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.Keeping pace with the progress of empiricalresearch, and integrating its contents with clinical wisdom, is for all of usone of the intellectual endeavours of our time.ACKNOWLEDGEMENTSThe preparation of this paper was supported in part by a COFIN grantno.11/2001-113555-004 and a NARSAD Independent Investigator Award. 98 ____________________________________________________________________________________________ PHOBIASREFERENCES1.American Psychiatric Association (1983) Publication Manual, 3rd edn.AmericanPsychiatric Association, Washington, DC.2.Monroe S.M., Simons A.D.(1991) Diathesis stress theories in the context of lifestress research.Psychol.Bull., 110: 406 425.3.Kendler K.S., Myers J., Prescott C.A.(2002) The etiology of phobias: anevaluation of the stress diathesis model.Arch.Gen.Psychiatry, 59: 242 248.4.Kendler K.S., Neale M.C., Kessler R.C., Heath A.C., Eaves L.J.(1992) Thegenetic epidemiology of phobias in women: the inter-relationship ofagoraphobia, social phobia, situational phobias, and simple phobias.Arch.Gen.Psychiatry, 49: 273 281.5.Battaglia M., Bertella S., Ogliari A., Bellodi L., Smeraldi E.(2001) Modulationby muscarinic antagonists of the response to carbon dioxide challenge in panicdisorder.Arch.Gen.Psychiatry, 58: 114 119.6.Battaglia M.(2002) Beyond the usual suspects: a cholinergic route for panicattacks.Mol.Psychiatry, 7: 239 246.7.Kaufer D., Frideman A., Seidman S., Soreq H.(1998) Acute stress facilitateslong-lasting changes in cholinergic gene expression.Nature, 393: 373 377.8.Klein D.F.(1993) False suffocation alarms, spontaneous panic, and relatedconditions.Arch.Gen.Psychiatry, 50: 306 317.9.Flint J.(2003) Animal models of anxiety.In Behavioral Genetics in the Post-Genomic Era (Eds R.Plomin, J.C.De Fries, I.W.Craig, P.McGuffin), pp.425 442.American Psychiatric Association, Washington, DC.10.Gershenfeld H.K., Paul S.M.(1997) Mapping QTLs for fear-like behaviors inmice.Genomics, 46: 1 8.11.Turri M.G, Datta S.R., DeFries J.C., Henderson N.D., Flint J.(2001) QTLanalysis identifies multiple behavioral dimensions in ethological tests ofanxiety in laboratory mice.Curr.Biol., 11: 725 734.12.Rutter M.L.(1996) Developmental psychopathology: concepts and prospects.In Frontiers of Developmental Psychopathology (Eds M.Lenzenweger, I.Haugaard), pp.209 237.Oxford University Press, New York.2.6Social Phobia and Bipolar Disorder:The Significance of a Counterintuitive and Neglected ComorbidityHagop S.Akiskal1 and Giulio Perugi2Andrews review of the epidemiology of phobic disorders, based on datagathered by the Diagnostic Interview Schedule (DIS) and the CompositeInternational Diagnostic Interview (CIDI), raises the problem of the lowtest retest reliability and validity of the lifetime estimates obtained with1International Mood Center, Department of Psychiatry at the University of California at San Diego,La Jolla, USA2Institute of Psychiatry, University of Pisa, Italy EPIDEMIOLOGY OF PHOBIAS: COMMENTARIES _______________________________________ 99structured interviews.This problem is particularly relevant in analysing thedata on comorbidity between phobic and mood disorders and theirinterrelationships.Epidemiological studies have been focused largely on comorbiditybetween phobias, in particular panic disorder with agoraphobia (PDA),social phobia (SP) and major depression; less attention has been devoted tothe comorbidity between phobic and bipolar disorders.The co-occurrenceof bipolar disorder in patients with phobias is counterintuitive, butincreasing evidence for such a relationship comes from both epidemiolo-gical and clinical studies.In the National Comorbidity Survey [1], thereported risk of comorbid PDA and SP is higher in bipolar (odds ratiosrespectively of 11.0 versus 4.6) compared to major depressive disorder(odds ratios respectively of 7.0 versus 3.6).More recently, in subjectsmeeting DSM-IV hypomania, recurrent brief hypomania and sporadic briefhypomania, Angst [2] reported elevated rates of comorbidity with PDA andSP over population controls.The foregoing findings from different epidemiological studies, in bothEurope and the US, fly against a common perception that the relationshipbetween anxiety and mood disorders is largely limited to unipolar depression and dysthymia.The relative neglect in epidemiological researchfor the comorbidity between bipolar spectrum disorders and phobicdisorders is due to the relative underdiagnosis of bipolar II disorders,often misdiagnosed as unipolar or personality disorders [3].Dunner andKai Tay [4] reported that clinicians specifically trained in the recognition ofbipolar II disorders outperformed routine interviewers in such structuredinterviews as the Schedule for Affective Disorders and Schizophrenia(SADS) or the Structured Clinical Interview for DSM-IV (SCID).Thismethodological point supports earlier recommendations based on researchin Memphis [5] that the diagnosis of hypomania among cyclothymicbipolar II subjects should be based on repeated expert interviews.Althoughthis point goes against the grain in the literature on structuredinterviewing, it is consistent in suggesting that the proper identificationof bipolar II disorders requires a more sophisticated approach in diagnosis.Therefore, it is likely that bipolar comorbidity, very common in clinicalsamples [6], is not so easily detected in epidemiological studies utilizingstructured interviews based on the diagnostic rules of DSM and ICDsystems.We do agree with Andrews view that there are clinical issues in SP thatwarrant special attention.The following case makes that point:A 29-year-old single woman was unemployed when she presented fortreatment at the clinical centre in Pisa.During her childhood, she wasvery shy and inhibited.At school, she was very anxious, exhibiting 100 __________________________________________________________________________________________ PHOBIASmarked neuro-vegetative symptoms and inability to talk fluently duringoral examinations.During adolescence, she reported major problems inspeaking in public, coping with the opposite sex, and performing in a lotof social situations, she blushed heavily and made every effort to avoidthese situations.She sought psychiatric help for the first time in her life atthe age of 26 upon the insistence of her parents.She was treated withparoxetine (40 mg/day) and after a few weeks her social phobiaimproved.In the following months she appeared less embarrassed ininterpersonal contexts, social anxiety completely disappeared andimpudence and shamelessness took its place.She felt elated andincreasingly self-confident and progressively developed the firm beliefthat other people could be envious of her because of her qualities andabilities [ Pobierz całość w formacie PDF ]