Abstract
This is a scholarly text edited by three international authors from the UK, USA and France. The book is divided into the three sections as in its title: clinical diagnosis, management and mechanisms.
The first section is four chapters related to clinical diagnostic issues and includes a chapter by Mark Oakley-Brown providing a brief overview of the health economics of panic disorder. The first of these four chapters commences with Heinz Katschnig tracing back the historical evolution of the nosology of panic disorder. The concept originated following Freud's classification of anxiety neurosis into the two separate disease entities used today: panic disorder and free floating anxiety (generalised anxiety disorder). The author highlights that the current term of ‘panic disorder’ may well be too broad and encumbering a term, and that future research and development may see even further subtyping of this disorder. The remainder of this section discusses epidemiological data on prevalence rates, comorbidity and the course and risk factors for panic disorder. This information is comprehensively referenced with the most recent references to 1997. Studies reviewed include those from several international community studies over the past 15 years. Oakley-Brown describes the economic impact of panic disorder. There are very limited, non-systematised reviews, which suggests that there are few economic evaluations of the current interventions for panic disorder. He concludes ‘if we are to deliver effective and efficient care for persons with panic disorder, further economic evaluation must be undertaken’.
The second section discusses brain mechanisms and circuits in panic disorder. It also includes a chapter on the current status of respiration in panic disorder, medical aspects of panic disorder and its relationship to other medical conditions, and the psychological theories of panic disorder. The first two chapters are complex, but well written. Busy clinicians may well skip these two chapters without losing the thread of the text. However, those who wish a clearer grasp of the pathophysiology in panic may benefit from a second read of these chapters.
The third section includes the treatment options in panic disorder. Treatment of panic disorder with tricyclics and monoamine oxidase inhibitors (MAOIs), benzodiazepines, selective serotonin reuptake inhibitors (SSRIs) and other drug treatments and augmentation therapies for panic disorder are discussed. Raben Rosenberg presents a superbly written and comprehensive discussion of quality issues when selecting studies for review, which would cheer the heart of those of our colleagues who advocate for evidence-based practices. The remainder of his chapter on the role of tricyclics and MAOIs is similarly well and comprehensively written and referenced. James Ballinger concludes his chapters on the roles of SSRIs by documenting that they are effective in panic disorder and deserve to be the pharmacological treatment of choice in panic disorder for many patients.
This is a clearly written text book supported by an educational grant from Smith Klein Beecham Pharmacueticals. As an introduction, the authors comment that this text book is ‘designed for everyone interested in the field of panic disorder. It contains rich amounts of clinical, diagnostic and treatment information for the practising clinician’. This is true.
Generally the book is well written, apart from repetition of information occurring in the first few chapters. Each chapter commences with the contents of key words in bold print, an introduction followed by a body of comprehensive detail and finally a conclusion with a discussion. This format allows for the reader who wishes to skim-read through the text to get a good idea of the book content by reading only the introductions and conclusions. All in all, this book is clearly written, well formatted and very easy to read.
I believe this text should be ‘must-read’ material for all psychiatry trainees and will be helpful to clinicians requiring a comprehensive overview of panic disorder.