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Sample records for agoraphobia

  1. Agoraphobia

    Science.gov (United States)

    ... Panic disorder with agoraphobia References American Psychiatric Association. Diagnostic and statistical manual of mental disorders . 5th ed. Arlington, VA: American Psychiatric Publishing. 2013. ...

  2. Agoraphobia Related to Unassertiveness in Panic Disorder.

    Science.gov (United States)

    Levitan, Michelle Nigri; Simoes, Pedro; Sardinha, Aline G; Nardi, Antonio E

    2016-05-01

    Despite developments in panic disorder (PD) research, a significant percentage of patients do not benefit from conventional treatments. Interpersonal factors have been identified as potential predictors of treatment failures. We aimed to evaluate assertiveness in a sample of patients with PD and its implications for treatment. Forty-six symptomatic patients with PD and 46 college students responded to assessment scales regarding assertiveness and clinical data. Seventy-five percent of the patients had a secondary diagnosis of agoraphobia. We found that the PD group was characterized as nonassertive and slightly less assertive than control subjects. Furthermore, the deficit in the level of assertiveness correlated with the severity of the PD. The diagnosis of agoraphobia was correlated with unassertiveness (p assertiveness in patients with PD accompanied by agoraphobia. PMID:26915016

  3. Agoraphobia and Panic Disorder: A Comparative Study

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    Ayse Kart

    2016-01-01

    Full Text Available Aim: In this study we aim to get more information about agoraphobia (AG which is an independent diagnosis in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5 and to evaluate overlaps or differences between agoraphobia and panic disorder (PD upon sociodemographic features and comorbidity with considering relation of these two disorders. Material and Method: Sociodemographic Data Form was given and Structural Clinical Interview for DSM Axis I Disorders (SCID-I was applied to 33 patients diagnosed as AG and 34 patients diagnosed as PD with AG (PDA.Results: AG group consisted of 21 females (63.1%, 12 males (36%, totally 33 patients and PDA group consisted of 23 females (67.6%, 11 males (32.4%, totally 34 patients. Mean age of onset was 32.4±10.2 in PDA group and 31.1±12.1 in AG group. According to sociodemographic features, violence in family and smoking rates were significantly higher in PDA group than AG group. Major Depressive Disorder (MDD as a comorbidity was higher in PDA group. Discussion: In this study, we tried to identify the overlaps and differences of PDA and AG. For a better recognition of AG, further studies are needed.

  4. Virtual reality applications to agoraphobia: a protocol.

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    Cárdenas, Georgina; Muñoz, Sandra; González, Maribel; Uribarren, Guillermo

    2006-04-01

    Recently, educators and instructional designers have focused on the development and implementation of virtual learning environments that effectively combine theoretical and applied knowledge to teach university students. One of the trusts of the Psychology Virtual Teaching Laboratory in collaboration with the IXTLI observatory is to develop dissemination programs to promote the insertion of virtual reality (VR) technologies applied to rehabilitation in their clinical practice. This paper describes the development of (1) agoraphobia VR learning objects to be use as a teaching support tools in class and (2) a multimedia teaching program that incorporate digital video and VR scenarios address to students in the field of mental health. Promotion among professors and students about the use of this technology will allow us to initiate research in our country as well as to validate contextualized applications for our culture, therefore contributing with new advances in this field. PMID:16640489

  5. Panic disorder and agoraphobia: An overview and commentary of DSM-5 changes

    NARCIS (Netherlands)

    Asmundson, G.J.G.; Taylor, S.; Smits, J.A.J.

    2014-01-01

    The recently published DSM-5 contains a number of changes pertinent to panic disorder and agoraphobia. These changes include separation of panic disorder and agoraphobia into separate diagnoses, the addition of criteria and guidelines for distinguishing agoraphobia from specific phobia, the addition

  6. Self-observation versus flooding in the treatment of agoraphobia

    NARCIS (Netherlands)

    Emmelkamp, Paul M.G.

    1974-01-01

    The effects on agoraphobia of (1) self-observation with a minimum of therapeutic intervention. (2) flooding, (3) a combination of flooding and self-observation, and (4) no-treatment control were compared. Assessments were made at the beginning of treatment, during and at the end of treatment and at

  7. Personality in panic disorder with agoraphobia: a Rorschach study

    NARCIS (Netherlands)

    C. de Ruiter; L. Cohen

    1992-01-01

    In this study, we tested several hypotheses derived from self psychology (Diamond, 1987) regarding personality features of patients suffering from panic disorder and agoraphobia (PDA). PDA patients are thought to suffer from a deficit in negative affect-regulating capacity, surrounded by defenses su

  8. Constraint and loneliness in agoraphobia: an empirical investigation.

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    Pehlivanidis, A; Koulis, S; Papakostas, Y

    2014-01-01

    While progress in the aetiopathology and treatment of panic disorder is indisputable, research regarding agoraphobia lacks behind. One significant-yet untested- theory by Guidano and Liotti, suggests the existence of inner representations of fear of "constraint" and fear of "loneliness" as two major schemata, important in the pathogenesis and manifestation of agoraphobia. Activation of these schemata may occur in situations in which the patient: (a) feels as in an inescapable trap (constraint) or (b) alone, unprotected and helpless (loneliness). Upon activation, the "constraint" schema elicits such symptoms as asphyxiation, chest pain, difficult breathing, motor agitation and muscular tension, while the "loneliness" schema elicits such symptoms as sensation of tachycardia, weakness of limbs, trembling or fainting. Activation of these schemata by content-compatible stimuli is expected to trigger various, yet distinct, response patterns, both of which are indiscriminately described within the term "agoraphobia". In order to investigate this hypothesis and its possible clinical applications, several mental and physical probes were applied to 20 patients suffering primarily from agoraphobia, and their responses and performance were recorded. Subjects also completed the "10-item Agoraphobia Questionnaire" prepared by our team aiming at assessing cognitions related to Guidano and Liotti's notion of "loneliness" and "constraint". Breath holding (BH) and Hyperventilation (HV) were selected as physical probes. BH was selected as an easily administered hypercapnea - induced clinical procedure, because of its apparent resemblance to the concept of "constraint". Subjects were instructed to hold their breath for as long as they could and stop at will. Similarly, it was hypothesized that HV might represent a physical "loneliness" probe, since it can elicit such symptoms as dizziness, paraesthesias, stiff muscles, cold hands or feet and trembling, reminiscent of a "collapsing

  9. [An ambulatory model for treatment of panic and agoraphobia].

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    Martinsen, E W

    1990-11-30

    The article describes an 11-session outpatient treatment programme in groups for patients with panic disorder and agoraphobia. The main components are cognitive-behavioural therapy and use of tricyclic antidepressives. Preliminary results after the first year of this programme indicate that most patients were much improved after completing the programme, and most of them had maintained their gains at follow-up. PMID:2274947

  10. Acceptability of Virtual Reality Interoceptive Exposure for the Treatment of Panic Disorder with Agoraphobia

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    Quero, Soledad; Pérez-Ara, M. Ángeles; Bretón-López, Juana; García-Palacios, Azucena; Baños, Rosa M.; Botella, Cristina

    2014-01-01

    Interoceptive exposure (IE) is a standard component of cognitive-behavioural therapy (CBT) for panic disorder and agoraphobia. The virtual reality (VR) program "Panic-Agoraphobia" has several virtual scenarios designed for applying exposure to agoraphobic situations; it can also simulate physical sensations. This work examines…

  11. Anxiety Sensitivity: A Missing Piece to the Agoraphobia-without-Panic Puzzle

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    Hayward, Chris; Wilson, Kimberly A.

    2007-01-01

    This article reviews the controversy surrounding the diagnosis of agoraphobia without panic attacks and proposes a key role for anxiety sensitivity in explaining agoraphobic avoidance among those who have never experienced panic. Although rare in clinical samples, agoraphobia without panic is commonly observed in population-based surveys,…

  12. Personality and treatment response in agoraphobia with panic attacks.

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    Clair, A L; Oei, T P; Evans, L

    1992-01-01

    The present study investigated the association of specific personality characteristics with agoraphobia, and whether they predicted long-term outcome following a group cognitive behavior therapy program. Thirty-three patients with agoraphobia with panic attacks, 18 with social phobia, and 26 "normals" were used in the study. Personality factors were measured with the Maudsley Personality Inventory (MPI), the Hostility and Direction of Hostility Questionnaire (HDHQ), and the Fundamental Interpersonal Relations Orientation-Behavior Scale (FIRO-B). The results showed that (1) agoraphobics are more extroverted and more likely to include others in their activities than are social phobics; however, they are less extroverted, more neurotic, more hostile and intropunitive, and less likely to include others in their activities than are normals; (2) social phobics are similarly less extroverted, more neurotic, and more hostile and intropunitive than normals, but, in addition, are less likely to exert control over others, more likely to want to be controlled, and less expressive of affection than normals; and (3) personality characteristics did not predict treatment outcome.

  13. The use of a self-help treatment intervention for panic disorder with agoraphobia

    OpenAIRE

    Gould, Robert Andrew

    1993-01-01

    A recent study suggested that bibliotherapy may be an effective intervention for panic disordered individuals with agoraphobia. The present study attempted to enhance this bibliotherapy intervention by adding audio- and videotape self-help supplements. Thirty subjects suffering panic disorder with mild to moderate agoraphobia were matched on level of avoidance and then randomly assigned to 1) a Wait-list control condition (WL). or 2) a Self-help condition (SH). The intervent...

  14. Change in interpersonal problems after cognitive agoraphobia and schema-focused therapy versus psychodynamic treatment as usual of inpatients with agoraphobia and Cluster C personality disorders.

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    Gude, Tore; Hoffart, Asle

    2008-04-01

    The aim was to study whether patients with panic disorder with agoraphobia and co-occurring Cluster C traits would respond differently regarding change in interpersonal problems as part of their personality functioning when receiving two different treatment modalities. Two cohorts of patients were followed through three months' in-patient treatment programs and assessed at follow-up one year after end of treatment. The one cohort comprised 18 patients treated with "treatment as usual" according to psychodynamic principles, the second comprised 24 patients treated in a cognitive agoraphobia and schema-focused therapy program. Patients in the cognitive condition showed greater improvement in interpersonal problems than patients in the treatment as usual condition. Although this quasi-experimental study has serious limitations, the results may indicate that agoraphobic patients with Cluster C traits should be treated in cognitive agoraphobia and schema-focused programs rather than in psychodynamic treatment as usual programs in order to reduce their level of interpersonal problems.

  15. Panic disorder and agoraphobia: an overview and commentary on DSM-5 changes.

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    Asmundson, Gordon J G; Taylor, Steven; Smits, Jasper A J

    2014-06-01

    The recently published DSM-5 contains a number of changes pertinent to panic disorder and agoraphobia. These changes include separation of panic disorder and agoraphobia into separate diagnoses, the addition of criteria and guidelines for distinguishing agoraphobia from specific phobia, the addition of a 6-month duration requirement for agoraphobia, the addition of panic attacks as a specifier to any DSM-5 diagnosis, changes to descriptors of panic attack types, as well as various changes to the descriptive text. It is crucial that clinicians and researchers working with individuals presenting with panic attacks and panic-like symptoms understand these changes. The purpose of the current paper is to provide a summary of the main changes, to critique the changes in the context of available empirical evidence, and to highlight clinical implications and potential impact on mental health service utilization. Several of the changes have the potential to improve access to evidence-based treatment; yet, although certain changes appear justified in that they were based on converging evidence from different empirical sources, other changes appear questionable, at least based on the information presented in the DSM-5 text and related publications. Ongoing research of DSM-5 panic disorder and agoraphobia as well as application of the new diagnostic criteria in clinical contexts is needed to further inform the strengths and limitations of DSM-5 conceptualizations of panic disorder and agoraphobia. PMID:24865357

  16. Efficacy of Cognitive-Behavioral Therapy for Comorbid Panic Disorder with Agoraphobia and Generalized Anxiety Disorder

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    Labrecque, Joane; Marchand, Andre; Dugas, Michel J.; Letarte, Andree

    2007-01-01

    The goal of this study was to evaluate the efficacy of cognitive-behavioral therapy for comorbid panic disorder with agoraphobia (PDA) and generalized anxiety disorder (GAD) by combining treatment strategies for both disorders. A single-case, multiple-baseline design across participants was used. Three participants with primary PDA and secondary…

  17. The hyperventilation syndrome in panic disorder, agoraphobia and generalized anxiety disorder

    NARCIS (Netherlands)

    C. de Ruiter; B. Garssen; H. Rijken; F. Kraaimaat

    1989-01-01

    The symptom complex of panic disorder and generalized anxiety disorder suggests an etiological role for hyperventilation. The present study investigates the overlap between DSM-III-R panic disorder, panic disorder with agoraphobia and generalized anxiety disorder with hyperventilation syndrome (HVS)

  18. A follow-up study on short-term treatment of agoraphobia

    NARCIS (Netherlands)

    H. Rijken; F. Kraaimaat; C. de Ruiter; B. Garssen

    1992-01-01

    The differential effectiveness of three treatment packages for agoraphobia was tested. Patients received one of three short-term treatments: Breathing Retraining and Cognitive Restructuring, graded Self-Exposure in vivo, or a combination of both. No differential effects were found between the treatm

  19. Cognitive-Behavioral Therapy for Comorbid Generalized Anxiety Disorder and Panic Disorder with Agoraphobia

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    Labrecque, Joane; Dugas, Michel J.; Marchand, Andre; Letarte, Andree

    2006-01-01

    The goal of this study was to evaluate the efficacy of a cognitive-behavioral treatment package for comorbid generalized anxiety disorder (GAD) and panic disorder with agoraphobia (PDA). A single-case, multiple-baseline, across-subjects design was used with 3 primary GAD patients with secondary PDA. The efficacy of the treatment was evaluated with…

  20. Management of Panic Anxiety with Agoraphobia by Using Cognitive Behavior Therapy

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    Naeem Aslam

    2012-01-01

    Full Text Available Panic disorder with agoraphobia is a psychological disorder. We are presenting a case report of male client, visted as out door patient in the counseling centre of National Institute of psychology. Client reported the symptoms such as palpitations, pounding heart, accelerated heart rate, sweating, trembling/shaking, feeling of choking, chest pain, discomfort, nausea, abdominal distress, feeling dizzy, lightheadedness, and fear of losing control when he is in the crowd. The signs and symptoms of a panic attack develop abruptly and usually reach their peak within 10 min. Most panic attacks end within 20 to 30 min, and they rarely last more than an hour. The client was diagnosed, Panic Anxiety with Agoraphobia. Cognitive behaviour therapy was used for the treatment. After seven sessions, client′s symptoms were diminished.

  1. Management of Panic Anxiety with Agoraphobia by Using Cognitive Behavior Therapy

    OpenAIRE

    Aslam, Naeem

    2012-01-01

    Panic disorder with agoraphobia is a psychological disorder. We are presenting a case report of male client, visted as out door patient in the counseling centre of National Institute of psychology. Client reported the symptoms such as palpitations, pounding heart, accelerated heart rate, sweating, trembling/shaking, feeling of choking, chest pain, discomfort, nausea, abdominal distress, feeling dizzy, lightheadedness, and fear of losing control when he is in the crowd. The signs and symptoms ...

  2. The relationships among separation anxiety disorder, adult attachment style and agoraphobia in patients with panic disorder.

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    Pini, Stefano; Abelli, Marianna; Troisi, Alfonso; Siracusano, Alberto; Cassano, Giovanni B; Shear, Katherine M; Baldwin, David

    2014-12-01

    Epidemiological studies indicate that separation anxiety disorder occurs more frequently in adults than children. It is unclear whether the presence of adult separation anxiety disorder (ASAD) is a manifestation of anxious attachment, or a form of agoraphobia, or a specific condition with clinically significant consequences. We conducted a study to examine these questions. A sample of 141 adult outpatients with panic disorder participated in the study. Participants completed standardized measures of separation anxiety, attachment style, agoraphobia, panic disorder severity and quality of life. Patients with ASAD (49.5% of our sample) had greater panic symptom severity and more impairment in quality of life than those without separation anxiety. We found a greater rate of symptoms suggestive of anxious attachment among panic patients with ASAD compared to those without ASAD. However, the relationship between ASAD and attachment style is not strong, and adult ASAD occurs in some patients who report secure attachment style. Similarly, there is little evidence for the idea that separation anxiety disorder is a form of agoraphobia. Factor analysis shows clear differentiation of agoraphobic and separation anxiety symptoms. Our data corroborate the notion that ASAD is a distinct condition associated with impairment in quality of life and needs to be better recognized and treated in patients with panic disorder.

  3. Agency and Anxiety: Delusions of Control and Loss of Control in Schizophrenia and Agoraphobia

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    Gallagher, Shaun; Trigg, Dylan

    2016-01-01

    We review the distinction between sense of agency and sense of ownership, and then explore these concepts, and their reflective attributions, in schizophrenic symptoms and agoraphobia. We show how the underlying dynamics of these experiences are different across these disorders. We argue that these concepts are complex and cannot be reduced to neural mechanisms, but involve embodied and situated processes that include the physical and social environments. We conclude by arguing that the subjective and intersubjective dimensions of agency and ownership cannot be considered in isolation from one another, but instead form an interdependent pairing. PMID:27725796

  4. Noninvasive brain stimulation by radioelectric asymmetric conveyor in the treatment of agoraphobia: open-label, naturalistic study

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    Mannu P

    2011-11-01

    Full Text Available Piero Mannu, Salvatore Rinaldi, Vania Fontani, Alessandro Castagna, Matteo Lotti MargottiDepartment of Neuro Psycho Physio Pathology, Rinaldi Fontani Institute, Florence, ItalyBackground: Agoraphobia is considered to be the most serious complication of panic disorder. It involves progressive development of debilitating anxiety symptoms related to being in situations where one would be extremely embarrassed and could not be rescued in the case of a panic attack. This study aimed to investigate the efficacy of noninvasive brain stimulation using a radioelectric asymmetric conveyor (REAC for agoraphobia.Patients and methods: Twenty-three patients (3 males and 20 females suffering from agoraphobia and without a history of panic disorder were evaluated by a psychiatrist using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, and the Agoraphobia Scale (AS. The patients were subjected to two 18-session cycles of noninvasive brain stimulation with the REAC, according to an established therapeutic protocol called neuro-psycho-physical optimization.Results: Analyzing the anxiety and avoidance parameters of the AS after the first and second cycles of REAC treatment revealed variation in levels of response to treatment, including weak (AS item 7, moderate (AS items 10 and 13, and good responses (AS items 1–6, 8, 9, 11, 12, and 14–20.Conclusion: These results highlight the potential of the REAC to treat complex clinical situations such as agoraphobia, which is typically resistant to pharmacologic treatments. Furthermore, these data show the advantages of REAC treatment, even compared with modern cognitive behavioral therapy, including a relatively rapid and “stable” clinical response (just over 6 months and economic cost.Keywords: anxiety, avoidance, fear, REAC

  5. Etizolam versus placebo in the treatment of panic disorder with agoraphobia: a double-blind study.

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    Savoldi, F; Somenzini, G; Ecari, U

    1990-01-01

    Thirty out-patients suffering from panic disorders associated with agoraphobia were enrolled in a double-blind, controlled trial to compare the effectiveness and tolerability of etizolam and placebo. After a 1-week washout period on placebo, patients were allocated at random to receive twice daily doses of either 0.5 mg etizolam or placebo over a period of 4 weeks. Assessments, made at baseline and after 2 and 4 weeks of treatment, used the Hamilton Rating Scales for Anxiety and for Depression, the Covi Anxiety Scale, and determination of the weekly panic crises frequency. The results showed that etizolam produced significant improvements in chronic anxiety, phobic ideas, associated depressive symptoms and episodic anxiety, and was significantly more effective than placebo. Etizolam treatment was generally well tolerated and was not significantly different from placebo in this respect. PMID:2272192

  6. The development of agoraphobia is associated with the symptoms and location of a patient's first panic attack

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    Hara Naomi

    2012-04-01

    Full Text Available Abstract Background The place where a patient experiences his/her first panic attack (FPA may be related to their agoraphobia later in life. However, no investigations have been done into the clinical features according to the place where the FPA was experienced. In particular, there is an absence of detailed research examining patients who experienced their FPA at home. In this study, patients were classified by the location of their FPA and the differences in their clinical features were explored (e.g., symptoms of FPA, frequency of agoraphobia, and severity of FPA. Methods The subjects comprised 830 panic disorder patients who were classified into 5 groups based on the place of their FPA (home, school/office, driving a car, in a public transportation vehicle, outside of home, The clinical features of these patients were investigated. Additionally, for panic disorder patients with agoraphobia at their initial clinic visit, the clinical features of patients who experienced their FPA at home were compared to those who experienced their attack elsewhere. Results In comparison of the FPAs of the 5 groups, significant differences were seen among the 7 descriptors (sex ratio, drinking status, smoking status, severity of the panic attack, depression score, ratio of agoraphobia, and degree of avoidance behavior and 4 symptoms (sweating, chest pain, feeling dizzy, and fear of dying. The driving and public transportation group patients showed a higher incidence of co-morbid agoraphobia than did the other groups. Additionally, for panic disorder patients with co-morbid agoraphobia, the at-home group had a higher frequency of fear of dying compared to the patients in the outside-of-home group and felt more severe distress elicited by their FPA. Conclusion The results of this study suggest that the clinical features of panic disorder patients vary according to the place of their FPA. The at-home group patients experienced "fear of dying" more frequently

  7. The development of agoraphobia is associated with the symptoms and location of a patient's first panic attack

    OpenAIRE

    Hara Naomi; Nishimura Yukika; Yokoyama Chika; Inoue Ken; Nishida Atsushi; Tanii Hisashi; Okada Motohiro; Kaiya Hisanobu; Okazaki Yuji

    2012-01-01

    Abstract Background The place where a patient experiences his/her first panic attack (FPA) may be related to their agoraphobia later in life. However, no investigations have been done into the clinical features according to the place where the FPA was experienced. In particular, there is an absence of detailed research examining patients who experienced their FPA at home. In this study, patients were classified by the location of their FPA and the differences in their clinical features were e...

  8. Predictors of comorbid personality disorders in patients with panic disorder with agoraphobia.

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    Latas, M; Starcevic, V; Trajkovic, G; Bogojevic, G

    2000-01-01

    The aim of this study was to ascertain predictors of comorbid personality disorders in patients with panic disorder with agoraphobia (PDAG). Sixty consecutive outpatients with PDAG were administered the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II) for the purpose of diagnosing personality disorders. Logistic regressions were used to identify predictors of any comorbid personality disorder, any DSM-IV cluster A, cluster B, and cluster C personality disorder. Independent variables in these regressions were gender, age, duration of panic disorder (PD), severity of PDAG, and scores on self-report instruments that assess the patient's perception of their parents, childhood separation anxiety, and traumatic experiences. High levels of parental protection on the Parental Bonding Instrument (PBI), indicating a perception of the parents as overprotective and controlling, emerged as the only statistically significant predictor of any comorbid personality disorder. This finding was attributed to the association between parental overprotection and cluster B personality disorders, particularly borderline personality disorder. The duration of PD was a significant predictor of any cluster B and any cluster C personality disorder, suggesting that some of the cluster B and cluster C personality disorders may be a consequence of the long-lasting PDAG. Any cluster B personality disorder was also associated with younger age. In conclusion, despite a generally nonspecific nature of the relationship between parental overprotection in childhood and adult psychopathology, the findings of this study suggest some specificity for the association between parental overprotection in childhood and personality disturbance in PDAG patients, particularly cluster B personality disorders. PMID:10646616

  9. Reexperiencing symptoms, dissociation, and avoidance behaviors in daily life of patients with PTSD and patients with panic disorder with agoraphobia.

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    Pfaltz, Monique C; Michael, Tanja; Meyer, Andrea H; Wilhelm, Frank H

    2013-08-01

    Panic attacks are frequently perceived as life threatening. Panic disorder (PD) patients may therefore experience symptoms of posttraumatic stress disorder (PTSD). The authors explored this in 28 healthy controls, 17 PTSD patients, and 24 PD patients with agoraphobia who completed electronic diaries 36 times during 1 week. Patient groups frequently reported dissociation as well as thoughts, memories, and reliving of their trauma or panic attacks. PTSD patients reported more trauma/panic attack thoughts (incidence rate ratio [IRR] = 2.9) and memories (IRR = 2.8) than PD patients. Patient groups relived their trauma or panic attacks equally frequently, and reported comparable bodily reactions and distress associated with trauma or panic attack memories. Clinical groups avoided trauma or panic attack reminders more often than healthy controls (avoidance of trauma- or panic attack-related thoughts (IRR = 8.0); avoidance of things associated with the trauma or panic attack (IRR = 40.7). PD patients avoided trauma or panic attack reminders less often than PTSD patients (avoidance of trauma- or panic attack-related thoughts [IRR = 2.5]; avoidance of things associated with the trauma or panic attack [IRR = 4.1]), yet these differences were nonsignificant when controlling for functional impairment. In conclusion, trauma-like symptoms are common in PD with agoraphobia and panic attacks may be processed similarly as trauma in PTSD. PMID:23893375

  10. Psychological Treatment for Panic Disorder with Agoraphobia: A Randomized Controlled Trial to Examine the Role of Therapist-Guided Exposure in situ in CBT

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    Gloster, Andrew T.; Wittchen, Hans-Ulrich; Einsle, Franziska; Lang, Thomas; Helbig-Lang, Sylvia; Fydrich, Thomas; Fehm, Lydia; Hamm, Alfons O.; Richter, Jan; Alpers, George W.; Gerlach, Alexander L.; Strohle, Andreas; Kircher, Tilo; Deckert, Jurgen; Zwanzger, Peter; Hofler, Michael; Arolt, Volker

    2011-01-01

    Objective: Cognitive-behavioral therapy (CBT) is a first-line treatment for panic disorder with agoraphobia (PD/AG). Nevertheless, an understanding of its mechanisms and particularly the role of therapist-guided exposure is lacking. This study was aimed to evaluate whether therapist-guided exposure in situ is associated with more pervasive and…

  11. Does Maintenance CBT Contribute to Long-Term Treatment Response of Panic Disorder with or without Agoraphobia? A Randomized Controlled Clinical Trial

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    White, Kamila S.; Payne, Laura A.; Gorman, Jack M.; Shear, M. Katherine; Woods, Scott W.; Saksa, John R.; Barlow, David H.

    2013-01-01

    Objective: We examined the possibility that maintenance cognitive behavior therapy (M-CBT) may improve the likelihood of sustained improvement and reduced relapse in a multi-site randomized controlled clinical trial of patients who met criteria for panic disorder with or without agoraphobia. Method: Participants were all patients (N = 379) who…

  12. Antianxiety medications for the treatment of complex agoraphobia: pharmacological interventions for a behavioral condition

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    Perna G

    2011-10-01

    Full Text Available Giampaolo Perna1-3, Silvia Daccò2, Roberta Menotti2, Daniela Caldirola21Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, University of Maastricht, Maastricht, the Netherlands; 2Department of Clinical Neuroscience, San Benedetto Hospital, Hermanas Hospitalarias, Albese con Cassano, Como, Italy; 3Department of Psychiatry and Behavioral Sciences, Leonard M Miller School of Medicine, University of Miami, Miami, FL, USABackground: Although there are controversial issues (the "American view" and the "European view" regarding the construct and definition of agoraphobia (AG, this syndrome is well recognized and it is a burden in the lives of millions of people worldwide. To better clarify the role of drug therapy in AG, the authors summarized and discussed recent evidence on pharmacological treatments, based on clinical trials available from 2000, with the aim of highlighting pharmacotherapies that may improve this complex syndrome.Methods: A systematic review of the literature regarding the pharmacological treatment of AG was carried out using MEDLINE, EBSCO, and Cochrane databases, with keywords individuated by MeSH research. Only randomized, placebo-controlled studies or comparative clinical trials were included.Results: After selection, 25 studies were included. All the selected studies included patients with AG associated with panic disorder. Effective compounds included selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, selective noradrenergic reuptake inhibitors, and benzodiazepines. Paroxetine, sertraline, citalopram, escitalopram, and clomipramine showed the most consistent results, while fluvoxamine, fluoxetine, and imipramine showed limited efficacy. Preliminary results suggested the potential efficacy of inositol; D-cycloserine showed mixed results for its ability to improve the outcome of exposure-based cognitive behavioral therapy

  13. Panic disorder with agoraphobia from a behavioral neuroscience perspective: Applying the research principles formulated by the Research Domain Criteria (RDoC) initiative.

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    Hamm, Alfons O; Richter, Jan; Pané-Farré, Christiane; Westphal, Dorte; Wittchen, Hans-Ulrich; Vossbeck-Elsebusch, Anna N; Gerlach, Alexander L; Gloster, Andrew T; Ströhle, Andreas; Lang, Thomas; Kircher, Tilo; Gerdes, Antje B M; Alpers, Georg W; Reif, Andreas; Deckert, Jürgen

    2016-03-01

    In the current review, we reconceptualize a categorical diagnosis-panic disorder and agoraphobia-in terms of two constructs within the domain "negative valence systems" suggested by the Research Domain Criteria initiative. Panic attacks are considered as abrupt and intense fear responses to acute threat arising from inside the body, while anxious apprehension refers to anxiety responses to potential harm and more distant or uncertain threat. Taking a dimensional view, panic disorder with agoraphobia is defined with the threat-imminence model stating that defensive responses are dynamically organized along the dimension of the proximity of the threat. We tested this model within a large group of patients with panic disorder and agoraphobia (N = 369 and N = 124 in a replication sample) and found evidence that panic attacks are indeed instances of circa strike defense. This component of the defensive reactivity was related to genetic modulators within the serotonergic system. In contrast, anxious apprehension-characterized by attentive freezing during postencounter defense-was related to general distress and depressive mood, as well as to genetic modulations within the hypothalamic-pituitary-adrenal (HPA) axis. Patients with a strong behavioral tendency for active and passive avoidance responded better to exposure treatment if the therapist guides the patient through the exposure exercises.

