Posts Tagged ‘anxiety disorders’

Serotonin in the Central Nervous System and Periphery

Serotonin in the Central Nervous System and Periphery

A Takada, G Curzon, editors

Amsterdam: Elsevier Science BV; 1995. 260 p

This book is part of the International Congress Series and contains the proceedings of the Symposium on Serotonin in the Central Nervous System and Periphery held in Nagoya, Japan, on April 1 -2, 1995. It is comprised of papers presented at the symposium and contains up-to-date information on the area, written by some of its top researchers, who were selected to participate in the symposium based on their expertise. It has become necessary for clinicians and scientists to focus on the basic science and fundamental actions of the new serotonin-acting drugs in order to understand their functions. This book attempts to provide such information in a timely fashion.

There are 7 sections in the book: Regulatory Mechanisms, Relationship with Feeding, Amines and Stress, Depression and Anxiety, Other Central Aspects, Vascular System, and Lung. The most useful and important section is the first, which covers the regulation of serotonin release, genes, and the pathophysiology of affective disorders. Even with a minimum of prior knowledge of the area, the clinician, by reading this section, can gain an understanding of how serotonergic drugs work. The section on depression and anxiety is a must-read for psychiatrists, though the majority of information refers to animal models. The relationship of serotonin and feeding behavior, pre- and postnatal stress reactions, antipsychotic medications, the psychoprotective effect of estrogen, learning and memory, Alzheimer’s disease, and physical health are also covered in the book.

Although this book suffers stylistically because of the number of different authors, it is, overall, a succinct, well-written, and extremely informative text. It provides recent information in the field of serotonin research and could prove to be a valuable teaching and research reference. We highly recommend this book to clinicians, who could apply it in their use of psychopharmacology, to biological researchers, who will find it a useful reference, and to residents in psychiatry, who may appreciate it as a learning tool.

Psychopharmacology: The Fourth Generation of Progress

Psychopharmacology: The Fourth Generation of Progress

FE Bloom, DJ Kupfer, editors

New York: Robin Press; 1995. 2002 p

This 2002-page monumental publication is the 4th in the series that started in 1968 with the book, Psychopharmacology: A Review of Progress 1957-1967. The 2 subsequent publications appeared at 10-year intervals and extensively reviewed progress in the decade before. This book, published less than 7 years after the last publication, reflects the highly accelerated pace of neuropsychopharmacology. As this volume is an official publication of the American College of Neuropsychopharmacology, its purpose (as for its 3 predecessors) is to redefine the scientific field for the College and to map the recent progress in neuropsychopharmacology.

The book is organized in 3 major sections: Preclinical, Clinical, and Special Topics. Part 1 (Preclinical) includes an introduction to preclinical neuropsychopharmacology by Floyd E Bloom, 5 chapters about critical analysis of methods, and 49 chapters detailing aspects of transmitter systems: amino acids, amines, peptides, and new neurotransmitters. Part 1 concludes with 9 chapters dealing with integrative concepts. Part 2 (Clinical) is similarly organized and starts with an introductory chapter to clinical neuropsychopharmacology by David J Kupfer, followed by 8 chapters about the critical analysis of methods. Psychiatric and age-related disorders are covered syndromally. The section includes mood disorders (19 chapters), schizophrenia (11 chapters), anxiety disorders (6 chapters), geriatric disorders (11 chapters), neurologic disorders (9 chapters), personality disorders (1 chapter), eating disorders (3 chapters), sleep disorders (1 chapter), childhood disorders (5 chapters), and substance abuse disorders (10 chapters). Part 2 concludes with 3 chapters about integrative concepts dealing with genetic strategies for multimodality research and methodological and statistical research. Part 3 (Special Topics) includes 6 chapters on diverse topics, namely, new drug design in psychopharmacology, ethical issues in genetic screening, the economics of psychotropic drug development, economic evaluations of drug treatment, ethnicity and culture in psychopharmacology, and psychopharmacology of violence and aggression.

This book is somewhat of a departure from previous volumes, not only by the expanded content and the long list of contributors (over 21 pages) but also by the way it is organized. The introductory chapter for every part provides an excellent and succinct overview that prepares the reader for the detailed and extensive information provided in the chapters that follow. The concluding integrative concepts of every major part provide excellent information, moving from individual systems as receptors and neurotransmitters to a more integrated brain functioning. The critical analysis of methods included in the preclinical and clinical sections provides useful information about the most current tools employed in the research approaches of the particular area.

