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New Challenges for Anxiety Disorders: Where Treatment, Resilience, and Economic Priority Converge

Published online by Cambridge University Press:  07 November 2014

Mark H. Pollack ,
Murray B. Stein ,
Jonathan R.T. Davidson  and
David L. Ginsberg
Mark H. Pollack
Affiliation:
Dr. Pollack is director of the Center for Anxiety and Traumatic Stress Related Disorders at Massachusetts General Hospital in Boston and associate professor of psychiatry in the Department of Psychiatry at, Harvard Medical School, in Boston.
Murray B. Stein
Affiliation:
Dr. Stein is professor of psychiatry at the, University of California, San Diego and director of the Anxiety and Traumatic Stress Disorders program at the VA San Diego Healthcare System.
Jonathan R.T. Davidson
Affiliation:
Dr. Davidson is professor of psychiatry and director of the Anxiety and Traumatic Stress Program in the Department of Psychiatry and Behavioral Sciences at, Duke University Medical Center, in Durham, North Carolina.
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Abstract

Anxiety disorders are highly prevalent, are increasing in incidence, affect individuals early in life, and significantly impact health care and quality of life. As such, they are serious public health problems that deserve attention now and in the future. Over the last 10–20 years, there has been marked improvement in pharmacologic and psychosocial interventions for anxiety. Due to their broad spectrum of efficacy against common comorbidities and lack of association with abuse and dependence, serotonergic and mixed serotonergic noradrenergic antidepressants are first-line therapies for anxiety disorders. Benzodiazepines are still widely used in clinical practice because they are well tolerated and work quickly and effectively. Other medications that are emerging as potentially useful for selected populations with anxiety include atypical neuroleptics and anticonvulsants. Cognitive-behavioral therapy (CBT) is at least as effective as medication for many patients with anxiety disorders and facilitates maintenance of benefit over the long term. Resilience, the capacity to bounce back from adversity, can be reliably measured with a psychometrically valid scale, the Connor-Davidson Resilience Scale. Compared with the general population, individuals with anxiety disorders exhibit decreased resilience. Studies have shown that pharmacologic treatment combined with CBT may increase resilience within 2–3 months. Emerging neurobiologic research indicates that noradrenergic pathways and 5-HT2 transporter efficiency may mediate effects on resiliency.

Type
Monograph Supplement
Information
CNS Spectrums , Volume 9 , Issue 4 , April 2004 , pp. 1 - 4
Copyright
Copyright © Cambridge University Press 2004

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References

1. Galea, S, Vlahov, D, Resnick, H, et al. Trends of probable posttraumatic stress disorder in New York City after the September 11 terrorist attacks. Am J Epidemiol. 2003;158(6):514–524.CrossRefGoogle ScholarPubMed
2. Kessler, RC, McGonagle, KA, Zhao, S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psychiatry. 1994;51(1):8–19.Google Scholar
3. Kessler, RC, Sonnega, A, Bromet, E, Hughes, M, Nelson, CB. Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry. 1995;52(12):1048–1060.Google Scholar
4. Stein, MB, Walker, JR, Hazen, AL, Forde, DR. Full and partial posttraumatic stress disorder: findings from a community survey. Am J Psychiatry. 1997;154(8):1114–1119.Google Scholar
5. Stein, MB, Forde, DR, Anderson, G, Walker, JR. Obsessive-compulsive disorder in the community: an epidemiologic survey with clinical reappraisal. Am J Psychiatry. 1997;154(8):1120–1126.Google Scholar
6. Kessler, RC, Berglund, P, Demler, O, et al. National Comorbidity Survey Replication. The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA. 2003;289(23):3095–3105.Google Scholar
7. Merikangas, KR, Zhang, H, Avenevoli, S, et al. Zurich Cohort Study. Longitudinal trajectories of depression and anxiety in a prospective community study: the Zurich Cohort Study. Arch Gen Psychiatry. 2003;60(10):993–1000.Google Scholar
8. Eisenman, DP, Gelberg, L, Liu, H, Shapiro, MF. Mental health and health-related quality of life among adult Latino primary care patients living in the United States with previous exposure to political violence. JAMA. 2003;290(5):627–634.Google Scholar
9. Andrews, G, Henderson, S, Hall, W. Prevalence, comorbidity, disability and service utilization: overview of the Australian National Mental Health Survey. Br J Psychiatry. 2002;178:145–153.Google Scholar
10. Katzelnick, DJ, Kobak, KA, DeLeire, T, et al. Impact of generalized social anxiety disorder in managed care. Am J Psychiatry. 2001;158(12):1999–2007.CrossRefGoogle ScholarPubMed
11. Stein, MB, Barrett-Connor, E. Quality of life in older adults receiving medications for anxiety, depression, or insomnia: findings from a community-based study. Am J Geriatr Psychiatry. 2002;10(5):568–574.CrossRefGoogle ScholarPubMed
12. Stein, MB, Lang, AJ, Laffaye, C, et al. Dresselhaus. Relationship of sexual assault history to somatic symptoms and health anxiety in women. Gen Hosp Psychiatry. In press.Google Scholar