  14. The clinical-familial correlates and naturalistic outcome of panic-disorder-agoraphobia with and without lifetime bipolar II comorbidity

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    Toni Cristina

    2008-11-01

    Full Text Available Abstract Background Much of the literature on panic disorder (PD-bipolar disorder (BP cormorbidity concerns BP-I. This literature emphasizes the difficulties encountered in pharmacologic treatment and outcome when such comorbidity is present. The present report explores these issues with respect to BP-II. Methods The sample comprised 326 outpatients (aged 34.5 ± 11.5 years old; 222 females with Diagnostic and Statistical Manual of Mental Disorders 3rd edn, revised (DSM-III-R PD-agoraphobia; among them 52 subjects (16% were affected by lifetime comorbidity with BP-II. Patients were evaluated by means of the Structured Clinical Interview for DSM-IV (SCID, the Panic-Agoraphobia Interview, and the Longitudinal Interview Follow-up Examination (Life-Up and treated according to routine clinical practice at the University of Pisa, Italy, for a period of 3 years. Clinical and course features were compared between subjects with and without BP-II. All patients received the clinicians' choice of antidepressants and, in the case of the subsample with BP-II, mood stabilizers (for example, valproate, lithium were among the mainstays of treatment. Results In comparison to patients without bipolar comorbidity, those with BP-II showed a significantly greater frequency of social phobia, obsessive-compulsive disorder, alcohol-related disorders, and separation anxiety during childhood and adolescence. Regarding family history, a significantly greater frequency of PD and mood disorders was present among the BP-II. No significant differences were observed in the long-term course of PD or agoraphobic symptoms under pharmacological treatment or the likelihood of spontaneous pharmacological treatment interruptions. Conclusion Although the severity and outcome of panic-agoraphobic symptomatology appear to be similar in patients with and without lifetime bipolar comorbidity, the higher number of concomitant disorders in our PD patients with BP-II does indicate a greater

  15. Experiential avoidance and anxiety sensitivity in patients with panic disorder and agoraphobia: Do both constructs measure the same?

    Directory of Open Access Journals (Sweden)

    Christiane K. Kämpfe

    2012-01-01

    Full Text Available Se examinó si la sensibilidad a la ansiedad (SA y la evitación experiencial (EE, dos constructos potencialmente relevantes en la evolución de los trastornos de ansiedad relacionadas con importantes consecuencias de los tratamientos cognitivoconductuales, se relacionan de forma diferencial con la expresión de síntomas en pacientes con trastorno de pánico y agorafobia. Dentro de un estudio multicentro, 369 pacientes que cumplían con los criterios DSM-IV-TR para el trastorno de pánico con agorafobia (TP/AG completaron la Panic and Agoraphobia Scale (PAS, el Anxiety Sensitivity Index (ASI, el Acceptance and Action Questionnaire-II (AAQ-II y el Beck Depression Inventory-II (BDI-II. Paralelamente se examina la validez predictiva de la SA y la EE mediante análisis exploratorio de los ítems y análisis de regresión múltiple. SA y EE correlacionaron de forma moderada entre sí (r = 0,50, p < 0,01. SA explicó un porcentaje de la varianza de las subescalas Ansiedad anticipatoria y Pánico relacionado con la incapacidad, pero no de Ataques de pánico, Evitación agorafóbica y Preocupaciones por la salud. ASI, AAQ-II y BDI-II explicaron un porcentaje de varianza entre bajo y moderado de las cinco subescalas PAS (R 2 = 0,04-0,29, p < 0,005. SA y EE se superponen en constructos distintos. Los resultados sugieren que SA contribuye a una comprensión mucho mejor de la vulnerabilidad, al menos en pacientes con TP/AG.

  16. Description of the case of a female with panic disorder with agoraphobia and elements of social phobia. The effectiveness of an intervention cognitive psychotherapy from the psychological sector of a general hospital

    Directory of Open Access Journals (Sweden)

    Koinis

    2015-07-01

    Full Text Available Introduction: Anxiety disorders are not a single disease but a group of disorders characterized by persistent highgrade feelings of anxiety and extreme discomfort and tension. Research has shown that cognitive psychotherapy combined with medication are the most entrenched in efficiency and more specific interventions proven to treat anxiety disorders generally and specifically. Aim: The purpose of this study is to show the effectiveness of cognitive psychotherapy in conjunction with medication, in treating anxiety panic disorder with agoraphobia and elements of social phobia. The specifics in applying cognitive psychotherapy in the treatment of anxiety disorders. Case Report: A 32 year old female presented as an emergency at the hospital's Emergency Department with intense panic disorder symptoms. The medical history of the family environment reveals that the patient had a strong sense of fear of "madness." Within the framework of liaison psychiatry the patient was referred by attending physicians for psychological observation and evaluation. The patient followed a course of recognized psychotherapeutic treatment for a duration of 30 sessions, administration of questionnaires at the beginning and end of treatment and adjustment of medication. Comment: This clinical case treated with the medication and cognitive psychotherapy. The differential diagnosis was generalized anxiety disorder and depressive disorder according to the system of mental disorders DSM-IV-TR classification of mental and behavioural disorders. Conclusions: Recognized psychotherapeutic interventions in combination with medication constitute a suitable approach for the treatment of anxiety panic disorder, agoraphobia and social phobia.

  17. Subtipo respiratório versus não respiratório no transtorno de pânico com agorafobia: avaliação com terapia cognitivo-comportamental Respiratory versus non respiratory subtypes of panic disorder with agoraphobia: cognitive behavioral therapy assessment

    Directory of Open Access Journals (Sweden)

    Anna Lucia Spear King

    2012-01-01

    Full Text Available OBJETIVO: verificar a resposta dos pacientes com transtorno de pânico com agorafobia à modelo proposto de terapia cognitivo-comportamental (TCC nos dois subtipos respiratórios de transtorno de pânico: o subtipo respiratório (SR e subtipo não respiratório (SNR Amostra randomizada por sorteio com 50 pacientes diagnosticados segundo o Manual Diagnóstico e Estatístico dos Transtornos Mentais. A medicação: antidepressivos tricíclicos ou inibidores seletivos de recaptação da serotonina. Setenta e sete ponto seis porcento da amostra de pacientes de ambos os grupos apresentaram o SR e 22,4 % o SNR. Os pacientes do SR, responderam satisfatoriamente ao tratamento com técnicas da TCC, reduzindo ansiedade, sintomas respiratórios e os ataques de pânico. Os pacientes do SR melhoraram, segundo a escala de avaliação global do funcionamento, de 55,8 para 70,9 em comparação com o SNR.The objective of the present study was to verify the response of patients with panic disorder (agoraphobia to existing cognitive-behavior therapy models (CBT of two respiratory subtypes of panic disorder (PD: respiratory subtype (RS and non respiratory subtype (NRS. We randomly selected a sample of 50 patients diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders. The medication used was tricycle or selective serotonin reuptake inhibitor antidepressants. Seventy-seven point six percent of the patients from both groups showed RS and 22.4% the NRS. The RS patients responded satisfactorily to the treatment with techniques of CBT decreasing anxiety, breathing symptoms and panic attacks. According to the global functioning assessment scale, RS patients improved from 55.8 to 70.9 in comparison with NRS ones.

  18. Perception of early parenting in panic and agoraphobia.

    Science.gov (United States)

    Faravelli, C; Panichi, C; Pallanti, S; Paterniti, S; Grecu, L M; Rivelli, S

    1991-07-01

    Thirty-two patients with a DSM-III-R diagnosis of panic disorder (PD) were administered the Parental Bonding Instrument (PBI), a 25-item self-report questionnaire devised to evaluate parental rearing practices. Compared with 32 matched healthy controls, PD patients scored both their parents as being significantly less caring and more overprotective. Moreover, the consistency of parental attitudes between the 2 parents was significantly lower, indicating lesser uniformity in the rearing patterns. PMID:1927567

  19. Panic Disorder and Agoraphobia: Considerations for DSM-V

    Science.gov (United States)

    Schmidt, Norman B.; Norr, Aaron M.; Korte, Kristina J.

    2014-01-01

    With the upcoming release of the fifth edition of the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-V) there has been a necessary critique of the DSM-IV including questions regarding how to best improve the next iteration of the DSM classification system. The aim of this article is to provide commentary on the probable…

  20. High sensitivity to multisensory conflicts in agoraphobia exhibited by virtual reality.

    Science.gov (United States)

    Viaud-Delmon, Isabelle; Warusfel, Olivier; Seguelas, Angeline; Rio, Emmanuel; Jouvent, Roland

    2006-10-01

    The primary aim of this study was to evaluate the effect of auditory feedback in a VR system planned for clinical use and to address the different factors that should be taken into account in building a bimodal virtual environment (VE). We conducted an experiment in which we assessed spatial performances in agoraphobic patients and normal subjects comparing two kinds of VEs, visual alone (Vis) and auditory-visual (AVis), during separate sessions. Subjects were equipped with a head-mounted display coupled with an electromagnetic sensor system and immersed in a virtual town. Their task was to locate different landmarks and become familiar with the town. In the AVis condition subjects were equipped with the head-mounted display and headphones, which delivered a soundscape updated in real-time according to their movement in the virtual town. While general performances remained comparable across the conditions, the reported feeling of immersion was more compelling in the AVis environment. However, patients exhibited more cybersickness symptoms in this condition. The result of this study points to the multisensory integration deficit of agoraphobic patients and underline the need for further research on multimodal VR systems for clinical use. PMID:17055951

  1. Efficacy of virtual reality exposure therapy combined with two pharmacotherapies in the treatment of agoraphobia

    OpenAIRE

    Marién González Lorenzo; Wenceslao Peñate Castro; Carmen Teresa Pitti González; Juan Manuel Bethencourt Pérez; Juan Antonio de la Fuente Portero; Ramón Gracia Marco

    2011-01-01

    Actualmente, se consideran tratamientos eficaces para la agorafobia algunos psicofármacos, la terapia cognitiva conductual (TCC) y la combinación de ambos. Entre los tratamientos psicológicos se han desarrollado nuevas alternativas terapéuticas, tales como técnicas de exposición con realidad virtual (TERV). El objetivo de este estudio experimental ha sido evaluar, en una muestra de pacientes con agorafobia (N = 64), la eficacia de la TERV combinada con dos psicofármacos (venlafaxina y paroxet...

  2. Patient-therapist interaction in the behavioral treatment of panic disorder with agoraphobia

    NARCIS (Netherlands)

    Keijsers, G.P.J.; Schaap, C.P.D.R.; Hoogduin, C.A.L.; Lammers, M.W.

    1995-01-01

    Although effective behavioral techniques have been developed, what aspects of the patient-therapist interaction affect treatment outcome remain largely unknown. This study hypothesized that the interaction between patient and therapist develops over several phases. Further, the association between b

  3. Cognitive-behavioral treatment and antidepressants combined with virtual reality exposure for patients with chronic agoraphobia

    Directory of Open Access Journals (Sweden)

    Wenceslao Peñate Castro

    2014-01-01

    Full Text Available En este estudio se comparó la eficacia de la exposición a estímulos virtuales combinada con terapia cognitivo-conductual (VRET con un programa tradicional cognitivo-conductual (CBT para reducir la sintomatología fóbica en una muestra de personas con agorafobia de larga evolución. Se utilizó un diseño entre sujetos con tres condiciones experimentales (grupo VRET, N = 30; grupo CBT, N = 30; y grupo con sólo medicación, N = 20 y medidas repetidas (pre, post- tratamiento y seguimiento a los seis meses. Todos los pacientes estaban tomando antidepresivos. Los resultados mostraron que todas las terapias fueron estadísticamente eficaces, tanto en el post-tratamiento como en el seguimiento. El grupo VRET mostró mayores mejoras clínicas en el seguimiento. El grupo CBT mostró las tasas más altas de abandono. VRET probablemente juega un papel intermedio para una exposición eficiente a los estímulos fóbicos. Más allá de las ventajas de un procedimiento VRET para el tratamiento de la agorafobia en términos de coste-beneficios, este estudio también destaca los posibles beneficios en la mejora en la motivación y adherencia al tratamiento.

  4. An Application of Functional Analytic Psychotherapy in a Case of Anxiety Panic Disorder without Agoraphobia

    Science.gov (United States)

    Bermudez, Miguel Angel Lopez; Garcia, Rafael Ferro; Calvillo, Manuel

    2010-01-01

    Traditional methods of diagnosis are of little therapeutic use when diagnostic criteria are based upon topographical rather than functional aspects of behavior. Also, this sentence in the original seemed rather awkward and a bit unclear. In contrast to this, several authors have put forward experience avoidance disorders as an alternative which…

  5. The possible function of positive reinforcement in home-bound agoraphobia: a case study.

    Science.gov (United States)

    O'Donohue, W; Plaud, J J; Hecker, J E

    1992-12-01

    We conducted an uncontrolled case study (ABA design) based upon the hypothesis that the behavior of a home-bound agoraphobic is at least partially maintained by positive reinforcement in the home and that a disruption of access to home-based reinforcement would lead to an increased frequency of out-of-the-home behavior. Data concerning the types and amounts of behavior engaged in by the subject within the confines of her home and yard were gathered during a 30-day base line period. In addition, potential reinforcers in the home were identified by a survey schedule and by self-report of time allocation. During an 18-day intervention period the subject agreed only to engage in certain reinforcing activities outside her home (e.g., only watching television at a neighbor's house). Postintervention results indicated that for the first time in over 7 years the subject began engaging in out-of-home activities, including walking to other parts of the street, visiting several neighbors' homes, and attending parties at neighbors' homes. Moreover, data suggested a positive trend in time spent outside the yard during both 2 and 18 month follow-up periods. However, significant restrictions in the range of mobility were still observed.

  6. Perceptions of College Students Diagnosed with Panic Disorder with Agoraphobia: Academic, Psychosocial, and Environmental Views of their College Experience

    OpenAIRE

    Angle, Susan Pugh

    1999-01-01

    ABSTRACT The number of reported students with psychiatric disabilities who are seeking services and/or accommodations is steadily increasing on college campuses. Much of the research and documentation that surround the study of college students with psychiatric disorders is extremely broad in focus and tends to group all psychiatric diagnoses together when reporting outcome studies. The research literature that is devoted to the study of the college student diagnoses with Panic Disor...

  7. Aerobic exercise training facilitates the effectiveness of cognitive behavioral therapy in patients with panic disorder with/without agoraphobia

    OpenAIRE

    Gaudlitz, Katharina Anna

    2015-01-01

    Introduction: Physical activity and especially aerobic exercise has been discussed as a therapeutic alternative or add-on for the treatment of anxiety disorders. Up to date, a small number of randomized controlled trials suggests supplementary clinical effectiveness of exercise for patients with panic disorder. The aim of this study was to determine whether aerobic exercise training compared to physical activity with low impact can improve the effect of cognitive behavioral therapy (CBT) in p...

  8. The effects of a treatment based on the use of virtual reality exposure and cognitive-behavioral therapy applied to patients with agoraphobia

    Directory of Open Access Journals (Sweden)

    Wenceslao Peñate

    2008-01-01

    Full Text Available La exposición a estímulos virtuales se ha verificado como un procedimiento útil en el tratamiento de los trastornos fóbicos. Sin embargo, existe una serie de problemas en la aplicación a la agorafobia (estímulos a utilizar, presencia de avatares, etc.. El propósito de este estudio experimental consiste en comparar la eficacia de un tratamiento combinado, exposición a la realidad virtual y tratamiento cognitivo conductual (VRET, con un acercamiento tradicional cognitivo-conductual (CBT. Quince pacientes con agorafobia crónica recibieron un tratamiento VRET en 3D y 13 pacientes recibieron un tratamiento CBT. Los dos grupos recibieron 11 sesiones. Las medidas postratamiento incluyeron un breve test de evitación conductual (BAT. Los resultados mostraron una significativa mejoría en los síntomas de la agorafobia (cogniciones, sensaciones corporales, nivel de ansiedad y depresión para los dos grupos que, en general, permanecieron en un seguimiento a tres meses. Los BAT mostraron la capacidad de los pacientes para exponerse a los estímulos fóbicos. Adicionalmente, el grupo VRET mostró mayores mejorías, aunque ligeras, en comparación con el grupo CBT. Estos resultados se discuten en relación con las dificultades del VRET para la agorafobia y en relación con la viabilidad de los siete ambientes fóbicos virtuales para generar una exposición aceptable a los estímulos fóbicos.

  9. Is a combined therapy more effective than either CBT or SSRI alone? Results of a multicenter trial on panic disorder with or without agoraphobia

    NARCIS (Netherlands)

    F.J. van Apeldoorn; W.J.P.J. Hout; P.P.A. Mersch; M. Huisman; B.R. Slaap; W.W., III Hale; S. Visser; R. van Dyck; J.A. den Boer

    2008-01-01

    Objective: To establish whether the combination of cognitive-behavioral therapy (CBT) and pharmacotherapy (SSRI) was more effective in treating panic disorder (PD) than either CBT or SSRI alone, and to evaluate any differential effects between the monotreatments. Method: Patients with PD (n = 150) w

  10. Is a combined therapy more effective than either CBT or SSRI alone? Results of a multicenter trial on panic disorder with or without agoraphobia

    NARCIS (Netherlands)

    van Apeldoorn, F. J.; van Hout, W. J. P. J.; Huisman, J.M.E.; Slaap, B. R.; Hale, W. W.; Visser, S.; van Dyck, R.; den Boer, J. A.; Mersch, P.P.A.

    2008-01-01

    Objective: To establish whether the combination of cognitive-behavioral therapy (CBT) and pharmacotherapy (SSRI) was more effective in treating panic disorder (PD) than either CBT or SSRI alone, and to evaluate any differential effects between the mono-treatments. Method: Patients with PD (n = 150)

  11. Addressing Relapse in Cognitive Behavioral Therapy for Panic Disorder: Methods for Optimizing Long-Term Treatment Outcomes

    Science.gov (United States)

    Arch, Joanna J.; Craske, Michelle G.

    2011-01-01

    In this paper, we present a client with panic disorder and agoraphobia who relapses following a full course of cognitive behavioral therapy (CBT). To frame the client's treatment, the major components of CBT for panic disorder with or without agoraphobia (PD/A) are reviewed. Likely reasons for the treatment's failure and strategies for improving…

  12. Untangling genetic networks of panic, phobia, fear and anxiety

    OpenAIRE

    Villafuerte, Sandra; Burmeister, Margit

    2003-01-01

    As is the case for normal individual variation in anxiety levels, the conditions panic disorder, agoraphobia and other phobias have a significant genetic basis. Recent reports have started to untangle the genetic relationships between predispositions to anxiety and anxiety disorders.

  13. Is the beck anxiety inventory a good tool to assess the severity of anxiety? A primary care study in the Netherlands Study of Depression and Anxiety (NESDA)

    OpenAIRE

    van der Feltz-Cornelis Christina M; Muntingh Anna DT; van Marwijk Harm WJ; Spinhoven Philip; Penninx Brenda WJH; van Balkom Anton JLM

    2011-01-01

    Abstract Background Appropriate management of anxiety disorders in primary care requires clinical assessment and monitoring of the severity of the anxiety. This study focuses on the Beck Anxiety Inventory (BAI) as a severity indicator for anxiety in primary care patients with different anxiety disorders (social phobia, panic disorder with or without agoraphobia, agoraphobia or generalized anxiety disorder), depressive disorders or no disorder (controls). Methods Participants were 1601 primary...

  14. Pharmacotherapy of panic disorder

    OpenAIRE

    Pull, Charles

    2008-01-01

    Charles B Pull1, Cristian Damsa21Department of Neurosciences, Centre Hospitalier de Luxembourg, Luxembourg; 2Department of Psychiatry, Clinical Investigation Program, University of Colorado Health Sciences Center, USAAbstract: Panic disorder (PD) is a common, persistent and disabling mental disorder. It is often associated with agoraphobia. The present article reviews the current status of pharmacotherapy for PD with or without agoraphobia as well as the current status of treatments combing p...

  15. Panic disorder and perceived parental rearing behavior investigated by the Japanese version of the EMBU scale.

    Science.gov (United States)

    Someya, T; Kitamura, H; Uehara, T; Sakado, K; Kaiya, H; Tang, S W; Takahashi, S

    2000-01-01

    Although recent studies have found dysfunctional parental rearing behaviour is associated with certain aspects of psychopathology of panic disorder (PD), the results are not in complete agreement. By using a translated Japanese version of the EMBU (Egna Minnen Beträffande Uppfostran), we investigated the parental rearing behavior perceived by 103 normal subjects, 71 PD patients with agoraphobia, and 32 PD patients without agoraphobia. The PD patients scored both parents as more rejecting and overprotective than did the controls. However, subgroup analysis showed that the patients with agoraphobia reported significantly more rejection from both parents and less emotional warmth from mothers, while the patients without agoraphobia, by contrast, reported more overprotection from both parents and more favouring subject from fathers than did the controls. Interestingly, these results were consistent with those documented in the Western literature, which reported "affectionless control" as a parenting style in PD, and, furthermore, indicated a cross-cultural similarity of parental rearing factor. In addition, it was suggested that a lack of care might be associated with the development of agoraphobia in Japan. PMID:10945135

  16. Specificity of Treatment Effects: Cognitive Therapy and Relaxation for Generalized Anxiety and Panic Disorders

    Science.gov (United States)

    Siev, Jedidiah; Chambless, Dianne L.

    2007-01-01

    The aim of this study was to address claims that among bona fide treatments no one is more efficacious than another by comparing the relative efficacy of cognitive therapy (CT) and relaxation therapy (RT) in the treatment of generalized anxiety disorder (GAD) and panic disorder without agoraphobia (PD). Two fixed-effects meta-analyses were…

  17. Panic disorder : A baseline period : predictability of agoraphobic avoidance behavior

    NARCIS (Netherlands)

    De Jong, G.Majella; Bouman, Theo K.

    1995-01-01

    This study addresses the relationship between panic symptomatology and situational avoidance behaviour. Eighty panic disordered patients were involved with various degrees of agoraphobia, ranging from nonavoidant to extremely avoidant. Subjects recorded panic attacks by means of a diary for a period

  18. The effect of mirtazapine in panic disorder : an open label pilot study with a single-blind placebo run-in period

    NARCIS (Netherlands)

    Boshuisen, ML; Slaap, BR; Vester-Blokland, ED; den Boer, JA

    2001-01-01

    In this open label pilot study, we studied the efficacy of mirtazapine (Remeron) in panic disorder. Twenty-eight patients with a DSM-IV diagnosis of panic disorder, with or without agoraphobia (10 males/18 females), were included and 19 patients completed the study. The 15-week trial started with a

  19. Evidens for psykodynamisk psykoterapi

    DEFF Research Database (Denmark)

    Alberdi, Francisco; Rosenbaum, Bent

    2010-01-01

    In general, psychodynamic psychotherapy is not considered evidence-based treatment. This review includes recent meta-analyses and review papers. We conclude that evidence in favour of psychodynamic psychotherapy exists for unipolar depression, panic anxiety with and without agoraphobia, social ph...

  20. Role of hyperventilation in panic disorder: a response to Ley

    NARCIS (Netherlands)

    C. de Ruiter; B. Garssen; H. Rijken; F. Kraaimaat

    1992-01-01

    Ley (Behaviour Research and Therapy, 29, 301-304, 1991) provided a reinterpretation of experimental findings on the efficacy of breathing retraining plus cognitive restructuring in reducing the symptomatology of patients with panic disorder with agoraphobia which were presented in a 1989 article in

  1. Poststructuralist historicism and the psychological construction of anxiety disorders.

    Science.gov (United States)

    Hoagwood, K

    1993-01-01

    When applied to the construction of anxiety disorders, theories of poststructuralist historicism emphasize acts of interpretation that constitute and construct the disorders and problematize the processes by which meaning is constructed. An examination of the historical formulations of anxiety disorders, and in particular, agoraphobia, provides the opportunity for reanalyzing traditional approaches to the classifications of disorders. Psychological issues of paradox, attachment, and personal identity, which are crucial to current conceptualizations of agoraphobia, are acutely problematized within a poststructuralist historicist hermeneutic. A rethinking of disorder construction from within this hermeneutic suggests replacing individualistic conceptualizations of personal identity with a broader view that recognizes and celebrates multiplicity and that displays formulations of the self in a contextualized and historicized status, thus enabling a fuller engagement with the social world. PMID:8510049

  2. The phenomenology of the first panic attack in clinical and community-based samples.

    Science.gov (United States)

    Pané-Farré, Christiane A; Stender, Jan P; Fenske, Kristin; Deckert, Jürgen; Reif, Andreas; John, Ulrich; Schmidt, Carsten Oliver; Schulz, Andrea; Lang, Thomas; Alpers, Georg W; Kircher, Tilo; Vossbeck-Elsebusch, Anna N; Grabe, Hans J; Hamm, Alfons O

    2014-08-01

    The purpose of the study was to contrast first panic attacks (PAs) of patients with panic disorder (PD) with vs. without agoraphobia and to explore differences between first PAs leading to the development of PD and those that remain isolated. Data were drawn from a community survey (N=2259 including 88 isolated PAs and 75 PD cases). An additional sample of 234 PD patients was recruited in a clinical setting. A standardized interview assessed the symptoms of the first PA, context of its occurrence and subsequent coping attempts. Persons who developed PD reported more severe first PAs, more medical service utilization and exposure-limiting coping attempts than those with isolated PAs. The context of the first PA did not differ between PD and isolated PAs. PD with agoraphobia was specifically associated with greater symptom severity and occurrence of first attacks in public. Future research should validate these findings using a longitudinal approach. PMID:24973697

  3. The role of anxiety in sexual disorders: The connection between agoraphobic and obsessive compulsive simptoms and sexual disorders

    Directory of Open Access Journals (Sweden)

    Ana Krevh

    2006-08-01

    Full Text Available Anxienty is closely related to sexual disorders, being their source, preserver, and consequence. Therefore, it represents an important obstacle in the course of a therapy. The role of anxiety in sexual disorders has already been widely investigated, but the question whether the above mentioned connection exists at a micro level remains unanswered. The present study focused on two specific anxiety disorders: agoraphobia and obsessive compulsive disorder. Two translated questionnaries were used: Mobility Inventory for Agoraphobia MIA (Chambless, Caputo, Jasin, & Gracely, 1985 and Padua Inventory PI (Sanavio, 1988. Participants were patients with sexual disorders who sought psychiatric help, and a group of students represented a control group. Results demonstrated a strong connection between agoraphobic and obsessive compulsive symptoms on one side and sexual disorders on the other. Among the possible explanations for this connection the circular model seems to be the most appropriate.

  4. Personalidad y trastorno de pánico: Un estudio de revisión

    OpenAIRE

    Jorge Osma; Azucena García-Palacios; Cristina Botella

    2014-01-01

    In this work we offer a comprehensive review of the scientific contributions that have been made in the last three decades on the influ-ence of personality in the psychopathology of panic disorder (PD) with or without agoraphobia (AG). The findings that are discussed are representa-tive of two different theoretical models in the assessment and the study of personality, the clinical approach to personality and the dimensional ap-proach to personality. From both perspectives, there is sufficien...

  5. Respiratory panic disorder subtype and sensitivity to the carbon dioxide challenge test

    OpenAIRE

    A.M. Valença; A.E. Nardi; Nascimento, I.; W.A. Zin; M. Versiani

    2002-01-01

    The aim of the present study was to verify the sensitivity to the carbon dioxide (CO2) challenge test of panic disorder (PD) patients with respiratory and nonrespiratory subtypes of the disorder. Our hypothesis is that the respiratory subtype is more sensitive to 35% CO2. Twenty-seven PD subjects with or without agoraphobia were classified into respiratory and nonrespiratory subtypes on the basis of the presence of respiratory symptoms during their panic attacks. The tests were carried out in...

  6. Main and Interactive Effects of Emotion Dysregulation and Breath-Holding Duration in Relation to Panic-Relevant Fear and Expectancies about Anxiety-Related Sensations among Adult Daily Smokers

    OpenAIRE

    Brandt, Charles P.; Johnson, Kirsten A.; Schmidt, Norman B.; Zvolensky, Michael J.

    2011-01-01

    The current study investigated the main and interactive effects of emotion dysregulation and distress tolerance in relation to panic-relevant variables among daily smokers. The sample consisted of 172 adults (61.2% male; Mage = 31.58, SD = 11.51), who reported smoking an average of 15.99 cigarettes per day (SD = 10.00). Results indicated that both emotion dysregulation and distress tolerance were significantly related to interoceptive fear and agoraphobia. Additionally, emotion dysregulation,...

  7. Development of mental health first aid guidelines for panic attacks: a Delphi study

    OpenAIRE

    Jorm Anthony F; Kelly Claire M; Kitchener Betty A

    2009-01-01

    Abstract Background Panic attacks are common, and while they are not life-threatening events, they can lead to the development of panic disorder and agoraphobia. Appropriate help at the time that a panic attack occurs may decrease the fear associated with the attack and reduce the risk of developing an anxiety disorder. However, few people have the knowledge and skills required to assist. Simple first aid guidelines may help members of the public to offer help to people who experience panic a...