The book provides extensive cross-referencing between preclinical and clinical topics, which allows readers at various levels of expertise to gain appreciation of the depth and complexity of the field. The extremely detailed preclinical section relates the rapid and extensive development in basic research that had been brought about by the major technological advances in recent years. The reader with less expertise in the field may find the complexities of basic research data difficult to follow at times, but this struggle can serve as a reminder for clinicians that brain behavior is an extremely complex subject. Nevertheless, it is important for clinicians and neuroscientists to appreciate such complexities. It is also equally important for researchers as well as educators in the field to attempt to bridge the gap between the new and exciting information overload and clinical practice. Though some of the major developments in the field are carried forward by basic scientists, it is encouraging to note the increased contributions from clinical researchers. This volume certainly makes an effort to connect the preclinical and clinical material in a way that makes it easier for the clinician to grasp the complex mechanisms and principles underlying drug actions.

Though the book contains 163 chapters written by a long list of contributors, the editors are to be complimented for assembling this vast amount of information by various contributors with different writing styles, maintaining general conformity with style, and allowing the information to flow easily. Obviously, this monumental work is not intended for the casual reader or the reader who needs a quick-fix on “how to,” but certainly it is a valuable tool for basic and clinician scientists. It is necessary reading for graduate students in neuropsychopharmacology. The book covers an extensive list of important topics, all of them relevant. The book would have benefitted, however, from more attention to a number of topics that can be grouped under the rubric of the social psychology of medication taking. After all, the development of the best medication is of little impact if our patients do not take it or if we lack the knowledge to make them take it. In addition, because a good base of knowledge about the interface of neuropsychopharmacology and other approaches, such as psychosocial contributions, is evolving, this textbook could have touched more specifically on this area of interest.

In conclusion, this book is valuable in the field of neuropharmacology and provides up-to-date information on the breadth and depth of the topic. In the practice of psychiatry, pharmacotherapy is only 1 part of the total management. In that sense, some emphasis on conceptual integrative approaches toward the treatment of psychiatric patients would have added value in the clinical section. Obviously, a major contribution of such magnitude cannot conceivably cover all the nuances of the field. I highly recommend this book, which represents a major and important endeavor; its editors are to be complimented. Given the current pace of neuroscience research developments, the next volume will likely be needed in the next few years. This raises the issue of the phenomenal demands on energy and time to publish such books and whether it is more practical between decades to rely on selected updates of certain topics that made significant progress in a short time.

The Treatment of Anxiety Disorders: Clinician’s Guide and Patient Manuals

The Treatment of Anxiety Disorders: Clinician’s Guide and Patient Manuals

G Andrews, R Crino, C Hunt, L Lampe, and A Page

New York: Cambridge University Press; 1995.423 p

The Treatment of Anxiety Disorders: Clinician’s Guide and Patient Manuals begins with a section entitled “How To Use This Unusual Book”. The warning is useful because this book is presented differently from most. It consists of 3 sections that are repeated for each anxiety disorder: first, a collection of relatively brief reviews of the presentation, aetiology and treatment of anxiety disorders; second, a series of brief therapists’ manuals; and third, a set of more extensive patient manuals. The authors and publishers generously give the reader permission to photocopy the patient manuals for repeated use. The authors are well-known clinician researchers working in Australia. The senior author, Gavin Andrews, has contributed widely to the anxiety disorder field for many years, particularly in issues of neurotic defense styles and the use of behavioral treatments for anxiety.

The brief reviews are adequate and represent a fairly succinct way of obtaining current information on anxiety disorders, largely from a cognitive-behavioral perspective. Despite this general perspective, issues relating to biological and aetiological theories, genetics, and drug treatments are expertly handled. The clinician guide to general treatment issues focusses on cognitive and behavioral approaches which may disappoint those with other therapeutic orientations, but help those looking for advice on how to deliver behavioral treatments in their own practices.

The book addresses each of the major anxiety disorder syndromes in turn, and provides the clinician with 5 structured manuals for the treatment of panic disorder and agoraphobia, social phobia, specific phobias, obsessive-compulsive disorder, and generalized anxiety disorder. Adjustment disorder and secondary anxiety are dealt with briefly without the manuals. The clinician manuals are useful guides to the step-wise treatments used in cognitive-behavioral therapy. The manual for panic and agoraphobia gives details of therapeutic tasks to be undertaken in each of 19 treatment sessions, and relates these steps to the patient manual consisting of 50 pages of information and exercises. Each of the other disorders is dealt with in similar fashion.

