Psychiatric Annals

FROM THE GUEST EDITORS 

Anxiety Disorders: Current Conceptualizations and Future Directions

Naomi M Simon, MD; Mark H Pollack, MD

Abstract

As we enter the new millennium, there is more ongoing research in the anxiety disorders than ever before. Pharmacologic treatment strategies available for the treatment of anxiety have expanded significantly beyond the benzodiazepines., tricyclic antidepressants, and monoamine oxidase inhibitors to include the selective serotonin reuptake inhibitors, anticonvulsants, and other agents, and continue to be developed and refined. There is now an abundance of data supporting the efficacy of cognitive-behavioral therapies for the anxiety disorders as well, reflecting growing advances in psychotherapy research and providing more options for patients and clinicians.

With the recognition that anxiety disorders cause significant distress and impairment in work, family, social life, and quality of life, and with the expansion of treatment options, the goal of treatment has shifted away from symptom reduction alone and toward more comprehensive relief. The current challenge to the field is to find effective, safe, and tolerable treatments that induce remission, as defined by broad measures of response, including functional and qualiry-otlife measures.

In addition to working toward more efficacious treatments, our focus has turned toward the many patients who remain undiagnosed or untreated, and ways to accomplish real-world "effectiveness" of our treatment interventions for all patients, including those who suffer from comorbid conditions.

Finally, the extraordinary advances in neuroscience and molecular biology of the past decade have opened the door for exciting research into the genetics and neurobiology of the anxiety disorders.

In this issue of Psychiatric Annals, the authors bring the reader up to date on current therapeutics and future directions for the pharmacologic and cognitive-behavioral treatment of social phobia, panic disorder, and obsessive-compulsive disorder. Scott and Heimberg discuss advances in the pharmacologic and cognitive-behavioral treatment of social phobia. Simon and Pollack provide an update on advances in the pharmacologic and cognitive-behavioral treatment of patients with panic disorder, including those refractory to initial treatment interventions. Mathew et al. review initial and next-step cognitive-behavioral and pharmacotherapy treatment strategies for obsessive-compulsive disorder.

In the next issue of Psychiatric Annals, the discussion of the anxiety disorders continues. Meltzer-Brody et al. discuss the epidemiology, risk factors, and costs for posttraumatic stress disorder, and bring the reader up to date on pharmacotherapy. Kent et al. review recent advances in understanding the neurobiology of fear and its application to understanding panic disorder and posttraumatic stress disorder. Smoller et al. provide an alternate view of the anxiety disorders based on biological and psychological phenotypes of "anxiety proneness," and their use in advancing our understanding of the genetics of the anxiety disorders.

The current combination of biological and psychological approaches to advancing our scientific knowledge and improving treatment strategies for the anxiety disorders provides a strong basis for future advances in the care of our patients with anxiety disorders.…

As we enter the new millennium, there is more ongoing research in the anxiety disorders than ever before. Pharmacologic treatment strategies available for the treatment of anxiety have expanded significantly beyond the benzodiazepines., tricyclic antidepressants, and monoamine oxidase inhibitors to include the selective serotonin reuptake inhibitors, anticonvulsants, and other agents, and continue to be developed and refined. There is now an abundance of data supporting the efficacy of cognitive-behavioral therapies for the anxiety disorders as well, reflecting growing advances in psychotherapy research and providing more options for patients and clinicians.

With the recognition that anxiety disorders cause significant distress and impairment in work, family, social life, and quality of life, and with the expansion of treatment options, the goal of treatment has shifted away from symptom reduction alone and toward more comprehensive relief. The current challenge to the field is to find effective, safe, and tolerable treatments that induce remission, as defined by broad measures of response, including functional and qualiry-otlife measures.

In addition to working toward more efficacious treatments, our focus has turned toward the many patients who remain undiagnosed or untreated, and ways to accomplish real-world "effectiveness" of our treatment interventions for all patients, including those who suffer from comorbid conditions.

Finally, the extraordinary advances in neuroscience and molecular biology of the past decade have opened the door for exciting research into the genetics and neurobiology of the anxiety disorders.

In this issue of Psychiatric Annals, the authors bring the reader up to date on current therapeutics and future directions for the pharmacologic and cognitive-behavioral treatment of social phobia, panic disorder, and obsessive-compulsive disorder. Scott and Heimberg discuss advances in the pharmacologic and cognitive-behavioral treatment of social phobia. Simon and Pollack provide an update on advances in the pharmacologic and cognitive-behavioral treatment of patients with panic disorder, including those refractory to initial treatment interventions. Mathew et al. review initial and next-step cognitive-behavioral and pharmacotherapy treatment strategies for obsessive-compulsive disorder.

In the next issue of Psychiatric Annals, the discussion of the anxiety disorders continues. Meltzer-Brody et al. discuss the epidemiology, risk factors, and costs for posttraumatic stress disorder, and bring the reader up to date on pharmacotherapy. Kent et al. review recent advances in understanding the neurobiology of fear and its application to understanding panic disorder and posttraumatic stress disorder. Smoller et al. provide an alternate view of the anxiety disorders based on biological and psychological phenotypes of "anxiety proneness," and their use in advancing our understanding of the genetics of the anxiety disorders.

The current combination of biological and psychological approaches to advancing our scientific knowledge and improving treatment strategies for the anxiety disorders provides a strong basis for future advances in the care of our patients with anxiety disorders.

10.3928/0048-5713-20001101-04

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