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Topics Anxiety Disorders

A systematic review of the quality and impact of anxiety disorder meta-analyses

Ipser JC, Stein DJ.
Department of Psychiatry and Mental Health, University of Cape Town, Groote Schuur Hospital, Anzio Road, Observatory, Cape Town, South Africa.
Curr Psychiatry Rep. 2009 Aug;11(4):302-9.

Meta-analyses are seen as representing the pinnacle of a hierarchy of evidence used to inform clinical practice. Therefore, the potential importance of differences in the rigor with which they are conducted and reported warrants consideration. In this review, we use standardized instruments to describe the scientific and reporting quality of meta-analyses of randomized controlled trials of the treatment of anxiety disorders. We also use traditional and novel metrics of article impact to assess the influence of meta-analyses across a range of research fields in the anxiety disorders. Overall, although the meta-analyses that we examined had some flaws, their quality of reporting was generally acceptable. Neither the scientific nor reporting quality of the meta-analyses was predicted by any of the impact metrics. The finding that treatment meta-analyses were cited less frequently than quantitative reviews of studies in current "hot spots" of research (ie, genetics, imaging) points to the multifactorial nature of citation patterns. A list of the meta-analyses included in this review is available on an evidence-based website of anxiety and trauma-related disorders.

Etiology and pathogenesis of anxiety disorders

Sher L.
Med Hypotheses. 2001 Jul;57(1):101-2.

The author suggests that biological abnormalities related to the development of anxiety disorders can be classified as real or relative. Individuals with 'real abnormalities' are not able to function under any circumstances, including the circumstances that are natural for humans. Persons with 'relative abnormalities' can function under the natural circumstances, but are not able to function in situations that are unnatural for humans. Unnatural situations include being in elevators, flying airplanes, driving cars, etc. The author suggests that all humans can be classified into four groups:
1. Individuals with excellent 'adaptational reserve' never develop anxiety disorders;
2. Individuals with good adaptational reserve develop anxiety disorders only if they are subjected to extremely stressful, unusual situations (e.g. being a hostage);
3. Individuals with moderate adaptational reserve develop anxiety disorders if they are exposed to unnatural situations. They have 'relative abnormalities';
4. Individuals with poor adaptational reserve develop anxiety disorders in situations that are natural for humans. They have 'real abnormalities'.