The patient manuals are rather repetitive and focus considerable attention on hyperventilation control and the use of relaxation. Appropriate attention is paid to the use of exposure methods and cognitive techniques. The patient manual for the treatment of obsessive-compulsive disorder is surprisingly short given the usual complexity of clinical cases of this disorder. One potential difficulty with the patient manuals is the level of reading skills necessary to understand them. With therapist help this will probably not be a problem, but the writing style of the 3 different sections varies less than expected.

This 423-page book sets out to tackle 3 large areas and it does so reasonably well. It cannot be all things to all anxiety sufferers, and there are other self-help manuals available that are more reader friendly. There are few sources for the clinician that combine, quite so conveniently, current information about the various anxiety disorders and their treatment. Andrews’ book can be recommended to clinicians looking for guidance on how to conduct cognitive-behavioral treatment. It is also a useful book for training junior colleagues, and I will use it in that setting. I expect that most clinicians who use this particular book and set of manuals will be reasonably satisfied, but they will probably want to add to their information base by turning to more comprehensive texts about the individual disorders.

5-HT1A Agonists, 5-HT3 Antagonists and Benzodiazepines: Their Comparative Behavioral Pharmacology

5-HT1A Agonists, 5-HT3 Antagonists and Benzodiazepines: Their Comparative Behavioral Pharmacology

RJ Rodgers and SJ Cooper

New York NY: John Wiley, 387 pp, 1991

Dr. Rodgers and Dr. Cooper have done a masterful job in gathering seminal information towards the understanding of the anxiolytic activities of serotonin, agonists, serotonin antagonists and benzodiazepines. Benzodiazepines are prescribed extensively in our society for anxiety disorders. Given the addiction potential associated with benzodiazepines, the need is great to find other types of medications to treat patients with anxiety disorders. This book attempts to empirically compare the anxiolytic medications currently available and to provide a focus for continuing research. While the core of the book is devoted to basic science, including a number of chapters on animal models and experimentation, the clinical aspects of pharmacology are not ignored. In chapters 11 and 12, the abuse, dependence and withdrawal potential of benzodiazepines are discussed and in chapter 13, Edward Schweizer and Karl Rickels review the efficacy of serotonergic anxiolytics.

An excellent discussion of benzodiazepine receptors and their ligands is found in the first chapter. In the past ten years there has been an explosion of knowledge in the pharmacology and chemistry of benzodiazepine receptors and we are now able to clone them. This book helps to explain why certain drugs are agonists, antagonists, partial agonists and inverse agonists. The 5-HT receptor family and their ligands, distribution and receptor-effector coupling are covered in the second chapter. Recent information on the anxiolytic effects of serotonergic-type drugs is promising, particularly the 5-T1A agonists and 5-HT3 antagonists.

This text is not meant for recreational reading since it contains a great deal of basic science. The style of writing produces consecutive and somewhat unrelated chapters written by different authors, each an expert in his or her field. Basic scientists will find this text informative and an excellent reference since long lists of articles are given at the end of each chapter. As well, clinicians dealing with anxiety disorders, in particular those who administer benzodiazepines and serotonergic-regulating medication, would benefit from reading this book so as to be able to properly use these medications. Knowledge in this field advances at a rapid rate; this pharmacological review will help both scientists and clinicians keep up-to-date.

Acquisitions en psychiatrie biologique

Acquisitions en psychiatrie biologique

J. Mendlewicz, Paris: Masson, 160 pp., 1991

During the past four decades, research in biological psychiatry and neuroscience has made unprecedented progress. New research methods and technologies in areas such as molecular biology and brain imaging have contributed to an extraordinary explosion of knowledge in the pathophysiology and treatment of many mental disorders. The timing of this book is appropriate, since we are in what has been named “the decade of the brain.”

This collaborative volume, edited by J. Mendlewicz, brings together 15 chapters on selected topics in biological psychiatry. The chapters covered include: a historical review of psychiatric nosology; the chronobiology of affective and schizophrenic disorders; hemispheric laterality and psychopathology; sleep disturbances; a review of the clinical use of neuroendocrine markers in psychiatry; the neurobiology of anxiety disorders; molecular genetics of affective disorders and schizophrenia, respectively; the pathophysiology of schizophrenia; dopaminergic mechanisms in the action of antipsychotic drugs; a general overview on tardive dyskinesia; receptor mechanisms in depression and the mode of action of antidepressant medication; a review of benzodiazepine receptors and anxiety and a final chapter on the status of biological psychiatry in developing countries.

