- Email: [email protected]
Comorbidity of Mood and Anxiety Disorders
556
BOOK REVIEWS
Mayo Clin Proc, May 1991, Vol 66
for deep vein thrombosis and the aim for a habitual abortions and gestational trophoblasprothrombin time ratio of1.4 to 1.6 times control tic disease. The strength of the book lies in the vast are unacceptable practices yet are presented accumulation of knowledge, data, and photodogmatically. In other sections, material could have been graphs contributed by Benirschke. As ifhis own omitted without jeopardizing the objectives of authority on the subject were not enough, he the text-for example, the paragraph on causes thoroughly reviews the literature; the 716 referof anemias with ineffective hematopoiesis, the ences in his chapter on multiple pregnancy illuslengthy discussion of heart diseases, and the trate this point. He cites the German literature section on when to perform a staging laparotomy. freely and extensively (in German, of coursel), This text unites many specialties and should In summary, this manual fills a definite need for those involved in the care of surgical pa- be well used in departments of pathology, obstettients. Because ofthe attempt to address a wide rics and gynecology, and pediatrics. Whether it spectrum of subjects, however, the discussions finds its way into the personal libraries ofphysiare superficial and best suited for medical per- cians depends on whether they recognize the sonnel who are beginning their training and who utility of studying the placenta. Once that task seek a briefreview of pertinent topics about their has been accomplished, Benirschke and Kaufmann's textbook will be the "definitive" patients. source on placental pathology. It is a classic. David N. Mohr, M.D. Thomas A. Gaffey, M.D. Division ofArea Medicine Division of Pathology
Pathology of the Human Placenta, 2nd ed, by Kurt Benirschke and Peter Kaufmann, 878 pp, with illus, $198, New York, SpringerVerlag, 1990 Although the placenta is often overlooked, it provides a unique window through which clinicians can study the link between reproductive pathogenesis and clinical obstetrics and pediatrics. This book presents comprehensive, up-todate information on the embryologic, anatomic, physiologic, and pathologic features of the human placenta. The first six chapters, written by Peter Kaufmann, focus on development and structure. Although these chapters are useful references, they are not as engaging as the 24 chapters contributed by Kurt Benirschke. Dr. Benirschke's energetic writing style (which corresponds to his personality) makes reading about the placenta enjoyable. The book is surprisingly "clinical," although from a different vantage point than are clinical obstetrics texts. Subjects range from infectious disease, hypertension, and lupus to
Karen K. Vernof, M.D. Department of Obstetrics and Gynecology
Comorbidity 'of Mood and Anxiety Disorders, edited by Jack D. Maser and C. Robert Cloninger, 869 pp, with illus, $59.95, Washington, DC, American Psychiatric Press, 1990 Comorbidity ofMood and Anxiety Disorders was written to explore the diagnostic overlap and interaction between mood and anxiety disorders. The concept for this book was initiated at a conference at the Sterling Forest Conference Center in Tuxedo, New York. Each of the 40 chapters is an article prepared by various experts in psychiatric medicine. Several criticisms of the text are apparent. Because of the numerous contributors, some chapters are poorly integrated, and considerable overlap of the material is evident. In some chapters, a specific problem is the unexpurgated
Mayo Clin Proc, May 1991, Vol 66
commentary about what authors of other chapters said. This problem could have been remedied by more stringent editorial review. Although the binding of the book is strong, the external cover is unimaginative, and the physical appearance of the book belies the price of $59.95. Despite the aforementioned criticisms, this book contributes substantially to the understanding of comorbidity. The 40 chapters are divided into 8 sections. The introductory section sets the tone and outlines several topics that will be addressed in the subsequent sections. Discussions that conceptualize the phenomenon of comorbidity using various paradigms are also included. The three chapters in section 2 that deal with issues of classification in comorbidity are repetitive and should have been condensed into one chapter. In these chapters, the influence of the various methods of classification on the frequency and type of observable comorbidities in clinical practice is described. In practice, the classification scheme used will determine the frequency and type of comorbidity observed. Section 3 is an informative review of the National Institute of Mental Health Epidemiologic Catchment Area Study, the Zurich cohort study, the Lundby 25-year prospective study, the Sterling County study, and others. Section 4 examines the evidence ofcomorbidity in treated samples and longitudinal studies and the concurrence of axis I and axis II disorders with anxiety and depression. For example, depression and anxiety are also comorbid with dysthymic disorder, somatoform disorder, and psychosexual disorder. Furthermore, specific types of personality disorders, especially the dramatic personality cluster, are associated with anxiety and affective disorders more frequently than expected by chance. In addition, this section thoroughly discusses somatization, "the most costly comorbidity" that is frequently quoted as occupying 20% ofthe average physician's time at a cost of an astounding $20 billion annually in the United States. Section 5 reviews the evidence for comorbidity in familial and genetic studies and contains some extremely useful reviews of methods of
