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Sample records for comorbid panic attacks

  1. The nocturnal panic attacks: polysomnographic features and comorbidities

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    LI Yan-lin

    2013-05-01

    Full Text Available Background Panic disorder refers to the repeated or unexpected anxiety or panic attacks. It makes patients feel extreme pain. Although the episodes of most patients with panic disorder happen at daytime, the nocturnal panic attacks (NPA are quite common. Paients pay more attention to NPA. Insomnia is more serious in patients with NPA than those patients with panic disorder attack at daytime. Many patients may occur anxiety and avoidance behavior after NPA. Patients are often afraid of sleeping, or even do not sleep. The aim of this study is to analyze polysomnographic (PSG parameter changes and clinical concomitant symptoms of patietns with NPA, to explore the characteristics of sleep, in order to provide better diagnosis, differential diagnosis and treatment for these patients. Methods The features of sleep of 20 NPA patients and 23 healthy controls were monitored by video-PSG. Hamilton Anxiety Rating Scale (HAMA and Hamilton Depression Rating Scale (HAMD were used to assess the state of anxiety, depression, and dyssomnia of the patients. Results In comparison with normal control group, the NPA group showed shortened total sleep time (TST, decreased sleep efficiency (SE and sleep maintenance rate, delayed arousal time, increased number of arousal and number of arousal episode longer than 5 minutes, increased percentage of non-rapid eye movement (NREM sleep stage Ⅰ, decreased percentage of NREM sleep stageⅢ and percentage of rapid eye movement (REM sleep (P 0.05, for all. In NPA group, there were 13 cases (13/20 with anxiety, 17 (17/20 with depression, 13 cases/times (13/20 with difficulty of falling asleep, 17 cases/times (17/20 with difficulties in maintaining sleep (frequent arousals and difficult to fall asleep again and 7 cases/times (7/20 with wake up early. Conclusion NPA patients present decreased deep sleep, increased shallow sleep and poor sleep quality, and are mostly accompanied with mild or moderate depression and (or anxiety

  2. Nocturnal panic attacks

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    Lopes Fabiana L.

    2002-01-01

    Full Text Available The panic-respiration connection has been presented with increasing evidences in the literature. We report three panic disorder patients with nocturnal panic attacks with prominent respiratory symptoms, the overlapping of the symptoms with the sleep apnea syndrome and a change of the diurnal panic attacks, from spontaneous to situational pattern. The implication of these findings and awareness to the distinct core of the nocturnal panic attacks symptoms may help to differentiate them from sleep disorders and the search for specific treatment.

  3. Panic Attack during Elective Gastrointestinal Endoscopy

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    Charalampos Mitsonis

    2011-01-01

    Full Text Available Background. Esophagogastroduodenoscopy (EGD and colonoscopy (CS can evoke anxiety, embarrassment, and discomfort. These concerns can culminate in panic attacks, which may traumatize patients and significantly decrease their compliance to the procedure. The objective of this study was to evaluate the relationship between preendoscopic anxiety and the possibility of a panic attack during an elective gastrointestinal endoscopy (EGE. Methods. The study population comprised of 79 Greek outpatients. The examination was carried out without the use of conscious sedation. Patients' anxiety levels were assessed before the procedure using the Greek version of the Spielberger State-Trait Anxiety Inventory (STAI-Y. Results. Seventy-nine patients were enrolled: 45 EGD and 34 CS. Females had higher state and trait anxiety levels than males (48.14 ± 7.94 versus 44.17 ± 7.43, <0.05; and 43.68 ± 6.95 versus 39.86 ± 7.46, <0.05. Patients who experienced panic attack had significantly higher levels of both trait and state anxiety, compared to those who were panic-free. There was no significant relationship between panic attacks and sex or type of procedure. Conclusions. Patients who experience panic attacks during endoscopic procedures appear to have significantly higher anxiety levels before the procedure. Administering the STAI questionnaire prior to the endoscopy seems to be a useful screening method for vulnerable patients.

  4. Examining the Panic Attack Specifier in Social Anxiety Disorder.

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    Allan, Nicholas P; Oglesby, Mary E; Short, Nicole A; Schmidt, Norman B

    2016-04-01

    Panic attacks (PAs) are characterized by overwhelming surges of fear and discomfort and are one of the most frequently occurring symptoms in psychiatric populations. The most recent version of the Diagnostic and Statistical Manual of Mental Disorders (i.e. DSM-5) allows for a panic attack (PA) specifier for all disorders, including social anxiety disorder (SAD). However, there is little research examining differences between individuals diagnosed with SAD with the PA specifier versus individuals diagnosed with SAD without the PA specifier. The current study examined social anxiety, mood, anxiety, and anxiety sensitivity social concerns, a risk factor for social anxiety in SAD-diagnosed individuals without (N = 52) and with (N = 14) the PA specifier. The groups differed only in somatic symptoms of anxiety. Result of the current study provides preliminary evidence that the presence of the PA specifier in social anxiety does not result in elevated levels of comorbidity or a more severe presentation of social anxiety.

  5. Recurrence of Panic Attacks after Influenza Vaccination: Two Case Reports

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    Kim, Han-Joon; Jeon, Sang-Won; Yoon, Ho-Kyoung

    2016-01-01

    Human influenza is a contagious respiratory illness caused by the influenza virus. The influenza vaccination is recommended annually, but several adverse effects related to allergic reactions have been reported. Panic attacks are also known to occur, but no case of a panic attack adverse effect has been reported in South Korea. We present two cases of panic disorder patients whose symptoms were aggravated by the influenza vaccination. We assumed that dysregulation of T-lymphocytes in panic disorder patients could have a role in activating various kinds of cytokines and chemokines, which then can lead to panic attack aggravation. PMID:27776395

  6. Impact of panic attacks on quality of life among patients with schizophrenia.

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    Ulaş, Halis; Polat, Selma; Akdede, Berna Binnur; Alptekin, Köksal

    2010-10-01

    Schizophrenia patients had decreased levels of quality of life compared to normal population. The aim of this study was to investigate the impact of panic attacks on quality of life in patients with schizophrenia. Eighty-eight patients with schizophrenia and 85 healthy subjects were included in the study. World Health Organization Quality of Life Instrument-Short Form (WHOQOL-Bref) was given to patients and healthy subjects to assess quality of life. Panic module of Structured Clinical Interview for DSM-IV (SCID) was administered to patients for diagnosis of panic attacks and panic disorder. Positive and Negative Syndrome Scale (PANSS) for symptom severity and Calgary Depression Scale (CDS) for depressive symptoms were administered to the patients. Patients with schizophrenia demonstrated significantly lower scores compared to healthy controls in all domains of WHOQOL-Bref. Twenty-five patients (28.4%) with schizophrenia had panic attacks (PA) and 10 patients (11.4%) met criteria for panic disorder (PD). Schizophrenia patients with PA had significantly lower scores on psychological domain of WHOQOL-Bref compared to the patients without PA. Schizophrenic patients with panic attacks had higher CDS scores than patients without PA. In the multivariate regression analyses the variance in psychological domain of WHOQOL-Bref was explained by depression rather than panic attack. In patients with schizophrenia comorbid panic attacks may have a negative impact on quality of life, which is associated with depression significantly. Panic attacks and depressive symptomatology must be examined comprehensively in order to improve quality of life in patients with schizophrenia. Copyright © 2010 Elsevier Inc. All rights reserved.

  7. Embarrassment about the first panic attack predicts agoraphobia in panic disorder patients.

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    Amering, M; Katschnig, H; Berger, P; Windhaber, J; Baischer, W; Dantendorfer, K

    1997-06-01

    In order to find out whether contextual variables of the first panic attack and the person's reaction to it predict the development of agoraphobia in panic disorder patients, 60 patients with a DSM-III-R diagnosis of panic disorder with agoraphobia and 30 patients suffering from panic disorder without agoraphobia were interviewed about their first panic attack. Single comparisons between groups of agoraphobic and non-agoraphobic patients were carried out and a logistic regression model was applied. Occurrence of the first panic attack in public and the feeling of embarrassment were found to be significantly associated with the development of agoraphobia. It is concluded that eliciting this specific form of social concern at an early stage might help to identify patients at risk for later agoraphobia, which could, in turn, help to further specify early therapeutic interventions and concentrate therapeutic efforts on a high-risk group of panic disorder patients.

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

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    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

  9. Parent-Reported Predictors of Adolescent Panic Attacks.

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    Hayward, Chris; Wilson, Kimberly A.; Lagle, Kristy; Killen, Joel D.; Taylor, C. Barr

    2004-01-01

    Objective: To identify parent-reported risk factors for adolescent panic attacks. Method: Structured diagnostic interviews were obtained from 770 parents of participants in a school-based risk factor study for adolescent panic. Parent-reported risk factors assessed included characteristics of the child (negative affect, separation anxiety disorder…

  10. Multiple Channel Exposure Therapy: Combining Cognitive-Behavioral Therapies for the Treatment of Posttraumatic Stress Disorder with Panic Attacks

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    Falsetti, Sherry A.; Resnick, Heidi S.; Davis, Joanne

    2005-01-01

    A large proportion of patients who present for treatment of posttraumatic stress disorder (PTSD) experience comorbid panic attacks, yet it is unclear to what extent currently available PTSD treatment programs address this problem. Here we describe a newly developed treatment, multiple-channel exposure therapy (M-CET), for comorbid PTSD and panic…

  11. Dimensional structure of bodily panic attack symptoms and their specific connections to panic cognitions, anxiety sensitivity and claustrophobic fears.

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    Drenckhan, I; Glöckner-Rist, A; Rist, F; Richter, J; Gloster, A T; Fehm, L; Lang, T; Alpers, G W; Hamm, A O; Fydrich, T; Kircher, T; Arolt, V; Deckert, J; Ströhle, A; Wittchen, H-U; Gerlach, A L

    2015-06-01

    Previous studies of the dimensional structure of panic attack symptoms have mostly identified a respiratory and a vestibular/mixed somatic dimension. Evidence for additional dimensions such as a cardiac dimension and the allocation of several of the panic attack symptom criteria is less consistent. Clarifying the dimensional structure of the panic attack symptoms should help to specify the relationship of potential risk factors like anxiety sensitivity and fear of suffocation to the experience of panic attacks and the development of panic disorder. In an outpatient multicentre study 350 panic patients with agoraphobia rated the intensity of each of the ten DSM-IV bodily symptoms during a typical panic attack. The factor structure of these data was investigated with nonlinear confirmatory factor analysis (CFA). The identified bodily symptom dimensions were related to panic cognitions, anxiety sensitivity and fear of suffocation by means of nonlinear structural equation modelling (SEM). CFA indicated a respiratory, a vestibular/mixed somatic and a cardiac dimension of the bodily symptom criteria. These three factors were differentially associated with specific panic cognitions, different anxiety sensitivity facets and suffocation fear. Taking into account the dimensional structure of panic attack symptoms may help to increase the specificity of the associations between the experience of panic attack symptoms and various panic related constructs.

  12. Does the panic attack activate the hypothalamic-pituitary-adrenal axis?

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    Graeff Frederico G.; Garcia-Leal Cybele; Del-Ben Cristina M; Guimarães Francisco S.

    2005-01-01

    A bibliographic search has been performed in MEDLINE using cortisol and panic as key-words, occurring in the title and/or in the abstract. Human studies were selected, with no time limit. The following publications were excluded: reviewarticles, case reports, panic attacks in disorders other than panic disorder, and studies on changes that occurred in-between panic attacks. The results showed that real-life panic attacks as well as those induced by selective panicogenic agents such as lactate...

  13. Affective comorbidity in panic disorder: is there a bipolar connection?

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    Savino, M; Perugi, G; Simonini, E; Soriani, A; Cassano, G B; Akiskal, H S

    1993-07-01

    Although theoretical explanations for comorbidity in panic disorder (PD) abound in the literature, the complex clinical challenges of these patients have been neglected, especially where panic, obsessive-compulsive and 'soft' bipolar (e.g., hypomanic, cyclothymic and hyperthymic) conditions might co-exist. The aim of the present study has been to systematically explore the spectrum of intra-episodic and longitudinal comorbidity of 140 DSM-III-R PD patients--67.1% of whom concomitantly met the criteria for Agoraphobia--and who were consecutively admitted to the ambulatory service of the Psychiatric Clinic of the University of Pisa over a 2-year period. Comorbidity with strictly defined anxiety disorders--i.e., not explained as mere symptomatic extensions of PD--was relatively uncommon, and included Simple Phobia (10.7%), Social Phobia (6.4%), Generalized Anxiety Disorder (3.6%), and Obsessive-Compulsive Disorder (4.2%). Comorbidity with Major Depression--strictly limited to the melancholic subtype--occurred in 22.9%. Comorbidity with Bipolar Disorders included 2.1% with mania, 5% with hypomania, as well as 6.4% with cyclothymia, for a total of 13.5%; an additional 34.3% of PD patients met the criteria for hyperthymic temperament. We submit that such comorbid patterns are at the root of unwieldy clinical constructs like 'atypical depression' and 'borderline personality'. The relationship of panic disorder to other anxious-phobic and depressive states has been known for some time. Our data extend this relationship to soft bipolar disorders. Studies from other centers are needed to verify that the proposed new link is not merely due to referral bias to a tertiary university setting.

  14. Hormonal response during a fenfluramine-associated panic attack

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    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

  15. Rational self-directed hypnotherapy: a treatment for panic attacks.

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    Der, D F; Lewington, P

    1990-01-01

    A single-subject research design was employed to assess the efficacy of rational self-directed hypnotherapy in the treatment of panic attacks. Presenting symptoms were acute fear, dizziness, constricted throat, upset stomach, loss of appetite, loss of weight, insomnia, fear of doctors, and fear of returning to work. Treatment lasted 13 weeks plus a 2-week baseline and posttherapy period and a 6-month follow-up. Objective measurements (MMPI, TSCS, POMS) and self-report assessments (physiological symptoms and a subjective stress inventory) were implemented. Using hypnosis and guided imagery, the subject reviewed critical incidents identifying self-defeating components within a cognitive paradigm, revising and rehearsing these incidents. Results showed an increased sense of control, improved self-concept, elimination of pathological symptoms, and cessation of panic attacks.

  16. Panic attacks and possession by djinns: lessons from ethnopsychiatry.

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    Bragazzi, Nicola Luigi; Del Puente, Giovanni

    2012-01-01

    This clinical case report shows how important it is for a psychiatrist to have a knowledge of the cultural and religious context of the patient, in order to understand fully his or her complaints. Culture and religion, in fact, are not neutral, but convey symbols, meanings, and myths that should be properly explored to shed light on the patient's inner world. Patient D was a 19-year-old Muslim Italo-Tunisian girl, who consulted a psychiatrist for anxiety and panic attacks, and reported being possessed by djinns (ie, "evil creatures", as described in the Qur'an). A culturally informed interview was carried out, together with administration of psychometric scales, including the Symptom Checklist-90 Revised and Psychological Measure of Islamic Religiousness. Based on her scores and the results of this multidimensional assessment, patient D was treated with transcultural psychotherapy and fluoxetine. After a year of follow-up, she reported no further episodes of panic disorder. For proper assessment and treatment, a combined anthropological, sociological, and psychopathological approach was necessary.

  17. Dyspnea during panic attacks. An Internet survey of incidences of changes in breathing.

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    Anderson, B; Ley, R

    2001-09-01

    This article presents the results of a survey that investigated breathing-related symptoms of panic attacks together with the frequency of other symptoms reported by active panickers. All the participants of this study experienced naturally occurring panic attacks and sought treatment guidance by visiting a Web site devoted to the treatment of panic. The results of a symptom questionnaire showed that 195 respondents (95.1%) reported breathing changes during panic attacks, and remarkable dyspnea was reported by more than two thirds (68%) of respondents. These findings are consistent with earlier studies but are contrary to conclusions that only a small number of panickers report shortness of breath as a symptom. This study concludes that outside of the laboratory, a large majority of people who suffer from panic attacks experience symptoms of dyspnea.

  18. Associations between psychedelic use, abuse, and dependence and lifetime panic attack history in a representative sample.

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    Bonn-Miller, Marcel O; Bernstein, Amit; Sachs-Ericsson, Natalie; Schmidt, Norman B; Zvolensky, Michael J

    2007-01-01

    The present investigation evaluated the associations between lifetime psychedelic use, abuse, and dependence and panic attacks. The study consisted of a representative epidemiological sample from a state wide survey of the Colorado general adult population (n=4745; 52% female). Consistent with prediction, after controlling for theoretically relevant variables, psychedelic abuse and dependence, but not use, were significantly related to an increased lifetime risk of panic attacks. The results are discussed in terms of better understanding the role of psychedelic use in relation to the occurrence of panic attacks.

  19. 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.

  20. 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

  1. Risk factors for fearful spells, panic attacks and panic disorder in a community cohort of adolescents and young adults.

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    Asselmann, Eva; Wittchen, Hans-Ulrich; Lieb, Roselind; Beesdo-Baum, Katja

    2016-03-15

    Panic attacks (PA) and panic disorder (PD) as well as fearful spells only (FS-only, attacks of anxiety not meeting full criteria for PA or PD) increase the risk for various mental disorders. It is unclear so far whether FS-only, PA and PD share the same etiologies and risk factors. A representative community sample of adolescents and young adults (n=3021, aged 14-24 at baseline) was prospectively followed up over up to 10 years. Panic pathology and putative risk factors were assessed using the DSM-IV/M-CIDI and its embedded assessment modules and questionnaires. In Cox regressions stratified by sex and age, female sex, parental anxiety and depression, behavioral inhibition, harm avoidance, lower coping-efficacy and parental rejection predicted the onset of FS-only, PA and PD (Hazard Ratios 1.2-3.0). Associations with other risk factors partially differed for FS-only, PA and PD and tended to be stronger for PA and PD than for FS-only. No strictly prospective analytical approach was used. Time intervals between some risk factors and their retrospective assessment were relatively long. Findings suggest that FS-only, PA and PD are etiologically similar and represent qualitatively equal, albeit differently severe forms of panic pathology that lie on different points of the same fear-panic dimension. Copyright © 2016. Published by Elsevier B.V.

  2. 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.

  3. 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.

  4. O tabagismo e o transtorno do pânico: gravidade e comorbidades Smoking and panic disorder: severity and comorbidities

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    Rafael Christophe da Rocha Freire

    2007-12-01

    Full Text Available INTRODUÇÃO: Estudos indicam que há uma associação entre tabagismo e transtorno do pânico, e alguns autores sugerem que o tabagismo aumenta o risco de ataques de pânico e transtorno do pânico. Este estudo analisa a hipótese de que pacientes fumantes com esse transtorno apresentam um quadro clínico mais grave. MÉTODO: Sessenta e quatro pacientes em tratamento no Laboratório do Pânico e Respiração (Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro, com transtorno do pânico, segundo critérios do Manual de Diagnóstico e Estatística das Perturbações Mentais (DSM, 4ª edição, foram divididos em grupos de tabagistas e não-tabagistas. Os grupos foram avaliados quanto a características sociodemográficas, comorbidades e gravidade do quadro clínico. RESULTADOS: Não houve diferença significativa em relação à gravidade do transtorno do pânico; no entanto, tabagistas tiveram prevalência de depressão significativamente maior (p = 0,014 do que não-tabagistas. CONCLUSÃO: Este estudo não evidenciou que o transtorno do pânico em tabagistas é mais grave, porém indicou que esses pacientes têm mais comorbidade com depressão.INTRODUCTION: Several studies indicate that panic disorder and tobacco smoking are associated, and some authors hypothesize that smoking increases the risk of panic attacks and panic disorder. The objective of this study is to investigate whether smokers have a more severe form of panic disorder than non-smokers. METHOD: Sixty-four patients already in treatment at the Laboratory of Panic and Respiration (Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro with panic disorder as established by the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, were divided into groups of smokers and non-smokers. Both groups were compared regarding sociodemographic data, comorbidities and clinical status severity. RESULTS: There was no statistically significant

  5. Childhood internalizing and externalizing problems predict the onset of clinical panic attacks over adolescence: the TRAILS study.

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    Christina M Mathyssek

    Full Text Available BACKGROUND: Panic attacks are a source of individual suffering and are an independent risk factor for later psychopathology. However, much less is known about risk factors for the development of panic attacks, particularly during adolescence when the incidence of panic attacks increases dramatically. We examined whether internalizing and externalizing problems in childhood predict the onset of panic attacks in adolescence. METHOD: This study is part of the TRacking Adolescents' Individual Lives Survey (TRAILS, a Dutch longitudinal population cohort study (N = 1,584. Internalizing and Externalizing Problems were collected using the Youth Self-Report (YSR and the parent-report Child Behavior Checklist (CBCL at baseline (age 10-12. At age 18-20, DSM-IV defined panic attacks since baseline were assessed with the Composite International Diagnostic Interview (CIDI. We investigated whether early adolescent Internalizing and Externalizing Problems predicted panic attacks between ages 10-20 years, using survival analysis in univariate and multivariate models. RESULTS: There were N = 314 (19.8% cases who experienced at least one DSM-IV defined panic attack during adolescence and N = 18 (1.2% who developed panic disorder during adolescence. In univariate analyses, CBCL Total Problems, Internalizing Problems and three of the eight syndrome scales predicted panic attack onset, while on the YSR all broad-band problem scales and each narrow-band syndrome scale predicted panic attack onset. In multivariate analyses, CBCL Social Problems (HR 1.19, p<.05, and YSR Thought Problems (HR 1.15, p<.05 and Social Problems (HR 1.26, p<.01 predicted panic attack onset. CONCLUSION: Risk indicators of panic attack include the wide range of internalizing and externalizing problems. Yet, when adjusted for co-occurring problem behaviors, Social Problems were the most consistent risk factor for panic attack onsets in adolescence.

  6. Perievent Panic Attack and Depression after the World Trade Center Disaster: A Structural Equation Model Analysis

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    Adams, Richard E.; Boscarino, Joseph A.

    2011-01-01

    Research suggests that perievent panic attackspanic attacks in temporal proximity to traumatic events – are predictive of later mental health status, including the onset of depression. Using a community sample of New York City residents interviewed 1 year and 2 years after the World Trade Center Disaster, we estimated a structural equation model (SEM) using pre-disaster psychological status and post-disaster life events, together with psychosocial resources, to assess the relationship between perievent panic and later onset depression. Bivariate results revealed a significant association between perievent panic and both year-1 and year-2 depression. Results for the SEM, however, showed that perievent panic was predictive of year-1 depression, but not year-2 depression, once potential confounders were controlled. Year-2 stressors and year-2 psychosocial resources were the best predictors of year-2 depression onset. Pre-disaster psychological problems were directly implicated in year-1 depression, but not year-2 depression. We conclude that a conceptual model that includes pre- and post-disaster variables best explains the complex causal pathways between psychological status, stressor exposure, perievent panic attacks, and depression onset two years after the World Trade Center attacks. PMID:21957721

  7. 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…

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

    Science.gov (United States)

    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…

  9. A bibliotherapy approach to relapse prevention in individuals with panic attacks.

    Science.gov (United States)

    Wright, J; Clum, G A; Roodman, A; Febbraro, G A

    2000-01-01

    The present study examined a relapse prevention (RP) program delivered via bibliotherapy in the treatment of individuals with panic attacks. Compared with a wait list control group, individuals receiving RP exhibited significant reductions on measures of frequency of panic attacks, panic cognitions, anticipatory anxiety, avoidance, and depression. In addition, individuals in the RP group were more likely to attain a "clinically significant change" in status on both panic-free status and level of avoidance more frequently than individuals in the control group. When compared with treatment effects evaluated in two prior phases of the study, the obtained results appear to be the product of a synchronous effect of bibliotherapy and minimal phone contact during the 6-month follow-up period. The results reflect the importance of brief therapist contact in increasing motivation for active participation in bibliotherapy interventions.

  10. Intolerance of uncertainty as a contributor to fear and avoidance symptoms of panic attacks.

    Science.gov (United States)

    Carleton, R Nicholas; Fetzner, Mathew G; Hackl, Jennifer L; McEvoy, Peter

    2013-01-01

    Panic disorder symptoms are persistent for 50-80% of cases even after treatment, resulting in experiences of disability and dissatisfaction in life. Previous research has focused on anxiety sensitivity (AS) and its dimensions as contributing to symptoms of panic disorder; however, recent research has suggested that intolerance of uncertainty (IU)-the tendency for a person to consider the possibility of a negative event occurring as threatening, irrespective of the actual probability of its occurrence-may also play a critical role. The current study was designed to assess the specific relationships between dimensions of IU (i.e. prospective IU and inhibitory IU) and the fear and avoidance symptoms associated with panic disorder. Participants included 122 community members (81% women) with a history of at least one panic attack who participated in a larger study on fear. Participants completed measures of AS, IU, and panic disorder symptoms. Correlation and regression analyses supported a significant and substantial relationship between AS, inhibitory IU, and panic disorder symptoms. Inhibitory IU accounted for relatively more variance in avoidance symptoms related to panic disorder than did the fears of physical sensations dimension of AS. As such, further investigation of the role of IU in panic disorder symptoms appears warranted. Comprehensive results, implications, and directions for future research are discussed.

  11. Panic disorder

    Science.gov (United States)

    ... Recalling a past attack may trigger panic attacks. Exams and Tests Many people with panic disorder first ... of exercise Getting enough sleep Reducing or avoiding caffeine, certain cold medicines, and stimulants Support Groups You ...

  12. Hot Flashes and Panic Attacks: A Comparison of Symptomatology, Neurobiology, Treatment, and a Role for Cognition

    Science.gov (United States)

    Hanisch, Laura J.; Hantsoo, Liisa; Freeman, Ellen W.; Sullivan, Gregory M.; Coyne, James C.

    2008-01-01

    Despite decades of research, the causal mechanisms of hot flashes are not adequately understood, and a biopsychosocial perspective on hot flashes remains underdeveloped. This article explores overlooked parallels between hot flashes and panic attacks within 5 areas: course and symptomatology, physiological indicators, neurocircuitry and…

  13. [Factors that influence comorbidity from panic disorder and PTSD after earthquakes].

    Science.gov (United States)

    Leiva-Bianchi, Marcelo; Candia, Claudia; Montecino, Karla

    2014-01-01

    After the earthquake and tsunami in Chile (F-27), we studied the effect of socio-demographic factors, exposure to the event, and state aid received on comorbidity from panic disorder (PD) and posttraumatic stress disorder (PTSD). Surveys that include the administration of the Davidson Trauma Scale (DTS) to 246 inhabitants. 19.1 % comorbidity was found (r=.583, R2=.340, pearthquakes/tsunamis and an instrument to detect cases at risk of PTSD. We suggest guidelines so that the government can improve its role after disasters.

  14. [Comorbidity of panic disorder and alcoholism in a sample of 100 alcoholic patients].

    Science.gov (United States)

    Segui, J; Salvador, L; Canet, J; Herrera, C; Aragón, C

    1994-01-01

    Among one hundred patients with alcohol dependence (DSM-III-R) studied in a drug abuse center in the "Bajo Llobregat" area (Barcelona industrial belt it was detected that 27% had life time rate of panic disorder. The age of onset of alcoholism was earlier than the one for panic disorder. In 78.8% of these patients alcoholismo appeared first. 70.4% refer worsening of the panic attacks when drinking large amounts of alcohol. Patients with Panic Disorder: a) are younger (p < 0.05); b) have attended school longer and have higher education (p < 0.01); c) have more alcoholism family history (p < 0.05); d) have more major depressive disorders (0.05) and dysthimic disorder (p < 0.01); e) Worse social functioning according to the GAS (p < 0.01); f) higher score for the Psychological disorders Scale (p < 0.001) and a lower performance at work (p < 0.001) measured by the ASI. The clinical significance of these findings is discussed.

  15. Panic attacks as a dimension of psychopathology: evidence for associations with onset and course of mental disorders and level of functioning

    NARCIS (Netherlands)

    Batelaan, N.M.; Rhebergen, D.; Graaf, R. de; Spijker, J.; Beekman, A.T.; Penninx, B.W.J.H.

    2012-01-01

    OBJECTIVE: One of the proposed revisions for DSM-5 is to rate panic attacks as a separate dimension across all mental disorders. The idea is that panic attacks occurring outside panic disorder are a dimension predicting important clinical outcomes. The aim of this study was to validate the propositi

  16. ETIOLOGY, TRIGGERS AND NEUROCHEMICAL CIRCUITS ASSOCIATED WITH UNEXPECTED, EXPECTED, AND LABORATORY-INDUCED PANIC ATTACKS

    Science.gov (United States)

    Johnson, Philip L.; Federici, Lauren M.; Shekhar, Anantha

    2014-01-01

    Panic disorder (PD) is a severe anxiety disorder that is characterized by recurrent panic attacks (PA), which can be unexpected (uPA, i.e., no clear identifiable trigger) or expected (ePA). Panic typically involves an abrupt feeling of catastrophic fear or distress accompanied by physiological symptoms such as palpitations, racing heart, thermal sensations, and sweating. Recurrent uPA and ePA can also lead to agoraphobia, where subjects with PD avoid situations that were associated with PA. Here we will review recent developments in our understanding of PD, which includes discussions on: symptoms and signs associated with uPA and ePAs; Diagnosis of PD and the new DSM-V; biological etiology such as heritability and gene x environment and gene x hormonal development interactions; comparisons between laboratory and naturally occurring uPAs and ePAs; neurochemical systems that are associated with clinical PAs (e.g. gene associations; targets for triggering or treating PAs), adaptive fear and panic response concepts in the context of new NIH RDoc approach; and finally strengths and weaknesses of translational animal models of adaptive and pathological panic states. PMID:25130976

  17. Weekly and holiday-related patterns of panic attacks in panic disorder: a population-based study.

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    Li-Ting Kao

    Full Text Available BACKGROUND: While chronobiological studies have reported seasonal variation in panic attacks (PA episodes, information on the timing of PA by week-days may enable better understanding of the triggers of PA episodes and thereby provide pointers for suitable interventional approaches to minimize PA attacks. This study investigated weekly variation in potential PA admissions including associations with holidays using a population-based longitudinal, administrative claims-based dataset in an Asian population. METHODS: This study used ambulatory care data from the "Longitudinal Health Insurance Database 2000. We identified 993 patients with panic disorder (PD, and they had 4228 emergency room (ER admissions for potential PA in a 3-year period between 1 January 2009 and 31 December 2011. One-way analysis of variance (ANOVA was used to examine associations between the potential PA admissions and holidays/weekend days/work-days of the week. RESULTS: The daily mean number of potential PA admissions was 3.96 (standard deviation 2.05. One-way ANOVA showed significant differences in potential PA admissions by holiday and day of the week (p<0.001. Daily frequencies showed a trough on Wednesday-Thursday, followed by a sharp increase on Saturday and a peak on Sunday. Potential PA admissions were higher than the daily mean for the sample patients by 29.4% and 22.1%, respectively on Sundays and holidays. Furthermore, the weekly variations were similar for females and males, although females always had higher potential PA admissions on both weekdays and holidays than the males. CONCLUSIONS: We found that potential PA admissions among persons with PD varied systematically by day of the week, with a significant peak on weekends and holidays.

  18. Separating depressive comorbidity from panic disorder: A combined functional magnetic resonance imaging and machine learning approach.

    Science.gov (United States)

    Lueken, Ulrike; Straube, Benjamin; Yang, Yunbo; Hahn, Tim; Beesdo-Baum, Katja; Wittchen, Hans-Ulrich; Konrad, Carsten; Ströhle, Andreas; Wittmann, André; Gerlach, Alexander L; Pfleiderer, Bettina; Arolt, Volker; Kircher, Tilo

    2015-09-15

    Depression is frequent in panic disorder (PD); yet, little is known about its influence on the neural substrates of PD. Difficulties in fear inhibition during safety signal processing have been reported as a pathophysiological feature of PD that is attenuated by depression. We investigated the impact of comorbid depression in PD with agoraphobia (AG) on the neural correlates of fear conditioning and the potential of machine learning to predict comorbidity status on the individual patient level based on neural characteristics. Fifty-nine PD/AG patients including 26 (44%) with a comorbid depressive disorder (PD/AG+DEP) underwent functional magnetic resonance imaging (fMRI). Comorbidity status was predicted using a random undersampling tree ensemble in a leave-one-out cross-validation framework. PD/AG-DEP patients showed altered neural activation during safety signal processing, while +DEP patients exhibited generally decreased dorsolateral prefrontal and insular activation. Comorbidity status was correctly predicted in 79% of patients (sensitivity: 73%; specificity: 85%) based on brain activation during fear conditioning (corrected for potential confounders: accuracy: 73%; sensitivity: 77%; specificity: 70%). No primary depressed patients were available; only medication-free patients were included. Major depression and dysthymia were collapsed (power considerations). Neurofunctional activation during safety signal processing differed between patients with or without comorbid depression, a finding which may explain heterogeneous results across previous studies. These findings demonstrate the relevance of comorbidity when investigating neurofunctional substrates of anxiety disorders. Predicting individual comorbidity status may translate neurofunctional data into clinically relevant information which might aid in planning individualized treatment. The study was registered with the ISRCTN80046034. Copyright © 2015 Elsevier B.V. All rights reserved.

  19. The relationship between cardiac anxiety and hostility in panic attack patients

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    Mavreas V.

    2010-07-01

    Full Text Available Panic attack is based on the belief that bodily sensations such as palpitations or discomfort may produce harmful consequences. It also, considered to be an episode of incredibly intense fear or apprehension that is of sudden onset. The objective of present study was to investigate the relationship between heart focused anxiety and hostility in this diagnostic group. In addition it was been considered of how this connection can be used within both diagnostic and treatment issues. 145 individuals (23 male and 122 female suffering from panic attack, at least once in their life, participated to the present study. The diagnosis of the attacks is held according to the DSM-V criteria. The measures used were: a The Cardiac Anxiety Questionnaire (CAQ, B The Hostility and Direction of Hostility Questionnaire (HDHQ and c A questionnaire concerning socio-demographic information. A positive correlation among fear of cardiac sensations and intropunitiveness and/or extrapunitiveness were observed in this target group. Higher levels of heart focused anxiety were connected with a hostile attitude, either against the others or against their-selves. Further research should be provide the ego-mechanisms as well as the relevant consequences of this relationship in clinical practice.

  20. Insomnia Symptoms Following Treatment for Comorbid Panic Disorder With Agoraphobia and Generalized Anxiety Disorder.

    Science.gov (United States)

    Cousineau, Héloïse; Marchand, André; Bouchard, Stéphane; Bélanger, Claude; Gosselin, Patrick; Langlois, Frédéric; Labrecque, Joane; Dugas, Michel J; Belleville, Geneviève

    2016-04-01

    Patients with panic disorder with agoraphobia (PDA) or generalized anxiety disorder (GAD) frequently also suffer from insomnia. However, the impact of cognitive-behavioral therapy (CBT) for anxiety disorders on insomnia has been understudied. Furthermore, comorbidity between anxiety disorders is common. Our main objective was to assess the impact of CBT for PDA or GAD on insomnia. In a quasi-experimental design, 86 participants with PDA and GAD received conventional CBT for their primary disorder or combined CBT for both disorders. Overall, CBTs had a significant impact on reducing insomnia symptoms (η = 0.58). However, among people with insomnia at pretest (67%), 33% still had an insomnia diagnosis, and the majority (63%) had clinically significant residual insomnia following treatment. In conclusion, the CBTs had a positive effect on the reduction of insomnia, but a significant proportion of participants still had insomnia problems following treatment. Clinicians should address insomnia during CBT for PDA and GAD.

  1. Electroconvulsive therapy in a physically restrained man with comorbid major depression, severe agoraphobia with panic disorder, and histrionic personality disorder.

    Science.gov (United States)

    Rapinesi, Chiara; Serata, Daniele; Del Casale, Antonio; Kotzalidis, Giorgio D; Romano, Silvia; Milioni, Mara; Capezzuto, Silvia; Carbonetti, Paolo; Angeletti, Gloria; Fensore, Claudio; Tatarelli, Roberto; Girardi, Paolo

    2012-03-01

    A 36-year-old man with comorbid panic disorder with agoraphobia, major depression, and histrionic personality disorder since age 21 was resistant to combined drug and psychotherapy treatment. His conditions had progressively worsened with time, causing him to withdraw socially and to simultaneously require continuous physical restraint, which further worsened his functioning. He spent almost 3 consecutive years in restraint, until he consented to receive bilateral ECT treatment. He improved after 13 sessions in all areas (social and role functioning, and panic, depressive, and histrionic symptoms) and is well 3 months later with a lithium-atypical antipsychotic combination.

  2. Cerebral correlates of heart rate variations during a spontaneous panic attack in the fMRI scanner.

    Science.gov (United States)

    Spiegelhalder, Kai; Hornyak, Magdolna; Kyle, Simon David; Paul, Dominik; Blechert, Jens; Seifritz, Erich; Hennig, Jürgen; Tebartz van Elst, Ludger; Riemann, Dieter; Feige, Bernd

    2009-12-01

    We report the first published case study of a suddenly occurring panic attack in a patient with no prior history of panic disorder during combined functional magnetic resonance imaging (fMRI, 1.5 Tesla) and electrocardiogram (ECG) recording. The single case was a 46-year-old woman who developed a panic attack near the planned end of the fMRI acquisition session, which therefore had to be aborted. Correlational analysis of heart rate fluctuations and fMRI data revealed a significant negative association in the left middle temporal gyrus. Additionally, regions-of-interest (ROI) analyses indicated significant positive associations in the left amygdala, and trends towards significance in the right amygdala and left insula.

  3. Isolated sleep paralysis and fearful isolated sleep paralysis in outpatients with panic attacks.

    Science.gov (United States)

    Sharpless, Brian A; McCarthy, Kevin S; Chambless, Dianne L; Milrod, Barbara L; Khalsa, Shabad-Ratan; Barber, Jacques P

    2010-12-01

    Isolated sleep paralysis (ISP) has received scant attention in clinical populations, and there has been little empirical consideration of the role of fear in ISP episodes. To facilitate research and clinical work in this area, the authors developed a reliable semistructured interview (the Fearful Isolated Sleep Paralysis Interview) to assess ISP and their proposed fearful ISP (FISP) episode criteria in 133 patients presenting for panic disorder treatment. Of these, 29.3% met lifetime ISP episode criteria, 20.3% met the authors' lifetime FISP episode criteria, and 12.8% met their recurrent FISP criteria. Both ISP and FISP were associated with minority status and comorbidity. However, only FISP was significantly associated with posttraumatic stress disorder, body mass, anxiety sensitivity, and mood and anxiety disorder symptomatology.

  4. Childhood Traumatic Experiences, Dissociative Symptoms, and Dissociative Disorder Comorbidity Among Patients With Panic Disorder: A Preliminary Study.

    Science.gov (United States)

    Ural, Cenk; Belli, Hasan; Akbudak, Mahir; Tabo, Abdulkadir

    2015-01-01

    This study assessed childhood trauma history, dissociative symptoms, and dissociative disorder comorbidity in patients with panic disorder (PD). A total of 92 psychotropic drug-naive patients with PD, recruited from outpatient clinics in the psychiatry department of a Turkish hospital, were involved in the study. Participants were assessed using the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D), Dissociation Questionnaire, Panic and Agoraphobia Scale, Panic Disorder Severity Scale, and Childhood Trauma Questionnaire. Of the patients with PD, 18 (19%) had a comorbid dissociative disorder diagnosis on screening with the SCID-D. The most prevalent disorders were dissociative disorder not otherwise specified, dissociative amnesia, and depersonalization disorders. Patients with a high degree of dissociation symptoms and dissociative disorder comorbidity had more severe PD than those without (p dissociation and PD. Among all of the subscales, the strongest relationship was with childhood emotional abuse. Logistic regression analysis showed that emotional abuse and severity of PD were independently associated with dissociative disorder. In our study, a significant proportion of the patients with PD had concurrent diagnoses of dissociative disorder. We conclude that the predominance of PD symptoms at admission should not lead the clinician to overlook the underlying dissociative process and associated traumatic experiences among these patients.

  5. The impact of an 8-day intensive treatment for adolescent panic disorder and agoraphobia on comorbid diagnoses.

    Science.gov (United States)

    Gallo, Kaitlin P; Chan, Priscilla T; Buzzella, Brian A; Whitton, Sarah W; Pincus, Donna B

    2012-03-01

    Previous research findings have shown positive effects of cognitive-behavioral therapy for primary anxiety disorders as well as for nonprimary, co-occurring anxiety disorders. In this study, we analyzed data from an existing randomized controlled trial of intensive treatment for panic disorder with or without agoraphobia (PDA) to examine the effects of the treatment on comorbid psychiatric diagnoses. The overall frequency and severity of aggregated comorbid diagnoses decreased in a group of adolescents who received an 8-day treatment for PDA. Results suggest that an 8-day treatment for PDA can alleviate the symptoms of some specific comorbid clinical diagnoses; in particular specific phobias, generalized anxiety disorder, and social phobia. These findings suggest that an intensive treatment for PDA is associated with reductions in comorbid symptoms even though disorders other than PDA are not specific treatment targets.

  6. Impact of comorbid panic and posttraumatic stress disorder on outcomes of collaborative care for late-life depression in primary care.

    Science.gov (United States)

    Hegel, Mark T; Unützer, Jürgen; Tang, Lingqi; Areán, Patricia A; Katon, Wayne; Noël, Polly Hitchcock; Williams, John W; Lin, Elizabeth H B

    2005-01-01

    Comorbid anxiety disorders may result in worse depression treatment outcomes. The authors evaluated the effect of comorbid panic disorder and posttraumatic stress disorder (PTSD) on response to a collaborative-care intervention for late-life depression in primary care. A total of 1,801 older adults with depression were randomized to a collaborative-care depression treatment model versus usual care and assessed at baseline, 3, 6, and 12 months, comparing differences among participants with comorbid panic disorder (N=262) and PTSD (N=191) and those without such comorbid anxiety disorders. At baseline, patients with comorbid anxiety reported higher levels of psychiatric and medical illness, greater functional impairment, and lower quality of life. Participants without comorbid anxiety who received collaborative care had early and lasting improvements in depression compared with those in usual care. Participants with comorbid panic disorder showed similar outcomes, whereas those with comorbid PTSD showed a more delayed response, requiring 12 months of intervention to show a significant effect. At 12 months, however, outcomes were comparable. Interactions of intervention status by comorbid PTSD or panic disorder were not statistically significant, suggesting that the collaborative-care model performed significantly better than usual care in depressed older adults both with and without comorbid anxiety. Collaborative care is more effective than usual care for depressed older adults with and without comorbid panic disorder and PTSD, although a sustained treatment response was slower to emerge for participants with PTSD. Intensive and prolonged follow-up may be needed for depressed older adults with comorbid PTSD.

  7. The effects of comorbid personality disorders on cognitive behavioral treatment for panic disorder

    NARCIS (Netherlands)

    Telch, M.J.; Kamphuis, J.H.; Schmidt, N.B.

    2011-01-01

    The present study investigated the influence of personality pathology assessed both dimensionally and categorically on acute clinical response to group cognitive-behavioral treatment in a large sample of panic disorder patients (N = 173) meeting DSMIII-R criteria for panic disorder with or without

  8. The effects of comorbid personality disorders on cognitive behavioral treatment for panic disorder

    NARCIS (Netherlands)

    M.J. Telch; J.H. Kamphuis; N.B. Schmidt

    2011-01-01

    The present study investigated the influence of personality pathology assessed both dimensionally and categorically on acute clinical response to group cognitive-behavioral treatment in a large sample of panic disorder patients (N = 173) meeting DSMIII-R criteria for panic disorder with or without a

  9. An investigation into the effectiveness of bibliotherapy and minimal contact interventions in the treatment of panic attacks.

    Science.gov (United States)

    Febbraro, Greg A R

    2005-06-01

    The present study investigated the effectiveness of bibliotherapy and minimal therapist-contact interventions in the treatment of panic attacks. Individuals were randomly assigned to one of three conditions: (1) bibliotherapy alone (BT); (2) bibliotherapy plus phone contact (BT+PC); or (3) phone contact alone (PC). Assessment (pre- and post-treatment) and treatment (8 weeks in duration) were conducted via mail and phone. Individuals receiving BT and BT+PC exhibited significant reductions from pre- to post-treatment on panic cognitions and fear of having a panic attack. Individuals receiving BT+PC exhibited significant reductions from pre- to post-treatment on panic symptoms and avoidance. In addition, individuals in the BT and BT+PC groups were more likely to exhibit clinically significant improvement on most dependent measures relative to PC alone. On some measures, individuals in the BT+PC group did clinically better than individuals in the BT group. Results of the present study also suggest that diagnosis may play some role in outcome.

  10. The Effectiveness of Cognitive-Behavioral Therapy (CBT in Reducing Worry, Anxiety and Panic Attacks Mitral Valve Prolapse Patients

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    AR Jamshidzehi ShahBakhsh

    2016-07-01

    Full Text Available Introduction: The mitral valve prolapse is a heart syndrome that is characterized by considerable physical and psychological consequences for affected patients. This study aimed to assess the efficacy of cognitive-behavioral therapy in reducing worrying, generalized anxiety and panic attacks in patients with mitral valve prolapse. Methods: This study is quasi-experimental research with pretest-posttest and control group. 16 patients with mitral valve prolapse divided into to two groups: experimental (n = 8 and control (n = 8 groups. CBT was used during 10 sessions twice a week with a focus on cognitive restructuring, modification of cognitive distortions and training of behavioral techniques for the experimental group. For participants health  concerns spot and doush (HCQ, Generalized anxiety disorder (GAD- 7 and Albania panic scales as pre-test, post-test. Results: Data were analyzed by covariance analysis. The results showed that worrying, anxiety, and panic attacks significantly reduced in the experimental group. Discussion: Cognitive behavioral therapy is remarkably effective for reducing fear, anxiety and panic patients with mitral valve prolapse. Therefore, it is recommended for the patients with mitral valve prolapse that cognitive behavioral therapy can be used as a complementary therapy.

  11. A comparison of low-dose risperidone to paroxetine in the treatment of panic attacks: a randomized, single-blind study

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    Galynker Igor I

    2009-05-01

    Full Text Available Abstract Background Because a large proportion of patients with panic attacks receiving approved pharmacotherapy do not respond or respond poorly to medication, it is important to identify additional therapeutic strategies for the management of panic symptoms. This article describes a randomized, rater-blind study comparing low-dose risperidone to standard-of-care paroxetine for the treatment of panic attacks. Methods Fifty six subjects with a history of panic attacks were randomized to receive either risperidone or paroxetine. The subjects were then followed for eight weeks. Outcome measures included the Panic Disorder Severity Scale (PDSS, the Hamilton Anxiety Scale (Ham-A, the Hamilton Depression Rating Scale (Ham-D, the Sheehan Panic Anxiety Scale-Patient (SPAS-P, and the Clinical Global Impression scale (CGI. Results All subjects demonstrated a reduction in both the frequency and severity of panic attacks regardless of treatment received. Statistically significant improvements in rating scale scores for both groups were identified for the PDSS, the Ham-A, the Ham-D, and the CGI. There was no difference between treatment groups in the improvement in scores on the measures PDSS, Ham-A, Ham-D, and CGI. Post hoc tests suggest that subjects receiving risperidone may have a quicker clinical response than subjects receiving paroxetine. Conclusion We can identify no difference in the efficacy of paroxetine and low-dose risperidone in the treatment of panic attacks. Low-dose risperidone appears to be tolerated equally well as paroxetine. Low-dose risperidone may be an effective treatment for anxiety disorders in which panic attacks are a significant component. Trial Registration ClinicalTrials.gov Identifier: NCT100457106

  12. 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

  13. Review of current treatment in panic disorder

    NARCIS (Netherlands)

    den Boer, JA; Slaap, BR

    1998-01-01

    The ideal properties for an antipanic agent include the ability to provide complete recovery from panic attacks, resolution of associated anxiety and avoidance behavior, relapse prevention, good tolerability, and efficacy in comorbid conditions including depression. We compared the properties of cur

  14. Frontal white matter alterations in short-term medicated panic disorder patients without comorbid conditions: a diffusion tensor imaging study.

    Directory of Open Access Journals (Sweden)

    Borah Kim

    Full Text Available The frontal cortex might play an important role in the fear network, and white matter (WM integrity could be related to the pathophysiology of panic disorder (PD. A few studies have investigated alterations of WM integrity in PD. The aim of this study was to determine frontal WM integrity differences between patients with PD without comorbid conditions and healthy control (HC subjects by using diffusion tensor imaging. Thirty-six patients with PD who had used medication within 1 week and 27 age- and sex-matched HC subjects participated in this study. Structural brain magnetic resonance imaging was performed on all participants. Panic Disorder Severity Scale and Beck Anxiety Inventory (BAI scores were assessed. Tract-based spatial statistics (TBSS was used for image analysis. TBSS analysis showed decreased fractional anisotropy (FA in frontal WM and WM around the frontal lobe, including the corpus callosum of both hemispheres, in patients with PD compared to HC subjects. Moreover, voxel-wise correlation analysis revealed that the BAI scores for patients with PD were positively correlated with their FA values for regions showing group differences in the FA of frontal WM of both hemispheres. Altered integrity in frontal WM of patients with PD without comorbid conditions might represent the structural pathophysiology in these patients, and these changes could be related to clinical symptoms of PD.

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

    NARCIS (Netherlands)

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

    2014-01-01

    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

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

    NARCIS (Netherlands)

    Carleton, R Nicholas; Duranceau, Sophie; Freeston, Mark H; Boelen, Paul A|info:eu-repo/dai/nl/174011954; McCabe, Randi E; Antony, Martin M

    2014-01-01

    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

  17. Panic Disorder: When Fear Overwhelms

    Science.gov (United States)

    ... have: Sudden and repeated panic attacks of overwhelming anxiety and fear A feeling of being out of control, or ... to react differently to the physical sensations of anxiety and fear that occur during panic attacks. For more information ...