Some chapters, which could have been grouped around a common theme, such as the chapter on the neurobiology of anxiety disorders and the chapter on benzodiazepine receptors and anxiety, are 58 pages apart. This contributes to a lack of unity in the volume. However, this book is ideally suited to the reader who is unfamiliar with and wishes a “glimpse” at some of the many developments that have occurred in the field of biological psychiatry.

A DSM III-R Case Book of Treatment Selection

A DSM III-R Case Book of Treatment Selection

Samuel Perry, Alan Francis, John Clarkin

New York, NY: Brunner/ Mazel Publishers, 416 pp., 1990

In the introduction to this book John Talbot states “as the science of psychiatry progresses at such a rapid pace it is apparent that its art must advance just as quickly. With every development, the selection of the most perfect treatment becomes more complex but also more critical.”

Talbot goes on to state “too often patients receive the treatment known best to, or practised primarily by the first person they consult, rather then that from which they might best benefit.” These ideas resonate very much with the concerns of many academic psychiatrists in North America.

The authors of this book have attempted to offer some guidelines for appropriate and yet critical treatment selection. They have written a fine introductory chapter in which they describe how treatment needs to be planned, they also indicate their biases. Some of these biases are that treatment decisions are not based on disgnosis alone, but in order for patients to receive the best and most effective treatment their past history, life style, current situation and interaction with the therapist must be considered in order to provide properly individually tailored treatment.

They indicate that there are somewhere between 130-200 treatments available in psychiatry, and that perhaps psychiatrists can be categorized in three groups: specialists, eclectics and sceptics who believe that non-specific factors are most important. The authors examine the setting, format, time, approach, and the question of somatic treatments or no treatment as entering into all treatment decisions.

They state that the process of treatment selection is truly a matter that academic psychiatrists must examine more carefully. For instance people can decide on a medical model entirely. The authors state this is too simple. They state that diagnosis has been shown to have only slight correlation with treatment selection and outcome and give a reference in the Archives of General Psychiatry to back up this statement.

A preferable method of selecting treatments is to consider other aspects of the patient in addition to treatment. One must train our students and all mental health professionals to consider the presenting problem, character traits, premorbid personality, motivation, psychological-mindedness, socio-economic status, family situations and ego strength. The authors point out that patients have expectations of treatment and that this influences outcome. This finding has been shown in many trials particularly in the area of depression.

And finally as we might expect, the cases which are outlined in all DSM III-R categories are rich and exciting to read. Furthermore, cases under mood disorders, anxiety disorders and adjustment disorders provide the most provocative and interesting discussions as to why various forms of psychotherapy or pharmacotherapy or a combination of these modalities have been chosen. It has always been my view that these are the most exciting areas in psychiatry because they lead to bias in treatment selection and should, in sophisticated academic centers, lead to an opportunity to further our knowledge by enlightened and constructive intellectual debate.

The Art of Psychotherapy

The Art of Psychotherapy, Second Edition

Anthony Storr

New York, NY: Routledge, 208 pp, 1990

In the first edition of The Art of Psychotherapy, published in 1980, the renowned psychiatrist, psychotherapist and author Dr. Anthony Storr tackled the monumental task of writing a truly introductory book about dynamic psychotherapy that is both accessible and understandable. He succeeded at that task admirably and ten years later has published a second edition which is just as effective an introduction. The second edition has an updated section on the obsessional patient and an added chapter outlining some of the ideas that he explored in Solitude, published in 1988. As always, Dr. Storr’s writing is readable, easy to understand and thoughtful.

Most writing in the field of dynamic psychotherapy can be inaccessible to those struggling to come to grips with the field because of language and terminology that is highly technical and often largely theory-bound. Although this type of writing allows for precision, it can also frustrate the new psychotherapist, who is already facing the anxiety of learning a very new and different way of working with patients.

Dr. Storr is able, in his book, to strip away almost all the theory-bound concepts and terminology that create confusion and still preserve the core ideas that underlie the work and art of dynamic psychotherapy. His ideas are clearly formulated and presented, divorced as much as possible from theory without losing their strength.

Other writers, in attempting introductions to this field, have used the approach of sticking to one theoretical model in an attempt to simplify the issues. However, this can create dogmatism as a defence against the anxiety of not knowing “the answers.” Storr’s approach instead is to introduce the core ideas and introduce the idea that there is uncertainty in any attempt to understand people, encouraging an openness to question that parallels the therapeutic stance in psychotherapy. Indeed, in this book he attacks the rigid adherence to one psychotherapeutic school several times, a practice he predicted would fade even in his first edition, which was written over ten years ago.