BOOK REVIEWS
557
study. Section 6 deals with comorbidity as determined by studies using biologic markers that have been researched as predictors of depression or anxiety disorders. Unfortunately, the sensitivity and specificity of the available biologic markers are too poor to facilitate analysis of the interaction of affective and anxiety disorders. Section 7 discusses the major psychopathologic theories, including the Kraepelinian biomedical, psychodynamic, sociocultural, and behavioral learning theories, and Cloninger's three-dimensional model of personality. This section is complete with the inclusion of the psychologic defense mechanisms that relate to affective and anxiety disorders. In addition, the seminal work done by Vaillant and others is reviewed. The final section addresses research issues, methods, and assessment. This wellwritten section examines statistical considerations, research design, self-report instruments, diagnostic interview schedules, and the role of treatment trials in understanding comorbidity between anxiety disorders and affective disorders. An excellent discussion on the odds of comorbidity developing is also included. In general, the strengths of this book outweigh its weaknesses. This publication explains that to understand why comorbidity develops in psychiatric populations, we may need to disregard exclusionary principles in our current diagnostic schemes so we can effectively study these occurrences. Diagnostic criteria currently used for depression, anxiety, somatization, and eating disorders substantially overlap. Whether depression and anxiety are the same illness or have the same underlying cause remains to be elucidated. This book will be useful for most practicing psychiatrists and residents in psychiatry and for general practitioners who have an interest in anxiety and depression because of the nature of their practice. It should be available in psychiatric libraries. John L. Black, M.D. Department of Psychiatry and Psychology
BOOK REVIEWS
Mayo Clin Proc, May 1991, Vol 66
for deep vein thrombosis and the aim for a habitual abortions and gestational trophoblasprothrombin time ratio of1.4 to 1.6 times control tic disease. The strength of the book lies in the vast are unacceptable practices yet are presented accumulation of knowledge, data, and photodogmatically. In other sections, material could have been graphs contributed by Benirschke. As ifhis own omitted without jeopardizing the objectives of authority on the subject were not enough, he the text-for example, the paragraph on causes thoroughly reviews the literature; the 716 referof anemias with ineffective hematopoiesis, the ences in his chapter on multiple pregnancy illuslengthy discussion of heart diseases, and the trate this point. He cites the German literature section on when to perform a staging laparotomy. freely and extensively (in German, of coursel), This text unites many specialties and should In summary, this manual fills a definite need for those involved in the care of surgical pa- be well used in departments of pathology, obstettients. Because ofthe attempt to address a wide rics and gynecology, and pediatrics. Whether it spectrum of subjects, however, the discussions finds its way into the personal libraries ofphysiare superficial and best suited for medical per- cians depends on whether they recognize the sonnel who are beginning their training and who utility of studying the placenta. Once that task seek a briefreview of pertinent topics about their has been accomplished, Benirschke and Kaufmann's textbook will be the "definitive" patients. source on placental pathology. It is a classic. David N. Mohr, M.D. Thomas A. Gaffey, M.D. Division ofArea Medicine Division of Pathology
Pathology of the Human Placenta, 2nd ed, by Kurt Benirschke and Peter Kaufmann, 878 pp, with illus, $198, New York, SpringerVerlag, 1990 Although the placenta is often overlooked, it provides a unique window through which clinicians can study the link between reproductive pathogenesis and clinical obstetrics and pediatrics. This book presents comprehensive, up-todate information on the embryologic, anatomic, physiologic, and pathologic features of the human placenta. The first six chapters, written by Peter Kaufmann, focus on development and structure. Although these chapters are useful references, they are not as engaging as the 24 chapters contributed by Kurt Benirschke. Dr. Benirschke's energetic writing style (which corresponds to his personality) makes reading about the placenta enjoyable. The book is surprisingly "clinical," although from a different vantage point than are clinical obstetrics texts. Subjects range from infectious disease, hypertension, and lupus to
