Anxiety Disorders in Adults: A Clinical Guide, 2nd ed

Anxiety Disorders in Adults: A Clinical Guide, 2nd ed

By Vladan Starcevic, MD, PhD, FRANZCP. Oxford University Press, New York, NY, 2010, 460 pages, $59.95 (hardcover).

The author’s stated purpose for this book (and the preceding edition) was to present the anxiety disorders with an emphasis on clinical relevance and attention to a full range of issues: conceptual, theoretical, etiologic, and therapeutic. The book is organized into 7 chapters; the first is an introduction, and each of the other chapters deals with one of the DSM anxiety disorders. In each of these 6 chapters, there are sections on Key Issues, Clinical Features, Relationship With Other Disorders, Assessment, Epidemiology, Course and Prognosis, Etiology and Pathogenesis, Biological Models, Psychological Models, Pharmacologic Treatment, Psychological Treatment, Combined Treatments, and Outlook for the Future.

I found this book to be especially useful for a number of reasons. The style of the writing is perfectly clear, and the descriptions are lucid and well organized. The Key Issues sections, new to this edition, consist of lists of important and controversial questions. I found these to be very helpful, in part because they express in a direct way the limits of what is known. Listing them as questions enables the author to remain neutral.

In the introduction, the author gives examples of expressions by clinicians of allegiance to particular treatment methods. He effectively illustrates a historical problem in our field. It is quite clear that this author sees these allegiances, to the extent that they persist, as a hindrance to patient care and research progress. In this book, the author’s point of view as a psychiatrist involved in clinical work, teaching, and research shows itself. Psychiatrists involved in clinical work and residency training will find that the author’s choices of material to include, and his choices concerning how detailed, elaborate, and lengthy each discussion should be, are very fortunate. The book is very readable and informative. As a clinician, I felt confidence that this author understands the issues that clinicians face.

This book is very up to date; I found cited references published as late as 2009. The British and European journals are well utilized here.

Some particular items are worth mentioning. Eye movement desensitization and reprocessing (EMDR) is discussed respectfully and very usefully, with a concise review of the relevant studies. Psychological debriefing is placed in historical perspective and reviewed critically. Psychodynamic psychotherapy is described, reviewed, and placed in perspective, in general terms in the introduction and in discussions of each of the anxiety disorders.

Concerning benzodiazepines, I have found that beginners often prescribe them more frequently (and more optimistically) than experienced and well-trained clinicians. I had hoped to find, in tabular form, a review of contraindications, risks, and side effects. This material is not present in a single location, perhaps because the text is organized disorder-by-disorder, not treatment-by-treatment. Once I read through the relevant passages in the text, I found that the author has dealt with all of the important considerations.

I will soon teach an annual course for residents on the anxiety disorders. In recent years, I have encouraged them to rely on general psychiatry textbooks and electronically available sources. This year, I will recommend this book as a textbook for my course, for a number of reasons. The organization and writing style help the reader to understand the material as a clinician wants to understand it. The lucidity makes it a pleasure to read. The size is ideal for bringing the book back and forth to work and for reading it chapter by chapter.

David J. Lynn, MD

david.lynn2@va.gov

Author affiliation: Loyola University Stritch School of Medicine, Chicago, Illinois. Potential conflicts of interest: None reported.

doi:10.4088/JCP.11bk07127

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