Unfortunately, the one weakness of the book as an introductory text is closely if not inextricably bound to its very strength. His avoidance of technical terminology, particularly as it pertains to diagnostic systems in vogue, will create some barriers in the task of introducing psychotherapy to people who are new to the field. With no attempt to integrate the ideas expressed in the DSM or ICD diagnostic systems, which new therapists will already know, the book may reinforce the apparent artificial dichotomy between these areas of psychotherapy and biological psychiatry. It can be useful to move away from these diagnostic systems at times in psychotherapy to enhance the understanding of individuals, but may also create resistance and misunderstanding in some readers new to this area. In part because of this lack of integration, references to the pharma-cotherapy of depressed patients infer that such treatment is generally incomplete and may be harmful in the long run, not allowing for complete resolution of the underlying depressive ideas. This may create unnecessary resistance to his other ideas and may reinforce the apparent dichotomy between biological and dynamic psychiatry.

This book is nonetheless excellent and one of the best books to introduce mental health professionals to the field of dynamic psychotherapy. It could well form the core of an introductory text in this area. Its tendency to avoid overreliance on theory, and Dr. Storr’s brilliant distillation of the core concepts of psychotherapy are quite unmatched now as they were unique ten years ago.

Neurobiology of Learning, Emotion, and Affect

Neurobiology of Learning, Emotion, and Affect

John Madden IV

New York, NY: Raven Press, 368 pp, 1991

This book comes at a time of progress and exciting new discoveries in the field of research involving the neural basis of learning, emotion and affect. The study of learning and memory has flourished for many years within the neuroscientific community. Although long neglected by all but a handful of neuroscientists, emotion and affect have begun to attract attention. A clear summary of the status of this recent work is therefore particularly welcomed.

The book is divided into three parts. The first part is devoted to recent advances in the research of the neural mechanisms of fear conditioning, in both invertebrates and vertebrates. Most exteroceptive stimuli we encounter in our life are affectively “neutral”. However, they can take on emotional properties and elicit emotional reactions, such as defence or approach responses, through association with other stimuli or events that are affectively charged. It is possible to study experimentally the ways in which the brain forms such associations through the use of Pavlovian conditioning techniques, whereby a “neutral” stimulus, the conditioned, or conditional stimulus (CS), is paired with a biologically significant (affectively charged) stimulus, the unconditional or unconditioned stimulus (US).

Pavlovian conditioning procedures have been used to study the biology of learning in many species. Whether or not it is reasonable to speak of Pavlovian conditioning as a process of emotional learning is debatable for invertebrates, many vertebrates, and even many mammalian species, if emotion is restricted to subjective, experiential factors. However, if by emotion we also mean the neural mechanisms by which stimuli are evaluated for their significance (LeDoux 1990), it is possible to view all animals as engaging in a form of emotional processing. What is different about humans and possibly higher primates is that the emotional processing of stimulus significance becomes represented as conscious content. This view is advantageous in that it places emotional processes on a continuum and allows for studies of emotion throughout the animal kingdom.

In the Aplysia model, described in detail by Hawkins, the cellular mechanisms and neural loci responsible for associative learning are, without a doubt, understood more than in any other animal model. Are the same basic mechanisms discovered in this simple model in operation also in more complex organisms? Hawkins believes that classical conditioning in Aplysia, Hermissenda, cat and rabbit involve the same neural mechanisms. In Aplysia, the US plays a modulatory role in stimulating the facilitator neurons. The convergence of this input with the appropriate CS input (the one that was paired with the US) increases presynaptic facilitation and produces classical conditioning. A similar mechanism is acting in vertebrate models as well, Hawkins suggests. The aminergic and cholinergic systems in the vertebrate nervous system can behave like the facilitator neurons of Aplysia. One challenge for the future is to test this simple and attractive theory.

Another elegant invertebrate model is Drosophila melanogaster. An advantage of this model is the possibility of using genetic tools. In recent years, the isolation of mutations that affect an aversive conditioning task in the fruit fly has considerably increased our understanding of the molecular mechanisms of learning and memory. Tim Tully reminds us that with Drosophila research, we probably have the only evidence that short-term and long-term memory are indeed two genetically distinct processes.