  8. Comorbid personality disorders in subjects with panic disorder: which personality disorders increase clinical severity?

    OpenAIRE

    Mustafa Ozkan; Abdurrahman Altindag

    2003-01-01

    Personality disorders are common in subjects with panic disorder. Personality disorders have shown to affect the course of panic disorder. The purpose of this study was to examine which personality disorders effect clinical severity in subjects with panic disorder. This study included 122 adults (71 female, 41 male), who met DSM-IV criteria for panic disorder (with or without agoraphobia). Clinical assessment was conducted by using the Structured Clinical Interview for DSM-IV Axis I Disorders...

  9. Assessment and management of anxiety disorders in children and adolescents

    OpenAIRE

    Creswell, Cathy; Waite, Polly; Cooper, Peter J.

    2014-01-01

    Anxiety disorders in childhood and adolescence are extremely common and are often associated with lifelong psychiatric disturbance. Consistent with DSM-5 and the extant literature, this review concerns the assessment and treatment of specific phobias, separation anxiety disorder, generalised anxiety disorder, social anxiety disorder, panic disorder and agoraphobia. Evidence-based psychological treatments (cognitive behaviour therapy; CBT) for these disorders have been developed and investigat...

  10. Anxiety and Anxiety Disorders in Children and Adolescents: Developmental Issues and Implications for DSM-V

    OpenAIRE

    Beesdo, Katja; Knappe, Susanne; Pine, Daniel S.

    2009-01-01

    This review summarizes findings on the epidemiology and etiology of anxiety disorders among children and adolescents including separation anxiety disorder, specific phobia, social phobia, agoraphobia, panic disorder, and generalized anxiety disorder, also highlighting critical aspects of diagnosis, assessment, and treatment. Childhood and adolescence is the core risk phase for the development of anxiety symptoms and syndromes, ranging from transient mild symptoms to full-blown anxiety disorde...

  11. The overlap between anxiety, depression, and obsessive-compulsive disorder

    OpenAIRE

    Goodwin, Guy M.

    2015-01-01

    The anxiety disorders include generalized anxiety disorder, specific phobia, social phobia, agoraphobia, and panic disorder. In addition to the specific symptoms of these disorders, there may be a common experience of anxiety and even dysphoria across the conditions, and of course recourse to the same drug or choice of drugs for treatment. This overlap probably occurs because of universal dimensions of distress or negative affectivity, a shared genetic predisposition, and a common neurobiolog...

  12. Positive affect regulation in anxiety disorders

    OpenAIRE

    Eisner, Lori R.; Johnson, Sheri L; Carver, Charles S.

    2009-01-01

    Although individual differences exist in how people respond to positive affect (PA), little research addresses PA regulation in people with anxiety disorders. The goal of this study was to provide information about responses to PA in people with symptoms of social phobia, generalized anxiety disorder, panic disorder, agoraphobia, and obsessive-compulsive disorder. The tendency to dampen PA and the ability to savor PA were examined in an undergraduate sample. Analyses examined the unique links...

  13. Neuronale Mechanismen der Angstreduktion durch Expositionstherapie

    OpenAIRE

    Thierfelder, Kolja

    2011-01-01

    In vivo exposure therapy offers an effective way to treat phobic disorders. However, neuronal mechanisms underlying successful fear reduction of this type of therapy are widely unknown. To examine neuronal mechanisms taking effect during exposure therapy, ten patients with DSM-IV diagnosed agoraphobia including the fear of confined spaces were subjected to an examination in the tube of a magnetic resonance tomograph using a therapeutic procedure very similar to a standard exposure therapy....

  14. Evidens for psykodynamisk psykoterapi

    DEFF Research Database (Denmark)

    Alberdi, Francisco; Rosenbaum, Bent

    2010-01-01

    phobia, generalised anxiety and post-traumatic stress disorder. For complex mental conditions, long-term psychodynamic psychotherapy shows greater effect than no treatment, standard treatment and short-term psychotherapy. Psychodynamic psychotherapy can be recommended for treatment of specific......In general, psychodynamic psychotherapy is not considered evidence-based treatment. This review includes recent meta-analyses and review papers. We conclude that evidence in favour of psychodynamic psychotherapy exists for unipolar depression, panic anxiety with and without agoraphobia, social...

  15. PENILAIAN KEPARAHAN SERTA KOMORBIDITAS GANGGUAN PANIK

    Directory of Open Access Journals (Sweden)

    Sivanesh Tamilselvan

    2015-09-01

    Full Text Available ASSESSMENT OF THE SEVERITY AND PANIC COMORBID DISORDERS ABSTRACT Background: Panic disorder with or without agoraphobia is a common anxiety disorders. Panic disorder patients who seek medical attention complaining of different emerging and many patients also suffer from anxiety disorders / other psychiatric or substance abuse disorders. Methods: This was a cross sectional study conducted using DSM IV TR criteria for panic disorder. Then patients with a diagnosis of panic disorder, panic disorder severity scale measured by 7 items (PDSS to assess the severity of panic disorder. Clinically evaluated for the presence of agoraphobia or not. Special attention is given to check whether the patients had other comorbid psychiatric disorders. Results: The majority of patients 65% were women, 52.5% were in the age group 15-24 years and the mean age of patients was 23.82 years. The mean age of onset of symptoms of panic disorder was 21.3 years. The most frequent use of a substance is tobacco in 30% of patients. The most frequent comorbidities are major depressive disorder in 40% of patients. Agoraphobia was found in 24 (60% patients. PA is the average duration of 22.37 minutes. 60% experienced moderate PD. The majority of the patterns of symptoms 67.5% of patients experienced symptoms of cardiovascular system (CVS. Conclusion: panic disorder often found in the age group 15-24 years. Symptoms often appear are the symptoms of a cardiovascular system that needs to be distinguished carefully. Needed attention to the high rates of comorbid substance use and psychiatric disorders in patients with panic disorder. Keywords: panic disorder, agoraphobia, epidemiology, severity, comorbidity

  16. Hormonal response during a fenfluramine-associated panic attack

    OpenAIRE

    A.H.G. Vieira; R.T. Ramos; Gentil, V

    1997-01-01

    Secretion curves for prolactin, cortisol, TSH, and GH from a 37-year old woman with dysthymia and panic disorder with agoraphobia were determined one day prior to (day I), and during a panic attack (day II) associated with an oral dose of 60 mg dl-fenfluramine, a drug known to increase anticipatory anxiety. The increased cortisol secretion observed is discussed in relation to the hormonal correlates of anxiety and the possible role of depression, dl-fenfluramine, and serotonergic receptor sen...

  17. Epidemiology of anxiety disorders in the 21st century

    OpenAIRE

    Bandelow, Borwin; Michaelis, Sophie

    2015-01-01

    Anxiety disorders, including panic disorder with or without agoraphobia, generalized anxiety disorder, social anxiety disorder, specific phobias, and separation anxiety disorder, are the most prevalent mental disorders and are associated with immense health care costs and a high burden of disease. According to large population-based surveys, up to 33.7% of the population are affected by an anxiety disorder during their lifetime. Substantial underrecognition and undertreatment of these disorde...

  18. The epidemiology of anxiety disorders: a review

    OpenAIRE

    Martin, Patrick

    2003-01-01

    Epidemiological studies show that anxiety disorders are highly prevalent and an important cause of functional impairment; they constitute the most frequent menial disorders in the community. Phobias are the most common with the highest rates for simple phobia and agoraphobia. Panic disorder (PD) and obsessive-compulsive disorder (OCD) are less frequent (2% lifetime prevalence), and there are discordant results for social phobia (SP) (2%-16%) and generalized anxiety disorder (GAD) (3%-30%). Th...

  19. Dizziness and fear of falling: A behavioural and physiological approach to Phobic Postural Vertigo

    OpenAIRE

    Holmberg, Johan

    2006-01-01

    Dizziness is a common problem and it often co-exists with anxiety. Level of anxiety is the best predictor of handicap for dizzy patients. There is diagnostic controversy and few treatment programs for such patients. These patients can be labeled as panic disorder with agoraphobia or by the concept of Phobic Postural Vertigo which is characterized by dizziness or imbalance in standing or walking despite normal clinical balance tests and avoidance behaviours. This thesis aimed to investigate th...

  20. Double-blind clonazepam vs placebo in panic disorder treatment

    OpenAIRE

    VALENÇA ALEXANDRE MARTINS; NARDI ANTONIO EGIDIO; NASCIMENTO ISABELLA; MEZZASALMA MARCO A.; LOPES FABIANA L.; ZIN WALTER

    2000-01-01

    OBJECTIVE: To assess the effectiveness of clonazepam, in a fixed dose (2 mg/day), compared with placebo in the treatment of panic disorder patients. METHOD: 24 panic disorder patients with agoraphobia were randomly selected. The diagnosis was obtained using the structured clinical interview for DSM-IV . All twenty-four subjects were randomly assigned to either treatment with clonazepam (2 mg/day) or placebo, during 6 weeks. Efficacy assessments included: change from baseline in the number of ...

  1. Double-blind clonazepam vs placebo in panic disorder treatment Estudo duplo-cego com clonazepam e placebo no tratamento do transtorno do pânico

    OpenAIRE

    ALEXANDRE MARTINS VALENÇA; ANTONIO EGIDIO NARDI; ISABELLA NASCIMENTO; MARCO A. MEZZASALMA; Fabiana L Lopes; WALTER ZIN

    2000-01-01

    OBJECTIVE: To assess the effectiveness of clonazepam, in a fixed dose (2 mg/day), compared with placebo in the treatment of panic disorder patients. METHOD: 24 panic disorder patients with agoraphobia were randomly selected. The diagnosis was obtained using the structured clinical interview for DSM-IV . All twenty-four subjects were randomly assigned to either treatment with clonazepam (2 mg/day) or placebo, during 6 weeks. Efficacy assessments included: change from baseline in the number of ...

  2. Faktorer relateret til suicidal adfærd blandt alkoholmisbrugere

    DEFF Research Database (Denmark)

    Benjaminsen, Sigurd E.; Thomsen, Rita L T; Balsløv, Kim D.;

    1998-01-01

    in the family and social circle. Significantly more attempters suffered from depressive disorder, feelings of hopelessness, anxiety attacks, agoraphobia, substance abuse or cluster B personality disorders (dissocial, impulsive, borderline, and histrionic). Also significantly more suicide attempters had...... alcohol or take drugs when faced with stressful events or difficulties. When evaluated on the Addiction Severity Index Scale, the suicide attempters were found to have a significantly greater need of treatment....

  3. “Nomophobia”: Impact of Cell Phone Use Interfering with Symptoms and Emotions of Individuals with Panic Disorder Compared with a Control Group

    OpenAIRE

    King, Anna Lucia Spear; Valença, Alexandre Martins; Silva, Adriana Cardoso; Sancassiani, Federica; Machado, Sergio; Nardi, Antonio Egidio

    2014-01-01

    Panic disorder refers to the frequent and recurring acute attacks of anxiety. Objective : This study describes the routine use of mobiles phones (MPs) and investigates the appearance of possible emotional alterations or symptoms related to their use in patients with panic disorder (PD). Background : We compared patients with PD and agoraphobia being treated at the Panic and Respiration Laboratory of The Institute of Psychiatry, Federal University of Rio de Janeiro, Brazil, to a control group ...

  4. Experiencing mindfulness meditation - a client narrative perspective

    OpenAIRE

    Stelter, Reinhard

    2009-01-01

    The study was based on the non-participant involvement of the researcher in four six-to-eight weeks' mindfulness meditation training courses led by chartered psychologists. The participants suffered from stress/sleeplessness, depression or agoraphobia in the presented cases. They were selected on the basis of recommendations by the psychologist who was the course instructor, who described them as positive and suitable. The participants wrote diaries on a weekly basis, and they were interviewe...

  5. Experiencing mindfulness meditation—a client narrative perspective

    OpenAIRE

    Stelter, Reinhard

    2009-01-01

    The study was based on the non-participant involvement of the researcher in four six-to-eight weeks' mindfulness meditation training courses led by chartered psychologists. The participants suffered from stress/sleeplessness, depression or agoraphobia in the presented cases. They were selected on the basis of recommendations by the psychologist who was the course instructor, who described them as positive and suitable. The participants wrote diaries on a weekly basis, and they were interviewe...

  6. The Common Traits of the ACC and PFC in Anxiety Disorders in the DSM-5: Meta-Analysis of Voxel-Based Morphometry Studies

    OpenAIRE

    Jing Shang; Yuchuan Fu; Zhengjia Ren; Tao Zhang; Mingying Du; Qiyong Gong; Su Lui; Wei Zhang

    2014-01-01

    BACKGROUND: The core domains of social anxiety disorder (SAD), generalized anxiety disorder (GAD), panic disorder (PD) with and without agoraphobia (GA), and specific phobia (SP) are cognitive and physical symptoms that are related to the experience of fear and anxiety. It remains unclear whether these highly comorbid conditions that constitute the anxiety disorder subgroups of the Diagnostic and Statistical Manual for Mental Disorders--Fifth Edition (DSM-5) represent distinct disorders or al...

  7. Childhood Separation Anxiety and the Risk of Subsequent Psychopathology: Results from a Community Study

    OpenAIRE

    Brückl, Tanja M.; Wittchen, Hans-Ulrich; Höfler, Michael; Pfister, Hildegard; Schneider, Silvia; Lieb, Roselind

    2012-01-01

    Objective: To examine the association between separation anxiety disorder (SAD) and mental disorders in a community sample and to evaluate whether separation anxiety is specifically related to panic disorder with and without agoraphobia. Method: The data come from a 4-year, prospective longitudinal study of a representative cohort of adolescents and young adults aged 14–24 years at baseline in Munich, Germany. The present analyses are based on a subsample of the younger cohort that comple...

  8. Three year naturalistic outcome study of panic disorder patients treated with paroxetine

    OpenAIRE

    Lowengrub Katherine; Cohen Ami; Iancu Iulian; Dannon Pinhas N; Grunhaus Leon; Kotler Moshe

    2004-01-01

    Abstract Background This naturalistic open label follow-up study had three objectives: 1) To observe the course of illness in Panic Disorder patients receiving long-term versus intermediate-term paroxetine treatment 2) To compare the relapse rates and side-effect profile after long-term paroxetine treatment between patients with Panic Disorder and Panic Disorder with Agoraphobia. 3) To observe paroxetine's tolerability over a 24 month period. Methods 143 patients with panic disorder (PD), wit...

  9. Role of Corticotropin Releasing Factor in Anxiety Disorders: A Translational Research Perspective

    OpenAIRE

    Risbrough, Victoria B.; Stein, Murray B.

    2006-01-01

    Anxiety disorders are a group of mental disorders that include generalized anxiety disorder (GAD), panic disorder, phobic disorders (e.g., specific phobias, agoraphobia, social phobia) and posttraumatic stress disorder (PTSD). Anxiety disorders are among the most common of all mental disorders and, when coupled with an awareness of the disability and reduced quality of life they convey, they must be recognized as a serious public health problem. Over 20 years of preclinical studies point to a...

  10. Cardio-respiratory symptoms in panic disorder: a contribution from cognitive-behaviour therapy

    Directory of Open Access Journals (Sweden)

    Anna Lucia Spear King

    2011-01-01

    Full Text Available Objective: To compare patients with panic disorder with agoraphobia treated with cognitive-behavioural therapy (CBT associated with the medication with patients treated only with medication and verify the behaviour of the cardio-respiratory symptoms of both groups. Methods: Randomized sample in the Psychiatry Institute of the Federal University of Rio de Janeiro, divided in two groups of 25 participants each. Group 1 undertook 10 weekly sessions of CBT with one hour of duration each together with medication. Group 2, Control, were administered medication that only consisted of tricyclic anti-depressants and selective inhibitors of the re-uptake of serotonin. Evaluation instruments were applied at the beginning and to the end of the interventions. Results: According to the applied scales, group 1 showed statistically more significant results than group 2, with: reduction of panic attacks, cardio-respiratory symptoms, anticipatory anxiety, agoraphobia avoidance and fear of bodily sensations. Conclusion: Exposures (in vivo and interoceptive, especially for induction symptom exercises and relaxation, were considered essential to prepare patients with panic disorder to handle future cardio-respiratory symptoms and panic attacks with agoraphobia.

  11. Early intervention in panic: randomized controlled trial and cost-effectiveness analysis

    Directory of Open Access Journals (Sweden)

    van Balkom Anton

    2008-11-01

    Full Text Available Abstract Background Panic disorder (PD is a common, severe and persistent mental disorder, associated with a high degree of distress and occupational and social disability. A substantial proportion of the population experiences subthreshold and mild PD and is at risk of developing a chronic PD. A promising intervention, aimed at preventing panic disorder onset and reducing panic symptoms, is the 'Don't Panic' course. It consists of eight sessions of two hours each. The purpose of this study is to evaluate the effectiveness of this early intervention – based on cognitive behavioural principles – on the reduction of panic disorder symptomatology. We predict that the experimental condition show superior clinical and economic outcomes relative to a waitlisted control group. Methods/design A pragmatic, pre-post, two-group, multi-site, randomized controlled trial of the intervention will be conducted with a naturalistic follow-up at six months in the intervention group. The participants are recruited from the general population and are randomized to the intervention or a waitlist control group. The intervention is offered by community mental health centres. Included are people over 18 years of age with subthreshold or mild panic disorder, defined as having symptoms of PD falling below the cut-off of 13 on the Panic Disorder Severity Scale-Self Report (PDSS-SR. Primary outcomes are panic disorder and panic symptoms. Secondary outcomes are symptoms of agoraphobia, anxiety, cognitive aspects of panic disorder, depressive symptoms, mastery, health-related quality of life, and cost-effectiveness. We will examine the following variables as potential mediators: cognitive aspects of panic disorder, symptoms of agoraphobia, anxiety and mastery. Potential moderating variables are: socio-demographic characteristics, panic disorder, agoraphobia, treatment credibility and mastery. Discussion This study was designed to evaluate the (cost effectiveness of an

  12. Hormonal response during a fenfluramine-associated panic attack

    Directory of Open Access Journals (Sweden)

    A.H.G. Vieira

    1997-07-01

    Full Text Available Secretion curves for prolactin, cortisol, TSH, and GH from a 37-year old woman with dysthymia and panic disorder with agoraphobia were determined one day prior to (day I, and during a panic attack (day II associated with an oral dose of 60 mg dl-fenfluramine, a drug known to increase anticipatory anxiety. The increased cortisol secretion observed is discussed in relation to the hormonal correlates of anxiety and the possible role of depression, dl-fenfluramine, and serotonergic receptor sensitivity

  13. Experiencing mindfulness meditation - a client narrative perspective

    DEFF Research Database (Denmark)

    Stelter, Reinhard

    2009-01-01

    The study was based on the non-participant involvement of the researcher in four six-to-eight weeks' mindfulness meditation training courses led by chartered psychologists. The participants suffered from stress/sleeplessness, depression or agoraphobia in the presented cases. They were selected...... and practicing mindfulness meditation. It is not the intention to give evidence about the effectiveness of mindfulness meditation in general, but to present the whats and hows of cases where mindfulness meditation appears to improve quality of life, health and well-being. Keywords: Mindfulness meditation...

  14. Posttraumatic Negative Cognitions in Connection with PTSD and Panic Attacks

    OpenAIRE

    Jeļena Harlamova

    2014-01-01

    Summary The aim of this doctor's dissertation was to study the connections between post-traumatic negative cognitions, post-traumatic stress disorder and panic attacks. The study involved 152 participants, aged 19 to 59 (M=32.40; SD=8.85). As a part of this study, three surveys were translated, adapted and used in Latvia for the first time: Post-traumatic Stress Diagnostic Scale (PDS); Foa, 1994; Post-traumatic Cognitions Inventory (PTCI); Foa at al., 1999; Panic and Agoraphobia Scale (...

  15. The mediational role of panic self-efficacy in cognitive behavioral therapy for panic disorder: A systematic review and meta-analysis

    DEFF Research Database (Denmark)

    Fentz, Hanne Nørr; Arendt, Mikkel; OToole, Mia Skytte;

    2014-01-01

    Cognitive models of panic disorder (PD) with and without agoraphobia have stressed the role of catastrophic beliefs of bodily symptoms as a central mediating variable of the efficacy of cognitive behavioral therapy (CBT). Perceived ability to cope with or control panic attacks, panic self......-efficacy, has also been proposed to play a key role in therapeutic change; however, this cognitive factor has received much less attention in research. The aim of the present review is to evaluate panic self-efficacy as a mediator of outcome in CBT for PD using descriptive and meta-analytic procedures. We...

  16. Comorbid personality disorders in subjects with panic disorder: which personality disorders increase clinical severity?

    Directory of Open Access Journals (Sweden)

    Mustafa Ozkan

    2003-03-01

    Full Text Available Personality disorders are common in subjects with panic disorder. Personality disorders have shown to affect the course of panic disorder. The purpose of this study was to examine which personality disorders effect clinical severity in subjects with panic disorder. This study included 122 adults (71 female, 41 male, who met DSM-IV criteria for panic disorder (with or without agoraphobia. Clinical assessment was conducted by using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I, the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II and the Panic and Agoraphobia Scale (PAS, Global Assessment Functioning Scale (GAF, Beck Depression Inventory (BDI, and State-Trait Anxiety Inventory (STAI. Patients who had a history of sexual abuse were assessed with Sexual Abuse Severity Scale. Logistic regressions were used to identify predictors of suicide attempts, suicidal ideation, agoraphobia, different panic attack symptoms, sexual abuse, and early onset of disorders. The rates of comorbid Axis I and Axis II psychiatric disorders were 80.3% and 33.9%, consecutively, in patients with panic disorder. Panic disorder patients with comorbid personality disorders had more severe anxiety, depression and agoraphobia symptoms, and had earlier ages of onset, and lower levels of functioning. The rates of suicidal ideation and suicide attempts were 34.8% and 9.8%, consecutively, in subjects with panic disorder. The rate of patients with panic disorder had a history of childhood sexual abuse was 12.5%. The predictor of sexual abuse was more than one comorbid Axis II diagnosis. The predictors of suicide attempt were comorbid paranoid and borderline personality disorders, and the predictor of suicidal ideation was major depressive disorder in subjects with panic disorder. In conclusion, this study documents that comorbid personality disorders increase the clinical severity of panic disorder. Patients with more than one

  17. Psychopharmacotherapy of panic disorder: 8-week randomized trial with clonazepam and paroxetine

    OpenAIRE

    Nardi, A.E.; A.M. Valença; R.C. Freire; M.D. Mochcovitch; Amrein, R.; Sardinha, A.; M.N. Levitan; I. Nascimento; V.L. de-Melo-Neto; King, A. L.; A.C. de O. e Silva; A.B. Veras; G.P. Dias; G.L. Soares-Filho; R.T. da Costa

    2011-01-01

    The objective of the present randomized, open-label, naturalistic 8-week study was to compare the efficacy and safety of treatment with clonazepam (N = 63) and paroxetine (N = 57) in patients with panic disorder with or without agoraphobia. Efficacy assessment included number of panic attacks and clinician ratings of the global severity of panic disorders with the clinical global impression (CGI) improvement (CGI-I) and CGI severity (CGI-S) scales. Most patients were females (69.8 and 68.4% i...

  18. Depression and quality of life in monogenic compared to idiopathic, early-onset Parkinson's disease

    DEFF Research Database (Denmark)

    Kasten, Meike; Kertelge, Lena; Tadic, Vera;

    2012-01-01

    Quality of life (QoL) is decreased in PD and is linked with depression and anxiety. However, little is known about QoL in monogenic PD. Subjects with mutations in PD genes were recruited from ongoing family and genetic studies (manifesting carriers, n = 23; nonmanifesting carriers, n = 19...... with severity of depression only. Social phobia (P = 0.018) and agoraphobia (P = 0.059) were more common in manifesting carriers than in any other group. QoL was decreased in the Parkinson groups, particularly in the early-onset cases (P

  19. A synopsis of original research projects published in scientific database in the Russian Federation.

    Science.gov (United States)

    Smirnova, Daria; Pavlichenko, Alexey; Karpenko, Olga; Schmeleva, Liubov; Morozov, Petr

    2015-06-01

    The article describes the current state of scientific publications in the field of psychiatry in the Russian Federation. Issues of academic dissertations, lack of access to recent Russian language research in foreign databases, and recent reforms in the Ministry of Education and Science for overcoming these limitations are discussed in detail. Four exemplary dissertation studies published in Russian language are summarized. The first research examines the contribution of patient's verbal behavior to the reliable diagnosis of mild depression, identifying objective signs for distinguishing it from normal sadness; the mood component influenced the whole mental status and was represented in both structure and semantics of patients' speech. The second paper describes the course of panic disorder with agoraphobia, with the notable results that debut of panic disorder with full-blown panic attacks, often declines to a second accompanied with agoraphobia, which after several years gives way to limited symptom attacks and decreased agoraphobic avoidance. The third study describes the high prevalence of affective and anxiety disorders in patients with diabetes mellitus type 1 and 2, and the role of personality traits in adherence to treatment in patients with poor glucose control. The fourth project uses functional MRI for probing the features of neuronal resting-state networks in patients with temporal lobe epilepsy; the association with affective symptoms provides a model for investigating the pathophysiology of mood disorder. PMID:26022056

  20. Polish adaptation and validation of the Agoraphobic Cognitions Questionnaire and the Body Sensations Questionnaire

    Directory of Open Access Journals (Sweden)

    Michałowski, Jarosław M.

    2013-07-01

    Full Text Available Aim. The present study aimed at the adaptation and validation of two questionnaires assessing fear of bodily sensations (BSQ; suggested Polish name: Kwestionariusz Doznań Cielesnych [KDC] and concerns specific to agoraphobics (ACQ; suggested Polish name: Kwestionariusz Myśli Towarzyszących Agorafobii [KMTA].Method. The study included a total of 82 patients diagnosed with agoraphobia or panic disorder with agoraphobia according to the diagnostic criteria of the DSM-IV as well as 100 control subjects who did not show the presence of mental disorders.Results. The results showed that both adapted questionnaires meet basic psychometric criteria. The Polish-language versions of the ACQ and BSQ are characterized by a high content validity, internal consistency and showed to be stable over a period of 28 days. Moreover, the factor structure of the Polish version of the ACQ showed to be highly similar to the original version.Conclusions Polish-language versions of the ACQ and BSQ have been found to be reliable and valid research and diagnostic instruments for the assessment of fear for bodily sensations and agoraphobic cognitions. Due to their high efficiency and adequate psychometric characteristics these measures might be very useful in research as well as in the diagnosis and evaluation of therapeutic effects.

  1. Respiratory rehabilitation: a physiotherapy approach to the control of asthma symptoms and anxiety

    Directory of Open Access Journals (Sweden)

    Renata André Laurino

    2012-11-01

    Full Text Available OBJECTIVES: The objectives of this study were to verify the degree of anxiety, respiratory distress, and health-related quality of life in a group of asthmatic patients who have experienced previous panic attacks. Additionally, we evaluated if a respiratory physiotherapy program (breathing retraining improved both asthma and panic disorder symptoms, resulting in an improvement in the health-related quality of life of asthmatics. METHODS: Asthmatic individuals were assigned to a chest physiotherapy group that included a breathing retraining program held once a week for three months or a paired control group that included a Subtle Touch program. All patients were assessed using the Diagnostic and Statistical Manual of Mental Disorders IV, the Sheehan Anxiety Scale, the Quality of Life Questionnaire, and spirometry parameter measurements. RESULTS: Both groups had high marks for panic disorder and agoraphobia, which limited their quality of life. The Breathing Retraining Group program improved the clinical control of asthma, reduced panic symptoms and agoraphobia, decreased patient scores on the Sheehan Anxiety Scale, and improved their quality of life. Spirometry parameters were unchanged. CONCLUSION: Breathing retraining improves the clinical control of asthma and anxiety symptoms and the health-related quality of life in asthmatic patients.

  2. Avaliação de Saúde Mental em Gestantes

    Directory of Open Access Journals (Sweden)

    Poliana Patrício Aliane

    2008-12-01

    Full Text Available The pregnancy and puerperium period is a phase of increased incidence of mental disorders in women,requiring special attention to ensure the maintenance of their well-being and prevention of future cognitive andemotional difficulties for their child. The present research aimed at verifying, through a pilot study, theincidence of psychiatric symptoms and alcohol use among pregnant women attending the public health systemof Juiz de Fora, MG. 33 pregnant women of 3 health units had been interviewed using the instruments QMPAand MINI/DSM-IV. It was verified that 54.5% of the women interviewed presented seven or more psychiatricsymptoms described in the QMPA, with a prominence of the anxiety subscale. Amongst the results of theMINI/DSM-IV, the high incidence of current Agoraphobia can be highlighted (37.7%, Agoraphobia withoutPanic Disorder (33.3%, Psychotic Syndrome (25.0%, Bigger Depressive Episode Current (24.2% andGeneralized Anxiety Disorder (15.2%. The high incidence of psychiatric disorders found indicated thenecessity of detailed clinical inquiries for the evaluation of the mental health of pregnant women and possiblereferal for treatment. The pilot study constitutes an important stage of the research, since the preliminary results,as well as the initial methodological difficulties, will ensure the improvement of the final study.

