Volume 1, Issue 3                                                                                            March, 2015


Welcome to the third issue of
The Psychiatry Letter!

The fever of psychiatry

In the second issue of PL, we discussed how “depression” doesn’t just mean depression.  Now we turn to the second major presentation of unhappiness in the clinic: anxiety.

Anxiety is the fever of psychiatry. It’s the most common, and most nonspecific, symptom of psychiatric clinical presentations. Just as fever is very uncomfortable, but not the cause or main focus of medical treatment of infections, anxiety is a major complaint, but it’s not usually caused by an anxiety disease, nor should it be the main focus of treatment. Fever can be a sign of a healthy immune system, so too can anxiety itself be a sign of health, not needing treatment at all.

This issue describes five basic kinds of anxiety, not just the DSM definitions. The history and science behind some DSM definitions, like generalized anxiety disorder (GAD), are examined and found to be questionable in scientific validity. 

The concept of neurotic depression is discussed in detail in the psychopathology article, and we review an important historical debate in England and the US about whether all depression is the same (as in major depressive disorder, MDD) or different (as in the neurotic depression subtype).  

In keeping with the anxiety theme, benzodiazepines are the drug class of the month and the case of the month is about the treatment of anxiety in post-traumatic stress disorder.

The current study of the month examines a recent analysis that shows that placebo effects, so commonly hailed as beneficial in practice, also bring with them nocebo (pain-producing) effects. 

I hope you enjoy this issue of PL, as we continue to  systematically examine and discuss the major fields of psychiatric practice.  

  Nassir Ghaemi MD, Editor

March 2015
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New truths begin as heresies and end as superstitions - T. H. Huxley

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