Current Medical Diagnosis & Treatment in Psychiatry

THE NEED FOR COLLABORATION

Current Concepts in AnxietyAug 01, 06

One of the major problems in therapeutic research has gone by the euphemistic label of “allegiance effect” (Klein, 1999). It has been shown repeatedly that supposed differences in therapeutic benefit and data interpretation are closely related to the antecedent beliefs of the investigators.

Comparative studies of treatment or, even supposedly more objective physiological investigations, carried out by single-minded enthusiasts are inferior to collaborations between scientists with opposing views who are willing to put them to the test.

The studies by Heimberg et al. and Barlow et al. are sterling examples of how scientists with differing views can develop and pursue such a fruitful collaboration.

There is no doubt that this is difficult, both administratively and financially. It would require a determined effort on the part of funding agencies to foster such work. It would also probably require a very determined effort on the part of scientists to convince funding agencies that this is worthwhile, if not positively necessary.

CONCLUSION
Clinicians should be pleased by recent progress in the treatment of anxiety disorders.

A wide range of pharmacological and psychological interventions have been shown effective in controlled objective studies. Such studies afford a solid basis for evidence based practice.

Nonetheless, many of these studies have not been directed at the complex comorbid patients often seen in the community. Nor has there been sufficient attention to the combination of therapies in terms of both acute and maintenance treatments.

As for our theoretical grasp of the anxiety disorders in terms of etiology, psychogenesis and pathophysiology, it is clear that we are only in the initial phases of understanding. The combination of molecular biology and brain imaging has led to a great deal of justified enthusiasm, especially with regard to the possibility of tracking normal brain function in living detail. The translation of these findings to psychopathology remains problematic.

REFERENCES
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imipramine, or their combination for panic disorder: A randomized controlled trial. JAMA 283(19): 2529 - 2536.
Bellodi L, Perna G, Caldirola D, Arancio C, Bertani A, Di Bella D (1998) CO2-induced panic attacks: A twin study. Am J Psychiatry 155: 1184 - 1188.
Brown TA, Barlow DH (1995) Long-term outcome and cognitive-behavioral treatment of panic disorder: Clinical predictors and alternative strategies for assessment. J Consult Clin Psychol 63: 754 - 765.
Griez E, Verburg C (1995) Angst, Paniek en Ademhaling. Utrecht: De Tijdstroom.
Heimberg RG, Liebowitz MR, Schneier FR, Hope DA, Holt CS, Welkowitz LA, Juster HR,
Campeas R, Bruch MA, Cloitre M, Fallon B, Klein DF (1998) Cognitive-behavioral group therapy vs phenelzine therapy for social phobia: 12-week outcome. Arch Gen Psychiatry 55(12): 1133 - 1141.
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Rappaport MH, Pollack M, Wolkow R, Mardekian J, Clary C (2000) Is placebo response the same as drug response in panic disorder? Am J Psychiatry 157(6), 1014 - 1016.
Sinha SS, Goetz R, Klein DF (2001) Non-fearful panic induction in normals with naloxone pretreatment of lactate infusion. Submitted. Neuropsychopharmacology.
Torgerson WA (1967) Multidimensional representation of similarity structures. In Katz MM,
Cole JO and Barton WE (eds) Methodology of Classi.cation in Psychiatry and Psychopathology.
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