  3. “Nomophobia”: Impact of Cell Phone Use Interfering with Symptoms and Emotions of Individuals with Panic Disorder Compared with a Control Group

    Science.gov (United States)

    King, Anna Lucia Spear; Valença, Alexandre Martins; Silva, Adriana Cardoso; Sancassiani, Federica; Machado, Sergio; Nardi, Antonio Egidio

    2014-01-01

    Panic disorder refers to the frequent and recurring acute attacks of anxiety. Objective: This study describes the routine use of mobiles phones (MPs) and investigates the appearance of possible emotional alterations or symptoms related to their use in patients with panic disorder (PD). Background: We compared patients with PD and agoraphobia being treated at the Panic and Respiration Laboratory of The Institute of Psychiatry, Federal University of Rio de Janeiro, Brazil, to a control group of healthy volunteers. Methods: An MP-use questionnaire was administered to a consecutive sample of 50 patients and 70 controls. Results: People with PD showed significant increases in anxiety, tachycardia, respiratory alterations, trembling, perspiration, panic, fear and depression related to the lack of an MP compared to the control group. Conclusions: Both groups exhibited dependence on and were comforted by having an MP; however, people with PD and agoraphobia showed significantly more emotional alterations as well as intense physical and psychological symptoms when they were apart from or unable to use an MP compared to healthy volunteers. PMID:24669231

  4. Examining sex and gender differences in anxiety disorders

    DEFF Research Database (Denmark)

    Christiansen, Dorte Mølgaard

    2015-01-01

    Several studies have examined sex differences in different anxiety disorders. Females are repeatedly found to be more likely than males to suffer from anxiety in general and to be diagnosed with most anxiety disorders, including agoraphobia (AG), panic disorder (PD), separation anxiety (SA......), specific phobia (SP), social anxiety disorder (SAD), generalised anxiety disorder (GAD), obsessive-compulsive disorder (OCD), and acute and posttraumatic stress disorder (ASD and PTSD), although the latter three are technically no longer categorised as anxiety disorders according to DSM-5. This chapter...... provides an overview of research on sex and gender differences in anxiety disorders ranging from the well-established female preponderance in prevalence and severity to possible sex differences in the risk and protective factors associated with anxiety, sex differences in the clinical presentation...

  5. Brief reviews on present evidence study status of treatment of anxiety disorders%简述焦虑障碍治疗循证研究现状

    Institute of Scientific and Technical Information of China (English)

    王一凡; 肖泽萍

    2009-01-01

    @@ 焦虑障碍是常见的精神疾病,根据DSM-IV主要分为六种:惊恐障碍(PD)伴或不伴有广场恐惧症(agoraphobia),强迫症(OCD),社交恐惧症(SAD),广泛性焦虑障碍(GAD),特定类型的恐惧症(specific phobia),创伤后应激障碍(PTSD).大部分焦虑障碍患者自身有强烈的求治愿望.如果不适当治疗,长此以往将损害患者社会功能,严重可导致自杀、物质滥用等.

  6. Autistic traits in couple dyads as a predictor of anxiety spectrum symptoms.

    Science.gov (United States)

    Lau, Winnie Yu-Pow; Gau, Susan Shur-Fen; Chiu, Yen-Nan; Wu, Yu-Yu

    2014-11-01

    The link between parental autistic tendency and anxiety symptoms was studied in 491 Taiwanese couples raising biological children with autism spectrum disorders (ASDs). Parental autistic tendency as measured by Autism Spectrum Quotient (AQ) was associated with anxiety symptoms across all domains. Large effect sizes were found in social phobia and post traumatic stress disorders for both parents, and in general anxiety disorder and agoraphobia for mothers. These associations were irrespective of child's autistic tendency, spouse's AQ scores and the couples' compatibility in their autistic tendency. Perceived family support and parental education moderated the link but not child's autistic severity. Research and clinical implications regarding psychiatric vulnerability of parents of children with ASD were drawn and discussed.

  7. Women who finished a violent relationship: personality, psychopathological, and socio-demographic characteristics [Mujeres que finalizaron una relación maltratante: características de personalidad, psicopatológicas y sociodemográficas

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    Paola Marcela Preciado-Gavidia

    2012-03-01

    Full Text Available This study examined the personality, psychopathological, and socio-demographic characteristics of women that concluded a violent partner relationship (n=54, comparing them with women that continued with this type of relationship (n=41. The participants are between 18-60 years (M=37.4. The applied instruments were a socio-demographic survey, the Big Five Questionnaire of Personality (Caprara, Barbaranelli, Borgogni & Perugini, 1995, and the Mini International Neuropsychiatric Interview (Sheehan & Lecrubier, 2000. The participants that finished the abusive relationship presented bigger punctuations in the dimensions of Agreeableness, Neuroticism, and Openness, a lower number of children, bigger help-seeking in government institutions after the violence episodes, and a lower prevalence of mayor depressive episode, dysthymia, low suicidal risk, panic disorder, agoraphobia, and generalized anxiety.

  8. Panic-attack-induced transient leukocytosis in a healthy male: a case report.

    Science.gov (United States)

    Iskandar, Joseph W; Griffeth, Benjamin; Sapra, Mamta; Singh, Karamjit; Giugale, Juan M

    2011-01-01

    The lifetime prevalence of panic attacks is 28.3% in American adults 18 years and older. The age of onset of panic attack extends throughout adulthood; however, it typically develops in early adulthood, with median age of onset of 22 years [Kessler R.C., Chiu W.T., Jin R., Ruscio A.M., Shear K., Walters E.E. The epidemiology of panic attacks, panic disorder, and agoraphobia in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2006 Apr;63(4):415-24.]. As reported in our case, panic attacks could induce transient leukocytosis in healthy adults. If practitioners recognize this association, expensive investigations and extensive hospital stays may be prevented, although prudent practice would likely still require some type of investigations. PMID:21601734

  9. Agoraphobic behavior and panic attack: a study of male twins.

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    Tsuang, Ming; Domschke, Katharina; Jerskey, Beth A; Lyons, Michael J

    2004-01-01

    We used data from 3372 pairs of male twins from the Vietnam Era Twin Registry to examine comorbidity and familial influences on the frequently observed association between agoraphobic behavior and panic. Due to low prevalence of DSM-III-R-defined panic disorder, we also examined subjects who had experienced at least one panic attack during their lives. Agoraphobic behavior among individuals with a history of panic attacks showed familial aggregation (odds ratio = 5.7; P = .018 ). Probands with panic attacks and agoraphobic behavior and their co-twins had higher risk of major depression than probands without agoraphobic avoidance and their co-twins (P = .01). Groups did not differ for alcohol dependence or antisocial personality. Agoraphobic behavior associated with panic attack is familial and associated with comorbid major depression. Agoraphobia following panic attack does not seem to reflect severity as agoraphobic behavior in the proband was unrelated to risk of panic attacks in the co-twin. PMID:15474853

  10. Reconciling RDoC and DSM Approaches in Clinical Psychophysiology and Neuroscience

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    McTeague, Lisa M.

    2016-01-01

    The Research Domain Criteria (RDoC) initiative endeavors to foster a science of psychopathology based around dimensions of brain-behavior relationships as opposed to subjectively based diagnostic categories. A rapidly accumulating array of transdiagnostic commonalities, across multiple objective and subjective measures, underscores the clear potential of this initiative. At the same time, a roadmap for guiding future RDoC research efforts is needed that draws upon the wealth of extant disorder-specific findings. In this issue, Hamm and colleagues provide an example of conceptualizing within-disorder processes in terms of dimensional brain-behavior relationships that advances the understanding of panic disorder with agoraphobia beyond the conventional nosological framework. Their findings and conceptual model are reviewed and discussed in terms of broader transdiagnostic implications. PMID:26877120

  11. Separation anxiety disorder across the lifespan: DSM-5 lifts age restriction on diagnosis.

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    Silove, Derrick; Rees, Susan

    2014-10-01

    DSM-5 has lifted the age criterion in the definition of separation anxiety disorder thereby overturning the long-standing convention of restricting the diagnosis to childhood. Previously, adults with separation anxiety symptoms were assigned to other conventional categories such as panic disorder, agoraphobia or generalized anxiety disorder. Over the past two decades, an evolving body of research has identified separation anxiety disorder in adulthood, with 20-40% of adult psychiatric outpatients being assigned that diagnosis. In the US, the lifetime prevalence of the disorder in adulthood is 6.6%. The removal of the age restriction on diagnosis has important implications for clinical practice. Whereas parents (particularly mothers) of children with separation anxiety disorder commonly attracted the diagnosis of agoraphobia, the latter are more likely now to be diagnosed with the adult form of separation anxiety disorder, focusing attention on the importance of intervening with both members of the dyad to overcome mutual reinforcement of symptoms. In addition, adults with separation anxiety disorder have been found to manifest high levels of disability and they tend to show a poor response to conventional psychological and pharmacological treatments. There is an urgent need therefore to devise novel psychological and pharmacological interventions for the adult form of the disorder. The reformulation of separation anxiety disorder in DSM-5 therefore requires a paradigm shift in which clinicians are alerted to identifying and treating the condition in all age groups. Research across countries is needed to examine the new formulation of separation anxiety disorder amongst populations of diverse ethnic and cultural backgrounds.

  12. Validity and Reliability of Agoraphobic Cognitions Questionnaire-Turkish Version

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    Ayşegül KART

    2013-11-01

    Full Text Available Validity and Reliability of Agoraphobic Cognitions Questionnaire-Turkish Version Objective: The aim of this study is to investigate the validity and reliability of Agoraphobic Cognitions Questionnaire -Turkish Version (ACQ. Method: ACQ was administered to 92 patients with agoraphobia or panic disorder with agoraphobia. BSQ Turkish version completed by translation, back-translation and pilot assessment. Reliability of ACQ was analyzed by test-retest correlation, split-half technique, Cronbach’s alpha coefficient. Construct validity was evaluated by factor analysis after the Kaiser-Meyer-Olkin (KMO and Bartlett test had been performed. Principal component analysis and varimax rotation used for factor analysis. Results: 64% of patients evaluated in the study were female and 36% were male. Age interval was between 18 and 58, mean age was 31.5±10.4. The Cronbach’s alpha coefficient was 0.91. Analysis of test-retest evaluations revealed that there were statistically significant correlations ranging between 24% and 84% concerning questionnaire components. In analysis performed by split-half method reliability coefficients of half questionnaires were found as 0.77 and 0.91. Again Spearmen-Brown coefficient was found as 0.87 by the same analysis. To assess construct validity of ACQ, factor analysis was performed and two basic factors found. These two factors explained 57.6% of the total variance. (Factor 1: 34.6%, Factor 2: 23% Conclusion: Our findings support that ACQ-Turkish version had a satisfactory level of reliability and validity

  13. Separation anxiety disorder across the lifespan: DSM-5 lifts age restriction on diagnosis.

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    Silove, Derrick; Rees, Susan

    2014-10-01

    DSM-5 has lifted the age criterion in the definition of separation anxiety disorder thereby overturning the long-standing convention of restricting the diagnosis to childhood. Previously, adults with separation anxiety symptoms were assigned to other conventional categories such as panic disorder, agoraphobia or generalized anxiety disorder. Over the past two decades, an evolving body of research has identified separation anxiety disorder in adulthood, with 20-40% of adult psychiatric outpatients being assigned that diagnosis. In the US, the lifetime prevalence of the disorder in adulthood is 6.6%. The removal of the age restriction on diagnosis has important implications for clinical practice. Whereas parents (particularly mothers) of children with separation anxiety disorder commonly attracted the diagnosis of agoraphobia, the latter are more likely now to be diagnosed with the adult form of separation anxiety disorder, focusing attention on the importance of intervening with both members of the dyad to overcome mutual reinforcement of symptoms. In addition, adults with separation anxiety disorder have been found to manifest high levels of disability and they tend to show a poor response to conventional psychological and pharmacological treatments. There is an urgent need therefore to devise novel psychological and pharmacological interventions for the adult form of the disorder. The reformulation of separation anxiety disorder in DSM-5 therefore requires a paradigm shift in which clinicians are alerted to identifying and treating the condition in all age groups. Research across countries is needed to examine the new formulation of separation anxiety disorder amongst populations of diverse ethnic and cultural backgrounds. PMID:25453710

  14. Detecting depressive and anxiety disorders in distressed patients in primary care; comparative diagnostic accuracy of the Four-Dimensional Symptom Questionnaire (4DSQ and the Hospital Anxiety and Depression Scale (HADS

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    Verhaak Peter FM

    2009-08-01

    Full Text Available Abstract Background Depressive and anxiety disorders often go unrecognized in distressed primary care patients, despite the overtly psychosocial nature of their demand for help. This is especially problematic in more severe disorders needing specific treatment (e.g. antidepressant pharmacotherapy or specialized cognitive behavioural therapy. The use of a screening tool to detect (more severe depressive and anxiety disorders may be useful not to overlook such disorders. We examined the accuracy with which the Four-Dimensional Symptom Questionnaire (4DSQ and the Hospital Anxiety and Depression Scale (HADS are able to detect (more severe depressive and anxiety disorders in distressed patients, and which cut-off points should be used. Methods Seventy general practitioners (GPs included 295 patients on sick leave due to psychological problems. They excluded patients with recognized depressive or anxiety disorders. Patients completed the 4DSQ and HADS. Standardized diagnoses of DSM-IV defined depressive and anxiety disorders were established with the Composite International Diagnostic Interview (CIDI. Receiver Operating Characteristic (ROC analyses were performed to obtain sensitivity and specificity values for a range of scores, and area under the curve (AUC values as a measure of diagnostic accuracy. Results With respect to the detection of any depressive or anxiety disorder (180 patients, 61%, the 4DSQ and HADS scales yielded comparable results with AUC values between 0.745 and 0.815. Also with respect to the detection of moderate or severe depressive disorder, the 4DSQ and HADS depression scales performed comparably (AUC 0.780 and 0.739, p 0.165. With respect to the detection of panic disorder, agoraphobia and social phobia, the 4DSQ anxiety scale performed significantly better than the HADS anxiety scale (AUC 0.852 versus 0.757, p 0.001. The recommended cut-off points of both HADS scales appeared to be too low while those of the 4DSQ anxiety

  15. Risk factors for early treatment discontinuation in patients with obsessive-compulsive disorder

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    Juliana Belo Diniz

    2011-01-01

    Full Text Available INTRODUCTION: In obsessive-compulsive disorder, early treatment discontinuation can hamper the effectiveness of first-line treatments. OBJECTIVE: This study aimed to investigate the clinical correlates of early treatment discontinuation among obsessive-compulsive disorder patients. METHODS: A group of patients who stopped taking selective serotonin reuptake inhibitors (SSRIs or stopped participating in cognitive behavioral therapy before completion of the first twelve weeks (total n = 41; n = 16 for cognitive behavioral therapy and n = 25 for SSRIs were compared with a paired sample of compliant patients (n = 41. Demographic and clinical characteristics were obtained at baseline using structured clinical interviews. Chisquare and Mann-Whitney tests were used when indicated. Variables presenting a p value <0.15 for the difference between groups were selected for inclusion in a logistic regression analysis that used an interaction model with treatment dropout as the response variable. RESULTS: Agoraphobia was only present in one (2.4% patient who completed the twelve-week therapy, whereas it was present in six (15.0% patients who dropped out (p = 0.044. Social phobia was present in eight (19.5% patients who completed the twelve-week therapy and eighteen (45% patients who dropped out (p = 0.014. Generalized anxiety disorder was present in eight (19.5% patients who completed the twelve-week therapy and twenty (50% dropouts (p = 0.004, and somatization disorder was not present in any of the patients who completed the twelveweek therapy; however, it was present in six (15% dropouts (p = 0.010. According to the logistic regression model, treatment modality (p = 0.05, agoraphobia, the Brown Assessment of Beliefs Scale scores (p = 0.03 and the Beck Anxiety Inventory (p = 0.02 scores were significantly associated with the probability of treatment discontinuation irrespective of interactions with other variables. DISCUSSION AND CONCLUSION: Early treatment

  16. Do bullied children become anxious and depressed adults?: A cross-sectional investigation of the correlates of bullying and anxious depression.

    Science.gov (United States)

    Gladstone, Gemma L; Parker, Gordon B; Malhi, Gin S

    2006-03-01

    There is little empirical research examining the historical and clinical correlates of exposure to childhood bullying in adult clinical subjects. Using structured clinical assessments, the authors studied a group of adult males and females presenting to an outpatient depression clinic, to examine the childhood risk factors and the distinguishing comorbid features associated with those reporting exposure to bullying. Just over a quarter of both men and women reported having experienced bullying that was severe and traumatic. More of these subjects also reported several other well studied childhood risk factors. Childhood correlates that were particularly relevant for exposure to bullying were parental overcontrol, illness or disability, and the tendency to have an inhibited temperament early in life. The experience of childhood bullying was strongly related to high levels of comorbid anxiety, both in terms of greater levels of state anxiety and a higher prevalence of both social phobia and agoraphobia. Independent of other childhood risk factors, exposure to bullying was especially predictive of subjects' higher levels of general state anxiety and the tendency to express anxious arousal externally when under stress. These results are compatible with both cross-sectional and prospective studies of child and adolescent samples, and highlight the potential etiological significance of early peer victimization experiences for a percentage of adults suffering from depression with comorbid anxiety. PMID:16534438

  17. Psychiatric Morbidity and Work and Social Adjustment Among Earthquake Survivors Extricated from under the Rubble

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    Shamaila Aziz

    2012-01-01

    Full Text Available Objectives: This cross-sectional study examined psychiatric co-morbidity and work and social adjustment after a natural disaster among survivors who were extricated from under the rubble. Materials and Methods: Individuals (N=40 belonging to district Muzaffarabad, a severely earthquake affected area on 8 th October 2005, were interviewed. The examination included the MINI International Neuropsychiatric Interview for DSM-IV Axis I disorders, Work and Social Adjustment Scale, and questions covering background characteristics and disaster exposure. Results: The most prevalent disorders were posttaumatic stress disorder (32.5%, major depressive disorder (17.5%, dysthymia (15.0%, agoraphobia (25.0%, and panic disorder (20.0%. Moreover, 77% of the respondents have been diagnosed with at least one psychiatric disorder. Work and soical adjustment was found to have an inverse relationship with the psychiatric co-morbidity. Conclusion: Small sample size and lack of comparison group from non-earthquake struck areas may limit the generalizability of the psychatric disorders. Psychiatric disorders other than PTSD, especially depressive and anxiety disorders, are of clinical importance when considering long-term mental health effect of disasters.

  18. Mindfulness-Based Exposure Strategies as a Transdiagnostic Mechanism of Change: An Exploratory Alternating Treatment Design.

    Science.gov (United States)

    Brake, C Alex; Sauer-Zavala, Shannon; Boswell, James F; Gallagher, Matthew W; Farchione, Todd J; Barlow, David H

    2016-03-01

    The present study explored whether distress reduction in response to strong negative emotions, a putative transdiagnostic mechanism of action, is facilitated by mindfulness strategies. Seven patients (mean age=31.14years, SD=12.28, range 19-48 years, 43% female, 86% Caucasian) with heterogeneous anxiety disorders (i.e., panic disorder with or without agoraphobia, social anxiety, generalized anxiety) were assigned a randomized order of weeklong blocks utilizing either mindfulness- or avoidance-based strategies while ascending a 6-week emotion exposure hierarchy. Participants completed three exposures per block and provided distress and avoidance use ratings following each exposure. Anxiety severity, distress aversion, and distraction/suppression tendencies were also assessed at baseline and the conclusion of each block. Visual, descriptive, and effect size results showing exposures utilizing mindfulness were associated with higher overall distress levels, compared with those utilizing avoidance. Within blocks, the majority of participants exhibited declining distress levels when employing mindfulness strategies, as opposed to more static distress levels in the avoidance condition. Systematic changes in anxiety severity, distress aversion, and distraction/suppression were not observed. These results suggest mindfulness strategies may be effective in facilitating emotion exposure; however, a minimum dosage may be necessary to overcome initial distress elevation. Potential transdiagnostic change mechanisms and clinical implications are discussed.

  19. The University of Queensland study of physical and psychological outcomes for claimants with minor and moderate injuries following a road traffic crash (UQ SuPPORT: design and methods

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    Justin Kenardy

    2014-05-01

    Full Text Available Background: To date research investigating how mental health impacts physical recovery following a road traffic crash (RTC has focused on cohorts with severe injuries. The UQ SuPPORT study aims to study the physical and psychological outcomes of claimants with minor injuries following an RTC under the Queensland common law compulsory insurance scheme. Objectives: This paper outlines the protocols of this study as a platform for future publications. Methods: The 2-year longitudinal cohort study collected interview and survey data from claimants at 6, 12, and 24 months post-RTC. Measures used in the telephone interview included the DSM-IV Composite International Diagnostic Interview for posttraumatic stress disorder, generalized anxiety disorder, major depressive episode, panic attacks, agoraphobia; and self-reported disability (WHO-DAS-II. Quality of life (SF-36v2, alcohol use (AUDIT, social support (MSPSS, quality-adjusted life years (EQ-5D, and return to work outcomes were assessed via postal questionnaires. Results: A total of 382 claimants consented to participate at the beginning of the study, and these participants were approached at each wave. Retention was high (65%. The average age of participants at Wave 1 was 48.6 years, with 65% of the sample sustaining minor injuries (Injury Severity Score=1–3. Conclusions: This study has collected a unique sample of data to investigate recovery patterns of claimants with minor injuries. Future publications will more fully assess the effects of the collected measures on recovery rates 2 years post-RTC.

  20. GPS Technology and Human Psychological Research: A Methodological Proposal

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    Pedro S. A. Wolf

    2010-10-01

    Full Text Available Animal behaviorists have made extensive use of GPS technology since 1991. In contrast, psychological research has made little use of the technology, even though the technology is relatively inexpensive, familiar, and widespread. Hence, its potential for pure and applied psychological research remains untapped. We describe three methods psychologists could apply to individual differences research, clinical research, or spatial use research. In the context of individual differences research, GPS technology permits us to test hypotheses predicting specific relations among patterns of spatial use and individual differences variables. In a clinical context, GPS technology provides outcome measures that may relate to the outcome of interventions designed to treat psychological disorders that, for example, may leave a person homebound (e.g. Agoraphobia, PTSD, TBI. Finally, GPS technology provides natural measures of spatial use. We, for example, used GPS technology to quantify traffic flow and exhibit use at the Arizona Sonora Desert Museum. Interested parties could easily extend this methodology some aspects of urban planning or business usage.DOI: 10.2458/azu_jmmss.v1i1.74

  1. fences

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    Elena Grigoryeva

    2013-05-01

    Full Text Available After the Public Spaces (PB 35, it is the right time to speak about fences. Space and fencing. We, the members of the editorial board, probably suffer from an acute form of agoraphilia – the love for an open space, a wide and open world made us talk about it (82. Our cities suffer from agoraphobia, a fear of open spaces, and its complication – fencephilia.Chekhov’s claustrophobia brought him to Sakhalin and gave widely cited descriptions to many Siberian cities. Irkutsk, unlike Tomsk, for example, was called “a cultured city… Almost Europe!” But not every Irkutsk citizen knows that this quotation is cut short. When using the word ‘cultured’, the writer meant the absence of “nasty fences, absurd advertisements and wastelands where signs prohibit stopping”.However, after 100 some odd years, “the cultural layer has grown, and the cultural level has dropped”.Why? Let’s return to education. Alexander Rappaport opens discussion about a school of the future (30.This issue comprises international and Siberian architectural events (14. And many good and different fences. Good fences are represented in the collection of articles on fences of all times and nations. The hot times of fencing are analyzed in the article by psychologist Konstantin Lidin (72.

  2. The DSM-5 Dimensional Anxiety Scales in a Dutch non-clinical sample: psychometric properties including the adult separation anxiety disorder scale.

    Science.gov (United States)

    Möller, Eline L; Bögels, Susan M

    2016-09-01

    With DSM-5, the American Psychiatric Association encourages complementing categorical diagnoses with dimensional severity ratings. We therefore examined the psychometric properties of the DSM-5 Dimensional Anxiety Scales, a set of brief dimensional scales that are consistent in content and structure and assess DSM-5-based core features of anxiety disorders. Participants (285 males, 255 females) completed the DSM-5 Dimensional Anxiety Scales for social anxiety disorder, generalized anxiety disorder, specific phobia, agoraphobia, and panic disorder that were included in previous studies on the scales, and also for separation anxiety disorder, which is included in the DSM-5 chapter on anxiety disorders. Moreover, they completed the Screen for Child Anxiety Related Emotional Disorders Adult version (SCARED-A). The DSM-5 Dimensional Anxiety Scales demonstrated high internal consistency, and the scales correlated significantly and substantially with corresponding SCARED-A subscales, supporting convergent validity. Separation anxiety appeared present among adults, supporting the DSM-5 recognition of separation anxiety as an anxiety disorder across the life span. To conclude, the DSM-5 Dimensional Anxiety Scales are a valuable tool to screen for specific adult anxiety disorders, including separation anxiety. Research in more diverse and clinical samples with anxiety disorders is needed. © 2016 The Authors International Journal of Methods in Psychiatric Research Published by John Wiley & Sons Ltd.

  3. Respiratory panic disorder subtype and sensitivity to the carbon dioxide challenge test

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    A.M. Valença

    2002-07-01

    Full Text Available The aim of the present study was to verify the sensitivity to the carbon dioxide (CO2 challenge test of panic disorder (PD patients with respiratory and nonrespiratory subtypes of the disorder. Our hypothesis is that the respiratory subtype is more sensitive to 35% CO2. Twenty-seven PD subjects with or without agoraphobia were classified into respiratory and nonrespiratory subtypes on the basis of the presence of respiratory symptoms during their panic attacks. The tests were carried out in a double-blind manner using two mixtures: 1 35% CO2 and 65% O2, and 2 100% atmospheric compressed air, 20 min apart. The tests were repeated after 2 weeks during which the participants in the study did not receive any psychotropic drugs. At least 15 of 16 (93.7% respiratory PD subtype patients and 5 of 11 (43.4% nonrespiratory PD patients had a panic attack during one of two CO2 challenges (P = 0.009, Fisher exact test. Respiratory PD subtype patients were more sensitive to the CO2 challenge test. There was agreement between the severity of PD measured by the Clinical Global Impression (CGI Scale and the subtype of PD. Higher CGI scores in the respiratory PD subtype could reflect a greater sensitivity to the CO2 challenge due to a greater severity of PD. Carbon dioxide challenges in PD may define PD subtypes and their underlying mechanisms.

  4. ANXIETY DISORDERS: A REVIEW

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    Arya Ashwani

    2011-05-01

    Full Text Available Anxiety disorders are a highly prevalent and disabling class of psychiatric disorders. Anxiety disorders are highly prevalent and associated with substantial distress, morbidity and mortality. Recent epidemiological studies of anxiety disorders provided evidence of their high frequency in the general population worldwide. Anxiety disorders afflict an estimated 15.7 million people in the United States each year. Anxiety disorders are highly prevalent in adults with females showing higher preponderance of 2:1 as compared to males. Anxiety disorders are a group of mental disorders characterized by various combinations of key features - Irritability, fear, Insomnia, Nervousness, Tachycardia, Inability to concentrate, poor coping skills, Palpitation, Sweating, Agoraphobia and Social Withdrawal. The anxiety disorders, including panic disorder (PD, generalized anxiety disorder (GAD, social anxiety disorder (SAD, and posttraumatic stress disorder (PTSD, are among the disabling medical disorders. The neurobiology of anxiety disorders is not fully understood, but several different biologic abnormalities have been implicated in their etiology. The GABA, NE and 5HT systems play crucial roles in mediating the affective circuitry underlying the highly related clinical disorders of anxiety. Anxiety is a common psychiatric condition characterized by unnecessary aggression, poor quality of life, fear, worry, avoidance, and compulsive rituals that are associated with significant distress.

  5. Quality of life and risk of psychiatric disorders among regular users of alcohol, nicotine, and cannabis: An analysis of the National Epidemiological Survey on Alcohol and Related Conditions (NESARC).

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    Cougle, Jesse R; Hakes, Jahn K; Macatee, Richard J; Chavarria, Jesus; Zvolensky, Michael J

    2015-01-01

    Research is limited on the effects of regular substance use on mental health-related outcomes. We used a large nationally representative survey to examine current and future quality of life and risk of psychiatric disorders among past-year regular (weekly) users of alcohol, nicotine, and cannabis. Data on psychiatric disorders and quality of life from two waves (Wave 1 N = 43,093, Wave 2 N = 34,653) of the National Epidemiological Survey on Alcohol and Related Conditions (NESARC) were used to test study aims. In cross-sectional analyses, regular nicotine and cannabis use were associated with higher rates of psychiatric disorder, though regular alcohol use was associated with lower rates of disorders. Prospective analyses found that regular nicotine use predicted onset of anxiety, depressive, and bipolar disorders. Regular alcohol use predicted lower risk of these disorders. Regular cannabis use uniquely predicted the development of bipolar disorder, panic disorder with agoraphobia, and social phobia. Lastly, regular alcohol use predicted improvements in physical and mental health-related quality of life, whereas nicotine predicted deterioration in these outcomes. Regular cannabis use predicted declines in mental, but not physical health. These data add to the literature on the relations between substance use and mental and physical health and suggest increased risk of mental health problems among regular nicotine and cannabis users and better mental and physical health among regular alcohol users. Examination of mechanisms underlying these relationships is needed. PMID:26022838

  6. Posttraumatic stress disorder: a state-of-the-science review.

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    Nemeroff, Charles B; Bremner, J Douglas; Foa, Edna B; Mayberg, Helen S; North, Carol S; Stein, Murray B

    2006-02-01

    This article reviews the state-of-the-art research in posttraumatic stress disorder (PTSD) from several perspectives: (1) Sex differences: PTSD is more frequent among women, who tend to have different types of precipitating traumas and higher rates of comorbid panic disorder and agoraphobia than do men. (2) Risk and resilience: The presence of Group C symptoms after exposure to a disaster or act of terrorism may predict the development of PTSD as well as comorbid diagnoses. (3) Impact of trauma in early life: Persistent increases in CRF concentration are associated with early life trauma and PTSD, and may be reversed with paroxetine treatment. (4) Imaging studies: Intriguing findings in treated and untreated depressed patients may serve as a paradigm of failed brain adaptation to chronic emotional stress and anxiety disorders. (5) Neural circuits and memory: Hippocampal volume appears to be selectively decreased and hippocampal function impaired among PTSD patients. (6) Cognitive behavioral approaches: Prolonged exposure therapy, a readily disseminated treatment modality, is effective in modifying the negative cognitions that are frequent among PTSD patients. In the future, it would be useful to assess the validity of the PTSD construct, elucidate genetic and experiential contributing factors (and their complex interrelationships), clarify the mechanisms of action for different treatments used in PTSD, discover ways to predict which treatments (or treatment combinations) will be successful for a given individual, develop an operational definition of remission in PTSD, and explore ways to disseminate effective evidence-based treatments for this condition. PMID:16242154

  7. [Do cognitive-behavioral group therapies in the treatment of anxiety disorders have an advantage over individual treatments?].

