The State of the art article in this issue is about the biol-ogy of fear and other emotions that relate to anxiety.Thierry Steimer (page 231) quotes authors from 19th and20th centuries who underlined the three aspects of emo-tions: physiology, subjective feelings, and behavioralchanges. He then integrates these manifestations of emo-tions with structural and functional aspects of the centralnervous system. The challenging message is that thereexists rather specific central nervous system circuitry foreach emotion, or even for each aspect of a given emotion.The field of genetic studies in psychiatry is steadilyexpanding. Deborah J. Morris-Rosendahl has written aBasic research review (page 251) to present what isknown about the genetics of anxiety disorders, in partic-ular the complex genetics of nonmendelian phenotypes.For most traits and disorders, a large number of differentgenes might be involved. However, there are already fas-cinating data showing that single-gene polymorphismsexplain part of the variance in the epidemiology of anxi-ety disorders. Not surprisingly, genes related to enzymesor receptors of the monoaminergic systems have beenimplicated. This review also lists a series of unexpectedresults, for example, those tied to the fascinating rela-tionship between joint hypermobility and phobias.The GABAergic (GABA, g-aminobutyric acid) system isknown to be a major inhibitory neurotransmittor systemand is the target of antianxiety medication, for example,benzodiazepines. This system could also be involved inthe pathophysiology of anxiety disorders. Molecular tech-niques that manipulate the structure and functioning ofthe subunits of the GABAA receptor confirm that specif-ic differences in receptors can have far-reaching behav-ioral consequences. In his Basic research article (page261), H. Möhler presents an update of the pharmacolo-gy of the neuronal inhibition by benzodiazepines, dis-cussing the major clinical effects of these compounds inrelation to spontaneous or induced changes in GABAer-gic receptors. He also discusses the clinical relevance ofthe GABAergic system for major psychiatric disorders.The Pharmacological aspects of anxiety disorders werereviewed by Giovanni B. Cassano, Nicolò Baldini, and Ste-fano Pini (page 271), who state that there is no ideal anx-iolytic. They review the issue of efficacy in terms ofresponse versus remission, the risk of dependence, andthe symptoms of withdrawal for several categories ofmedication. It is interesting to note that a number of anx-iolytic compounds belong to other pharmacological cat-egories, such as antidepressants or b-blocking drugs. Theresults with each category of medication are described bythe authors under each major anxiety disorder diagnosis,making this article highly useful for taking evidence-based decisions in the pharmacological treatment of anx-iety disorders.In his Clinical research article (page 287), Jerome Kaganreviews the results of the long-term studies that he setup with his collaborators to assess childhood predictorsof states of anxiety. He has studied children from the ageof 4 months onwards, and has shown that physiologicalvariables as well as behavioral variables are stable overtime and that they have a predictive value of the evolu-tion of the child at the age of 11. Children considered asshy or inhibited at an early age seem to have a higher riskof anxiety disorders, in particular social phobia. These fas-cinating results are a bridge between temperaments andaxis I DSM-IV (Diagnostic and Statistical Manual of Men-tal Disorders, Fourth Edition) disorders. The concept ofheterotypic continuation means that a given characteris-tic expresses itself differently according to the age of thesubject, a concept well illustrated by the work of Kaganand his collaborators.Donald F. Klein has played a major role in the identifica-tion of panic disorder. Indeed, he was the first to reportthat imipramine was useful for the treatment of thesepatients. He has contributed much to a better definitionof anxiety states, their treatment, and their pathophysiol-ogy. In this Clinical research review (page 295), he givesus his view of the evolution of the concept of anxiety dur-ing the last 100 years. The reader is offered a fascinatingoverview, ranging from historical and early clinical obser-vations to recent pathophysiological hypotheses concern-ing the mechanisms of panic attacks. This overview is atribute to both astute clinicians and the recent develop-ment of major efforts in biological psychiatry research.In the Clinical research section (page 305), Jean Cottrauxreviews the efficacy of cognitive behavior therapy (CBT) inanxiety disorders such as panic disorder, generalized anx-iety, posttraumatic stress disorder, and phobia. The effi-cacy of CTB is comparable to that of pharmacologicaltreatment. This review confirms the generally held opin-ion that other psychotherapeutic techniques such as psy-2 2 9I n t h i s i s s u e . . .
Alert