Our understanding of the molecular and underlying elementary neural mechanisms which make learning possible in an individual is far less developed in vertebrate models. In recent years, however, simple vertebrate model systems have been worked out, and important neural structures and pathways essential in learning have been shown. It now appears that different types of learning are mediated by different but, in some cases, overlapping neural circuits.

One promising vertebrate model is the conditioned fear-potentiated startle paradigm. In this behavioral model, the conditioned stimulus (usually a light) is paired with a shock and startle response elicited by a noise burst in either the presence or absence of the light. If the startle response is greater when elicited in the presence of the light, the fear-potentiated startle has occurred.

The role of the amygdala in this reflex has been demonstrated by Davis and collaborators; in this book they review the current state of affairs. The amygdala is the centerpiece of the neural pathway involved in fear-potentiated startle, as well as in other fear conditioning situations (Kapp et al 1990; LeDoux 1990). Davis and collaborators show that the activation of the amygdala from the visual conditioned stimulus pathway triggers the startle reflex pathway. The central nucleus of the amygdala carries this out through its connection with the nucleus reticularis pontis caudalis (a nucleus in the startle circuit). Davis and colleagues believe that the visual input comes to the amygdala through cortical pathways. However, findings from our laboratory suggest that visual fear conditioning can be mediated by subcortical visual inputs to the amygdala (LeDoux 1990).

There is a general consensus about the involvement of the amygdala in mediating the acquisition of autonomic responses in the aversive classical conditioning. These responses are defined as “non-specific” and include heart rate, generalized motor activity (freezing, startle response) and skin resistance. They all develop rapidly after a few trials, sometimes requiring just a single contingent pairing. “Specific” responses, on the other hand, are discrete, skeletal muscle responses elicited by specific aversive stimuli. They are much slower to develop and are more specifically adaptive for the organism.

Steinmetz and Thompson describe how the cerebellum, in particular the interpositus nucleus, is an important site for the acquisition of these discrete, specific responses. Using a multi-technique approach (recording, stimulation, lesion studies) they developed a detailed anatomical map of the circuitry involved in the adaptation to aversive events for these behavioral responses. According to Steinmetz and Thompson, the cerebellum plays an “informational” role in the learning of the organism. It is activated in conjunction with the aversive system that involves higher brain regions (the amygdala, for example). These two systems in the brain are distinct, but they interact in the adaptive learning phase. The US pathway activates both systems. And while the cerebellum appears to play an important role in learning the specific response, recent studies also suggest that the amygdala is involved in the early phases of learning. The final attempts to relate these ideas to the popular Rescorla-Wagner learning theory.

Part II of the book deals with experimental situations in which the animal is allowed little or no control over the aversive stimulation How do the subjects cope with stressful events when species-specific defense responses are not helpful? What kind of behavioral and biochemical changes will stressful events elicit? Results from these experimental studies are particularly valuable for their clinical implications. Weiss, using an uncontrollable shock paradigm, suggests in fact that stressed animals show symptoms closely corresponding to those developed by depressed individuals. Moreover, the author proposes that stressful events (for example, uncontrollable shock) elicit both anxiety and behavioral depression. In his analysis, Weiss shows how the locus coeruleus seems to be a key structure in the neurochemical unbalance produced by the uncontrollable shock.

Cognitive deficits may also occur as part of the response to stress. Animals that are exposed to shocks that they cannot avoid or escape later fail to escape shock in a situation in which escape is possible. They also fall well behind control animals (that were allowed to escape or avoid shock in the first phase of the experiment) in Y-maze or water-maze learning tests. Some researchers have explained these results in terms of a simple motoric impairment: the shocked animals learn a coping response in the new situation, but they cannot perform it. Maier rejects this hypothesis; his work suggests that inescapable shock gives rise to learning deficits that cannot be explained by a motor activity deficit.

However, the impairment is not the result of associational learning between the first phase of the experiment and later test situations, as it was suggested in the early explanations of this phenomenon. What is impaired in these subjects, according to Maier, is the capacity to attend the salient external cues; the deficit is then a cognitive one, not an associative one (the learned helplessness hypothesis). Whether this cognitive deficit will be connected to some neural loci or biochemical systems will have to be determined in future studies.