    Science.gov (United States)

    Pomini, Valentino

    2004-01-01

    Group cognitive-behavior therapies in the treatment of anxiety disorders for adult psychiatric patients were historically developed on the basis of validated individual treatments. They have been widely employed and studied for social phobia, panic disorders, agoraphobia and obsessive-compulsive disorders, with generally positive results similar to those obtained with the corresponding individual methods. The cognitive-behavioural group treatments for generalized anxiety and posttraumatic stress disorders have not yet received sufficient validation. The results of evaluative research show that the format of the therapy (individual or group) does not appear to predict the outcome. Therefore an indication for an individual or a group therapy cannot be made on the basis of the diagnosis alone. It has to be based on other criteria, in particular economical, organisational or clinical. Group therapies can certainly offer advantages in comparison with individual procedures, even if they cannot always fit perfectly the specific needs of every patient. Indication has to be made individually, in order to allow the therapists to judge their patients' capacities and interest to participate in a group program. PMID:15470567

  8. Mindfulness-Based Exposure Strategies as a Transdiagnostic Mechanism of Change: An Exploratory Alternating Treatment Design.

    Science.gov (United States)

    Brake, C Alex; Sauer-Zavala, Shannon; Boswell, James F; Gallagher, Matthew W; Farchione, Todd J; Barlow, David H

    2016-03-01

    The present study explored whether distress reduction in response to strong negative emotions, a putative transdiagnostic mechanism of action, is facilitated by mindfulness strategies. Seven patients (mean age=31.14years, SD=12.28, range 19-48 years, 43% female, 86% Caucasian) with heterogeneous anxiety disorders (i.e., panic disorder with or without agoraphobia, social anxiety, generalized anxiety) were assigned a randomized order of weeklong blocks utilizing either mindfulness- or avoidance-based strategies while ascending a 6-week emotion exposure hierarchy. Participants completed three exposures per block and provided distress and avoidance use ratings following each exposure. Anxiety severity, distress aversion, and distraction/suppression tendencies were also assessed at baseline and the conclusion of each block. Visual, descriptive, and effect size results showing exposures utilizing mindfulness were associated with higher overall distress levels, compared with those utilizing avoidance. Within blocks, the majority of participants exhibited declining distress levels when employing mindfulness strategies, as opposed to more static distress levels in the avoidance condition. Systematic changes in anxiety severity, distress aversion, and distraction/suppression were not observed. These results suggest mindfulness strategies may be effective in facilitating emotion exposure; however, a minimum dosage may be necessary to overcome initial distress elevation. Potential transdiagnostic change mechanisms and clinical implications are discussed. PMID:26956654

  9. Disability and Comorbidity: Diagnoses and Symptoms Associated with Disability in a Clinical Population with Panic Disorder

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    Caroline A. Bonham

    2014-01-01

    Full Text Available Background. Anxiety disorders are associated with considerable disability in the domains of (1 work, (2 social, and (3 family and home interactions. Psychiatric comorbidity is also known to be associated with disability. Methods. Data from the Cross-National Collaborative Panic Study was used to identify rates of comorbid diagnoses, anxiety and depression symptom ratings, and Sheehan disability scale ratings from a clinical sample of 1165 adults with panic disorder. Results. Comorbid diagnoses of agoraphobia, major depression, and social phobia were associated with disability across the three domains of work, social, and family and home interactions. The symptom of agoraphobic avoidance makes the largest contribution to disability but there is no single symptom cluster that entirely predicts impairment and disability. Limitations. The findings about the relative contributions that comorbid diagnoses make to disability only apply to a population with panic disorder. Conclusions. Although panic disorder is not generally considered to be among the serious and persistent mental illnesses, when it is comorbid with other diagnoses, it is associated with considerable impairment. In particular, the presence of agoraphobic avoidance should alert the clinician to the likelihood of important functional impairment. When measuring the functional impact of comorbid anxiety disorders, both the categorical and the dimensional approaches to diagnosis make valuable contributions.

  10. "But it might be a heart attack": intolerance of uncertainty and panic disorder symptoms.

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    Carleton, R Nicholas; Duranceau, Sophie; Freeston, Mark H; Boelen, Paul A; McCabe, Randi E; Antony, Martin M

    2014-06-01

    Panic disorder models describe interactions between feared anxiety-related physical sensations (i.e., anxiety sensitivity; AS) and catastrophic interpretations therein. Intolerance of uncertainty (IU) has been implicated as necessary for catastrophic interpretations in community samples. The current study examined relationships between IU, AS, and panic disorder symptoms in a clinical sample. Participants had a principal diagnosis of panic disorder, with or without agoraphobia (n=132; 66% women). IU was expected to account for significant variance in panic symptoms controlling for AS. AS was expected to mediate the relationship between IU and panic symptoms, whereas IU was expected to moderate the relationship between AS and panic symptoms. Hierarchical linear regressions indicated that IU accounted for significant unique variance in panic symptoms relative to AS, with comparable part correlations. Mediation and moderation models were also tested and suggested direct and indirect effects of IU on panic symptoms through AS; however, an interaction effect was not supported. The current cross-sectional evidence supports a role for IU in panic symptoms, independent of AS. PMID:24873884

  11. [Polygraphy of a panic attack].

    Science.gov (United States)

    Noffke, H U; Roser, M

    2001-09-01

    We studied a 24-year old female patient with Type 1 diabetes mellitus suffering for 4 weeks from a major depressive episode combined with panic disorder without agoraphobia. A spontaneous panic attack was serendipitously recorded by polygraph while the subject was at rest. Electrocardiogram, finger blood-flow, respiratory rhythm and muscle tone (forearm, forehead) were recorded. A triphasic course consisting of a "dynamic phase" (appr. 80 s) preceded by a discrete "initial phase" (appr. 140 s) and a "declining phase" (appr. 180 s) was observed. The dynamic phase is characterized by an acute increase of fingertip vasoconstriction and heart rate. The patient was not aware of the panic attack before the dynamic phase. The recognisable central regulation confirms previously published findings indicating a sympathetic-norepinephrine activation at the beginning of the panic attack without activating the musculoskeletal system. Furthermore, a paradoxical phenomenon involving heart and respiratory rate was observed before the onset of anxiety, i.e. an increase of the heart rate and a simultaneous decline of the respiratory rate, suggesting a non-antagonistic regulation of the ergotropic-trophotropic system. The autonomic state of the patient points to a lability in homeostasis from which panic attacks as a form of CNS response could develop. PMID:11572106

  12. Neuropeptide S receptor gene -- converging evidence for a role in panic disorder.

    Science.gov (United States)

    Domschke, K; Reif, A; Weber, H; Richter, J; Hohoff, C; Ohrmann, P; Pedersen, A; Bauer, J; Suslow, T; Kugel, H; Heindel, W; Baumann, C; Klauke, B; Jacob, C; Maier, W; Fritze, J; Bandelow, B; Krakowitzky, P; Rothermundt, M; Erhardt, A; Binder, E B; Holsboer, F; Gerlach, A L; Kircher, T; Lang, T; Alpers, G W; Ströhle, A; Fehm, L; Gloster, A T; Wittchen, H-U; Arolt, V; Pauli, P; Hamm, A; Deckert, J

    2011-09-01

    Animal studies have suggested neuropeptide S (NPS) and its receptor (NPSR) to be involved in the pathogenesis of anxiety-related behavior. In this study, a multilevel approach was applied to further elucidate the role of NPS in the etiology of human anxiety. The functional NPSR A/T (Asn¹⁰⁷Ile) variant (rs324981) was investigated for association with (1) panic disorder with and without agoraphobia in two large, independent case-control studies, (2) dimensional anxiety traits, (3) autonomic arousal level during a behavioral avoidance test and (4) brain activation correlates of anxiety-related emotional processing in panic disorder. The more active NPSR rs324981 T allele was found to be associated with panic disorder in the female subgroup of patients in both samples as well as in a meta-analytic approach. The T risk allele was further related to elevated anxiety sensitivity, increased heart rate and higher symptom reports during a behavioral avoidance test as well as decreased activity in the dorsolateral prefrontal, lateral orbitofrontal and anterior cingulate cortex during processing of fearful faces in patients with panic disorder. The present results provide converging evidence for a female-dominant role of NPSR gene variation in panic disorder potentially through heightened autonomic arousal and distorted processing of anxiety-relevant emotional stimuli.

  13. The work of a clinical psychologist in primary care.

    Science.gov (United States)

    Johnston, M

    1978-11-01

    The data presented suggest that general practitioners would be likely to refer a large number of patients with diverse problems to clinical psychologists working in health centres. Compared with a centrally organized clinical psychology service, the work of the primary care psychologist is likely to offer the following advantages:1. Access to psychological help for patients with a need for such help, but who could not attend a central clinic owing to problems associated with travel, work, physical disability, or even a presenting problem such as agoraphobia.2. Greater continuity of care of patients.3. Increased communication between the psychologist and members of the primary care teams.4. Possibility of the psychologist seeing the patient earlier, before the problems have become entrenched.5. Less need for referral to other agencies.6. Reduced stigma for the patient.7. Development of new therapeutic approaches relevant to problems presenting in primary care.8. More flexible and more relevant therapy due to seeing the patients in their home setting.9. Greater therapeutic involvement of the patient's family.10. Reduced costs and inconvenience for the patient's family.11. Reduced administrative and ambulance service costs.While these points do not overcome the need for a formal evaluation of the work of psychologists in primary care, they do suggest that there are advantages in this type of service over the services which are currently available and that a full evaluation would be worth undertaking.

  14. Health Anxiety in Panic Disorder, Somatization Disorder and Hypochondriasis

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    Özgün Karaer KARAPIÇAK

    2012-03-01

    Full Text Available Objective: Health anxiety is the fear of being or getting seriously sick due to the misinterpretation of physical symptoms. Severe health anxiety is also named as hypochondriasis. Belief of having a disease due to the misinterpretation of physical symptoms is also seen in panic disorder and somatization disorder. The aim of this study is to search the health anxiety in panic disorder, somatization disorder and hypochondriasis and compare it with healthy volunteers. Method: SCID-I was used to determine psychiatric disorders in patient group. In order to assess the clinical state and disease severity of the patient group; Panic and Agoraphobia Scale, Hamilton Anxiety Rating Scale, Inventory of Depressive Symptomatology were used for patients with panic disorder and Symptom Interpretation Questionnaire, Hamilton Anxiety Rating Scale, Inventory of Depressive Symptomatology were used for patients with somatization disorder and hypochondriasis. Brief Symptom Inventory was used to assess psychopathology in healthy group. In order to evaluate health anxiety of both groups, Health Anxiety Inventory-Short Form was used. Results: Results of this study support that health anxiety is a significant major component of hypochondriasis. On the other hand, health anxiety seems to be common in panic disorder and somatization disorder. Health anxiety also may be a part of depression or present in healthy people. Conclusion: Further studies are needed in order to search how to manage health anxiety appropriately and which psychotherapeutic interventions are more effective.

  15. The high prevalence of "soft" bipolar (II) features in atypical depression.

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    Perugi, G; Akiskal, H S; Lattanzi, L; Cecconi, D; Mastrocinque, C; Patronelli, A; Vignoli, S; Bemi, E

    1998-01-01

    Seventy-two percent of 86 major depressive patients with atypical features as defined by the DSM-IV and evaluated systematically were found to meet our criteria for bipolar II and related "soft" bipolar disorders; nearly 60% had antecedent cyclothymic or hyperthymic temperaments. The family history for bipolar disorder validated these clinical findings. Even if we limit the diagnosis of bipolar II to the official DSM-IV threshold of 4 days of hypomania, 32.6% of atypical depressives in our sample would meet this conservative threshold, a rate that is three times higher than the estimates of bipolarity among atypical depressives in the literature. By definition, mood reactivity was present in all patients, while interpersonal sensitivity occurred in 94%. Lifetime comorbidity rates were as follows: social phobia 30%, body dysmorphic disorder 42%, obsessive-compulsive disorder 20%, and panic disorder (agoraphobia) 64%. Both cluster A (anxious personality) and cluster B (e.g., borderline and histrionic) personality disorders were highly prevalent. These data suggest that the "atypicality" of depression is favored by affective temperamental dysregulation and anxiety comorbidity, clinically manifesting in a mood disorder subtype that is preponderantly in the realm of bipolar II. In the present sample, only 28% were strictly unipolar and characterized by avoidant and social phobic features, without histrionic traits. PMID:9515190

  16. Recognition and diagnosis of atypical depression.

    Science.gov (United States)

    Thase, Michael E

    2007-01-01

    The term atypical depression dates to the first wave of reports describing differential response to monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants (TCAs). In contrast to more TCA-responsive depressions, patients with so-called atypical symptoms (e.g., hypersomnia, interpersonal sensitivity, leaden paralysis, increased appetite and/or weight, and phobic anxiety) were observed to be more responsive to MAOIs. After several decades of controversy and debate, the phrase "with atypical features" was added as an episode specifier in the DSM-IV in 1994. The 1-year prevalence of the defined atypical depression subtype is approximately 1% to 4%; around 15% to 29% of patients with major depressive disorder have atypical depression. Hardly "atypical" in contemporary contexts, atypical depression also is common in dysthymic bipolar II disorders and is notable for its early age at onset, more chronic course, and high rates of comorbidity with social phobia and panic disorder with agoraphobia. The requirement of preserved mood reactivity is arguably the most controversial of the DSM-IV criteria for atypical depression. When compared with melancholia, the neurobiological profiles of patients with atypical depression are relatively normal. The utility of the atypical depression subtype for differential therapeutics diminished substantially when the TCAs were supplanted as first-line antidepressants by the selective serotonin reuptake inhibitors. Although introduction of safer MAOIs has fostered renewed interest in atypical depression, the validity and importance of the DSM-IV definition of atypical depression for the nosology of affective illness remains an open question. PMID:17640153

  17. Imipramine for vestibular dysfunction in panic disorder: a prospective case series

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    Marco Andre Mezzasalma

    2011-04-01

    Full Text Available OBJECTIVE: The purpose of this study was to evaluate the efficacy and effectiveness of imipramine on the treatment of comorbid chronic dizziness and panic disorder. METHOD: Nine patients with panic disorder and agoraphobia associated with chronic dizziness underwent otoneurological screening and were treated with a 3-months course of imipramine. Anxiety levels were measured with the Hamilton Anxiety Scale (HAM-A, dizziness levels were evaluated using the Dizziness Handicap Inventory (DHI, and panic severity and treatment outcome were assessed with the Clinical Global Impression Scale (CGI. RESULTS: At the baseline 33.3% (n=3 had a bilateral peripheral deficit vestibulopathy, the mean scores for HAM-A were 27.2±10.4, for DHI were 51.7±22.7, and for CGI-S were 4.8±0.9. All patients had a significant reduction in their HAM-A (11.1±5.5, p=0.008, DHI (11.5±8.1, p=0.008 and CGI-I (1.8±0.7, p=0.011 levels after 3-months imipramine treatment (mean=72.2±23.2 mg/day. CONCLUSION: This study found a decrease in anxiety levels and in the impact of dizziness in the patients' quality of life after a 3-months treatment course with imipramine.

  18. Specific phobia: a review of DSM-IV specific phobia and preliminary recommendations for DSM-V.

    Science.gov (United States)

    LeBeau, Richard T; Glenn, Daniel; Liao, Betty; Wittchen, Hans-Ulrich; Beesdo-Baum, Katja; Ollendick, Thomas; Craske, Michelle G

    2010-02-01

    The present review was conducted in order to evaluate the current diagnostic criteria for specific phobia (SP) in light of the empirical evidence gathered since DSM-IV and to propose changes to DSM-V where change is clearly and reliably indicated by the evidence. In response to questions put forth by the DSM-V Anxiety, OC Spectrum, Posttraumatic, and Dissociative Disorder Work Group, four primary areas were determined for this review: the accuracy and utility of the current SP type classification system, the validity of test anxiety as a type of SP, the boundary between agoraphobia and SP, and the reliability and utility of the diagnostic criteria for SP. Developmental issues are addressed within each area. Literature reviews examining academic findings published between 1994 and 2009 were carried out and the results are included herein. The review presents a number of options and preliminary recommendations to be considered for DSM-V. All of these recommendations should be considered tentative as they await the field trials and expert consensus necessary prior to their inclusion in the DSM-V. The present review also reveals a great need for future research in the area of SP and directions for such research is provided.

  19. The role of optimism in the process of schema-focused cognitive therapy of personality problems.

    Science.gov (United States)

    Hoffart, Asle; Sexton, Harold

    2002-06-01

    The aim of this study was to examine the determinants and effects of optimism in the process of schema-focused cognitive therapy of personality problems. The sample consisted of 35 patients with panic disorder and/or agoraphobia and DSM-IV Cluster C personality traits who participated in an 11-week residential program with one symptom-focused and one personality-focused phase. This study examines the role played by optimism during the individual sessions of the second phase, using a time series approach. Decreased patient's belief in his/her primary Early Maladaptive Schema and increased patient-experienced empathy from the therapist in a session predicted increased patient-rated optimism before the subsequent session. Increased patient-rated optimism in turn predicted decreased schema belief and distress and increased insight, empathy, and therapist-rated optimism. The slope of optimism across sessions was related to change in most of the overall outcome measures. There appears to be a positive feedback in the process of schema-focused cognitive therapy between decreased schema belief and increased optimism. In addition, optimism appears to mediate the effects of schema belief and therapist empathy on overall improvement, and to serve as an antecedent to decreased distress and to increased empathy, insight, and therapist's optimism.

  20. Development and validation of the 48-item Symptom Questionnaire (SQ-48) in patients with depressive, anxiety and somatoform disorders.

    Science.gov (United States)

    Carlier, Ingrid; Schulte-Van Maaren, Yvonne; Wardenaar, Klaas; Giltay, Erik; Van Noorden, Martijn; Vergeer, Peter; Zitman, Frans

    2012-12-30

    Self-report measures of psychological distress or psychopathology are widely used and can be easily implemented as psychiatric screening tools. Positive psychological constructs such as vitality/optimism and work functioning have scarcely been incorporated. We aimed to develop and validate a psychological distress instrument, including measures of vitality and work functioning. A patient sample with suspected depressive, anxiety, and somatoform disorders (N=242) and a reference sample of the general population (N=516) filled in the 48-item Symptom Questionnaire (SQ-48) plus a battery of observer-rated and self-report scales (MINI Plus, MADR, BAS, INH, BSI), using a web-based ROM programme. The resulting SQ-48 is multidimensional and includes the following nine subscales: Depression (MOOD, six items), Anxiety (ANXI, six items), Somatization (SOMA, seven items), Agoraphobia (AGOR, four items), Aggression (AGGR, four items), Cognitive problems (COGN, five items), Social Phobia (SOPH, five items), Work functioning (WORK, five items), and Vitality (VITA, six items). The results showed good internal consistency as well as good convergent and divergent validity. The SQ-48 is meant to be available in the public domain for Routine Outcome Monitoring (ROM) and can be used as a screening/ monitoring tool in clinical settings (psychiatric and non-psychiatric), as a benchmark tool, or for research purposes.

  1. Psychosocial recovery after serious injury

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    Meaghan O'Donnell

    2014-12-01

    Full Text Available Background: The 2010 iteration of the Global Burden of Disease statistics (Murray et al., 2012 points to the growing impact of injury and highlights the mounting burden of psychiatric disorder. It is essential to examine the intersection between these two contributors to disease burden. Methods: The Australian Injury Vulnerability Study collected data of over 1,000 injury patients from their initial hospitalization to 6 years post-injury. Structured clinical interviews were used to diagnose psychiatric disorder and self-report measures for disability and symptom severity. Results: A wide range of psychiatric disorders developed following injury, which included posttraumatic stress disorder, agoraphobia, depression, and substance use disorders (Bryant, O'Donnell, Creamer, Silove, & McFarlane, 2010. Although prevalence rates for these disorders were generally consistent over time, examination of trajectory data showed that different people had the disorders at different times. Importantly, the data showed that early anxiety, depression, and PTSD symptoms played a significant role in the development of long term disability after injury (Carty, O'Donnell, Evans, Kazantzis, & Creamer, 2011; O'Donnell et al., 2013. Conclusions: These data support the view that transdiagnostic models for early intervention may be required to address the complex psychiatric disorder trajectories that develop after injury.

  2. Brazilian Portuguese Validated Version of the Cardiac Anxiety Questionnaire

    International Nuclear Information System (INIS)

    Cardiac Anxiety (CA) is the fear of cardiac sensations, characterized by recurrent anxiety symptoms, in patients with or without cardiovascular disease. The Cardiac Anxiety Questionnaire (CAQ) is a tool to assess CA, already adapted but not validated to Portuguese. This paper presents the three phases of the validation studies of the Brazilian CAQ. To extract the factor structure and assess the reliability of the CAQ (phase 1), 98 patients with coronary artery disease were recruited. The aim of phase 2 was to explore the convergent and divergent validity. Fifty-six patients completed the CAQ, along with the Body Sensations Questionnaire (BSQ) and the Social Phobia Inventory (SPIN). To determine the discriminative validity (phase 3), we compared the CAQ scores of two subgroups formed with patients from phase 1 (n = 98), according to the diagnoses of panic disorder and agoraphobia, obtained with the MINI - Mini International Neuropsychiatric Interview. A 2-factor solution was the most interpretable (46.4% of the variance). Subscales were named 'Fear and Hypervigilance' (n = 9; alpha = 0.88), and 'Avoidance', (n = 5; alpha = 0.82). Significant correlation was found between factor 1 and the BSQ total score (p < 0.01), but not with factor 2. SPIN factors showed significant correlations with CAQ subscales (p < 0.01). In phase 3, 'Cardiac with panic' patients scored significantly higher in CAQ factor 1 (t = -3.42; p < 0.01, CI = -1.02 to -0.27), and higher, but not significantly different, in factor 2 (t = -1.98; p = 0.51, CI = -0.87 to 0.00). These results provide a definite Brazilian validated version of the CAQ, adequate to clinical and research settings

  3. Changes in Regional Cerebral Blood Flow with Cognitive Behavioral Therapy in the Treatment of Panic Disorder

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    Won, K. S.; Jun, S. K.; Kim, J. B.; Jang, E. J. [College of Medicine, Univ. of Kyemyoung, Taegu (Korea, Republic of)

    2003-07-01

    This study attempted to prospectively investigate changes in regional cerebral blood flow (rCBF) on SPECT and clinical response to cognitive behavioral therapy (CBT) in patients with panic disorder with (PDA) and without (PD) agoraphobia. Using 99mTc-ECD brain SPECT, we assessed brain perfusion in 5 out patients at rest before and after CBT. The subjects received 12 weekly sessions of CBT. Subjects were assessed by Agoraphobic Cognitions Questionnaire, Body Sensations Questionnaire, Beck Anxiety Inventory, Anxiety Sensitivity Index, Beck Depression Inventory-II, Panic Disorder Severity Scale (PDSS) and clinical global improvement (CGI) scale measurement were used as outcome measures. Patients were considered responders to CBT if they are much or very much improved on CGI scale and have a PDSS score at least 30% below their baseline. The scans were statistically analyzed by using statistical parametric mapping (SPM99). The baseline scans were compared to the post-CBT scans by using the statistics option multi subject, different conditions. Of 5 subjects 4 were male, 3 diagnosed PDA, and 4 on anti-anxiety medication. All of the subjects were classified as CBT responders. Their mean pretreatment and posttreatment PDSS were 17.4 (SD=8.2) and 4.2 (SD=3.1), respectively. The results of SPM analysis showed a significant decrease in blood flow after CBT in the thalamus bilaterally and right middle frontal gyrus (Brodmann's area 6). All results were thresholded at an uncorrected p<0.001 (for voxel height) and a corrected p<0.04 (for spatial extent). These preliminary data suggest that SPM analysis of 99mTc-ECD brain SPECT can reveal the change of rCBF in patient with panic disorder before and after CBT and the CBT effect may be associated with limbic and thalamic networks. However this study was a short trial with small number of subjects. Further studies with larger patient cohorts are needed.

  4. Stepped care for depression and anxiety: from primary care to specialized mental health care: a randomised controlled trial testing the effectiveness of a stepped care program among primary care patients with mood or anxiety disorders

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    Seekles Wike

    2009-06-01

    Full Text Available Abstract Background Mood and anxiety disorders are highly prevalent and have a large impact on the lives of the affected individuals. Therefore, optimal treatment of these disorders is highly important. In this study we will examine the effectiveness of a stepped care program for primary care patients with mood and anxiety disorders. A stepped care program is characterized by different treatment steps that are arranged in order of increasing intensity. Methods This study is a randomised controlled trial with two conditions: stepped care and care as usual, whereby the latter forms the control group. The stepped care program consists of four evidence based interventions: (1 Watchful waiting, (2 Guided self-help, (3 Problem Solving Treatment and (4 Medication and/or specialized mental health care. The study population consists of primary care attendees aged 18–65 years. Screeners are sent to all patients of the participating general practitioners. Individuals with a Diagnostic and Statistical Manual of mental disorders (DSM diagnosis of major depression, dysthymia, panic disorder (with or without agoraphobia, generalized anxiety disorder, or social phobia are included as well as individuals with minor depression and anxiety disorders. Primary focus is the reduction of depressive and anxiety symptoms. Both conditions are monitored at 8, 16 and 24 weeks. Discussion This study evaluates the effectiveness of a stepped care program for patients with depressive and anxiety disorder. If effective, a stepped care program can form a worthwhile alternative for care as usual. Strengths and limitations of this study are discussed. Trial Registration Current Controlled Trails: ISRCTN17831610.

  5. Study of psychiatric comorbidity in patients with headache using a short structured clinical interview in a rural neurology clinic in Western India

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    Soaham Dilip Desai

    2014-01-01

    Full Text Available Background: Psychiatric disorders are common in patients attending neurology clinics with headache. Evaluation of psychiatric comorbidity in patients with headache is often missed in the busy neurology clinics. Aims: To assess the prevalence of Axis-I DSM-IV psychiatric disorders in patients with primary headache disorders in a rural-based tertiary neurology clinic in Western India. Settings and Design : A cross-sectional observation survey was conducting assessing all patients with migraine, tension-type headache and chronic daily headache attending the Neurology Clinic of Shree Krishna Hospital, a rural medical teaching hospital in Karamsad, in Gujarat in Western India. Materials and Methods: A total of 101 consecutive consenting adults with headache were interviewed using Mini International Neuropsychiatric Interview (M.I.N.I., a structured diagnostic clinical interview to assess prevalence of Axis-I DSM-IV psychiatric disorders. Statistical Analysis: Descriptive statistics were calculated using SPSS software version 16 and a binomial regression model was used to study the relationship of psychiatric co-morbidity with patient-related factors. Results: 49 out of 101 (48.5% patients with headache suffered from depressive disorders (dysthymia or depression or suicidality, 18 out of 101 patients with headache (17.90% suffered from anxiety related disorders (generalized anxiety disorder or agoraphobia or social phobia or panic disorder. Conclusions: Axis-I psychiatric disorders are a significant comorbidity among patients with headache disorders. M.I.N.I. can be used as a short, less time consuming instrument to assess all patients with headache disorders.

  6. Association of psychiatric co-morbidity and efficacy of treatment in chronic daily headache in Indian population

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    Ajai Kumar Singh

    2013-01-01

    Full Text Available Objective: To study the prevalence of psychiatric co-morbidity in patients of chronic daily headache (CDH and compare the efficacy of treatment between various type of headache associated with psychiatric co-morbidity. Materials and Methods: Prospective case control cohort study, 92 consecutive patients of CDH meeting eligibility criteria. The diagnosis of various subtypes of CDH was made according to the IHS criteria. Age, sex, educational, marital and socioeconomic status, matched controls were also selected. Patients were evaluated with the Mini International Neuropsychiatric Interview (MINI scale at the time of enrolment and at 3 months. Results: CDH accounted for 28% of all headache patients. The mean age of presentation was 30.2 ± 10.3 years, male: Female ratio of 28:64 and mean duration of 4.56 ± 0.56 years. Chronic migraine (CM accounted for 59 patients, chronic tension type headache (CTTH 22 patients, new daily persistent headache (NDPH 3 patients and miscellaneous 8 patients. Psychiatric co-morbidity was present in 53.3% patients with CDH, and was more common in CM (62.7% as compared to CTTH (36.4%. Single psychiatric co-morbidity was seen in 26 patients, while 23 patients had multiple co-morbidity. Major depressive episode, anxiety disorder, agoraphobia and dysthymia were significant psychiatric co-morbidities. Patients with CM were treated with topiramate or divalproex sodium ER and CTTH were treated with amitriptyline. 55 patients came for follow up at 3 months, improvement in headache was seen in 29 patients. Conclusion: Psychiatric co-morbidity was present in more than 50% patients with CDH and its presence along with a duration of ≥2 years was associated with a poor response to treatment.