  18. Neck-focused panic attacks among Cambodian refugees; a logistic and linear regression analysis.

    Science.gov (United States)

    Hinton, Devon E; Chhean, Dara; Pich, Vuth; Um, Khin; Fama, Jeanne M; Pollack, Mark H

    2006-01-01

    Consecutive Cambodian refugees attending a psychiatric clinic were assessed for the presence and severity of current--i.e., at least one episode in the last month--neck-focused panic. Among the whole sample (N=130), in a logistic regression analysis, the Anxiety Sensitivity Index (ASI; odds ratio=3.70) and the Clinician-Administered PTSD Scale (CAPS; odds ratio=2.61) significantly predicted the presence of current neck panic (NP). Among the neck panic patients (N=60), in the linear regression analysis, NP severity was significantly predicted by NP-associated flashbacks (beta=.42), NP-associated catastrophic cognitions (beta=.22), and CAPS score (beta=.28). Further analysis revealed the effect of the CAPS score to be significantly mediated (Sobel test [Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173-1182]) by both NP-associated flashbacks and catastrophic cognitions. In the care of traumatized Cambodian refugees, NP severity, as well as NP-associated flashbacks and catastrophic cognitions, should be specifically assessed and treated.

  19. Panic Attacks and Panic Disorder

    Science.gov (United States)

    ... For example, yoga, deep breathing and progressive muscle relaxation — tensing one muscle at a time, and then completely releasing the tension until every muscle in the body is relaxed — also may be helpful. Get physically active. Aerobic activity may have a calming effect on ...

  20. Negative reinforcement/negative affect reduction cigarette smoking outcome expectancies: incremental validity for anxiety focused on bodily sensations and panic attack symptoms among daily smokers.

    Science.gov (United States)

    Zvolensky, Michael J; Gonzalez, Adam; Bonn-Miller, Marcel O; Bernstein, Amit; Goodwin, Renee D

    2008-02-01

    The present investigation evaluated the incremental validity of negative reinforcement/negative affect reduction smoking outcome expectancies in the prediction of anxious and fearful responding to bodily sensations. Participants included 171 daily smokers (82 women, 89 men; mean age = 25.67 years, SD = 10.54). Consistent with prediction, negative reinforcement/negative affect reduction smoking outcome expectancies were significantly predictive of anxiety focused on bodily sensations and postchallenge intensity of cognitive panic attack symptoms, but not of physical panic symptoms. The observed effects were evident above and beyond the statistically significant variance accounted for by the covariates of anxiety sensitivity, negative affectivity, cigarettes per day, and weekly alcohol use and independent of other smoking outcome expectancy factors. Findings are discussed in terms of the role of negative reinforcement/negative affect reduction smoking outcome expectancies and vulnerability for panic symptoms and psychopathology.

  1. Ataques de pânico são realmente inofensivos? O impacto cardiovascular do transtorno de pânico Are panic attacks really harmless? The cardiovascular impact of panic disorder

    Directory of Open Access Journals (Sweden)

    Aline Sardinha

    2009-03-01

    autonomic pattern found in patients with panic disorder, particularly the reduction in heart rate variability, are discussed as potential mediators of the cardiovascular impact of panic disorder. CONCLUSIONS: Despite de established association between panic disorder and cardiac diseases, current literatures data points to a knowledge gap on treating and diagnosing the comorbidity between panic disorder and cardiovascular diseases. Cognitive-behavioral therapy and regular supervised exercise are recommended as potential adjunct therapeutic interventions.

  2. The effect of a combined versus a conventional cognitive-behavioral therapy on quality of life for comorbid panic disorder with agoraphobia and generalized anxiety disorder: preliminary results.

    Science.gov (United States)

    Primiano, Sandra; Marchand, André; Gosselin, Patrick; Langlois, Frédéric; Bouchard, Stéphane; Bélanger, Claude; Labrecque, Joane; Dugas, Michel; Dupuis, Gilles

    2014-01-01

    Concurrent panic disorder with agoraphobia (PDA) and generalized anxiety disorder (GAD) are the most common diagnostic occurrences among anxiety disorders. This particular comorbidity is associated with significant impairments in quality of life (QOL). The current study sought to investigate the efficacy of a combined cognitive-behavioral psychotherapy that addressed both conditions compared with a conventional psychotherapy, which attends solely to the primary disorder. The hypotheses postulated firstly, that both treatment conditions would lead to improvements in participants' QOL and secondly, that the combined therapy would lead to greater QOL ameliorations. Twenty-five participants with comorbid PDA/GAD diagnoses were evaluated with a number of clinical interviews and self-report questionnaires, and were provided with either conventional or combined cognitive-behavioral psychotherapy, which consisted of 14 one-hour weekly sessions. Participants were once again evaluated in the same fashion 2-weeks after the completion of the psychotherapy. The results revealed that both conditions led to significant improvements in participants' QOL, but that the two groups did not significantly differ in terms of the effect on QOL. The results also reveal that the two conditions did not significantly differ in terms of their effect on PDA and GAD symptomatology or psychiatric comorbidity. The results demonstrate that the combined psychotherapy, which addresses both conditions simultaneously, is similar to the conventional psychotherapy employed for the primary disorder in terms of QOL enhancement, symptom severity, and comorbidity reduction.

  3. Social phobia with sudden onset-Post-panic social phobia?

    DEFF Research Database (Denmark)

    Kristensen, Ann Suhl; Mortensen, Erik Lykke; Mors, Ole

    2008-01-01

    Overlap between social phobia (SP) and panic disorder (PD) has been observed in epidemiological, family, and challenge studies. One possible explanation is that some cases of SP develop as a consequence of a panic attack in a social situation. By definition, these cases of SP have sudden onset....... It is hypothesized that patients with SP with sudden onset are more similar to patients with comorbid SP and PD than to patients with SP without sudden onset regarding age of onset, extraversion, and prevalence of anxiety symptoms. One hundred and eighty-two patients with a lifetime diagnosis of PD and/or SP were...

  4. 31-Year-Old Female Shows Marked Improvement in Depression, Agitation, and Panic Attacks after Genetic Testing Was Used to Inform Treatment

    Directory of Open Access Journals (Sweden)

    Scott Lawrence

    2014-01-01

    Full Text Available This case describes a 31-year-old female Caucasian patient with complaints of ongoing depression, agitation, and severe panic attacks. The patient was untreated until a recent unsuccessful trial of citalopram followed by venlafaxine which produced a partial response. Genetic testing was performed to assist in treatment decisions and revealed the patient to be heterozygous for polymorphisms in 5HT2C, ANK3, and MTHFR and homozygous for a polymorphism in SLC6A4 and the low activity (Met/Met COMT allele. In response to genetic results and clinical presentation, venlafaxine was maintained and lamotrigine was added leading to remission of agitation and depression.

  5. Milnacipran in panic disorder with agoraphobia and major depressive disorder: a case report.

    Science.gov (United States)

    Chen, Mu-Hong; Liou, Ying-Jay

    2011-01-01

    A 51-year-old woman had panic disorder with agoraphobia and major depressive disorder sequentially. The aforementioned symptoms subsided significantly after treatment with milnacipran, 125 mg, administered daily for 2 months. However, panic attacks with agoraphobia were noted frequently when she tapered down milnacipran to 50 mg daily. She consequently experienced depression that gradually increased in degree, with poor energy, poor sleep, thoughts of helplessness, and ideas of death. After administration of a daily dose of 125 mg of milnacipran for 1 month, her panic attacks with agoraphobia and depressed mood were again alleviated. The present report shows significant effects of milnacipran on the comorbidity of panic disorder with agoraphobia and major depressive disorder.

  6. The epidemiology of panic disorder and agoraphobia in Europe.

    Science.gov (United States)

    Goodwin, R D; Faravelli, C; Rosi, S; Cosci, F; Truglia, E; de Graaf, R; Wittchen, H U

    2005-08-01

    A literature search, in addition to expert survey, was performed to estimate the size and burden of panic disorder in the European Union (EU). Epidemiologic data from EU countries were critically reviewed to determine the consistency of prevalence estimates across studies and to identify the most pressing questions for future research. A comprehensive literature search focusing on epidemiological studies in community and clinical settings in European countries since 1980 was conducted (Medline, Web of Science, Psychinfo). Only studies using established diagnostic instruments on the basis of DSM-III-R or DSM-IV, or ICD-10 were considered. Thirteen studies from a total of 14 countries were identified. Epidemiological findings are relatively consistent across the EU. The 12-month prevalence of panic disorder and agoraphobia without history of panic were estimated to be 1.8% (0.7-2.2) and 1.3% (0.7-2.0) respectively across studies. Rates are twice as high in females and age of first onset for both disorders is in adolescence or early adulthood. In addition to comorbidity with agoraphobia, panic disorder is strongly associated with other anxiety disorders, and a wide range of somatoform, affective and substance use disorders. Even subclinical forms of panic disorder (i.e., panic attacks) are associated with substantial distress, psychiatric comorbidity and functional impairment. In general health primary care settings, there appears to be substantial underdiagnosis and undertreatment of panic disorder. Moreover, panic disorder and agoraphobia are poorly recognized and rarely treated in mental health settings, despite high health care utilization rates and substantial long-term disability.

  7. Comorbidity

    Science.gov (United States)

    ... Anabolic) Synthetic Cannabinoids (K2/Spice) Synthetic Cathinones (Bath Salts) Tobacco/Nicotine Other Drugs Related Topics Addiction Science Adolescent Brain Comorbidity College-Age & Young Adults ...

  8. Validation of the diagnoses of panic disorder and phobic disorders in the US National Comorbidity Survey Replication Adolescent (NCS-A) supplement.

    Science.gov (United States)

    Green, Jennifer Greif; Avenevoli, Shelli; Finkelman, Matthew; Gruber, Michael J; Kessler, Ronald C; Merikangas, Kathleen R; Sampson, Nancy A; Zaslavsky, Alan M

    2011-06-01

    Validity of the adolescent version of the World Health Organization Composite International Diagnostic Interview (CIDI) Version 3.0, a fully-structured research diagnostic interview designed to be used by trained lay interviewers, is assessed in comparison to independent clinical diagnoses based on the Schedule for Affective Disorders and Schizophrenia for School-age Children (K-SADS). This assessment is carried out in the clinical reappraisal sub-sample (n = 347) of the US National Comorbidity Survey Adolescent (NCS-A) supplement, a large (n = 10,148) community epidemiological survey of the prevalence and correlates of adolescent mental disorders in the United States. The diagnoses considered are panic disorder and phobic disorders (social phobia, specific phobia, agoraphobia). CIDI diagnoses are found to have good concordance with K-SADS diagnoses [area under the receiver operating characteristic curve (AUC) = 0.81-0.94], although the CIDI diagnoses are consistency somewhat higher than the K-SADS diagnoses. Data are also presented on criterion-level concordance in an effort to pinpoint CIDI question series that might be improved in future modifications of the instrument. Finally, data are presented on the factor structure of the fears associated with social phobia, the only disorder in this series where substantial controversy exists about disorder subtypes. Copyright © 2011 John Wiley & Sons, Ltd.

  9. Disorder-specific versus transdiagnostic and clinician-guided versus self-guided internet-delivered treatment for panic disorder and comorbid disorders: A randomized controlled trial.

    Science.gov (United States)

    Fogliati, V J; Dear, B F; Staples, L G; Terides, M D; Sheehan, J; Johnston, L; Kayrouz, R; Dear, R; McEvoy, P M; Titov, N

    2016-04-01

    Transdiagnostic cognitive behaviour therapy (TD-CBT) aims to target the symptoms of multiple disorders whereas disorder-specific CBT (DS-CBT) targets the symptoms of principal disorders. This study compared the relative benefits of internet-delivered TD-CBT and DS-CBT when provided in clinician-guided (CG-CBT) and self-guided (SG-CBT) formats for people with a principal diagnosis of Panic Disorder (PD). Participants (n=145) were randomly allocated to receive TD-CBT or DS-CBT and CG-CBT or SG-CBT. Large reductions in symptoms of PD (Cohen's d ≥ 0.71; avg. reduction ≥ 36%) and moderate-to-large reductions in symptoms of comorbid depression (Cohen's d ≥ 0.71; avg. reduction ≥ 33%), generalised anxiety disorder (Cohen's d ≥ 0.91; avg. reduction ≥ 34%) and social anxiety disorder (Cohen's d ≥ 0.50; avg. reduction ≥ 15%) were found over the 24-month follow-up period. Highlighting their efficacy and acceptability, no marked and consistent differences were observed between TD-CBT and DS-CBT or CG-CBT and DS-CBT.

  10. Induced abortion and anxiety, mood, and substance abuse disorders: isolating the effects of abortion in the national comorbidity survey.

    Science.gov (United States)

    Coleman, Priscilla K; Coyle, Catherine T; Shuping, Martha; Rue, Vincent M

    2009-05-01

    The purpose of this study was to examine associations between abortion history and a wide range of anxiety (panic disorder, panic attacks, PTSD, Agoraphobia), mood (bipolar disorder, mania, major depression), and substance abuse disorders (alcohol and drug abuse and dependence) using a nationally representative US sample, the national comorbidity survey. Abortion was found to be related to an increased risk for a variety of mental health problems (panic attacks, panic disorder, agoraphobia, PTSD, bipolar disorder, major depression with and without hierarchy), and substance abuse disorders after statistical controls were instituted for a wide range of personal, situational, and demographic variables. Calculation of population attributable risks indicated that abortion was implicated in between 4.3% and 16.6% of the incidence of these disorders. Future research is needed to identify mediating mechanisms linking abortion to various disorders and to understand individual difference factors associated with vulnerability to developing a particular mental health problem after abortion.

  11. Do Panic Symptoms Affect the Quality of Life and Add to the Disability in Patients with Bronchial Asthma?

    Directory of Open Access Journals (Sweden)

    A. D. Faye

    2015-01-01

    Full Text Available Background. Anxiety and panic are known to be associated with bronchial asthma with variety of impact on clinical presentation, treatment outcome, comorbidities, quality of life, and functional disability in patients with asthma. This study aims to explore the pattern of panic symptoms, prevalence and severity of panic disorder (PD, quality of life, and disability in them. Methods. Sixty consecutive patients of bronchial asthma were interviewed using semistructured proforma, Panic and Agoraphobia scale, WHO Quality of life (QOL BREF scale, and WHO disability schedule II (WHODAS II. Results. Though 60% of the participants had panic symptoms, only 46.7% had diagnosable panic attacks according to DSM IV TR diagnostic criteria and 33.3% had PD. Most common symptoms were “sensations of shortness of breath or smothering,” “feeling of choking,” and “fear of dying” found in 83.3% of the participants. 73.3% of the participants had poor quality of life which was most impaired in physical and environmental domains. 55% of the participants had disability score more than a mean (18.1. Conclusion. One-third of the participants had panic disorder with significant effect on physical and environmental domains of quality of life. Patients with more severe PD and bronchial asthma had more disability.

  12. Effectiveness of Cognitive Behavioral Group Therapy for Treatment of Panic Disorder: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Servet Kacar Basaran

    2016-03-01

    Full Text Available This study aims to review empirical studies that evaluate effectiveness of cognitive-behavioral group therapy programs for treatment for panic disorder. Articles in English and Turkish that were published between the years of 2000 and 2015 (February have been searched in the national and international databases. The articles that were not therapy effectiveness studies, and group therapies that not based on cognitive behavioral approach were eliminated. The remaining 19 studies that were met the criteria were introduced in terms of method, therapy characteristics and results. The results of the studies showed that cognitive behavioral group therapies have similar efficacy with individual cognitive behavioral therapy on panic disorder symptoms (panic attacks frequency, the level of agoraphobia etc. and comorbid disorders (depression, anxiety sensitivity. However, cognitive behavioral group therapy is more cost-effective. [Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry 2016; 8(Supplement 1: 79-94

  13. Anger attacks in obsessive compulsive disorder

    Directory of Open Access Journals (Sweden)

    Nitesh Prakash Painuly

    2011-01-01

    Full Text Available Background: Research on anger attacks has been mostly limited to depression, and only a few studies have focused on anger attacks in obsessive compulsive disorder. Materials and Methods: In a cross-sectional study all new obsessive compulsive disorder patients aged 20-60 years attending an outpatient clinic were assessed using the anger attack questionnaire, irritability, depression and anxiety scale (for the direction of the aggressive behavior and quality of life (QOL. Results: The sample consisted of 42 consecutive subjects with obsessive compulsive disorder, out of which 21 (50% had anger attacks. The obsessive compulsive disorder subjects with and without anger attacks did not show significant differences in terms of sociodemographic variables, duration of illness, treatment, and family history. However, subjects with anger attacks had significantly higher prevalence of panic attacks and comorbid depression. Significantly more subjects with anger attacks exhibited aggressive acts toward spouse, parents, children, and other relatives in the form of yelling and threatening to hurt, trying to hurt, and threatening to leave. However, the two groups did not differ significantly in terms of QOL, except for the psychological domain being worse in the subjects with anger attacks. Conclusion: Anger attacks are present in half of the patients with obsessive compulsive disorder, and they correlate with the presence of comorbid depression.

  14. 心理干预对体部伽玛刀治疗中惊恐发作的效果%Effect of psychological therapy on the panic attack of patients with body gamma-knife treatment

    Institute of Scientific and Technical Information of China (English)

    齐文杰; 康静波; 郭勇; 张新红; 蔡昌兰

    2013-01-01

    Objective To explore the cause of panic attack during body gamma-knife treatment in patients with cancer and the methods of psychological intervention,so as to improve the patients' confidence and ensure their gamma-knife treatment successfully.Methods Comprehensive psychological treatment was adopted,including cognitive therapy,relaxation therapy and psychological counseling,and 36 cases complicated with panic attack were received,before and after the intervention,they were evaluated by the self-rating anxiety scale (SAS).Results Thirty-three cases (91.7%) complicated with panic attack successfully completed gamma-knife treatment after psychological therapy.The SAS score was significantly decreased compared to that before therapy (t =3.878,P < 0.05).Conclusions Comprehensive psychological therapy can effectively prevent and cure panic attack during gamma-knife treatment.%目的 探讨患者在体部伽玛刀治疗中惊恐发作的原因及进行心理干预的方法,以增强患者战胜疾病的信心,保障患者完成伽玛刀治疗计划.方法 应用认知疗法、放松疗法、心理疏导对36例伴有惊恐发作的癌症患者进行综合性心理治疗,对治疗前、后焦虑量表(SAS)进行测评.结果 通过心理干预,33例(91.7%)患者顺利完成伽玛刀治疗计划,治疗后SAS分值均明显降低[(57.00±6.49)比(63.75±6.35)],差异有统计学意义(t=3.878,P<0.05).结论 伽玛刀治疗中进行综合性心理干预可以有效防治惊恐发作.

  15. [Panic disorders and agoraphobia: Freudian concepts and DSM IV].

    Science.gov (United States)

    Manfredi de Poderoso, Clelia; Linetzky, Leonardo

    2003-01-01

    This paper refers to the relationship between panic and agoraphobia, regarding Panic Disorder and Agoraphobia (DSM IV), from two different points of view coming from Psychoanalysis and Psychiatry. Psychoanalysis (S. Freud) considers agoraphobia as a defensive organization to avoid anxiety, not bound to the original conflict, but to substitutive formation. The exposure to space (its unconscious significance) provokes panic attack. The psychiatric approach considers agoraphobia, meaningless by its own, as a consequence of spontaneous panic attacks. The etiology is referred to neurophysiological mechanisms. The authors reviewd D Klein's hypothesis about panic and Freud's theories on anxiety, partiularly Anxiety Neurosis.

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

    Science.gov (United States)

    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.

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

    Directory of Open Access Journals (Sweden)

    Alexandre M Valença

    2001-03-01

    Full Text Available OBJETIVOS: Verificar a sensibilidade de pacientes com transtorno de pânico (TP ao teste de indução de ataques de pânico com dióxido de carbono (CO2 a 35% e analisar a intensidade, a duração e a sintomatologia dos ataques de pânico produzidos por esse agente em laboratório, comparando-os com os ataques de pânico espontâneos nesses pacientes. MÉTODOS: Foram selecionados 31 pacientes com TP com ou sem agorafobia (DSM-IV. Após uma semana sem medicação, os pacientes realizavam duas inalações de capacidade vital: uma de mistura carbogênica (CO2 35% e O2 65% e outra de ar atmosférico comprimido ("placebo", ordenadas ao acaso e separadas por um intervalo de 20 minutos. Essas inalações eram repetidas após duas semanas. Nesse período, os pacientes não recebiam nenhuma medicação psicotrópica. RESULTADOS: Dos pacientes, 22 (71,0% apresentaram ataque de pânico em pelo menos um dos testes com CO2. Os sintomas relatados por eles com maior freqüência foram: dificuldade de respirar (n=20, 91,0%, sensação de sufocação/asfixia (n=18, 81,8%, tontura (n=18, 81,8%, estremecimento (n=14, 63,6%, palpitações (n=13, 59,0% e medo de enlouquecer (n=12, 54,5%. Desse grupo, 11 pacientes (50,0% consideraram os ataques de pânico experimentados no laboratório mais intensos, comparados aos ataques de pânico espontâneos, quatro (18,2% consideraram haver a mesma intensidade entre os dois, e sete (31,8% consideraram o ataque de pânico no laboratório mais leve. CONCLUSÃO: Pacientes com TP têm elevada sensibilidade ao CO2. A inalação de mistura gasosa com 35% de CO2 produz sintomas semelhantes aos ataques de pânico espontâneos, em pacientes com TP. Esse teste pode ser considerado um bom modelo laboratorial para o TP.OBJECTIVES: To verify the sensibility of panic disorder patients to carbon dioxide challenge test and the intensity, duration and symptoms of panic attacks produced by the gas in these patients, comparing these data with

  18. Modeling panic disorder in rodents.

    Science.gov (United States)

    Moreira, Fabrício A; Gobira, Pedro H; Viana, Thércia G; Vicente, Maria A; Zangrossi, Hélio; Graeff, Frederico G

    2013-10-01

    Panic disorder (PD) is a subtype of anxiety disorder in which the core phenomenon is the spontaneous occurrence of panic attacks. Although studies with laboratory animals have been instrumental for the understanding of its neurobiology and treatment, few review articles have focused on the validity of the currently used animal models for studying this psychopathology. Therefore, the aim of the present paper is to discuss the strengths and limits of these models in terms of face, construct and predictive validity. Based on the hypothesis that panic attacks are related to defensive responses elicited by proximal threat, most animal models measure the escape responses induced by specific stimuli. Some apply electrical or chemical stimulation to brain regions proposed to modulate fear and panic responses, such as the dorsal periaqueductal grey or the medial hypothalamus. Other models focus on the behavioural consequences caused by the exposure of rodents to ultrasound or natural predators. Finally, the elevated T-maze associates a one-way escape response from an open arm with panic attacks. Despite some limitations, animal models are essential for a better understanding of the neurobiology and pharmacology of PD and for discovering more effective treatments.

  19. Schizophrenia dissection by five anxiety and depressive subtype comorbidities: Clinical implications and evolutionary perspective.

    Science.gov (United States)

    Veras, André B; Cougo, Simone; Meira, Fernanda; Peixoto, Clayton; Barros, Jorge A; Nardi, Antonio E; Malaspina, Dolores; Poyurovsky, Michael; Kahn, Jeffrey P

    2017-07-26

    Twenty patients with DSM5 schizophrenia were comprehensively and formally assessed by an experienced psychiatrist. All subjects were assessed for: positive and negative psychotic symptoms; social anxiety; panic anxiety; obsessive compulsive disorder, atypical depression; major depression; suicide risk; and global assessment of functioning. Different profiles of clinical presentation and symptom evolution emerged for patients with schizophrenia who had co-morbid depression (15%), OCD (15%), panic or limited symptom attacks (55%) and social anxiety (5%). At least eighty percent of the sample had one or more of these co-morbidities. Summing up, the data support our previous finding that panic is highly prevalent in Schizophrenia with Auditory Hallucinations (>73% here, versus 100% before), and panic was paroxysmally concurrent with voice onset. Moreover, characteristic clinical findings may help point clinicians to five specific co-morbidity psychosis subtypes. Moreover, co-morbidity dissection of psychotic diagnoses recalls and parallels the historical psychopharmacologic dissection of non-psychotic anxiety and depressive subtypes diagnoses. Larger studies should further test and explore these preliminary findings. Copyright © 2017. Published by Elsevier B.V.

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

    Directory of Open Access Journals (Sweden)

    VALENÇA ALEXANDRE MARTINS

    2000-01-01

    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.

  1. The Psycho-social Context of Panic Disorder (Barriers in Communication with the Client's Immediate Environment)

    OpenAIRE

    Svitáková, Marie

    2010-01-01

    The thesis entitled Psychosocial Context of the Panic Disorder; Barriers in Communication with the Client's Immediate Environment traces the influence of panic disorder on the social aspects of the client's life. The thesis attempts to define the term panic disorder, traces selected treatment possibilities, characterizes the panic attack and describes the impact of the panic disorder on the behaviour and mentality of the patient. Further, it focuses on the communication of non-psychiatric med...

  2. Analysis of Acupoint Selection Rules for Adult Panic Attack by Acupuncture and Moxibustion%针灸治疗成人惊恐发作取穴规律探讨

    Institute of Scientific and Technical Information of China (English)

    钟正; 潘洪权; 黄焕琳; 任晓娜; 黄泳

    2015-01-01

    目的:总结并分析针灸治疗成人惊恐发作的临床文献中的取穴规律。方法:电子检索中国期刊全文数据库( CNKI)、维普中文期刊数据库( VIP)和万方学术期刊全文数据库、中国生物医学文献光盘数据库( CBM disc)、Pubmed等数据库中1980年1月~2014年8月收录有关针灸治疗成人惊恐发作的临床文献,将纳入文献进行描述性分析。结果:共纳入26篇中文文献,选用腧穴数最多的经脉从多到少依次为足阳明胃经、足太阳膀胱经、足少阳胆经;使用频次大于5次的腧穴从多到少依次为内关、神门、三阴交。结论:目前临床上针灸治疗本病的取穴组方较为繁杂,仍需进一步探寻及规范化。%Objective:To summarize and analyze acupoint rules for the treatment of adult panic attack from clinical documents.Methods:Search the related articles on adult panic attack by acupuncture and moxibustion therapy from China National Knowledge Infrastructure database ( CNKI) , VIP database ( VIP) , Wanfang data-base, Chinese Biomedical Literature database (CBMdisc) and Pubmed from January 1980 to August 2014.Re-sults:Totally there were 26 Chinese articles involved lin this study.According to the amount of acupoints of me-ridians,the stomach meridian of Foot-Yangming,the bladder meridian of Foot-Taiyang and the gallbladder meridian of Foot-Shaoyang were the widely used meridians.While the most frequently used acupoints were Neiguan (PC6), Shenmen (HT7) and Sanyinjiao (SP6).Conclusion:Currently, the acupoint selection rules for adult panic attacks are multifarious, which still needs to be further explored and standardized.

  3. Comorbidity of Migraine

    Directory of Open Access Journals (Sweden)

    Shuu-Jiun Wang

    2010-08-01

    Full Text Available Migraine is a common neurological disorder and can cause severely disabling during attacks. The highest prevalence occurs between the ages of 25 and 55 years, potentially the most productive period of life. Migraine leads to a burden not only to the individual, but also to the family and society. Prior studies have found migraine occurs with some illness at a greater than coincidental rate than is seen in the general population. These occurrences are called “comorbidity”, which means that these disorders are interrelated with migraine. To delineate migraine comorbidity is important because it can help improve treatment strategies and understand the possible pathophysiology of migraine. The comorbid illnesses in patients with migraine include stroke, sub-clinical vascular brain lesions, coronary heart disease, hypertension, patent foramen ovale, psychiatric diseases (depression, anxiety, bipolar disorder, panic disorder, and suicide, restless legs syndrome, epilepsy, and asthma. In this paper, we review the existing epidemiological and hospital based studies and illustrate the connections between these illness and migraine.

  4. Cardiac sarcoidosis resembling panic disorder: a case report.

    Science.gov (United States)

    Tokumitsu, Keita; Demachi, Jun; Yamanoi, Yukichi; Oyama, Shigeto; Takeuchi, Junko; Yachimori, Koji; Yasui-Furukori, Norio

    2017-01-13

    Sarcoidosis is a systemic disease of unknown etiology, in which granulomas develop in various organs, including the skin, lungs, eyes, or heart. It has been reported that patients with sarcoidosis are more likely to develop panic disorder than members of the general population. However, there are many unknown factors concerning the causal relationship between these conditions. We present the case of a 57-year-old woman who appeared to have panic disorder, as she experienced repeated panic attacks induced by transient complete atrioventricular block, associated with cardiac sarcoidosis. Psychotherapy and pharmacotherapy were not effective in the treatment of her panic attacks. However, when we implanted a permanent pacemaker and initiated steroid treatment for cardiac sarcoidosis, panic attacks were ameliorated. Based on these findings, we diagnosed the patient's symptoms as an anxiety disorder associated with cardiac sarcoidosis, rather than panic disorder. This report highlights the importance of considering cardiac sarcoidosis in the differential diagnosis of panic disorder. This cardiac disease should be considered especially in patients have a history of cardiac disease (e.g., arrhythmia) and atypical presentations of panic symptoms. Panic disorder is a psychiatric condition that is typically diagnosed after other medical conditions have been excluded. Because the diagnosis of sarcoidosis is difficult in some patients, caution is required. The palpitations and symptoms of heart failure associated with cardiac sarcoidosis can be misdiagnosed as psychiatric symptoms of panic disorder. The condition described in the current case study appears to constitute a physical disease, the diagnosis of which requires significant consideration and caution.

  5. The genetic basis of panic disorder.

    Science.gov (United States)

    Na, Hae-Ran; Kang, Eun-Ho; Lee, Jae-Hon; Yu, Bum-Hee

    2011-06-01

    Panic disorder is one of the chronic and disabling anxiety disorders. There has been evidence for either genetic heterogeneity or complex inheritance, with environmental factor interactions and multiple single genes, in panic disorder's etiology. Linkage studies have implicated several chromosomal regions, but no research has replicated evidence for major genes involved in panic disorder. Researchers have suggested several neurotransmitter systems are related to panic disorder. However, to date no candidate gene association studies have established specific loci. Recently, researchers have emphasized genome-wide association studies. Results of two genome-wide association studies on panic disorder failed to show significant associations. Evidence exists for differences regarding gender and ethnicity in panic disorder. Increasing evidence suggests genes underlying panic disorder overlap, transcending current diagnostic boundaries. In addition, an anxious temperament and anxiety-related personality traits may represent intermediate phenotypes that predispose to panic disorder. Future research should focus on broad phenotypes, defined by comorbidity or intermediate phenotypes. Genome-wide association studies in large samples, studies of gene-gene and gene-environment interactions, and pharmacogenetic studies are needed.

  6. Coincidence of paroxysmal supraventricular tachycardia and panic disorder: two case reports

    Directory of Open Access Journals (Sweden)

    Breithardt Günter

    2010-04-01

    Full Text Available Abstract Panic disorder (PD is characterised by sudden attacks of intense fear with somatic symptoms including palpitations and tachycardia. Reciprocally, palpitations caused by paroxysmal supraventricular tachycardia (PSVT are commonly associated with anxiety and may therefore be misdiagnosed as PD. As demonstrated by two case reports, PSVT and PD can occur comorbidly in a chronological sequence, with PSVT possibly precipitating and maintaining PD via interoceptive processes or, alternatively, with PD increasing the risk for PSVT by elevating stress levels. As both PSVT and PD require different treatments, potentially helpful differential clinical diagnostic criteria are proposed.

  7. Anxiety disorders and onset of cardiovascular disease: the differential impact of panic, phobias and worry.

    Science.gov (United States)

    Batelaan, Neeltje M; ten Have, Margreet; van Balkom, Anton J L M; Tuithof, Marlous; de Graaf, Ron

    2014-03-01

    Anxiety has been linked to onset of cardiovascular disease. This study examines the differential impact of types of anxiety (panic, phobia and worry) on 3-year onset of non-fatal cardiovascular disease (CVD). By investigating anxiety disorders as opposed to anxiety symptoms and by using a reliable diagnostic instrument to assess anxiety, limitations of previous studies are considered. 5149 persons at risk for CVD were interviewed using the Composite International Diagnostic Interview. The panic-type included panic disorder and panic attacks; the phobic-type included agoraphobia and social phobia, and the worry-type included generalized anxiety disorder. CVD was self-reported and required treatment or monitoring by a doctor. Analyses were adjusted for sociodemographics, behavioral variables, and comorbid somatic and psychiatric disorders. During follow-up, 62 persons (1.2%) developed CVD. Baseline generalized anxiety disorder was strongly associated with onset of CVD (adjusted OR: 3.39). Further research should replicate findings and focus on biological underpinnings of this association.

  8. [The psychoimmunological network og panic disorders, agoraphobia and allergic reactions].

    Science.gov (United States)

    Schmidt-Traub, S

    1995-02-01

    While treating panic and agoraphobia patients with behaviour therapy, a high frequency of allergic reaction of the IgE-mediated type I was observed. Panic disorder, agoraphobia, allergic disorder, and vasomotor reactions are briefly discussed in the framework of psycho-endocrino-immunological research. A pilot study had shown a high correlation between panic disorder with and without agoraphobia and allergic reaction. A controlled study was then planned to test the hypothesized psychoimmunological relationship. 100 allergic patients, 79 panic/agoraphobic patients, and 66 controls underwent psychodiagnostic and allergic screening. 70% of the anxiety patients responded to test allergens with IgE-mediated type-I immediate reactions in comparison to 28% of the control persons. Another 15% of the panic patients reacted to nickle compound with type-IV delayed skin reactions (7% of the controls). Conversely, 10% of the allergic patients suffered from panic disorder (45% had experienced panic attacks) in contrast to 2% of the controls (24% of these reported panic attacks). The relative risk for allergic patients to develop panic disorder with and without agoraphobia is obviously five times as high as for controls. With this assumption of a psychoimmunological preparedness in mind, a behavioural medical diagnostic and therapeutic concept seems more adequate in coping both with panic/agoraphobia and allergic disorder.

  9. Comorbidity, systemic inflammation and outcomes in the ECLIPSE cohort.

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    Miller, Joy; Edwards, Lisa D; Agustí, Alvar; Bakke, Per; Calverley, Peter M A; Celli, Bartolome; Coxson, Harvey O; Crim, Courtney; Lomas, David A; Miller, Bruce E; Rennard, Steve; Silverman, Edwin K; Tal-Singer, Ruth; Vestbo, Jørgen; Wouters, Emiel; Yates, Julie C; Macnee, William

    2013-09-01

    Comorbidities, are common in COPD, have been associated with poor outcomes and are thought to relate to systemic inflammation. To investigate comorbidities in relation to systemic inflammation and outcomes we recorded comorbidities in a well characterized cohort (ECLIPSE study) for 2164 clinically stable COPD subjects, 337 smokers and 245 non-smokers with normal lung function. COPD patients had a higher prevalence of osteoporosis, anxiety/panic attacks, heart trouble, heart attack, and heart failure, than smokers or nonsmokers. Heart failure (Hazard Ratio [HR] 1.9, 95% Confidence Interval [CI] 1.3-2.9), ischemic heart disease (HR 1.5, 95% CI 1.1-2.0), heart disease (HR 1.5, 95% CI 1.2-2.0), and diabetes (HR 1.7, 95% CI 1.2-2.4) had increased odds of mortality when coexistent with COPD. Multiple comorbidities had accumulative effect on mortality. COPD and cardiovascular disease was associated with poorer quality of life, higher MRC dyspnea scores, reduced 6MWD, higher BODE index scores. Osteoporosis, hypertension and diabetes were associated with higher MRC dyspnea scores and reduced 6MWD. Higher blood concentrations of fibrinogen, IL-6 and IL-8 levels occurred in those with heart disease. Comorbidity is associated with poor clinical outcomes in COPD. The comorbidities of heart disease, hypertension and diabetes are associated with increased systemic inflammation.

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

    Science.gov (United States)

    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,…

  11. Ambulatory Assessment in Panic Disorder and Specific Phobia

    Science.gov (United States)

    Alpers, Georg W.

    2009-01-01

    Anxiety disorders are among the most prevalent mental disorders. In panic disorder, panic attacks often occur at unpredictable times, making it difficult to study these episodes in the laboratory. In specific phobias, symptoms occur in very circumscribed situations and specific triggers are sometimes difficult to reproduce in the laboratory.…

  12. 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

  13. Critical neuropsychobiological analysis of panic attack- and anticipatory anxiety-like behaviors in rodents confronted with snakes in polygonal arenas and complex labyrinths: a comparison to the elevated plus- and T-maze behavioral tests

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    Norberto C. Coimbra

    Full Text Available Objective: To compare prey and snake paradigms performed in complex environments to the elevated plus-maze (EPM and T-maze (ETM tests for the study of panic attack- and anticipatory anxiety-like behaviors in rodents. Methods: PubMed was reviewed in search of articles focusing on the plus maze test, EPM, and ETM, as well as on defensive behaviors displayed by threatened rodents. In addition, the authors’ research with polygonal arenas and complex labyrinth (designed by the first author for confrontation between snakes and small rodents was examined. Results: The EPM and ETM tests evoke anxiety/fear-related defensive responses that are pharmacologically validated, whereas the confrontation between rodents and snakes in polygonal arenas with or without shelters or in the complex labyrinth offers ethological conditions for studying more complex defensive behaviors and the effects of anxiolytic and panicolytic drugs. Prey vs. predator paradigms also allow discrimination between non-oriented and oriented escape behavior. Conclusions: Both EPM and ETM simple labyrinths are excellent apparatuses for the study of anxiety- and instinctive fear-related responses, respectively. The confrontation between rodents and snakes in polygonal arenas, however, offers a more ethological environment for addressing both unconditioned and conditioned fear-induced behaviors and the effects of anxiolytic and panicolytic drugs.

  14. Critical neuropsychobiological analysis of panic attack- and anticipatory anxiety-like behaviors in rodents confronted with snakes in polygonal arenas and complex labyrinths: a comparison to the elevated plus- and T-maze behavioral tests.

    Science.gov (United States)

    Coimbra, Norberto C; Paschoalin-Maurin, Tatiana; Bassi, Gabriel S; Kanashiro, Alexandre; Biagioni, Audrey F; Felippotti, Tatiana T; Elias-Filho, Daoud H; Mendes-Gomes, Joyce; Cysne-Coimbra, Jade P; Almada, Rafael C; Lobão-Soares, Bruno

    2017-01-01

    To compare prey and snake paradigms performed in complex environments to the elevated plus-maze (EPM) and T-maze (ETM) tests for the study of panic attack- and anticipatory anxiety-like behaviors in rodents. PubMed was reviewed in search of articles focusing on the plus maze test, EPM, and ETM, as well as on defensive behaviors displayed by threatened rodents. In addition, the authors' research with polygonal arenas and complex labyrinth (designed by the first author for confrontation between snakes and small rodents) was examined. The EPM and ETM tests evoke anxiety/fear-related defensive responses that are pharmacologically validated, whereas the confrontation between rodents and snakes in polygonal arenas with or without shelters or in the complex labyrinth offers ethological conditions for studying more complex defensive behaviors and the effects of anxiolytic and panicolytic drugs. Prey vs. predator paradigms also allow discrimination between non-oriented and oriented escape behavior. Both EPM and ETM simple labyrinths are excellent apparatuses for the study of anxiety- and instinctive fear-related responses, respectively. The confrontation between rodents and snakes in polygonal arenas, however, offers a more ethological environment for addressing both unconditioned and conditioned fear-induced behaviors and the effects of anxiolytic and panicolytic drugs.

  15. Caffeine challenge test and panic disorder: a systematic literature review.

    Science.gov (United States)

    Vilarim, Marina Machado; Rocha Araujo, Daniele Marano; Nardi, Antonio Egidio

    2011-08-01

    This systematic review aimed to examine the results of studies that have investigated the induction of panic attacks and/or the anxiogenic effect of the caffeine challenge test in patients with panic disorder. The literature search was performed in PubMed, Biblioteca Virtual em Saúde and the ISI Web of Knowledge. The words used for the search were caffeine, caffeine challenge test, panic disorder, panic attacks and anxiety disorder. In total, we selected eight randomized, double-blind studies where caffeine was administered orally, and none of them controlled for confounding factors in the analysis. The percentage of loss during follow-up ranged between 14.3% and 73.1%. The eight studies all showed a positive association between caffeine and anxiogenic effects and/or panic disorder.

  16. [Panic disorder and angina pectoris].

    Science.gov (United States)

    Prenninger, Markus; Giefing, Georg; Auer, Johann; Windhager, Elmar; Eber, Bernd

    2004-02-01

    Panic attacks are a frequently cited cause of noncardiac chest pain. A strict separation of the internist's job (i. e., ruling out an "organic" cause of the patient's complaints) from the psychiatrist's job (e. g., diagnosing and treating panic disorder if present) may not always be the most efficient way of diagnostic work-up. We present the case of a 56-year-old female referred to our institution for elective coronary arteriography. Significant cardiovascular risk factors and symptoms compatible with unstable angina illustrate the common problem of a high probability of cardiac pathology in a patient with possible psychiatric symptoms. A modified SCID-interview complementing the coronary angiography results finally led to the definite diagnosis in this patient after symptoms had been present for over 20 years.

  17. Gender differences in psychopathologic features of agoraphobia with panic disorder

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    Latas Milan

    2006-01-01

    Full Text Available Background/Aim. To examine gender differences in the major psychopathologic features in agoraphobia with panic disorder. Method. The study was conducted as a clinical study. The sample consisted of 119 patients, 32 men (26.9% and 87 women (73.1% with the basic diagnosis of agoraphobia with panic disorder. All the patients were evaluated with the clinical instruments suitable for the assessment of various clinical features associated with agoraphobia with panic disorder - questionnaires (the Hopkins Symptom Checklist 90, the Panic Appraisal Inventory, the Fear Questionnaire, the Beck Anxiety Inventory, and the Beck Depression Inventory, and the clinical rating scale (the Panic and Agoraphobia Scale. After the data collection, the sample was divided into two groups by the gender. Then the groups were compared. Results. There were no differences between the genders in the global psychopathologic features (the age at the onset of a disorder, duration of a disorder, severity and frequency of panic attacks, intensity of general psychiatric symptoms, intensity of general anxiety and depression. The women, however, reported a subjective perception of a more severe agoraphobic avoidance and males were significantly more likely than the females to anticipate the serious somatic consequences of panic attacks and worry about somatic health. Conclusion. There were a few gender specific psychopathologic features in patients with agoraphobia with panic disorder, so further studies would be necessary to come to a more precise conclusion.

  18. Translational approach to the pathophysiology of panic disorder: Focus on serotonin and endogenous opioids.

    Science.gov (United States)

    Graeff, Frederico G

    2017-05-01

    Panic patients experience recurrent panic attacks. Two main neurochemical hypotheses have been proposed to explain this vulnerability. The first suggests that panic patients have deficient serotonergic inhibition of neurons localized in the dorsal periaqueductal gray matter of the midbrain that organizes defensive reactions to cope with proximal threats as well as of sympathomotor control areas of the rostral ventrolateral medulla that generate neurovegetative symptoms of the panic attack. The second proposes that endogenous opioids buffer panic attacks in normal subjects, and their deficit results in heightened sensitivity to suffocation and separation anxiety in panic patients. Experimental results obtained in rat models of panic indicate that serotonin interacts synergistically with endogenous opioids in the dorsal periaqueductal gray through 5-HT1A and μ-opioid receptors to inhibit proximal defense and, supposedly, panic attacks. These findings allow reconciliation of the serotonergic and opioidergic hypotheses of panic pathophysiology. They also indicate that endogenous opioids are likely to participate in the panicolytic action of antidepressants and suggest that exogenous opioids may be useful for treating panic patients resistant to conventional pharmacotherapy. Copyright © 2016 Elsevier Ltd. All rights reserved.

  19. Sex-related and non-sex-related comorbidity subtypes of tic disorders: a latent class approach.

    Science.gov (United States)

    Rodgers, S; Müller, M; Kawohl, W; Knöpfli, D; Rössler, W; Castelao, E; Preisig, M; Ajdacic-Gross, V

    2014-05-01

    Recent evidence suggests that there may be more than one Gilles de la Tourette syndrome (GTS)/tic disorder phenotype. However, little is known about the common patterns of these GTS/tic disorder-related comorbidities. In addition, sex-specific phenomenological data of GTS/tic disorder-affected adults are rare. Therefore, this community-based study used latent class analyses (LCA) to investigate sex-related and non-sex-related subtypes of GTS/tic disorders and their most common comorbidities. The data were drawn from the PsyCoLaus study (n = 3691), a population-based survey conducted in Lausanne, Switzerland. LCA were performed on the data of 80 subjects manifesting motor/vocal tics during their childhood/adolescence. Comorbid attention-deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder, depressive, phobia and panic symptoms/syndromes comprised the selected indicators. The resultant classes were characterized by psychosocial correlates. In LCA, four latent classes provided the best fit to the data. We identified two male-related classes. The first class exhibited both ADHD and depression. The second class comprised males with only depression. Class three was a female-related class depicting obsessive thoughts/compulsive acts, phobias and panic attacks. This class manifested high psychosocial impairment. Class four had a balanced sex proportion and comorbid symptoms/syndromes such as phobias and panic attacks. The complementary occurrence of comorbid obsessive thoughts/compulsive acts and ADHD impulsivity was remarkable. To the best of our knowledge, this is the first study applying LCA to community data of GTS symptoms/tic disorder-affected persons. Our findings support the utility of differentiating GTS/tic disorder subphenotypes on the basis of comorbid syndromes. © 2013 The Author(s) European Journal of Neurology © 2013 EFNS.

  20. Visual height intolerance and acrophobia: clinical characteristics and comorbidity patterns.

    Science.gov (United States)

    Kapfhammer, Hans-Peter; Huppert, Doreen; Grill, Eva; Fitz, Werner; Brandt, Thomas

    2015-08-01

    The purpose of this study was to estimate the general population lifetime and point prevalence of visual height intolerance and acrophobia, to define their clinical characteristics, and to determine their anxious and depressive comorbidities. A case-control study was conducted within a German population-based cross-sectional telephone survey. A representative sample of 2,012 individuals aged 14 and above was selected. Defined neurological conditions (migraine, Menière's disease, motion sickness), symptom pattern, age of first manifestation, precipitating height stimuli, course of illness, psychosocial impairment, and comorbidity patterns (anxiety conditions, depressive disorders according to DSM-IV-TR) for vHI and acrophobia were assessed. The lifetime prevalence of vHI was 28.5% (women 32.4%, men 24.5%). Initial attacks occurred predominantly (36%) in the second decade. A rapid generalization to other height stimuli and a chronic course of illness with at least moderate impairment were observed. A total of 22.5% of individuals with vHI experienced the intensity of panic attacks. The lifetime prevalence of acrophobia was 6.4% (women 8.6%, men 4.1%), and point prevalence was 2.0% (women 2.8%; men 1.1%). VHI and even more acrophobia were associated with high rates of comorbid anxious and depressive conditions. Migraine was both a significant predictor of later acrophobia and a significant consequence of previous acrophobia. VHI affects nearly a third of the general population; in more than 20% of these persons, vHI occasionally develops into panic attacks and in 6.4%, it escalates to acrophobia. Symptoms and degree of social impairment form a continuum of mild to seriously distressing conditions in susceptible subjects.

  1. The therapeutic potential of escitalopram in the treatment of panic disorder

    Directory of Open Access Journals (Sweden)

    Mark H Townsend

    2007-01-01

    Full Text Available Mark H Townsend, Erich J ConradDepartment of Psychiatry, Louisiana State University Health Sciences Center New Orleans, New Orleans, Louisiana, USAAbstract: Panic disorder is a chronic and disabling condition that is often accompanied by other psychiatric and medical conditions. The serotonin reuptake inhibitors (SSRIs and serotoninnorepinephrine reuptake inhibitors (SNRIs have been used effectively with panic disorder (PD and conditions in which panic attacks frequently occur. Escitalopram is the most selective SSRI and a variety of evidence suggests it is of great value in the treatment of panic disorder. In this paper, we review the theoretical and practical implications of its use.Keywords: panic disorder, escitalopram, antidepressant, serotonin

  2. Startle reflex modulation and autonomic responding during anxious apprehension in panic disorder patients.

    Science.gov (United States)

    Melzig, Christiane A; Weike, Almut I; Zimmermann, Jörg; Hamm, Alfons O

    2007-11-01

    The present study explored anxious apprehension in panic disorder patients and controls in two threat conditions, darkness and threat of shock. Autonomic arousal and startle eyeblink reflexes were recorded in 26 panic disorder patients and 22 controls during adaptation, a safe condition, threat of shock, and darkness. Exposure to darkness resulted in a clear potentiation of the startle reflex. Panic patients but not controls responded with an increase in heart rate that was positively related to severity of agoraphobic avoidance. Threat of shock resulted in a startle potentiation that tended to be stronger in panic patients without comorbid depression than controls and attenuated in those patients who suffered from severe depression. These data suggest that only panic patients without depression belong to the fear disorders spectrum whereas panic patients with comorbid depression might rather belong to the distress disorders profile.

