Fear, anxiety and their disorders: past, present and future neural theories

This paper reviews the historical development of a two-dimensional (direction x distance (?)) neural model of defense. It begins with Miller's (1944) analysis, and model, of approach, avoidance and conflict; adds Hinde's (1966) ethological perspective and Flynn's (1967) neural model of fear; and then considers Gray's (1967, 1970) work linking barbiturate action to the hippocampus, McNaughton's (1977) extension of this to other classes of anxiolytics, and Gray & McNaughton's (1983) detailed behavioral comparison of anxiolytics and hippocampal lesions. This work led to Gray's (1982) detailed model of the neuropsychology of anxiety. Rapoport's (1989) model of the control of obsession by the cingulate cortex, and Ledoux's (1994) model of the control of both fear and anxiety to the amygdala, suggested a more complex organisation of defense systems. McNaughton (1989) argued that evolutionary function defines an emotion, and Blanchard and Blanchard (1990) argued for its assessment via ethoexperimental analysis. Graeff (1994) then produced a neural model that mapped defensive distance to neural level, treating all anxiety as being at a greater defensive distance than fear. Seeing this, and the treatment of anxiety as due to uncertainty (which is inconsistent with Miller's data), as being unsatisfactory, Gray and McNaughton (2000) and then McNaughton and Corr (2004) developed the two-dimensional model of defensive systems. This model is clearly incomplete at the present time and its links with neuroeconomics, personality, and stress and greater specification of frontal cortical contributions are suggested as directions for future development.

Some notes on a historical perspective of panic disorder

This article aims to describe important points in the history of panic disorder concept, as well as to highlight the importance of its diagnosis for clinical and research developments. Panic disorder has been described in several literary reports and folklore. One of the oldest examples lies in Greek mythology - the god Pan, responsable for the term panic. The first half of the 19th century witnessed the culmination of medical approach. During the second half of the 19th century came the psychological approach of anxiety. The 20th century associated panic disorder to hereditary, organic and psychological factors, dividing anxiety into simple and phobic anxious states. Therapeutic development was also observed in psychopharmacological and psychotherapeutic fields. Official classification began to include panic disorder as a category since the third edition of the American Classification Manual (1980). Some biological theories dealing with etiology were widely discussed during the last decades of the 20th century. They were based on laboratory studies of physiological, cognitive and biochemical tests, as the false suffocation alarm theory and the fear network. Such theories were important in creating new diagnostic paradigms to modern psychiatry. That suggests the need to consider a wide range of historical variables to understand how particular features for panic disorder diagnosis have been developed and how treatment has emerged.

El trastorno de angustia y la enfermedad de Freud / Anxiety disorder and Freud's disease

The author examined Freud's chest pains and arrythmia beginning in late 1893 according to the new available data and modern psychiatry. Published studies and recent findings were reviewed. The major works of Freud were also considered. Among the issues examined are clinical features, comorbidity, bounderies with other disorders. The findings of this review provided support for the dual diagnosis of panic disorder without agoraphobia and nicotine dependence. Freud's scientific learning was wide-ranging and his scientific ambition vast. During this period (1893-1897) Freud laid the foundations for the theory of anxiety. He referred to the conditions caused by the damned-up libido as the actual neuroses. Although the work of Freud has the same aim as the modern DSM-IV, the classification of the Austrian author reflects a different tradition. A discrepancy exists between anxiety neuroses (Freud) and anxiety disorders (DSM-IV)