  7. Effectiveness and cost-effectiveness of web-based treatment for phobic outpatients on a waiting list for psychotherapy: protocol of a randomised controlled trial

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    Kok Robin N

    2012-08-01

    Full Text Available Abstract Background Phobic disorders are highly prevalent and constitute a considerable burden for patients and society. As patients wait for face-to-face psychotherapy for phobic disorders in outpatient clinics, this time can be used for guided self-help interventions. The aim of this study is to investigate a five week internet-based guided self-help programme of exposure therapy in terms of clinical effectiveness and impact on speed of recovery in psychiatric outpatients, as well as the cost-effectiveness of this pre-treatment waiting list intervention. Methods/design A randomised controlled trial will be conducted among 244 Dutch adult patients recruited from waiting lists of outpatient clinics for face-to-face psychotherapy for phobic disorders. Patients suffering from at least one DSM-IV classified phobic disorder (social phobia, agoraphobia or specific phobia are randomly allocated (at a 1:1 ratio to either a five-week internet-based guided self-help program followed by face-to-face psychotherapy, or a control group followed by face-to-face psychotherapy. Waiting list status and duration are unchanged and actual need for further treatment is evaluated prior to face-to-face psychotherapy. Clinical and economic self-assessment measurements take place at baseline, post-test (five weeks after baseline and at 3, 6, 9 and 12 months after baseline. Discussion Offering pre-treatment internet-based guided self-help efficiently uses time otherwise lost on a waiting list and may increase patient satisfaction. Patients are expected to need fewer face-to-face sessions, reducing total treatment cost and increasing speed of recovery. Internet-delivered treatment for phobias may be a valuable addition to psychotherapy as demand for outpatient treatment increases while budgets decrease. Trial registration Netherlands Trial Register NTR2233

  8. Correlates of gender dysphoria in Taiwanese university students.

    Science.gov (United States)

    Lai, Meng-Chuan; Chiu, Yen-Nan; Gadow, Kenneth D; Gau, Susan Shur-Fen; Hwu, Hai-Gwo

    2010-12-01

    There have been no published reports regarding the epidemiological and psychiatric features of gender dysphoria in non-clinical young adults. The current study aimed to investigate the demographics, co-occurring psychiatric symptoms, and perceived parenting style and family support in Taiwanese young adults with gender dysphoria. The sample consisted of 5010 university freshmen (male, 51.6%) with a mean age of 19.6 years (SD = 2.7) from a national university in Taiwan. The questionnaires used for this university-based survey included the Adult Self Report Inventory-4 for psychopathology (including gender dysphoria), the Parental Bonding Instrument for parenting style, and the Family APGAR for perceived family support. Results showed that gender dysphoria was more prevalent in females (7.3%) than males (1.9%). Young adults with gender dysphoria were more likely to meet a wide but specific range of co-occurring psychiatric symptoms. The most significantly associated symptoms for males were agoraphobia, hypochondriasis, manic episode, and pathological gambling, and for females dissociative disorder, hypochondriasis, and body dysmorphic disorder. Both males and females with gender dysphoria perceived significantly less support from their families and less affection/care from both parents. Findings suggest that gender dysphoria, associated with a specific range of psychopathology and family/parenting dissatisfaction (with both similar and dissimilar patterns between sexes), is not uncommon in Taiwanese university students, particularly in females. This implies the importance of attention and specific measures to offset psychiatric conditions and to promote mental well-being of this population.

  9. Ovarian Leydig cell tumor in a peri-menopausal woman with severe hyperandrogenism and virilization.

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    Nardo, L G; Ray, D W; Laing, I; Williams, C; McVey, R J; Seif, M W

    2005-10-01

    The authors report a case of Leydig cell tumor in a 46-year-old woman who first presented with severe clinical hyperandrogenism and associated complex medical history. Investigations revealed markedly raised serum concentrations of testosterone (28.3 nmol/l) and free androgen index (54.4), whereas sex hormone binding globulin, random cortisol, androstenedione, 17-hydroxyprogesterone and dehydroepiandrosterone sulphate concentrations were all within the normal range. Transabdominal ultrasound and computed tomography scan of the pelvis and abdomen showed a slightly bulky right ovary, but no other abnormalities. An ovarian source of androgens was suspected and surgery was arranged. Following a three-year history of defaulting appointments due to agoraphobia, she underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy and intraoperative selective ovarian venous sampling. Histopathological examination revealed a 2 cm Leydig cell tumor within the right ovary. Successful intraoperative ovarian venous sampling demonstrated significantly elevated testosterone levels (>260 nmol/l) from the right ovarian vein. Hyperandrogenaemia normalized post-operatively. The patient showed significant regression of clinical signs and symptoms, including the anxiety disorder. Clinical presentation, biochemistry and imaging modalities should allow to detect androgen-secreting ovarian tumors, while selective venous sampling should be reserved for patients whom uncertainty remains. The present case confirms that androgen-secreting ovarian tumors represent a diagnostic and therapeutic challenge. They have to be considered in the differential diagnosis of severe hyperandrogenism even in peri-menopausal women. Although selective venous sampling is of diagnostic value, however, its impact on future management should be considered on individual basis.

  10. Meta-analysis of the prevalence of anxiety disorders in mainland China from 2000 to 2015.

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    Guo, Xiaojing; Meng, Zhen; Huang, Guifeng; Fan, Jingyuan; Zhou, Wenwen; Ling, Weijun; Jiang, Juan; Long, Jianxiong; Su, Li

    2016-01-01

    Although anxiety disorders (ADs) have been recognized as one of the most prevalent mental disorders in mainland China, the prevalence of ADs has not been reported until now. The lack of a consolidated and comparable review on the prevalence of ADs in mainland China necessitated this meta-analysis to measure the prevalence. To identify the relevant studies on ADs for the analysis, we searched published studies in electronic databases up to July 2015. The pooled prevalence in the overall population and the prevalences by gender and location were estimated. A total of 21 studies were included in the analysis. The pooled current/lifetime prevalences of ADs, generalized AD, non-specific AD, panic disorder, social phobia, agoraphobia, specific phobia, post-traumatic stress disorder, and obsessive-compulsive disorder were 24.47‰/41.12‰, 5.17‰/4.66‰, 8.30‰/6.89‰, 1.08‰/3.44‰, 0.70‰/4.11‰, 0.19‰/2.15‰, 0.63‰/19.61‰, 0.49‰/1.83‰, and 0.90‰/3.17‰, respectively. Subgroup analyses indicated that compared with males, females had a consistently significantly higher prevalence of ADs. However, no difference was observed between those in urban and rural areas. The pooled prevalence of ADs was relatively lower than those of some other countries. A higher prevalence of ADs in women than in men was commonly observed, whereas the prevalences in urban and rural areas were nearly the same. PMID:27306280

  11. Brazilian Portuguese Validated Version of the Cardiac Anxiety Questionnaire

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    Sardinha, Aline, E-mail: alinesardinhapsi@gmail.com; Nardi, Antonio Egidio [Laboratório de Pânico e Respiração do Programa de Pós-Graduação em Psiquiatria e Saúde Mental do Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro (Brazil); Instituto Nacional de Ciência e Tecnologia - Translational Medicine (INCT-TM, CNPq), Rio de Janeiro (Brazil); Araújo, Claudio Gil Soares de [Programa de Pós-Graduação em Ciências do Exercício e do Esporte da Universidade Gama Filho, Rio de Janeiro (Brazil); CLINIMEX - Clínica de Medicina do Exercício, Rio de Janeiro (Brazil); Ferreira, Maria Cristina [Programa de Pós-Graduação em Psicologia da Universidade Salgado de Oliveira, Rio de Janeiro (Brazil); Eifert, Georg H. [Schmid College of Science and Technology Psychology, Crean School of Health and Life Sciences -Chapman University (United States)

    2013-12-15

    Cardiac Anxiety (CA) is the fear of cardiac sensations, characterized by recurrent anxiety symptoms, in patients with or without cardiovascular disease. The Cardiac Anxiety Questionnaire (CAQ) is a tool to assess CA, already adapted but not validated to Portuguese. This paper presents the three phases of the validation studies of the Brazilian CAQ. To extract the factor structure and assess the reliability of the CAQ (phase 1), 98 patients with coronary artery disease were recruited. The aim of phase 2 was to explore the convergent and divergent validity. Fifty-six patients completed the CAQ, along with the Body Sensations Questionnaire (BSQ) and the Social Phobia Inventory (SPIN). To determine the discriminative validity (phase 3), we compared the CAQ scores of two subgroups formed with patients from phase 1 (n = 98), according to the diagnoses of panic disorder and agoraphobia, obtained with the MINI - Mini International Neuropsychiatric Interview. A 2-factor solution was the most interpretable (46.4% of the variance). Subscales were named 'Fear and Hypervigilance' (n = 9; alpha = 0.88), and 'Avoidance', (n = 5; alpha = 0.82). Significant correlation was found between factor 1 and the BSQ total score (p < 0.01), but not with factor 2. SPIN factors showed significant correlations with CAQ subscales (p < 0.01). In phase 3, 'Cardiac with panic' patients scored significantly higher in CAQ factor 1 (t = -3.42; p < 0.01, CI = -1.02 to -0.27), and higher, but not significantly different, in factor 2 (t = -1.98; p = 0.51, CI = -0.87 to 0.00). These results provide a definite Brazilian validated version of the CAQ, adequate to clinical and research settings.

  12. Are major repeater patients addicted to suicidal behavior?

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    Blasco-Fontecilla, Hilario; Artieda-Urrutia, Paula; Berenguer-Elias, Nuria; Garcia-Vega, Juan Manuel; Fernandez-Rodriguez, Monica; Rodriguez-Lomas, Cesar; Gonzalez-Villalobos, Isabel; Iruela-Cuadrado, Luis; de Leon, José

    2014-01-01

    The literature provides support for the hypothesis that some major repeaters (individuals with >=5 lifetime suicide attempts) are addicted to suicidal behavior (SB). This study explores whether major repeaters are addicted to SB or not using 7 criteria: tolerance (Criterion 1), withdrawal (Criterion 2), loss of control (Criterion 3), problems in quitting/cutting down (Criterion 4), much time spent using (Criterion 5), substantial reduction in activities (Criterion 6), and adverse physiological/physical consequences (Criterion 7). Total dependence on SB was indicated by the presence of 3 or more of the 7 criteria in the last 12 months. This cross-sectional study at Puerta de Hierro University Hospital (Madrid, Spain) recruited 118 suicide attempters including 8 major repeaters (7%, 8/118), who were all females. The association between each SB addiction criterion, physiological dependence and total dependence with major repeater status was tested for significance and for effect size with odds ratios (ORs) and their 95% confidence intervals. As hypothesized, major repeaters met significantly higher frequency of criteria for total dependence on SB, OR=62.9 (6.4-615). A backward stepwise logistic regression model was used to provide an OR between major repeater status and total dependence status corrected by confounding variables. Age, panic disorder without agoraphobia, borderline personality disorder, history of psychiatric inpatient admission, and total dependence on SB were introduced as independent variables with major repeater status as the dependent variable. The model selected total dependence and age as the remaining significant variables in the last step. Accordingly, major repeaters appear to be addicted to SB. PMID:25580865

  13. MAOA and mechanisms of panic disorder revisited: from bench to molecular psychotherapy.

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    Reif, A; Richter, J; Straube, B; Höfler, M; Lueken, U; Gloster, A T; Weber, H; Domschke, K; Fehm, L; Ströhle, A; Jansen, A; Gerlach, A; Pyka, M; Reinhardt, I; Konrad, C; Wittmann, A; Pfleiderer, B; Alpers, G W; Pauli, P; Lang, T; Arolt, V; Wittchen, H-U; Hamm, A; Kircher, T; Deckert, J

    2014-01-01

    Panic disorder with agoraphobia (PD/AG) is a prevalent mental disorder featuring a substantial complex genetic component. At present, only a few established risk genes exist. Among these, the gene encoding monoamine oxidase A (MAOA) is noteworthy given that genetic variation has been demonstrated to influence gene expression and monoamine levels. Long alleles of the MAOA-uVNTR promoter polymorphism are associated with PD/AG and correspond with increased enzyme activity. Here, we have thus investigated the impact of MAOA-uVNTR on therapy response, behavioral avoidance and brain activity in fear conditioning in a large controlled and randomized multicenter study on cognitive behavioral therapy (CBT) in PD/AG. The study consisted of 369 PD/AG patients, and genetic information was available for 283 patients. Carriers of the risk allele had significantly worse outcome as measured by the Hamilton Anxiety scale (46% responders vs 67%, P=0.017). This was accompanied by elevated heart rate and increased fear during an anxiety-provoking situation, that is, the behavioral avoidance task. All but one panic attack that happened during this task occurred in risk allele carriers and, furthermore, risk allele carriers did not habituate to the situation during repetitive exposure. Finally, functional neuroimaging during a classical fear conditioning paradigm evidenced that the protective allele is associated with increased activation of the anterior cingulate cortex upon presentation of the CS+ during acquisition of fear. Further differentiation between high- and low-risk subjects after treatment was observed in the inferior parietal lobes, suggesting differential brain activation patterns upon CBT. Taken together, we established that a genetic risk factor for PD/AG is associated with worse response to CBT and identify potential underlying neural mechanisms. These findings might govern how psychotherapy can include genetic information to tailor individualized treatment approaches

  14. Reliability and validity of Chinese version of the Generalized Anxiety Disorder 7-item (GAD-7) scale in screening anxiety disorders in outpatients from traditional Chinese internal department%广泛性焦虑量表中文版在中医内科门诊人群应用的信度和效度

    Institute of Scientific and Technical Information of China (English)

    曾庆枝; 何燕玲; 刘寒; 缪菊明; 陈建新; 徐海楠; 王静夷

    2013-01-01

    Generalized Anxiety Disorder (GAD-7) scale in screening out anxiety disorders and to identify the cut-off score for screening anxiety in outpatients from traditional Chinese internal department, thereby providing scientific evidence for its implication. Methods: Totally 2011 patients aged 18 -65 years old were selected from an internal department of traditional Chinese medicine. They were assessed with the GAD-7 and interviewed with the Mini International Neuropsy-chiatric Interview (M. I. N. I. ). Internal consistency, explosive factor analysis, receiver operating characteristic curve (ROC), and variance analysis were used to evaluate the reliability and validity of GAD-7. Results: The Cron-bach's coefficient of GAD-7 was 0. 91, and the range of correlation coefficient within the 7 items and between items and the total score of the scale was 0. 52 -0. 68 and 0. 75 -0. 85, respectively (P <0. 01). The Cronbach's coefficients were stable when any of the 7 items had been deleted. The scale was shown to be one dimensional through factor analysis (explained variance = 72%). The results of ROC analysis indicated that the area under the curve (AUC) was very good for both the generalized anxiety disorder (for GAD, AUC =0. 88) and panic disorder (for panic disorder, AUC = 0. 80), but not for agoraphobia (for agoraphobia, AUC = 0. 63). A cut point of 6 showed adequate values of sensitivity and specificity for GAD (0. 86, 0. 76), and panic disorder (0. 78, 0. 74), while inadequate for agoraphobia (0. 50, 0. 73) or mixed anxiety-depressive disorder (0. 61, 0. 74). The GAD-7 scores were higher in patients with depressive disorders, any anxiety disorders or chronic physical conditions than in those without (P <0. 05). There was a strong association between increasing GAD-7 severity scores and health service utilization or worsening function. And for outpatients without anxiety, or with mild, moderate and severe anxiety severity score, the doctor visits were 8. 09, 8. 34,13. 45 and 11. 97

  15. Altered olfactory processing of stress-related body odors and artificial odors in patients with panic disorder.

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    Gloria-Beatrice Wintermann

    Full Text Available BACKGROUND: Patients with Panic Disorder (PD direct their attention towards potential threat, followed by panic attacks, and increased sweat production. Onés own anxiety sweat odor influences the attentional focus, and discrimination of threat or non-threat. Since olfactory projection areas overlap with neuronal areas of a panic-specific fear network, the present study investigated the neuronal processing of odors in general and of stress-related sweat odors in particular in patients with PD. METHODS: A sample of 13 patients with PD with/ without agoraphobia and 13 age- and gender-matched healthy controls underwent an fMRI investigation during olfactory stimulation with their stress-related sweat odors (TSST, ergometry as well as artificial odors (peach, artificial sweat as non-fearful non-body odors. PRINCIPAL FINDINGS: The two groups did not differ with respect to their olfactory identification ability. Independent of the kind of odor, the patients with PD showed activations in fronto-cortical areas in contrast to the healthy controls who showed activations in olfaction-related areas such as the amygdalae and the hippocampus. For artificial odors, the patients with PD showed a decreased neuronal activation of the thalamus, the posterior cingulate cortex and the anterior cingulate cortex. Under the presentation of sweat odor caused by ergometric exercise, the patients with PD showed an increased activation in the superior temporal gyrus, the supramarginal gyrus, and the cingulate cortex which was positively correlated with the severity of the psychopathology. For the sweat odor from the anxiety condition, the patients with PD showed an increased activation in the gyrus frontalis inferior, which was positively correlated with the severity of the psychopathology. CONCLUSIONS: The results suggest altered neuronal processing of olfactory stimuli in PD. Both artificial odors and stress-related body odors activate specific parts of a fear

  16. Development of mental health first aid guidelines for panic attacks: a Delphi study

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    Jorm Anthony F

    2009-08-01

    Full Text Available Abstract Background Panic attacks are common, and while they are not life-threatening events, they can lead to the development of panic disorder and agoraphobia. Appropriate help at the time that a panic attack occurs may decrease the fear associated with the attack and reduce the risk of developing an anxiety disorder. However, few people have the knowledge and skills required to assist. Simple first aid guidelines may help members of the public to offer help to people who experience panic attacks. Methods The Delphi method was used to reach consensus in a panel of experts. Experts included 50 professionals and 6 people who had experience of panic attacks and were active in mental health advocacy. Statements about how to assist someone who is having a panic attack were sourced through a systematic search of both professional and lay literature. These statements were rated for importance as first aid guidelines by the expert and consumer panels and guidelines were written using the items most consistently endorsed. Results Of 144 statements presented to the panels, 27 were accepted. These statements were used to develop the guidelines appended to this paper. Conclusion There are a number of actions which are considered to be useful for members of the public to do if they encounter someone who is having a panic attack. These guidelines will be useful in revision of curricula of mental health first aid programs. They can also be used by members of the public who want immediate information about how to assist someone who is experiencing panic attacks.

  17. Psychedelics and mental health: a population study.

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    Teri S Krebs

    Full Text Available BACKGROUND: The classical serotonergic psychedelics LSD, psilocybin, mescaline are not known to cause brain damage and are regarded as non-addictive. Clinical studies do not suggest that psychedelics cause long-term mental health problems. Psychedelics have been used in the Americas for thousands of years. Over 30 million people currently living in the US have used LSD, psilocybin, or mescaline. OBJECTIVE: To evaluate the association between the lifetime use of psychedelics and current mental health in the adult population. METHOD: Data drawn from years 2001 to 2004 of the National Survey on Drug Use and Health consisted of 130,152 respondents, randomly selected to be representative of the adult population in the United States. Standardized screening measures for past year mental health included serious psychological distress (K6 scale, mental health treatment (inpatient, outpatient, medication, needed but did not receive, symptoms of eight psychiatric disorders (panic disorder, major depressive episode, mania, social phobia, general anxiety disorder, agoraphobia, posttraumatic stress disorder, and non-affective psychosis, and seven specific symptoms of non-affective psychosis. We calculated weighted odds ratios by multivariate logistic regression controlling for a range of sociodemographic variables, use of illicit drugs, risk taking behavior, and exposure to traumatic events. RESULTS: 21,967 respondents (13.4% weighted reported lifetime psychedelic use. There were no significant associations between lifetime use of any psychedelics, lifetime use of specific psychedelics (LSD, psilocybin, mescaline, peyote, or past year use of LSD and increased rate of any of the mental health outcomes. Rather, in several cases psychedelic use was associated with lower rate of mental health problems. CONCLUSION: We did not find use of psychedelics to be an independent risk factor for mental health problems.

  18. The early-onset fearful panic attack as a predictor of severe psychopathology.

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    Goodwin, Renee D; Hamilton, Steven P

    2002-01-31

    The objective of this study was to replicate previous findings indicating that early-onset panic attack (< or =20 years) with fear represents a possible prodrome of early-onset severe psychopathology. Data were drawn from the Epidemiologic Catchment Area Survey (ECA) (n=20 291), a household sample of adults aged 18 and older drawn from five cities in the United States. Multivariate logistic regression analyses were used to differentiate those with early-onset panic attacks with fear from those with other panic attacks (early-onset without fear, late-onset without fear, late-onset with fear) with regard to psychiatric comorbidity, age at onset of comorbid mental disorders, and suicidal ideation and suicide attempts. Results of statistical analyses revealed that early-onset fearful panic attack (n=368) was associated with increased likelihood of major affective and substance use disorders, significantly earlier onset of comorbid mental disorders, higher rates of suicidal ideation and suicide attempt, and higher rates of antisocial personality disorder compared with those with other subtypes of panic attacks. Multiple logistic regression analyses showed that early-onset fearful panic was independently associated with increased odds of major depression [OR=3.0 (2.6, 3.5)], bipolar disorder [OR=7.9 (5.7, 10.8)], antisocial personality disorder [OR=1.5 (1.3, 1.7)], agoraphobia [OR=1.2 (1.1, 1.4)], simple phobia [OR=1.6 (1.4, 1.8)], and alcohol dependence [OR=1.3 (1.2, 1.5)], compared with those with all other panic attacks. These findings are consistent with previous epidemiologic data and provide new evidence to suggest that early-onset fearful panic attack may be a marker of increased vulnerability to severe and persistent psychopathology and associated with high rates of suicidality. PMID:11850053

  19. Are major repeater patients addicted to suicidal behavior?

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    Blasco-Fontecilla, Hilario; Artieda-Urrutia, Paula; Berenguer-Elias, Nuria; Garcia-Vega, Juan Manuel; Fernandez-Rodriguez, Monica; Rodriguez-Lomas, Cesar; Gonzalez-Villalobos, Isabel; Iruela-Cuadrado, Luis; de Leon, José

    2014-01-01

    The literature provides support for the hypothesis that some major repeaters (individuals with >=5 lifetime suicide attempts) are addicted to suicidal behavior (SB). This study explores whether major repeaters are addicted to SB or not using 7 criteria: tolerance (Criterion 1), withdrawal (Criterion 2), loss of control (Criterion 3), problems in quitting/cutting down (Criterion 4), much time spent using (Criterion 5), substantial reduction in activities (Criterion 6), and adverse physiological/physical consequences (Criterion 7). Total dependence on SB was indicated by the presence of 3 or more of the 7 criteria in the last 12 months. This cross-sectional study at Puerta de Hierro University Hospital (Madrid, Spain) recruited 118 suicide attempters including 8 major repeaters (7%, 8/118), who were all females. The association between each SB addiction criterion, physiological dependence and total dependence with major repeater status was tested for significance and for effect size with odds ratios (ORs) and their 95% confidence intervals. As hypothesized, major repeaters met significantly higher frequency of criteria for total dependence on SB, OR=62.9 (6.4-615). A backward stepwise logistic regression model was used to provide an OR between major repeater status and total dependence status corrected by confounding variables. Age, panic disorder without agoraphobia, borderline personality disorder, history of psychiatric inpatient admission, and total dependence on SB were introduced as independent variables with major repeater status as the dependent variable. The model selected total dependence and age as the remaining significant variables in the last step. Accordingly, major repeaters appear to be addicted to SB.

  20. Duloxetine in panic disorder with somatic gastric pain

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    Preve M

    2013-11-01

    Full Text Available Matteo Preve,1 Cristiana Nisita,1 Massimo Bellini,2 Liliana Dell'Osso1 1Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, 2Department of Gastroenterology, Gastrointestinal Unit, University of Pisa, Pisa, Italy Abstract: Panic disorder is the most common type of anxiety disorder, and its most common expression is panic attacks characterized with sudden attacks of anxiety with numerous symptoms, including palpitations, tachycardia, tachypnea, nausea, and vertigo: ie, cardiovascular, gastroenterologic, respiratory, and neuro-otologic symptoms. In clinical practice, panic disorder manifests with isolated gastroenteric or cardiovascular symptoms, requiring additional clinical visits after psychiatric intervention. The first-line treatment for anxiety disorders, and in particular for panic disorder, is the selective serotonin reuptake inhibitors. However, these drugs can have adverse effects, including sexual dysfunction, increased bodyweight, and abnormal bleeding, that may be problematic for some patients. Here we report the case of a 29-year-old Caucasian woman affected by panic disorder with agoraphobia who was referred to our clinic for recurrent gastroenteric panic symptoms. The patient reported improvement in her anxiety symptoms and panic attacks while on a selective serotonin reuptake inhibitor, but not in her gastric somatic problems, so the decision was taken to start her on duloxetine, a serotonin-norepinephrine reuptake inhibitor. After 6 months of treatment, the patient achieved complete remission of her gastric and panic-related symptoms, and was able to stop triple gastric therapy. Other authors have hypothesized and confirmed that duloxetine has greater initial noradrenergic effects than venlafaxine and is effective in patients with panic disorder. This case report underscores the possibility of tailoring therapeutic strategies for the gastroenteric expression of panic disorder. Keywords: anxiety disorder, panic

  1. Female Flinders Sensitive Line rats show estrous cycle-independent depression-like behavior and altered tryptophan metabolism.

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    Eskelund, Amanda; Budac, David P; Sanchez, Connie; Elfving, Betina; Wegener, Gregers

    2016-08-01

    Clinical studies suggest a link between depression and dysfunctional tryptophan (TRP) metabolism. Even though depression is twice as prevalent in women as men, the impact of the estrous cycle on TRP metabolism is not well-understood. Here we investigated 13 kynurenine and serotonin metabolites in female Flinders Sensitive Line (FSL) rats, a genetic rat model of depression. FSL rats and controls (Flinders Resistant Line rats), 12-20weeks old, were subject to the forced swim test (FST), a commonly used measure of depression-like behavior. Open field was used to evaluate locomotor ability and agoraphobia. Subsequently, plasma and hemispheres were collected and analyzed for their content of TRP metabolites using liquid chromatography-tandem mass spectrometry. Vaginal saline lavages were obtained daily for ⩾2 cycles. To estimate the effects of sex and FST we included plasma from unhandled, naïve male FSL and FRL rats. Female FSL rats showed a depression-like phenotype with increased immobility in the FST, not confounded by anxiety. In the brain, 3-hydroxykynurenine was increased whereas anthranilate and 5-hydroxytryptophan were decreased. In plasma, anthranilate and quinolinate levels were lower in FSL rats compared to the control line, independent of sex and FST. The estrous cycle neither impacted behavior nor TRP metabolite levels in the FSL rat. In conclusion, the female FSL rat is an interesting preclinical model of depression with altered TRP metabolism, independent of the estrous cycle. The status of the pathway in brain was not reflected in the plasma, which may indicate that an inherent local, cerebral regulation of TRP metabolism occurs. PMID:27210075

  2. Atypical depression: useful concept, but it's time to revise the DSM-IV criteria.

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    Thase, Michael E

    2009-12-01

    Stewart et al (2009) have outlined the evidence in support of the validity of the DSM-IV definition of the 'With Atypical Features' episode specifier. Although recognizing the historical significance and clinical utility of the concept of atypical depression, this article takes issue with the DSM-IV criteria. It is concluded that mood reactivity, the A or obligative criterion, is neither significantly associated with the other symptomatic criteria nor useful to diagnose atypical depression, and thus should be eliminated. Problems with operationalization, specification, and reliability of ratings of the diagnostic criteria further limit validity. Despite these limitations in classification, many of the features associated with atypical depression are linked to an early onset of affective illness, including trait-like interpersonal sensitivity, comorbid social anxiety and agoraphobia, a history of childhood physical or sexual trauma, and indicators of the 'soft' side of the bipolar spectrum. Neurophysiologic studies also suggest that chronic, early-onset atypical depressions differ from both melancholia and normality. Re-analyses of the Columbia group's seminal studies suggest that preferential response to phenelzine vs imipramine--arguably the strongest validator of atypical depression--similarly appears to be limited to patients with chronic, early-onset syndromes. The criteria for atypical depression need to be revised in DSM-V, including sharpening the operational definitions for the specific symptoms. The importance of age of onset and comorbid anxiety warrant further study. Research examining the validity of a subform of atypical depression characterized by trait-like interpersonal sensitivity and a chronic, early-onset course may further enhance the clinical utility of the DSM-V classification. PMID:19741592

  3. Psychological evaluation of patients with a thyroid nodule before and after surgical treatment

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    Čaparević Zorica

    2002-01-01

    Full Text Available Introduction Association between endocrine and mental disorders has been recognized a long time ago, as well as their mutual dependence. The aim of this study was to evaluate the psychological structure of patients with thyroid nodule before and after surgical treatment. Material and methods In order to establish the type and degree of psychological disorders, we have examined 60 patients with thyroid nodule before and after surgical treatment by using DSM-IV classification of mental disorders and psychological instruments: semi structured psychiatric interview, MMPI, Zung Depression Scale and a list of panic symptoms. Patients with nonautonomous ("cold" nodules presented as euthyroid, and those with autonomous ("hot" nodules (after a period of drug therapy if they were hyperthyroid, required surgery. After a period of drug therapy two groups of patients were compared: group 1- euthyroid with "cold" nodules and group 2 - euthyroid with "hot" nodules. Before surgical treatment both groups under went psychological evaluation. Group 2 presented with: anxiety, depression and panic disorder with or without agoraphobia (72%, 46%, 28% while group 1 presented with following results: 48%, 23%, 14% respectively. After surgical treatment patients from group 1 presented with psychologic disorders in less than 1%. Discussion and conclusion In some physical disorders, psychologic factors contribute directly or indirectly to the etiology, in others, psychologic symptoms are the direct results of a lesion affecting neural or endocrine organs. One of the key etiological factors is often a short-time or long-time stress and its direct consequence is altered functioning of various hormonal systems. Unexpected high percentage of psychological disorders in patients with thyroid disorders suggests that psychological evaluation before and after surgical treatment is unavoidable for good assessment and choice of treatment. These patients need psychotherapeutic and

  4. The common traits of the ACC and PFC in anxiety disorders in the DSM-5: meta-analysis of voxel-based morphometry studies.