  3. Therapeutic response to benzodiazepine in panic disorder subtypes

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    Alexandre Martins Valença

    Full Text Available CONTEXT: This study makes a comparison between two subtypes of panic disorder regarding the clinical efficacy of clonazepam, a benzodiazepine. OBJECTIVES: To evaluate the clinical efficacy of clonazepam in a fixed dosage (2 mg/day, compared to placebo, in the treatment of panic disorder patients and to verify whether there are any differences in the responses to clonazepam between panic disorder patients with the respiratory and non-respiratory subtypes. TYPE OF STUDY: Randomized study with clonazepam and placebo. SETTING: Outpatient Anxiety and Depression Unit of the Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil. PARTICIPANTS: 34 patients with a diagnosis of panic disorder with agoraphobia, between 18 and 55 years old. PROCEDURES: Administration of clonazepam or placebo for 6 weeks, in panic disorder patients, after they were classified within two subtypes of panic disorder: respiratory and non-respiratory. MAIN MEASUREMENTS: Changes in the number of panic attacks in comparison with the period before the beginning of the study; Hamilton Anxiety Scale; Global Clinical Impression Scale; and Patient's Global Impression scale. RESULTS: In the group that received clonazepam, by the end of the 6th week there was a statistically significant clinical improvement, shown by the remission of panic attacks (p < 0.001 and decrease in anxiety (p = 0.024. In the group that received clonazepam there was no significant difference between the respiratory and non-respiratory subtypes of panic disorder, regarding the therapeutic response to clonazepam. CONCLUSION: Clonazepam was equally effective in the treatment of the respiratory and non-respiratory subtypes of panic disorder, suggesting there is no difference in the therapeutic response between the two subtypes.

  4. New perspective on the pathophysiology of panic: merging serotonin and opioids in the periaqueductal gray

    Directory of Open Access Journals (Sweden)

    F.G. Graeff

    2012-04-01

    Full Text Available Panic disorder patients are vulnerable to recurrent panic attacks. Two neurochemical hypotheses have been proposed to explain this susceptibility. The first assumes that panic patients have deficient serotonergic inhibition of neurons localized in the dorsal periaqueductal gray matter of the midbrain that organize defensive reactions to cope with proximal threats and of sympathomotor control areas of the rostral ventrolateral medulla that generate most of the neurovegetative symptoms of the panic attack. The second suggests that endogenous opioids buffer normal subjects from the behavioral and physiological manifestations of the panic attack, and their deficit brings about heightened suffocation sensitivity and separation anxiety in panic patients, making them more vulnerable to panic attacks. Experimental results obtained in rats performing one-way escape in the elevated T-maze, an animal model of panic, indicate that the inhibitory action of serotonin on defense is connected with activation of endogenous opioids in the periaqueductal gray. This allows reconciliation of the serotonergic and opioidergic hypotheses of panic pathophysiology, the periaqueductal gray being the fulcrum of serotonin-opioid interaction.

  5. 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

    -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......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...

  6. Candidate genes in panic disorder

    DEFF Research Database (Denmark)

    Howe, A. S.; Buttenschön, Henriette N; Bani-Fatemi, A.

    2016-01-01

    The utilization of molecular genetics approaches in examination of panic disorder (PD) has implicated several variants as potential susceptibility factors for panicogenesis. However, the identification of robust PD susceptibility genes has been complicated by phenotypic diversity, underpowered...... association studies and ancestry-specific effects. In the present study, we performed a succinct review of case-control association studies published prior to April 2015. Meta-analyses were performed for candidate gene variants examined in at least three studies using the Cochrane Mantel-Haenszel fixed......-effect model. Secondary analyses were also performed to assess the influences of sex, agoraphobia co-morbidity and ancestry-specific effects on panicogenesis. Meta-analyses were performed on 23 variants in 20 PD candidate genes. Significant associations after correction for multiple testing were observed...

  7. Panic disorder: a review of DSM-IV panic disorder and proposals for DSM-V.

    Science.gov (United States)

    Craske, Michelle G; Kircanski, Katharina; Epstein, Alyssa; Wittchen, Hans-Ulrich; Pine, Danny S; Lewis-Fernández, Roberto; Hinton, Devon

    2010-02-01

    This review covers the literature since the publication of DSM-IV on the diagnostic criteria for panic attacks (PAs) and panic disorder (PD). Specific recommendations are made based on the evidence available. In particular, slight changes are proposed for the wording of the diagnostic criteria for PAs to ease the differentiation between panic and surrounding anxiety; simplification and clarification of the operationalization of types of PAs (expected vs. unexpected) is proposed; and consideration is given to the value of PAs as a specifier for all DSM diagnoses and to the cultural validity of certain symptom profiles. In addition, slight changes are proposed for the wording of the diagnostic criteria to increase clarity and parsimony of the criteria. Finally, based on the available evidence, no changes are proposed with regard to the developmental expression of PAs or PD. This review presents a number of options and preliminary recommendations to be considered for DSM-V.

  8. The norepinephrine transporter gene is a candidate gene for panic disorder

    DEFF Research Database (Denmark)

    Buttenschøn, H N; Kristensen, A S; Buch, H N

    2011-01-01

    Panic disorder (PD) is an anxiety disorder characterized by recurrent panic attacks with a lifetime prevalence of 4.7%. Genetic factors are known to contribute to the development of the disorder. Several lines of evidence point towards a major role of the norepinephrine system in the pathogenesis...

  9. The effect of Korean-group cognitive behavioural therapy among patients with panic disorder in clinic settings.

    Science.gov (United States)

    Choi, Y S; Lee, E J; Cho, Y

    2017-02-01

    WHAT IS KNOWN ON THE SUBJECT?: Panic disorder patients display various panic-related physical symptoms and catastrophic misinterpretation of bodily sensations, which lower their quality of life by interfering with daily activities. Cognitive behavioural therapy (CBT) is a useful strategy for panic disorder patients to manage symptoms associated with inaccurate cognitive interpretation of situations resulting from the patient's cognitive vulnerability. In South Korea, however, despite the increasing prevalence of panic disorder, CBT is not a common element of nursing care plans for panic disorder patients. Moreover, few Korean researchers have attempted to assess the effects of CBT on such patients. WHAT THIS PAPER ADD TO EXISTING KNOWLEDGE?: In a strategy combining CBT and routine treatments, patients with panic disorder can experience greater positive effects in the acute treatment phase than those they experience when receiving only routine treatment. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health professionals, especially psychiatric nurses in local clinics who operate most special mental health programmes for panic disorder patients, should apply a panic disorder management programme that integrates CBT and routine treatments. The integrated approach is more effective for reducing the number of panic attacks and cognitive misinterpretation in patients than providing routine treatment alone. For patients with panic disorder, the objective of CBT is to understand the relationship between psychological panic disorder sensations, emotions, thoughts and behaviours. Therefore, nurses can help patients address and improve biological, social and psychological aspects of physical health problems as well as help them improve their coping skills in general. Introduction In panic disorder, sensitivity to bodily sensations increases due to the patient's cognitive vulnerability. Cognitive behavioural therapy (CBT) can help to decrease sensitivity to bodily sensations

  10. New-onset panic, depression with suicidal thoughts, and somatic symptoms in a patient with a history of lyme disease.

    Science.gov (United States)

    Garakani, Amir; Mitton, Andrew G

    2015-01-01

    Lyme Disease, or Lyme Borreliosis, caused by Borrelia burgdorferi and spread by ticks, is mainly known to cause arthritis and neurological disorders but can also cause psychiatric symptoms such as depression and anxiety. We present a case of a 37-year-old man with no known psychiatric history who developed panic attacks, severe depressive symptoms and suicidal ideation, and neuromuscular complaints including back spasms, joint pain, myalgias, and neuropathic pain. These symptoms began 2 years after being successfully treated for a positive Lyme test after receiving a tick bite. During inpatient psychiatric hospitalization his psychiatric and physical symptoms did not improve with antidepressant and anxiolytic treatments. The patient's panic attacks resolved after he was discharged and then, months later, treated with long-term antibiotics for suspected "chronic Lyme Disease" (CLD) despite having negative Lyme titers. He however continued to have subsyndromal depressive symptoms and chronic physical symptoms such as fatigue, myalgias, and neuropathy. We discuss the controversy surrounding the diagnosis of CLD and concerns and considerations in the treatment of suspected CLD patients with comorbid psychiatric diagnoses.

  11. New-Onset Panic, Depression with Suicidal Thoughts, and Somatic Symptoms in a Patient with a History of Lyme Disease

    Science.gov (United States)

    Garakani, Amir; Mitton, Andrew G.

    2015-01-01

    Lyme Disease, or Lyme Borreliosis, caused by Borrelia burgdorferi and spread by ticks, is mainly known to cause arthritis and neurological disorders but can also cause psychiatric symptoms such as depression and anxiety. We present a case of a 37-year-old man with no known psychiatric history who developed panic attacks, severe depressive symptoms and suicidal ideation, and neuromuscular complaints including back spasms, joint pain, myalgias, and neuropathic pain. These symptoms began 2 years after being successfully treated for a positive Lyme test after receiving a tick bite. During inpatient psychiatric hospitalization his psychiatric and physical symptoms did not improve with antidepressant and anxiolytic treatments. The patient's panic attacks resolved after he was discharged and then, months later, treated with long-term antibiotics for suspected “chronic Lyme Disease” (CLD) despite having negative Lyme titers. He however continued to have subsyndromal depressive symptoms and chronic physical symptoms such as fatigue, myalgias, and neuropathy. We discuss the controversy surrounding the diagnosis of CLD and concerns and considerations in the treatment of suspected CLD patients with comorbid psychiatric diagnoses. PMID:25922779

  12. New-Onset Panic, Depression with Suicidal Thoughts, and Somatic Symptoms in a Patient with a History of Lyme Disease

    Directory of Open Access Journals (Sweden)

    Amir Garakani

    2015-01-01

    Full Text Available Lyme Disease, or Lyme Borreliosis, caused by Borrelia burgdorferi and spread by ticks, is mainly known to cause arthritis and neurological disorders but can also cause psychiatric symptoms such as depression and anxiety. We present a case of a 37-year-old man with no known psychiatric history who developed panic attacks, severe depressive symptoms and suicidal ideation, and neuromuscular complaints including back spasms, joint pain, myalgias, and neuropathic pain. These symptoms began 2 years after being successfully treated for a positive Lyme test after receiving a tick bite. During inpatient psychiatric hospitalization his psychiatric and physical symptoms did not improve with antidepressant and anxiolytic treatments. The patient’s panic attacks resolved after he was discharged and then, months later, treated with long-term antibiotics for suspected “chronic Lyme Disease” (CLD despite having negative Lyme titers. He however continued to have subsyndromal depressive symptoms and chronic physical symptoms such as fatigue, myalgias, and neuropathy. We discuss the controversy surrounding the diagnosis of CLD and concerns and considerations in the treatment of suspected CLD patients with comorbid psychiatric diagnoses.

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

    Science.gov (United States)

    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.

  14. [Deleterious Results of Safety Seeking Behaviours in Panic Disorder: Polydipsia and Diabetes Mellitus Type 2].

    Science.gov (United States)

    Kurt, Emel; Karabaş, Özer; Yorguner, Neşe; Wurz, Axel; Topçuoğlu, Volkan

    2016-01-01

    Panic disorder is an anxiety disorder that involves recurrent panic attacks, which emerge when a harmless stimulus is interpreted as "catastrophic". In an attempt to avoid the panic attack or prevent confrontation, the patient exhibits a dysfunctional attitude and behavior, such as evasion and safety-seeking behavior (SSB). Dysfunctional behavior leads to an increase in the recurrence of panic attacks and affects the patient's life in a negative way. According to the cognitive behavioral therapy model, SSB contributes to the continuation of unrealistic beliefs (e.g. physical experiences) regarding and prevents the patient from grasping new information that may potentially contradict the unrealistic cognitions. In this paper, we present a case with a primary diagnosis of panic disorder. Interestingly, this patient developed diabetes mellitus (DM) type 2 and psychogenic polydipsia (PPD) as a consequence of his SSB. PPD is a common occurrence in patients with psychiatric disorders, especially in schizophrenia. Up to now, no case of a panic disorder with either DM or PPD has been reported in the literature. While it is accepted that major depression poses a risk for DM type 2, panic disorder may also increase this risk. Treatment of the panic disorder with cognitive behavioral therapy (CBT) resulted in improvement of PPD and DM type 2. In conclusion, the role of SSB in medical disorders accompanied by psychiatric disorders should be kept in mind when treating these patients.

  15. Cognitive Behavioral Treatment of Panic Disorder and Agoraphobia in a Multiethnic Urban Outpatient Clinic: Initial Presentation and Treatment Outcome

    Science.gov (United States)

    Friedman, Steven; Braunstein, Jeffrey W.; Halpern, Beth

    2006-01-01

    Few studies examine the effectiveness of panic control treatment across diverse ethnic groups. In this paper we present data on 40 patients (African American, n = 24; Caucasian, n = 16) with panic disorder and comorbid agoraphobia who presented at an anxiety disorder clinic in an inner-city area. On initial assessment both groups were similar on…

  16. Separation anxiety and panic disorder in clinically referred youth.

    Science.gov (United States)

    Doerfler, Leonard A; Toscano, Peter F; Connor, Daniel F

    2008-05-01

    This study examined whether youngsters with separation anxiety disorder (SAD) and panic disorder (PD) had experienced more separation-related events than youngsters with SAD (without comorbid PD). We also examined whether age of onset of SAD and comorbidity with other psychological disorders was related to the occurrence of PD. We compared youngsters who were diagnosed with SAD and PD (N=31) with youngsters who were diagnosed with SAD without comorbid PD (N=63) for the number of separation-related events, severity of psychopathology, and parent and child CBCL ratings, age of onset of SAD, and the number of comorbid diagnoses. The findings indicate that youngsters with SAD and PD had a later age of onset of SAD and more extensive psychopathology and functional impairment than youngsters with SAD (without comorbid PD). Contrary to hypothesis, there were no differences between the groups in the occurrence or number of separation-related events.

  17. Hypophosphatemia. From retrospective analysis to the analysis of the potential role of phosphatemia in panic disorders

    Directory of Open Access Journals (Sweden)

    Alessandro Riccardi

    2010-09-01

    Full Text Available The detection of a low serum phosphate level is not unusual in an Emergency Department, especially in clinical conditions linked to hyperventilation and subsequent respiratory alkalosis, asthma, sepsis, severe pain, anxiety. Symptoms of hypophosphatemia are typically not specific when the imbalance is not particularly severe, but if hyphophosphatemia does not resolve rhabdomyolisis, hemolysis, decreased tissue oxygenation and respiratory failure can be observed. Only recently some authors have pointed out that the level of serum phosphate in patient with anxiety and panic disorders can give information on the severity of the attacks as well on the clinical course of the disease. In a retrospective analysis on 599 case of hypophosphatemia observed in our ED, the percentage of case of panic disorders was particularly high among patients with lower phosphatemia. Therefore, we decided to examine this aspect closely, assessing if the determination of serum phosphate could be useful in the management of panic attacks at first approach in emergency room. Our observation are consistent with the statement that hypophosphatemia is one of the main clinical aspect of panic attack, and strongly support the hypothesis that hypophosphatemia correlates with the most severe symptoms of panic attack and should be itself considered as one of the most important aspect of this syndrome. Serum phosphate levels appear to mirror its clinical course, and can be used in the clinical setting of an Emergency Department, for the confirmation of a diagnosis of anxiety-panic disorder and as marker of the response to therapy

  18. Low-dose imipramine for treatment of panic disorder during pregnancy: a retrospective chart review.

    Science.gov (United States)

    Uguz, Faruk; Sahingoz, Mine; Gungor, Buket; Askin, Rustem

    2014-08-01

    Although imipramine is one of the antidepressants that could be effective in the treatment of panic disorder, data on its usage for this diagnosis in the pregnancy period are limited. This report presents the results of 16 pregnant women with panic disorder without comorbid diagnosis who underwent low-dose imipramine (10-40 mg/d) treatment. According to the Clinical Global Impression-Improvement Scale, 12 (75%) of 16 women responded to the treatment. The results suggest that low-dose imipramine may be useful for the treatment of panic disorder during pregnancy.

  19. Panic Disorder in Children and Adolescents

    Science.gov (United States)

    ... for Families Guide Panic Disorder In Children And Adolescents No. 50; Updated July 2013 Panic disorder is a common and treatable disorder. Children and adolescents with panic disorder have unexpected and repeated periods ...

  20. The relationship between panic disorder/agoraphobia and personality disorders.

    Science.gov (United States)

    Mavissakalian, M

    1990-12-01

    This selective review of the relationship between panic disorder/agoraphobia and DSM-III personality disorders points to a preponderance of dependent, avoidant, and histrionic features and reveals a certain degree of covariation between severity of Axis I disorder and personality functioning. However, the link between panic/agoraphobia and Axis II disorders does not appear to be specific because (1) general features such as neuroticism, stress, dysphoric mood, and interpersonal sensitivity, rather than duration and severity of panic attacks and phobias, emerge as unique predictors or determinants of personality disorder; and (2) similar personality profiles are obtained in a heterogenous population of psychiatric outpatients or patients with social phobia, obsessive-compulsive disorder, and major depression.

  1. Longitudinal course of panic disorder with and without agoraphobia using the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC).

    Science.gov (United States)

    Nay, William; Brown, Ruth; Roberson-Nay, Roxann

    2013-06-30

    Few naturalistic, longitudinal studies of panic disorder with and without agoraphobia (PD/PDA) exist, limiting our knowledge of the temporal rates of incidence, relapse, and chronicity, or the factors that predict category transition. Data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) wave 1 (n=43,093) and wave 2 (n=34,653) were utilized to determine transitional rates, and predictors of category transitions, over a 3-year period. Analyses revealed very high 3-year remission rates for PD and PDA (75% and 67%, respectively), although relapse also was relatively frequent (PD=12%; PDA=21%). Logistic regression revealed previous history of panic attacks, generalized anxiety disorder/major depression (GAD/MDD), nicotine dependence, female sex, younger age, and major financial crises to be reliable predictors of incidence and relapse. The direction and magnitude of association of many predictor variables were similar for PD and PDA, with notable exceptions for social anxiety and romantic relationship factors. Clinicians should be aware of the relapsing-remitting nature of PD and PDA and, thus, take caution to not reduce or eliminate effective treatments prematurely. Similarly, the current study suggests clinicians pay particular attention to concurrent factors relevant to relapse in PD/PDA that may also be clinically addressed (e.g., co-morbid MDD/GAD and nicotine dependence).

  2. Diagnosis and treatment of agoraphobia with panic disorder.

    Science.gov (United States)

    Perugi, Giulio; Frare, Franco; Toni, Cristina

    2007-01-01

    Agoraphobia with panic disorder is a phobic-anxious syndrome where patients avoid situations or places in which they fear being embarrassed, or being unable to escape or get help if a panic attack occurs. During the last half-century, agoraphobia has been thought of as being closely linked to the recurring panic attack syndrome, so much so that in most cases it appears to be the typical development or complication of panic disorder. Despite the high prevalence of agoraphobia with panic disorder in patients in primary-care settings, the condition is frequently under-recognised and under-treated by medical providers. Antidepressants have been demonstrated to be effective in preventing panic attacks, and in improving anticipatory anxiety and avoidance behaviour. These drugs are also effective in the treatment of the frequently coexisting depressive symptomatology. Among antidepressant agents, SSRIs are generally well tolerated and effective for both anxious and depressive symptomatology, and these compounds should be considered the first choice for short-, medium- and long-term pharmacological treatment of agoraphobia with panic disorder. The few comparative studies conducted to date with various SSRIs reported no significant differences in terms of efficacy; however, the SSRIs that are less liable to produce withdrawal symptoms after abrupt discontinuation should be considered the treatments of first choice for long-term prophylaxis. Venlafaxine is not sufficiently studied in the long-term treatment of panic disorder, while TCAs may be considered as a second choice of treatment when patients do not seem to respond to or tolerate SSRIs. High-potency benzodiazepines have been shown to display a rapid onset of anti-anxiety effect, having beneficial effects during the first few days of treatment, and are therefore useful options for short-term treatment; however, these drugs are not first-choice medications in the medium and long term because of the frequent development

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

    Directory of Open Access Journals (Sweden)

    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.

  4. Panic and phobic anxiety: associations among neuroticism, physiological hyperarousal, anxiety sensitivity, and three phobias.

    Science.gov (United States)

    Longley, Susan L; Watson, David; Noyes, Russell; Yoder, Kevin

    2006-01-01

    A dimensional and psychometrically informed taxonomy of anxiety is emerging, but the specific and nonspecific dimensions of panic and phobic anxiety require greater clarification. In this study, confirmatory factor analyses of data from a sample of 438 college students were used to validate a model of panic and phobic anxiety with six content factors; multiple scales from self-report measures were indicators of each model component. The model included a nonspecific component of (1) neuroticism and two specific components of panic attack, (2) physiological hyperarousal, and (3) anxiety sensitivity. The model also included three phobia components of (4) classically defined agoraphobia, (5) social phobia, and (6) blood-injection phobia. In these data, agoraphobia correlated more strongly with both the social phobia and blood phobia components than with either the physiological hyperarousal or the anxiety sensitivity components. These findings suggest that the association between panic attacks and agoraphobia warrants greater attention.

  5. The role of 5-HT1A receptors in the anti-aversive effects of cannabidiol on panic attack-like behaviors evoked in the presence of the wild snake Epicrates cenchria crassus (Reptilia, Boidae).

    Science.gov (United States)

    Twardowschy, André; Castiblanco-Urbina, Maria Angélica; Uribe-Mariño, Andres; Biagioni, Audrey Francisco; Salgado-Rohner, Carlos José; Crippa, José Alexandre de Souza; Coimbra, Norberto Cysne

    2013-12-01

    The potential anxiolytic and antipanic properties of cannabidiol have been shown; however, its mechanism of action seems to recruit other receptors than those involved in the endocannabinoid-mediated system. It was recently shown that the model of panic-like behaviors elicited by the encounters between mice and snakes is a good tool to investigate innate fear-related responses, and cannabidiol causes a panicolytic-like effect in this model. The aim of the present study was to investigate the 5-hydroxytryptamine (5-HT) co-participation in the panicolytic-like effects of cannabidiol on the innate fear-related behaviors evoked by a prey versus predator interaction-based paradigm. Male Swiss mice were treated with intraperitoneal (i.p.) administrations of cannabidiol (3 mg/kg, i.p.) and its vehicle and the effects of the peripheral pre-treatment with increasing doses of the 5-HT1A receptor antagonist WAY-100635 (0.1, 0.3 and 0.9 mg/kg, i.p.) on instinctive fear-induced responses evoked by the presence of a wild snake were evaluated. The present results showed that the panicolytic-like effects of cannabidiol were blocked by the pre-treatment with WAY-100635 at different doses. These findings demonstrate that cannabidiol modulates the defensive behaviors evoked by the presence of threatening stimuli, and the effects of cannabidiol are at least partially dependent on the recruitment of 5-HT1A receptors.

  6. Anti-aversive effects of cannabidiol on innate fear-induced behaviors evoked by an ethological model of panic attacks based on a prey vs the wild snake Epicrates cenchria crassus confrontation paradigm.

    Science.gov (United States)

    Uribe-Mariño, Andrés; Francisco, Audrey; Castiblanco-Urbina, Maria Angélica; Twardowschy, André; Salgado-Rohner, Carlos José; Crippa, José Alexandre S; Hallak, Jaime Eduardo Cecílio; Zuardi, Antônio Waldo; Coimbra, Norberto Cysne

    2012-01-01

    Several pharmacological targets have been proposed as modulators of panic-like reactions. However, interest should be given to other potential therapeutic neurochemical agents. Recent attention has been given to the potential anxiolytic properties of cannabidiol, because of its complex actions on the endocannabinoid system together with its effects on other neurotransmitter systems. The aim of this study was to investigate the effects of cannabidiol on innate fear-related behaviors evoked by a prey vs predator paradigm. Male Swiss mice were submitted to habituation in an arena containing a burrow and subsequently pre-treated with intraperitoneal administrations of vehicle or cannabidiol. A constrictor snake was placed inside the arena, and defensive and non-defensive behaviors were recorded. Cannabidiol caused a clear anti-aversive effect, decreasing explosive escape and defensive immobility behaviors outside and inside the burrow. These results show that cannabidiol modulates defensive behaviors evoked by the presence of threatening stimuli, even in a potentially safe environment following a fear response, suggesting a panicolytic effect.

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

    OpenAIRE

    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 ...

  8. Angiotensin-II is a putative neurotransmitter in lactate-induced panic-like responses in rats with disruption of GABAergic inhibition in the dorsomedial hypothalamus.

    Science.gov (United States)

    Shekhar, Anantha; Johnson, Philip L; Sajdyk, Tammy J; Fitz, Stephanie D; Keim, Stanley R; Kelley, Pamela E; Gehlert, Donald R; DiMicco, Joseph A

    2006-09-06

    Intravenous sodium lactate infusions or the noradrenergic agent yohimbine reliably induce panic attacks in humans with panic disorder but not in healthy controls. However, the exact mechanism of lactate eliciting a panic attack is still unknown. In rats with chronic disruption of GABA-mediated inhibition in the dorsomedial hypothalamus (DMH), achieved by chronic microinfusion of the glutamic acid decarboxylase inhibitor L-allylglycine, sodium lactate infusions or yohimbine elicits panic-like responses (i.e., anxiety, tachycardia, hypertension, and tachypnea). In the present study, previous injections of the angiotensin-II (A-II) type 1 receptor antagonist losartan and the nonspecific A-II receptor antagonist saralasin into the DMH of "panic-prone" rats blocked the anxiety-like and physiological components of lactate-induced panic-like responses. In addition, direct injections of A-II into the DMH of these panic-prone rats also elicited panic-like responses that were blocked by pretreatment with saralasin. Microinjections of saralasin into the DMH did not block the panic-like responses elicited by intravenous infusions of the noradrenergic agent yohimbine or by direct injections of NMDA into the DMH. The presence of the A-II type 1 receptors in the region of the DMH was demonstrated using immunohistochemistry. Thus, these results implicate A-II pathways and the A-II receptors in the hypothalamus as putative substrates for sodium lactate-induced panic-like responses in vulnerable subjects.

  9. Pharmacotherapy of panic disorder

    Directory of Open Access Journals (Sweden)

    Charles B Pull

    2008-09-01

    Full Text Available 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 pharmacotherapy with cognitive behavior therapy (CBT. The review has been written with a focus on randomized controlled trials, meta-analyses, and reviews that have been published over the past few years. Effective pharmacological treatments include tricyclic antidepressants, monoamine oxidase inhibitors, selective serotonin reuptake inhibitors, serotonin norepinephrine reuptake inhibitors, and various benzodiazepines. Treatment results obtained with CBT compare well with pharmacotherapy, with evidence that CBT is at least as effective as pharmacotherapy. Combining pharmacotherapy with CBT has been found to be superior to antidepressant pharmacotherapy or CBT alone, but only in the acute-phase treatment. Long term studies on treatments combining pharmacotherapy and CBT for PD with or without agoraphobia have found little benefit, however, for combination therapies versus monotherapies. New investigations explore the potential additional value of sequential versus concomitant treatments, of cognitive enhancers and virtual reality exposure therapy, and of education, self management and Internet-based interventions.Keywords: Panic disorder, agoraphobia, pharmacotherapy, cognitive-behavioral therapy, combination treatments.

  10. Panic symptoms and elevated suicidal ideation and behaviors among trauma exposed individuals: Moderating effects of post-traumatic stress disorder.

    Science.gov (United States)

    Albanese, Brian J; Norr, Aaron M; Capron, Daniel W; Zvolensky, Michael J; Schmidt, Norman B

    2015-08-01

    Panic attacks (PAs) are highly prevalent among trauma exposed individuals and have been associated with a number of adverse outcomes. Despite high suicide rates among trauma exposed individuals, research to date has not examined the potential relation between panic symptoms and suicidal ideation and behaviors among this high risk population. The current study tested the association of panic with suicidal ideation and behaviors among a large sample of trauma exposed smokers. Community participants (N=421) who reported a lifetime history of trauma exposure were assessed concurrently for current panic, suicidal ideation and behaviors, and psychiatric diagnoses. Those who met criteria for a current panic disorder diagnosis were removed from analyses to allow for the assessment of non-PD related panic in line with the recent addition of the PA specifier applicable to all DSM-5 disorders. Findings indicated that panic symptoms were significantly associated with suicidal ideation and behaviors beyond the effects of depression and number of trauma types experienced. Further, post-traumatic stress disorder (PTSD) diagnostic status significantly moderated this relationship, indicating that the relationship between panic and suicidal ideation and behaviors is potentiated among individuals with a current PTSD diagnosis. This investigation suggests that panic symptoms may be a valuable clinical target for the assessment and treatment of suicidal ideation and behaviors among trauma exposed individuals.

  11. Catastrophic interpretations and anxiety sensitivity as predictors of panic-spectrum psychopathology in chronic obstructive pulmonary disease.

    Science.gov (United States)

    Livermore, Nicole; Sharpe, Louise; McKenzie, David

    2012-05-01

    Panic-spectrum psychopathology (denoting panic attacks and panic disorder) is highly prevalent in chronic obstructive pulmonary disease (COPD), and the cognitive model of panic has been proposed as an explanation of this high prevalence. In the current cross-sectional study we investigated factors predicting panic-spectrum psychopathology in COPD, and hypothesized that, consistent with the cognitive model, both the catastrophic interpretation of shortness of breath and elevated anxiety sensitivity would be significant predictors when variance shared with confounding variables was controlled. Sixty-two participants with COPD were interviewed with the Anxiety Disorders Interview Schedule for DSM-IV, Panic Disorder section, and completed measures of interpretation of breathing difficulty, anxiety sensitivity, anxiety, depression, disease-specific quality of life, and stressful life events. Objective disease severity was measured using forced expiratory volume in the first second. Direct logistic regression was performed, and worse depressive symptoms, more catastrophic interpretations of shortness of breath, higher anxiety sensitivity, higher magnitude of recent stressful life events, and worse disease severity were each found to be significant unique predictors of panic-spectrum psychopathology in COPD after shared variance was controlled. The results of the study provide support for the cognitive model of panic, and also suggest a diathesis-stress explanation of the development of panic-spectrum psychopathology in COPD. The findings have implications for future preventative psychological interventions. Crown Copyright © 2012. Published by Elsevier Inc. All rights reserved.

  12. Increased opioid dependence in a mouse model of panic disorder

    Directory of Open Access Journals (Sweden)

    Xavier Gallego

    2010-02-01

    Full Text Available Panic disorder is a highly prevalent neuropsychiatric disorder that shows co-occurrence with substance abuse. Here, we demonstrate that TrkC, the high affinity receptor for neurotrophin-3, is a key molecule involved in panic disorder and opiate dependence, using a transgenic mouse model (TgNTRK3. Constitutive TrkC overexpression in TgNTRK3 mice dramatically alters spontaneous firing rates of locus coeruleus neurons and the response of the noradrenergic system to chronic opiate exposure, possibly related to the altered regulation of neurotrophic peptides observed. Notably, TgNTRK3 locus coeruleus neurons showed an increased firing rate in saline-treated conditions and profound abnormalities in their response to met5-enkephalin. Behaviorally, chronic morphine administration induced a significantly increased withdrawal syndrome in TgNTRK3 mice. In conclusion, we show here that the NT-3/TrkC system is an important regulator of neuronal firing in locus coeruleus and could contribute to the adaptations of the noradrenergic system in response to chronic opiate exposure. Moreover, our results indicate that TrkC is involved in the molecular and cellular changes in noradrenergic neurons underlying both panic attacks and opiate dependence and support a functional endogenous opioid deficit in panic disorder patients.

  13. Assessing the clinical utility of agoraphobia in the context of panic disorder.

    Science.gov (United States)

    Schmidt, Norman B; Cromer, Kiara R

    2008-01-01

    In the DSM-IV, a panic disorder (PD) diagnosis includes specification of agoraphobia, which is primarily an index of situational avoidance due to fear of panic. No other anxiety diagnosis requires specification of level of avoidance. This raises the question as to whether agoraphobia provides unique information beyond the core features of PD (i.e., panic attacks and panic-related worry). The incremental validity of agoraphobia, defined using DSM-IV specifiers versus level of situational avoidance, was examined in relation to the expression and treatment of PD (N=146). Analyses indicate that agoraphobia status adds uniquely to the prediction of PD symptoms, impairment, and response to treatment. However, level of situational avoidance, defined either as a continuous or dichotomous variable, appears to have greater utility compared to the DSM-IV method of classifying agoraphobia. In summary, the agoraphobia specifier seems to have clinical utility but this could be improved by focusing on a dimensional assessment of situational avoidance.

  14. 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.

  15. A genome-wide study of panic disorder suggests the amiloride-sensitive cation channel 1 as a candidate gene

    DEFF Research Database (Denmark)

    Gregersen, Noomi; Dahl, Hans A.; Buttenschön, Henriette N.

    2012-01-01

    Panic disorder (PD) is a mental disorder with recurrent panic attacks that occur spontaneously and are not associated to any particular object or situation. There is no consensus on what causes PD. However, it is recognized that PD is influenced by environmental factors, as well as genetic factor...... of PD in a larger outbred population.European Journal of Human Genetics advance online publication, 3 August 2011; doi:10.1038/ejhg.2011.148....

  16. Panic and Culture: Hysterike Pnix in the Ancient Greek World.

    Science.gov (United States)

    Mattern, Susan P

    2015-10-01

    Starting perhaps in the second century BCE, and with Hippocratic precedent, ancient medical writers described a condition they called hysterike pnix or "uterine suffocation." This paper argues that uterine suffocation was, in modern terms, a functional somatic syndrome characterized by chronic anxiety and panic attacks. Transcultural psychiatrists have identified and described a number of similar panic-type syndromes in modern populations, and a plausible theory of how they work has been advanced. These insights, applied to the ancient disease of hysterike pnix, demystify the condition and illuminate the experience of the women who suffered from it. © The Author 2014. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  17. Neurobiological correlates of panic disorder and agoraphobia.

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    Al-Haddad M

    2001-01-01

    Full Text Available Panic Disorder and agoraphobia offer considerable diagnostic and management challenges, particularly in general practice. We describe a typical case of panic disorder in a young adult. The recent advances in our understanding of brain functions can be used to explain to a certain extent the biologic basis of panic disorder. A hypothetical model integrating current views on panic disorder and agoraphobia has been proposed. The management principles including the role of cognitive therapy and pharmacotherapy have been discussed.

  18. Navigating the Zika panic

    Science.gov (United States)

    Grubaugh, Nathan D.; Andersen, Kristian G.

    2016-01-01

    The epidemics of Ebola virus in West Africa and Zika virus in America highlight how viruses can explosively emerge into new territories. These epidemics also exposed how unprepared we are to handle infectious disease emergencies. This is also true when we consider hypothesized new clinical features of infection, such as the associations between Zika virus infection and severe neurological disease, including microcephaly and Guillain-Barré syndrome. On the surface, these pathologies appear to be new features of Zika virus infection, however, causal relationships have not yet been established. Decades of limited Zika virus research are making us scramble to determine the true drivers behind the epidemic, often at the expense of over-speculation without credible evidence. Here we review the literature and find no conclusive evidence at this time for significant biological differences between the American Zika virus strains and those circulating elsewhere. Rather, the epidemic scale in the Americas may be facilitated by an abnormally warm climate, dense human and mosquito populations, and previous exposure to other viruses. Severe disease associated with Zika virus may therefore not be a new trait for the virus, rather it may have been overlooked due to previously small outbreaks. Much of the recent panic regarding Zika virus has been about the Olympics in Brazil. We do not find any substantial evidence that the Olympics will result in a significant number of new Zika virus infections (~10 predicted) or that the Olympics will promote further epidemic spread over what is already expected. The Zika virus epidemic in the Americas is a serious situation and decisions based on solid scientific evidence - not hyped media speculations - are required for effective outbreak response.

  19. Personality disorder traits as predictors of subsequent first-onset panic disorder or agoraphobia.

    Science.gov (United States)

    Bienvenu, O Joseph; Stein, Murray B; Samuels, Jack F; Onyike, Chiadi U; Eaton, William W; Nestadt, Gerald

    2009-01-01

    Determining how personality disorder traits and panic disorder and/or agoraphobia relate longitudinally is an important step in developing a comprehensive understanding of the etiology of panic/agoraphobia. In 1981, a probabilistic sample of adult (> or =18 years old) residents of east Baltimore were assessed for Axis I symptoms and disorders using the Diagnostic Interview Schedule (DIS); psychiatrists reevaluated a subsample of these participants and made Axis I diagnoses, as well as ratings of individual Diagnostic and Statistical Manual of Mental Disorders, Third Edition personality disorder traits. Of the participants psychiatrists examined in 1981, 432 were assessed again in 1993 to 1996 using the DIS. Excluding participants who had baseline panic attacks or panic-like spells from the risk groups, baseline timidity (avoidant, dependent, and related traits) predicted first-onset DIS panic disorder or agoraphobia over the follow-up period. These results suggest that avoidant and dependent personality traits are predisposing factors, or at least markers of risk, for panic disorder and agoraphobia-not simply epiphenomena.

  20. Neuroticism moderates the effect of maximum smoking level on lifetime panic disorder: a test using an epidemiologically defined national sample of smokers.

    Science.gov (United States)

    Zvolensky, Michael J; Sachs-Ericsson, Natalie; Feldner, Matthew T; Schmidt, Norman B; Bowman, Carrie J

    2006-03-30

    The present study evaluated a moderational model of neuroticism on the relation between smoking level and panic disorder using data from the National Comorbidity Survey. Participants (n=924) included current regular smokers, as defined by a report of smoking regularly during the past month. Findings indicated that a generalized tendency to experience negative affect (neuroticism) moderated the effects of maximum smoking frequency (i.e., number of cigarettes smoked per day during the period when smoking the most) on lifetime history of panic disorder even after controlling for drug dependence, alcohol dependence, major depression, dysthymia, and gender. These effects were specific to panic disorder, as no such moderational effects were apparent for other anxiety disorders. Results are discussed in relation to refining recent panic-smoking conceptual models and elucidating different pathways to panic-related problems.

  1. Treatment-resistant panic disorder: a systematic review.

    Science.gov (United States)

    Freire, Rafael C; Zugliani, Morena M; Garcia, Rafael F; Nardi, Antonio E

    2016-01-01

    The prevalence of panic disorder (PD) in the population is high and these patients have work impairment, high unemployment rates, seek medical treatment more frequently and have more hospitalizations than people without panic symptoms. Despite the availability of pharmacological, psychological and combined treatments, approximately one-third of all PD patients have persistent panic attacks and other PD symptoms after treatment. MEDLINE/Pubmed, CENTRAL, PsycINFO and Web of Science databases were searched for clinical trials in treatment-resistant PD. Only studies published between 1980 and 2015, in English, with human subjects, considered "journal articles" and clinical trial were included. We included trials recruiting only adult subjects with treatment-resistant PD, consistent with criteria from DSM-III to DSM5. We included all prospective experimental studies. Case, case series, retrospective studies or studies with <10 PD subjects were not included. Only 11 articles were included in this review. There were few quality studies, only two were randomized, controlled and double blind. Augmentation of the pharmacological treatment with cognitive-behavioral therapy demonstrated some short-term efficacy in treatment-resistant PD. There were also preliminary evidences of efficacy for monotherapy with reboxetine and olanzapine, and augmentation with pindolol, divalproex sodium, aripiprazole and olanzapine in short-term treatment.

  2. Anxiety sensitivity, catastrophic misinterpretations and panic self-efficacy in the prediction of panic disorder severity: towards a tripartite cognitive model of panic disorder.

    Science.gov (United States)

    Sandin, Bonifacio; Sánchez-Arribas, Carmen; Chorot, Paloma; Valiente, Rosa M

    2015-04-01

    The present study examined the contribution of three main cognitive factors (i.e., anxiety sensitivity, catastrophic misinterpretations of bodily symptoms, and panic self-efficacy) in predicting panic disorder (PD) severity in a sample of patients with a principal diagnosis of panic disorder. It was hypothesized that anxiety sensitivity (AS), catastrophic misinterpretation of bodily sensations, and panic self-efficacy are uniquely related to panic disorder severity. One hundred and sixty-eight participants completed measures of AS, catastrophic misinterpretations of panic-like sensations, and panic self-efficacy prior to receiving treatment. Results of multiple linear regression analyses indicated that AS, catastrophic misinterpretations and panic self-efficacy independently predicted panic disorder severity. Results of path analyses indicated that AS was direct and indirectly (mediated by catastrophic misinterpretations) related with panic severity. Results provide evidence for a tripartite cognitive account of panic disorder.

  3. Gender differences in associations of glutamate decarboxylase 1 gene (GAD1 variants with panic disorder.

    Directory of Open Access Journals (Sweden)

    Heike Weber

    Full Text Available BACKGROUND: Panic disorder is common (5% prevalence and females are twice as likely to be affected as males. The heritable component of panic disorder is estimated at 48%. Glutamic acid dehydrogenase GAD1, the key enzyme for the synthesis of the inhibitory and anxiolytic neurotransmitter GABA, is supposed to influence various mental disorders, including mood and anxiety disorders. In a recent association study in depression, which is highly comorbid with panic disorder, GAD1 risk allele associations were restricted to females. METHODOLOGY/PRINCIPAL FINDINGS: Nineteen single nucleotide polymorphisms (SNPs tagging the common variation in GAD1 were genotyped in two independent gender and age matched case-control samples (discovery sample n = 478; replication sample n = 584. Thirteen SNPs passed quality control and were examined for gender-specific enrichment of risk alleles associated with panic disorder by using logistic regression including a genotype×gender interaction term. The latter was found to be nominally significant for four SNPs (rs1978340, rs3762555, rs3749034, rs2241165 in the discovery sample; of note, the respective minor/risk alleles were associated with panic disorder only in females. These findings were not confirmed in the replication sample; however, the genotype×gender interaction of rs3749034 remained significant in the combined sample. Furthermore, this polymorphism showed a nominally significant association with the Agoraphobic Cognitions Questionnaire sum score. CONCLUSIONS/SIGNIFICANCE: The present study represents the first systematic evaluation of gender-specific enrichment of risk alleles of the common SNP variation in the panic disorder candidate gene GAD1. Our tentative results provide a possible explanation for the higher susceptibility of females to panic disorder.

  4. Learning Processes Associated with Panic-Related Symptoms in Families with and without Panic Disordered Mothers

    Science.gov (United States)

    de Albuquerque, Jiske E. G.; Munsch, Simone; Margraf, Jurgen; Schneider, Silvia

    2013-01-01

    The present study compared learning processes associated with panic-related symptoms in families with and without panic disordered mothers. Using a multi-informant approach, 86 mothers [of whom 58 had a primary diagnosis of panic disorder (PD)], their partners and teenage children (mean age, 16.67 years) reported about parents' behavior (modeling…

  5. 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.

  6. Electroencephalographic findings in panic disorder

    Directory of Open Access Journals (Sweden)

    Marcele Regine de Carvalho

    2013-12-01

    Full Text Available Some studies have reported the importance of electroencephalography (EEG as a method for investigating abnormal parameters in psychiatric disorders. Different findings in time and frequency domain analysis with regard to central nervous system arousal during acute panic states have already been obtained. This study aimed to systematically review the EEG findings in panic disorder (PD, discuss them having a currently accepted neuroanatomical hypothesis for this pathology as a basis, and identify limitations in the selected studies. Literature search was conducted in the databases PubMed and ISI Web of Knowledge, using the keywords electroencephalography and panic disorder; 16 articles were selected. Despite the inconsistency of EEG findings in PD, the major conclusions about the absolute power of alpha and beta bands point to a decreased alpha power, while beta power tends to increase. Different asymmetry patterns were found between studies. Coherence studies pointed to a lower degree of inter-hemispheric functional connectivity at the frontal region and intra-hemispheric at the bilateral temporal region. Studies on possible related events showed changes in memory processing in PD patients when exposed to aversive stimuli. It was noticed that most findings reflect the current neurobiological hypothesis of PD, where inhibitory deficits of the prefrontal cortex related to the modulation of amygdala activity, and the subsequent activation of subcortical regions, may be responsible to trigger anxiety responses. We approached some important issues that need to be considered in further researches, especially the use of different methods for analyzing EEG signals. Keywords: Electroencephalography, panic disorder, neurobiology, brain mapping.

  7. Electroencephalographic findings in panic disorder.

    Science.gov (United States)

    Carvalho, Marcele Regine de; Velasques, Bruna Brandao; Cagy, Mauricio; Marques, Juliana Bittencourt; Teixeira, Silmar; Nardi, Antonio Egidio; Piedade, Roberto; Ribeiro, Pedro

    2013-12-01

    Some studies have reported the importance of electroencephalography (EEG) as a method for investigating abnormal parameters in psychiatric disorders. Different findings in time and frequency domain analysis with regard to central nervous system arousal during acute panic states have already been obtained. This study aimed to systematically review the EEG findings in panic disorder (PD), discuss them having a currently accepted neuroanatomical hypothesis for this pathology as a basis, and identify limitations in the selected studies. Literature search was conducted in the databases PubMed and ISI Web of Knowledge, using the keywords electroencephalography and panic disorder; 16 articles were selected. Despite the inconsistency of EEG findings in PD, the major conclusions about the absolute power of alpha and beta bands point to a decreased alpha power, while beta power tends to increase. Different asymmetry patterns were found between studies. Coherence studies pointed to a lower degree of inter-hemispheric functional connectivity at the frontal region and intra-hemispheric at the bilateral temporal region. Studies on possible related events showed changes in memory processing in PD patients when exposed to aversive stimuli. It was noticed that most findings reflect the current neurobiological hypothesis of PD, where inhibitory deficits of the prefrontal cortex related to the modulation of amygdala activity, and the subsequent activation of subcortical regions, may be responsible to trigger anxiety responses. We approached some important issues that need to be considered in further researches, especially the use of different methods for analyzing EEG signals.

  8. Temporal patterns of change in panic disorder during cognitive behaviour therapy: an Indian study.

    Science.gov (United States)

    Manjula, M; Prasadarao, P S D V; Kumaraiah, V; Raguram, R

    2014-09-01

    CBT has been proven to be effective in the treatment of panic disorder; however, attempts to study the process of change are limited. The study evaluated the temporal patterns of change in the panic symptoms, cognitions, behaviours, and anxiety sensitivity in subjects with panic disorder being treated with CBT. Thirty subjects with panic disorder were allocated to two groups: Cognitive Behaviour Therapy (CBT, n = 15) and Behaviour Therapy (BT, n = 15). Assessments were carried out weekly for five consecutive weeks using the Semi-Structured Interview Schedule, the Anxiety Sensitivity Index, the Agoraphobic Cognitions Questionnaire, and the Texas Panic Attack Record Form. The CBT group received comprehensive CBT and the BT group received psycho-education and Applied Relaxation. Following intervention the change was continuous and gradual on all the variables in the CBT group and the scores reduced to a functional range after 4-5 weeks of therapy. Such a change was not evident in the BT group. Significant change was evident in cognitive domains following the introduction of the exposure and cognitive restructuring within the CBT group. Both cognitive and behavioural techniques contributed to the overall change. CBT had an impact on the cognitive domains and significant changes were evident corresponding to the addition of cognitive restructuring and exposure techniques in the 3rd to 5th week. Both cognitive and behavioural components are therefore crucial for overall improvement to occur.

  9. 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.

  10. Panic disorder in a breath-holding challenge test: a simple tool for a better diagnosis

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    Nardi Antonio E.

    2003-01-01

    Full Text Available OBJECTIVE: Our aim was to observe if anxiety disorder patients - DSM-IV - respond in a similar way to the induction of panic attacks by a breath-holding challenge test. METHOD: We randomly selected 29 panic disorder (PD patients, 27 social anxiety disorder (SAD patients, 21 generalized anxiety disorder (GAD patients. They were induced to breath-hold for as long as possible four times with two-minute interval between them. Anxiety scales were applied before and after the test. RESULTS: A total of 44.8% (n=13 PD patients, 14.8% (n=4 SAD patients, 9.5% (n=2 GAD patients had a panic attack after the test (c²= 21.44, df= 2, p=0.001. There was no heart rate or anxiety levels difference among the groups before and after the test. CONCLUSION: In this breath-holding challenge test the panic disorder patients were more sensitive than other anxiety disorder patients.

  11. The Neuroanatomical Basis of Panic Disorder and Social Phobia in Schizophrenia: A Voxel Based Morphometric Study

    Science.gov (United States)

    Picado, Marisol; Carmona, Susanna; Hoekzema, Elseline; Pailhez, Guillem; Bergé, Daniel; Mané, Anna; Fauquet, Jordi; Hilferty, Joseph; Moreno, Ana; Cortizo, Romina; Vilarroya, Oscar; Bulbena, Antoni

    2015-01-01

    Objective It is known that there is a high prevalence of certain anxiety disorders among schizophrenic patients, especially panic disorder and social phobia. However, the neural underpinnings of the comorbidity of such anxiety disorders and schizophrenia remain unclear. Our study aims to determine the neuroanatomical basis of the co-occurrence of schizophrenia with panic disorder and social phobia. Methods Voxel-based morphometry was used in order to examine brain structure and to measure between-group differences, comparing magnetic resonance images of 20 anxious patients, 20 schizophrenic patients, 20 schizophrenic patients with comorbid anxiety, and 20 healthy control subjects. Results Compared to the schizophrenic patients, we observed smaller grey-matter volume (GMV) decreases in the dorsolateral prefrontal cortex and precentral gyrus in the schizophrenic-anxiety group. Additionally, the schizophrenic group showed significantly reduced GMV in the dorsolateral prefrontal cortex, precentral gyrus, orbitofrontal cortex, temporal gyrus and angular/inferior parietal gyrus when compared to the control group. Conclusions Our findings suggest that the comorbidity of schizophrenia with panic disorder and social phobia might be characterized by specific neuroanatomical and clinical alterations that may be related to maladaptive emotion regulation related to anxiety. Even thought our findings need to be replicated, our study suggests that the identification of neural abnormalities involved in anxiety, schizophrenia and schizophrenia-anxiety may lead to an improved diagnosis and management of these conditions. PMID:25774979

  12. The neuroanatomical basis of panic disorder and social phobia in schizophrenia: a voxel based morphometric study.

    Directory of Open Access Journals (Sweden)

    Marisol Picado

    Full Text Available It is known that there is a high prevalence of certain anxiety disorders among schizophrenic patients, especially panic disorder and social phobia. However, the neural underpinnings of the comorbidity of such anxiety disorders and schizophrenia remain unclear. Our study aims to determine the neuroanatomical basis of the co-occurrence of schizophrenia with panic disorder and social phobia.Voxel-based morphometry was used in order to examine brain structure and to measure between-group differences, comparing magnetic resonance images of 20 anxious patients, 20 schizophrenic patients, 20 schizophrenic patients with comorbid anxiety, and 20 healthy control subjects.Compared to the schizophrenic patients, we observed smaller grey-matter volume (GMV decreases in the dorsolateral prefrontal cortex and precentral gyrus in the schizophrenic-anxiety group. Additionally, the schizophrenic group showed significantly reduced GMV in the dorsolateral prefrontal cortex, precentral gyrus, orbitofrontal cortex, temporal gyrus and angular/inferior parietal gyrus when compared to the control group.Our findings suggest that the comorbidity of schizophrenia with panic disorder and social phobia might be characterized by specific neuroanatomical and clinical alterations that may be related to maladaptive emotion regulation related to anxiety. Even thought our findings need to be replicated, our study suggests that the identification of neural abnormalities involved in anxiety, schizophrenia and schizophrenia-anxiety may lead to an improved diagnosis and management of these conditions.

