Given the need for more efficacious treatments in OCD, and given emergent findings on the role of the glutamatergic system in this disorder, there is a need for additional pharmacotherapy trials on glutamatergic agents in OCD. Possible research designs for such trials might include stand-alone approaches, pharmacotherapy augmentation, or psychotherapy augmentation.
Anxiety and related disorders are the most prevalent mental disorders in the general population. There is a strong bidirectional association between anxiety and related disorders and co-occurring general medical conditions. The co-occurrence of anxiety and related disorders and general medical conditions is associated with significant impairment, morbidity and economic costs. At the same time, recognition of anxiety and related disorders in people with medical illness may be challenging when comorbid with physical illness due in part to overlap in symptomatology. Furthermore, there is a relatively limited evidence base of randomized controlled trials in this population. Additional work is needed to improve screening for anxiety and related disorders in medical illness, to enhance diagnosis and assessment, and to optimize treatment. © 2015 S. Karger AG, BaselAnxiety disorders, obsessive-compulsive and related disorders, and trauma-and stressor-related disorders are the most prevalent psychiatric disorders in the general population [1, 2], with generalized anxiety disorder the most common anxiety disorder in primary care populations [3]. Indeed, these anxiety and related disorders occur frequently with a range of general medical disorders [4,5], including gastrointestinal disease [6], pulmonary disease [7, 8], cardiovascular disease [9], endocrine disorders [10], dermatological disorders [11] and cancer [12], as well as neuropsychiatric disorders such as chronic pain [13, 14], migraines [15], dementia [16] and Parkinson's disease [17]. In this chapter we review the epidemiology of comorbid anxiety and related disorders and physical illness, the growing evidence of a bidirectional relationship between these sets of conditions [18] and relevant randomized controlled trials in this area. EpidemiologyAnxiety and related disorders are the most common psychiatric disorders worldwide, with a 12-month prevalence worldwide of between 4 and 20% [2]. The onset of anxiety and related disorders usually happens in childhood or adolescence, with many individuals first presenting with physical symptoms in primary care settings Sartorius N, Holt RIG, Maj M (eds): Comorbidity of Mental and Physical Disorders.
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