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    Jing Shang

    Full Text Available BACKGROUND: The core domains of social anxiety disorder (SAD, generalized anxiety disorder (GAD, panic disorder (PD with and without agoraphobia (GA, and specific phobia (SP are cognitive and physical symptoms that are related to the experience of fear and anxiety. It remains unclear whether these highly comorbid conditions that constitute the anxiety disorder subgroups of the Diagnostic and Statistical Manual for Mental Disorders--Fifth Edition (DSM-5 represent distinct disorders or alternative presentations of a single underlying pathology. METHODS: A systematic search of voxel-based morphometry (VBM studies of SAD, GAD, PD, GA, and SP was performed with an effect-size signed differential mapping (ES-SDM meta-analysis to estimate the clusters of significant gray matter differences between patients and controls. RESULTS: Twenty-four studies were eligible for inclusion in the meta-analysis. Reductions in the right anterior cingulate gyrus and the left inferior frontal gyrus gray matter volumes (GMVs were noted in patients with anxiety disorders when potential confounders, such as comorbid major depressive disorder (MDD, age, and antidepressant use were controlled for. We also demonstrated increased GMVs in the right dorsolateral prefrontal cortex (DLPFC in comorbid depression-anxiety (CDA, drug-naïve and adult patients. Furthermore, we identified a reduced left middle temporal gyrus and right precentral gyrus in anxiety patients without comorbid MDD. CONCLUSION: Our findings indicate that a reduced volume of the right ventral anterior cingulate gyrus and left inferior frontal gyrus is common in anxiety disorders and is independent of comorbid depression, medication use, and age. This generic effect supports the notion that the four types of anxiety disorders have a clear degree of overlap that may reflect shared etiological mechanisms. The results are consistent with neuroanatomical DLPFC models of physiological responses, such as worry and

  5. Routine general practice care for panic disorder within the lifestyle approach to managing panic study

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    Rodney A. Lambert

    2012-07-01

    Full Text Available Routine general practice (GP care is rarely comprehensively described in clinical trials. This paper examines routine GP care within the lifestyle approach to managing panic (LAMP study. The aim of this paper is to describe/discuss routine GP care for panic disorder (PD patients within both study arms in the LAMP study. An unblinded pragmatic randomised controlled trial in 15 East of England GP practices (2 primary care trusts. Participants met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for PD with/without agoraphobia. Follow-up measures recorded at 20 weeks/10 months following randomisation. Control arm, unrestricted routine GP care (practice appointments, referrals and prescriptions. Trial arm, occupational therapyled lifestyle treatment comprising lifestyle review of fluid intake, diet pattern, exercise, caffeine, alcohol and nicotine. Primary outcome measure: beck anxiety inventory. At baseline, participants attended 2-3 times more GP appointments than population average, reducing at 10 months to 1.6 times population average for routine GP care and 0.97 population average for lifestyle arm. At 10 months, 33% fewer referrals (6 referrals; 0 mental health than at baseline (9 referrals; 2 mental health were made for lifestyle arm patients compared with 42% increase (from 12 referrals; 8 mental health at baseline to 17 referrals; 7 mental health in GP care arm. Selective serotonin reuptake inhibitors were prescribed most often. Benzodiazepines and beta-blockers were prescribed more often than tricyclic against current clinical guidelines. In conclusion, we found that PD patients at baseline were high healthcare resource users. Treatment in both study arms reduced resource use. Routine GP care requires further review for this patient group.

  6. Suicide risk and alcohol and drug abuse in outpatients with HIV infection and Chagas disease

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    Patrícia M. Guimarães

    2014-05-01

    Full Text Available Objective: To evaluate psychiatric comorbidities in outpatients receiving care for HIV and Chagas disease at Instituto de Pesquisa Clínica Evandro Chagas (IPEC, Fundação Oswaldo Cruz (Fiocruz, Rio de Janeiro, Brazil. Methods: Cross-sectional study with a consecutive sample of 125 patients referred to an outpatient psychiatric clinic from February to December 2010. The Mini International Neuropsychiatric Interview (MINI was used. Factors associated with more frequent mental disorders were estimated by odds ratios (OR with 95% confidence intervals (95%CI by multiple logistic regression. Results: Seventy-six (60.8% patients with HIV, 40 (32% patients with Chagas disease, and nine (7.2% patients with human T-lymphotropic virus were interviewed. The majority were women (64%, with up to 8 years of formal education (56%, and unemployed (81.6%. The median age was 49 years. Suicide risk (n=71 (56%, agoraphobia (n=65 (52%, major depressive episode (n=56 (44.8%, and alcohol/drug abuse (n=43 (34.4% predominated, the latter being directly associated with lower family income (OR = 2.64; 95%CI 1.03-6.75 and HIV infection (OR = 5.24; 95%CI 1.56-17.61. Suicide risk was associated with non-white skin color (OR = 2.21; 95%CI 1.03-4.75, unemployment (OR = 2.72; 95%CI 1.01-7.34, and diagnosis of major depression (OR = 3.34; 95%CI 1.54-7.44. Conclusion: Measures targeting adverse socioeconomic conditions and psychiatric and psychological monitoring and care should be encouraged in this population, considering the association with abuse of alcohol/other psychoactive drugs and suicide risk.

  7. Extraversion and psychopathology: A facet-level analysis.

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    Watson, David; Stasik, Sara M; Ellickson-Larew, Stephanie; Stanton, Kasey

    2015-05-01

    The goal of this study was to explicate how the lower order facets of extraversion are related to psychopathology. We used a "bottom-up" approach in which specific extraversion scales from 3 comprehensive personality inventories were used to model these facets as latent factors. We collected both self-report and interview measures of a broad range of psychopathology from a large community sample. Replicating previous findings using a similar approach (Naragon-Gainey & Watson, 2014; Naragon-Gainey, Watson, & Markon, 2009), structural analyses yielded four factors: Positive Emotionality, Sociability, Assertiveness, and Experience Seeking. Scores on these latent dimensions were related to psychopathology in correlational analyses and in two sets of regressions (the first series used the four facets as predictors; the second included composite scores on the other Big Five domains as additional predictors). These results revealed a striking level of specificity. As predicted, Positive Emotionality displayed especially strong negative links to depressive symptoms and diagnoses. Sociability also was negatively related to psychopathology, showing particularly strong associations with indicators of social dysfunction and the negative symptoms of schizotypy (i.e., social anxiety, social aloofness, and restricted affectivity). Assertiveness generally had weak associations at the bivariate level but was negatively related to social anxiety and was positively correlated with some forms of externalizing. Finally, Experience Seeking had substantial positive associations with a broad range of indicators related to externalizing and bipolar disorder; it also displayed negative links to agoraphobia. These differential correlates demonstrate the importance of examining personality-psychopathology relations at the specific facet level. PMID:25751628

  8. Psychopharmacotherapy of panic disorder: 8-week randomized trial with clonazepam and paroxetine

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    A.E. Nardi

    2011-04-01

    Full Text Available The objective of the present randomized, open-label, naturalistic 8-week study was to compare the efficacy and safety of treatment with clonazepam (N = 63 and paroxetine (N = 57 in patients with panic disorder with or without agoraphobia. Efficacy assessment included number of panic attacks and clinician ratings of the global severity of panic disorders with the clinical global impression (CGI improvement (CGI-I and CGI severity (CGI-S scales. Most patients were females (69.8 and 68.4% in the clonazepam and paroxetine groups, respectively and age (mean ± SD was 35.9 ± 9.6 years for the clonazepam group and 33.7 ± 8.8 years for the paroxetine group. Treatment with clonazepam versus paroxetine resulted in fewer weekly panic attacks at week 4 (0.1 vs 0.5, respectively; P < 0.01, and greater clinical improvements at week 8 (CGI-I: 1.6 vs 2.9; P = 0.04. Anxiety severity was significantly reduced with clonazepam versus paroxetine at weeks 1 and 2, with no difference in panic disorder severity. Patients treated with clonazepam had fewer adverse events than patients treated with paroxetine (73 vs 95%; P = 0.001. The most common adverse events were drowsiness/fatigue (57%, memory/concentration difficulties (24%, and sexual dysfunction (11% in the clonazepam group and drowsiness/fatigue (81%, sexual dysfunction (70%, and nausea/vomiting (61% in the paroxetine group. This naturalistic study confirms the efficacy and tolerability of clonazepam and paroxetine in the acute treatment of patients with panic disorder.

  9. Psychiatric morbidity in dermatology patients: Frequency and results of consultations

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    Seyhan Muammer

    2006-01-01

    Full Text Available BACKGROUND: Dermatological patients quite commonly depict psychiatric morbidity. PURPOSES: To study the psychiatric morbidity among skin patients of our clinic. METHODS: In the present study, the patients who were treated in the Dermatology Clinic of Inonu University Medical Faculty were evaluated retrospectively. The age, gender, marital status, habits, dermatological and systemic diseases, previously used drugs, current therapy and psychiatric diagnosis of each patient were recorded. FINDINGS: Of 636 patients involved in the study, 15.3% had psychopathological problems, which were depression (32.0%, adjustment difficulty (15.5%, anxiety (13.4%, psychosomatic disorders (10.3%, obsessive-compulsive disorder and conversion (5.1%, dysthymic disorder (4.1%, attention deficit and hyperactivity disorder (2.1%, panic attack (1.0%, premenstrual syndrome, schizophrenia, somatization disorder, insomnia, alcohol dependency, bipolar affective disorder, mental retardation, agoraphobia, social phobia and dementia. The dermatological diseases defined for the patients with psychopathology diagnosis were chronic urticaria (25.8%; psoriasis (15.5%; alopecia areata, totalis and iniversalis (11.3%; acute urticaria, neurodermatitis and Behcet′s disease (5.1%; atopic dermatitis and drug eruptions (4.1%; pemphigus (3.1%; angioedema, contact dermatitis and generalized pruritus (2.1%; folliculitis and the others (1.0%. CONCLUSIONS: Psychiatric morbidity has an affect on the course of dermatological diseases. When required, psychiatric consultation should be sought by dermatology clinics and patients should be followed with the cooperation of dermatologists and psychiatrists. LIMITATION: The indoor-based study had not included any control group and any domicillary patient.

  10. The vestibular dysfunction and anxiety disorder interface: a descriptive study with special reference to the elderly.

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    Nagaratnam, Nages; Ip, Jerome; Bou-Haidar, Pascal

    2005-01-01

    Vestibular abnormalities co-existing with anxiety disorders are not uncommon and there has been a renewal of interest in recent times. Although well known over centuries, there is often a delay in the recognition of this relationship by the primary care physician and the specialist alike. Dizziness embracing vertigo, unsteadiness and imbalance are common in the elderly, so is generalized anxiety disorder, which is a common psychiatric problem in later life. This is a retrospective study of eight patients with vestibular symptoms and an anxiety disorder present over several years with lack of awareness of their relationship. The diagnoses of the anxiety disorders were based on the Diagnostic and Statistical Manual (DSM-IV) criteria and the effect of treatment measured on a clinician-based impression interview. There was one male and seven females and the mean age was 72 years. Apart from the vestibular symptoms present in all the patients, the anxiety disorders comprised, generalized anxiety disorder in three, panic attacks in five and with agoraphobia in three. Four patients had hyperventilation, one sleep apnea, and two somatization disorders. They had all presented to clinicians in different disciplines and had had several investigations. Five had been treated in this study with alprazolam and three with citalopram, with modest to good results. Two had rehabilitation therapy as well. The cases described mirror the well-documented co-existence of vestibular and anxiety disorders together with hyperventilation and sleep apnea. The positive findings associated with vestibular dysfunction need recognition in addition to the non-specific psychiatric and behavioral symptoms. We emphasize this relationship and review the literature to alert the clinician. PMID:15814159

  11. [Separation anxiety. Theoretical considerations].

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    Blandin, N; Parquet, P J; Bailly, D

    1994-01-01

    The interest in separation anxiety is nowadays increasing: this disorder appearing during childhood may predispose to the occurrence of anxiety disorders (such as panic disorder and agoraphobia) and major depression into adulthood. Psychoanalytic theories differ on the nature of separation anxiety and its place in child development. For some authors, separation anxiety must be understood as resulting from the unconscious internal conflicts inherent in the individuation process and gradual attainment of autonomy. From this point of view, the fear of loss of mother by separation is not regarded as resulting from a real danger. However, Freud considers the primary experience of separation from protecting mother as the prototype situation of anxiety and compares the situations generating fear to separation experiences. For him, anxiety originates from two factors: the physiological fact is initiated at the time of birth but the primary traumatic situation is the separation from mother. This point of view may be compared with behavioral theories. Behavioral theories suggest that separation anxiety may be conditioned or learned from innate fears. In Freud's theory, the primary situation of anxiety resulting from the separation from mother plays a role comparable to innate fears. Grappling with the problem of separation anxiety, Bowlby emphasizes then the importance of the child's attachment to one person (mother or primary caregiver) and the fact that this attachment is instinctive. This point of view, based on the watch of infants, is akin to ethological theories on behaviour of non human primates. Bowlby especially shows that the reactions of infant separated from mother evolve on three stages: the phase of protestation which may constitute the prototype of adulthood anxiety, the phase of desperation which may be the prototype of depression, and the phase of detachment. He emphasizes so the role of early separations in the development of vulnerability to depression

  12. Comorbid anxiety and depression disorders in patients with chronic pain Transtornos ansiosos e depressivos em pacientes com dor crônica

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    Martha Castro

    2009-12-01

    Full Text Available OBJECTIVE: To evaluate the frequency of anxiety and depression disorders in patients with chronic pain. METHOD: Patients receiving care at the pain clinic of the Federal University of Bahia between February 2003 and November 2006. The MINI PLUS - Mini International Neuropsychiatric Interview was used to evaluate the patients and establish psychiatric diagnoses. RESULTS: 400 patients were evaluated mean age was 45.6±11.37 years; 82.8% were female, 17.3% male; 48.5% were married; 55.1% were Catholics; and 40.5% had only high school education. Of these 29.9% reported intense pain and 70.8% reported suffering pain daily. The most frequent medical diagnosis was herniated disc (24.5%, and 48.5% of patients had been undergoing treatment at the pain clinic for less than 3 months. Comorbidities found were depressive episodes (42%, dysthymia (54%, social phobia (36.5%, agoraphobia (8.5% and panic disorder (7.3%. CONCLUSION: Psychiatric comorbidities are prevalent in patients suffering chronic pain.OBJETIVO: Avaliar a freqüência de transtornos ansiosos e depressivos em pacientes com dor crônica. MÉTODO: Os pacientes foram avaliados na clínica da dor da Universidade Federal da Bahia entre fevereiro 2003 e novembro 2006. O Mini-plus - entrevista neuropsiquiátrica internacional foi usado para estabelecer diagnósticos psiquiátricos nos pacientes. RESULTADOS: Foram avaliados 400 pacientes com idade média de 45,6±11,37 anos; 82,8% eram mulheres, homens 17,3%; 48,5% eram casados; 55,1% católicos; e 40,5% concluíram o segundo grau, 29,9% relataram dor intensa e 70,8% relataram sentir dor diariamente. O diagnóstico médico o mais freqüente foi hérnia de disco (24,5%, e 48,5% dos pacientes submeteu-se ao tratamento na clínica da dor por menos de 3 meses. Comorbidades encontradas foram episódios depressivos (42%, distimia (54%, fobia social (36,5%, agorafobia (8,5% e transtorno de pânico (7,3%. CONCLUSÃO: Comorbidades psiquiátricas s

  13. Psychiatric comorbidities in patients with major depressive disorder

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    Thaipisuttikul P

    2014-11-01

    Full Text Available Papan Thaipisuttikul, Pichai Ittasakul, Punjaporn Waleeprakhon, Pattarabhorn Wisajun, Sudawan Jullagate Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand Background: Psychiatric comorbidities are common in major depressive disorder (MDD. They may worsen outcome and cause economic burden. The primary objective was to examine the prevalence of psychiatric comorbidities in MDD. The secondary objectives were to compare the presence of comorbidities between currently active and past MDD, and between patients with and without suicidal risk.Methods: This was a cross-sectional study. A total of 250 patients with lifetime MDD and age ≥18 years were enrolled. The Mini International Neuropsychiatric Interview (MINI, Thai version, was used to confirm MDD diagnosis and classify comorbidities. MDD diagnosis was confirmed in 190, and 60 patients were excluded due to diagnosis of bipolar disorder.Results: Of the 190 MDD patients, 25.8% had current MDD and 74.2% had past MDD. Eighty percent were women. The mean age at enrollment was 50 years, and at MDD onset was 41 years. Most patients were married (53.2%, employed (54.8%, and had ≥12 years of education (66.9%. There were 67 patients (35.3% with one or more psychiatric comorbidities. Comorbidities included dysthymia (19.5%, any anxiety disorders (21.1% (panic disorder [6.8%], agoraphobia [5.8%], social phobia [3.7%], obsessive–compulsive disorder [OCD] [4.7%], generalized anxiety disorder [5.3%], and post-traumatic stress disorder [4.2%], alcohol dependence (0.5%, psychotic disorder (1.6%, antisocial personality (1.1%, and eating disorders (0%. Compared with past MDD, the current MDD group had significantly higher OCD (P<0.001, psychotic disorder (P=0.048, past panic disorder (P=0.017, and suicidal risk (P<0.001. Suicidal risk was found in 32.1% of patients. Patients with suicidal risk had more comorbid anxiety disorder of any type (P=0.019 and

  14. Predictors of suicide attempters in substance-dependent patients: a six-year prospective follow-up

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    Vaglum Per

    2007-10-01

    Full Text Available Abstract Background This is a six-year prospective follow-up of a former cross sectional study of suicide attempters in a sample of treatment-seeking substance-dependent patients. The aims were to explore the frequency of patients with new suicide attempts (SA during the six-year observation period, and to explore the predictive value of lifetime Axis I and II disorders, measured at index admission, on SA in the observation period, when age, gender and substance-use variables, measured both at admission and at follow-up, were controlled for. Methods A consecutive sample of 156 alcohol-dependent and 131 poly-substance-dependent inpatients and outpatients in two Norwegian counties were assessed at index admission (T1 with the Composite International Diagnostic Interview (Axis I disorders, Mon's Clinical Multiaxial Inventory (Axis II disorders and Hopkins Symptom Checklist-25 (mental distress. At follow-up six years later (T2, 56% (160/287 subjects, 29% women were assessed using the HSCL-25 and measures of harmful substance use (Alcohol Use Disorders Identification Test and Drug Use Disorders Identification Test. Results The prevalence of patients with SA between T1 and T2 was 19% (30/160, with no difference between sexes or between patient type (alcohol-dependent versus poly-substance-dependent. Sober patients also attempted suicide. At the index admission, lifetime eating disorders, agoraphobia with and without panic disorder, and major depression were significantly and independently associated with SA. Prospectively, only lifetime dysthymia increased the risk of SA during the following six years, whereas lifetime generalized anxiety disorder reduced the risk of SA. Individually, neither the numbers of Axis I and Axis II disorders nor the sum of these disorders were independently related to SA in the observation period. Substance use measured at T1 did not predict SA in the follow-up period, nor did harmful use of substances at follow-up or in

  15. Decreased mean platelet volume in panic disorder

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    Göğçegöz Gül I

    2014-09-01

    Full Text Available Işil Göğçegöz Gül, Gül Eryilmaz, Eylem Özten, Gökben Hizli Sayar Neuropsychiatry Health, Practice, and Research Center, Uskudar University, Istanbul, Turkey Aim: The relationship between psychological stress and platelet activation has been widely studied. It is well known that platelets may reflect certain biochemical changes that occur in the brain when different mental conditions occur. Platelet 5-hydroxytryptamine (5-HT is also extensively studied in psychiatry. The mean platelet volume (MPV, the accurate measure of platelet size, has been considered a marker and determinant of platelet function. The aim of the present study was to search for any probable difference in the MPV of subjects with panic disorder (PD.Methods: A total of 37 drug-free subjects, aged 18 to 65 years, diagnosed with PD, with or without agoraphobia, according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth edition (DSM-IV criteria and 45 healthy control subjects were included in the study. Platelet count and MPV were measured and recorded for each subject.Results: There were no statistically significant differences between groups in terms of female/male ratio, age, or body mass index between the PD group and control group (P=0.91, P=0.82, and P=0.93, respectively. The MPV was found to be significantly lower in the PD group compared with the control group (8.8±0.9 fL vs 9.2±0.8 fL; P=0.02. All the participants had MPV values in the standard range of 6.9–10.8 fL.Conclusion: We concluded that abnormalities of the 5-HT1A receptor function in the central nervous system of subjects with a diagnosis of PD are also mirrored in as an alteration in platelet activity. Measurements of platelet activity may be used as a tool for neuropsychiatric and psychopharmacological research and for studying how certain mental diseases and medications affect the central nervous system. Keywords: 5-HT, thrombocyte, anxiety 

  16. An empirical comparison of atypical bulimia nervosa and binge eating disorder

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    Fontenelle L.F.

    2005-01-01

    Full Text Available The International Classification of Diseases, 10th edition (ICD-10 defines atypical bulimia nervosa (ABN as an eating disorder that encompasses several different syndromes, including the DSM-IV binge eating disorder (BED. We investigated whether patients with BED can be differentiated clinically from patients with ABN who do not meet criteria for BED. Fifty-three obese patients were examined using the Structured Clinical Interview for DSM-IV and the ICD-10 criteria for eating disorders. All volunteers completed the Binge Eating Scale (BES, the Beck Depression Inventory, and the Symptom Checklist-90 (SCL-90. Individuals fulfilling criteria for both ABN and BED (N = 18, ABN without BED (N = 16, and obese controls (N = 19 were compared and contrasted. Patients with ABN and BED and patients with ABN without BED displayed similar levels of binge eating severity according to the BES (31.05 ± 7.7 and 30.05 ± 5.5, respectively, which were significantly higher than those found in the obese controls (18.32 ± 8.7; P < 0.001 and P < 0.001, respectively. When compared to patients with ABN and BED, patients with ABN without BED showed increased lifetime rates of agoraphobia (P = 0.02 and increased scores in the somatization (1.97 ± 0.85 vs 1.02 ± 0.68; P = 0.001, obsessive-compulsive (2.10 ± 1.03 vs 1.22 ± 0.88; P = 0.01, anxiety (1.70 ± 0.82 vs 1.02 ± 0.72; P = 0.02, anger (1.41 ± 1.03 vs 0.59 ± 0.54; P = 0.005 and psychoticism (1.49 ± 0.93 vs 0.75 ± 0.55; P = 0.01 dimensions of the SCL-90. The BED construct may represent a subgroup of ABN with less comorbities and associated symptoms.

  17. Psychiatric disorders and associated factors in cancer: results of an interview study with patients in inpatient, rehabilitation and outpatient treatment.

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    Härter, M; Reuter, K; Aschenbrenner, A; Schretzmann, B; Marschner, N; Hasenburg, A; Weis, J

    2001-07-01

    disorders are mainly due to phobias (simple, social and agoraphobia) without urgent need for treatment. A relatively large portion of patients, however, fulfil the criteria of minor depressive disorder which deserves clinical attention. PMID:11435069

  18. Psychotherapy mediated by remote communication technologies: a meta-analytic review

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    Richards David

    2008-07-01

    Full Text Available Abstract Background Access to psychotherapy is limited by psychopathology (e.g. agoraphobia, physical disability, occupational or social constraints and/or residency in under-served areas. For these populations, interventions delivered via remote communication technologies (e.g. telephone, internet may be more appropriate. However, there are concerns that such delivery may influence the therapeutic relationship and thus reduce therapy effectiveness. This review aimed to determine the clinical effectiveness of remotely communicated, therapist-delivered psychotherapy. Methods Systematic review (including electronic database searching and correspondence with authors of randomised trials of individual remote psychotherapy. Electronic databases searched included MEDLINE (1966–2006, PsycInfo (1967–2006, EMBASE (1980–2006 and CINAHL databases (1982–2006. The Cochrane Central Register of Controlled Trials (CENTRAL and the Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Register (CCDAN-CTR. All searches were conducted to include studies with a publication date to July 2006. Results Thirteen studies were identified, ten assessing psychotherapy by telephone, two by internet and one by videoconference. Pooled effect sizes for remote therapy versus control conditions were 0.44 for depression (95%CI 0.29 to 0.59, 7 comparisons, n = 726 and 1.15 for anxiety-related disorders (95%CI 0.81 to 1.49, 3 comparisons, n = 168. There were few comparisons of remote versus face-to-face psychotherapy. Conclusion Remote therapy has the potential to overcome some of the barriers to conventional psychological therapy services. Telephone-based interventions are a particularly popular research focus and as a means of therapeutic communication may confer specific advantages in terms of their widespread availability and ease of operation. However, the available evidence is limited in quantity and quality. More rigorous trials are required to

  19. Plant-based medicines for anxiety disorders, part 2: a review of clinical studies with supporting preclinical evidence.

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    Sarris, Jerome; McIntyre, Erica; Camfield, David A

    2013-04-01

    Research in the area of herbal psychopharmacology has revealed a variety of promising medicines that may provide benefit in the treatment of general anxiety and specific anxiety disorders. However, a comprehensive review of plant-based anxiolytics has been absent to date. Thus, our aim was to provide a comprehensive narrative review of plant-based medicines that have clinical and/or preclinical evidence of anxiolytic activity. We present the article in two parts. In part one, we reviewed herbal medicines for which only preclinical investigations for anxiolytic activity have been performed. In this current article (part two), we review herbal medicines for which there have been both preclinical and clinical investigations of anxiolytic activity. A search of MEDLINE (PubMed), CINAHL, Scopus and the Cochrane Library databases was conducted (up to 28 October 2012) for English language papers using the search terms 'anxiety' OR 'anxiety disorder' OR 'generalized anxiety disorder' OR 'social phobia' OR 'post-traumatic stress disorder' OR 'panic disorder' OR 'agoraphobia' OR 'obsessive compulsive disorder' in combination with the search terms 'Herb*' OR 'Medicinal Plants' OR 'Botanical Medicine' OR 'Chinese herb*', in addition to individual herbal medicines. This search of the literature revealed 1,525 papers, of which 53 plants were included in the review (having at least one study using the whole plant extract). Of these plants, 21 had human clinical trial evidence (reviewed here in part two), with the other 32 having solely preclinical evidence (reviewed in part one). Support for efficacy was found for chronic use (i.e. greater than one day) of the following herbs in treating a range of anxiety disorders in human clinical trials: Piper methysticum, Matricaria recutita, Ginkgo biloba, Scutellaria lateriflora, Silybum marianum, Passiflora incarnata, Withania somniferum, Galphimia glauca, Centella asiatica, Rhodiola rosea, Echinacea spp., Melissa officinalis and Echium

  20. Plant-based medicines for anxiety disorders, part 2: a review of clinical studies with supporting preclinical evidence.