  13. Anchoring the Panic Disorder Severity Scale

    Science.gov (United States)

    Keough, Meghan E.; Porter, Eliora; Kredlow, M. Alexandra; Worthington, John J.; Hoge, Elizabeth A.; Pollack, Mark H.; Shear, M. Katherine; Simon, Naomi M.

    2012-01-01

    The Panic Disorder Severity Scale (PDSS) is a clinician-administered measure of panic disorder symptom severity widely used in clinical research. This investigation sought to provide clinically meaningful anchor points for the PDSS both in terms of clinical severity as measured by the Clinical Global Impression-Severity Scale (CGI-S) and to extend…

  14. Charles Darwin and panic disorder.

    Science.gov (United States)

    Barloon, T J; Noyes, R

    1997-01-08

    Charles Darwin (1809-1882) suffered from a chronic illness that, throughout much of his adult life, impaired his functioning and severely limited his activities. The writings of this famous scientist as well as biographical materials indicate that he probably suffered from an anxiety disorder. His symptoms, when considered individually, suggest a variety of conditions, but taken together they point toward panic disorder with agoraphobia. This diagnosis brings coherence to Darwin's activities and explains his secluded lifestyle, including difficulty in speaking before groups and meeting with colleagues.

  15. Depression, anxiety and panic disorders in chronic obstructive pulmonary disease patients: correlations with tobacco use, disease severity and quality of life.

    Science.gov (United States)

    Pascal, Oana Irinel; Trofor, Antigona Carmen; Lotrean, Lucia Maria; Filipeanu, Dumitru; Trofor, Letitia

    2017-01-01

    The objective of this study is to assess anxiety, depression and panic disorders among patients diagnosed with COPD and to investigate their correlation with disease severity, quality of life as well as tobacco use. An observational study was performed between January and September 2014 among 60 patients diagnosed with COPD. COPD staging according to GOLD criteria, while anxiety and depression were assessed using Hospital Anxiety and Depression Scale and panic attacks were evaluated based on ICD 10 criteria. Almost 40% of the sample were smokers, the medium packs-years was 34.3 and the medium Fagerstrom score was 7.5. Overall, mean Modified Medical Research Council Dyspnea Scale (mMRC) was 2.86, mean COPD Assessment Test (CAT) score was 21.75 and study participants had 1.93 COPD exacerbations/year. Mean distribution of anxiety and depression symptoms scores among COPD subjects was 10.65 ± 3.5 and 9.93 ± 3.8, respectively. Smokers and ex-smokers had similar scores with regard to anxiety, depression or the presence of panic attacks. The results of the bivariate correlations indicated associations between anxiety, depression, panic attacks and disease severity, as well as poor quality of life of patients with COPD, regardless of their current tobacco use status. In conclusion, the results of this study indicate that anxiety, depression and panic attacks were constant characteristics among COPD patients- regardless of their current tobacco use.

  16. Heart Attack

    Science.gov (United States)

    ... a million people in the U.S. have a heart attack. About half of them die. Many people have permanent heart damage or die because they don't get ... It's important to know the symptoms of a heart attack and call 9-1-1 if someone ...

  17. Attack surfaces

    DEFF Research Database (Denmark)

    Gruschka, Nils; Jensen, Meiko

    2010-01-01

    The new paradigm of cloud computing poses severe security risks to its adopters. In order to cope with these risks, appropriate taxonomies and classification criteria for attacks on cloud computing are required. In this work-in-progress paper we present one such taxonomy based on the notion...... of attack surfaces of the cloud computing scenario participants. © 2010 IEEE....

  18. Life events in panic disorder-an update on "candidate stressors".

    Science.gov (United States)

    Klauke, Benedikt; Deckert, Jürgen; Reif, Andreas; Pauli, Paul; Domschke, Katharina

    2010-08-01

    Studies on gene-environment interactions in mental disorders are characterized by powerful genetic techniques and well defined "candidate genes," whereas a definition of "candidate stressors," in most cases assessed in the form of life events (LEs), is inconsistent or not even provided. This review addresses this problem, with particular attention to the clinical phenotype of panic disorder (PD), by providing an overview and critical discussion for which life events are known to contribute to the etiology of the disease and how they may be conceptualized. There is converging evidence for a significant impact of cumulative as well as specific life events, such as threat, interpersonal and health-related events in adulthood, and abuse or loss/separation experiences in childhood, respectively, on the pathogenesis of panic disorder with some overlapping effect across the anxiety disorder spectrum as well as on comorbid major depression. Besides genetic vulnerability factors, personality and behavioral characteristics, such as anxiety sensitivity, neuroticism, and cognitive appraisal might moderate the influence of LEs on the development of panic disorder. The present state of knowledge regarding the specification and conceptualization of LEs in PD within a more complex multifactorial model, involving mediating and moderating factors in between genes and the clinical phenotype, is hoped to aid in informing future gene-environment interaction studies in panic disorder.

  19. [Gabapentin treatment in a female patient with panic disorder and adverse effects under carbamazepine during benzodiazepine withdrawal].

    Science.gov (United States)

    Himmerich, Hubertus; Nickel, Thomas; Dalal, Mira A; Müller, Marianne B

    2007-03-01

    Despite their addictive potential, benzodiazepines belong to the most often prescribed drugs. We report on a patient with alprazolam dependence, who initially was treated with carbamazepine because of severe withdrawal symptoms. Due to liver enzyme elevation related to carbamazepine, we had to stop this treatment and instead of that started gabapentin treatment. Under this new therapy, the patient showed a dramatic relief of withdrawal symptoms and of the panic attacks recurring during withdrawal. Hence, due to their effectiveness and tolerability, newer anticonvulsants could be considered as medication for benzodiazepine withdrawal and as an alternative for benzodiazepine treatment in panic disorders.

  20. Ritalin®: Panic in the USA

    Directory of Open Access Journals (Sweden)

    Toby Miller

    2011-04-01

    Full Text Available  Ritalin® is a popular pharmaceutical. It keeps young people quiet and focused, but attracts intense opprobrium. Beginning with an account of the dimensions of Ritalin®’s use in the United States and controversies surrounding it, this article outlines how this might be understood in moral-panic terms and examines the role of the psy-function and various conflicts of interest, coverage in popular culture, and governmental responses. In many cases, progressive academics and activists have criticised moral panics, recuperating moral-panic folk devils as semiotic guerrillas struggling against authority. In this instance, however, the scene is too complex and multifaceted for that heroisation. There are no good guys; there is lots of panic, from all political-economic quarters. Some of it is justified—and none of it is straightforward.

  1. Ritalin®: Panic in the USA

    Directory of Open Access Journals (Sweden)

    Toby Miller

    2011-04-01

    Full Text Available Ritalin® is a popular pharmaceutical. It keeps young people quiet and focused, but attracts intense opprobrium. Beginning with an account of the dimensions of Ritalin®’s use in the United States and controversies surrounding it, this article outlines how this might be understood in moral-panic terms and examines the role of the psy-function and various conflicts of interest, coverage in popular culture, and governmental responses. In many cases, progressive academics and activists have criticised moral panics, recuperating moral-panic folk devils as semiotic guerrillas struggling against authority. In this instance, however, the scene is too complex and multifaceted for that heroisation. There are no good guys; there is lots of panic, from all political-economic quarters. Some of it is justified—and none of it is straightforward.

  2. Symbolic Interactionism, Mass Panics and Urban Legends

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    Ivan Kovačević

    2016-02-01

    Full Text Available The constructionist approach to social problems has developed a thesis about mass panics and urban legends as "unconstructed social problems". This thesis, advanced by the American sociologist Joel Best, and his analysis of the urban legend of Halloween sadism, have provided the model for studying three mass panics and two urban legends. The three panics in question are the mass exodus from Kraljevo because of a prophesy that the town would be destroyed in an earthquake, the mass fear of body parts thieves in three villages in Srem, and the panic over the appearance of a cannibal sect in the town of Šabac. The two urban legends involve the rich old emigrant whose acquaintance a child from a poor family made while dialling phone numbers at random, and the thieving postman who set up his own business in Russia with the stolen pension money he had been supposed to deliver.

  3. Empirically Supported Treatments for Panic Disorder

    NARCIS (Netherlands)

    McHugh, R.K.; Smits, J.A.J.; Otto, M.W.

    2009-01-01

    This article provides an empirical review of the elements and efficacy of both pharmacologic and psychosocial treatments for panic disorder. Both monotherapies and combination treatment strategies are considered. The available evidence suggests that both cognitive behavioral therapy (CBT) and

  4. Serotonin in anxiety and panic: contributions of the elevated T-maze.

    Science.gov (United States)

    Zangrossi, Hélio; Graeff, Frederico G

    2014-10-01

    The elevated T-maze (ETM) was developed to test the hypothesis that serotonin (5-HT) plays an opposing role in the regulation of defensive behaviors associated with anxiety and panic. This test allows the measurement in the same rat of inhibitory avoidance acquisition, related to generalized anxiety disorder, and of one-way escape, associated with panic disorder. The evidence so far reported with the ETM supports the above hypothesis and indicates that: (1) whereas 5-HT neurons located at the dorsal raphe nucleus are involved in the regulation of both inhibitory avoidance and escape, those of the median raphe nucleus are primarily implicated in the former task; (2) facilitation of 5-HT1A- and 5-HT2A-mediated neurotransmission in the dorsal periaqueductal gray (dPAG) is likely to mediate the panicolytic drug action; (3) stimulation of 5-HT2C receptors in the basolateral amygdala increases anxiety and is implicated in the anxiogenesis caused by short-term administration of antidepressant drugs, and (4) 5-HT1A and the μ-opioid receptors work together in the dPAG to modulate escape or panic attacks. These last results point to the possible benefits of adjunctive opioid therapy for panic patients resistant to antidepressants that act on 5-HT neurotransmission. Copyright © 2014 Elsevier Ltd. All rights reserved.

  5. The co-morbidity of anxiety and depression in the perspective of genetic epidemiology. A review of twin and family studies

    NARCIS (Netherlands)

    Middeldorp, C.M.; Cath, D.C.; Dyck, van R.; Boomsma, D.I.

    2005-01-01

    BACKGROUND: Co-morbidity within anxiety disorders, and between anxiety disorders and depression, is common. According to the theory of Gray and McNaughton, this co-morbidity is caused by recursive interconnections linking the brain regions involved in fear, anxiety and panic and by heritable persona

  6. Psychiatric comorbidities in patients with major depressive disorder

    Directory of Open Access Journals (Sweden)

    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

  7. Panic disorder: Psychobiological aspects of personality dimensions

    Directory of Open Access Journals (Sweden)

    Draganić-Gajić Saveta

    2005-01-01

    Full Text Available Attempts to understand the underlying mechanisms of association between psychological factors and panic disorder have been mostly based on psychodynamic description. Evidence of the importance of serotonergic (5-HT system in panic disorder (PD, however, has substanti ally increased in recent years. OBJECTIVE The objective of our study was to determine whether there was a specific personality profile of panic disorder patients and how it was related to possible neurobiological mechanisms underlying personality dimensions. PATIENTS AND METHODS Sample consisted of 14 inpatients with ICD-X diagnosis of panic disorder and 34 healthy control subjects. Personality dimensions were assessed by Minnesota Multiphasic Personality Inventory (MMPI-201 and Tridimensional Personality Questionnaire (TPQ. To assess central 5-HT function, platelet monoamine-oxidase (MAO activity was measured. RESULTS In panic disorder group, higher scores of histrionic, depressive and hypochondriac subscales and significant increase of harm avoidance (HA scale as well as low MAO activity were found. Negative correlation was established between MAO activity and psychopathic deviance MMPI scale. CONCLUSION The obtained results might indicate a specific personality profile of patients with panic disorder, which is characterized by high neuroticism, fearfulness, inhibition, shyness and apprehensive worry. Low MAO activity and high HA scores possibly indicate underlying hyperserotonergic state. The observed correlation between personality traits and MAO activity provide additional support for the hypothesized functional relationship between underlying central monoaminergic activity and temperament traits associated with anxiety, depression and impulsivity.

  8. Social anxiety disorder in the Chinese military: prevalence, comorbidities, impairment, and treatment-seeking.

    Science.gov (United States)

    Wang, Huaning; Zhang, Ruiguo; Chen, Yunchun; Wang, Huaihai; Zhang, Yahong; Gan, Jingli; Zhang, Liyi; Tan, Qingrong

    2014-12-30

    The objective of this work is To investigate the prevalence, comorbidities, impairment, and treatment-seeking of social anxiety disorder in the Chinese military personnel. Military personnel (n=11,527) were surveyed from May to August 2007 using a multistage whole cohort probability sampling method. A Chinese version of the World Health Organization Composite International Diagnostic Interview (CIDI) was used for assessment, and a military-related socio-demographic questionnaire was used to describe the prevalence distribution. A unified survey was performed to investigate 11 different social situations. The short-form health survey was used to assess role impairment. The 12-month and lifetime prevalence rates of social anxiety disorder were 3.34% (95% CI: 3.25-3.42%) and 6.22% (95% CI: 6.11-6.32%), respectively. Social anxiety disorder was associated with increased odds of depression, substance abuse, panic attacks/disorder, and generalized anxiety disorder. Childhood foster, female, stressful life events, younger age, and being divorced/widowed increase the incidence of social anxiety disorder. Treatment-seeking was relatively rare. Social anxiety disorder is a common disorder in military personnel in China, and it is a risk factor for subsequent depressive illness, substance abuse and other mental disorder. Early detection and treatment of social anxiety disorder are important because of the low rate of treatment-seeking. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  9. Lack of specific association between panicogenic properties of caffeine and HPA-axis activation. A placebo-controlled study of caffeine challenge in patients with panic disorder.

    Science.gov (United States)

    Masdrakis, Vasilios G; Markianos, Manolis; Oulis, Panagiotis

    2015-09-30

    A subgroup of patients with Panic Disorder (PD) exhibits increased sensitivity to caffeine administration. However, the association between caffeine-induced panic attacks and post-caffeine hypothalamic-pituitary-adrenal (HPA)-axis activation in PD patients remains unclear. In a randomized, double-blind, cross-over experiment, 19 PD patients underwent a 400-mg caffeine-challenge and a placebo-challenge, both administered in the form of instant coffee. Plasma levels of adrenocorticotropic hormone (ACTH), cortisol and dehydroepiandrosterone sulfate (DHEAS) were assessed at both baseline and post-challenge. No patient panicked after placebo-challenge, while nine patients (47.3%) panicked after caffeine-challenge. Placebo administration did not result in any significant change in hormones' plasma levels. Overall, sample's patients demonstrated significant increases in ACTH, cortisol, and DHEAS plasma levels after caffeine administration. However, post-caffeine panickers and non-panickers did not differ with respect to the magnitude of the increases. Our results indicate that in PD patients, caffeine-induced panic attacks are not specifically associated with HPA-axis activation, as this is reflected in post-caffeine increases in ACTH, cortisol and DHEAS plasma levels, suggesting that caffeine-induced panic attacks in PD patients are not specifically mediated by the biological processes underlying fear or stress. More generally, our results add to the evidence that HPA-axis activation is not a specific characteristic of panic.

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

    Directory of Open Access Journals (Sweden)

    Valença A.M.

    2002-01-01

    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.

  11. Neuronal network of panic disorder: the role of the neuropeptide cholecystokinin.

    Science.gov (United States)

    Zwanzger, P; Domschke, K; Bradwejn, J

    2012-09-01

    Panic disorder (PD) is characterized by panic attacks, anticipatory anxiety and avoidance behavior. Its pathogenesis is complex and includes both neurobiological and psychological factors. With regard to neurobiological underpinnings, anxiety in humans seems to be mediated through a neuronal network, which involves several distinct brain regions, neuronal circuits and projections as well as neurotransmitters. A large body of evidence suggests that the neuropeptide cholecystokinin (CCK) might be an important modulator of this neuronal network. Key regions of the fear network, such as amygdala, hypothalamus, peraqueductal grey, or cortical regions seem to be connected by CCKergic pathways. CCK interacts with several anxiety-relevant neurotransmitters such as the serotonergic, GABA-ergic and noradrenergic system as well as with endocannabinoids, NPY and NPS. In humans, administration of CCK-4 reliably provokes panic attacks, which can be blocked by antipanic medication. Also, there is some support for a role of the CCK system in the genetic pathomechanism of PD with particularly strong evidence for the CCK gene itself and the CCK-2R (CCKBR) gene. Thus, it is hypothesized that genetic variants in the CCK system might contribute to the biological basis for the postulated CCK dysfunction in the fear network underlying PD. Taken together, a large body of evidence suggests a possible role for the neuropeptide CCK in PD with regard to neuroanatomical circuits, neurotransmitters and genetic factors. This review article proposes an extended hypothetical model for human PD, which integrates preclinical and clinical findings on CCK in addition to existing theories of the pathogenesis of PD.

  12. Cognitive factors in panic disorder, agoraphobic avoidance and agoraphobia.

    Science.gov (United States)

    Berle, David; Starcevic, Vladan; Hannan, Anthony; Milicevic, Denise; Lamplugh, Claire; Fenech, Pauline

    2008-02-01

    There remains a lack of consensus regarding the possibility that especially high levels of panic-related cognitions characterise panic disorder with agoraphobia. We administered the Anxiety Sensitivity Index, the Agoraphobic Cognitions Questionnaire and the Anxious Thoughts and Tendencies Scale as well as measures of agoraphobic avoidance to patients diagnosed with panic disorder with agoraphobia (n=75) and without agoraphobia (n=26). Patients with panic disorder with agoraphobia did not score significantly higher on any of the cognitive variables than did panic disorder patients without agoraphobia. However, most of the cognitive variables showed small to moderate-strength correlations with self-report measures of agoraphobic avoidance. Our findings suggest that anxiety sensitivity, catastrophising of the consequences of panic and a general anxiety-prone cognitive style, although to some extent associated with agoraphobic avoidance, do not discriminate panic disorder with agoraphobia from panic disorder without agoraphobia.

  13. Shark attack.

    Science.gov (United States)

    Guidera, K J; Ogden, J A; Highhouse, K; Pugh, L; Beatty, E

    1991-01-01

    Shark attacks are rare but devastating. This case had major injuries that included an open femoral fracture, massive hemorrhage, sciatic nerve laceration, and significant skin and muscle damage. The patient required 15 operative procedures, extensive physical therapy, and orthotic assistance. A review of the literature pertaining to shark bites is included.

  14. Co-morbid disorders in Tourette syndrome

    DEFF Research Database (Denmark)

    Debes, Nanette Marinette Monique

    2013-01-01

    -morbid disorders, like rage, anxiety, and conduct disorders. The symptoms of a co-morbid disorder might appear prior to the time that tics reach clinical attention. The TS phenotype probably changes during the course of the disease. The exact aetiology of the co-occurrence of co-morbid disorders and TS......Tourette syndrome (TS) is often accompanied by other symptoms and syndromes. The two best-known co-morbidities are Attention Deficit Hyperactivity Disorder (ADHD) and Obsessive Compulsive Disorder (OCD), but also other conditions like rage-attacks, depression, and sleeping disturbances are frequent...... is not known, but they probably all are neurotransmitter disorders. European guidelines recommend first-choice pharmacological treatment, but randomised double-blinded trials are needed. Professionals need to be aware of the close relationship between TS and co-morbidities in order to give the patients...

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

    Science.gov (United States)

    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. © 2016 Society for Psychophysiological Research.

  16. Prevalence of comorbid anxiety disorders in schizophrenia

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    Chandra Kiran

    2016-01-01

    Full Text Available Background: Diagnostic and treatment hierarchical reductionisms have resulted in an oversight of anxiety syndromes in schizophrenia. Aim: The aim of this study was to find the prevalence of different anxiety disorders in schizophrenia patients. Materials and Methods: The study was conducted on inpatients of a tertiary care psychiatric hospital using a prospective, purposive sampling technique. The study consisted of 93 schizophrenia patients and a similar number of normal controls. The schizophrenia patients and controls were evaluated for psychopathology and the presence of anxiety disorder. Results: The prevalence of anxiety disorder was significantly higher in schizophrenia patients (45.16% compared to controls (16.12%. Further, the prevalence of panic disorder, social anxiety disorder, and obsessive-compulsive disorder (OCD was significantly higher in schizophrenia patients. No significant correlation was observed between anxiety disorder scores and psychopathology scores. Conclusions: The prevalence of comorbid anxiety disorders (panic disorder, social anxiety disorder, and OCD in schizophrenia is significantly higher in the general population. The onset of anxiety disorder commonly precedes the onset of schizophrenia.

  17. Panic disorder and hyperventilation Transtorno do pânico e hiperventilação

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    ANTONIO EGIDIO NARD

    1999-12-01

    Full Text Available Respiratory abnormalities are associated with anxiety, particularly with panic attacks. Symptoms such as shortness of breath, "empty-head" feeling, dizziness, paresthesias and tachypnea have been described in the psychiatric and respiratory physiology related to panic disorder. Panic disorder patients exhibit both behaviorally and physiologically abnormal responses to respiratory challenges tests. Objective: We aim to observe the induction of panic attacks by hyperventilation in a group of panic disorder patients (DSM-IV. Method: 13 panic disorder patients and 11 normal volunteers were randomly selected. They were drug free for a week. They were induced to hyperventilate (30 breaths/min for 3 minutes. Anxiety scales were taken before and after the test. Results: 9 (69.2% panic disorder patients and one (9.1% of control subjects had a panic attack after hyperventilating (pDistúrbios respiratórios estão associados à ansiedade, especialmente aos ataques de pânico. Sufocamento, sensação de "cabeça leve", tonteira, parestesias e taquipnéia aparecem na descrição psiquiátrica e respiratória do transtorno do pânico. Pacientes com transtorno do pânico apresentam respostas comportamentais e fisiológicas anormais a testes respiratórios. Objetivo: Observamos a indução de ataques de pânico através de hiperventilação em um grupo de pacientes com transtorno do pânico (DSM-IV. Método: Selecionamos de forma randomizada 13 pacientes com transtorno do pânico e 11 voluntários normais. Todos estavam sem medicação há uma semana. Foram induzidos a hiperventilar (30 inspirações/minuto durante 3 minutos. Escalas de ansiedade foram utilizadas antes e após o teste. Resultados: No grupo com transtorno de pânico, 9 (69,2% pacientes apresentaram ataque de pânico após a hiperventilação e apenas 1 (9,1% no grupo controle (p<0,05. Conclusão: Os pacientes com transtorno do pânico foram mais sensíveis à hiperventilação que o grupo

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

    Directory of Open Access Journals (Sweden)

    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.

  19. Cardiorespiratory concerns shape brain responses during automatic panic-related scene processing in patients with panic disorder.

    Science.gov (United States)

    Feldker, Katharina; Heitmann, Carina Yvonne; Neumeister, Paula; Brinkmann, Leonie; Bruchmann, Maximillan; Zwitserlood, Pienie; Straube, Thomas

    2017-09-26

    Increased automatic processing of threat-related stimuli has been proposed as a key element in panic disorder. Little is known about the neural basis of automatic processing, in particular to task-irrelevant, panic-related, ecologically valid stimuli, or about the association between brain activation and symptomatology in patients with panic disorder. The present event-related fMRI study compared brain responses to task-irrelevant, panic-related and neutral visual stimuli in medication-free patients with panic disorder and healthy controls. Panic-related and neutral scenes were presented while participants performed a spatially nonoverlapping bar orientation task. Correlation analyses investigated the association between brain responses and panic-related aspects of symptomatology, measured using the Anxiety Sensitivity Index (ASI). We included 26 patients with panic disorder and 26 heatlhy controls in our analysis. Compared with controls, patients with panic disorder showed elevated activation in the amygdala, brainstem, thalamus, insula, anterior cingulate cortex and midcingulate cortex in response to panic-related versus neutral task-irrelevant stimuli. Furthermore, fear of cardiovascular symptoms (a subcomponent of the ASI) was associated with insula activation, whereas fear of respiratory symptoms was associated with brainstem hyperactivation in patients with panic disorder. The additional implementation of measures of autonomic activation, such as pupil diameter, heart rate, or electrodermal activity, would have been informative during the fMRI scan as well as during the rating procedure. Results reveal a neural network involved in the processing of panic-related distractor stimuli in patients with panic disorder and suggest an automatic weighting of panic-related information depending on the magnitude of cardiovascular and respiratory symptoms. Insula and brainstem activations show function-related associations with specific components of panic symptomatology.

  20. Facing the fear--clinical and neural effects of cognitive behavioural and pharmacotherapy in panic disorder with agoraphobia.

    Science.gov (United States)

    Liebscher, Carolin; Wittmann, André; Gechter, Johanna; Schlagenhauf, Florian; Lueken, Ulrike; Plag, Jens; Straube, Benjamin; Pfleiderer, Bettina; Fehm, Lydia; Gerlach, Alexander L; Kircher, Tilo; Fydrich, Thomas; Deckert, Jürgen; Wittchen, Hans-Ulrich; Heinz, Andreas; Arolt, Volker; Ströhle, Andreas

    2016-03-01

    Cognitive behavioural therapy (CBT) and pharmacological treatment with selective serotonin or serotonin-noradrenalin reuptake inhibitors (SSRI/SSNRI) are regarded as efficacious treatments for panic disorder with agoraphobia (PD/AG). However, little is known about treatment-specific effects on symptoms and neurofunctional correlates. We used a comparative design with PD/AG patients receiving either two types of CBT (therapist-guided (n=29) or non-guided exposure (n=22)) or pharmacological treatment (SSRI/SSNRI; n=28) as well as a wait-list control group (WL; n=15) to investigate differential treatment effects in general aspects of fear and depression (Hamilton Anxiety Rating Scale HAM-A and Beck Depression Inventory BDI), disorder-specific symptoms (Mobility Inventory MI, Panic and Agoraphobia Scale subscale panic attacks PAS-panic, Anxiety Sensitivity Index ASI, rating of agoraphobic stimuli) and neurofunctional substrates during symptom provocation (Westphal-Paradigm) using functional magnetic resonance imaging (fMRI). Comparisons of neural activation patterns also included healthy controls (n=29). Both treatments led to a significantly greater reduction in panic attacks, depression and general anxiety than the WL group. The CBT groups, in particular, the therapist-guided arm, had a significantly greater decrease in avoidance, fear of phobic situations and anxiety symptoms and reduction in bilateral amygdala activation while the processing of agoraphobia-related pictures compared to the SSRI/SSNRI and WL groups. This study demonstrates that therapist-guided CBT leads to a more pronounced short-term impact on agoraphobic psychopathology and supports the assumption of the amygdala as a central structure in a complex fear processing system as well as the amygdala's involvement in the fear system's sensitivity to treatment. Copyright © 2016 Elsevier B.V. and ECNP. All rights reserved.

  1. Underachievement, Failing Youth and Moral Panics

    Science.gov (United States)

    Smith, Emma

    2010-01-01

    This paper considers contemporary "moral panics" around the underachievement of boys in school examinations in the UK and America. In the UK, in particular, the underachievement of boys is central to current "crisis accounts" about falling standards and failing pupils. "Underachievement" is a familiar word to those…

  2. Behavioral, neuroendocrine and biochemical effects of different doses of 5-HTP in panic disorder.

    Science.gov (United States)

    van Vliet, I M; Slaap, B R; Westenberg, H G; Den Boer, J A

    1996-05-01

    To investigate the role of serotonin (5-HT) in the pathophysiology of panic disorder (PD) a challenge test with L-5-hydroxytryptophan (5-HTP) was conducted. Seven patients suffering from PD and seven healthy controls received an i.v. challenge with 10 mg, 20 mg and 40 mg 5-HTP and placebo in random order on four different occasions. Before, during and until 2 h after 5-HTP administration anxious and depressive symptomatology was assessed. In addition, plasma levels of 5-HTP, cortisol, and 5-HIAA were measured at several timepoints. During and after infusion of placebo or any of the different dosages of 5-HTP, none of the patients or controls experienced a panic attack or showed an increase in anxiety or depressive symptoms. There was a dose-related increase in side effects, like nausea, dizziness and fatigue. Only infusion with 40 mg 5-HTP led to an increase in plasma cortisol in both patients and controls. The observed increase in plasma cortisol level was higher for patients compared to controls only at 30 min after infusion. In conclusion, stimulation of the serotonergic neuronal system by three different dosages of 5-HTP did not induce panic or anxiety in PD patients and healthy controls. The 5-HT hypersensitivity hypothesis of PD could not be confirmed in the present study.

  3. Ovarian Cancer and Comorbidity

    DEFF Research Database (Denmark)

    Noer, Mette Calundann; Sperling, Cecilie Dyg; Ottesen, Bent

    2017-01-01

    OBJECTIVES: Comorbidity influences survival in ovarian cancer, but the causal relations between prognosis and comorbidity are not well characterized. The aim of this study was to investigate the associations between comorbidity, system delay, the choice of primary treatment, and survival in Danish...... ovarian cancer patients. METHODS: This population-based study was conducted on data from 5317 ovarian cancer patients registered in the Danish Gynecological Cancer Database. Comorbidity was classified according to the Charlson Comorbidity Index and the Ovarian Cancer Comorbidity Index. Pearson χ test...... and multivariate logistic regression analyses were used to investigate the association between comorbidity and primary outcome measures: primary treatment ("primary debulking surgery" vs "no primary surgery") and system delay (more vs less than required by the National Cancer Patient Pathways [NCPPs]). Cox...

  4. Carbon dioxide inhalation as a human experimental model of panic: the relationship between emotions and cardiovascular physiology.

    Science.gov (United States)

    Leibold, Nicole K; Viechtbauer, Wolfgang; Goossens, Liesbet; De Cort, Klara; Griez, Eric J; Myin-Germeys, Inez; Steinbusch, Harry W M; van den Hove, Daniël L A; Schruers, Koen R J

    2013-10-01

    Inhaling carbon dioxide (CO2)-enriched air induces fear and panic symptoms resembling real-life panic attacks, the hallmark of panic disorder. The present study aimed to describe the emotional and cardiovascular effects evoked by inhaling CO2, taking shortcomings of previous studies into account. Healthy volunteers underwent a double inhalation of 0, 9, 17.5, and 35% CO2, according to a randomized, cross-over design. In addition to fear, discomfort, and panic symptom ratings, blood pressure and heart rate were continuously monitored. Results showed a dose-dependent increase in all self-reports. Systolic and diastolic blood pressure rose with increasing CO2 concentration, whereas heart rate results were less consistent. Diastolic blood pressure and heart rate variation correlated with fear and discomfort. Based on this relationship and the observation that the diastolic blood pressure most accurately mimicked the degree of self-reported emotions, it might serve as a putative biomarker to assess the CO2-reactivity in the future.

  5. [Analgesic abuse and psychiatric comorbidity in headache patients].

    Science.gov (United States)

    Radat, F; Irachabal, S; Swendsen, J; Henry, P

    2002-01-01

    Headache patients frequently overuse analgesic medications: 20% of the patients from headache centers is concerned by this problem, which has been estimated to occur in four percent of the community migrainers. Frequent use of various types of headache medication may paradoxically cause an increase in headache attack frequency as well as their chronicisation due to potentially complex mechanisms of sensitization. Patients will enter into a self- perpetuating cycle of daily headaches and use of symptomatic medications which can lead to addiction and to social and occupational impairement. Indeed, many patients will experience pharmacological tolerance and dependence but also by some kind of craving. International Headache Society qualify these patients as abusers referring mostly to the amount of substance ingested. Hence patients are labelled analgesic abusers . However, as many of these analgesic medications contained psychotropic substances (i.e. caffeine, codeine.), these patients may fulfill DSM IV criteria of dependance. Nevertheless, the dependance criteria should be adapted to chronic pain patients. Indeed, if pharmacological dependence and tolerance criteria are easy to apply in such patients, it is not the case for the criteria a great deal of time spent to obtain substances, to use substances or to recover from substances effects . As analgesic medications are legally obtained from medical practitioners, drug seeking behaviours are mostly: obtaining medications from multiple providers, repeating episodes of prescription loss and multiplying requests for early refills. Moreover the detrimental effects of analgesic abuse on psychosocial functioning is likely to be related to pain rather than to medication overuse. Finally the best indicator of addictive behaviors in such patients, is the loss of control over the use of analgesic medication despite the adverse consequences over pain. Comorbidity with addiction to other substances has never been specifically

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

    NARCIS (Netherlands)

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

    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

  7. Moral panic, moral regulation, and the civilizing process.

    Science.gov (United States)

    Hier, Sean

    2016-09-01

    This article compares two analytical frameworks ostensibly formulated to widen the focus of moral panic studies. The comparative analysis suggests that attempts to conceptualize moral panics in terms of decivilizing processes have neither substantively supplemented the explanatory gains made by conceptualizing moral panic as a form of moral regulation nor provided a viable alternative framework that better explains the dynamics of contemporary moral panics. The article concludes that Elias's meta-theory of the civilizing process potentially provides explanatory resources to investigate a possible historical-structural shift towards the so-called age of (a)moral panic; the analytical demands of such a project, however, require a sufficiently different line of inquiry than the one encouraged by both the regulatory and decivilizing perspectives on moral panic. © London School of Economics and Political Science 2016.

  8. Panic Disorder: Is the PAG Involved?

    Directory of Open Access Journals (Sweden)

    Cristina Marta Del-Ben

    2009-01-01

    Full Text Available Data from studies with humans have suggested that abnormalities of midbrain structures, including the periaqueductal gray matter (PAG, could be involved in the neurobiology of panic disorder (PD. The electrical stimulation of the PAG in neurosurgical patients induces panic-like symptoms and the effect of drugs that are effective in the treatment of PD in the simulation of public speaking model of anxiety is in agreement with data from animal models of PD. Structural neuroimaging studies have shown increases in gray matter volume of midbrain and pons of PD patients. There is also evidence of lower serotonin transporter and receptor binding, and increases of metabolism in the midbrain of PD patients. Nevertheless, these midbrain abnormalities can not be considered as specific findings, since neuroimaging data indicate that PD patients have abnormalities in other brain structures that process fear and anxiety.

  9. Panic disorder: is the PAG involved?

    Science.gov (United States)

    Del-Ben, Cristina Marta; Graeff, Frederico Guilherme

    2009-01-01

    Data from studies with humans have suggested that abnormalities of midbrain structures, including the periaqueductal gray matter (PAG), could be involved in the neurobiology of panic disorder (PD). The electrical stimulation of the PAG in neurosurgical patients induces panic-like symptoms and the effect of drugs that are effective in the treatment of PD in the simulation of public speaking model of anxiety is in agreement with data from animal models of PD. Structural neuroimaging studies have shown increases in gray matter volume of midbrain and pons of PD patients. There is also evidence of lower serotonin transporter and receptor binding, and increases of metabolism in the midbrain of PD patients. Nevertheless, these midbrain abnormalities can not be considered as specific findings, since neuroimaging data indicate that PD patients have abnormalities in other brain structures that process fear and anxiety.

  10. Lamotrigine administration in panic disorder with agoraphobia.

    Science.gov (United States)

    Masdrakis, Vasilios G; Papadimitriou, George N; Oulis, Panagiotis

    2010-05-01

    Several anticonvulsants, although as yet not lamotrigine (LTG), have been found useful in the treatment of panic disorder with (PDA) or without agoraphobia. We administered LTG (200 mg/d) to 4 outpatients with PDA, as an augmentation therapy (3 patients with chronic and severe agoraphobia) or monotherapy (1 drug-naive patient with first-onset PDA) in a 14-week trial. The patient under LTG monotherapy improved significantly, whereas PDA symptoms in 2 of the other patients improved to some extent.

  11. Panic disorder: the psychobiology of external treat and introceptive distress.

    Science.gov (United States)

    Stein, Dan J

    2008-01-01

    Panic disorder seems to be mediated by the neuronal circuitry and neurochemical systems that have evolved to respond to external threatening stimuli. Distant threats activate prefrontal cortex (involved in complex planning of avoidance strategies), while immediate threats activate midbrain structures (involved in fast reflexive behaviors). Panic disorder may, however, also involve more specific interoceptive mechanisms. For example, the association between respiratory dysfunction and panic disorder has bolstered a false suffocation alarm hypothesis. Genetic and environmental contributors to panic disorder are beginning to be delineated. Effective pharmacotherapy and psychotherapy are able to normalize the relevant psychobiology.

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

    Directory of Open Access Journals (Sweden)

    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

  13. The attack navigator

    DEFF Research Database (Denmark)

    Probst, Christian W.; Willemson, Jan; Pieters, Wolter

    2016-01-01

    -technical system, the attack navigator identifies routes to an attacker goal. Specific attacker properties such as skill or resources can be included through attacker profiles. This enables defenders to explore attack scenarios and the effectiveness of defense alternatives under different threat conditions....

  14. Falls and comorbidity

    DEFF Research Database (Denmark)

    Jørgensen, Terese Sara Høj; Hansen, Annette Højmann; Sahlberg, Marie

    2014-01-01

    AIMS: To compare nationwide time trends and mortality in hip and proximal humeral fractures; to explore associations between incidences of falls risk related comorbidities (FRICs) and incidence of fractures. METHODS: The study is a retrospective cohort study using nationwide Danish administrative....... CONCLUSIONS: The results suggest that the overall reduction in fractures can be explained by reduction in falls related comorbidity....

  15. Psychiatric comorbidity in adolescent electronic and conventional cigarette use.

    Science.gov (United States)

    Leventhal, Adam M; Strong, David R; Sussman, Steve; Kirkpatrick, Matthew G; Unger, Jennifer B; Barrington-Trimis, Jessica L; Audrain-McGovern, Janet

    2016-02-01

    The popularity of electronic (e-) cigarettes has greatly increased recently, particularly in adolescents. However, the extent of psychiatric comorbidity with adolescent e-cigarette use and dual use of conventional (combustible) and e-cigarettes is unknown. This study characterized psychiatric comorbidity in adolescent conventional and e-cigarette use. Ninth grade students attending high schools in Los Angeles, CA (M age = 14) completed self-report measures of conventional/e-cigarette use, emotional disorders, substance use/problems, and transdiagnostic psychiatric phenotypes consistent with the NIMH-Research Domain Criteria Initiative. Outcomes were compared by lifetime use of: (1) neither conventional nor e-cigarettes (non-use; N = 2557, 77.3%); (2) e-cigarettes only (N = 412, 12.4%); (3) conventional cigarettes only (N = 152, 4.6%); and (4) conventional and e-cigarettes (dual use; N = 189, 5.6%). In comparison to adolescents who used conventional cigarettes only, e-cigarette only users reported lower levels of internalizing syndromes (depression, generalized anxiety, panic, social phobia, and obsessive-compulsive disorder) and transdiagnostic phenotypes (i.e., distress intolerance, anxiety sensitivity, rash action during negative affect). Depression, panic disorder, and anhedonia were higher in e-cigarette only vs. non-users. For several externalizing outcomes (mania, rash action during positive affect, alcohol drug use/abuse) and anhedonia, an ordered pattern was observed, whereby comorbidity was lowest in non-users, moderate in single product users (conventional or e-cigarette), and highest in dual users. These findings: (1) raise question of whether emotionally-healthier ('lower-risk') adolescents who are not interested in conventional cigarettes are being attracted to e-cigarettes; (2) indicate that research, intervention, and policy dedicated to adolescent tobacco-psychiatric comorbidity should distinguish conventional cigarette, e-cigarette, and dual use.

  16. Comorbidities in psoriasis

    Directory of Open Access Journals (Sweden)

    Sanjeev J Aurangabadkar

    2013-01-01

    Full Text Available Moderate to severe psoriasis is associated with concomitant diseases that may have a significant impact on patients. It is necessary for the treating physician to recognize these concomitant diseases, known as comorbidities, early as they influence the management options. Important comorbidities are psoriatic arthritis, metabolic syndrome, Crohn′s disease, depression, and cancer. Patients with severe psoriasis may be at an increased risk for myocardial infarction and this subgroup of patients tends to have a reduced life expectancy. The presence of co-morbid diseases is associated with an increase in concomitant medication, some of which may worsen psoriasis; conversely, systemic treatment of psoriasis with certain drugs may impact the co-morbid conditions. As dermatologists are the primary health-care providers for psoriasis, adequate knowledge of comorbidities helps in choosing the appropriate therapy as well as timely intervention.

  17. The analysis on comorbidity cases with post-traumatic stress disorder aroused by Wenchuan Earthquake%汶川地震所致创伤后应激障碍患者的共病分析

    Institute of Scientific and Technical Information of China (English)

    崔利军; 梁光明; 马弘; 栗克清; 于欣; 严保平; 程章; 刘永桥; 马宁; 杨磊; 党卫民; 韩彦超; 何鸣

    2012-01-01

    Objective: To investigate comorbidity of post-traumatic stress disorder aroused by Wenchuan earthquake and related factors on comorbidity. Method: Parts of heavy victims of An County and Pingwu and Beichuan residents were interviewed by Structured Clinical Interview for DSM-IV Axis I Disorders(SCID-I/P). Results; 138 people were diagnosed as PTSD, 90 of whom (65.2%) had comorbidity with other mental disorder, namely ,42. 8% major depressive disorder, 12. 3% specific phobia, 10. 9% panic attack. People with close relatives dead in the earthquake showed higher comorbid major depressive disorder ( n = 35 ) than those without close relative dead (n =24) (x2 = 4.16,P =0.04). Conclusion;62.5% patients with PTSD show comorbidity with other mental disorder, of which major depressive disorder, specific phobia and panic attack were most. The comorbidity was associated with age,close relatives dead in the earthquake can increase the risk of comorbidity with major depressive disorder.%目的:了解汶川地震部分极重灾区所致创伤后应激障碍(PTSD)患者共病其他精神障碍的情况,以及影响共病的因素. 方法:采用方便取样,对四川省绵阳市所辖的安县、平武县及北川县部分受灾群众进行调查,以DSM-Ⅳ-TR轴Ⅰ障碍定式临床检查(SCID-I/P)为诊断工具. 结果:共138例诊断PTSD,其中90例共病其他精神障碍,共病率65.2%;42.8%患者共病重性抑郁障碍,12.3%共病特殊恐怖症,10.9%共病惊恐发作;40 ~59岁共病率最高为70.4%(x2=5.94,P=0.05),有亲人死亡者共病抑郁症35例,明显高于无亲人死亡者24例,两者差异有统计学意义(x2=4.16;P=0.04). 结论:65.2% PTSD患者共病其他精神障碍,以共病重性抑郁障碍、特殊恐怖症、惊恐发作最多见,共病率与年龄相关,地震中有亲人死亡将增加PTSD共病抑郁症风险.

  18. A risk-benefit assessment of pharmacological treatments for panic disorder.

    Science.gov (United States)

    Bennett, J A; Moioffer, M; Stanton, S P; Dwight, M; Keck, P E

    1998-06-01

    Panic disorder, a psychiatric disorder characterised by frequent panic attacks, is the most common anxiety disorder, affecting 2 to 6% of the general population. No one line of treatment has been found to be superior, making a risk-benefit assessment of the treatments available useful for treating patients. Choice of treatment depends on a number of issues, including the adverse effect profile, efficacy and the presence of concomitant syndromes. Tricyclic antidepressants (TCAs) are beneficial in the treatment of panic disorder. They have a proven efficacy, are affordable and are conveniently administered. Adverse effects, including jitteriness syndrome, bodyweight gain, anticholinergic effects and orthostatic hypotension are commonly associated with TCAs, but can be managed successfully. Selective serotonin (5-hydroxytryptamine; 5HT) reuptake inhibitors are also potential first line agents and are well tolerated and effective, with a favourable adverse effects profile. There is little risk in overdose or of anticholinergic effects. Adverse effects include sedation, dyspepsia and headache early in treatment, and sexual dysfunction and increased anxiety, but these can be effectively managed with proper dosage escalation and management. Benzodiazepines are an effective treatment, providing short-term relief of panic-related symptoms. Patients respond to treatment quickly, providing rapid relief of symptoms. Adverse effects include ataxia and drowsiness, and cognitive and psycho-motor impairment. There are reservations over their first-line use because of concerns regarding abuse and dependence. Monoamine oxidase inhibitors, because of their adverse effects profile, potential drug interactions, dietary restrictions, gradual onset of effect and overdose risk, are not considered to be first-line agents. They are effective however, and should be considered for patients with refractory disease. Valproic acid (valproate sodium), while not intensively studied, shows

  19. Frozen style and strong emotions of panic and separation

    DEFF Research Database (Denmark)

    Grodal, Torben Kragh

    2012-01-01

    The article analyses the aesthetics of two Trier prologues using cognitive psychology. It focuses on how the films evoke anxiety and panic, and how the panic is contained by means of providing visual and musical aesthetic order to the dynamic emotional forces; by providing ambiguous reality indic...

  20. The Reliability and Validity of the Panic Disorder Self-Report: A New Diagnostic Screening Measure of Panic Disorder

    Science.gov (United States)

    Newman, Michelle G.; Holmes, Marilyn; Zuellig, Andrea R.; Kachin, Kevin E.; Behar, Evelyn

    2006-01-01

    This study examined the Panic Disorder Self-Report (PDSR), a new self-report diagnostic measure of panic disorder based on the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994). PDSR diagnoses were compared with structured interview diagnoses of individuals with generalized anxiety…

  1. Serum biomarkers predictive of depressive episodes in panic disorder.

    Science.gov (United States)

    Gottschalk, M G; Cooper, J D; Chan, M K; Bot, M; Penninx, B W J H; Bahn, S

    2016-02-01

    Panic disorder with or without comorbid agoraphobia (PD/PDA) has been linked to an increased risk to develop subsequent depressive episodes, yet the underlying pathophysiology of these disorders remains poorly understood. We aimed to identify a biomarker panel predictive for the development of a depressive disorder (major depressive disorder and/or dysthymia) within a 2-year-follow-up period. Blood serum concentrations of 165 analytes were evaluated in 120 PD/PDA patients without depressive disorder baseline diagnosis (6-month-recency) in the Netherlands Study of Depression and Anxiety (NESDA). We assessed the predictive performance of serum biomarkers, clinical, and self-report variables using receiver operating characteristics curves (ROC) and the area under the ROC curve (AUC). False-discovery-rate corrected logistic regression model selection of serum analytes and covariates identified an optimal predictive panel comprised of tetranectin and creatine kinase MB along with patient gender and scores from the Inventory of Depressive Symptomatology (IDS) rating scale. Combined, an AUC of 0.87 was reached for identifying the PD/PDA patients who developed a depressive disorder within 2 years (n = 44). The addition of biomarkers represented a significant (p = 0.010) improvement over using gender and IDS alone as predictors (AUC = 0.78). For the first time, we report on a combination of biological serum markers, clinical variables and self-report inventories that can detect PD/PDA patients at increased risk of developing subsequent depressive disorders with good predictive performance in a naturalistic cohort design. After an independent validation our proposed biomarkers could prove useful in the detection of at-risk PD/PDA patients, allowing for early therapeutic interventions and improving clinical outcome.

  2. Comorbidities of epilepsy

    National Research Council Canada - National Science Library

    H Srinivas; Urvashi Shah

    2017-01-01

    .... This article besides addressing these issues also explores the therapeutic management. A systematic search of PubMed from Jan 2006 to August 2016 was undertaken using the terms "comorbidities" and "epilepsy...

  3. Comorbidities of COPD

    Directory of Open Access Journals (Sweden)

    Arnaud Cavaillès

    2013-12-01

    Full Text Available By 2020, chronic obstructive pulmonary disease (COPD will be the third cause of mortality. Extrapulmonary comorbidities influence the prognosis of patients with COPD. Tobacco smoking is a common risk factor for many comorbidities, including coronary heart disease, heart failure and lung cancer. Comorbidities such as pulmonary artery disease and malnutrition are directly caused by COPD, whereas others, such as systemic venous thromboembolism, anxiety, depression, osteoporosis, obesity, metabolic syndrome, diabetes, sleep disturbance and anaemia, have no evident physiopathological relationship with COPD. The common ground between most of these extrapulmonary manifestations is chronic systemic inflammation. All of these diseases potentiate the morbidity of COPD, leading to increased hospitalisations and healthcare costs. They can frequently cause death, independently of respiratory failure. Comorbidities make the management of COPD difficult and need to be evaluated and treated adequately.

  4. Diabetes + Hypertension (comorbidity)

    Data.gov (United States)

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — This data set provides de-identified population data for diabetes and hypertension comorbidity prevalence in Allegheny County.