More complex issues of depression and human affect disorders, which involve multiple interactions between emotional and cognitive systems operating at conscious and unconscious levels, are difficult to probe with vertebrates too distant from us in the evolutionary ladder and in social habits. Suomi describes a primate model of affective disorders, the separation model. Humans share over 90% of non-replicated DNA material with higher primates. In addition, the behavior of these animals is characterized by advanced and dynamic social interactions among members of the same species. Rhesus monkeys, in particular, have been studied extensively in the wild and in laboratory settings. Stressful events caused by social relationships among individuals closely resemble human social life. Separation from an attachment object, such as a mother or a loved conspecific, produces profound behavioral and physiological effects, both in the wild and in the laboratory. The evidence of individual differences in these animals makes this model particularly interesting. Not all subjects respond to the same social separation in the same manner. There is also consistency in this behavior in individuals. The same monkeys “at risk” are more readily aroused by and behaviorally fearful of other stressful events. Having individuated the groups “at risk” in the rhesus monkeys population, it may be possible to forecast or even prevent the affective disorder. The “separation/risk” model in monkeys, as Suomi defines it, seems to be extremely promising for improving our understanding of the psychobiology of human affective disorders.

There is evidence from this primate model that the noradrenergic system is involved in mediating depressive states. Matthysse reaches the same conclusion in his analysis of mood disorders. In particular, the locus coeruleus, an important source of forebrain noradrenalin, is advanced as a candidate for depression, as Weiss also proposed for the helplessness model. According to Matthysse, this nucleus becomes activated by excited unhappy memories, which are the result of early loss or other traumatic events. Cerebral activation is then reduced by the increased firing of the locus coeruleus. At this point, physostigmine, the cholinergic agent, enters the circuit to produce the physiological symptoms of depression. In Matthysse’s view, while the memories are the primary cause of noradrenergic changes, the biogenic amines are only the effectors in this theory. Matthysse points out that human studies suggest that decreased cerebral activation is produced by physiostigmine in normal subjects (for example, the subjects feel “apathy, slowness of speech and movement”). Physiostigmine physiological symptoms closely resemble those of depression. In his fascinating theory, however, Matthysse does not tell us where these memories may be stored in the brain or why, at a certain point, they overflow to reach the locus coeruleus. Also, it will be interesting to try to define the role of anxiety in this context. Under identical conditions of stress some people respond only with anxiety; do they have the capacity to deal with the unhappy memories activation in a different way? Interesting questions arise from this theory that only future experiments can elucidate.

Control over stressors is a critical factor that influences biological functions which regulate adaptive and maladaptive behaviors. Bandura states that the ability to control stress effects is the principal factor that makes a person cope with stress events. It is the ability to control the stress effects that prevents the release of stress-related hormones or the impairment of the immune system. With the support of human quasi-experimental studies, Bandura describes the effect of being able to gain control over the stressful situation. For instance, catecholamine levels in phobic patients dropped after allowing them to acquire controlling efficacy. Pain tolerance was increased in normal subjects when there was self-efficacy, even in those subjects to whom naloxone was administered to block opioid activation. Self-efficacy mechanisms play an essential role in the individual’s well-being. Bandura’s theory proposes an entire psychological approach to deal with stressful events that deteriorate our biological systems. This approach provides an intelligent stimulus to operate in the sphere of human maladaptive behaviors with “clean” psychological tools but with an attentive eye on the neurobiological domain.

Part III of the book explores broader issues in the field of emotion and affect and presents two models. Gray describes three systems that control emotional behavior. Each of these systems is associated with a particular area in the brain. One of these systems, the behavioral inhibition system, is thought by Gray to be centered around the hippocampal formation. This system is responsive to stimuli associated with punishment or with the conditioned aversive stimuli and is involved in increasing the level of arousal and increasing attention to the environment to cope with the new situation. Anxiolytic drugs affect the septohippocampal system, and lesions of this system lead to a behavioral syndrome similar to that seen after the administration of anxiolytic drugs. These results are the strong-hold of Gray’s theory. The amygdala, a structure that has long been considered to play a pivital role in fear, including fear learning, is not included in the behavioral inhibition system. It is involved instead in the second system, the fight/flight system, which is responsive to unconditioned punishment and non-reward, that is, to issue commands either for fight or for flight depending on the context and type of punishment received. Gray dismisses fear conditioning studies as irrelevant to the problem of anxiety and relegates them to elicitor of a more species-specific type of defence or attack responses. We do not agree with such a view. Nevertheless, Gray’s model is commendable in its breadth and attempt to synthesize divergent findings into a unified theory of anxiety. The second model uses the opponent-process theory to explain a large set of affective phenomena, taken from everyday life and experimental settings. This model states that it is possible to produce acquired motives by non-associative mechanisms alone. The mechanism is repetition, not conditioning (association). Solomon believes that his approach can explain food intake, drug addiction and related phenomena that Pavlovian conditioning is not able to explain. An important question that the author raises is whether or not the opponent-process states are predictable. He is convinced that they are and analyzes the process of food intake and obesity following the logic of opponent-process theory.

