North America RSS feed: Current Issue. Psychiatric Clinics of North America updates you on the latest trends in patient management; keeps you up to date on the newest advances; and provides a sound basis for choosing treatment options. Each issue focuses on a single topic in psychiatry and is presented under the direction of an experienced guest editor.http://www.psych.theclinics.com/?rss=yesElsevier Inc.en © 2009 Published by Elsevier Inc. All rights reserved. Psychiatric Clinics of North America0193-953X323September 2009 © 2009 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.psych.theclinics.com/article/PIIS0193953X09000653/abstract?rss=yesContents10.1016/S0193-953X(09)00065-3Psychiatric Clinics of North America 32, 3 (2009)2009-09-01Psychiatric Clinics of North America2009-09-01323S0193-953X(09)X0005-5viixhttp://www.psych.theclinics.com/article/PIIS0193953X09000665/abstract?rss=yesForthcoming Issues10.1016/S0193-953X(09)00066-5Psychiatric Clinics of North America 32, 3 (2009)2009-09-01Psychiatric Clinics of North America2009-09-01323S0193-953X(09)X0005-5xixihttp://www.psych.theclinics.com/article/PIIS0193953X09000598/abstract?rss=yesA wide range of epidemiological community studies worldwide converge on several incontrovertible facts regarding anxiety disorders: they occur frequently, begin at an early age, significantly impair multiple areas of development and life, and are associated with numerous adverse correlates and consequences. Furthermore, evidence clearly points to the fact that the majority of patients who have anxiety disorders still go undetected and undertreated, despite considerable efforts over the last two decades to improve this situation. Less than half receive any treatment at all and only a fraction of those receive what can be considered even “minimally adequate treatment.”Developments in the Treatment and Diagnosis of Anxiety DisordersHans-Ulrich Wittchen, Andrew T. Gloster10.1016/j.psc.2009.07.001Psychiatric Clinics of North America 32, 3 (2009)2009-09-01Psychiatric Clinics of North America2009-09-01323S0193-953X(09)X0005-5xiiixixhttp://www.psych.theclinics.com/article/PIIS0193953X09000586/abstract?rss=yesIt has been suggested that the relationship between mental disorders can be summarized by a 3-factor model consisting of “anxious-misery,” “fear,” and “externalizing.” This article examines the assumptions and predictions of this model, with particular emphasis on the anxiety disorders. Results indicate that the 3-factor model is not robust when additional diagnoses are included or when developmental factors are considered. Further, the assumption of a higher-order internalizing factor could not be consistently confirmed. Other factor solutions might fit the data equally as well. Further, the anxiety disorders did not load onto predicted factors as postulated in the 3-factor model. The authors results and considerations strongly suggest that caution is needed with this factor analytic approach in general and its use with classificatory issues. Extant results are not stable enough to form the basis of clinical diagnostic classification systems such as DSM and the International Classification of Diseases.The Position of Anxiety Disorders in Structural Models of Mental DisordersHans-Ulrich Wittchen, Katja Beesdo, Andrew T. Gloster10.1016/j.psc.2009.06.004Psychiatric Clinics of North America 32, 3 (2009)2009-09-01Psychiatric Clinics of North America2009-09-01323S0193-953X(09)X0005-5465481http://www.psych.theclinics.com/article/PIIS0193953X09000562/abstract?rss=yesThis review summarizes findings on the epidemiology and etiology of anxiety disorders among children and adolescents including separation anxiety disorder, specific phobia, social phobia, agoraphobia, panic disorder, and generalized anxiety disorder, also highlighting critical aspects of diagnosis, assessment, and treatment. Childhood and adolescence is the core risk phase for the development of anxiety symptoms and syndromes, ranging from transient mild symptoms to full-blown anxiety disorders. This article critically reviews epidemiological evidence covering prevalence, incidence, course, and risk factors. The core challenge in this age span is the derivation of developmentally more sensitive assessment methods. Identification of characteristics that could serve as solid predictors for onset, course, and outcome will require prospective designs that assess a wide range of putative vulnerability and risk factors. This type of information is important for improved early recognition and differential diagnosis as well as prevention and treatment in this age span.Anxiety and Anxiety Disorders in Children and Adolescents: Developmental Issues and Implications for DSM-VKatja Beesdo, Susanne Knappe, Daniel S. Pine10.1016/j.psc.2009.06.002Psychiatric Clinics of North America 32, 3 (2009)2009-09-01Psychiatric