  5. Diagnosis and management of generalized anxiety disorder and panic disorder in adults.

    Science.gov (United States)

    Locke, Amy B; Kirst, Nell; Shultz, Cameron G

    2015-05-01

    Generalized anxiety disorder (GAD) and panic disorder (PD) are among the most common mental disorders in the United States, and they can negatively impact a patient's quality of life and disrupt important activities of daily living. Evidence suggests that the rates of missed diagnoses and misdiagnosis of GAD and PD are high, with symptoms often ascribed to physical causes. Diagnosing GAD and PD requires a broad differential and caution to identify confounding variables and comorbid conditions. Screening and monitoring tools can be used to help make the diagnosis and monitor response to therapy. The GAD-7 and the Severity Measure for Panic Disorder are free diagnostic tools. Successful outcomes may require a combination of treatment modalities tailored to the individual patient. Treatment often includes medications such as selective serotonin reuptake inhibitors and/or psychotherapy, both of which are highly effective. Among psychotherapeutic treatments, cognitive behavior therapy has been studied widely and has an extensive evidence base. Benzodiazepines are effective in reducing anxiety symptoms, but their use is limited by risk of abuse and adverse effect profiles. Physical activity can reduce symptoms of GAD and PD. A number of complementary and alternative treatments are often used; however, evidence is limited for most. Several common botanicals and supplements can potentiate serotonin syndrome when used in combination with antidepressants. Medication should be continued for 12 months before tapering to prevent relapse.

  6. Pituitary volume in patients with panic disorder.

    Science.gov (United States)

    Kartalci, Sukru; Dogan, Metin; Unal, Suheyla; Ozcan, A Cemal; Ozdemir, Serdal; Atmaca, Murad

    2011-01-15

    Panic patients have many functional deficiencies in the hypothalamic-pituitary-adrenal (HPA) axis. Previous studies have shown changed pituitary gland volume in some psychiatric disorders that have functional deficiencies in the HPA axis. However, to date no study has evaluated the pituitary gland volume in patients with panic disorder (PD). We investigated the pituitary gland volume in patients with PD (n=27) and age- and sex-matched healthy controls (n=27), using 1.5-T magnetic resonance imaging in this study. Analysis showed that patients with PD had significantly smaller pituitary volume compared to healthy subjects. Patients with agoraphobia especially had a significantly smaller pituitary volume than patients without agoraphobia. There was a significant relationship between the pituitary volume and both the severity of symptoms and the illness duration in the patient group. The results show that patients with PD have reduced pituitary volume, which may reflect the functional abnormalities seen in this disorder. These findings may help us better understand the pathology of PD. Copyright © 2010 Elsevier Inc. All rights reserved.

  7. Quality of Life Impairment in Generalized Anxiety Disorder, Social Phobia, and Panic Disorder

    Science.gov (United States)

    Barrera, Terri L.; Norton, Peter J.

    2009-01-01

    Interest in the assessment of quality of life in the anxiety disorders is growing. The present study examined quality of life impairments in individuals with Generalized Anxiety Disorder (GAD), Social Phobia, and Panic Disorder. Results showed that individuals with these disorders reported less satisfaction with their quality of life than non-anxious adults in the community. However, the degree of quality of life impairment is similar across these three disorders. Additionally, comorbid depression, but not anxiety, was found to negatively impact quality of life in these individuals. Finally, diagnostic symptom severity was not found to influence quality of life, indicating that subjective measures of quality of life offer unique information on the effects of anxiety disorders. PMID:19640675

  8. Visuospatial and mathematical dysfunction in major depressive disorder and/or panic disorder: A study of parietal functioning.

    Science.gov (United States)

    Nelson, Brady D; Shankman, Stewart A

    2016-01-01

    The parietal cortex is critical for several different cognitive functions, including visuospatial processing and mathematical abilities. There is strong evidence indicating parietal dysfunction in depression. However, it is less clear whether anxiety is associated with parietal dysfunction and whether comorbid depression and anxiety are associated with greater impairment. The present study compared participants with major depression (MDD), panic disorder (PD), comorbid MDD/PD and controls on neuropsychological measures of visuospatial processing, Judgement of Line Orientation (JLO), and mathematical abilities, Wide Range Achievement Test (WRAT) Arithmetic. Only comorbid MDD/PD was associated with decreased performance on JLO, whereas all psychopathological groups exhibited comparably decreased performance on WRAT Arithmetic. Furthermore, the results were not accounted for by other comorbid disorders, medication use or psychopathology severity. The present study suggests comorbid depression and anxious arousal are associated with impairment in visuospatial processing and provides novel evidence indicating mathematical deficits across depression and/or anxiety. Implications for understanding parietal dysfunction in internalising psychopathology are discussed.

  9. Comorbidity of migraine and somatic diseases

    Directory of Open Access Journals (Sweden)

    Martinović Žarko

    2005-01-01

    Full Text Available Introduction A 5-year prospective follow-up study was performed at the Institute of Mental Health in Belgrade, and it included adult patients diagnosed with migraine. Material and methods A protocol for prospective fallow-up of comorbiditiy of migraine and somatic diseases was designed, whereas data were analyzed using standard statistical methods. Results The study comprised 381 patients, mean age 35.8 (range 19-60 years, 60 (15.8% males and 321 (84,2% females. The mean duration of migraine history before the first visit to the doctor was 7.7 (0-36 years. There was no concomitant disease in 50.5% of examinees. The most common concomitant diseases in the study population were: spondylosis (15.9%, head injury (12.9%, gynecological disorders (11.6% of female subgroup, hypotension (8.8%, hypertension (8.5%, allergy and asthma (5.8%, various cardiovascular diseases (4% and epilepsy (3%. The incidence of the majority of diseases is in accordance with known epidemiological data for general population (except for head injury and epilepsy. In the subgroup of patients with comorbidity, almost 70% of patients reported more than one migraine attack per month, compared to 35% of patients without concomitant diseases, and about 60% of them had a higher intensity of headache in comparison with 35% of those without comorbidity. Conclusion Present results indicate an increased severity of migraine attacks in patients with comorbidity. Therefore, it is necessary to assess how good management of comorbid diseases can alleviate the course and intensity of migraine headaches.

  10. Quality of life and cost factors in panic disorder.

    Science.gov (United States)

    Davidson, J R

    1996-01-01

    Quality of life encompasses domains of personal happiness, role fulfillment, and health status. Increasing attention has been paid to the relationship between quality of life and panic disorder, with accumulating evidence now available to suggest impairment in several domains among subjects with panic disorder. This review summarizes the results of community-based and treatment-seeking populations of subjects with panic disorder. Impaired personal happiness, restricted role functioning, and increased use of health services are all described. Evidence suggests that accurate diagnosis and effective treatment can significantly lessen health service utilization, resulting in substantial cost offset and also leading to increased work productivity and personal effectiveness.

  11. Recognition of facial expressions of emotion in panic disorder.

    Science.gov (United States)

    Cai, Liqiang; Chen, Wanzhen; Shen, Yuedi; Wang, Xinling; Wei, Lili; Zhang, Yingchun; Wang, Wei; Chen, Wei

    2012-01-01

    Whether patients with panic disorder behave differently or not when recognizing the facial expressions of emotion remains unsettled. We tested 21 outpatients with panic disorder and 34 healthy subjects, with a photo set from the Matsumoto and Ekman Japanese and Caucasian facial expressions of emotion, which includes anger, contempt, disgust, fear, happiness, sadness, and surprise. Compared to the healthy subjects, patients showed lower accuracies when recognizing disgust and fear, but a higher accuracy when recognizing surprise. These results suggest that the altered specificity to these emotions leads tso self-awareness mechanisms to prevent further emotional reactions in panic disorder patients. Copyright © 2012 S. Karger AG, Basel.

  12. [Heart failure and comorbidities].

    Science.gov (United States)

    Boully, Clémence; Hanon, Olivier

    2015-03-01

    Heart failure is a frequent disease in the elderly. Its clinical presentation is less typical and the prognosis more severe than in younger subjects because heart failure occurs in patients with multiple comorbidities. A comprehensive geriatric assessment should therefore be performed to detect the vulnerabilities and manage the comorbidities. The main diseases associated with heart failure are dementia, depression, malnutrition, atrial fibrillation, coronary artery disease, orthostatic hypotension, renal failure, anemia and iron deficiency. Comorbidities worsen heart failure and makes its treatment more difficult. The identification and treatment of comorbidities improve the prognosis in terms of mortality but especially in terms of quality of life. Caution with drugs is necessary because of pharmacokinetic or pharmacodynamic changes related to aging and the comorbidities. In this context, clinical and laboratory monitoring should be increased, mostly during an acute event (acute heart failure, infection, dehydration, fall, new therapy…). Therefore, the follow-up of elderly patients with heart failure requires a multidisciplinary approach that involves close cooperation between cardiologists, geriatricians, general practitioners, nurses, and pharmacists.

  13. Generating IDS Attack Pattern Automatically Based on Attack Tree

    Institute of Scientific and Technical Information of China (English)

    向尕; 曹元大

    2003-01-01

    Generating attack pattern automatically based on attack tree is studied. The extending definition of attack tree is proposed. And the algorithm of generating attack tree is presented. The method of generating attack pattern automatically based on attack tree is shown, which is tested by concrete attack instances. The results show that the algorithm is effective and efficient. In doing so, the efficiency of generating attack pattern is improved and the attack trees can be reused.

  14. Terapia cognitivo-comportamental no transtorno de pânico Cognitive-behavioral therapy in panic disorder

    Directory of Open Access Journals (Sweden)

    Gisele Gus Manfro

    2008-10-01

    Full Text Available OBJETIVO: O transtorno de pânico é uma condição crônica e recorrente que prejudica a qualidade de vida e o funcionamento psicossocial dos portadores. Embora os medicamentos sejam efetivos na redução dos ataques de pânico, muitos pacientes não respondem adequadamente a essas intervenções. A terapia cognitivo-comportamental fornece um método alternativo eficaz para tratar transtorno de pânico e evitação agorafóbica. O objetivo do estudo é o de descrever o uso de técnicas cognitivo-comportamentais no tratamento do transtorno de pânico. MÉTODO: Revisão narrativa a partir dos bancos de dados do Medline, SciELO e PsycInfo e de livros-texto especializados. RESULTADOS: Foram descritos os fundamentos da terapia cognitivo-comportamental no tratamento do transtorno pânico e revisadas as evidências de eficácia em curto e longo prazos. O uso de medicação concomitante a terapia cognitivo-comportamental foi também discutido. CONCLUSÕES: A terapia cognitivo-comportamental individual ou em grupo é eficaz para pacientes com transtorno de pânico, seja como tratamento de primeira linha ou como um próximo passo para pacientes com resposta parcial a outros tratamentos.OBJECTIVE: Panic disorder is a chronic and recurrent condition that impairs an individual's psychosocial functioning and quality of life. Despite the efficacy of psychopharmacological treatment in reducing panic attacks, many patients fail to respond adequately to these interventions. Cognitive behavioral therapy provides an alternative and efficacious method for treating panic disorder and agoraphobic avoidance. The objective of the study is to describe the use of cognitive behavioral therapy for panic disorder. METHOD: Narrative review of data collected from Medline, SciELO and PsycInfo and specialized textbooks. RESULTS: We describe the cognitive-behavioral model for the treatment of panic disorder, and review both short and long-term efficacy findings. We also discuss

  15. Comorbidity of periodontal disease

    DEFF Research Database (Denmark)

    Holmstrup, Palle; Damgaard, Christian; Olsen, Ingar

    2017-01-01

    Increasing evidence has suggested an independent association between periodontitis and a range of comorbidities, for example cardiovascular disease, type 2 diabetes, rheumatoid arthritis, osteoporosis, Parkinson's disease, Alzheimer's disease, psoriasis, and respiratory infections. Shared...... inflammatory pathways are likely to contribute to this association, but distinct causal mechanisms remain to be defined. Some of these comorbid conditions may improve by periodontal treatment, and a bidirectional relationship may exist, where, for example, treatment of diabetes can improve periodontal status....... The present article presents an overview of the evidence linking periodontitis with selected systemic diseases and calls for increased cooperation between dentists and medical doctors to provide optimal screening, treatment, and prevention of both periodontitis and its comorbidities....

  16. Framing crime: moral panic in Argentine newspapers

    Directory of Open Access Journals (Sweden)

    Natalia ARUGUETE

    2013-01-01

    Full Text Available Carolina Píparo was shot a few minutes after withdrawing cash from a bank branch. This case outraged the public opinion because she was eight months pregnant at the moment of the assault. She had to undergo a caesarean section and her baby only survived one week. Through an exploratory and inductive research we will analyze how the Argentine newspapers presented the case. We aim at elaborating a content analysis code book that can be validated in future similar researches on the subject. We apply the Framing theory in order to detect the frames used in the news coverage and to observe if they are compatible with the idea of «moral panic» proposed by Stanley Cohen.

  17. 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 Agoraphobia predisposes individuals to dependency and insecurity about their ability to overcome anxiogenic situations. These data demonstrate the importance of managing assertiveness in patients with PD accompanied by agoraphobia.

  18. Heart attack first aid

    Science.gov (United States)

    First aid - heart attack; First aid - cardiopulmonary arrest; First aid - cardiac arrest ... A heart attack occurs when the blood flow that carries oxygen to the heart is blocked. The heart muscle ...

  19. Transient Ischemic Attack

    Medline Plus

    Full Text Available Transient Ischemic Attack TIA , or transient ischemic attack, is a "mini stroke" that occurs when a blood ... The only difference between a stroke and TIA is that with TIA the blockage is transient (temporary). ...

  20. Social engineering attack framework

    CSIR Research Space (South Africa)

    Mouton, F

    2014-07-01

    Full Text Available link. A social engineering attack targets this weakness by; using various manipulation techniques in order to elicit sensitive; information. The field of social engineering is still in its infancy; stages with regards to formal definitions and attack...

  1. Transient Ischemic Attack

    Medline Plus

    Full Text Available ... Ischemic Attack TIA , or transient ischemic attack, is a "mini stroke" that occurs when a blood clot blocks an artery for a short time. The only difference between a stroke ...

  2. Comorbidities of hidradenitis suppurativa.

    Science.gov (United States)

    Porter, Martina L; Kimball, Alexa B

    2017-06-01

    Hidradenitis suppurativa (HS) is an inflammatory skin disorder with many associated comorbidities, including obesity, metabolic syndrome, smoking, depression, arthritis, autoinflammatory syndromes, inflammatory bowel disease, and genetic syndromes. In addition, HS patients can suffer from a variety of diseases related to the chronic inflammatory nature of their HS such as cardiovascular disease and anemia. An understanding of these comorbidities and associations is essential for the management of HS, and routine screening for these entities should be considered in all HS patients. ©2017 Frontline Medical Communications.

  3. Moral panic in Icelandic society: Arrival of ecstasy to Iceland

    Directory of Open Access Journals (Sweden)

    Jón Orri Jónasson

    2014-12-01

    Full Text Available The use of illegal drugs has often been shown to ignite fear and insecurity in society. When a new drug appears the media typically reports on this drug and the risk it poses. Soon after ecstasy appeared in Iceland in the 1990s its use created a major public uproar and insecurity in Icelandic society. In the article the theory of moral panic will be used to examine if the arrival of ecstasy to Iceland ignited a moral panic. Media reports on ecstasy, public reactions, interest groups and government institutions will be analysed. Discourse analysis is employed on newspaper reporting on ecstasy between 1985 and 1997 to detect signs of moral panic. The main conclusion is that evidence suggests that a moral panic existed in Iceland as described in well-known theories on the subject.

  4. Don't Panic! | NIH MedlinePlus the Magazine

    Science.gov (United States)

    ... of this page please turn Javascript on. Feature: Phobias and Anxiety Disorders Don't Panic! Past Issues / Fall 2010 Table of Contents Phobias and other anxiety disorders affect millions of Americans. ...

  5. The dual role of serotonin in defense and the mode of action of antidepressants on generalized anxiety and panic disorders.

    Science.gov (United States)

    Graeff, Frederico G; Zangrossi, Hélio

    2010-09-01

    Antidepressants are widely used to treat several anxiety disorders, among which generalized anxiety disorder (GAD) and panic disorder (PD). Serotonin (5-HT) is believed to play a key role in the mode of action of these agents, a major question being which pathways and receptor subtypes are involved in each type of anxiety disorder. The dual role of 5-HT in defense hypothesis assumes that 5-HT facilitates defensive responses to potential threat, like inhibitory avoidance, related to anxiety, whereas it inhibits defensive responses to proximal danger, like one-way escape, related to panic. The former action would be exerted at the forebrain, chiefly the amygdala and medial prefrontal cortex (PFC), while the latter would be exerted at the dorsal periaqueductal gray (DPAG) matter of the midbrain. The present review is focused on studies designed to test this hypothesis, performed in animal models of anxiety and panic, as well as in human experimental anxiety tests. The reviewed results suggest that chronic, but not acute, administration of antidepressants suppress panic attacks by increasing the release of 5-HT and enhancing the responsivity of post-synaptic 5-HT1A and 5-HT2A receptors in the DPAG. The attenuation of generalized anxiety, also caused by the same drug treatment, would be due to the desensitization of 5-HT2C receptors and, less certainly, to increased stimulation of 5-HT1A receptors in forebrain structures. This action would result in less activation of the amygdala, medial PFC and insula by warning signals, as shown by the reviewed results obtained with functional neuroimaging in healthy volunteers and patients with anxiety disorders.

  6. Watermark copy attack

    OpenAIRE

    Kutter, Martin; Voloshynovskyy, Svyatoslav; Herrigel, Alexander

    2000-01-01

    Research in digital watermarking has progressed along two paths. While new watermarking technologies are being developed, some researchers are also investigating di erent ways of attacking digital watermarks. Common attacks to watermarks usually aim to destroy theembedded watermark or to impair its detection. In this paper we propose a conceptually new attack for digitally watermarked images. The proposed attack doesnot destroy anembedded watermark, but copies it from one image to a di erent ...

  7. The Watermark Template Attack

    OpenAIRE

    Herrigel, Alexander; Voloshynovskyy, Svyatoslav; Rytsar, Yuriy

    2001-01-01

    This paper presents a new attack, called the watermark template attach, for watermarked images. In contrast to the Stirmark benchmark, this attack does not severely reduce the quality of the image. This attack maintains, therefore, the commercial value of the watermarked image. In contrast to previous approaches, it is not the aim of the attack to change the statistics of embedded watermarks fooling the detection process but to utilize specific concepts that have been recently developed for m...

  8. A meta-analysis of the influence of comorbidity on treatment outcome in the anxiety disorders.

    Science.gov (United States)

    Olatunji, Bunmi O; Cisler, Josh M; Tolin, David F

    2010-08-01

    Although psychiatric comorbidity is common among patients with anxiety disorders, its impact on treatment outcome remains unclear. The present study used meta-analytic techniques to examine the relationship between diagnostic comorbidity and treatment outcome for patients with anxiety disorders. One hundred forty-eight anxiety-disordered treatment samples (combined N=3534) were examined for post-treatment effects from the PsychINFO database. Samples consisted of those exposed to both active (CBT, dynamic therapy, drug treatment, CBT+drug treatment, mindfulness) and inactive treatments (placebo/attention control, wait-list). All treatments were associated with significant improvement at post-treatment, and active treatments were associated with greater effects than were inactive treatments. However, overall comorbidity was generally unrelated to effect size at post-treatment or at follow-up. A significant negative relationship between overall comorbidity and treatment outcome was found for mixed or "neurotic" anxiety samples when examining associations between comorbidity and specific diagnoses. Conversely, there was a significant positive relationship between overall comorbidity and treatment outcome for panic disorder and/or agoraphobia and PTSD or sexual abuse survivors. These findings suggest that while diagnostic comorbidity may not impact the effects of specific anxiety disorder treatments, it appears to differentially impact outcome for specific anxiety disorder diagnoses.

  9. The brain acid-base homeostasis and serotonin: A perspective on the use of carbon dioxide as human and rodent experimental model of panic.

    Science.gov (United States)

    Leibold, N K; van den Hove, D L A; Esquivel, G; De Cort, K; Goossens, L; Strackx, E; Buchanan, G F; Steinbusch, H W M; Lesch, K P; Schruers, K R J

    2015-06-01

    Panic attacks (PAs), the core feature of panic disorder, represent a common phenomenon in the general adult population and are associated with a considerable decrease in quality of life and high health care costs. To date, the underlying pathophysiology of PAs is not well understood. A unique feature of PAs is that they represent a rare example of a psychopathological phenomenon that can be reliably modeled in the laboratory in panic disorder patients and healthy volunteers. The most effective techniques to experimentally trigger PAs are those that acutely disturb the acid-base homeostasis in the brain: inhalation of carbon dioxide (CO2), hyperventilation, and lactate infusion. This review particularly focuses on the use of CO2 inhalation in humans and rodents as an experimental model of panic. Besides highlighting the different methodological approaches, the cardio-respiratory and the endocrine responses to CO2 inhalation are summarized. In addition, the relationships between CO2 level, changes in brain pH, the serotonergic system, and adaptive physiological and behavioral responses to CO2 exposure are presented. We aim to present an integrated psychological and neurobiological perspective. Remaining gaps in the literature and future perspectives are discussed.

  10. “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

  11. "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. 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). 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. An MP-use questionnaire was administered to a consecutive sample of 50 patients and 70 controls. 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. 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.

  12. Dynamic Modeling of the Economic Impacts of a Terrorist Attack using a Radiological Dispersion Device

    Science.gov (United States)

    2009-03-01

    combined, the model uses historical examples of responses from the September 11 attacks, the Three Mile Island and Goiania , Brazil incidents, natural...radiological incidents is gathered from the Goiania , Brazil, Chernobyl, and Three Mile Island incidents. “The tragic radiological accident that occurred...treated for radiation burns, and 249 others were exposed to the cesium 137 radiation. Mass panic ensued across Goiania as the result of the incident

  13. Quality of Smartphone Apps Related to Panic Disorder

    OpenAIRE

    Van Singer, Mathias; Chatton, Anne; Khazaal, Yasser

    2015-01-01

    Quality of smartphone apps related to panic: smartphone apps have a growing role in health care. This study assessed the quality of English-language apps for panic disorder (PD) and compared paid and free apps. Keywords related to PD were entered into the Google Play Store search engine. Apps were assessed using the following quality indicators: accountability, interactivity, self-help score (the potential of smartphone apps to help users in daily life), and evidence-based content quality. Th...

  14. Impulsivity in patients with panic disorder-agoraphobia: the role of cyclothymia.

    Science.gov (United States)

    Del Carlo, Alessandra; Benvenuti, Marzia; Toni, Cristina; Dell'osso, Liliana; Perugi, Giulio

    2013-10-01

    The relationship between Panic Disorder (PD) and impulsivity is not well explored. The present investigation aims to compare impulsivity, measured by different rating tools, in PD patients vs. healthy controls and to explore the influence of co-morbid Cyclothymic Disorder (CD) on the relationship between PD and impulsivity. Sixty-four subjects with PD and 44 matched controls underwent a diagnostic and symptomatological evaluations by the Mini Neuropsychiatric Interview (M.I.N.I) Plus 5.0; the Bech-Rafaelsen Depression and Mania Scale (BRDMS), the State-Trait Anxiety Inventory (STAI), the Hypomania Check List (HCL-32) and the Clinical Global Impression (CGI); the Questionnaire for the Affective and Anxious Temperament Evaluation of Memphis, Pisa, Paris and San Diego-Modified (TEMPS-M), the Separation Anxiety Sensitivity Index (SASI), the Interpersonal Sensitivity Symptoms Inventory (ISSI). Finally, psychometric and neurocognitive evaluations of impulsivity was carried out using the Barratt Impulsiveness Scale (BIS-11) and the Immediate and Delayed Memory Task (IMT/DMT). Subjects with PD were more impulsive than the controls in all the explored measures, reporting higher scores in symptomatological and temperamental scales. The comparison between PD patients with (Cyclo+) and without (Cyclo-) comorbid CD and controls showed that Cyclo+ are the most impulsive subjects in all the investigated measures and are characterized by the greatest symptomatological impairment, the highest scores in temperamental scales, and the highest levels of interpersonal sensitivity and separation anxiety. In our patients with PD, without lifetime comorbidity with major mood episodes, trait and state impulsivity may be related to the presence of comorbid cyclothymic mood instability.

  15. Metabolic decoupling in daily life in patients with panic disorder and agoraphobia.

    Science.gov (United States)

    Pfaltz, Monique C; Kolodyazhniy, Vitaliy; Blechert, Jens; Margraf, Jürgen; Grossman, Paul; Wilhelm, Frank H

    2015-09-01

    Various studies have assessed autonomic and respiratory underpinnings of panic attacks, yet the psychophysiological functioning of panic disorder (PD) patients has rarely been examined under naturalistic conditions at times when acute attacks were not reported. We hypothesized that emotional activation in daily life causes physiologically demonstrable deviations from efficient metabolic regulation in PD patients. Metabolic coupling was estimated as within-individual correlations between heart rate (HR) and indices of metabolic activity, i.e., physical activity (measured by 3-axial accelerometry, Acc), and minute ventilation (Vm, measured by calibrated inductive plethysmography, as proxy for oxygen consumption). A total of 565 daytime hours were recorded in 19 PD patients and 20 healthy controls (HC). Pairwise cross-correlations of minute-by-minute averages of these metabolic indices were calculated for each participant and then correlated with several indices of self-reported anxiety. Ambulatory HR was elevated in PD (p = .05, d = 0.67). Patients showed reduced HR-Acc (p < .006, d = 0.97) and HR-Vm coupling (p < .009, d = 0.91). Combining Vm and Acc to predict HR showed the strongest group separation (p < .002, d = 1.07). Discriminant analyses, based on the combination of Vm and Acc to predict HR, classified 77% of all participants correctly. In PD, HR-Acc coupling was inversely related to trait anxiety sensitivity, as well as tonic and phasic daytime anxiety. The novel method that was used demonstrates that anxiety in PD may reduce efficient long-term metabolic coupling. Metabolic decoupling may serve as physiological characteristic of PD and might aid diagnostics for PD and other anxiety disorders. This measure deserves further study in research on health consequences of anxiety and psychosocial stress.

  16. Agoraphobia, panic disorder and generalized anxiety disorder: some implications of recent advances.

    Science.gov (United States)

    Roth, M

    1984-01-01

    The nature of the relationship between 'panic disorder', agoraphobia and general anxiety disorder remains open. The aetiological theories which have tried to link them with the aid of biological and psychological concepts fail to take account of conflicting observations. 'Panic' attacks are not confined to agoraphobic and related disorders, being indistinguishable from the attacks of acute anxiety and phobic aversion manifest in a wide range of anxiety and affective disorders. There is continuity and discontinuity in the evolution of agoraphobia; those affected differ in respect of a range of premorbid features from patients with other disorders and control subjects. These variables include family history, life development, trait anxiety and other personality characteristics including introversion, neuroticism and probably emotional dependence on others. Not all the claims made on behalf of the efficacy of pharmacological treatment on the one hand and behavioural therapies on the other are substantiated. The success achieved by behavioural treatment appear to endure over some years. But the residual disabilities and defects that follow all forms of treatment and the problems posed by patient selection and high drop-out rates have received insufficient attention. Aetiological theories of agoraphobia and related conditions have been advanced along biomedical, psychological and psychodynamic lines. Some evidence supports each kind of theory. But none is wholly consistent with the findings regarding its phenomenology and evolution. Recent biological investigations have led to the formulation of hypotheses in relation to anticipatory and chronic anxiety in terms of changes in synaptic connections, enhancement of transmitter release as well as alterations in molecular configuration and regulation of gene expression. It would be premature to conclude that these findings can provide a unitary conceptual framework for the explanation of human anxiety disorders. The

  17. Panic! Affect Contagion, Mimesis and Suggestion in the Social Field

    Directory of Open Access Journals (Sweden)

    Anna Gibbs

    2011-04-01

    Full Text Available This essay describes the phenomenon of panic from both neurological and affective points of view. It draws on the work of Japp Panksepp, who argues for the importance of distinguishing between fear as a response to physical threat, and panic as a response to the loss of the attachment object. While fear flees, panic, perhaps contrary to appearances, seeks security. This view of panic throws a new light on classic analyses of crowd behaviour, among them those of Le Bon, Tarde and Canetti, but it also has implications for how panic takes hold via electronic media, and for how outbreaks may be calmed. Finally, the essay argues that mediatised panic is a distraction from fear—in which anything at all may represent physical danger, but which at least offers a range of possible responses for addressing the problem, and offers the opportunity for the transformative work performed by cognition on affect. Here the paper draws on the script theory of Silvan Tomkins to provoke questions of the social usefulness of fear in the face of some current arguments to the contrary.

  18. The efficacy of milnacipran in panic disorder: an open trial.

    Science.gov (United States)

    Blaya, Carolina; Seganfredo, Ana Carolina; Dornelles, Marina; Torres, Mariana; Paludo, Angela; Heldt, Elizeth; Manfro, Gisele G

    2007-05-01

    The aim of this study is to evaluate the efficacy of milnacipran in the acute treatment of patients with panic disorder. Thirty-one patients who met Diagnostic and statistical manual of mental disorders-IV criteria for panic disorder with or without agoraphobia were included in the study. Patients were initially treated with milnacipran 25 mg twice daily and then 50 mg twice daily until the 10th week. The treatment outcome and panic disorder severity were determined by the Panic Disorder Severity Scale, Panic Inventory, Clinical Global Impression and Hamilton Anxiety Scale, all of which were applied during every evaluation interview. Quality of life (WHOQOL-bref) was evaluated at baseline and at the end of the study. Missing data were handled by using the last observation carried forward for all participants who had taken at least one dose of study medication. Intention-to-treat was used in the analyses. Pharmacological treatment resulted in a clinically and statistically significant mean reduction in all severity measures. Remission (Clinical Global Impression < or = 2) was obtained in 58.1% of the sample. Regarding WHOQOL, we found a significant improvement (P<0.05) across treatment in all the domains studied. Although results may be influenced by the open design of this pilot study and by the small sample size, our findings suggest that milnacipran may be effective for the treatment of panic disorder and justify further research.

  19. Recovery From Comorbidity

    Directory of Open Access Journals (Sweden)

    Mathew Carter

    2013-11-01

    Full Text Available Comorbidity among mood, anxiety, and alcohol disorders is common and burdensome, affecting individuals, families, and public health. A systematic and integrative review of the literature across disciplines and research methodologies was performed. Supradisciplinary approaches were applied to the review and the ensuing critical appraisal. Definitions, measurement, and estimation are controversial and inconstant. Recovery from comorbidity cannot be easily extricated from a sociocultural milieu. Methodological challenges in quantitative and qualitative research and across disciplines are many and are discussed. The evidence supporting current treatments is sparse and short-term, and modalities operating in isolation typically fail. People easily fall into the cracks between mental health and addiction services. Clinicians feel untrained and consumers bear the brunt of this: Judgmental and moralistic interactions persist and comorbidity is unrecognized in high-risk populations. Competing historical paradigms of mental illness and addiction present a barrier to progress and reductionism is an impediment to care and an obstacle to the integration and interpretation of research. What matters to consumers is challenging to quantify but worth considering: Finding employment, safe housing, and meaning are crucial to recovery. Complex social networks and peer support in recovery are important but poorly understood. The focus on modalities of limited evidence or generalizability persists in literature and practice. We need to consider different combinations of comorbidity, transitions as opposed to dichotomies of use or illness, and explore the long-term view and emic perspectives.

  20. Composite Dos Attack Model

    Directory of Open Access Journals (Sweden)

    Simona Ramanauskaitė

    2012-04-01

    Full Text Available Preparation for potential threats is one of the most important phases ensuring system security. It allows evaluating possible losses, changes in the attack process, the effectiveness of used countermeasures, optimal system settings, etc. In cyber-attack cases, executing real experiments can be difficult for many reasons. However, mathematical or programming models can be used instead of conducting experiments in a real environment. This work proposes a composite denial of service attack model that combines bandwidth exhaustion, filtering and memory depletion models for a more real representation of similar cyber-attacks. On the basis of the introduced model, different experiments were done. They showed the main dependencies of the influence of attacker and victim’s properties on the success probability of denial of service attack. In the future, this model can be used for the denial of service attack or countermeasure optimization.

  1. What Can ADHD without Comorbidity Teach Us about Comorbidity?

    Science.gov (United States)

    Takeda, Toshinobu; Ambrosini, Paul J.; deBerardinis, Rachel; Elia, Josephine

    2012-01-01

    Neuropsychiatric comorbidity in ADHD is frequent, impairing and poorly understood. In this report, characteristics of comorbid and comorbid-free ADHD subjects are investigated in an attempt to identify differences that could potentially advance our understanding of risk factors. In a clinically-referred ADHD cohort of 449 youths (ages 6-18), age,…

  2. Behavioural effects of rapid intravenous administration of meta-chlorophenylpiperazine (m-CPP) in patients with generalized social anxiety disorder, panic disorder and healthy controls.

    Science.gov (United States)

    Van Veen, J F; Van der Wee, N J A; Fiselier, J; Van Vliet, I M; Westenberg, H G M

    2007-10-01

    Findings from epidemiological, pharmacotherapeutical, genetic and neurobiological studies suggest a possible overlap in the neurobiology of generalized social anxiety disorder (gSAD) and panic disorder (PD). Previously we have found a rapid intravenous m-CPP challenge of 0.1 mg/kg to be highly sensitive and selective in the provocation of panic attacks in patients with PD. We therefore directly compared the behavioural, neuroendocrine and physiological effects of this rapid m-CPP challenge in a small sample of patients with gSAD, patients with PD and matched healthy controls. Panic attacks were significantly more provoked in patients with PD (85%), but not in patients with gSAD (14%) as compared to healthy controls (0%). Effects on the other behavioural parameters, but not on the neuroendocrine and physiological parameters, were significantly greater in patients with PD compared to patients with gSAD and controls. Our preliminary data do not support a shared neurobiology of gSAD and PD.

  3. Psychiatric comorbidity : fact or artifact?

    NARCIS (Netherlands)

    van Loo, Hanna; Romeijn, Jan-Willem

    2015-01-01

    The frequent occurrence of comorbidity has brought about an extensive theoretical debate in psychiatry. Why are the rates of psychiatric comorbidity so high and what are their implications for the ontological and epistemological status of comorbid psychiatric diseases? Current explanations focus eit

  4. Somatic comorbidity in neurological disease.

    NARCIS (Netherlands)

    Nuyen, J.; Bos, G.A.M. van den; Groenewegen, P.P.; Schellevis, F.G.

    2004-01-01

    Background: Patients with comorbidity in general have a higher risk of dying, a poorer quality of life and greater use of health services. Relativel few studies have examined the occurrence of somatic comorbid conditions in neurological diseases. Aim: Therefore, the size of somatic comorbidity in fo

  5. Emotional vulnerability as a function of physical activity among individuals with panic disorder

    NARCIS (Netherlands)

    Smits, J.A.J.; Zvolensky, M.J.

    2006-01-01

    This investigation evaluated the association between physical inactivity and emotional vulnerability in panic disorder. Participants were 39 adults (69% females) with a primary diagnosis of panic disorder (with or without agoraphobia), recruited through the community. Consistent with prediction, cur

  6. Return of ambiguity attacks

    Science.gov (United States)

    Craver, Scott A.

    2002-04-01

    The ambiguity attack, or invertibility attack, was described several years ago as a potential threat to digital watermarking systems. By manipulating the invertibility of watermark embedding, one could negate or subvert the meaning of a copyright mark. These attacks were easily prevented, however, with the appropriate application of one-way functions and cryptographic hashes in watermarking protocols. New research in watermarking, however, has caused the ambiguity attack to resurface as a threat, and this time it will not be as easy averted. Recent work in public-key watermarking create scenarios in which one-way functions may be ineffective against this threat. Furthermore, there are also positive uses for ambiguity attacks, as components in watermarking protocols. This paper provides an overview of the past and possible future of these unusual attacks.

  7. Adversary Model: Adaptive Chosen Ciphertext Attack with Timing Attack

    OpenAIRE

    2014-01-01

    We have introduced a novel adversary model in Chosen-Ciphertext Attack with Timing Attack (CCA2-TA) and it was a practical model because the model incorporates the timing attack. This paper is an extended paper for 'A Secure TFTP Protocol with Security Proofs'. Keywords - Timing Attack, Random Oracle Model, Indistinguishabilit, Chosen Plaintext Attack, CPA, Chosen Ciphertext Attack, IND-CCA1, Adaptive Chosen Ciphertext Attack, IND-CCA2, Trivial File Transfer Protocol, TFTP, Security, Trust, P...

  8. Seven Deadliest Microsoft Attacks

    CERN Document Server

    Kraus, Rob; Borkin, Mike; Alpern, Naomi

    2010-01-01

    Do you need to keep up with the latest hacks, attacks, and exploits effecting Microsoft products? Then you need Seven Deadliest Microsoft Attacks. This book pinpoints the most dangerous hacks and exploits specific to Microsoft applications, laying out the anatomy of these attacks including how to make your system more secure. You will discover the best ways to defend against these vicious hacks with step-by-step instruction and learn techniques to make your computer and network impenetrable. Windows Operating System-Password AttacksActive Directory-Escalat

  9. Transient Ischemic Attack

    Medline Plus

    Full Text Available ... stroke symptoms. Popular Topics TIA Cardiac Catheter Cholesterol Heart Attack Stent © 2017, American Heart Association, Inc. All rights reserved. Unauthorized use prohibited. ...

  10. Seven Deadliest Network Attacks

    CERN Document Server

    Prowell, Stacy; Borkin, Mike

    2010-01-01

    Do you need to keep up with the latest hacks, attacks, and exploits effecting networks? Then you need Seven Deadliest Network Attacks. This book pinpoints the most dangerous hacks and exploits specific to networks, laying out the anatomy of these attacks including how to make your system more secure. You will discover the best ways to defend against these vicious hacks with step-by-step instruction and learn techniques to make your computer and network impenetrable. Attacks detailed in this book include: Denial of Service War Dialing Penetration "Testing" Protocol Tunneling Spanning Tree At

  11. Seven deadliest USB attacks

    CERN Document Server

    Anderson, Brian

    2010-01-01

    Do you need to keep up with the latest hacks, attacks, and exploits effecting USB technology? Then you need Seven Deadliest USB Attacks. This book pinpoints the most dangerous hacks and exploits specific to USB, laying out the anatomy of these attacks including how to make your system more secure. You will discover the best ways to defend against these vicious hacks with step-by-step instruction and learn techniques to make your computer and network impenetrable. Attacks detailed in this book include: USB Hacksaw USB Switchblade USB Based Virus/Malicous Code Launch USB Device Overflow RAMdum

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

    Directory of Open Access Journals (Sweden)

    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.

  13. QT wave dispersion in patients with panic disorder

    Institute of Scientific and Technical Information of China (English)

    Murad Atmaca; Mustafa Yavuzkir; Filiz Izci; M. Gurkan Gurok; Sahin Adiyaman

    2012-01-01

    [Objective] QT dispersion (QTd),defined as the maximal inter-lead difference in QT intervals on 12 leads of the surface electrocardiogram (ECG),reflects the regional heterogeneity of ventricular repolarization and has been suggested as an important marker for risk of arrhythmia in addition to the QT interval.Some investigators proposed that it might be a predisposing factor for arrhythmic events and sudden death.Thus,we aimed to investigate whether QTd differs in patients with panic disorder from that in healthy controls.[Methods] In 40 panic disorder patients and 40 healthy controls,Qmax,Qmin,and QTd values were measured.In addition,the Hamilton depression rating scale and the panic agoraphobia scale were scored for both patients and healthy volunteers.[Results] Qmax and Qmin values in the panic disorder patients were significantly higher than those in healthy controls.The mean corrected QTd was significantly greater in the patients than in the controls.One-way analysis of covariance (ANCOVA,using left atrial size,age and heart rate as covariates) also corrected the significant difference.In addition,ANCOVA revealed a significant main effect for the diagnosis,indicating a significantly higher QTd for patients compared with controls.[Conclusion]QTd might be associated with panic disorder.Future studies in larger samples evaluating the effects of treatment are required.

  14. CRHR1 promoter hypomethylation: An epigenetic readout of panic disorder?

    Science.gov (United States)

    Schartner, Christoph; Ziegler, Christiane; Schiele, Miriam A; Kollert, Leonie; Weber, Heike; Zwanzger, Peter; Arolt, Volker; Pauli, Paul; Deckert, Jürgen; Reif, Andreas; Domschke, Katharina

    2017-02-20

    The corticotropin releasing hormone receptor 1 (CRHR1) is crucially involved in the hypothalamic-pituitary-adrenal axis and thus a major regulator of the stress response. CRHR1 gene variation is associated with several mental disorders including anxiety disorders. Studies in rodents have demonstrated epigenetic regulation of CRHR1 gene expression to moderate response to stressful environment. In the present study, we investigated CRHR1 promoter methylation for the first time regarding its role in panic disorder applying a case-control approach (N=131 patients, N=131 controls). In an independent sample of healthy volunteers (N=255), CRHR1 methylation was additionally analyzed for association with the Beck Anxiety Inventory (BAI) score as a dimensional panic-related intermediate phenotype. The functional relevance of altered CRHR1 promoter methylation was investigated by means of luciferase-based reporter gene assays. In panic disorder patients, a significantly decreased CRHR1 methylation was discerned (p<0.001). Accordingly, healthy controls with high BAI scores showed significantly decreased CRHR1 methylation. Functional analyses revealed an increased gene expression in presence of unmethylated as compared to methylated pCpGl_CRHR1 reporter gene vectors. The present study identified a potential role of CRHR1 hypomethylation - conferring increased CRHR1 expression - in panic disorder and a related dimensional intermediate phenotype. This up-regulation of CRHR1 gene expression driven by de-methylation might constitute a link between the stress response and panic disorder risk.

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

    NARCIS (Netherlands)

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

    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)

  16. Sertraline versus paroxetine in the treatment of panic disorder: an acute, double-blind noninferiority comparison.

    NARCIS (Netherlands)

    Bandelow, B.; Behnke, K.; Lenoir, S.; Hendriks, G.J.; Alkin, T.; Goebel, C.; Clary, C.M.

    2004-01-01

    OBJECTIVE: Several classes of medications have demonstrated efficacy in panic disorder, but direct comparison of 2 proven treatments is still uncommon. The purpose of this study was to compare sertraline and paroxetine in the acute treatment of panic disorder. METHOD: Adult outpatients with panic di

  17. Assessment of automatic associations with bodily sensations and agoraphobic situations in panic disorder

    NARCIS (Netherlands)

    Woud, M.L.; Becker, E.S.; Rinck, M.; Harmer, C.J.; Reinecke, A.

    2016-01-01

    Background and objectives: One of the central assumptions of cognitive models of Panic Disorder (PD) is that automatic panic-related associations are a core feature of PD. However, empirical findings are mixed and inconsistent, rendering it difficult to evaluate the role of panic-related association

  18. Overlap of symptom domains of separation anxiety disorder in adulthood with panic disorder-agoraphobia.

    Science.gov (United States)

    Silove, Derrick; Marnane, Claire

    2013-01-01

    There is a need to explain the high level of comorbidity between separation anxiety disorder (SAD) in adulthood and panic disorder with agoraphobia (Pd-Ag). One possibility is that inadequate specification of symptom domains and/or diagnostic questions accounts for some of the comorbidity. The present anxiety clinic study examined responses of adult patients (n = 646) with SAD and/or Pd-Ag on eight symptom domains based on a previous factor analysis of a commonly used separation anxiety measure, the ASA-27, as well as on the Anxiety Sensitivity Index. We also examined questionnaire items that did not load on the factor structure. All separation anxiety domains distinguished strongly between SAD and Pd-Ag. Comparisons across three groups (SAD alone, Pd-Ag alone and comorbid SAD/Pd-Ag) revealed that two symptom domains (anxiety about embarking on trips, and sleep disturbances) showed some overlap between Pd-Ag and SAD. Two of the items of the ASA-27 that did not load with other items in the factor analysis also showed overlap with Pd-Ag, with both referring to anxieties about leaving home. Patients with SAD (with or without Pd-Ag) returned higher scores on anxiety sensitivity than those with Pd-Ag alone. The findings support the distinctiveness of the construct of SAD and the capacity of the ASA-27 to discriminate between that disorder and Pd-Ag. SAD appears to be a more severe form of anxiety than Pd-Ag. There may be a need to refine items to include the reasons for avoiding leaving home, reluctance to sleep alone and to embark on trips, to ensure accurate discrimination between Pd-Ag and SAD in adulthood.

  19. Virtual reality: a new tool for panic disorder therapy.

    Science.gov (United States)

    Vincelli, Francesco; Riva, Giuseppe

    2002-05-01

    The use of a multicomponent cognitive-behavioral treatment strategy for panic disorder with agoraphobia is actually one of the preferred therapeutical approach for this disturbance. This method involves a mixture of cognitive and behavioral techniques which are intended to help patients identify and modify their dysfunctional anxiety-related thoughts, beliefs and behavior. Emphasis is placed on reversing the maintaining factors identified in the cognitive and behavioral patterns. The treatment protocol includes exposure to the feared situation, interoceptive exposure and cognitive restructuring. The paper presents a treatment protocol for panic disorder and agoraphobia, named experiential-cognitive therapy, that integrates the use of virtual reality in a multicomponent cognitive-behavioral treatment strategy. The goal of experiential-cognitive therapy is to decondition fear reactions, to modify misinterpretational cognition related to panic symptoms and to reduce anxiety symptoms.

  20. The effects of extraverted temperament on agoraphobia in panic disorder.

    Science.gov (United States)

    Rosellini, Anthony J; Lawrence, Amy E; Meyer, Joseph F; Brown, Timothy A

    2010-05-01

    Although situational avoidance is viewed as the most disabling aspect of panic disorder, few studies have evaluated how dimensions of neurotic (i.e., neuroticism, behavioral inhibition) and extraverted (i.e., extraversion, behavioral activation) temperament may influence the presence and severity of agoraphobia. Using logistic regression and structural equation modeling, we examined the unique effects of extraverted temperament on situational avoidance in a sample of 274 outpatients with a diagnosis of panic disorder with and without agoraphobia. Results showed low extraverted temperament (i.e., introversion) to be associated with both the presence and the severity of situational avoidance. Findings are discussed in regard to conceptualizations of conditioned avoidance, activity levels, sociability, and positive emotions within the context of panic disorder with agoraphobia.

  1. PANIC: A Near-infrared Camera for the Magellan Telescopes

    CERN Document Server

    Martini, P; Murphy, D C; Birk, C; Shectman, S A; Grunnels, S M; Koch, E

    2004-01-01

    PANIC (Persson's Auxiliary Nasmyth Infrared Camera) is a near-infrared camera designed to operate at any one of the f/11 folded ports of the 6.5m Magellan telescopes at Las Campanas Observatory, Chile. The instrument is built around a simple, all-refractive design that reimages the Magellan focal plane to a plate scale of 0.125'' pixel^{-1} onto a Rockwell 1024x1024 HgCdTe detector. The design goals for PANIC included excellent image quality to sample the superb seeing measured with the Magellan telescopes, high throughput, a relatively short construction time, and low cost. PANIC has now been in regular operation for over one year and has proved to be highly reliable and produce excellent images. The best recorded image quality has been ~0.2'' FWHM.

  2. COMORBIDITY IN RHEUMATOID ARTHRITIS

    Directory of Open Access Journals (Sweden)

    T. A. Panafidina

    2014-01-01

    Full Text Available The peak onset of rheumatoid arthritis (RA is at 30-55 years of age. At this age, the patients have also other concomi- tant diseases (comorbidities that affect the course and prognosis of RA, the choice of its treatment policy, quality of life of the patients. Objective: to identify the most important and common comorbidities in patients with RA. Subjects and methods. Two hundred patients (median age 55 [46; 61] years were enrolled; there was a preponderance of women (82.5% with median disease duration 5 [1; 10] years, seropositive for IgM rheumatoid factor (83.0% and anti-cyclic citrullinated peptide antibodies (81.6% with moderate and high disease activity (median DAS28 value 3.9 [3.1; 4.9]. Varying degrees of destructive changes in hand and foot joints were radiologically detected in 71.2% of the patients; 64.5% of the patients had Functional Class II. Methotrexate was given to 69.5% of the patients; therapy with biological agents was used in 21.0% of the cases. 15.5% of the patients did not receive DMARD or biologics. 43.0% of the patients with RA received glucocorticoids. Results. Comorbidities were present in 72.0% of the patients with RA. The most common diseases were hypertension (60.0%, dyslipidemia (45.0%, fractures at various sites (29.5%, and coronary heart disease (21.0%. Myocardial infarction and stroke were observed in 1.5 and 1.0% of cases, respectively. There was diabetes mellitus (DM in 7.5% of the cases and osteoporosis in 15.5% of the patients. 81.7% of the patients with RA and hypertension and 80.0% of those with RA and DM received antihypertensive and sugar-lowering therapy, respectively. At the same time the RA patients with dyslipidemia and osteoporosis received specific drugs far less frequently (30.0 and 29.0%, respectively. Conclusion. Comorbidities are frequently encountered in RA. By taking into account the fact that cardiovascular dis- eases are a main cause of death in RA; it is necessary to adequately and timely

  3. Panic in otolaryngology patients presenting with dizziness or hearing loss.

    Science.gov (United States)

    Clark, D B; Hirsch, B E; Smith, M G; Furman, J M; Jacob, R G

    1994-08-01

    This study compared 50 patients presenting to an otolaryngology clinic with a complaint of dizziness and 50 patients presenting with hearing loss on questionnaire measures of panic, phobic avoidance, generalized anxiety, and depression. Clinical and laboratory evaluations of vestibular and audiological complaints were also completed. Twenty percent of the group with dizziness and none of the group with hearing loss reported symptoms that met DSM-III-R criteria for panic disorder. Patients with dizziness and peripheral vestibulopathy had more symptoms of phobic avoidance, generalized anxiety, and depression than patients with confirmed hearing loss.

  4. Mathematical Attacks on RSA Cryptosystem

    Directory of Open Access Journals (Sweden)

    Imad K. Salah

    2006-01-01

    Full Text Available In this paper some of the most common attacks against Rivest, Shamir, and Adleman (RSA cryptosystem are presented. We describe the integer factoring attacks, attacks on the underlying mathematical function, as well as attacks that exploit details in implementations of the algorithm. Algorithms for each type of attacks are developed and analyzed by their complexity, memory requirements and area of usage.

