Generalized Anxiety Disorder: Advances in Research and Practice

Generalized anxiety disorder is the most commonly seen anxiety disorder in primary care, with the highest rate of comorbidity of all mood and anxiety disorders. Generalized Anxiety Disorder: Advances in Research and Practice is a useful review of generalized anxiety disorder, being entirely dedicated to the disorder as a distinct (not residual) diagnosis that is accompanied by functional impairment comparable to that associated with major depressive disorder.

The book is divided into four sections, covering generalized anxiety disorder in the clinic and in the community, theoretical and empirical approaches, assessment and treatment, and special populations. It is subdivided into 16 chapters, each of which could be read in one good sitting. Of the 38 contributors, four are M.D.s. The book has more focus on theory and evaluative tools than I care for, but some of the theoretical ideas are interesting, such as the various psychological functions of worry—the cardinal symptom of generalized anxiety disorder—and the role of intolerance of uncertainty. I thought the first chapter, on clinical presentation and diagnostic features, by the three editors, was strong, as were the chapters on cognitive-behavioral therapy and integrative psychotherapy (cognitive-behavioral therapy and interpersonal therapy).

As with the often-repeated statement that about 50 percent of patients with generalized anxiety disorder show significant improvement with cognitive-behavioral therapy, other approaches, including an interpersonal therapy component and pharmacotherapy, are important. The chapter on pharmacotherapy is adequate. Here I noted one of a number of generally small editorial errors—in Table 14.2, the daily dose ranges of venlafaxine and mirtrazepine are reversed. This chapter commendably includes herbals but only mentions one, and that one, kava, is presented positively, without mention of reported potential serious side effects.

Generalized Anxiety Disorder includes helpful tips, such as tapering benzodiazepines after long-term use: taper over three to six months, more slowly after 50 percent reduction of the original dose. Also continue to use divided doses of short half-life benzodiazepines during the taper to avoid interdose fluctuation in plasma concentrations. Also included is a helpful table containing information for patients about insomnia. Other comments are also interesting, such as the fact that older adults are the primary consumers of anxiolytics in the United States, and, even though antidepressants are considered superior to benzodiazepines as a first-line treatment of generalized anxiety disorder, benzodiazepines are used more.

I recommend this book generally to practitioners and especially to researchers, perhaps less so to M.D. clinicians. I would also say that I am a participant in American Psychiatric Publishing, Inc.'s journal Focus, in which the summer 2004 module just happens to be on anxiety disorders; one of the lead articles is on generalized anxiety disorder. As a busy practicing psychiatrist, I prefer the material in Focus.

Dr. Storch is clinical associate professor of psychiatry at the University of Maryland School of Medicine in Baltimore.