Karen K. Vernof, M.D. Department of Obstetrics and Gynecology
Comorbidity 'of Mood and Anxiety Disorders, edited by Jack D. Maser and C. Robert Cloninger, 869 pp, with illus, $59.95, Washington, DC, American Psychiatric Press, 1990 Comorbidity ofMood and Anxiety Disorders was written to explore the diagnostic overlap and interaction between mood and anxiety disorders. The concept for this book was initiated at a conference at the Sterling Forest Conference Center in Tuxedo, New York. Each of the 40 chapters is an article prepared by various experts in psychiatric medicine. Several criticisms of the text are apparent. Because of the numerous contributors, some chapters are poorly integrated, and considerable overlap of the material is evident. In some chapters, a specific problem is the unexpurgated
Mayo Clin Proc, May 1991, Vol 66
commentary about what authors of other chapters said. This problem could have been remedied by more stringent editorial review. Although the binding of the book is strong, the external cover is unimaginative, and the physical appearance of the book belies the price of $59.95. Despite the aforementioned criticisms, this book contributes substantially to the understanding of comorbidity. The 40 chapters are divided into 8 sections. The introductory section sets the tone and outlines several topics that will be addressed in the subsequent sections. Discussions that conceptualize the phenomenon of comorbidity using various paradigms are also included. The three chapters in section 2 that deal with issues of classification in comorbidity are repetitive and should have been condensed into one chapter. In these chapters, the influence of the various methods of classification on the frequency and type of observable comorbidities in clinical practice is described. In practice, the classification scheme used will determine the frequency and type of comorbidity observed. Section 3 is an informative review of the National Institute of Mental Health Epidemiologic Catchment Area Study, the Zurich cohort study, the Lundby 25-year prospective study, the Sterling County study, and others. Section 4 examines the evidence ofcomorbidity in treated samples and longitudinal studies and the concurrence of axis I and axis II disorders with anxiety and depression. For example, depression and anxiety are also comorbid with dysthymic disorder, somatoform disorder, and psychosexual disorder. Furthermore, specific types of personality disorders, especially the dramatic personality cluster, are associated with anxiety and affective disorders more frequently than expected by chance. In addition, this section thoroughly discusses somatization, "the most costly comorbidity" that is frequently quoted as occupying 20% ofthe average physician's time at a cost of an astounding $20 billion annually in the United States. Section 5 reviews the evidence for comorbidity in familial and genetic studies and contains some extremely useful reviews of methods of
BOOK REVIEWS
557
study. Section 6 deals with comorbidity as determined by studies using biologic markers that have been researched as predictors of depression or anxiety disorders. Unfortunately, the sensitivity and specificity of the available biologic markers are too poor to facilitate analysis of the interaction of affective and anxiety disorders. Section 7 discusses the major psychopathologic theories, including the Kraepelinian biomedical, psychodynamic, sociocultural, and behavioral learning theories, and Cloninger's three-dimensional model of personality. This section is complete with the inclusion of the psychologic defense mechanisms that relate to affective and anxiety disorders. In addition, the seminal work done by Vaillant and others is reviewed. The final section addresses research issues, methods, and assessment. This wellwritten section examines statistical considerations, research design, self-report instruments, diagnostic interview schedules, and the role of treatment trials in understanding comorbidity between anxiety disorders and affective disorders. An excellent discussion on the odds of comorbidity developing is also included. In general, the strengths of this book outweigh its weaknesses. This publication explains that to understand why comorbidity develops in psychiatric populations, we may need to disregard exclusionary principles in our current diagnostic schemes so we can effectively study these occurrences. Diagnostic criteria currently used for depression, anxiety, somatization, and eating disorders substantially overlap. Whether depression and anxiety are the same illness or have the same underlying cause remains to be elucidated. This book will be useful for most practicing psychiatrists and residents in psychiatry and for general practitioners who have an interest in anxiety and depression because of the nature of their practice. It should be available in psychiatric libraries. John L. Black, M.D. Department of Psychiatry and Psychology