  5. MAOA gene hypomethylation in panic disorder-reversibility of an epigenetic risk pattern by psychotherapy.

    Science.gov (United States)

    Ziegler, C; Richter, J; Mahr, M; Gajewska, A; Schiele, M A; Gehrmann, A; Schmidt, B; Lesch, K-P; Lang, T; Helbig-Lang, S; Pauli, P; Kircher, T; Reif, A; Rief, W; Vossbeck-Elsebusch, A N; Arolt, V; Wittchen, H-U; Hamm, A O; Deckert, J; Domschke, K

    2016-04-05

    Epigenetic signatures such as methylation of the monoamine oxidase A (MAOA) gene have been found to be altered in panic disorder (PD). Hypothesizing temporal plasticity of epigenetic processes as a mechanism of successful fear extinction, the present psychotherapy-epigenetic study for we believe the first time investigated MAOA methylation changes during the course of exposure-based cognitive behavioral therapy (CBT) in PD. MAOA methylation was compared between N=28 female Caucasian PD patients (discovery sample) and N=28 age- and sex-matched healthy controls via direct sequencing of sodium bisulfite-treated DNA extracted from blood cells. MAOA methylation was furthermore analyzed at baseline (T0) and after a 6-week CBT (T1) in the discovery sample parallelized by a waiting time in healthy controls, as well as in an independent sample of female PD patients (N=20). Patients exhibited lower MAOA methylation than healthy controls (P<0.001), and baseline PD severity correlated negatively with MAOA methylation (P=0.01). In the discovery sample, MAOA methylation increased up to the level of healthy controls along with CBT response (number of panic attacks; T0-T1: +3.37±2.17%), while non-responders further decreased in methylation (-2.00±1.28%; P=0.001). In the replication sample, increases in MAOA methylation correlated with agoraphobic symptom reduction after CBT (P=0.02-0.03). The present results support previous evidence for MAOA hypomethylation as a PD risk marker and suggest reversibility of MAOA hypomethylation as a potential epigenetic correlate of response to CBT. The emerging notion of epigenetic signatures as a mechanism of action of psychotherapeutic interventions may promote epigenetic patterns as biomarkers of lasting extinction effects.

  6. MAOA gene hypomethylation in panic disorder—reversibility of an epigenetic risk pattern by psychotherapy

    Science.gov (United States)

    Ziegler, C; Richter, J; Mahr, M; Gajewska, A; Schiele, M A; Gehrmann, A; Schmidt, B; Lesch, K-P; Lang, T; Helbig-Lang, S; Pauli, P; Kircher, T; Reif, A; Rief, W; Vossbeck-Elsebusch, A N; Arolt, V; Wittchen, H-U; Hamm, A O; Deckert, J; Domschke, K

    2016-01-01

    Epigenetic signatures such as methylation of the monoamine oxidase A (MAOA) gene have been found to be altered in panic disorder (PD). Hypothesizing temporal plasticity of epigenetic processes as a mechanism of successful fear extinction, the present psychotherapy-epigenetic study for we believe the first time investigated MAOA methylation changes during the course of exposure-based cognitive behavioral therapy (CBT) in PD. MAOA methylation was compared between N=28 female Caucasian PD patients (discovery sample) and N=28 age- and sex-matched healthy controls via direct sequencing of sodium bisulfite-treated DNA extracted from blood cells. MAOA methylation was furthermore analyzed at baseline (T0) and after a 6-week CBT (T1) in the discovery sample parallelized by a waiting time in healthy controls, as well as in an independent sample of female PD patients (N=20). Patients exhibited lower MAOA methylation than healthy controls (P<0.001), and baseline PD severity correlated negatively with MAOA methylation (P=0.01). In the discovery sample, MAOA methylation increased up to the level of healthy controls along with CBT response (number of panic attacks; T0–T1: +3.37±2.17%), while non-responders further decreased in methylation (−2.00±1.28% P=0.001). In the replication sample, increases in MAOA methylation correlated with agoraphobic symptom reduction after CBT (P=0.02–0.03). The present results support previous evidence for MAOA hypomethylation as a PD risk marker and suggest reversibility of MAOA hypomethylation as a potential epigenetic correlate of response to CBT. The emerging notion of epigenetic signatures as a mechanism of action of psychotherapeutic interventions may promote epigenetic patterns as biomarkers of lasting extinction effects. PMID:27045843

  7. [Genetic Bases of Human Comorbidity].

    Science.gov (United States)

    Puzyrev, V P

    2015-04-01

    In this review, the development of ideas focused on the phenomenon of disease combination (comorbidity) in humans is discussed. The genetic bases of the three forms of the phenomenon, comorbidity (syntropias), inverse comorbidity (dystropias), and comorbidity of Mendelian and multifactorial diseases, are analyzed. The results of personal genome-wide association studies of the genetic risk profile that may predispose an individual to cardiovascular disease continuum (CDC), including coronary heart disease, type 2 diabetes, hypertension, and hypercholesterolemia (CDC syntropy), as well as the results of bioinformatic analysis of common genes and the networks of molecular interactions for two (bronchial asthma and pulmonary tuberculosis) diseases rarely found in one patient (dystropy), are presented. The importance of the diseasome and network medicine concepts in the study of comorbidity is emphasized. Promising areas in genomic studies of comorbidities for disease classification and the development of personalized medicine are designated.

  8. Co-morbidity in psoriasis

    DEFF Research Database (Denmark)

    Lønnberg, Ann Sophie; Skov, Lone

    2016-01-01

    INTRODUCTION: Psoriasis is a common, chronic, immune-mediated inflammatory disorder. The disease is associated with several co-morbidities including cardiovascular disease, metabolic syndrome, and psychiatric disorders. It is important to identify and treat these co-morbidities because they have...... a strongly negative effect on the overall health of patients with psoriasis. Unfortunately, these co-morbidities are often overlooked and/or left untreated. Therefore, the aim of this review is to discuss the mechanisms of how co-morbidities are associated with psoriasis as well as implications...... for the clinic to be able to recognize such co-morbidities. AREAS COVERED: This is a review of studies investigating and discussing co-morbidities of psoriasis and screening. Literature was retrieved by searching on the PubMed database using individual and combined search terms related to relevant co...

  9. A subtle grey-matter increase in first-episode, drug-naive major depressive disorder with panic disorder after 6 weeks' duloxetine therapy.

    Science.gov (United States)

    Lai, Chien-Han; Hsu, Yuan-Yu

    2011-03-01

    We designed this study to investigate the modulating effects of duloxetine on symptoms and grey matter of patients with major depressive disorder combined with panic disorder. We also aimed to discover if there was any persistence of grey-matter deficits after remission and to find 'trait markers' for this comorbidity. High-resolution magnetic resonance imaging and voxel-based morphometric measurements were performed on 15 patients at baseline and remitted status (week 6) compared to 15 healthy control subjects who were scanned twice within 6 wk. The rating scales of depressive and panic symptoms improved with statistical significance (corrected pgrey-matter deficits in infero-frontal, limbic, occipital, temporo-parietal, cerebellar areas (trait marker regions) in drug-naive patients were observed compared to controls at baseline (family-wise error corrected pgrey matter in healthy controls over the 6-wk period. Duloxetine-induced increases of grey matter were very subtle in left infero-frontal cortex, right fusiform gyrus, and right cerebellum VIIIa areas (state marker regions) after 6-wk therapy (uncorrected pgrey matter to the level of control subjects and grey-matter deficits in patients appear largely unaffected by duloxetine. We suggest that short-term duloxetine therapy improved the clinical symptoms of patients with major depressive disorder combined with panic disorder. These improvements might be related to a modest increase of grey matter in state marker regions of the brain. The deficits of trait marker regions were more evident and are likely to be important for pathogenesis.

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

    Directory of Open Access Journals (Sweden)

    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.

  11. Medical Comorbidities in Pediatric Headache.

    Science.gov (United States)

    Jacobs, Howard; Singhi, Samata; Gladstein, Jack

    2016-02-01

    Comorbid conditions frequently occur in pediatric headaches and may significantly affect their management. Comorbidities that have been associated with pediatric headaches include attention-deficit or hyperactivity disorder, autism, developmental disabilities, depression, anxiety, epilepsy, obesity, infantile colic, atopic disorders, inflammatory bowel disease, and irritable bowel syndrome. The goal of this article is to review these comorbidities associated with pediatric headache, thereby empowering child neurologists to identify common triggers and tailor management strategies that address headache and its comorbidities. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Ansiedade, pânico e o eixo hipotálamo-pituitária-adrenal Anxiety, panic and the hypothalamic-pituitary-adrenal axis

    Directory of Open Access Journals (Sweden)

    Frederico G Graeff

    2007-05-01

    experimental studies that assayed adrenocorticotropic hormone, cortisol and prolactin show that real-life panic attacks, as well as those induced by selective panicogenic agents such as lactate and carbon dioxide, do not activate the hypothalamic-pituitary-adrenal axis. Agonists of the cholecystokinin receptor B such as the cholecystokinin-4 peptide and pentagastrin increase stress hormones regardless of the occurrence of a panic attack and, thus, seem to activate the hypothalamic-pituitary-adrenal axis directly. The benzodiazepine antagonist flumazenil does not increase stress hormones, but this agent does not reliably induce panic attacks. Pharmacological agents that increase anxiety in both normal people and panic patients (caffeine, yohimbine, serotonergic agonists raise stress hormone levels. CONCLUSIONS: In addition to the differences in symptomatology and pharmacological response, generalized anxiety disorder and panic disorder affect stress hormones in distinct ways. While anticipatory anxiety and generalized anxiety disorder activate both the hypothalamic-pituitary-adrenal and the sympathoadrenal axes, panic attack causes major sympathetic activation, but has little effect on the hypothalamic-pituitary-adrenal axis.

  13. Supply Chain Attack Framework and Attack Patterns

    Science.gov (United States)

    2013-12-01

    Malware is embedded in a replacement server motherboard (e.g., in the flash memory) in order to alter server functionality from that intended. Attack...Slashdot: Dell Ships Infected Motherboards July 21, 2010(c/o Rick Dove) Threat: An adversary with access to hardware procurement, maintenance, or upgrade...control can embed malware in a critical component server motherboard . Vulnerabilities: The control processes and mechanisms for hardware

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

    Directory of Open Access Journals (Sweden)

    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

  15. Decreased mean platelet volume in panic disorder

    Directory of Open Access Journals (Sweden)

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

    Science.gov (United States)

    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. PMID:12914652

  17. Dropout prediction in cognitive behavior therapy for panic disorder

    NARCIS (Netherlands)

    Keijsers, G.P.J.; Kampman, M.; Hoogduin, C.A.L.

    2001-01-01

    The aim of this study was to attempt to identify reliable factors associated with dropout risk in a sample of 161 panic disorder patients treated with manualized cognitive behavior therapy. Four possible predictors of dropout were selected from the literature: level of education, treatment motivatio

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

    NARCIS (Netherlands)

    de Ruiter, C.; Cohen, L.

    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

  19. TREATMENT OF PANIC DISORDER IN THE REAL WORLD

    African Journals Online (AJOL)

    Enrique

    Panic disorder is classified as an anxiety disorder in the DSM-IV.1 It affects between. 2% and 4% of the ... there is a rapid escalation of symptoms over approxi- ... Electrolyte. Heart failure ... these, medications have a more rapid onset of effect ...

  20. Are TMEM genes potential candidate genes for panic disorder?

    DEFF Research Database (Denmark)

    Gregersen, Noomi O; Buttenschøn, Henriette Nørmølle; Hedemand, Anne

    2014-01-01

    We analysed single nucleotide polymorphisms in two transmembrane genes (TMEM98 and TMEM132E) in panic disorder (PD) patients and control individuals from the Faroe Islands, Denmark and Germany. The genes encode single-pass membrane proteins and are located within chromosome 17q11.2-q12...

  1. Medications for Panic Disorder and Generalized Anxiety Disorder During Pregnancy

    OpenAIRE

    Rubinchik, Sofya M.; Kablinger, Anita S.; Gardner, J. Suzette

    2005-01-01

    Objective: Approximately 30% of women experience some type of anxiety disorder during their lifetime. In addition, some evidence exists that anxiety disorders can affect pregnancy outcomes. This article reviews the literature on the course of generalized anxiety disorder (GAD) and panic disorder during pregnancy and the postpartum period and presents guidelines for management.

  2. [Comorbidity of alcohol dependence with other psychiatric disorders. Part I. Epidemiology of dual diagnosis].

    Science.gov (United States)

    Klimkiewicz, Anna; Klimkiewicz, Jakub; Jakubczyk, Andrzej; Kieres-Salomoński, Ilona; Wojnar, Marcin

    2015-01-01

    The paper is a review of the literature on the comorbidity of alcohol dependence with other psychiatric disorders. A condition when alcohol dependence is accompanied by another mental disorder is much more common than it is commonly believed. It is estimated that more than one third of people diagnosed with mental disorders, abuses or is dependent on psychoactive substances, especially alcohol; among alcohol-dependent patients 37% suffer from other mental disorders. Alcohol dependence is associated with increased risk of mood disorders - more than three times higher, depression - almost four times higher, bipolar disorder - more than six times higher, anxiety disorders in general - more than twice, generalized anxiety disorder - more than four times higher, panic disorders - almost double, posttraumatic stress disorder - more than twice. Underestimating of comorbidity is an important problem during treatment of such population of patients. Social skills training can improve a stress management and decrease alcohol and drug use among dual diagnosed patients.

  3. Transient Ischemic Attack

    Medline Plus

    Full Text Available ... TIA , or transient ischemic attack, is a "mini stroke" that occurs when a blood clot blocks an ... a short time. The only difference between a stroke and TIA is that with TIA the blockage ...

  4. Heart Attack Payment - Hospital

    Data.gov (United States)

    U.S. Department of Health & Human Services — Payment for heart attack patients measure – provider data. This data set includes provider data for payments associated with a 30-day episode of care for heart...

  5. Heart Attack Payment - State

    Data.gov (United States)

    U.S. Department of Health & Human Services — Payment for heart attack patients measure – state data. This data set includes state-level data for payments associated with a 30-day episode of care for heart...

  6. Heart Attack Payment - National

    Data.gov (United States)

    U.S. Department of Health & Human Services — Payment for heart attack patients measure – national data. This data set includes national-level data for payments associated with a 30-day episode of care for heart...

  7. Transient Ischemic Attack

    Medline Plus

    Full Text Available ... TIA , or transient ischemic attack, is a "mini stroke" that occurs when a blood clot blocks an ... a short time. The only difference between a stroke and TIA is that with TIA the blockage ...

  8. Transient Ischemic Attack

    Medline Plus

    Full Text Available ... Attack Stent © 2017, American Heart Association, Inc. All rights reserved. Unauthorized use prohibited. The content in this library is for educational purposes only, and therefore is not intended to be ...

  9. Cooperating attackers in neural cryptography.

    Science.gov (United States)

    Shacham, Lanir N; Klein, Einat; Mislovaty, Rachel; Kanter, Ido; Kinzel, Wolfgang

    2004-06-01

    A successful attack strategy in neural cryptography is presented. The neural cryptosystem, based on synchronization of neural networks by mutual learning, has been recently shown to be secure under different attack strategies. The success of the advanced attacker presented here, called the "majority-flipping attacker," does not decay with the parameters of the model. This attacker's outstanding success is due to its using a group of attackers which cooperate throughout the synchronization process, unlike any other attack strategy known. An analytical description of this attack is also presented, and fits the results of simulations.

  10. Bayesian Watermark Attacks

    OpenAIRE

    Shterev, Ivo; Dunson, David

    2012-01-01

    This paper presents an application of statistical machine learning to the field of watermarking. We propose a new attack model on additive spread-spectrum watermarking systems. The proposed attack is based on Bayesian statistics. We consider the scenario in which a watermark signal is repeatedly embedded in specific, possibly chosen based on a secret message bitstream, segments (signals) of the host data. The host signal can represent a patch of pixels from an image or a video frame. We propo...

  11. DNS rebinding attacks

    OpenAIRE

    Kokkinopoulos, Georgios

    2009-01-01

    Approved for public release, distribution unlimited. A Domain Name System (DNS) Rebinding attack compromises the integrity of name resolution in DNS with the goal of controlling the IP address of the host to which the victim ultimately connects. The same origin policy and DNS Pinning techniques were introduced to protect Web browsers from DNS rebinding attacks, but their effectiveness has been undermined by vulnerabilities introduced by plug-ins such as JavaScript and Adobe Flash Play...

  12. Dorsal periaqueductal gray stimulation facilitates anxiety-, but not panic-related, defensive responses in rats tested in the elevated T-maze

    Energy Technology Data Exchange (ETDEWEB)

    Camplesi, M. Jr. [Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO (Brazil); Bortoli, V.C. de [Departamento de Ciências da Saúde, Centro Universitário Norte do Espírito Santo, Universidade Federal do Espírito Santo, São Mateus, ES (Brazil); Paula Soares, V. de [Departamento de Biofísica e Farmacologia, Centro de Biociências, Universidade Federal do Rio Grande do Norte, Natal, RN (Brazil); Nogueira, R.L. [Laboratório de Psicologia Comparada, Universidade Estácio de Sá, Rio de Janeiro, RJ (Brazil); Zangrossi, H. Jr. [Departamento de Farmacologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP (Brazil)

    2012-08-03

    The escape response to electrical or chemical stimulation of the dorsal periaqueductal gray matter (DPAG) has been associated with panic attacks. In order to explore the validity of the DPAG stimulation model for the study of panic disorder, we determined if the aversive consequences of the electrical or chemical stimulation of this midbrain area can be detected subsequently in the elevated T-maze. This animal model, derived from the elevated plus-maze, permits the measurement in the same rat of a generalized anxiety- and a panic-related defensive response, i.e., inhibitory avoidance and escape, respectively. Facilitation of inhibitory avoidance, suggesting an anxiogenic effect, was detected in male Wistar rats (200-220 g) tested in the elevated T-maze 30 min after DPAG electrical stimulation (current generated by a sine-wave stimulator, frequency at 60 Hz) or after local microinjection of the GABA{sub A} receptor antagonist bicuculline (5 pmol). Previous electrical (5, 15, 30 min, or 24 h before testing) or chemical stimulation of this midbrain area did not affect escape performance in the elevated T-maze or locomotion in an open-field. No change in the two behavioral tasks measured by the elevated T-maze was observed after repetitive (3 trials) electrical stimulation of the DPAG. The results indicate that activation of the DPAG caused a short-lived, but selective, increase in defensive behaviors associated with generalized anxiety.

  13. μ-Opioid and 5-HT1A receptors in the dorsomedial hypothalamus interact for the regulation of panic-related defensive responses.

    Science.gov (United States)

    Roncon, Camila Marroni; Yamashita, Paula Shimene de Melo; Frias, Alana Tercino; Audi, Elisabeth Aparecida; Graeff, Frederico Guilherme; Coimbra, Norberto Cysne; Zangrossi, Helio

    2017-06-01

    The dorsomedial hypothalamus (DMH) and the dorsal periaqueductal gray (DPAG) have been implicated in the genesis and regulation of panic-related defensive behaviors, such as escape. Previous results point to an interaction between serotonergic and opioidergic systems within the DPAG to inhibit escape, involving µ-opioid and 5-HT1A receptors (5-HT1AR). In the present study we explore this interaction in the DMH, using escape elicited by electrical stimulation of this area as a panic attack index. The obtained results show that intra-DMH administration of the non-selective opioid receptor antagonist naloxone (0.5 nmol) prevented the panicolytic-like effect of a local injection of serotonin (20 nmol). Pretreatment with the selective μ-opioid receptor (MOR) antagonist CTOP (1 nmol) blocked the panicolytic-like effect of the 5-HT1AR agonist 8-OHDPAT (8 nmol). Intra-DMH injection of the selective MOR agonist DAMGO (0.3 nmol) also inhibited escape behavior, and a previous injection of the 5-HT1AR antagonist WAY-100635 (0.37 nmol) counteracted this panicolytic-like effect. These results offer the first evidence that serotonergic and opioidergic systems work together within the DMH to inhibit panic-like behavior through an interaction between µ-opioid and 5-HT1A receptors, as previously described in the DPAG.

  14. Behavioural effects of rapid intravenous administration of meta-chlorophenylpiperazine in patients with panic disorder and controls.

    Science.gov (United States)

    van der Wee, Nic J A; Fiselier, Jasha; van Megen, Harold J G M; Westenberg, Herman G M

    2004-10-01

    Oral and intravenous challenge paradigms with the direct 5-HT agonist meta-chlorophenylpiperazine (m-CPP) in panic disorder (PD) have shown only moderate sensitivity or selectivity of the panicogenic effects in PD. However, the results of a study examining the effects of rapid intravenous administration of 0.1 mg/kg of m-CPP in healthy volunteers suggested that this approach may be a more selective and sensitive panicogenic paradigm in PD. We therefore compared the behavioural, neuroendocrine and physiological effects of rapid intravenous administration of 0.1 mg/kg of m-CPP in 10 patients with PD and 10 healthy controls. Panic attacks were significantly more provoked in patients with PD (90%) compared to healthy controls (0%). Effects on the behavioural, but not on the neuroendocrine and physiological parameters, were significantly greater in patients. Our data suggests that the behavioural effects of rapid intravenous administration of 0.1 mg/kg of m-CPP in patients with PD indeed show a unique combination of high sensitivity and selectivity.

  15. Response to meta-chlorophenylpiperazine in panic disorder patients and healthy subjects: influence of reduction in intravenous dosage.

    Science.gov (United States)

    Germine, M; Goddard, A W; Sholomskas, D E; Woods, S W; Charney, D S; Heninger, G R

    1994-11-01

    As a further test of the hypothesis of serotonin hypersensitivity in panic disorder (PD), the serotonin agonist meta-chlorophenylpiperazine (MCPP) was administered intravenously in a dose of 0.05 mg/kg to 27 PD patients and 22 normal control subjects. This is one-half the dose used in our previous study of PD patients, where the dose may have been too high to provide evidence of hypersensitivity to the agent. Responses of anxiety and nervousness were statistically indistinguishable by analysis of variance in the two groups, replicating our previous findings. Panic attack symptom score (PASS) ratings were significantly higher in the PD group, compared with a trend toward higher PASS ratings in the 0.1 mg/kg study. Cortisol, human growth hormone, and male prolactin responses showed no significant differences in the two groups by analysis of variance. Prolactin responses were significantly blunted in the female patients. The unexpected blunted prolactin response to MCPP in female PD patients may reflect a nonspecific blunting of prolactin response to stress. The PASS data provide some evidence of serotonergic hypersensitivity in PD.

  16. High Order Differential Attack and Trace Attack to Block Ciphers

    Institute of Scientific and Technical Information of China (English)

    HU Yupu; CHEN Kai; Xiao Guozhen

    2001-01-01

    In this paper, we prove a high or-der differential property of power function, then giverespectively high order differential attack and traceattack to block ciphers. These attacks depend onlyon block cipher's algebraic shape on GF(2n) and haveno relation with its designing structure. The condi-tions are given for both effective attacks and strengthagainst attacks.

  17. Differences in Cortisol Response to Trauma Activation in Individuals with and without Comorbid PTSD and Depression

    Directory of Open Access Journals (Sweden)

    Sharon Dekel

    2017-05-01

    Full Text Available Background: Although depression symptoms are often experienced by individuals who develop posttraumatic stress disorder (PTSD following trauma exposure, little is know about the biological correlates associated with PTSD and depression co-morbidity vs. those associated with PTSD symptoms alone.Methods: Here we examined salivary cortisol responses to trauma activation in a sample of 60 survivors of the World Trade Center attacks on September 11, 2001. Participants recalled the escape from the attacks 7 months post 9/11. Salivary cortisol levels were measured before and after their recollection of the trauma. PTSD, depression, and somatic symptoms were also assessed. From the behavioral assessment scales, the participants were grouped into three conditions: those with comorbid PTSD and depressive symptoms, PTSD alone symptoms, or no-pathology.Results: Baseline and cortisol response levels differed between the comorbid, PTSD alone, and no-pathology groups. Individuals endorsing co-morbid symptoms had higher PTSD and somatic symptom severity and their cortisol response decreased following their trauma reminder while a trend of an elevated response to the trauma was found in the PTSD alone group. Our findings show distinct psychological and biological correlates related to the endorsement of PTSD with and without depression comorbidity.Conclusions: The findings suggest that comorbidity symptoms manifestation entails a separate trauma induced condition from PTSD. Future research on biological correlates of comorbid PTSD and depression is warranted.

  18. A brief cognitive-behavioral intervention for treating depression and panic disorder in patients with noncardiac chest pain: a 24-week randomized controlled trial.

    Science.gov (United States)

    van Beek, M H C T; Oude Voshaar, R C; Beek, A M; van Zijderveld, G A; Visser, S; Speckens, A E M; Batelaan, N; van Balkom, A J L M

    2013-07-01

    Most patients with noncardiac chest pain experience anxiety and depressive symptoms. Commonly they are reassured and referred back to primary care, leaving them undiagnosed and untreated. Some small studies have suggested efficacy of 12 cognitive behavioral therapy (CBT) sessions. Our aim was to examine efficacy of brief CBT in reducing anxiety and depressive symptoms in patients with noncardiac chest pain and comorbid panic and/or depressive disorders. In this 24-week randomized controlled trial comparing CBT (n = 60) versus treatment as usual (TAU, n = 53), we included all adults who presented at the cardiac emergency unit of a university hospital with noncardiac chest pain, scored ≥8 on the hospital anxiety and depression scale (HADS) and were diagnosed with a comorbid panic and/or depressive disorder with the Mini International Neuropsychiatric Interview. CBT consisted of six individual sessions. Main outcome was disease severity assessed with the clinical global inventory (CGI) by a blinded independent rater. ANCOVA in the intention-to-treat and completer sample showed that CBT was superior to TAU after 24 weeks in reducing disease severity assessed with CGI (P depressive symptoms (Hamilton depression rating scale) were in line with these results except for HADS-depression (P = .10), fear questionnaire (P = .13), and STAI-state (P = .11). Brief CBT significantly reduces anxiety and depressive symptoms in patients with noncardiac chest pain who are diagnosed with panic and/or depressive disorders. Patients presenting with noncardiac chest pain should be screened for psychopathology and if positive, CBT should be considered. © 2013 Wiley Periodicals, Inc.

  19. Is There Room for Second-Generation Antipsychotics in the Pharmacotherapy of Panic Disorder? A Systematic Review Based on PRISMA Guidelines

    Directory of Open Access Journals (Sweden)

    Giampaolo Perna

    2016-04-01

    Full Text Available A role for second-generation antipsychotics (SGAs in the treatment of panic disorders (PD has been proposed, but the actual usefulness of SGAs in this disorder is unclear. According to the PRISMA guidelines, we undertook an updated systematic review of all of the studies that have examined, in randomized controlled trials, the efficacy and tolerability of SGAs (as either monotherapy or augmentation in the treatment of PD, with or without other comorbid psychiatric disorders. Studies until 31 December 2015 were identified through PubMed, PsycINFO, Embase, Cochrane Library and Clinical trials.gov. Among 210 studies, five were included (two involving patients with a principal diagnosis of PD and three involving patients with bipolar disorder with comorbid PD or generalized anxiety disorder. All were eight-week trials and involved treatments with quetiapine extended release, risperidone and ziprasidone. Overall, a general lack of efficacy of SGAs on panic symptoms was observed. Some preliminary indications of the antipanic effectiveness of risperidone are insufficient to support its use in PD, primarily due to major limitations of the study. However, several methodological limitations may have negatively affected all of these studies, decreasing the validity of the results and making it difficult to draw reliable conclusions. Except for ziprasidone, SGAs were well tolerated in these short-term trials.

  20. Life After a Heart Attack

    Science.gov (United States)

    ... symptoms of a heart attack. It presents one woman's real-life experience with heart attack symptoms, which started during her pregnancy. The video also explains how a heart attack occurs and encourages women to seek care right away for heart attack symptoms. For more information, ...

  1. What Is a Heart Attack?

    Science.gov (United States)

    ... symptoms of a heart attack. It presents one woman's real-life experience with heart attack symptoms, which started during her pregnancy. The video also explains how a heart attack occurs and encourages women to seek care right away for heart attack symptoms. For more information, ...

  2. What Causes a Heart Attack?

    Science.gov (United States)

    ... symptoms of a heart attack. It presents one woman's real-life experience with heart attack symptoms, which started during her pregnancy. The video also explains how a heart attack occurs and encourages women to seek care right away for heart attack symptoms. For more information, ...

  3. XQuery Injection Attack and Countermeasures

    Institute of Scientific and Technical Information of China (English)

    谭玉森

    2014-01-01

    As a database that allows data to be stored in XML format, XML database suffers from some similar attacks as traditional relational database does. These attacks include injection attack by XQuey function in application software. These include BaseX, eXist and MarkLogic. In order to defeat these attacks, countermeasures are proposed.

  4. Seven Deadliest Wireless Technologies Attacks

    CERN Document Server

    Haines, Brad

    2010-01-01

    How can an information security professional keep up with all of the hacks, attacks, and exploits? One way to find out what the worst of the worst are is to read the seven books in our Seven Deadliest Attacks Series. Not only do we let you in on the anatomy of these attacks but we also tell you how to get rid of them and how to defend against them in the future. Countermeasures are detailed so that you can fight against similar attacks as they evolve. Attacks featured in this book include:Bluetooth AttacksCredit Card, Access Card, and Passport AttacksBad Encryption

  5. Psoriasis and Co-morbidities

    Directory of Open Access Journals (Sweden)

    Ayla Gülekon

    2008-12-01

    Full Text Available Psoriasis is a chronic inflammatory skin disorder affecting about 1-3% of general population, is defined among Immune Mediated Inflammatory Disease (IMID since it develops with immune associated mechanisms. It has been proposed that the chronic inflammation in psoriasis have role in the development of metabolic and vascular disorders related with psoriasis and recent studies have focused on the psoriasis associating comorbidities and their mechanisms. Psoriasis comorbidities include psoriatic arthritis, Crohn’s disease, pustular disorders, metabolic syndrome, malignities, comorbidities related to treatments, pulmonary diseases, smoking, infections, impact on life quality and depression, and alcohol.

  6. The political attack ad

    Directory of Open Access Journals (Sweden)

    Palma Peña-Jiménez, Ph.D.

    2011-01-01

    Full Text Available During election campaigns the political spot has a clear objective: to win votes. This message is communicated to the electorate through television and Internet, and usually presents a negative approach, which includes a direct critical message against the opponent, rather than an exposition of proposals. This article is focused on the analysis of the campaign attack video ad purposely created to encourage the disapproval of the political opponent among voters. These ads focus on discrediting the opponent, many times, through the transmission of ad hominem messages, instead of disseminating the potential of the political party and the virtues and manifesto of its candidate. The article reviews the development of the attack ad since its first appearance, which in Spain dates back to 1996, when the famous Doberman ad was broadcast, and examines the most memorable campaign attack ads.

  7. Shark attack in Natal.

    Science.gov (United States)

    White, J A

    1975-02-01

    The injuries in 5 cases of shark attack in Natal during 1973-74 are reviewed. Experience in shark attacks in South Africa during this period is discussed (1965-73), and the value of protecting heavily utilized beaches in Natal with nets is assessed. The surgical applications of elasmobranch research at the Oceanographic Research Institute (Durban) and at the Headquarters of the Natal Anti-Shark Measures Board (Umhlanga Rocks) are described. Modern trends in the training of surf life-guards, the provision of basic equipment for primary resuscitation of casualties on the beaches, and the policy of general and local care of these patients in Natal are discussed.

  8. Alexithymia and posttraumatic stress disorder following asthma attack.

    Science.gov (United States)

    Chung, Man Cheung; Wall, Natalie

    2013-09-01

    This study examined the levels of posttraumatic stress disorder (PTSD) following asthma attack (post-asthma attack PTSD) and psychiatric co-morbidity among college students. It also investigated the association between these variables and alexithymia. One hundred and six college students participated in the study and completed an on-line survey comprising the Asthma Symptom Checklist, PTSD Checklist, General Health Questionnaire-28 and Toronto Alexithymia Scale. Ninety-one students without asthma and major illness formed the control group. 2 % met the diagnostic criteria for full-PTSD, while 42 and 56 % met the partial and no-PTSD criteria respectively. Compared with the control, the asthma group reported significantly more somatic problems, social dysfunction and depression and was five times more likely to have an elevated risk of developing a general psychiatric disorder. After adjusting age, marital status, asthma experience and symptoms, alexithymia did not predict PTSD, while difficulty identifying feelings predicted psychiatric co-morbidity. Mediational analyses showed that asthma symptoms partially mediated the link between difficulty identifying feelings and psychiatric co-morbidity. People can develop PTSD symptoms and other psychological difficulties following asthma attack. Alexithymia influenced general psychological difficulties independently of PTSD symptoms.

  9. 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

  10. The genetic basis of panic and phobic anxiety disorders.

    Science.gov (United States)

    Smoller, Jordan W; Gardner-Schuster, Erica; Covino, Jennifer

    2008-05-15

    Panic disorder and phobic anxiety disorders are common disorders that are often chronic and disabling. Genetic epidemiologic studies have documented that these disorders are familial and moderately heritable. Linkage studies have implicated several chromosomal regions that may harbor susceptibility genes; however, candidate gene association studies have not established a role for any specific loci to date. Increasing evidence from family and genetic studies suggests that genes underlying these disorders overlap and transcend diagnostic boundaries. Heritable forms of anxious temperament, anxiety-related personality traits and neuroimaging assays of fear circuitry may represent intermediate phenotypes that predispose to panic and phobic disorders. The identification of specific susceptibility variants will likely require much larger sample sizes and the integration of insights from genetic analyses of animal models and intermediate phenotypes.

  11. Multi-professional Panics in the Aftermath of Refugee Arrivals

    DEFF Research Database (Denmark)

    Padovan-Özdemir, Marta; Øland, Trine

    2017-01-01

    express concerns regarding single male refugees (without family), polygamous refugee families, unaccompanied refugee children (broken families), dysfunctional (traumatised) families etc.Analytical questions that reflect a theoretically informed understanding the object of study based on readings......In the Summer of 2015, in all European welfare nation-states professionals, policy makers, administrators, and civil society organisations were in highest alert over the major refugee arrivals from Afghanistan, Syria, and the African continent. In Denmark, in particular, the government responded...... with stricter border controls and containment of refugees in temporary tent camps. Local administrative and professional bodies created panics about the lack of resources and lack of professional knowledge for managing the new refugee groups. The professional panics are particularly interesting in a historical...

  12. Collective behaviors: mass panic and outbreaks of multiple unexplained symptoms.

    Science.gov (United States)

    Pastel, R H

    2001-12-01

    The general public, the mass media, and many government officials believe that the use of weapons of mass destruction (WMD) will inevitably lead to mass panic and/or mass hysteria. However, studies of disasters and wars show that disorganized flight in the presence of a real or perceived danger (i.e., mass panic) is rare. On the other hand, in a real or perceived WMD scenario, outbreaks of multiple unexplained symptoms (i.e., mass psychogenic illness, mass sociogenic illness, mass hysteria, or epidemic hysteria) may be prevalent. Many of the symptoms (fatigue, nausea, vomiting, headache, dizziness/lightheadedness, and anorexia) are common in combat and after toxic chemical exposure, chemical weapon exposure, prodromal infectious illness, and acute radiation sickness.

  13. Psoriasis: classical and emerging comorbidities*

    Science.gov (United States)

    de Oliveira, Maria de Fátima Santos Paim; Rocha, Bruno de Oliveira; Duarte, Gleison Vieira

    2015-01-01

    Psoriasis is a chronic inflammatory systemic disease. Evidence shows an association of psoriasis with arthritis, depression, inflammatory bowel disease and cardiovascular diseases. Recently, several other comorbid conditions have been proposed as related to the chronic inflammatory status of psoriasis. The understanding of these conditions and their treatments will certainly lead to better management of the disease. The present article aims to synthesize the knowledge in the literature about the classical and emerging comorbidities related to psoriasis. PMID:25672294

  14. Comorbidity in inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    Antonio López San Román; Fernando Mu(n)oz

    2011-01-01

    Patients with inflammatory bowel disease (IBD) can be affected by other unrelated diseases. These are called comorbid conditions, and can include any secondary health problem that affects a person suffering from a primary or main disease, and which is neither linked physiopathologically to the primary condition, nor is it due to the treatments used for the primary condition or to its long-term anatomical or physiological consequences.Different comorbid conditions, as well as their influence on IBD, are discussed.

  15. Addressing psychiatric comorbidity.

    Science.gov (United States)

    Woody, G E; McLellan, A T; O'Brien, C P; Luborsky, L

    1991-01-01

    Research studies indicate that addressing psychiatric comorbidity can improve treatment for selected groups of substance-abusing patients. However, the chances for implementing the necessary techniques on a large scale are compromised by the absence of professional input and guidance within programs. This is especially true in public programs, which treat some of the most disadvantaged, disturbed, and socially destructive individuals in the entire mental health system. One starting point for upgrading the level of knowledge and training of staff members who work in this large treatment system could be to develop a better and more authoritative information dissemination network. Such a system exists in medicine; physicians are expected to read appropriate journals and to guide their treatment decisions using the data contained in the journals. Standards of practice and methods for modifying current practice are within the tradition of reading new facts, studying old ones, and comparing treatment outcome under different conditions with what is actually being done. No such general system of information-gathering or -sharing exists, particularly in public treatment programs. One of the most flagrant examples of this "educational shortfall" can be found among those methadone programs that adamantly insist on prescribing no more than 30 to 35 mg/day for all patients, in spite of the overwhelming evidence that these dose levels generally are inadequate. In some cases, program directors are unaware of studies that have shown the relationship between dose and outcome. In other cases, they are aware of the studies but do not modify their practices accordingly. This example of inadequate dosing is offered as an example of one situation that could be improved by adherence to a system of authoritative and systematic information dissemination. Many issues in substance abuse treatment do not lend themselves to information dissemination as readily as that of methadone dosing

  16. OKLAHOMA BANK BEHAVIOR AND THE PANIC OF 1907

    Directory of Open Access Journals (Sweden)

    Loren Gatch

    2010-01-01

    Full Text Available While the Panic of 1907 began in New York City, its effects reverberated throughout the United States. This article examines the response of Oklahoma banks to the nationwide restriction of payments beginning in late October of that year. Despite the widespread support of local communities for their banks, Oklahoma institutions cut back on loans and built up their reserves to a greater degree than did country banks nationwide. Of particular concern for Oklahomans in late 1907 was the financing of the cotton crop. Balance sheet evidence suggests that Oklahoma banks in cotton-growing areas reacted more defensively than did banks in wheat-growing areas, where the harvest had already been completed. A multiple regression model exploring changes in Oklahoma bank reserves before and after the Panic not only confirms the relevance of cotton as a factor but also points to bank size, the use of cash substitutes, and political jurisdiction as variables that influenced the extent to which Oklahoma banks increased their reserves in response to the Panic.

  17. Newer antidepressants and panic disorder: a meta-analysis.

    Science.gov (United States)

    Andrisano, Costanza; Chiesa, Alberto; Serretti, Alessandro

    2013-01-01

    Selective serotonin reuptake inhibitors and venlafaxine are currently considered as first-line agents for patients with panic disorder (PD). However, a systematic comparison of newer antidepressants for the treatment of PD is lacking thus far. Eligible studies focusing on PD patients treated with newer antidepressants were entered in the Cochrane Collaboration Review Manager. Our primary outcome measure was the mean change in panic symptoms from the baseline to the endpoint in patients treated with antidepressants as compared with those treated with placebo. Secondary outcome measures included the mean change in the overall anxiety scores and dropout rates. Sensitivity analyses were also carried out. Fifty studies focusing on 5236 patients were included. The following antidepressants were significantly superior to placebo for PD patients with the following increasing order of effectiveness: citalopram, sertraline, paroxetine, fluoxetine, and venlafaxine for panic symptoms and paroxetine, fluoxetine, fluvoxamine, citalopram, venlafaxine, and mirtazapine for overall anxiety symptoms. Aside from reboxetine and fluvoxamine, all drugs were associated with significantly lower dropout rates as compared with placebo. Several clinical variables moderated clinical outcomes. However, because of some inconsistencies across the studies and limited evidence for some drugs under investigation, further head-to-head comparisons are required.

  18. “Whole Language” and Moral Panic in Australia

    Directory of Open Access Journals (Sweden)

    Susanne Gannon

    2007-05-01

    Full Text Available This paper examines the media and political landscapes within which “whole language” is currently constituted in Australia. Through surveying the themes and rhetoric deployed in media texts over recent years, we consider how “whole language” has been taken up as part of a wider media campaign around education generally. We consider how this campaign has been instrumental in constructing a moral panic around literacy education in particular. We begin with an overview of how the literacy standards of Australia's young people compare on international measures with young people elsewhere. We consider how the media has bundled these with populist concerns about literacy pedagogy and other educational issues to create a sense of national crisis about education. We argue that the sociological concept of "moral panic" provides a useful and systematic theoretical framework for reading these discursive tactics of the media. Finally, we examine how a National Inquiry into literacy responded to this panic by reinscribing a familiar – and unhelpful - binary between “whole language” and phonics-based instruction. In the title and in the body of the paper we keep “whole language” in quotation marks to remind the readers that use of the term in the media texts that are analysed differs widely from its usage by literacy specialists.

  19. Bluetooth security attacks comparative analysis, attacks, and countermeasures

    CERN Document Server

    Haataja, Keijo; Pasanen, Sanna; Toivanen, Pekka

    2013-01-01

    This overview of Bluetooth security examines network vulnerabilities and offers a comparative analysis of recent security attacks. It also examines related countermeasures and proposes a novel attack that works against all existing Bluetooth versions.

  20. The role of hyperventilation: hypocapnia in the pathomechanism of panic disorder O papel da hiperventilação: a hipocapnia no patomecanismo do distúrbio de pânico

    Directory of Open Access Journals (Sweden)

    Andras Sikter

    2007-12-01

    Full Text Available OBJECTIVE: The authors present a profile of panic disorder based on and generalized from the effects of acute and chronic hyperventilation that are characteristic of the respiratory panic disorder subtype. The review presented attempts to integrate three premises: hyperventilation is a physiological response to hypercapnia; hyperventilation can induce panic attacks; chronic hyperventilation is a protective mechanism against panic attacks. METHOD: A selective review of the literature was made using the Medline database. Reports of the interrelationships among panic disorder, hyperventilation, acidosis, and alkalosis, as well as catecholamine release and sensitivity, were selected. The findings were structured into an integrated model. DISCUSSION: The panic attacks experienced by individuals with panic disorder develop on the basis of metabolic acidosis, which is a compensatory response to chronic hyperventilation. The attacks are triggered by a sudden increase in (pCO2 when the latent (metabolic acidosis manifests as hypercapnic acidosis. The acidotic condition induces catecholamine release. Sympathicotonia cannot arise during the hypercapnic phase, since low pH decreases catecholamine sensitivity. Catecholamines can provoke panic when hyperventilation causes the hypercapnia to switch to hypocapnic alkalosis (overcompensation and catecholamine sensitivity begins to increase. CONCLUSION: Therapeutic approaches should address long-term regulation of the respiratory pattern and elimination of metabolic acidosis.OBJETIVO: Os autores apresentam um modelo de transtorno do pânico que se baseia nos efeitos da hiperventilação aguda e crônica, característicos do subtipo respiratório de transtorno do pânico. O modelo é generalizado a partir desses efeitos. Ele integra três características da hiperventilação: a hiperventilação é uma resposta fisiológica à hipercapnia; a hiperventilação pode induzir ataques de pânico; a hiperventila

  1. Headache and anxiety-depressive disorder comorbidity: the HADAS study.

    Science.gov (United States)

    Beghi, E; Allais, G; Cortelli, P; D'Amico, D; De Simone, R; d'Onofrio, F; Genco, S; Manzoni, G C; Moschiano, F; Tonini, M C; Torelli, P; Quartaroli, M; Roncolato, M; Salvi, S; Bussone, G

    2007-05-01

    Psychiatric comorbidity (prevalence and types) was tested in a naturalistic sample of adult patients with pure migraine without aura, and in two control groups of patients, one experiencing pure tension-type headache and the other combined migraine and tension-type headaches. The study population included 374 patients (158, 110 and 106) from nine Italian secondary and tertiary centres. Psychiatric comorbidity was recorded through structured interview and also screened with the Mini International Neuropsychiatry Interview (MINI). Only anxiety and depression were investigated. Psychiatric disorders were reported by 49 patients (14.6%; 10.9% of patients with migraine, 12.8% of those with tension-type headache and 21.4% of those with combined migraine and tension-type headaches). The MINI interview detected a depressive episode in 59.9% of patients with migraine, 68.3% of patients with tension-type headache and 69.6% of patients with combined migraine and tension-type headaches. Depression subtypes were significantly different across groups (p=0.03). Anxiety (mostly generalised) was reported by 18.4% of patients with migraine, 19.3% of patients with tension-type headache, and 18.4% of patients with combined migraine and tension-type headaches. The values for panic disturbance were 12.7, 5.5 and 14.2, and those for obsessive-compulsive disorders were 2.3, 1.1 and 9.4% (p=0.009). Based on these results, psychopathology of primary headache can be a reflection of the burden of the disease rather than a hallmark of a specific headache category.

  2. When women attack.

    Science.gov (United States)

    McLaughlin, Bryan; Davis, Catasha; Coppini, David; Kim, Young Mie; Knisely, Sandra; McLeod, Douglas

    2015-01-01

    The common assumption that female candidates on the campaign trail should not go on the attack, because such tactics contradict gender stereotypes, has not received consistent support. We argue that in some circumstances gender stereotypes will favor female politicians going negative. To test this proposition, this study examines how gender cues affect voter reactions to negative ads in the context of a political sex scandal, a context that should prime gender stereotypes that favor females. Using an online experiment involving a national sample of U.S. adults (N = 599), we manipulate the gender and partisan affiliation of a politician who attacks a male opponent caught in a sex scandal involving sexually suggestive texting to a female intern. Results show that in the context of a sex scandal, a female candidate going on the attack is evaluated more positively than a male. Moreover, while female participants viewed the female sponsor more favorably, sponsor gender had no effect on male participants. Partisanship also influenced candidate evaluations: the Democratic female candidate was evaluated more favorably than her Republican female counterpart.

  3. Attack Trees with Sequential Conjunction

    NARCIS (Netherlands)

    Jhawar, Ravi; Kordy, Barbara; Mauw, Sjouke; Radomirović, Sasa; Trujillo-Rasua, Rolando

    2015-01-01

    We provide the first formal foundation of SAND attack trees which are a popular extension of the well-known attack trees. The SAND at- tack tree formalism increases the expressivity of attack trees by intro- ducing the sequential conjunctive operator SAND. This operator enables the modeling of

  4. Psoriasis and comorbid diseases: Epidemiology.

    Science.gov (United States)

    Takeshita, Junko; Grewal, Sungat; Langan, Sinéad M; Mehta, Nehal N; Ogdie, Alexis; Van Voorhees, Abby S; Gelfand, Joel M

    2017-03-01

    Psoriasis is a common chronic inflammatory disease of the skin that is increasingly being recognized as a systemic inflammatory disorder. Psoriatic arthritis is a well-known comorbidity of psoriasis. A rapidly expanding body of literature in various populations and settings supports additional associations between psoriasis and cardiometabolic diseases, gastrointestinal diseases, kidney disease, malignancy, infection, and mood disorders. The pathogenesis of comorbid disease in patients with psoriasis remains unknown; however, shared inflammatory pathways, cellular mediators, genetic susceptibility, and common risk factors are hypothesized to be contributing elements. As additional psoriasis comorbidities continue to emerge, education of health care providers is essential to ensuring comprehensive medical care for patients with psoriasis. Copyright © 2016 American Academy of Dermatology, Inc. All rights reserved.

  5. Replacement Attack: A New Zero Text Watermarking Attack

    Science.gov (United States)

    Bashardoost, Morteza; Mohd Rahim, Mohd Shafry; Saba, Tanzila; Rehman, Amjad

    2017-03-01

    The main objective of zero watermarking methods that are suggested for the authentication of textual properties is to increase the fragility of produced watermarks against tampering attacks. On the other hand, zero watermarking attacks intend to alter the contents of document without changing the watermark. In this paper, the Replacement attack is proposed, which focuses on maintaining the location of the words in the document. The proposed text watermarking attack is specifically effective on watermarking approaches that exploit words' transition in the document. The evaluation outcomes prove that tested word-based method are unable to detect the existence of replacement attack in the document. Moreover, the comparison results show that the size of Replacement attack is estimated less accurate than other common types of zero text watermarking attacks.

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

    Science.gov (United States)

    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…

  7. Virtual Reality Exposure in the Treatment of Panic Disorder with Agoraphobia: A Case Study

    Science.gov (United States)

    Martin, Helena Villa; Botella, Cristina; Garcia-Palacios, Azucena; Osma, Jorge

    2007-01-01

    In this work we present a case example of the use of virtual reality exposure for the treatment of panic disorder with agoraphobia. The assessment protocol and procedure (including a baseline period) and the cognitive-behavioral treatment program are described. The clinical measures were categorized into target behaviors, panic and agoraphobia…

  8. Changes in respiration mediate changes in fear of bodily sensations in panic disorder

    NARCIS (Netherlands)

    Meuret, A.E.; Rosenfield, D.; Hofmann, S.G.; Suvak, M.K.; Roth, W.T.

