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Panic disorder Clinical biological and treatment aspects. Gregory M. Asnis M.D. and Herman M. van Praag M.D. Ph.D. John Wiley & Sons Inc. New York 1995 354 pp. $39

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Book Reviews
In subsequent chapters, the relationship of other
clinical conditions to the immune system are described, including schizophrenia, multiple sclerosis,
and food allergies. T h e authors carefully review the
literature to elucidate the possible interrelationships
of the brain and immune system for each of these
illnesses. In the concluding chapter, Rosch offers
thought-provoking direction for future research in
psychoneuroimmunology, including psychoelectroneuroimmunology, a term he coins for the study of
energies generated internally by emotions and intense
mental activities which may influence immune activities. While this latter concept is purely speculative,
Rosch integrates important concepts described earlier in
the book to address the larger arena of psychoneuroimmunology and psychosomatic illness. He specifically
addresses the role of stress and AIDS, tuberculosis,
streptococcal infections and the common cold. H e
eloquently articulates the need for more imaginative
future research by drawing from the creative achievements of such pioneers as Claude Bernard, Walter
Canon, Hans Selye, and Louis Pasteur.
At a time when a topic such as psychoneuroimmunology generates more research than any one investigator can keep up with, this book provides an
important review for clinicians. It is a practical guide
which provides a brief account of both the past and
present work on stress and immunity and translates
relevant findings into clinically accessible information.
Psychiatrists and other mental health professionals
with any interest in the field of psychoneuroimmunology will find this book to be a useful and concise review.
J. Stephen McDaniel
Associate Professor of Psychiatry and Behavioral
Emory University School of Medicine
Atlanta, Georgia
PANIC DISORDER: Clinical, Biological, and
Treatment Aspects. Gregory M. Asnis, M.D., and
Herman M. van Praag, M.D., Ph.D. John Wiley &
Sons, Inc., New York, 1995. 354 pp., $39.95.
The editors of Panic Disorder: Clinical, Biological, and
Treatment Aspects set for themselves a rather lofty goal
(p. 2 ) : “The purpose of this book is to provide, in one
volume, a comprehensive review of what is known
about panic disorder. It has focused on psychological,
clinical, and biological aspects of this anxiety disorder,
providing both clinicians and academicians a resource
to better understand, study, and treat this illness.”
This edited book is presented in three sections and
contains a total of 13 chapters. Part I, “Clinical Aspects
of Panic Disorder,” is comprised of five chapters describ-
ing phenomenology and differential diagnosis (Rathus
and Asnis), the epidemiology (Eaton and Keyl) and genetics (Woodman and Crowe) of panic disorder, its
comorbidity with other psychiatric disorders (Wetzler
and Sanderson), and its relationship to suicidal behavior
(Arnold, Sanderson and Beck). Part 11, “Biologrcal Underpinnings of Panic Disorder,” contains six chapters
covering the relationship of the norepinephrine (Asnis
and van Praag) and serotonin (Kahn et al.) neurotransmitter systems to panic disorder and models of panic disorder based on challenge with caffeine (Uhde), lactate
(Cowley et al.) cholecystokinin (Bradwejn and Koszycki),
and carbon dioxide (Papp and Gorman). Part 111, “Treatment of Panic Disorder,” includes two chapters, one on
somatic treatments (Raj and Sheehan) and one on cognitive-behavioral approaches (Sanderson and Wetzler).
The editors have certainly assembled a cast of characters
with significant expertise in their areas.
How well have the editors achieved their stated goal?
As a clinical psychologist with less than complete knowledge of biochemistry, I may not be the ideal person to
evaluate their success or failure in goal attainment, but I
will try nonetheless. The editors seem to have intended
to communicate primarily with a medical audience and
have assumed that readers possess a fair degree of sophstication in that regard. Not possessing that degree of sophistication myself, I found that I labored through
several of the chapters in the text, most notably in Part
11. I was surprised that the chapter contributors seemed
to put little effort into the definition of terms or the description of procedures that may be foreign to many who
are not intimately involved in biochemistry or neurobiology research. While experienced persons may have no
difficulty and may gain much from their reading, I wonder how much medical students or persons without this
specific background would be able to take from their effort and whether they would persist in their attempts to
understand this rather heady material. O n the other
hand, I did make the commitment to that struggle and
found that I had acquired quite a bit of useful information by the time I got to the end. Within the limits of my
knowledge, it seems that each and every chapter contributor in Part I1 has done a thorough review and analysis of his or her assigned area.
Part I was quite a bit easier to digest, with the exception of the chapter on the genetics of panic disorder, which may be described in the same terms as the
chapters in Part 11. I was generally quite pleased with
the quality of these chapters as well. T h e chapter by
Arnold et al. on panic disorder and suicide stands as
one of the best reviews of this issue that I have had the
pleasure to read, and all other contributors to Part I
have covered their territory well.
The chapters in Part I11 are both of high quality.
While I must leave it to physicians who read the book to
determine whether the recommendations by Raj and
Sheehan are on the mark, I found that chapter to present
a very cogent and user-friendly strategy for the systematic pharmacotherapy of panic disorder. Nonmedical
Book Reviews
therapists will find it a useful p d e to these medications
when they are called on to work collaboratively with
physicians in the treatment of panic disorder. Sanderson
and Wetzler have provided an excellent summary of cognitive-behavioral treatment of panic disorder. Most physicians would do well to closely examine their arguments
about the potentially negative addition of benzodiazepines to cognitive-behavioral treatment.
The editors have attempted to pull together everything clinicians and academicians need to know about
panic disorder. It seems to me that they have, at least
partially, accomplished their goal. They have provided
very thorough, if complex, coverage of the biological
aspects of panic disorder; they have provided balanced
summaries of both cognitive-behavioral and pharma-
cological approaches to treatment; and they have done
a reasonable job of describing the clinical presentation
of the disorder. One area that seems to receive much
less attention is the psychological aspects of panic disorder. In this very ferule and active area of theory and
research, the book falls short, and the interested
reader would be advised to consult the writings of
David Barlow, David Clark, or &chard McNally.
Richard G.Heimberg,Pb.D.
Department of Psychology
Center for Stress and h e t y Disorders
University at Albany
State University of New York
Albany, New York
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treatment, pani, van, aspects, biological, disorder, asnis, 354, hermann, praag, inc, sons, new, john, 1995, york, clinical, gregory, wiley
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