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The Evolution of Electroconvulsive Therapy
Published in Barry M. Maletzky, C. Conrad Carter, James L. Fling, Multiple-Monitored Electroconvulsive Therapy, 2019
The “personality disorders” are often cited as not being responsive to ECT but the diagnostic ambiguity inherent in this term weakens this contention. Certainly, literature is sparse to nonexistent which cites any benefit from ECT in cases of sociopathic behaviors, phobias, alcoholism (except as secondary to affective disorders), drug abuse, hypochondriasis, conversion reactions, and hysterical personality patterns. Typical cases of anxiety neurosis usually fail to respond as well.
Anxiety disorders
Published in Ben Green, Problem-based Psychiatry, 2018
Generalised anxiety disorder (anxiety neurosis) is an illness with two components – psychological and somatic. Psychological symptoms of anxiety include a fearful preoccupation with the future, but with a free-floating anxiety. In other words, the anxiety cannot be pinned down to any particular event or person. The somatic symptoms include tachycardia, palpitations, essential tremor, muscular tension, hypertension, dizziness, sweating, hyperventilation, and epigastric discomfort. Anxiety is often a presenting symptom of depressive illness, and it can be difficult to distinguish the two. Anxiety may also be the presenting symptom of physical disorders. Several physical causes of anxiety are listed in Table 4.1 on p. 67. Generalised anxiety disorder is twice as common in females and affects up to 5% of the general population.
A Conceptual History of Anxiety and Depression
Published in Siegfried Kasper, Johan A. den Boer, J. M. Ad Sitsen, Handbook of Depression and Anxiety, 2003
With this boom in psychopharmacological research, increasingly stringent criteria for the definition of psychiatric syndromes were drawn up. This was principally for the sake of comparability between research groups. Thus, psychopharmacological and biological psychiatric research constituted a powerful impetus for the development of the Feigh- ner Criteria [225]. These, together with the Research Diagnostic Criteria [226] formed the basis of the DSM-III and its further editions. The emphasis on descriptive precision led to the demarcation of various forms of anxiety and to an abandonment of the concept of neurosis, which was considered to be too vague. The depressive neurosis of DSM-II (1968) became dysthymia in DSM-III, falling under the affective disorders. Two types of hysterical neurosis, hypochondria and depersonalization, were classified under somatoform and dissociative disorders, respectively. Neurasthenic neurosis was discarded. Anxiety neurosis, phobic neurosis, and obsessive-compulsive neurosis were combined under the heading of anxiety disorders. Post-traumatic stress disorder, a newcomer, was added to the anxiety disorders [227,228]. The anxiety neurosis was subsequently split up into panic disorder and generalized anxiety disorder, while the phobic neuroses were divided up into agoraphobia, simple phobias, and social phobia [229,230].
The mysteries of hysteria: a historical perspective
Published in International Review of Psychiatry, 2020
It must be emphasized that while the term of “conversion” appeared in Freud’s writings in 1894 (psychonevr) and was used again the following year in the report of the Emmy von N case report in the “Studien ueber Hysterie”, the term of “conversion hysteria” never appeared in Freud’s early writings. He used it for the first time in reporting the case of the young Hans (1909), in order to distinguish it from “anxiety hysteria” (Angsthysterie), which had been introduced one year before by W. Stekel, upon a suggestion by Freud (vocab). In anxiety hysteria, the central symptom was phobia, which focussed on an object concentrating the patient’s anxiety. Anxiety hysteria thus differed from anxiety neurosis (Angstneurosis), which dated back to 1895, and where anxiety was not focussed on a specific object. Contrary to anxiety hysteria, conversion hysteria generated no anxiety, and corresponded to an attempt to solve an intrapsychic conflict into a somatic expression, which avoided anxious manifestations. In anxiety hysteria and conversion hysteria, the term of “hysteria” was justified, because in both conditions, the repression attempted to separate mental representations from their corresponding affects.
Novel investigational therapeutics for generalized anxiety disorder (GAD)
Published in Expert Opinion on Investigational Drugs, 2019
Bella Schanzer, Ana Maria Rivas-Grajales, Aamir Khan, Sanjay J Mathew
The diagnosis of GAD was first described in 1980 by the Diagnostic and Clinical Manual of Mental Disorders (DSM) III. The need arose around this time to separate ‘anxiety neurosis’ into panic disorder and GAD, given their distinct responses to imipramine [4]. The diagnostic criteria for GAD were modified in the late 1980s in the DSM-III-R given its high comorbidity with other disorders [4]. From DSM-III to III-R, the required duration of symptoms was increased from 1 month to 6 months, and a specific number of symptoms was added (6 out of 18). The increased symptom duration decreased the lifetime prevalence by a factor of 5, but it did not raise the threshold for the diagnosis [5]. This change was eventually attributed to the high comorbidity of MDD with GAD [5].
The blurred line between anxiety and depression: hesitations on comorbidity, thresholds and hierarchy
Published in International Review of Psychiatry, 2020
Koen Demyttenaere, Elke Heirman
The subsequent DSM versions more and more dissected ‘anxiety and depression’, until recently DSM-5 (American Psychiatric Association, 2013) attempting to reconnect them, at the same time dividing them further. While in DSM-I (American Psychiatric Association, 1952) and DSM-II (American Psychiatric Association, 1968) depression and anxiety were mostly conceived as intimately related and possible forms of both normal and pathological emotional responses, they were included as separate disorders in DSM III (American Psychiatric Association, 1980; Crocq, 2017). DSM-III further innovated by splitting the former anxiety neurosis into different disorders (American Psychiatric Association, 1980). Panic disorder (characterized by spontaneous episodes of intense anxiety) was introduced based on its then believed differential response to pharmacological treatment with imipramine (Klein, 1964). However, the past decades clearly showed that many ‘antidepressants’ are not only effective in treating major depressive disorder (MDD), but also in treating most of the anxiety disorders and no longer concluding to a differential response in the one or the other anxiety disorder. Other diagnoses were introduced, such as post-traumatic stress disorder and social phobia. The diagnosis generalized anxiety disorder (GAD) was included as a residual category (a kind of ‘wastebasket’ diagnosis) and was defined by chronic anxiety in the absence of panic attacks. DSM-5 (American Psychiatric Association, 2013) again made substantial changes regarding the anxiety disorders and the delineation between the different anxiety disorders, as well as regarding the delineation between depressive disorders and anxiety disorders. Indeed, obsessive-compulsive disorder and post-traumatic disorder were taken out of the anxiety disorder section, while separation anxiety disorder, agoraphobia and selective mutism were added. Moreover, DSM-5 added a ‘panic attack specifier’ to the anxiety disorder chapter (which can be added to any anxiety disorder as well as to other mental disorders and to some medical conditions) and also added an ‘anxious distress specifier’ for MDD [and for persistent depressive disorder (PDD) as well as for bipolar disorder] (American Psychiatric Association, 2013).