    2009-01-01

    The purpose of the study was to examine whether changes in pCO(2) mediate changes in fear of bodily sensation (as indexed by anxiety sensitivity) in a bio-behavioral treatment for panic disorder that targets changes in end-tidal pCO(2). Thirty-five panic patients underwent 4 weeks of capnometry-assi

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

    Science.gov (United States)

    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 patients'…

  10. 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

  11. Preventing panic disorder: Cost-effectiveness analysis alongside a pragmatic randomised trial

    NARCIS (Netherlands)

    F. Smit (Filip); G. Willemse (Godelief); P. Meulenbeek (Peter); M.A. Koopmanschap (Marc); A.J.L.M. van Balkom (Anton); P. Spinhoven (Philip); P. Cuijpers (Pim)

    2009-01-01

    textabstractBackground: Panic disorder affects many people, is associated with a formidable disease burden, and imposes costs on society. The annual influx of new cases of panic disorder is substantial. From the public health perspective it may therefore be a sound policy to reduce the influx of new

  12. 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

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

    Science.gov (United States)

    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 patients'…

  14. Addiction and depression comorbidity approaches

    Directory of Open Access Journals (Sweden)

    Crnić Katarina A.B.

    2016-01-01

    Full Text Available Topic: Comorbidities, simultaneous occurrence of two or more disorders are common in psychiatry; therefore the concept of dual diagnosis was established due to new ethiopatogenetic dilemmas and principles of diagnosis and treatment of these conditions. The most common are comorbid affective disorders and comorbidity of drug addictions and affective disorders. Topic position in medical public: Epidemiological studies show a high percentage of comorbidity of drug addictions and depression. Various studies show that about one-third of individuals with depression have addiction, and often some other psychiatric disorders are present, such as personality disorder, anxiety, and bipolar affective disorder. Comorbid disorders exacerbate one another; have tendencies to chronicity and treatment resistance. The problem of adequate diagnosis is common; other diagnosis is neglected, leading to inadequate treatment and poor outcomes. Researches of possible causes of addiction and depression comorbidity follow different theoretical assumptions. One favor genetically determined vulnerability, the others are addressing to the impact of trauma in the formative stages of personality development. Widespread is the theoretical assumption on the deficit functioning of the same regions of the CNS and the same neurotransmitters system. In previous studies the preclinical ones dominate, which are theoretically placed in the context of the CNS of a man. Most of the research are related to dysfunction of the serotonergic and dopaminergic systems, whose influence on addiction and depression are clear, and recent studies show the importance of neuromodulators and their receptors, for example, the role of natural opioid dynorphin and 'kappa' receptors in the mesolimbic reward system. Further action: The better diagnosis would require proper screening of patients entering addiction treatments for affective disorders and vice versa. Treatment have to be combined; in addition

  15. Structural Learning of Attack Vectors for Generating Mutated XSS Attacks

    Directory of Open Access Journals (Sweden)

    Yi-Hsun Wang

    2010-09-01

    Full Text Available Web applications suffer from cross-site scripting (XSS attacks that resulting from incomplete or incorrect input sanitization. Learning the structure of attack vectors could enrich the variety of manifestations in generated XSS attacks. In this study, we focus on generating more threatening XSS attacks for the state-of-the-art detection approaches that can find potential XSS vulnerabilities in Web applications, and propose a mechanism for structural learning of attack vectors with the aim of generating mutated XSS attacks in a fully automatic way. Mutated XSS attack generation depends on the analysis of attack vectors and the structural learning mechanism. For the kernel of the learning mechanism, we use a Hidden Markov model (HMM as the structure of the attack vector model to capture the implicit manner of the attack vector, and this manner is benefited from the syntax meanings that are labeled by the proposed tokenizing mechanism. Bayes theorem is used to determine the number of hidden states in the model for generalizing the structure model. The paper has the contributions as following: (1 automatically learn the structure of attack vectors from practical data analysis to modeling a structure model of attack vectors, (2 mimic the manners and the elements of attack vectors to extend the ability of testing tool for identifying XSS vulnerabilities, (3 be helpful to verify the flaws of blacklist sanitization procedures of Web applications. We evaluated the proposed mechanism by Burp Intruder with a dataset collected from public XSS archives. The results show that mutated XSS attack generation can identify potential vulnerabilities.

  16. [Psychiatric comorbidity in pathological gambling].

    Science.gov (United States)

    Skokauskas, Norbertas; Satkeviciūte, Regina; Burba, Benjaminas

    2003-01-01

    In this article the peculiarities of psychiatric comorbidity in pathological gambling were investigated. The authors were based both on the data of many foreign scientists and on their own one. Our data on 77 cases of pathological gambling were collected based on interviews of Lithuanian psychiatrists and psychotherapists about their patients with gambling addiction in period from 1991 to 2001. The data that we publish and analyze allows us to make conclusions that pathological gambling can reveal together with very wide spectrum of psychiatric disorders, but more often with alcoholism and depression. The mechanism of psychiatric comorbidity in pathological gambling is very complex.

  17. Comorbidities in interstitial lung diseases

    Directory of Open Access Journals (Sweden)

    George A. Margaritopoulos

    2017-01-01

    Full Text Available Fibrosing lung disorders include a large number of diseases with diverse behaviour. Patients can die because of the progression of their illness, remain stable or even improve after appropriate treatment has been instituted. Comorbidities, such as acute and chronic infection, gastro-oesophageal reflux, pulmonary hypertension, lung cancer, cardiovascular diseases, and obstructive sleep apnoea, can pre-exist or develop at any time during the course of the disease and, if unidentified and untreated, may impair quality of life, impact upon the respiratory status of the patients, and ultimately lead to disease progression and death. Therefore, early identification and accurate treatment of comorbidities is essential.

  18. Vascular comorbidities in multiple sclerosis

    DEFF Research Database (Denmark)

    Thormann, Anja; Magyari, Melinda; Koch-Henriksen, Nils

    2016-01-01

    To investigate the occurrence of vascular comorbidities before and after the clinical onset of multiple sclerosis. In this combined case-control and cohort study, all Danish born citizens with onset of multiple sclerosis 1980-2005 were identified from the Danish Multiple Sclerosis Registry...... and randomly matched with controls regarding year of birth, gender, and municipality on January 1st in the year of multiple sclerosis (MS) onset (index date). Individual-level information on comorbidities was obtained from several independent nationwide registries and linked to the study population by unique...

  19. Seven Deadliest Unified Communications Attacks

    CERN Document Server

    York, Dan

    2010-01-01

    Do you need to keep up with the latest hacks, attacks, and exploits effecting Unified Communications technology? Then you need Seven Deadliest Unified Communication Attacks. This book pinpoints the most dangerous hacks and exploits specific to Unified Communications, laying out the anatomy of these attacks including how to make your system more secure. You will discover the best ways to defend against these vicious hacks with step-by-step instruction and learn techniques to make your computer and network impenetrable. Attacks featured in this book include: UC Ecosystem Attacks Insecure Endpo

  20. Panic with a twist: an unusual presentation of combined psychiatric and neurologic symptoms in a tactical jet aviator.

    Science.gov (United States)

    Krentz, M J; Hopkins, E W; Moore, J L

    1997-03-01

    A 28-yr-old Naval F-14 aviator presented with complaints of flight-related anxiety occurring intermittently over an 18-mo period. Symptoms included sensation of strangeness, concern over the welfare of his radar intercept officer, flushing, nausea, and intense need to immediately land the aircraft. He also described a 6-mo history of episodes wherein he would see "shooting stars" in the periphery of his vision, accompanied by dizziness and disorientation. These latter attacks were always precipitated by head turning, usually in combination with positive Gz maneuvers, and were relieved by head straightening. The anxiety symptoms were consistent with a form of panic attack, but the neurological symptoms provoked further workup. Magnetic resonance cerebral angiogram demonstrated a dominant right vertebral artery and hypoplastic left vertebral artery. All symptoms resolved once the aviator was removed from flying the aircraft. After a year of follow-up with an aviation psychiatrist, he remained asymptomatic and was reassigned to maritime patrol aircraft. This case illustrates a difficult diagnostic, therapeutic, and disposition challenge. This aviator suffered from a complex interaction of neurologic and psychiatric manifestations having a common inciting stimulus, namely flying the F-14 Tomcat. A promising aviation career was preserved upon removal of that stimulus.

  1. Agent Based Modeling and Simulation of Pedestrian Crowds In Panic Situations

    KAUST Repository

    Alrashed, Mohammed

    2016-11-01

    The increasing occurrence of panic stampedes during mass events has motivated studying the impact of panic on crowd dynamics and the simulation of pedestrian flows in panic situations. The lack of understanding of panic stampedes still causes hundreds of fatalities each year, not to mention the scarce methodical studies of panic behavior capable of envisaging such crowd dynamics. Under those circumstances, there are thousands of fatalities and twice that many of injuries every year caused be crowd stampede worldwide, despite the tremendous efforts of crowd control and massive numbers of safekeeping forces. Pedestrian crowd dynamics are generally predictable in high-density crowds where pedestrians cannot move freely and thus gives rise to self-propelling interactions between pedestrians. Although every pedestrian has personal preferences, the motion dynamics can be modeled as a social force in such crowds. These forces are representations of internal preferences and objectives to perform certain actions or movements. The corresponding forces can be controlled for each individual to represent a different variety of behaviors that can be associated with panic situations such as escaping danger, clustering, and pushing. In this thesis, we use an agent-based model of pedestrian behavior in panic situations to predict the collective human behavior in such crowd dynamics. The proposed simulations suggests a practical way to alleviate fatalities and minimize the evacuation time in panic situations. Moreover, we introduce contagious panic and pushing behavior, resulting in a more realistic crowd dynamics model. The proposed methodology describes the intensity and spread of panic for each individual as a function of distances between pedestrians.

  2. Structural Learning of Attack Vectors for Generating Mutated XSS Attacks

    CERN Document Server

    Wang, Yi-Hsun; Lee, Hahn-Ming; 10.4204/EPTCS.35.2

    2010-01-01

    Web applications suffer from cross-site scripting (XSS) attacks that resulting from incomplete or incorrect input sanitization. Learning the structure of attack vectors could enrich the variety of manifestations in generated XSS attacks. In this study, we focus on generating more threatening XSS attacks for the state-of-the-art detection approaches that can find potential XSS vulnerabilities in Web applications, and propose a mechanism for structural learning of attack vectors with the aim of generating mutated XSS attacks in a fully automatic way. Mutated XSS attack generation depends on the analysis of attack vectors and the structural learning mechanism. For the kernel of the learning mechanism, we use a Hidden Markov model (HMM) as the structure of the attack vector model to capture the implicit manner of the attack vector, and this manner is benefited from the syntax meanings that are labeled by the proposed tokenizing mechanism. Bayes theorem is used to determine the number of hidden states in the model...

  3. Exercício aeróbio como terapia de exposição a estímulos interoceptivos no tratamento do transtorno de pânico Aerobic exercise as exposure therapy to interoceptive cues in panic disorder

    Directory of Open Access Journals (Sweden)

    Ricardo William Muotri

    2007-10-01

    Full Text Available Os ataques de pânico são representados por um período distinto no qual há o início súbito de intensa apreensão, temor ou terror, freqüentemente associados com sentimentos de catástrofe iminente, diagnosticado em aproximadamente 10% da população. O Transtorno de Pânico é um transtorno de ansiedade que se caracteriza pela recorrência de ataques de pânico: crises súbitas de mal-estar e sensação de perigo ou morte iminente, acompanhadas de diversos sintomas físicos e cognitivos. Os indivíduos com Transtorno de Pânico apresentam, caracteristicamente, preocupações acerca das implicações ou conseqüências dos ataques de pânico. É uma condição clínica complexa que envolve diferentes modalidades ou conglomerados de sintomas. Assim, o foco nas sensações físicas erroneamente interpretadas no transtorno de pânico e na hipocondria centraliza-se basicamente nas manifestações autonômicas, como taquicardia e dispnéia. Há poucos estudos sobre atividade física e transtorno de pânico. O principal objetivo do estudo visa identificar com diferentes descrições se há uma população "nuclear" com sintomas predominantemente respiratórios apresentando esquiva de atividade física e a influência do exercício nesta população.Panic attacks are represented by distinct periods in which there is a sudden beginning of internal apprehension, fear or terror, frequently associated with feelings of imminent catastrophe, diagnosed in approximately 10% of the population. The panic disorder is an anxiety crisis that is characterized by the recurrence of panic attacks: sudden crises of uneasiness and sensation of danger or imminent death, followed by diverse physical and cognitive symptoms. Individuals with panic disorder are characteristically concerned about panic attacks implications or consequences. It is a complex clinical condition that involves different modalities or myriad of symptoms. Thus, the focus on the physical

  4. Fobia social e transtorno de pânico: relação temporal com dependência de substâncias psicoativas Fobia Social y trastorno de pánico: relación temporaria con dependencia de sustancias psicoactivas Social phobia and panic disorder: temporal relation with psychoactive substance dependence

    Directory of Open Access Journals (Sweden)

    Mauro Barbosa Terra

    2003-12-01

    of panic disorder and social phobia. RESULTS: Only 1 (2 % patient had panic disorder before using psychoactive substances. Most of the patients suffering from panic disorder fulfilled the criteria for the diagnosis of anxiety disorder induced by use of the substance: 11 (22.9 % of them had panic attacks only while under the effect of drugs or during the withdrawal syndrome, i.e., secondarily to the use of drugs. Sixteen (33.3 % of the patients had social phobia, and in all of them, the social phobia began before the use of psychoactive substances. CONCLUSIONS: The findings confirmed the high frequency of social phobia in psychoactive substance-dependent patients and they reinforce the self-medication hypothesis in this comorbidity, since that kind of phobia tends to precede the use of drugs. As for panic disorder, in our sample it appears to derive from a complication of the use of psychoactive substances.

  5. Interaction effects in comorbid psychopathology.

    Science.gov (United States)

    Keeley, Jared W; Chmielewski, Michael S; Bagby, R Michael

    2015-07-01

    Comorbidity in psychopathology is the norm. Despite some initial evidence, few studies have examined if the presence of comorbid conditions changes the expression of the pathology, either through increased severity of the syndrome(s) or by expanding to symptoms beyond the syndrome(s) (i.e., symptom overextension). The following report provides an illustration of interactive effects and overextension in comorbid pathology. A large pool of patients from a university hospital were assessed using SCID-I/P interviews. Of these, 230 patients diagnosed with major depressive disorder, social phobia, or both were included in the study. Symptoms not belonging to either index condition (major depressive disorder or social phobia) reliably overextended in comorbid cases (odds ratios between 2.82 and 15.75). Current research methodologies (e.g., structured interviews) do not allow for the examination of overextended symptoms. The authors make a call for future psychopathological research to search systematically for interactive effects by adopting more inclusive or flexible assessments. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. Inverse comorbidity in multiple sclerosis

    DEFF Research Database (Denmark)

    Thormann, Anja; Koch-Henriksen, Nils; Laursen, Bjarne

    2016-01-01

    onset of MS 1980-2005. We randomly matched each MS-case with five population controls. Comorbidity data were obtained from multiple, independent nationwide registries. Cases and controls were followed from January 1977 to the index date, and from the index date through December 2012. We controlled...

  7. Comorbidity among the anxiety disorders

    NARCIS (Netherlands)

    de Ruiter, C.; Rijken, H.; Garssen, B.; van Schaik, A.; Kraaimaat, F.

    1989-01-01

    This paper reports on the diagnoses of 120 consecutive referrals to an outpatient research program on anxiety disorders. Patients were diagnosed according to DSM-III-R criteria using a structured interview. Patterns of comorbidity among disorders were examined using two diagnostic procedures. One

  8. Attacks on computer systems

    Directory of Open Access Journals (Sweden)

    Dejan V. Vuletić

    2012-01-01

    Full Text Available Computer systems are a critical component of the human society in the 21st century. Economic sector, defense, security, energy, telecommunications, industrial production, finance and other vital infrastructure depend on computer systems that operate at local, national or global scales. A particular problem is that, due to the rapid development of ICT and the unstoppable growth of its application in all spheres of the human society, their vulnerability and exposure to very serious potential dangers increase. This paper analyzes some typical attacks on computer systems.

  9. The attack navigator

    DEFF Research Database (Denmark)

    Probst, Christian W.; Willemson, Jan; Pieters, Wolter

    2016-01-01

    The need to assess security and take protection decisions is at least as old as our civilisation. However, the complexity and development speed of our interconnected technical systems have surpassed our capacity to imagine and evaluate risk scenarios. This holds in particular for risks...... that are caused by the strategic behaviour of adversaries. Therefore, technology-supported methods are needed to help us identify and manage these risks. In this paper, we describe the attack navigator: a graph-based approach to security risk assessment inspired by navigation systems. Based on maps of a socio...

  10. Lack of association between the serotonin transporter promoter polymorphism (5-HTTLPR) and personality traits in asymptomatic patients with panic disorder.

    Science.gov (United States)

    Wachleski, Cláudia; Blaya, Carolina; Salum, Giovanni Abrahão; Vargas, Verônica; Leistner-Segal, Sandra; Manfro, Gisele Gus

    2008-01-31

    The serotonin transporter promoter polymorphism (5-HTTLPR) has been investigated regarding its association with neuroticism, which, in its turn, is a personality dimension often found in patients with panic disorder (PD). It has been recently evidenced that the long 5-HTTLPR polymorphism has a genetic variation (Lg), which is related to its lower expression. The objective of this study was to assess the association between the 5-HTTLPR polymorphism in the triallelic system and the neurotic personality traits in patients in PD remission. Sixty-seven Caucasian patients with PD diagnosis according to the DSM-IV-TR assessed with the MINI (mini international neuropsychiatric interview) were included. The MMPI (Minnesota multiphasic personality inventory) was used to assess the personality. The remission of PD symptoms was defined as CGI (clinical global impression) panic attacks. The patients' genotypes were grouped according to the level of expression: low expression (SS, SLg and LgLg), intermediate expression (SLa, LgLa) and high expression (LaLa). There was no significant deviation from Hardy-Weinberg equilibrium (chi2=0.52, d.f.=1, p=0.471). According to the triallelic classification, the distribution of alleles in these patients was as follows: S 58 (43.3%), Lg 17 (12.7%) and La 59 (44.0%). There were no significant differences on the MMPI scales between different genotype classifications and allele analyses. Larger samples are necessary to exclude the less relevant genetic influences on these traits. In addition, other polymorphisms should be considered in the characterization of a heritable phenotype in the PD.

  11. A serotonergic deficit in the dorsal periaqueductal gray matter may underpin enhanced panic-like behavior in diabetic rats.

    Science.gov (United States)

    Gambeta, Eder; Sestile, Caio C; Fogaça, Manoela V; Guimarães, Francisco S; Audi, Elisabeth A; da Cunha, Joice M; Zangrossi, Hélio; Shimene de Melo Yamashita, Paula; Zanoveli, Janaina M

    2017-08-09

    It is known that diabetic (DBT) animals present dysregulation on the serotonergic system in several brain areas associated with anxiety-like responses. The aim of this study was to investigate the involvement of 5-HT1A receptors on dorsal periaqueductal gray (dPAG) in the behavioral response related to panic disorder in type-1 DBT animals. For this, the escape response by electric stimulation (ES) of dPAG in DBT and normoglycemic (NGL) animals was assessed. Both NGL and DBT animals were exposed to an open-field test (OFT) 28 days after DBT confirmation. The current threshold to induce escape behavior in DBT animals was reduced compared with NGL animals. No impairment in locomotor activity was observed when DBT animals were compared with NGL animals. An intra-dPAG injection of the 5-HT1A receptor agonist (±)-8-hydroxy-2-(di-n-propylamino)tetralin (8-OH-DPAT) increased the [INCREMENT] threshold in both DBT and NGL, suggesting a panicolytic-like effect. DBT animals presented a more pronounced panicolytic-like response compared with NGL as a higher [INCREMENT] threshold was observed after 8-OH-DPAT treatment, which could be a consequence of the increased expression of the 5-HT1A receptor in the dPAG from DBT animals. Our results are in line with the proposal that a deficiency in serotonergic modulation of the dPAG is involved in triggering the panic attack and the 5-HT1A receptors might be essential for the panicolytic-like response.

  12. Recent "phishing" attacks

    CERN Multimedia

    IT Department

    2009-01-01

    Over the last few weeks there has been a marked increase in the number of attacks on CERN made by cybercriminals. Typical attacks arrive in the form of e-mail messages purporting to come from the CERN Help Desk, Mail Service, or some similarly official-sounding entity and suggest that there is a problem with your account, such as it being over-quota. They then ask you to click on a link or to reply and give your password. Please don’t! Be cautious of any unexpected messages containing web links even if they appear to come from known contacts. If you happen to click on such a link and if your permission is requested to run or install software, always decline it. NEVER provide your password or other details if these are requested. These messages try to trick you into clicking on Web links which will help them to install malicious software on your computer, and anti-virus software cannot be relied on to detect all cases. In case of questions on this topic, you may contact mailto:helpdesk@cern.ch. CERN Comput...

  13. Refluxo gastroesofágico participando da cascata cognitiva do pânico Gastroesophageal reflux participating on panic cognitive cascade

    Directory of Open Access Journals (Sweden)

    Kalil Duailibi

    2008-01-01

    Full Text Available O transtorno do pânico (TP é um transtorno ansioso não-fóbico que acomete de 1,5% a 4% da população mundial. É caracterizado por ataques imotivados de mal-estar psíquico e sintomas somáticos, além de ansiedade antecipatória à crise, com prejuízo funcional ao indivíduo. O objetivo deste relato de caso é descrever a associação entre transtorno do pânico e doença do refluxo gastroesofágico (DRGE. MCL, 25 anos, apresentava crises de pânico frequentes, pouco responsivas ao tratamento durante 6 meses, mesmo com readequação da farmacoterapia. Iniciou-se investigação, sendo fechado o diagnóstico de DRGE, cujo tratamento culminou em remissão das crises de pânico. A dor torácica aguda da DRGE era interpretada como ameaça proximal, ocasionando dúvidas sobre passar mal e hiperventilação, servindo como gatilho da cascata cognitiva do pânico, no mesencéfalo dorsal. A inflamação da mucosa esofágica funciona como ameaça distal, estimulando a amígdala e causando ansiedade antecipatória, mantendo a elevação dos hormônios de estresse. Segundo o modelo de Deakin-Graeff, embora a 5-HT iniba o ataque de pânico e facilite a ansiedade antecipatória, no TP esta última é estimulada por meio do núcleo dorsal da rafe. Portanto, casos que incluem a associação TP e DRGE devem ser mais bem examinados, para que haja diagnóstico e tratamento adequados.Panic disorder (PD is a non phobic anxiety disorder that affects 1,5 to 4% worldwide. It is characterized by unmotivated acute attacks, with mental and somatic symptoms, and by an anxiety which precedes the crises, resulting in functional disturbance. The objective of this case study is to describe the association between PD and gastroesophageal reflux (GR. MCL, 25 years, presented with frequent panic crises, with low response to the therapy for 6 months, even after modification of medication doses. Investigation was carried out and diagnoses defined as GR. The treatment resulted

  14. The internalizing and externalizing structure of psychiatric comorbidity in combat veterans.

    Science.gov (United States)

    Miller, Mark W; Fogler, Jason M; Wolf, Erika J; Kaloupek, Danny G; Keane, Terence M

    2008-02-01

    This study examined the latent structure of psychiatric disorders in a sample with a high prevalence of PTSD. A series of confirmatory factor analyses tested competing models for the covariation between Structured Clinical Interview for DSM-III-R diagnoses among 1,325 Vietnam veterans. The best-fitting solution was a 3-factor model that included two correlated internalizing factors: anxious-misery, defined by PTSD and major depression, and fear, defined by panic disorder/agoraphobia and obsessive-compulsive disorder. The third factor, externalizing, was defined by antisocial personality disorder, alcohol abuse/dependence, and drug abuse/dependence. Both substance-related disorders also showed significant, albeit smaller, cross-loadings on the anxious-misery factor. These findings shed new light on the structure of psychiatric comorbidity in a treatment-seeking sample characterized by high rates of PTSD.

  15. Mindfulness-based stress reduction for comorbid anxiety and depression: case report and clinical considerations.

    Science.gov (United States)

    Hazlett-Stevens, Holly

    2012-11-01

    Growing research literature has documented the effectiveness of mindfulness-based interventions for anxiety and depressive disorders. Mindfulness-based stress reduction (MBSR) teaches a series of mindfulness meditation and yoga practices, delivered in a group format during eight weekly sessions plus one full-day session. This case report demonstrates how MBSR was associated with dramatic clinical improvement of an individual with symptoms of panic, generalized anxiety, and depression. Scores on clinical assessment measures suggested clinically severe levels of anxious arousal, generalized anxiety, worry, fear of negative evaluation, and depression at the beginning of the intervention. The scores on all these measures fell well within normal limits 7 weeks later at the end of the intervention, and no remaining symptoms were reported afterward. Increased life satisfaction and quality of life were documented as well. This case illustrates the potential benefit of MBSR as an alternative or adjunctive treatment for comorbid anxiety and depressive disorder symptoms.

  16. Quality of Smartphone Apps Related to Panic Disorder.

    Science.gov (United States)

    Van Singer, Mathias; Chatton, Anne; Khazaal, Yasser

    2015-01-01

    Quality of smartphone apps related to panic: smartphone apps have a growing role in health care. This study assessed the quality of English-language apps for panic disorder (PD) and compared paid and free apps. Keywords related to PD were entered into the Google Play Store search engine. Apps were assessed using the following quality indicators: accountability, interactivity, self-help score (the potential of smartphone apps to help users in daily life), and evidence-based content quality. The Brief DISCERN score and the criteria of the "Health on the Net" label were also used as content quality indicators as well as the number of downloads. Of 247 apps identified, 52 met all inclusion criteria. The content quality and self-help scores of these PD apps were poor. None of the assessed indicators were associated with payment status or number of downloads. Multiple linear regressions showed that the Brief DISCERN score significantly predicted the content quality and self-help scores. Poor content quality and self-help scores of PD smartphone apps highlight the gap between their technological potential and the overall quality of available products.

  17. Implications of Psychiatric Comorbidity Among Combat Veterans

    Science.gov (United States)

    2013-10-01

    through the military health care network. Mental health care from non-TRICARE providers were not included in our data. Furthermore, out of fear of...Yonkers KA, Otto MW, et al; Influence of psychiatric comor- bidity on recovery and recurrence in generalized anxiety disorder, social phobia , and panic

  18. Decreased left temporal lobe volume of panic patients measured by magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Uchida, R.R.; Del-Ben, C.M.; Araujo, D.; Crippa, J.A.; Graeff, F.G. [Sao Paulo Univ., Ribeirao Preto, SP (Brazil). Dept. de Neurologia e Psicologia Medica]. E-mail: fgraeff@keynet.com.br; Santos, A.C. [Sao Paulo Univ., Ribeirao Preto, SP (Brazil). Dept. de Clinica Medica; Guimaraes, F.S. [Sao Paulo Univ., Ribeirao Preto, SP (Brazil). Dept. de Farmacologia

    2003-07-01

    Reported neuroimaging studies have shown functional and morphological changes of temporal lobe structures in panic patients, but only one used a volumetric method. The aim of the present study was to determine the volume of temporal lobe structures in patients with panic disorder, measured by magnetic resonance imaging. Eleven panic patients and eleven controls matched for age, sex, handedness, socioeconomic status and years of education participated in the study. The mean volume of the left temporal lobe of panic patients was 9% smaller than that of controls (t{sub 21} = 2.37, P = 0.028). In addition, there was a trend (P values between 0.05 and 0.10) to smaller volumes of the right temporal lobe (7%, t{sub 21} = 1.99, P = 0.06), right amygdala (8%, t{sub 21} = 1.83, P = 0.08), left amygdala (5%, t{sub 21} = 1.78, P 0.09) and left hippocampus (9%, t{sub 21} = 1.93, P = 0.07) in panic patients compared to controls. There was a positive correlation between left hippocampal volume and duration of panic disorder (r = 0.67, P = 0.025), with recent cases showing more reduction than older cases. The present results show that panic patients have a decreased volume of the left temporal lobe and indicate the presence of volumetric abnormalities of temporal lobe structures. (author)

  19. Do panic patients process unconditioned fear vs. conditioned anxiety differently than normal subjects?

    Science.gov (United States)

    Del-Ben, C M; Vilela, J A; Hetem, L A; Guimarães, F S; Graeff, F G; Zuardi, A W

    2001-11-30

    Panic patients were evaluated with two models of experimental anxiety that are believed to generate distinct emotional states: (1) a stimulated public speaking test (SPS), a presumed indicator of unconditioned fear, and (2) conditioning of skin conductance responses (CSCR) to a tone associated with an aversive white noise, an index of conditioned anxiety. Subjective states were evaluated through the visual analogue mood scale (VAMS) and a bodily symptoms scale (BSS). In the SPS test, panic patients showed higher baseline levels of VAMS-measured anxiety than controls. Unlike controls, panic patients failed to show increased anxiety before and during speech. Although baseline levels of arousal were similar in both groups, VAMS mental sedation decreased in controls, but not in panic patients during the SPS. Panic patients showed more discontent than controls throughout the whole experimental session. They also scored higher than controls on several items of the BSS. In the CSCR test, panic patients showed more spontaneous fluctuations of skin conductance than controls. Nevertheless, conditioning of skin conductance responses to the tone was similar in both groups. Therefore, panic patients seemed to process unconditioned fear abnormally.

  20. SIRS Model of Passengers’ Panic Propagation under Self-Organization Circumstance in the Subway Emergency

    Directory of Open Access Journals (Sweden)

    Haifeng Zhao

    2014-01-01

    Full Text Available Subway emergency may lead to passengers’ panic, especially under self-organizing circumstance, which will spread rapidly and have an adverse impact on the society. This paper builds an improved SIRS model of passengers’ panic spread in subway emergency with consideration of passengers’ density, the characteristic of subway car with the confined space, and passengers’ psychological factors. The spread of passengers’ panic is simulated by use of Matlab, which draws the rules of how group panic spreads dynamically. The trend of stable point of the infection ratio is analyzed by changing different parameters, which help to draw a conclusion that immunization rate, spontaneous immune loss rate, and passenger number have a great influence on the final infected ratio. Finally, we propose an integrated control strategy and find the peak of passengers’ panic and the final infected ratio is greatly improved through the numerical simulation. The research plays a vital role in helping the government and subway administration to master the panic spread mechanism and reduce the panic spread by improving measures and also provides certain reference significance for rail system construction, emergency contingency plans, and the construction and implementation of emergency response system.

  1. Vestibular vertigo and comorbid cognitive and psychiatric impairment: the 2008 National Health Interview Survey.

    Science.gov (United States)

    Bigelow, Robin T; Semenov, Yevgeniy R; du Lac, Sascha; Hoffman, Howard J; Agrawal, Yuri

    2016-04-01

    Patients with vestibular disease have been observed to have concomitant cognitive and psychiatric dysfunction. We evaluated the association between vestibular vertigo, cognitive impairment and psychiatric conditions in a nationally representative sample of US adults. We performed a cross-sectional analysis using the 2008 National Health Interview Survey (NHIS), which included a Balance and Dizziness Supplement, and questions about cognitive function and psychiatric comorbidity. We evaluated the association between vestibular vertigo, cognitive impairment (memory loss, difficulty concentrating, confusion) and psychiatric diagnoses (depression, anxiety and panic disorder). We observed an 8.4% 1-year prevalence of vestibular vertigo among US adults. In adjusted analyses, individuals with vestibular vertigo had an eightfold increased odds of 'serious difficulty concentrating or remembering' (OR 8.3, 95% CI 4.8 to 14.6) and a fourfold increased odds of activity limitation due to difficulty remembering or confusion (OR 3.9, 95% CI 3.1 to 5.0) relative to the rest of the US adults. Individuals with vestibular vertigo also had a threefold increased odds of depression (OR 3.4, 95% CI 2.9 to 3.9), anxiety (OR 3.2, 95% CI 2.8 to 3.6) and panic disorder (OR 3.4, 95% CI 2.9 to 4.0). Our findings indicate that vestibular impairment is associated with increased risk of cognitive and psychiatric comorbidity. The vestibular system is anatomically connected with widespread regions of the cerebral cortex, hippocampus and amygdala. Loss of vestibular inputs may lead to impairment of these cognitive and affective circuits. Further longitudinal research is required to determine if these associations are causal. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  2. Tracing Technique for Blaster Attack

    CERN Document Server

    S., Siti Rahayu; S., Shahrin; A., Faizal M; M, Mohd Zaki; R, Irda

    2009-01-01

    Blaster worm of 2003 is still persistent, the infection appears to have successfully transitioned to new hosts as the original systems are cleaned or shut off, suggesting that the Blaster worm, and other similar worms, will remain significant Internet threats for many years after their initial release. This paper is to propose technique on tracing the Blaster attack from various logs in different OSI layers based on fingerprint of Blaster attack on victim logs, attacker logs and IDS alert log. The researchers intended to do a preliminary investigation upon this particular attack so that it can be used for further research in alert correlation and computer forensic investigation.

  3. The Timing of Terrorist Attacks

    DEFF Research Database (Denmark)

    Jensen, Thomas

    2016-01-01

    I use a simple optimal stopping model to derive policy relevant insights on the timing of one-shot attacks by small autonomous terrorist units or “lone wolf” individuals. A main insight is that an increase in proactive counterterrorism measures can lead to a short term increase in the number...... of attempted terrorist attacks because it makes it more risky for existing terrorist units to pursue further development of capabilities. This is consistent with the events in London in 2005 where a terrorist attack on 7 July was followed by a similar but unsuccessful attack two weeks later....

  4. Seven Deadliest Social Network Attacks

    CERN Document Server

    Timm, Carl

    2010-01-01

    Do you need to keep up with the latest hacks, attacks, and exploits effecting social networks? Then you need Seven Deadliest Social Network Attacks. This book pinpoints the most dangerous hacks and exploits specific to social networks like Facebook, Twitter, and MySpace, laying out the anatomy of these attacks including how to make your system more secure. You will discover the best ways to defend against these vicious hacks with step-by-step instruction and learn techniques to make your computer and network impenetrable. Attacks detailed in this book include: Social Networking Infrastruct

  5. Seven Deadliest Web Application Attacks

    CERN Document Server

    Shema, Mike

    2010-01-01

    Do you need to keep up with the latest hacks, attacks, and exploits effecting web applications? Then you need Seven Deadliest Web Application Attacks. This book pinpoints the most dangerous hacks and exploits specific to web applications, laying out the anatomy of these attacks including how to make your system more secure. You will discover the best ways to defend against these vicious hacks with step-by-step instruction and learn techniques to make your computer and network impenetrable. .. .. Attacks detailed in this book include: ..: ..; Cross-Site Scripting (XSS) ..; Cross-Site Request Fo

  6. Cardiovascular comorbidity in rheumatoid arthritis

    OpenAIRE

    Holmqvist, Marie E

    2010-01-01

    This thesis is based on four different studies, all focusing on co-morbidities in rheumatoid arthritis. Diabetes mellitus is assessed as a risk factor for rheumatoid arthritis, the temporal relationship between ischemic heart disease and rheumatoid arthritis, and the extent of coronary stenosis in rheumatoid arthritis, is studied. The rationale for this is that patients with rheumatoid arthritis suffer an increased risk of ischemic heart disease that cannot be explained by traditional risk fa...

  7. Global panic reaction--a therapeutic approach to a world-wide economic crisis.

    Science.gov (United States)

    Sperling, W; Biermann, T; Maler, J M

    2009-08-01

    Drastic losses on the stock markets within short periods have been the subject of numerous investigations in view of the fact that they are often irrational. In a recently published model we reported about the world-wide phenomenon of Global panic reaction (GPR) [Sperling W, Bleich S, Reulbach U. Black Monday on stock markets throughout the world - a new phenomenon of collective panic disorder? A psychiatric approach. Med Hypotheses 2008;71(6):972-4], which illustrate typical psychiatric symptoms of panic disorder. We now complete this model by a therapeutic approach for the patient. Therefore the identification of a therapeutic regime "step by step" was necessary.

  8. The Living Dead: the Uncanny and Nineteenth-Century Moral Panic over Premature Burial

    Directory of Open Access Journals (Sweden)

    Natalia Wójcicka

    2010-11-01

    Full Text Available The fear of premature burial during the nineteenth century escalated to a phenomenon of moral panic. Fueled by the imperfections of the cardiorespiratory standard of death, which allowed for mistakes in pronouncing a person dead, and by the feeling of the uncanny connected to doubts whether an object – a corpse – is animate or inanimate, the moral panic surfaced in a number of forms, including literature, journalism, but also science and legislation. The present study shows how these forms were both an effect of the panic and, simultaneously, a factor which served to uphold and shape it further.

  9. Efficacy of atropine combined with paroxetine in vagus nerve excitatory panic disorder

    Directory of Open Access Journals (Sweden)

    Du N

    2015-07-01

    Full Text Available Na Du, Xue-Li Sun Department of Psychiatry, West China Hospital, Sichuan University, Chengdu, People’s Republic of China Abstract: Panic disorder is often associated with the autonomic nervous system pattern – sympathetic activation and parasympathetic (vagal withdrawal. However, we present one special case here to show a totally reversed pathogenesis – vagal activation occupying the leading role, which requires atropine to cure the patient’s symptoms. Through this report, it is reasonably proven that panic disorder may be a heterogeneous condition, whose mechanism might be the imbalance between the sympathetic and parasympathetic tone. Keywords: panic disorder, vagal activation, bradycardia, atropine

  10. Financial News and Market Panics in the Age of Highfrequency Sentiment Trading Algorithms

    DEFF Research Database (Denmark)

    Kleinnijenhuis, Jan; Schultz, Friederike; Oegema, Dirk

    2013-01-01

    Whether financial news may contribute to market panics is not an innocent question. A positive answer is easily used as a legitimation to limit the freedom of financial journalists. Long-term effects of news are moreover inconsistent with the Efficient Market Hypothesis (EMH), which maintains....... As a case study of a market panic we show the impact of US news, UK news and Dutch news on three Dutch banks during the financial crisis of 2007–9. To avoid market panics, financial journalists may strive for greater transparency, not only on asset prices and corporate philosophies, but also on network...

  11. Panic-like defensive behavior but not fear-induced antinociception is differently organized by dorsomedial and posterior hypothalamic nuclei of Rattus norvegicus (Rodentia, Muridae

    Directory of Open Access Journals (Sweden)

    A.F. Biagioni

    2012-04-01

    Full Text Available The hypothalamus is a forebrain structure critically involved in the organization of defensive responses to aversive stimuli. Gamma-aminobutyric acid (GABAergic dysfunction in dorsomedial and posterior hypothalamic nuclei is implicated in the origin of panic-like defensive behavior, as well as in pain modulation. The present study was conducted to test the difference between these two hypothalamic nuclei regarding defensive and antinociceptive mechanisms. Thus, the GABA A antagonist bicuculline (40 ng/0.2 µL or saline (0.9% NaCl was microinjected into the dorsomedial or posterior hypothalamus in independent groups. Innate fear-induced responses characterized by defensive attention, defensive immobility and elaborate escape behavior were evoked by hypothalamic blockade of GABA A receptors. Fear-induced defensive behavior organized by the posterior hypothalamus was more intense than that organized by dorsomedial hypothalamic nuclei. Escape behavior elicited by GABA A receptor blockade in both the dorsomedial and posterior hypothalamus was followed by an increase in nociceptive threshold. Interestingly, there was no difference in the intensity or in the duration of fear-induced antinociception shown by each hypothalamic division presently investigated. The present study showed that GABAergic dysfunction in nuclei of both the dorsomedial and posterior hypothalamus elicit panic attack-like defensive responses followed by fear-induced antinociception, although the innate fear-induced behavior originates differently in the posterior hypothalamus in comparison to the activity of medial hypothalamic subdivisions.

  12. Panic-like defensive behavior but not fear-induced antinociception is differently organized by dorsomedial and posterior hypothalamic nuclei of Rattus norvegicus (Rodentia, Muridae)

    Science.gov (United States)

    Biagioni, A.F.; Silva, J.A.; Coimbra, N.C.

    2012-01-01

    The hypothalamus is a forebrain structure critically involved in the organization of defensive responses to aversive stimuli. Gamma-aminobutyric acid (GABA)ergic dysfunction in dorsomedial and posterior hypothalamic nuclei is implicated in the origin of panic-like defensive behavior, as well as in pain modulation. The present study was conducted to test the difference between these two hypothalamic nuclei regarding defensive and antinociceptive mechanisms. Thus, the GABAA antagonist bicuculline (40 ng/0.2 µL) or saline (0.9% NaCl) was microinjected into the dorsomedial or posterior hypothalamus in independent groups. Innate fear-induced responses characterized by defensive attention, defensive immobility and elaborate escape behavior were evoked by hypothalamic blockade of GABAA receptors. Fear-induced defensive behavior organized by the posterior hypothalamus was more intense than that organized by dorsomedial hypothalamic nuclei. Escape behavior elicited by GABAA receptor blockade in both the dorsomedial and posterior hypothalamus was followed by an increase in nociceptive threshold. Interestingly, there was no difference in the intensity or in the duration of fear-induced antinociception shown by each hypothalamic division presently investigated. The present study showed that GABAergic dysfunction in nuclei of both the dorsomedial and posterior hypothalamus elicit panic attack-like defensive responses followed by fear-induced antinociception, although the innate fear-induced behavior originates differently in the posterior hypothalamus in comparison to the activity of medial hypothalamic subdivisions. PMID:22437484

  13. Invisible Trojan-horse attack.

    Science.gov (United States)

    Sajeed, Shihan; Minshull, Carter; Jain, Nitin; Makarov, Vadim

    2017-08-21

    We demonstrate the experimental feasibility of a Trojan-horse attack that remains nearly invisible to the single-photon detectors employed in practical quantum key distribution (QKD) systems, such as Clavis2 from ID Quantique. We perform a detailed numerical comparison of the attack performance against Scarani-Ac´ın-Ribordy-Gisin (SARG04) QKD protocol at 1924 nm versus that at 1536 nm. The attack strategy was proposed earlier but found to be unsuccessful at the latter wavelength, as reported in N. Jain et al., New J. Phys. 16, 123030 (2014). However at 1924 nm, we show experimentally that the noise response of the detectors to bright pulses is greatly reduced, and show by modeling that the same attack will succeed. The invisible nature of the attack poses a threat to the security of practical QKD if proper countermeasures are not adopted.

  14. Cognitive processing of emotional information in panic disorder.

    Science.gov (United States)

    McNally, R J; Riemann, B C; Louro, C E; Lukach, B M; Kim, E

    1992-03-01

    Panic-disordered (PD) patients, obsessive-compulsive (OCD) patients, and normal control subjects were exposed to either a high (i.e. exercise) or low arousal manipulation prior to performing a computerized version of the modified Stroop color-naming paradigm. Subjects named the colors of neutral nonlexical stimuli, positive words, and threat words associated with fear, bodily sensations, and catastrophes. After the Stroop task, subjects rated the personal emotional significance of the words. Inconsistent with the emotionality hypothesis of Stroop interference, PD patients rated positive words as more emotional than catastrophe words, but took longer to color-name the latter than the former. Yet consistent with the emotionality hypothesis, PD patients took as long to color-name positive words as to color-name fear and bodily sensation words. Contrary to expectation, OCD patients resembled PD patients in terms of interference, and arousal did not enhance interference for threat words in PD patients.

  15. Maternal panic disorder: Infant prematurity and low birth weight.

    Science.gov (United States)

    Warren, Susan L; Racu, Camellia; Gregg, Vanessa; Simmens, Samuel J

    2006-01-01

    The aim of this pilot research was to investigate whether infants of mothers with panic disorder (PD) would be at higher risk for prematurity and low birth weight (corrected for gestational age) than controls. Medical records were reviewed for 25 mothers with PD and 33 mothers without a lifetime history of anxiety disorders or other major psychopathology as determined by diagnostic interview. Mothers also completed questionnaires concerning demographic information and life stresses. Compared to controls, infants with PD mothers were not significantly more likely to be born prematurely or earlier than controls but did show smaller birth weight corrected for gestational age, even after accounting for possible confounding influences. Additional research is needed to confirm these preliminary findings. Studying PD mothers during pregnancy could provide insight concerning mechanisms for the development of low birth weight and psychopathology.

  16. How to catch a parasite: Parasite Niche Modeler (PaNic) meets Fishbase

    Science.gov (United States)

    Strona, Giovanni; Lafferty, Kevin D.

    2012-01-01

    Parasite Niche Modeler (PaNic) is a free online software tool that suggests potential hosts for fish parasites. For a particular parasite species from the major helminth groups (Acanthocephala, Cestoda, Monogenea, Nematoda, Trematoda), PaNic takes data from known hosts (maximum body length, growth rate, life span, age at first maturity, trophic level, phylogeny, and biogeography) and hypothesizes similar fish species that might serve as hosts to that parasite. Users can give varying weights to host attributes and create custom models. In addition to suggesting plausible hosts (with varying degrees of confidence), the models indicate known host species that appear to be outliers in comparison to other known hosts. These unique features make PaNic an innovative tool for addressing both theoretical and applied questions in fish parasitology. PaNic can be accessed at .

  17. Behavioral, Cognitive, and Pharmacological Treatments of Panic Disorder with Agoraphobia: Critique and Synthesis.

    Science.gov (United States)

    Michelson, Larry K.; Marchione, Karen

    1991-01-01

    Examines theoretical, methodologic, and research issues as well as strengths, limitations, and possible interactions pertaining to behavioral, cognitive, and pharmacological treatments of panic disorder with agoraphobia. Compares attrition, outcome, and maintenance effects and presents composite indices of significant improvement, endstate…

  18. Which factors influence onset and latency to treatment in generalized anxiety disorder, panic disorder, and obsessive-compulsive disorder?

    Science.gov (United States)

    Benatti, Beatrice; Camuri, Giulia; Dell'Osso, Bernardo; Cremaschi, Laura; Sembira, Ester; Palazzo, Carlotta; Oldani, Lucio; Dobrea, Cristina; Arici, Chiara; Primavera, Diego; Carpiniello, Bernardo; Castellano, Filippo; Carrà, Giuseppe; Clerici, Massimo; Baldwin, David S; Altamura, Alfredo Carlo

    2016-11-01

    Anxiety disorders are common, comorbid, and disabling conditions, often underdiagnosed and under-treated, typically with an early onset, chronic course, and prolonged duration of untreated illness. The present study aimed to explore the influence of sociodemographic and clinical factors in relation to onset and latency to treatment in patients with generalized anxiety disorder (GAD), panic disorder (PD), and obsessive-compulsive disorder (OCD). A total of 157 patients with a Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Text Revision (DSM-IV-TR) diagnosis of PD (n=49), GAD (n=68), and OCD (n=40) were recruited, and epidemiological and clinical variables were collected through a specific questionnaire. Statistical analyses were carried out to compare variables across diagnostic groups. PD, GAD, and OCD patients showed a duration of untreated illness of 53.9±81.5, 77.47±95.76, and 90.6±112.1 months, respectively. Significant differences between groups were found with respect to age, age of first diagnosis, age of first treatment, family history of psychiatric illness, onset-related stressful events, benzodiazepine prescription as first treatment, antidepressant prescription as first treatment, and help-seeking (self-initiated vs. initiated by others). Patients with GAD, PD, and OCD showed significant differences in factors influencing onset and latency to treatment, which may, in turn, affect condition-related outcome and overall prognosis. Further studies with larger samples are warranted in the field.

  19. A Lifetime Prevalence of Comorbidity Between Bipolar Affective Disorder and Anxiety Disorders: A Meta-analysis of 52 Interview-based Studies of Psychiatric Population

    Science.gov (United States)

    Nabavi, Behrouz; Mitchell, Alex J.; Nutt, David

    2015-01-01

    Background Bipolar affective disorder has a high rate of comorbidity with a multitude of psychiatric disorders and medical conditions. Among all the potential comorbidities, co-existing anxiety disorders stand out due to their high prevalence. Aims To determine the lifetime prevalence of comorbid anxiety disorders in bipolar affective disorder under the care of psychiatric services through systematic review and meta-analysis. Method Random effects meta-analyses were used to calculate the lifetime prevalence of comorbid generalised anxiety disorder, panic disorder, social anxiety disorder, specific phobia, agoraphobia, obsessive compulsive disorder and posttraumatic stress disorder in bipolar affective disorder. Results 52 studies were included in the meta-analysis. The rate of lifetime comorbidity was as follows: panic disorder 16.8% (95% CI 13.7–20.1), generalised anxiety disorder 14.4% (95% CI 10.8–18.3), social anxiety disorder13.3% (95% CI 10.1–16.9), post-traumatic stress disorder 10.8% (95% CI 7.3–14.9), specific phobia 10.8% (95% CI 8.2–13.7), obsessive compulsive disorder 10.7% (95% CI 8.7–13.0) and agoraphobia 7.8% (95% CI 5.2–11.0). The lifetime prevalence of any anxiety disorders in bipolar disorder was 42.7%. Conclusions Our results suggest a high rate of lifetime concurrent anxiety disorders in bipolar disorder. The diagnostic issues at the interface are particularly difficult because of the substantial symptom overlap. The treatment of co-existing conditions has clinically remained challenging. PMID:26629535

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

    Directory of Open Access Journals (Sweden)

    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.