Neurobiology of Learning, Emotion, and Affect is a well organized, multi-disciplinary book. It presents a range of approaches and contributions. The literature on behavioral neuroscience, in general, has increased tremendously in the last few years. Moreover, there is a growing interest in research on emotion, which has been somewhat neglected in the age of cognition. This book will help bring research on emotion into the limelight. The book will be very useful as an introduction to research on the biology of emotion and learning and will also be useful as reference point for future research.

Nutritional Influences on Mental Illness: A Source Book of Clinical Research

Nutritional Influences on Mental Illness: A Source Book of Clinical Research

Melvyn R. Werback

Third Line Press, Inc., 360 pp., 1991

Publication of this book is timely as nutritional science is emerging as an essential component of the practice of medicine. The book is a sequel to “Nutritional Influences on Illness” by the same author. In “Nutritional Influences on Mental Illness” the focus is narrowed to psychiatric illness.

The book is aptly described as a “source book for clinical research”. Part I of the book is composed of a thorough review of the literature on the relationship of nutritional abnormality to psychiatric illnesses such as depression, anxiety, schizophrenia, learning disabilities, premenstrual syndrome and so on. Additional chapters address the influence of nutritional abnormality on symptoms such as fatigue, insomnia and aggressive behavior. Most chapters begin with a brief overview on the subject under study followed by a compilation of relevant publications on the topic, fully referenced for any one who wishes to undertake his own further study in the specific area. The presentation is extremely well organized and thorough. However, the author seldom offers his own critical appraisal of the mass of volume he has reviewed.

Part II of the book consists of six practical appendices such as “Common Nutritional Deficiencies,” “Dangers of Nutritional Supplementation” and “Guidelines to Nutritional Supplementation”. Once again, this is largely a compilation of previously published work in this area presented in an organized and easily readable way. The scope is wide, looking at everything from proteins and carbohydrates to vitamins and minerals.

Overall, the author has succeeded in his objective to bring together the plethora of literature on the relationship of nutrition to cognition, emotion and behavior. However, the author leaves it up to the reader to arrive at his own final conclusions and derive from it any therapeutic value. In this respect the book does not represent original work. As a source for clinical research, this book will serve to avoid the tedious task of a literature search. I would recommend it for institutional libraries and for health care workers with a special interest in nutrition.

Psychological Assessment, Psychiatric Diagnosis, and Treatment Planning

Psychological Assessment, Psychiatric Diagnosis, and Treatment Planning

S.W. Hurt, M. Reznikoff, J.F. Clarking

New York: Brunner/Mazel Publishers, 506 pp., 1991

This book begins with an overview of psychological testing. It establishes perspective by regarding the historical role of assessment in the general field of mental health. It first presents the history of the psychological testing movement, reviews the development of the American Psychiatric Association Diagnostic and Statistical manuals, and then relates the two. The remainder of the book is organized according to the DSM-III-R manual, discussing first the Axis-I disorders focussing on the disorders of infancy, childhood and adolescence, the schizophrenias, major affective disorders, anxiety disorders, and adjustment disorders, and then Axis-II disorders focussing primarily on paranoid, borderline, and narcissistic personality disorders.

The book uses the case method as a vehicle for teaching psychological assessment, and describes ways in which these assessment results might be analyzed, interpreted, and applied to treatment planning. It will be of particular interest for the student of clinical psychology who is attempting to acquire assessment skills that are relevant and applicable in the clinical situation. The book, while of interest to others in the mental health field, will probably not be as relevant as it is to the clinical psychologist. Those in other mental health disciplines, such as psychiatric nursing, psychiatry, and occupational therapy, would also be interested in this book since it offers a clear discussion of psychological assessment. However, the detail of its coverage would preclude its general use for these disciplines.

This book bridges a gap which has been present for many years in clinical application of psychological assessment. There is concern among members of the health care team that clinical psychology assessments do not go far enough in aiding the treatment team to generate an effective treatment plan This book enables the clinical psychologist to extend his/her capabilities and be better able to make significant input into the treatment planning process, aiding the team to make a useful plan.

In summary, this book is well written, readable, and important, especially in the area of training of clinical psychologists to provide more relevant, effective, and applicable assessment of psychiatric patients.