Clinics of North America2009-09-01323S0193-953X(09)X0005-5483524http://www.psych.theclinics.com/article/PIIS0193953X09000471/abstract?rss=yesIn this article, the authors assess the successes, remaining challenges, and new developments in cognitive behavioral therapy (CBT) for anxiety disorders. They define CBT, examine treatment components, review treatment efficacy, and discuss the challenges of attrition, long-term follow-up, co-occurring/comorbid disorders, limited treatment comparisons, treatment mediators, and broader implementation. In addition, they present recent developments in cognitive behavioral therapy for anxiety disorders, including linking exposure therapy to basic science, mindfulness and acceptance-based treatments, and unified or transdiagnostic treatment protocols.First-line Treatment: A Critical Appraisal of Cognitive Behavioral Therapy Developments and AlternativesJoanna J. Arch, Michelle G. Craske10.1016/j.psc.2009.05.001Psychiatric Clinics of North America 32, 3 (2009)2009-09-01Psychiatric Clinics of North America2009-09-01323S0193-953X(09)X0005-5525547http://www.psych.theclinics.com/article/PIIS0193953X09000501/abstract?rss=yesAnxiety disorders are highly comorbid with each other and with major depressive disorder. As syndromes, anxiety and mood disorders share many symptoms, and several treatments are effective for both. Despite this overlap, there exist many distinguishing features that support the continued classification of individual anxiety disorders that are distinct from each other and from major depression. The goal of this article is to describe the key biological similarities and differences between anxiety disorders.The Neurobiology of Anxiety Disorders: Brain Imaging, Genetics, and PsychoneuroendocrinologyElizabeth I. Martin, Kerry J. Ressler, Elisabeth Binder, Charles B. Nemeroff10.1016/j.psc.2009.05.004Psychiatric Clinics of North America 32, 3 (2009)2009-09-01Psychiatric Clinics of North America2009-09-01323S0193-953X(09)X0005-5549575http://www.psych.theclinics.com/article/PIIS0193953X09000549/abstract?rss=yesExposure based treatments in which patients are systematically confronted with their feared objects of situations are highly effective in the treatment of specific phobias and produce stable improvement both in reported fear and behavioral avoidance. Exposure in reality is more effective in most cases than exposure in sensu. For situations that are difficult to realize, exposure in virtual environments has become increasingly valuable. Exposure in vivo is clearly superior to pharmacotherapy, although cognitive enhancers have been successfully used recently to increase the effect of exposure therapy. The induction of relaxation is not a necessary precondition for exposure therapy. Rather the current mechanisms of change focus on extinction learning as being the central mechanism both on a cognitive level namely that the feared object is no longer associated with severely threatening consequence but also on an affective level, meaning that feared cue is no longer capable to activate the fear circuit in the brain. Accordingly future diagnostic categorizations of phobic disorders in the DSM-V should rather focus on the pattern of the fear response that needs to be changed than on the eliciting cues or situations that are avoided.Specific PhobiasAlfons O. Hamm10.1016/j.psc.2009.05.008Psychiatric Clinics of North America 32, 3 (2009)2009-09-01Psychiatric Clinics of North America2009-09-01323S0193-953X(09)X0005-5577591http://www.psych.theclinics.com/article/PIIS0193953X09000513/abstract?rss=yesThis article provides an empirical review of the elements and efficacy of both pharmacologic and psychosocial treatments for panic disorder. Both monotherapies and combination treatment strategies are considered. The available evidence suggests that both cognitive behavioral therapy (CBT) and pharmacotherapy (prominently, selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors) are effective first-line agents and that CBT offers particular cost efficacy relative to both pharmacotherapy alone and combined pharmacotherapy and CBT. Predictors of non-response and mechanisms of action are considered, as are novel treatment strategies, including the use of memory enhancers to improve CBT outcome.Empirically Supported Treatments for Panic DisorderR. Kathryn McHugh, Jasper A.J. Smits, Michael W. Otto10.1016/j.psc.2009.05.005Psychiatric Clinics of North America 32, 3 (2009)2009-09-01Psychiatric Clinics of North America2009-09-01323S0193-953X(09)X0005-5593610http://www.psych.theclinics.com/article/PIIS0193953X09000525/abstract?rss=yesThis article presents the current evidence base for pharmacotherapy of generalized anxiety disorder (GAD) and an update on the phenomenology of GAD and its association with other psychiatric and somatic conditions. It discusses nosological issues