    Science.gov (United States)

    Sarris, Jerome; McIntyre, Erica; Camfield, David A

    2013-04-01

    Research in the area of herbal psychopharmacology has revealed a variety of promising medicines that may provide benefit in the treatment of general anxiety and specific anxiety disorders. However, a comprehensive review of plant-based anxiolytics has been absent to date. Thus, our aim was to provide a comprehensive narrative review of plant-based medicines that have clinical and/or preclinical evidence of anxiolytic activity. We present the article in two parts. In part one, we reviewed herbal medicines for which only preclinical investigations for anxiolytic activity have been performed. In this current article (part two), we review herbal medicines for which there have been both preclinical and clinical investigations of anxiolytic activity. A search of MEDLINE (PubMed), CINAHL, Scopus and the Cochrane Library databases was conducted (up to 28 October 2012) for English language papers using the search terms 'anxiety' OR 'anxiety disorder' OR 'generalized anxiety disorder' OR 'social phobia' OR 'post-traumatic stress disorder' OR 'panic disorder' OR 'agoraphobia' OR 'obsessive compulsive disorder' in combination with the search terms 'Herb*' OR 'Medicinal Plants' OR 'Botanical Medicine' OR 'Chinese herb*', in addition to individual herbal medicines. This search of the literature revealed 1,525 papers, of which 53 plants were included in the review (having at least one study using the whole plant extract). Of these plants, 21 had human clinical trial evidence (reviewed here in part two), with the other 32 having solely preclinical evidence (reviewed in part one). Support for efficacy was found for chronic use (i.e. greater than one day) of the following herbs in treating a range of anxiety disorders in human clinical trials: Piper methysticum, Matricaria recutita, Ginkgo biloba, Scutellaria lateriflora, Silybum marianum, Passiflora incarnata, Withania somniferum, Galphimia glauca, Centella asiatica, Rhodiola rosea, Echinacea spp., Melissa officinalis and Echium

  1. Pensamentos negativos automáticos em pacientes com transtorno do pânico (Automatic Negative Thought in Patients with Panic Disorder

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    José Maria Montiel

    2014-12-01

    Full Text Available RESUMO: O transtorno do pânico (TP é caracterizado por ataques de pânico, os quais surgem acompanhados por uma série de pensamentos inadequados ao contexto. Objetivo: identificar e sistematizar a distorção cognitiva e os tipos de pensamentos negativos automáticos (PNA presentes em pacientes com TP. Participantes: 20 indivíduos na faixa etária de 32 anos e com diagnóstico de TP. Instrumentos: Anamnese e entrevista semi-estruturada, Inventário Beck de Ansiedade e Escala para Pânico e Agorafobia. Resultados: os dados apontaram níveis de ansiedade significativos, corroborando o diagnóstico de transtorno do pânico nos sujeitos. Já os PNA - como «Estou com dor de cabeça. Será que é uma crise?» - e os padrões de distorções cognitivas identificados, incluindo suposição, catastrofização, generalização e subestimação/ superestimação, estão em acordo com a literatura apresentada e são condizentes com a prática clínica. ABSTARCT: Panic disorder (PD is characterized by attacks of panic, which are accompanied by a series of thoughts, inappropriate to the context. Objective: to identify and systematize the cognitive distortion and the types of automatic negative thoughts (ANT present in patients with (PD. Participants: 20 individuals in the age of 32 years and with a diagnosis of PD. Instruments: Anamnesis and semi-structured interview, Beck anxiety inventory and scale of panic and agoraphobia. Results: data showed significant levels of anxiety, corroborating the diagnosis of disorders of panic in the subjects. Already the ANT - as «I have a headache. Is it a crisis?» - and the standards identified cognitive distortions, including assumptions, pessimism, generalization and under-estimation / over-estimation, they are subject to the presented literature and they are suitable for clinical practice.

  2. Case report of visual hallucinaitons in anxiety%病例报告:焦虑障碍出现幻视一例

    Institute of Scientific and Technical Information of China (English)

    Sachdeva A; Saxena A; Kandpal M

    2015-01-01

    Summary:Hallucinations rarely occur in individuals with anxiety disorders. This case report describes a 36-year-old male with Social Phobia and Agoraphobia with Panic Attacks who had prominent visual hallucinations that were both distressing and incapacitating. Treatment with sertraline 200 mg/d, clonazepam 1 mg/d, and propranolol 20 mg/day for one month completely resolved both his anxiety and the hallucinations, after which he was able to return to his social and occupational life. The report underscores the fact that visual hallucinations are not always indicators of a psychotic disorder, they may be present across a spectrum of mental disorders. In cases where hallucinations occur in non-psychoitc disorders, treatment of the underlying condiiton usually simultaneously resolves the associated hallucinaitons without the need to resort to the use of anitpsychoitc medicaiton. Detailed analyses of such unusual cases can help improve our understanding of the pathogenesis of psychoitc-like symptoms.%概述:焦虑障碍患者很少出现幻视。本病例报告描述了一位男性患者,36岁,患有社交恐惧症和伴惊恐发作的广场恐惧症。该患者幻视明显,令其深受困扰、功能受损。用舍曲林200 mg/d、氯硝西泮1mg/d和普萘洛尔20 mg/d治疗一个月后,患者的焦虑和幻视缓解,能继续工作,恢复社会生活。本报告强调这样一个事实,即幻视并不一定预示着精神病性障碍,很多精神障碍都可能出现视幻觉。如果非精神病性障碍患者出现幻视,那么治疗这些非精神病性障碍通常也能同时缓解相关的幻视,而无需使用抗精神病药物。详细分析此类罕见病例有助于加深对精神病样症状的病理机制的认识。

  3. The crossroads of anxiety: distinct neurophysiological maps for different symptomatic groups

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    Gerez M

    2016-01-01

    Full Text Available Montserrat Gerez,1–3 Enrique Suárez,2,3 Carlos Serrano,2,3 Lauro Castanedo,2 Armando Tello1,3 1Departamento de Neurofisiología Clínica, Hospital Español de México, Mexico City, Mexico; 2Departamento de Psiquiatría, Hospital Español de México, Mexico City, Mexico; 3Unidad de Postgrado, Universidad Nacional Autónoma de México, Mexico City, Mexico Background: Despite the devastating impact of anxiety disorders (ADs worldwide, long-lasting debates on causes and remedies have not solved the clinician’s puzzle: who should be treated and how? Psychiatric classifications conceptualize ADs as distinct entities, with strong support from neuroscience fields. Yet, comorbidity and pharmacological response suggest a single “serotonin dysfunction” dimension. Whether AD is one or several disorders goes beyond academic quarrels, and the distinction has therapeutic relevance. Addressing the underlying dysfunctions should improve treatment response. By its own nature, neurophysiology can be the best tool to address dysfunctional processes.Purpose: To search for neurophysiological dysfunctions and differences among panic disorder (PD, agoraphobia-social-specific phobia, obsessive–compulsive disorder (OCD and generalized anxiety disorder.Methods: A sample population of 192 unmedicated patients and 30 aged-matched controls partook in this study. Hypothesis-related neurophysiological variables were combined into ten independent factors: 1 dysrhythmic patterns, 2 delta, 3 theta, 4 alpha, 5 beta (whole-head absolute power z-scores, 6 event-related potential (ERP combined latency, 7 ERP combined amplitude (z-scores, 8 magnitude, 9 site, and 10 site of hyperactive networks. Combining single variables into representative factors was necessary because, as in all real-life phenomena, the complexity of interactive processes cannot be addressed through single variables and the multiplicity of potentially implicated variables would demand an extremely large

  4. 惊恐障碍的诊治

    Institute of Scientific and Technical Information of China (English)

    李舜伟

    2002-01-01

    @@ 一、历史 1894年Freud把焦虑性神经症(anxiety neurosis,又称焦虑症),从神经衰弱中单独划分出来,焦虑症作为独立的疾病已有100多年的历史.美国精神病学会对该病的名称和诊断标准曾多次研究制定,在美国精神病诊断和统计手册第3版中采用了焦虑障碍(anxiety disorder)的名称,对它的几种不同亚型进行了定义,制定出临床诊断标准.该书经过反复修订,到1994年出版的第4版,焦虑障碍包括了惊恐障碍(panic disorder)、广场恐怖(agoraphobia)、特殊恐怖(specific phobia)、社交恐怖(social phobia)、强迫症(obsessive-compulsive disorder)、创伤后应激障碍(posttraumatic stress disorder)、急性应激障碍(acute stress disorder)、广泛性焦虑障碍(generalized anxiety disorder)和未特别指明的焦虑障碍(anxiety disorder not otherwise specified)不同亚型,现国际上广泛采用了焦虑障碍这一名称.2001年出版的第3版继续沿用焦虑性神经症,惊恐发作被列为焦虑性神经症的一个亚型.所以国内医疗科研机构采用的诊断名称与国际尚未完全统一.

  5. Double-blind clonazepam vs placebo in panic disorder treatment Estudo duplo-cego com clonazepam e placebo no tratamento do transtorno do pânico

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    ALEXANDRE MARTINS VALENÇA

    2000-12-01

    Full Text Available OBJECTIVE: To assess the effectiveness of clonazepam, in a fixed dose (2 mg/day, compared with placebo in the treatment of panic disorder patients. METHOD: 24 panic disorder patients with agoraphobia were randomly selected. The diagnosis was obtained using the structured clinical interview for DSM-IV . All twenty-four subjects were randomly assigned to either treatment with clonazepam (2 mg/day or placebo, during 6 weeks. Efficacy assessments included: change from baseline in the number of panic attacks; CGI scores for panic disorder; Hamilton rating scale for anxiety; and panic associated symptoms scale. RESULTS: At the therapeutic endpoint, only one of 9 placebo patients (11.1% were free of panic attacks, compared with 8 of 13 (61.5% clonazepam patients (Fisher exact test; p=0,031. CONCLUSION: the results provide evidence for the efficacy of clonazepam in panic disorder patients.OBJETIVO: Avaliar a eficácia do clonazepam, em uma dose fixa (2 mg/dia, comparado ao placebo, no tratamento de pacientes com transtorno do pânico. MÉTODO: Foram selecionados randomicamente 24 pacientes com transtorno do pânico com agorafobia. O diagnóstico foi obtido através da entrevista clínica estruturada do DSM-IV. Todos os 24 pacientes foram randomicamente designados para tratamento com clonazepam (2 mg/dia ou placebo, durante 6 semanas. Para avaliação da eficácia foram utilizadas: mudança do número de ataques de pânico em relação ao per��odo anterior ao tratamento; escala de Hamilton de ansiedade; escala de sintomas associados ao transtorno do pânico. RESULTADOS: No final da sexta semana, apenas um de 9 dos pacientes que receberam placebo(11,1% ficaram livres de ataques de pânico, comparados a 8 de 13 (61,5% pacientes que receberam clonazepam (prova exata de Fisher; p=0,031. CONCLUSÃO: Os resultados evidenciam a eficácia do clonazepam no tratamento de pacientes com transtorno do pânico.

  6. Sobre o transtorno de pânico e a hipocondria: uma revisão Panic disorder and hypochondriasis: a review

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    Albina Rodrigues Torres

    2002-09-01

    ógicas identificáveis e relevantes, com implicações diagnósticas e terapêuticas.Introduction/Objectives: Hypochondriasis has been associated with several anxiety disorders, especially with panic disorder (PD. It is estimated that 50% to 70% of PD patients have hypochondriacal symptoms and 13% to 17% of patients with hypochondriasis have associated PD. The objective of this study was to review the literature on clinical, phenomenological, cognitive and psychodynamic relationships between PD and hypochondriasis, and to discuss conceptual aspects and diagnostic criteria. Methods: A Medline search was conducted between 1990 and 2001 using the following keywords: panic disorder, agoraphobia, hypochondriasis, and hypochondriacal concerns. Results: It is considered hypochondriasis comorbidity in PD only when health worries are not restricted to panic attack symptoms. Although usually regarded as a secondary phenomenon, hypochondriacal preoccupations precede the first panic attack in many PD patients and may be considered prodromal symptoms. In a vicious circle, anxiety may lead to excessive health worries, selective self-observation and anticipation of the worst outcomes. Though a catastrophic bias is common to both diseases, in PD the autonomic symptoms increase rapidly culminating in a panic attack, and the dread catastrophe seems to be imminent, leading to avoidant behaviors and immediate quest for help. Hypochondriasis is characterized by a fear of more insidious diseases, hypervigilance, search for reassurance behaviors, more dysfunctional beliefs, poorer doctor-patient relationship, and a wider range of feelings misinterpreted as catastrophic. Pathological fear of death and alexithymia may play an important role in both disorders. Conclusions: The clinical overlapping of PD/agoraphobia and hypochondriasis is significant but not complete. The relationship between the two disorders is complex and possibly bidirectional, both increasing their mutual vulnerability. There are

  7. 精神专科医院抑郁障碍和双相Ⅱ型抑郁患者共病特征分析%Psychiatric comorbidities in patients with major depressive disorder and patients with bipolar Ⅱ depression in a psychiatric setting

    Institute of Scientific and Technical Information of China (English)

    吴志国; 曹岚; 李豪喆; 王凡; 邱美慧; 李宁宁; 向慧; 黄悦琦; 廖力维

    2015-01-01

    Objective This report aimed at exploring magnitude of psychiatric comorbidities of patients with major depressive disorder (MDD) or bipolar Ⅱ depression.Comorbidity patterns between MDD and bipolar Ⅱ depression were compared and the association of clinical presentation with the two types of depressive episodes were analyzed.Methods A cross-sectional survey was conducted on a total of 833 patients that met the Diagnostic and Statistical Manual of Mental Disorders,Fourth Edition Text Revision criteria for MDD or bipolar Ⅱ depression with current major depressive episodes who were seeking help in a psychiatric hospital were enrolled.Endorsement of comorbid psychiatric disorders were based on the MINI-International Neuropsychiatric Interview (Chinese version).Psychiatric comorbidities were compared between the two groups and the binary logistic model was developed to estimate association of endorsement of psychiatric comorbidities with the two types of depressive episodes.Results Up to 68.0% (70/125) of participants with bipolar Ⅱ depression and 53.1% (277/708) of participants with MDD adopted at least one psychiatric comorbidity (x2=9.534,P=0.002).Significant difference of presence of agoraphobia (without panic attack) (26.4% (33/125) vs.8.1% (57/708),x2=31.118,P=0.000),social anxiety disorder (21.6% (27/125) vs.11.4% (81/708),x2=9.718,P=0.002),psychosis (11.2% (14/125) vs.2.4% (17/708),x2=22.957,P=0.000) and eating disorders (3.2% (4/125)vs.0.7% (5/708),P=0.033) were detected between the two groups.Comorbid agoraphobia (OR=3.332,95% CI 1.970-5.635,P=0.000) or psychosis (OR=3.432,95% CI 1.543-7.632,P=0.002),and endorsement of recurrent depression (OR=2.457,95% CI 1.625-3.714,P=0.000) or attempted suicides (OR=1.764,95% CI 1.045-2.975,P=0.033) was associated with bipolar Ⅱ depression.Conclusions MDD and bipolar Ⅱ depression differed in comorbidity patterns although psychiatric comorbidities are both commonly seen in the two

  8. Transtornos de humor e de ansiedade comórbidos em vítimas de violência com transtorno do estresse pós-traumático Comorbid mood and anxiety disorders in victims of violence with posttraumatic stress disorder

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    Lucas C. Quarantini

    2009-10-01

    disorder and mood disorders, as well as between posttraumatic stress disorder and other anxiety disorders. METHOD: We searched Medline for studies, published in English through April, 2009, using the following keywords: "posttraumatic stress disorder", "PTSD", "mood disorder", "major depressive disorder", "major depression", "bipolar disorder", "dysthymia", "anxiety disorder", "generalized anxiety disorder", "agoraphobia", "obsessive-compulsive disorder", "panic disorder", "social phobia", and "comorbidity". RESULTS: Major depression is one of the most frequent comorbid conditions in posttraumatic stress disorder individuals, but individuals with posttraumatic stress disorder are also more likely to present with bipolar disorder, other anxiety disorders and suicidal behaviors. These comorbid conditions are associated with greater clinical severity, functional impairment, and impaired quality of life in already compromised individuals with posttraumatic stress disorder. Depression symptoms also mediate the association between posttraumatic stress disorder and severity of pain among patients with chronic pain. CONCLUSION: Available studies suggest that individuals with posttraumatic stress disorder are at increased risk of developing affective disorders compared with trauma-exposed individuals who do not develop posttraumatic stress disorder. Conversely, pre-existing affective disorders increase a person's vulnerability to the posttraumatic stress disorder--inducing effects of traumatic events. Also, common genetic vulnerabilities can help to explain these comorbidity patterns. However, because the studies addressing this issue are few in number, heterogeneous and based on a limited sample, more studies are needed in order to adequately evaluate these comorbidities, as well as their clinical and therapeutic implications.

  9. Instituto Nacional de Ciência e Tecnologia em Medicina Translacional (INCT-TM: abordagens metodológicas National Science and Technology Institute for Translational Medicine (INCT-TM: advancing the field of translational medicine and mental health

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    Jaime E. C. Hallak

    2010-03-01

    , translational research offers an opportunity for applying the findings obtained from basic research to every-day clinical applications. The National Science and Technology Institute for Translational Medicine is comprised of six member institutions (Universidade Federal do Rio Grande do Sul, Universidade de São Paulo-Ribeirão Preto, Universidade Federal do Rio de Janeiro, Pontifícia Universidade Católica do Rio Grande do Sul, Universidade Estadual de Santa Catarina and a core facility that serves all centers. The objectives of the project are divided into four areas: Institutional, Research, Human Resources and Technology for the Community and Productive Sector. METHOD: In this manuscript, we describe some of the approaches used to attain the main objectives of the National Science and Technology Institute for Translational Medicine, which include the development of 1 animal models for bipolar disorder; 2 strategies to investigate neurobehavioral function and cognitive dysfunction associated with brain disorders; 3 experimental models of brain function and behavior, neuropsychiatric disorders, cell proliferation, and cancer; 4 Simulated Public Speaking and 5 Virtual reality simulation for inducing panic disorder and agoraphobia. CONCLUSION: The main focus of the National Science and Technology Institute for Translational Medicine is the development of more useful methods that allow for a better application of basic research-based knowledge to the medical field.

  10. Anxiety and joint hypermobility association: a systematic review Associação entre ansiedade e hipermobilidade articular: uma revisão sistemática

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    Simone H. Bianchi Sanches

    2012-06-01

    Full Text Available BACKGROUND: Anxiety disorders are often associated with several non-psychiatric medical conditions. Among the clinical conditions found in association with anxiety stands out the joint hypermobility (JH. OBJECTIVES: To carry out a systematic review of the clinical association between anxiety disorders and JH. METHOD: A survey was conducted in MEDLINE, PsychINFO, LILACS e SciELO databases up to December 2011. We searched for articles using the keywords 'anxiety', 'joint' and 'hypermobility' and Boolean operators. The review included articles describing empirical studies on the association between JH and anxiety. The reference lists of selected articles were systematically hand-searched for other publications relevant to the review. RESULTS: Seventeen articles were included in the analysis and classified to better extract data. We found heterogeneity between the studies relate to the methodology used. Most of the studies found an association between anxiety features and JH. Panic disorder/agoraphobia was the anxiety disorder associated with JH in several studies. Etiological explanation of the relationship between anxiety and JH is still controversial. CONCLUSION: Future research in large samples from the community and clinical setting and longitudinal studies of the association between anxiety and HA and the underlying biological mechanisms involved in this association are welcome.INTRODUÇÃO: Os transtornos de ansiedade estão frequentemente associados a vários quadros clínicos não psiquiátricos. Dentre os quadros clínicos associados à ansiedade destaca-se a hipermobilidade articular (HA. Objetivo: Realizar uma revisão sistemática da associação entre os transtornos de ansiedade e a HA. MÉTODO: Foi realizada uma pesquisa nos bancos de dados MEDLINE, PsychINFO, LILACS e SciELO em busca de artigos publicados até dezembro de 2011. Usamos as palavras-chave anxiety , joint e hypermobility e os operadores boolianos. A revisão incluiu

  11. Estudo retrospectivo da associação entre transtorno de pânico em adultos e transtorno de ansiedade na infância Retrospective study of the association between adulthood panic disorder and childhood anxiety disorders

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    Gisele Gus Manfro

    2002-03-01

    history of childhood anxiety disorders. There was a significant association between generalized anxiety disorder history during childhood and panic disorder in adult life and its comorbidities such as agoraphobia (p=0,05 and depression (p=0,03. CONCLUSION: This study suggests that childhood anxiety disorder may be a predictor of the severity of panic disorder in adult life.

  12. Impact of dissociation on treatment of depressive and anxiety spectrum disorders with and without personality disorders

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    Prasko J

    2016-10-01

    Full Text Available Jan Prasko,1 Ales Grambal,1 Petra Kasalova,1 Dana Kamardova,1 Marie Ociskova,1 Michaela Holubova,1,2 Kristyna Vrbova,1 Zuzana Sigmundova,1 Klara Latalova,1 Milos Slepecky,3 Marta Zatkova3 1Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University in Olomouc, University Hospital Olomouc, Olomouc, 2Psychiatric Department, Hospital Liberec, Liberec, Czech Republic; 3Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra, Slovak Republic Objective: The central goal of the study was to analyze the impact of dissociation on the treatment effectiveness in patients with anxiety/neurotic spectrum and depressive disorders with or without comorbid personality disorders.Methods: The research sample consisted of inpatients who were hospitalized in the psychiatric department and met the ICD-10 criteria for diagnosis of depressive disorder, panic disorder, generalized anxiety disorder, mixed anxiety–depressive disorder, agoraphobia, social phobia, obsessive compulsive disorder, posttraumatic stress disorder, adjustment disorders, dissociative/conversion disorders, somatoform disorder, or other anxiety/neurotic spectrum disorder. The participants completed these measures at the start and end of the therapeutic program – Beck Depression Inventory, Beck Anxiety Inventory, a subjective version of Clinical Global Impression-Severity, Sheehan Patient-Related Anxiety Scale, and Dissociative Experience Scale.Results: A total of 840 patients with anxiety or depressive spectrum disorders, who were resistant to pharmacological treatment on an outpatient basis and were referred for hospitalization for the 6-week complex therapeutic program, were enrolled in this study. Of them, 606 were statistically analyzed. Data from the remaining 234 (27.86% patients were not used because of various reasons (103 prematurely finished the program, 131 did not fill in most of the

  13. Relação entre prática religiosa, uso de álcool e transtornos psiquiátricos em gestantes Relationship between religious practice, alcohol use, and psychiatric disorders among pregnant women

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    Cristiane Schumann Silva

    2010-01-01

    Identification Test (AUDIT. RESULTS: Most pregnant women practiced a religion (60.8%. Religious women show a lower frequency (p < 0.05 of diagnoses of Major Depressive Episode with Melancholic features, Hypomania episode, current Panic disorder with Agoraphobia, current Social Anxiety disorder, and Post-traumatic stress disorder. In the diagnosis of abuse of one or more psychoactive substances, there was a tendency to lower prevalence in the groups of religious women (p = 0,057. DISCUSSION: It was observed in this study, that the religious women tend to have lower rates of mood disorders and anxiety disorders than pregnant women that do not practice their religion.

  14. Confiabilidade de instrumentos diagnósticos: estudo do inventário de sintomas psiquiátricos do DSM-III aplicado em amostra populacional Reliability of diagnostic instruments: investigating the psychiatric DSM-III checklist applied to community samples

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    Sérgio Baxter Andreoli

    2001-12-01

    Full Text Available O objetivo foi estudar a confiabilidade do inventário de sintomas psiquiátricos do DSM-III aplicado em amostras representativas da população geral de três cidades brasileiras. Foram utilizados os métodos do entrevistador-observador e de consistência interna para medir a confiabilidade. Os diagnósticos de ansiedade generalizada, na vida (k = 0,46, no ano (k = 1,00, depressão na vida (k = 0,77 e os diagnósticos de abuso e dependência de álcool na vida (k = 1,00 foram confiáveis de forma consistente nos dois métodos empregados. Os diagnósticos de agorafobia (k = 1,00, fobia simples (k = 0,77, transtorno psicótico não esquizofrênico (k = 1,00 e o de fatores psicológicos que afetam o físico (1,00, todos feitos para a vida, apresentaram confiabilidade excelente medidos por meio do Kappa. O principal problema de medir a confiabilidade em estudos populacionais é a baixa prevalência de alguns diagnósticos que resulta em uma pequena variabilidade nas respostas positivas, o que impossibilita o cálculo do Kappa. Por causa disso, apenas 11 dos 39 diagnósticos que compõem o inventário puderam ser examinados. Recomenda-se a utilização do método de teste e re-teste com um tempo curto entre as entrevistas para diminuir esse problema.This study focused on the reliability of the DSM-III inventory of psychiatric symptoms in representative general population samples in three Brazilian cities. Reliability was assessed through two different designs: inter-rater reliability and internal consistency. Diagnosis of lifetime (k = 0.46 and same-year generalized anxiety (k = 1.00, lifetime depression (k = 0.77, and lifetime alcohol abuse and dependence (k = 1.00 was consistently reliable in the two methods. Lifetime diagnosis of agoraphobia (k = 1.00, simple phobia (k = 0.77, non-schizophrenic psychosis (k = 1.00, and psychological factors affecting physical health (1.00 showed excellent reliability as measured by the kappa coefficient. The main

  15. Quality of life assessment by WHOQOL-BREF in panic disorder patients during treatment Investigação de qualidade de vida pela WHOQOL-BREF em pacientes com transtorno de pânico durante o tratamento

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    Valfrido Leão de Melo-Neto

    2008-01-01

    Full Text Available BACKGROUND: Panic disorder (PD patients show more physical and psychological impairment, than the general population. OBJECTIVES: Our aims are to compare quality of life between PD patients during treatment and healthy subjects and to associate social, demographic and clinical factors with quality of life scores. METHODS: It is a cross-sectional study with 20 PD patients and 20 healthy controls. Anxiety levels assessment: Beck Anxiety Inventory, Hamilton Anxiety Rating Scale, STAIT - Form Y. Panic severity; Panic Agoraphobia Scale; social and environmental problems and global assessment functioning (Axis IV and V, DSM-IV-TR and quality of life by WHOQOL-BREF. RESULTS: PD patients were 65% female. Mean age = 37.55 ± 9.06. Quality of life domain scores: physical = 57.86 ± 17.56; psychological = 56.04 ± 18.31; social = 56.25 ± 25.92; and environmental = 47.03 ± 16.92; smokers = 20%; BAI = 23.40 ± 15; STAI-S= 43.50 ± 8.79; STAI-T = 50.10 ± 9.19; PAS = 13.60 ± 9.40. DISCUSSION: No significant differences were observed between groups about gender, age, schooling, religion, marital status nor individual income, but family income was significantly higher among controls. All domains of quality of life are significantly impaired among PD patients, compared to healthy controls. Panic disorder compromises well being. Psychosocial problems and high levels of anxiety can also negatively impact quality of life of PD patients.CONTEXTO: Pacientes com transtorno de pânico (TP apresentam maior comprometimento físico e psicológico que a população geral. OBJETIVOS: Comparar escores de qualidade de vida entre pacientes com TP em tratamento e indivíduos normais. MÉTODOS: Trata-se de estudo transversal com 20 portadores de TP e 20 controles normais. Avaliação da ansiedade inclui: Inventário de Ansiedade de Beck, Escala de Ansiedade de Hamilton, Inventário de Estado e Traço Ansioso, Escala de Pânico e Agorafobia; além de avaliação de problemas

  16. Ataques de pânico provocados pelo dióxido de carbono: estudo clínico-fenomenológico Carbon dioxide-induced panic attacks: clinical-phenomenologic study

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    Alexandre M Valença

    2001-03-01

    those from spontaneous panic attacks. METHODS: Thirty-one patients with panic disorder with or without agoraphobia (DSM-IV were selected. After one week without receiving any medication, these patients were asked to perform two full inhalations (vital capacity: one with a carbonic mixture (35% CO2, 65% O2 and the other with compressed atmospheric air (placebo, assigned randomly and separated by a 20-minute interval. These inhalations were repeated after 2 weeks. During this period no participants in the study received any kind of psychotropic drug. RESULTS: Twenty-two patients (71.0% had a panic attack in at least one of the tests where the CO2 mixture was used. Among them (n=22, the most frequently reported symptoms were: shortness of breath (n=20, 91.0%, a feeling of suffocation or asphyxia (n=18, 81.8%, dizziness (n=18, 81.8%, trembling (n=14, 63.6%, palpitations (n=13, 59.0%, and fear of losing one's mind (n=12, 54.5%. Eleven patients (50.0% thought the laboratory-induced panic attacks were more intense than the spontaneous ones, 4 (18.2% felt both had the same intensity and 7 (31.8% considered the laboratory-induced panic attacks as less intense. CONCLUSION: Panic disorder patients have high sensitivity to CO2. The 35% CO2 mixture inhalation triggers in these patients symptoms similar to those seen in spontaneous panic attacks. This test may be considered a good experimental model for studying panic disorder.

  17. Science.gov (United States)

    Pérez Benítez, Carlos I; Vicente, Benjamin; Zlotnick, Caron; Kohn, Robert; Johnson, Jennifer; Valdivia, Sandra; Rioseco, Pedro

    2009-01-01

    is not an uncommon psychiatric illness, it is associated with a high degree of psychiatric comorbidity, it is more likely to predate other psychiatric disorders. Also, the results showed that men are more likely to be exposed to traumas than women, women are more likely than men to develop PTSD, and that PTSD is associated with relatively high treatment utilization.However, compared to another country in Latin America, such as Mexico, Chile has a lower prevalence of PTSD and trauma exposure, which may due to socio-economic factors, such as less inequity between the wealthy and the poor and less violence, crime, and poverty in Chile than Mexico. These studies also suggest that traumatic events that occur in childhood are related to specific disorders rather than those that occurred later in life.Individuals with childhood interpersonal trauma exposure are more likely to suffer from lifetime panic disorder, agoraphobia or PTSD compared to those who experience interpersonal trauma as an adult. However, research should examine the specificity of these disorders in relation to various types of childhood traumas.Limitations of the current study include the use of lay interviewers who, despite acceptable levels of reliability and validity, may be less accurate than clinicians as interviewers.Also the retrospective recall of lifetime disorders is likely to be less accurate than a more recent time frame. The sample used in this study does not show nation wide perspective, because the Southern portion of the country which includes much of the indigenous population was excluded. This study, like most epidemiological studies, did not use an-depth or validated index of trauma, which may have diluted findings. Since this study was cross-sectional, a direct cause-effect relationship cannot be assumed between trauma exposure and subsequent disorders. PMID:21113425