and suggests ways to improve recognition, treatment, and care for patients who have GAD.Generalized Anxiety Disorder: Between Now and DSM-VChrister Allgulander10.1016/j.psc.2009.05.006Psychiatric Clinics of North America 32, 3 (2009)2009-09-01Psychiatric Clinics of North America2009-09-01323S0193-953X(09)X0005-5611628http://www.psych.theclinics.com/article/PIIS0193953X09000483/abstract?rss=yesGeneralized anxiety disorder (GAD) differs from other anxiety disorders. Patients do not fear a specific external object or situation; there is no distinct symptomatic reaction pattern; and the feared scenarios are not bizarre, improbable, or inflexible. Avoidance, although central, is less obvious and often is prominent only on the cognitive-emotional level. The key component of GAD, uncontrollable and persistent worrying, is easily confused with the lay concept of worry, and comorbid disorders often make the recognition of GAD difficult. This article discusses the challenges and the innovative, promising, and specific new developments in treating GAD.Psychotherapy for Generalized Anxiety Disorder: Don't Worry, It Works!Juergen Hoyer, Andrew T. Gloster10.1016/j.psc.2009.05.002Psychiatric Clinics of North America 32, 3 (2009)2009-09-01Psychiatric Clinics of North America2009-09-01323S0193-953X(09)X0005-5629640http://www.psych.theclinics.com/article/PIIS0193953X09000495/abstract?rss=yesSocial phobia is a prevalent anxiety disorder that may be treated with pharmacotherapy, psychotherapy, or both. This article reviews the empirical evidence for these interventions and discusses new treatment developments. Active ingredients and mechanisms involved in the effectiveness of treatment are discussed. In addition, the elements of social phobia and its treatment that are similar to other anxiety and non-anxiety disorders are considered. Finally, it discusses future efforts to improve diagnosis and treatment for social phobia, including possible revisions to the diagnostic criteria that might be considered in the forthcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, as well as routine care and obstacles for dissemination.Social Phobia: An Update on TreatmentEllen C. Jørstad-Stein, Richard G. Heimberg10.1016/j.psc.2009.05.003Psychiatric Clinics of North America 32, 3 (2009)2009-09-01Psychiatric Clinics of North America2009-09-01323S0193-953X(09)X0005-5641663http://www.psych.theclinics.com/article/PIIS0193953X09000537/abstract?rss=yesThis article reviews current issues in the diagnosis and treatment of obsessive–compulsive disorder (OCD). The introduction of the selective serotonin reuptake inhibitors and of cognitive–behavioral therapy were significant advances for treating OCD. Nevertheless, there is a need to improve awareness of OCD and its management, and to develop novel approaches to treatment-refractory patients. Although the diagnostic criteria for OCD have remained unchanged for some time, there are several areas where potential modification may be useful. There is a growing evidence base on OCD symptom dimensions and subtyping, and it is timely to consider incorporating some of these emerging data into diagnostic classification systems.Obsessive–compulsive Disorder: Diagnostic and Treatment IssuesDan J. Stein, Damiaan Denys, Andrew T. Gloster, Eric Hollander, James F. Leckman, Scott L. Rauch, Katharine A. Phillips10.1016/j.psc.2009.05.007Psychiatric Clinics of North America 32, 3 (2009)2009-09-01Psychiatric Clinics of North America2009-09-01323S0193-953X(09)X0005-5665685http://www.psych.theclinics.com/article/PIIS0193953X09000550/abstract?rss=yesPosttraumatic stress disorder (PTSD) is a prevalent anxiety disorder. Symptoms present shortly after an exposure to a traumatic event, abate with time in the majority of those who initially express them, and leave a significant minority with chronic PTSD. PTSD may be treated with pharmacotherapy or psychotherapy. Treatment of the early expressions of the disorder constitutes a separate domain of theory and research. Treatment of chronic PTSD often stabilizes the condition but rarely produces stable remission. This article reviews the empirical evidence on the treatment of acute and chronic PTSD, outlines similarities and differences between PTSD and other Axis I disorders, evaluates new therapeutic approaches, and discusses the implications of current knowledge for the forthcoming DSM-V.Posttraumatic Stress Disorder and Stress-Related DisordersArieh Y. Shalev10.1016/j.psc.2009.06.001Psychiatric Clinics of North America 32, 3 (2009)2009-09-01Psychiatric Clinics of North America2009-09-01323S0193-953X(09)X0005-5687704http://www.psych.theclinics.com/article/PIIS0193953X09000677/abstract?rss=yesIndex10.1016/S0193-953X(09)00067-7Psychiatric Clinics of North America 32, 3 (2009)2009-09-01Psychiatric Clinics of North America2009-09-01323S0193-953X(09)X0005-5705718