  1. Obsessive-compulsive disorder symptom dimensions show specific relationships to psychiatric comorbidity.

    Science.gov (United States)

    Hasler, Gregor; LaSalle-Ricci, V Holland; Ronquillo, Jonne G; Crawley, Sarah A; Cochran, Lauren W; Kazuba, Diane; Greenberg, Benjamin D; Murphy, Dennis L

    2005-06-15

    The goals of this study were to examine relationships among symptom categories in obsessive-compulsive disorder (OCD), to establish OCD symptom dimensions by factor- and cluster-analytic analyses, and to explore associations between OCD symptom dimensions and comorbid neuropsychiatric conditions. A total of 317 OCD participants underwent a systematic diagnostic interview using the Structured Clinical Interview for DSM-IV. OCD symptoms assessed by the Yale-Brown Obsessive-Compulsive Scale Symptom Checklist (N=169) and by the Thoughts and Behaviors Inventory (N=275) were subjected to factor and cluster analyses. An identical four-factor solution emerged in two different data sets from overlapping samples, in agreement with most smaller factor-analytic studies employing the YBOCS checklist alone. The cluster analysis confirmed the four-factor solution and provided additional information on the similarity among OCD symptom categories at five different levels. OCD symptom dimensions showed specific relationships to comorbid psychiatric disorders: Factor I (aggressive, sexual, religious and somatic obsessions, and checking compulsions) was broadly associated with comorbid anxiety disorders and depression; Factor II (obsessions of symmetry, and repeating, counting and ordering/arranging compulsions) with bipolar disorders and panic disorder/agoraphobia; and Factor III (contamination obsessions and cleaning compulsions) with eating disorders. Factors I and II were associated with early onset OCD. This study encourages the use of cluster analyses as a supplementary method to factor analyses to establish psychiatric symptom dimensions. The frequent co-occurrence of OCD with other psychiatric disorders and the relatively specific association patterns between OCD symptom dimensions and comorbid disorders support the importance of OCD subtyping for treatment, genetic, and other research studies of this heterogeneous disorder.

  2. Comorbidity of Anxiety Disorders and Substance Abusewith Bipolar Mood Disorders and Relationship with ClinicalCourse

    Directory of Open Access Journals (Sweden)

    Ali Reza Shafiee-Kandjani

    2009-12-01

    Full Text Available "n Objective: Patients with bipolar mood disorder constitute a relatively large number of individuals hospitalized in psychiatric hospitals. This disorder is highly co-morbid with other psychiatric disorders and may effect their clinical course. The goal of this study was to determine the co-occurrence rate of anxiety disorders and substance abuse with bipolar mood disorders and their impact on clinical course. "n Methods: 153 bipolar patients (type I were selected among the hospitalized patients at Razi Psychiatric Hospital in Tabriz, Iran, from September 2007 to October 2008 through convenience sampling method. The participants were evaluated by a structured clinical interview based on DSM-IV criteria (SCID, Hamilton Rating Scale for Depression (HRSD and Young Mania Rating Scale (YMRS. Results: Co-morbidity of anxiety disorders was 43% . Occurrence of anxiety disorders was 26% for obsessive-compulsive disorder, 24.8% for generalized anxiety disorder, 3.9% for phobia and 2% for panic disorder. Co-morbidity of substance abuse was 7.2% and the highest occurrence of substance abuse was 5.2% for alcoholism and 3.9% for opium. No significant difference was observed between the severity of disease and duration of hospitalization in bipolar patients with or without anxiety disorder. The severity of disease and duration of hospitalization in bipolar patients with substance abuse was higher compared to bipolar patients without substance abuse (P<0.05. "nConclusions: This study suggests that there is a high co-morbidity between anxiety disorders and substance abuse with bipolar disorder. Further, this study suggests that co-occurrence of substance abuse disorder with bipolar disorder increases the severity of the disease and duration of hospitalization.

  3. Influence of spatial frequency and emotion expression on face processing in patients with panic disorder.

    Science.gov (United States)

    Shim, Miseon; Kim, Do-Won; Yoon, Sunkyung; Park, Gewnhi; Im, Chang-Hwan; Lee, Seung-Hwan

    2016-06-01

    Deficits in facial emotion processing is a major characteristic of patients with panic disorder. It is known that visual stimuli with different spatial frequencies take distinct neural pathways. This study investigated facial emotion processing involving stimuli presented at broad, high, and low spatial frequencies in patients with panic disorder. Eighteen patients with panic disorder and 19 healthy controls were recruited. Seven event-related potential (ERP) components: (P100, N170, early posterior negativity (EPN); vertex positive potential (VPP), N250, P300; and late positive potential (LPP)) were evaluated while the participants looked at fearful and neutral facial stimuli presented at three spatial frequencies. When a fearful face was presented, panic disorder patients showed a significantly increased P100 amplitude in response to low spatial frequency compared to high spatial frequency; whereas healthy controls demonstrated significant broad spatial frequency dependent processing in P100 amplitude. Vertex positive potential amplitude was significantly increased in high and broad spatial frequency, compared to low spatial frequency in panic disorder. Early posterior negativity amplitude was significantly different between HSF and BSF, and between LSF and BSF processing in both groups, regardless of facial expression. The possibly confounding effects of medication could not be controlled. During early visual processing, patients with panic disorder prefer global to detailed information. However, in later processing, panic disorder patients overuse detailed information for the perception of facial expressions. These findings suggest that unique spatial frequency-dependent facial processing could shed light on the neural pathology associated with panic disorder. Copyright © 2016 Elsevier B.V. All rights reserved.

  4. Serotonin function in panic disorder: intravenous administration of meta-chlorophenylpiperazine.

    Science.gov (United States)

    Wetzler, S; Asnis, G M; DeLecuona, J M; Kalus, O

    1996-09-27

    A placebo-controlled study of the direct serotonin receptor agonist meta-chlorophenylpiperazine (MCPP), intravenously infused over 90 s in a 0.06 mg/kg dose, was conducted in 10 patients with panic disorder and 9 normal control subjects. Cortisol, MCPP serum levels, and behavioral responses in both groups. Differences between intravenous and oral administration of MCPP are discussed, and the present findings are related to the serotonergic hypothesis of panic disorder.

  5. Comorbidity of epilepsy and migraines epidemiological and clinical aspects

    Directory of Open Access Journals (Sweden)

    Vujisic Slavica

    2012-03-01

    Full Text Available In patients with migraines, epilepsy occurs in 5.9% (1-17% of cases compared to a prevalence of 0.5-1% in the general population. Comorbidity of migraines and epilepsy can be explained by neuronal hyperexcitability, while cortical spreading depression is considered to be a pathophysiological mechanism that lies in the basis of the migraine aura. The study included 259 patients with epilepsy and 40 patients with both epilepsy and migraines. The aim of the investigation was to determine the prevalence of migraines, the existence of a temporal association between epileptic and migraine attacks, to determine the clinical characteristics of joint epileptic and migraine attacks, the existence of a significant connection between a certain type of epileptic seizure and type of headache, and finally to determine heredity for epilepsy and migraines in patients who have these conditions associated. Patients were diagnosed clinically, neurophysiologically and neuroradiologically. The research results show that the frequency of associated epilepsy and migraines occurred in 15.44%. The results of this investigation point to a significantly higher frequency of epilepsy and migraines in female patients (ratio 5 : 1, which is different from the data we found in existing studies. Temporally connected attacks of epilepsy and migraines were observed in 48% of patients. Preictal headaches appeared in 20% of patients, postictal in 28% of patients. There was no significant association between migraines and the particular type of epileptic attack. Heredity for migraines was present in 35% of patients with both epilepsy and migraines. This data is significantly lower than the data found in other studies.

  6. Comorbidity variation in patients with obsessive-compulsive disorder according to symptom dimensions: Results from a large multicentre clinical sample.

    Science.gov (United States)

    Torres, Albina R; Fontenelle, Leonardo F; Shavitt, Roseli G; Ferrão, Ygor A; do Rosário, Maria Conceição; Storch, Eric A; Miguel, Euripedes C

    2016-01-15

    Obsessive-compulsive disorder (OCD) has a heterogeneous and complex phenomenological picture, characterized by different symptom dimensions and comorbid psychiatric disorders, which frequently co-occur or are replaced by others over the illness course. To date, very few studies have investigated the associations between specific OCD symptom dimensions and comorbid disorders. Cross-sectional, multicenter clinical study with 1001 well-characterized OCD patients recruited within the Brazilian Research Consortium on Obsessive-Compulsive and Related Disorders. The primary instruments were the Dimensional Yale-Brown Obsessive Compulsive Scale (DY-BOCS) and the Structured Clinical Interview for DSM-IV Axis I Disorders. Bivariate analyses between symptom dimensions and comorbidities were followed by logistic regression. The most common comorbidities among participants (56.8% females) were major depression (56.4%), social phobia (34.6%), generalized anxiety disorder (34.3%), and specific phobia (31.4%). The aggressive dimension was independently associated with posttraumatic stress disorder (PTSD), separation anxiety disorder, any impulse-control disorder and skin picking; the sexual-religious dimension was associated with mood disorders, panic disorder/agoraphobia, social phobia, separation anxiety disorder, non-paraphilic sexual disorder, any somatoform disorder, body dysmorphic disorder and tic disorders; the contamination-cleaning dimension was related to hypochondriasis; and the hoarding dimension was associated with depressive disorders, specific phobia, PTSD, impulse control disorders (compulsive buying, skin picking, internet use), ADHD and tic disorders. The symmetry-ordering dimension was not independently associated with any comorbidity. Cross-sectional design; participants from only tertiary mental health services; personality disorders not investigated. Different OCD dimensions presented some specific associations with comorbid disorders, which may influence

  7. The Deakin/Graeff hypothesis: focus on serotonergic inhibition of panic

    Science.gov (United States)

    Paul, Evan D.; Johnson, Philip L.; Shekhar, Anantha; Lowry, Christopher A.

    2014-01-01

    The Deakin/Graeff hypothesis proposes that different subpopulations of serotonergic neurons through topographically organized projections to forebrain and brainstem structures modulate the response to acute and chronic stressors, and that dysfunction of these neurons increases vulnerability to affective and anxiety disorders, including Panic Disorder. We outline evidence supporting the existence of a serotonergic system originally discussed by Deakin/Graeff that is implicated in the inhibition of panic-like behavioral and physiological responses. Evidence supporting this panic inhibition system comes from the following observations: 1) serotonergic neurons located in the ‘ventrolateral dorsal raphe nucleus (DRVL) as well as the ventrolateral periaqueductal gray (VLPAG) inhibit dorsal periaqueductal gray-elicited panic-like responses; 2) chronic, but not acute, antidepressant treatment potentiates serotonin’s panicolytic effect; 3) contextual fear activates a central nucleus of the amygdala-DRVL/VLPAG circuit implicated in mediating freezing and inhibiting panic-like escape behaviors; 4) DRVL/VLPAG serotonergic neurons are central chemoreceptors and modulate the behavioral and cardiorespiratory response to panicogenic agents such as sodium lactate and CO2. Implications of the panic inhibition system are discussed. PMID:24661986

  8. Correlates of DSM-III personality disorder in panic disorder and agoraphobia.

    Science.gov (United States)

    Mavissakalian, M; Hamann, M S

    1988-01-01

    One hundred eighty-seven patients meeting DSM-III criteria for panic disorder (n = 26) or agoraphobia with panic (n = 161) were assessed with the Personality Diagnostic Questionnaire (PDQ), a self-rating scale designed to assess Axis II personality disorders and traits. Results replicated our earlier findings of a preponderance of dependent, avoidant, and histrionic features and the finding that patients exhibiting a greater number of personality traits were also significantly more symptomatic. Patients with the diagnosis of panic disorder did not differ on any personality disorder variables from patients with the diagnosis of agoraphobia with panic. Furthermore, none of the specific symptom dimensions, i.e., panic, anxiety, or agoraphobia, was selected as a unique predictor of any personality variables in the regression analyses. Rather, the most important correlates of personality disorder in these patients consisted of general factors such as dysphoric mood, social phobia, or interpersonal sensitivity, and Eysenck's neuroticism dimension. The results are discussed in light of recent findings suggesting a nonspecific link between panic disorder or agoraphobia and personality disorder.

  9. Major depressive disorder following terrorist attacks: A systematic review of prevalence, course and correlates

    Science.gov (United States)

    2011-01-01

    Background Terrorist attacks are traumatic events that may result in a wide range of psychological disorders for people exposed. This review aimed to systematically assess the current evidence on major depressive disorder (MDD) after terrorist attacks. Methods A systematic review was performed. Studies included assessed the impact of human-made, intentional, terrorist attacks in direct victims and/or persons in general population and evaluated MDD based on diagnostic criteria. Results A total of 567 reports were identified, 11 of which were eligible for this review: 6 carried out with direct victims, 4 with persons in general population, and 1 with victims and general population. The reviewed literature suggests that the risk of MDD ranges between 20 and 30% in direct victims and between 4 and 10% in the general population in the first few months after terrorist attacks. Characteristics that tend to increase risk of MDD after a terrorist attack are female gender, having experienced more stressful situations before or after the attack, peritraumatic reactions during the attack, loss of psychosocial resources, and low social support. The course of MDD after terrorist attacks is less clear due to the scarcity of longitudinal studies. Conclusions Methodological limitations in the literature of this field are considered and potentially important areas for future research such as the assessment of the course of MDD, the study of correlates of MDD or the comorbidity between MDD and other mental health problems are discussed. PMID:21627850

  10. Student Support in E-Learning Courses in Higher Education--Insights from a Metasynthesis "A Pedagogy of Panic Attacks"

    Science.gov (United States)

    Minnaar, A.

    2011-01-01

    E-learning includes the use of the internet for accessing learning materials, interacting with learning content and with instructors and students to obtain support during the learning process in order to gain knowledge and personal meaning and to grow. It occurs when students have electronic access to resources and where they are in regular online…

  11. Clinical episodes of restlessness and panic in the terrorist attacks of 11 of September of 2001 in United States.

    Directory of Open Access Journals (Sweden)

    Francisco Sacristán

    2009-11-01

    Full Text Available Introducción: Conviene especificar que los nervios son una taxonomía biomédica antigua de la enfermedad, cuyas nociones se han reelaborado en contextos populares. Hoy es una enfermedad presente en muchas sociedades occidentales que expresan una manera del sufrimiento. Objetivo: Este estudio se centra en explorar el impacto del 11-S en los nervios de los inmigrantes mexicanos que viven en los Estados Unidos. Metodología: Está dirigida por la tradición de la antropología de la enfermedad. Se apoya en los materiales originales, recolectados en Highland Park (Illinois, Estados Unidos. El trabajo en el terreno se hizo de septiembre de 2001 a febrero de 2002 entre usuarios del «Programa Latino» de la Agencia «Servicio a la Familia de South Lake County». Los datos provienen de entrevistas recogidas en profundidad a los informadores calificados. Se consideraron tres dimensiones principales en la metodología y en el plan de trabajo. Primera, el impacto del episodio de las torres en la vida de cada día de los inmigrantes mexicanos, la manera en que su salud se afectó, y cómo se originaron y manifestaron los nervios. En segundo lugar, se consideran de forma particular algunas cuestiones como la incertidumbre sobre su futuro y su miedo, ligados no solamente a las posibilidades de nuevos ataques sino también en relación con los cambios internos y las políticas federales. En un tercer momento, se exploró cómo la identidad mexicana fue redefinida como consecuencia del ataque. Resultados: Ofrecen el dato que el padecimiento nervioso entre mexicanos inmigrantes en relación con la violencia política básicamente no difiere de las manifestaciones y teorías etiológicas señaladas por numerosos autores en relación con diversos grupos sociales, culturales y étnicos en trabajos previos. Conclusiones: Lo más destacable consiste en que el contexto social y político que se genera a partir de los atentados agudiza las experiencias de nervios entre la población mexicana. En resumen, la sensación de peligro inminente revela el temor no sólo a que se repitan nuevos actos terroristas, sino también a las consecuencias que lleva consigo la decisión del país de iniciar acciones bélicas.

  12. (Don't) panic in the scanner! How panic patients with agoraphobia experience a functional magnetic resonance imaging session.

    Science.gov (United States)

    Lueken, Ulrike; Muehlhan, Markus; Wittchen, Hans-Ulrich; Kellermann, Thilo; Reinhardt, Isabelle; Konrad, Carsten; Lang, Thomas; Wittmann, André; Ströhle, Andreas; Gerlach, Alexander L; Ewert, Adrianna; Kircher, Tilo

    2011-07-01

    Although functional magnetic resonance imaging (fMRI) has gained increasing importance in investigating neural substrates of anxiety disorders, less is known about the stress eliciting properties of the scanner environment itself. The aim of the study was to investigate feasibility, self-reported distress and anxiety management strategies during an fMRI experiment in a comprehensive sample of patients with panic disorder and agoraphobia (PD/AG). Within the national research network PANIC-NET, n=89 patients and n=90 controls participated in a multicenter fMRI study. Subjects completed a retrospective questionnaire on self-reported distress, including a habituation profile and exploratory questions about helpful strategies. Drop-out rates and fMRI quality parameters were employed as markers of study feasibility. Different anxiety measures were used to identify patients particularly vulnerable to increased scanner anxiety and impaired data quality. Three (3.5%) patients terminated the session prematurely. While drop-out rates were comparable for patients and controls, data quality was moderately impaired in patients. Distress was significantly elevated in patients compared to controls; claustrophobic anxiety was furthermore associated with pronounced distress and lower fMRI data quality in patients. Patients reported helpful strategies, including motivational factors and cognitive coping strategies. The feasibility of large-scale fMRI studies on PD/AG patients could be proved. Study designs should nevertheless acknowledge that the MRI setting may enhance stress reactions. Future studies are needed to investigate the relationship between self-reported distress and fMRI data in patient groups that are subject to neuroimaging research. Copyright © 2010 Elsevier B.V. All rights reserved.

  13. WILD PIG ATTACKS ON HUMANS

    Energy Technology Data Exchange (ETDEWEB)

    Mayer, J.

    2013-04-12

    Attacks on humans by wild pigs (Sus scrofa) have been documented since ancient times. However, studies characterizing these incidents are lacking. In an effort to better understand this phenomenon, information was collected from 412 wild pig attacks on humans. Similar to studies of large predator attacks on humans, data came from a variety of sources. The various attacks compiled occurred in seven zoogeographic realms. Most attacks occurred within the species native range, and specifically in rural areas. The occurrence was highest during the winter months and daylight hours. Most happened under non-hunting circumstances and appeared to be unprovoked. Wounded animals were the chief cause of these attacks in hunting situations. The animals involved were typically solitary, male and large in size. The fate of the wild pigs involved in these attacks varied depending upon the circumstances, however, most escaped uninjured. Most human victims were adult males traveling on foot and alone. The most frequent outcome for these victims was physical contact/mauling. The severity of resulting injuries ranged from minor to fatal. Most of the mauled victims had injuries to only one part of their bodies, with legs/feet being the most frequent body part injured. Injuries were primarily in the form of lacerations and punctures. Fatalities were typically due to blood loss. In some cases, serious infections or toxemia resulted from the injuries. Other species (i.e., pets and livestock) were also accompanying some of the humans during these attacks. The fates of these animals varied from escaping uninjured to being killed. Frequency data on both non-hunting and hunting incidents of wild pig attacks on humans at the Savannah River Site, South Carolina, showed quantitatively that such incidents are rare.

  14. The Cyber-Physical Attacker

    DEFF Research Database (Denmark)

    Vigo, Roberto

    2012-01-01

    The world of Cyber-Physical Systems ranges from industrial to national interest applications. Even though these systems are pervading our everyday life, we are still far from fully understanding their security properties. Devising a suitable attacker model is a crucial element when studying...... the security properties of CPSs, as a system cannot be secured without defining the threats it is subject to. In this work an attacker scenario is presented which addresses the peculiarities of a cyber-physical adversary, and we discuss how this scenario relates to other attacker models popular in the security...

  15. Superposition Attacks on Cryptographic Protocols

    DEFF Research Database (Denmark)

    Damgård, Ivan Bjerre; Funder, Jakob Løvstad; Nielsen, Jesper Buus

    2011-01-01

    Attacks on classical cryptographic protocols are usually modeled by allowing an adversary to ask queries from an oracle. Security is then defined by requiring that as long as the queries satisfy some constraint, there is some problem the adversary cannot solve, such as compute a certain piece...... of information. In this paper, we introduce a fundamentally new model of quantum attacks on classical cryptographic protocols, where the adversary is allowed to ask several classical queries in quantum superposition. This is a strictly stronger attack than the standard one, and we consider the security...

  16. Multiculturalism & The Charlie Hebdo Attack

    DEFF Research Database (Denmark)

    Lægaard, Sune

    2016-01-01

    The attack on Charlie Hebdo has by many been linked to multiculturalism. But it is unclear exactly how the connection between multiculturalism and the attack should be understood and whether there indeed is such a connection. The article discusses this by distinguishing between different senses o...... of multiculturalism and different ways in which one might think that there is a link between multiculturalism and the attack. On this basis the resulting claims are discussed as to whether they are in fact plausible, which many of them turn out not to be....

  17. Multiculturalism & The Charlie Hebdo Attack

    DEFF Research Database (Denmark)

    Lægaard, Sune

    2016-01-01

    The attack on Charlie Hebdo has by many been linked to multiculturalism. But it is unclear exactly how the connection between multiculturalism and the attack should be understood and whether there indeed is such a connection. The article discusses this by distinguishing between different senses...... of multiculturalism and different ways in which one might think that there is a link between multiculturalism and the attack. On this basis the resulting claims are discussed as to whether they are in fact plausible, which many of them turn out not to be....

  18. [Compulsive buying and psychiatric comorbidity].

    Science.gov (United States)

    Mueller, Astrid; Mühlhans, Barbara; Silbermann, Andrea; Müller, Ulrike; Mertens, Christian; Horbach, Thomas; Mitchell, James E; de Zwaan, Martina

    2009-08-01

    Compulsive buying is an excessive behavior that has begun to receive attention from researchers in recent years. The current study provides an overview of research on compulsive buying and examines the psychiatric co-morbidity in a German female treatment seeking compulsive buying sample in comparison with age and gender-matched normal buying control groups. Thirty women suffering from compulsive buying disorder, 30 community controls, and 30 bariatric surgery candidates were assessed with the German versions of the Structured Clinical Interview for DSM-IV diagnoses (SCID). Women with compulsive buying disorder showed significantly higher prevalence rates of affective, anxiety, and eating disorders compared to community controls, and suffered significantly more often from affective and anxiety disorders compared to bariatric surgery candidates. The compulsive buying group presented with the highest rates of personality disorders, most commonly avoidant, depressive, obsessive-compulsive, and borderline personality disorder, and reported the highest prevalence rates of other impulse control disorders, especially for intermittent explosive disorder. The findings suggest an elevated psychiatric co-morbidity in patients with compulsive buying disorder.

  19. Social Engineering:A Partial Technical attack

    OpenAIRE

    P.S.Maan; Manish Sharma

    2012-01-01

    This paper suggests the crystal clear concept behind the social engineering attack. Basically social engineering is a non technical attack. But social engineering attack is an attack on human psychology to get the information, but using what? Basically it is an attack on human psychology by using some technical skills or technology. Social engineering attack has many types like fake mail, telephonic cheat etc. which are impossible without any technical skills, so in this paper we suggest that...

  20. Comorbidities in Patients with Psoriatic Arthritis

    Science.gov (United States)

    Haddad, Amir; Zisman, Devy

    2017-01-01

    Epidemiological studies have shown that patients with psoriatic arthritis (PsA) are often affected by numerous comorbidities that carry significant morbidity and mortality. Reported comorbidities include diabetes mellitus, obesity, metabolic syndrome, cardiovascular diseases, osteoporosis, inflammatory bowel disease, autoimmune eye disease, non-alcoholic fatty liver disease, depression, and fibromyalgia. All health care providers for patients with PsA should recognize and monitor those comorbidities, as well as understand their effect on patient management to ensure an optimal clinical outcome. PMID:28178440

  1. Comorbidity of paraphilia and depression in Mexico

    Science.gov (United States)

    Haasen, Christian

    2010-01-01

    The comorbidity of paraphilia-related disorders and other psychiatric disorders is high, but the paraphilia-related disorder often remains untreated until patients seek help for the comorbid disorder. A case of a patient in Mexico with comorbid paraphilia and depressive disorder, who was effectively treated with antidepressive medication and psychotherapy, is reported. The effect of stigmatization of homosexuality on the access to care of persons with sexual disorders is discussed. PMID:25478091

  2. Comorbidity of paraphilia and depression in Mexico

    Directory of Open Access Journals (Sweden)

    Christian Haasen

    2010-01-01

    Full Text Available The comorbidity of paraphilia-related disorders and other psychiatric disorders is high, but the paraphilia-related disorder often remains untreated until patients seek help for the comorbid disorder. A case of a patient in Mexico with comorbid paraphilia and depressive disorder, who was effectively treated with antidepressive medication and psychotherapy, is reported. The effect of stigmatization of homosexuality on the access to care of persons with sexual disorders is discussed.

  3. Genetic attack on neural cryptography.

    Science.gov (United States)

    Ruttor, Andreas; Kinzel, Wolfgang; Naeh, Rivka; Kanter, Ido

    2006-03-01

    Different scaling properties for the complexity of bidirectional synchronization and unidirectional learning are essential for the security of neural cryptography. Incrementing the synaptic depth of the networks increases the synchronization time only polynomially, but the success of the geometric attack is reduced exponentially and it clearly fails in the limit of infinite synaptic depth. This method is improved by adding a genetic algorithm, which selects the fittest neural networks. The probability of a successful genetic attack is calculated for different model parameters using numerical simulations. The results show that scaling laws observed in the case of other attacks hold for the improved algorithm, too. The number of networks needed for an effective attack grows exponentially with increasing synaptic depth. In addition, finite-size effects caused by Hebbian and anti-Hebbian learning are analyzed. These learning rules converge to the random walk rule if the synaptic depth is small compared to the square root of the system size.

  4. Social Engineering:A Partial Technical attack

    Directory of Open Access Journals (Sweden)

    P. S. Maan

    2012-03-01

    Full Text Available This paper suggests the crystal clear concept behind the social engineering attack. Basically social engineering is a non technical attack. But social engineering attack is an attack on human psychology to get the information, but using what? Basically it is an attack on human psychology by using some technical skills or technology. Social engineering attack has many types like fake mail, telephonic cheat etc. which are impossible without any technical skills, so in this paper we suggest that , it is a partial technical attack and can be divided in human based and typical computer based social engineering attack.

  5. On the guestion of comorbidity in psoriasis

    Directory of Open Access Journals (Sweden)

    Bakulev A.L.

    2014-09-01

    Full Text Available Goal: analysis of comorbidity in patients with various forms of psoriasis. Material and methods. The study involved 105 patients with various forms of psoriasis. Comorbidities were established on the basis of medical history, clinical findings, laboratory tests and consultation with other specialists. Results. Among the most common comorbidities in psoriasis encountered pathology of the cardiovascular system, gastrointestinal tract, endocrinopathy, metabolic syndrome, psoriatic arthritis and depressive disorders. Conclusion. In most patients, psoriasis is combined with certain comorbid conditions that must be considered when choosing the tactics of treatment

  6. Comorbid insomnia and cognitive behavior therapy.

    Science.gov (United States)

    Chand, Suma P

    2015-01-01

    Insomnia most commonly presents comorbidly in association with medical and psychiatric disorders. Comorbid insomnia, however, remains under treated in the majority of patients. Concerns about drug interactions, adverse events, and dependence as well as the assumption that treating the insomnia as a secondary presentation that will resolve when the primary condition improves are all factors that contribute to the under treatment of comorbid insomnia. This article presents the growing research evidence that highlights the benefits and importance of targeting the insomnia that presents comorbidly with medical and psychiatric conditions utilizing the nonpharmacological and effective treatment of cognitive behavior therapy.

  7. Microarchitectural Side-Channel Attacks

    OpenAIRE

    Gallais, Jean-Francois

    2013-01-01

    Cryptanalysis is the science which evaluates the security of a cryptosystem and detects its weaknesses and flaws. Initially confined to the black-box model, where only the input and output data were considered, cryptanalysis is now broadened to the security evaluation of the physical implementation of a cryptosystem. The implementation attacks which compose physical cryptanalysis are divided into fault attacks, exploiting the effect of disruption of the normal functioning of the device, and s...

  8. Additive attacks on speaker recognition

    Science.gov (United States)

    Farrokh Baroughi, Alireza; Craver, Scott

    2014-02-01

    Speaker recognition is used to identify a speaker's voice from among a group of known speakers. A common method of speaker recognition is a classification based on cepstral coefficients of the speaker's voice, using a Gaussian mixture model (GMM) to model each speaker. In this paper we try to fool a speaker recognition system using additive noise such that an intruder is recognized as a target user. Our attack uses a mixture selected from a target user's GMM model, inverting the cepstral transformation to produce noise samples. In our 5 speaker data base, we achieve an attack success rate of 50% with a noise signal at 10dB SNR, and 95% by increasing noise power to 0dB SNR. The importance of this attack is its simplicity and flexibility: it can be employed in real time with no processing of an attacker's voice, and little computation is needed at the moment of detection, allowing the attack to be performed by a small portable device. For any target user, knowing that user's model or voice sample is sufficient to compute the attack signal, and it is enough that the intruder plays it while he/she is uttering to be classiffed as the victim.

  9. [Comorbidity of tics and stuttering].

    Science.gov (United States)

    Surushkina, S Yu; Chutko, L S; Aitbekov, K A; Nikishena, I S; Bondarchuk, Yu I

    2014-01-01

    To determine the clinical presentations of stuttering in children with tics treated with noofen. Authors examined 181 children with tics, aged 7-13. Stuttering was identified in 23.2% of cases. Thirty children with tics and comorbid stuttering received noofen. RESULTS AND СONCLUSION: The prevalence of stuttering in children with tics was significantly higher than in the population. Stuttering was significantly more frequent in children with transient tics than chronic tics. Neurotic stuttering was recorded more frequently. The high efficacy of noofen was shown; the decrease in ticks was obtained in 80% of cases, the reduction of stuttering in 66.7% of cases. The data of clinical, psychological and neurophysiological studies, confirming the improvement of patients after treatment, are presented.

  10. Sensory symptom profiles and co-morbidities in painful radiculopathy.

    Directory of Open Access Journals (Sweden)

    Friederike Mahn

    Full Text Available Painful radiculopathies (RAD and classical neuropathic pain syndromes (painful diabetic polyneuropathy, postherpetic neuralgia show differences how the patients express their sensory perceptions. Furthermore, several clinical trials with neuropathic pain medications failed in painful radiculopathy. Epidemiological and clinical data of 2094 patients with painful radiculopathy were collected within a cross sectional survey (painDETECT to describe demographic data and co-morbidities and to detect characteristic sensory abnormalities in patients with RAD and compare them with other neuropathic pain syndromes. Common co-morbidities in neuropathic pain (depression, sleep disturbance, anxiety do not differ considerably between the three conditions. Compared to other neuropathic pain syndromes touch-evoked allodynia and thermal hyperalgesia are relatively uncommon in RAD. One distinct sensory symptom pattern (sensory profile, i.e., severe painful attacks and pressure induced pain in combination with mild spontaneous pain, mild mechanical allodynia and thermal hyperalgesia, was found to be characteristic for RAD. Despite similarities in sensory symptoms there are two important differences between RAD and other neuropathic pain disorders: (1 The paucity of mechanical allodynia and thermal hyperalgesia might be explained by the fact that the site of the nerve lesion in RAD is often located proximal to the dorsal root ganglion. (2 The distinct sensory profile found in RAD might be explained by compression-induced ectopic discharges from a dorsal root and not necessarily by nerve damage. These differences in pathogenesis might explain why medications effective in DPN and PHN failed to demonstrate efficacy in RAD.

  11. Motor coordination impairment and migraine in children: a new comorbidity?

    Science.gov (United States)

    Esposito, Maria; Verrotti, Alberto; Gimigliano, Francesca; Ruberto, Maria; Agostinelli, Sergio; Scuccimarra, Goffredo; Pascotto, Antonio; Carotenuto, Marco

    2012-11-01

    Migraine without aura (MoA) could be considered the most frequent form of primary headache in children, associated with many known comorbidities, but only the recent literature has begun to consider the importance of motor impairment linked to the attacks. The developmental coordination disorder (DCD) is a very common problem among children, with a prevalence ranging up to 19 %. The aim of this study was to evaluate the presence of motor coordination impairment in a population of children affected by MoA, and its role as putative risk factor for motor skills impairment. This observational study was performed in the Clinic of Child and Adolescent Neuropsychiatry of the Second University of Naples. MoA was diagnosed according to the International Classification of Headache Disorders (IHS-2) criteria. The study population consisted of 27 patients affected by MoA (16 females, 11 males) (mean age: 8.7 ± 2.15 years) and 59 typically developing children (34 females, 25 males) (mean age: 8.0 ± 2.1 years). The whole population underwent a clinical evaluation in order to assess the total IQ level, the visual motor integration skills, and the presence of DCD. Our results showed that MoA children had more impairments in motor coordination (p DCD and migraine could represent a not yet understood or identified comorbidity, even if further reports are necessary, and that migraine probably could be considered not only a painful syndrome in future.

  12. Screening for Generalized Anxiety Disorder Symptoms in the Wake of Terrorist Attacks: A Study in Primary Care

    Science.gov (United States)

    Ghafoori, Bita; Neria, Yuval; Gameroff, Marc J.; Olfson, Mark; Lantigua, Rafael; Shea, Steven; Weissman, Myrna M.

    2013-01-01

    Little is known about the mental health impact of terrorism beyond posttraumatic stress disorder (PTSD) and depression. The associations between exposure to the September 11, 2001 (9/11) attacks in New York City and generalized anxiety disorder (GAD) symptoms were examined in a sample of 929 primary care patients. After controlling for PTSD, depression, panic and substance use disorders, and pre-9/11 trauma, patients who screened positive (vs. negative) for GAD symptoms were roughly twice as likely to report having a loved one at the 9/11 disaster site, twice as likely to know someone who was killed by the attacks, and twice as likely to know someone who was involved with the rescue/recovery efforts after the disaster. Implications for treatment and future research are discussed. PMID:19475656

  13. The effects of an Internet based self-help course for reducing panic symptoms - Don't Panic Online: study protocol for a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Kramer Jeannet

    2011-03-01

    Full Text Available Abstract Background Internet based self-help for panic disorder (PD has proven to be effective. However, studies so far have focussed on treating a full-blown disorder. Panic symptoms that do not meet DSM-IV criteria are more prevalent than the full-blown disorder and patients with sub-clinical panic symptoms are at risk of developing PD. This study is a randomised controlled trial aimed to evaluate an Internet based self-help intervention for sub-clinical and mild PD compared to a waiting list control group. Methods Participants with mild or sub-clinical PD (N = 128 will be recruited in the general population. Severity of panic and anxiety symptoms are the primary outcome measures. Secondary outcomes include depressive symptoms, quality of life, loss of production and health care consumption. Assessments will take place on the Internet at baseline and three months after baseline. Discussion Results will indicate the effectiveness of Internet based self-help for sub-clinical and mild PD. Strengths of this design are the external validity and the fact that it is almost completely conducted online. Trial registration Netherlands Trial Register (NTR: NTR1639 The Netherlands Trial Register is part of the Dutch Cochrane Centre.

  14. Responses to panic induction procedures in subjects with multiple chemical sensitivity/idiopathic environmental intolerance: understanding the relationship with panic disorder.

    Science.gov (United States)

    Tarlo, Susan M; Poonai, Naveen; Binkley, Karen; Antony, Martin M; Swinson, Richard P

    2002-08-01

    Idiopathic environmental intolerance (IEI), also known as multiple chemical sensitivity, is a clinical description for a cluster of symptoms of unknown etiology that have been attributed by patients to multiple environmental exposures when other medical explanations have been excluded. Because allergy has not been clearly demonstrated and current toxicological paradigms for exposure-symptom relationships do not readily accommodate IEI, psychogenic theories have been the focus of a number of investigations. A significantly higher lifetime prevalence of major depression, mood disorders, anxiety disorders, and somatization disorder has been reported among patients with environmental illness compared with that in controls. Symptoms often include anxiety, lightheadedness, impaired mentation, poor coordination, breathlessness (without wheezing), tremor, and abdominal discomfort. Responses to intravenous sodium lactate challenge or single-breath inhalation of 35% carbon dioxide versus a similar breath inhalation of clean air have shown a greater frequency of panic responses in subjects with IEI than in control subjects, although such responses did not occur in all subjects. Preliminary genetic findings suggest an increased frequency of a common genotype with panic disorder patients. The panic responses in a significant proportion of IEI patients opens a therapeutic window of opportunity. Patients in whom panic responses may at least be a contributing factor to their symptoms might be responsive to intervention with psychotherapy to enable their desensitization or deconditioning of responses to odors and other triggers, and/or may be helped by anxiolytic medications, relaxation training, and counseling for stress management.

  15. Assessment of major comorbidities in adults with atopic dermatitis using the Charlson comorbidity index

    DEFF Research Database (Denmark)

    Thyssen, Jacob P; Skov, Lone; Hamann, Carsten R

    2017-01-01

    BACKGROUND: There is a growing interest in comorbidities of adults with atopic dermatitis (AD). OBJECTIVES: To examine the burden of comorbidities in adult patients with AD using the Charlson comorbidity index (CCI) in nationwide registries. METHODS: All Danish patients ≥18 years on January 1, 2012...

  16. Gender and autoimmune comorbidity in multiple sclerosis

    DEFF Research Database (Denmark)

    Magyari, Melinda; Koch-Henriksen, Nils; Pfleger, Claudia C

    2014-01-01

    BACKGROUND: The female preponderance in incidence of multiple sclerosis (MS) calls for investigations into sex differences in comorbidity with other autoimmune diseases (ADs). OBJECTIVES: To determine whether male and female patients with MS have a higher frequency of autoimmune comorbidity than...

  17. Treating Comorbid Anxiety and Aggression in Children

    Science.gov (United States)

    Levy, Karyn; Hunt, Caroline; Heriot, Sandra

    2007-01-01

    Objective: The aim of the study was to evaluate the effectiveness of an intervention that targeted both anxious and aggressive behaviors in children with anxiety disorders and comorbid aggression by parent report. Method: The effects of a cognitive-behavioral therapy intervention targeting comorbid anxiety and aggression problems were compared…

  18. Prevention of comorbid mental and physical disorders

    NARCIS (Netherlands)

    Hosman, C.M.H.

    2015-01-01

    This chapter aims to explore the possibilities of preventing comorbid mental and physical disorders. It presents a framework of optional preventive strategies based on four explanatory models of comorbidity and six strategic dimensions. Addressing common early risk factors is discussed as one of the

  19. Co-morbidities in heart failure

    NARCIS (Netherlands)

    van Deursen, Vincent M.; Damman, Kevin; van der Meer, Peter; Wijkstra, Peter J.; Luijckx, Gert-Jan; van Beek, Andre; van Veldhuisen, Dirk J.; Voors, Adriaan A.

    2014-01-01

    Heart failure is a clinical syndrome characterized by poor quality of life and high morbidity and mortality. Co-morbidities frequently accompany heart failure and further decrease in both quality of life and clinical outcome. We describe that the prevalence of co-morbidities in patients with heart f

  20. Assessing comorbidity using claims data: an overview.

    Science.gov (United States)

    Klabunde, Carrie N; Warren, Joan L; Legler, Julie M

    2002-08-01

    Comorbidity, additional disease beyond the condition under study that increases a patient's total burden of illness, is one dimension of health status. For investigators working with observational data obtained from administrative databases, comorbidity assessment may be a useful and important means of accounting for differences in patients' underlying health status. There are multiple ways of measuring comorbidity. This paper provides an overview of current approaches to and issues in assessing comorbidity using claims data, with a particular focus on established indices and the SEER-Medicare database. In addition, efforts to improve measurement of comorbidity using claims data are described, including augmentation of claims data with medical record, patient self-report, or health services utilization data; incorporation of claims data from sources other than inpatient claims; and exploration of alternative conditions, indices, or ways of grouping conditions. Finally, caveats about claims data and areas for future research in claims-based comorbidity assessment are discussed. Although the use of claims databases such as SEER-Medicare for health services and outcomes research has become increasingly common, investigators must be cognizant of the limitations of comorbidity measures derived from these data sources in capturing and controlling for differences in patient health status. The assessment of comorbidity using claims data is a complex and evolving area of investigation.

  1. Psychological features in panic disorder: a comparison with major depression

    Directory of Open Access Journals (Sweden)

    Almeida Yasmin A.

    2002-01-01

    Full Text Available OBJECTIVE: We aim to evaluate the psychodymanic model for panic disorder (PD formulated by Shear et al. (1993, comparing PD patients and major depression (MD patients. METHOD: We evaluated these parameters in open interviews in 10 PD patients and 10 patients with MD (DSM-IV. The data were recorded on videotape and were examined by 5 diagnostic blind appraisers. RESULTS: The data allowed a comparative analysis that underscores the existence of a psychological model for PD vs MD: 1 the protracted symbiotic phase of development and the existence of problems with separation in PD patients; 2 patients with MD tended to have a particularly negative impression of relationship with the first objects; furthermore, they had remarkable experiences of loss; and 3 while the PD patients tended to be shy and inhibited in childhood, especially showing a clear difficulty in expressing aggressiveness, the depressed patients tended to disclose an impulsive aggressiveness from infancy to adulthood. CONCLUSION: Exposure to parental behaviours that augment fearfulness may result in disturbances in object relations and persistence of conflicts between dependence and independence may predispose to anxiety symptoms and fears of PD.

  2. Neuropsychological impairments in panic disorder: a systematic review.

    Science.gov (United States)

    O'Sullivan, Kate; Newman, Emily F

    2014-01-01

    There is a growing body of literature investigating the neuropsychological profile of panic disorder (PD), some of which suggests potential cognitive dysfunction. This paper systematically reviews the existing literature on neuropsychological performance in PD. PsycINFO, EMBASE, MEDLINE and PsycARTICLES databases were searched to identify articles reporting on neuropsychological function in PD published in English during the time period 1980 to March 2012. 14 studies were identified. There was limited support for impairment in short term memory among individuals with PD, although this was not found across all studies. Overall, the reviewed studies did not support the presence of impairment in other areas of cognitive functioning, including executive function, long term memory, visuospatial or perceptual abilities and working memory. Studies with samples of fewer than 15 participants per group were excluded from this review. A limited amount of research has been published on this topic and small sample sizes (under 25 per group) have been used by many studies. Therefore, the current review is based on a small number of studies with limited power. There is limited evidence of specific neuropsychological impairments in participants with PD. Impairments in short term memory warrant further investigation to establish their relevance to clinical practice. Larger sample sizes and appropriate statistical adjustment for multiple comparisons in future studies is highly recommended. Copyright © 2014 Elsevier B.V. All rights reserved.

  3. Psychological vulnerabilities in patients with major depression vs panic disorder.

    Science.gov (United States)

    Cox, B J; Enns, M W; Walker, J R; Kjernisted, K; Pidlubny, S R

    2001-05-01

    The tripartite model (Clark & Watson, 1991: Clark, L. A., & Watson, D. (1991). Tripartite model of anxiety and depression: Psychometric evidence and taxonomic implications. Journal of Abnormal Psychology, 100, 316-336) posits that anxiety and depression share nonspecific features of neuroticism but that somatic arousal appears unique to anxiety, and low positive affect appears unique to depression. The present study controlled for these higher-order effects and evaluated the relative contributions of four, specific lower-order vulnerabilities (anxiety sensitivity, rumination, self-criticism, self-oriented perfectionism). Participants were 38 depressed patients and 38 patients with panic disorder matched as closely as possible for age and gender, and all were diagnosed using the same structured interview by an experienced clinician. Results from hierarchical logistic regression analysis were consistent with predictions from the tripartite model in that only the unique features of arousal and positive affectivity differentiated the two diagnostic groups. At a lower-order level, only anxiety sensitivity (and its facet of fear of physical symptoms) and a ruminative response style demonstrated incremental predictive ability. The discussion focuses on the relationships among these higher-order and lower-order variables, and their potential importance for understanding specific manifestations of psychopathology.

  4. Quality of smartphone apps related to panic disorder.

    Directory of Open Access Journals (Sweden)

    mathias eVan-Singer

    2015-07-01

    Full Text Available Smartphone apps have a growing role in health care. This study assessed the quality of English-language apps for panic disorder (PD and compared paid and free apps. Keywords related to PD were entered into the Google Play Store search engine. Apps were assessed using the following quality indicators: accountability, interactivity, self-help score (the potential of smartphone apps to help users in daily life, and evidence-based content quality. The Brief DISCERN score and the criteria of the Health on the Net label were also used as content quality indicators as well as the number of downloads. Of 247 apps identified, 52 met all inclusion criteria. The content quality and self-help scores of these PD apps were poor. None of the assessed indicators were associated with payment status or number of downloads. Multiple linear regressions showed that the Brief DISCERN score significantly predicted content quality and self-help scores. Poor content quality and self-help scores of PD smartphone apps highlight the gap between their technological potential and the overall quality of available products

  5. Gender differences in brain serotonin transporter availability in panic disorder.

    Science.gov (United States)

    Maron, Eduard; Tõru, Innar; Hirvonen, Jussi; Tuominen, Lauri; Lumme, Ville; Vasar, Veiko; Shlik, Jakov; Nutt, David J; Helin, Semi; Någren, Kjell; Tiihonen, Jari; Hietala, Jarmo

    2011-07-01

    The role of the serotonin (5-HT) system in the neurobiology and treatment of panic disorder (PD) remains unproven. Previously we detected lower brain 5-HT transporter (SERT) availability in PD, but the findings were preliminary and mainly limited to female patients. The aim of this study was to assess non-displaceable brain SERT binding potential (BP (ND)) in male and female patients with PD. The SERT BP (ND) was measured in groups of patients with PD (five males and six females) and matched healthy control subjects (12 males and 12 females) using positron emission tomography (PET) and [¹¹C]MADAM tracer. SERT BP (ND) were significantly higher in 13 of 20 studied brain regions, including several cortical and raphe areas, but lower in the hippocampus in males with PD as compared with healthy males. No significant differences in SERT BP (ND) were observed between female patients and controls. The results suggest gender-dependent regional differences in brain SERT availability and converge with previous PET findings of reduced 5-HT(1A) receptor binding in similar brain areas in PD. Distinctive functioning of the 5-HT system in males and females may underlie certain gender-dependent differences in expressions of PD.

  6. Is there a specific relationship between asthma and panic disorder?

    Science.gov (United States)

    Van Peski-Oosterbaan, A S; Spinhoven, P; Van der Does, A J; Willems, L N; Sterk, P J

    1996-04-01

    The objective of the present study was three-fold: (1) to assess the prevalence of PD in asthmatic patients in comparison with non-asthmatic patients; (2) to investigate possible differences in pulmonary function and anxiety symptomatology between asthmatic patients with PD and those without; and (3) to evaluate possible differences in symptom perception during histamine-induced bronchoconstriction between asthmatic patients with PD versus asthmatic controls without PD matched for age, sex and bronchial responsiveness to histamine (PC20). The study was performed on 123 consecutive patients referred to the lung function laboratory of a university hospital for a histamine challenge test. Firstly, baseline measures for FEV1, anxiety (ADIS-R, ACQ, BSQ, and STAI) and depression (SDS) were collected. Subsequently, before and during induced bronchoconstriction FEV1, perceived breathlessness (Borg scale), subjective anxiety (SUDS), and somatic panic symptoms (PAQ) were assessed. The prevalence of PD in asthmatic patients, although higher than in the general population, was very similar to the rate observed in non-asthmatic patients. Baseline level of FEV1 and bronchial responsiveness to histamine (PC20) were also not significantly different between asthmatic patients with and without PD. Moreover, in comparison with matched controls, PD cases reported significantly higher levels of perceived breathlessness during induced bronchoconstriction, although their mean fall in FEV1 was very comparable. It is concluded that the higher prevalence of PD in asthma is non-specific and probably due to selection bias.

  7. Gout treatment and comorbidities: a retrospective cohort study in a large US managed care population

    Directory of Open Access Journals (Sweden)

    Plana Estel

    2011-05-01

    Full Text Available Abstract Background Gout prevalence increased in recent years to become one of the most common causes of inflammatory arthritis in most industrialised countries. Comorbidities may affect the disease severity and treatment patterns. We describe the main characteristics of gout patients, gout-related treatment patterns and prevalent comorbidities in a managed care population. Methods From the large US PharMetrics Patient-Centric Database, patients aged 20-89 with at least 2 claims for a diagnosis of gout (ICD9 274.xx and related prescriptions between January 1, 1996 and December 31, 2008 were included. Gout flares were ascertained during follow-up. Sex-specific multivariable Poisson regression models were used to assess factors associated with number of flares. Results 177,637 gout patients were included (mean age 55.2 years; men 75.6%. Overall, more than half (58.1% had any of the considered comorbidities; hypertension (36.1%, dyslipidemia (27.0% and diabetes (15.1% being the most common. Nonselective NSAIDs were the most commonly dispensed (in 38.7% of patients. Notably, 39% of patients did not receive any prescription medication for gout. Patients with comorbidities were significantly more likely to receive anti-gout prescriptions. During an acute episode the prescription of NSAIDs and colchicine increased; and 29.9% of patients received allopurinol. The risk of flares was associated with cardiometabolic comorbidities and older age in women (highest at age 60-69, while in men it decreased by age. Women with these conditions were 60% more likely to have flares (incidence rate ratio, IRR 1.60;1.48-1.74, while men were 10% (IRR 1.10; 1.06-1.13 more likely. Conclusions Comorbidities affected gout treatment patterns and the occurrence and frequency of acute attacks. Cardiometabolic comorbidities, common in this patients' population, were associated with an increased risk of flares.

  8. Copeptin - A potential endocrine surrogate marker of CCK-4-induced panic symptoms?

    Science.gov (United States)

    Demiralay, Cüneyt; Agorastos, Agorastos; Yassouridis, Alexander; Jahn, Holger; Wiedemann, Klaus; Kellner, Michael

    2017-02-01

    Intravenous cholecystokinin-tetrapeptide (CCK-4) administration reliably and dose-dependently provokes panic anxiety in man, accompanied by adrenocorticotropic hormone (ACTH) and cortisol release. Preclinical findings suggest that behavioral and endocrine effects of CCK-4 are mediated via corticotropin-releasing hormone (CRH) release. Anxiogenic stimulation of the central CCK-receptors in man was shown to increase as well vasopressin (AVP), which acts synergistically with CRH as pituitary-adrenocortical axis stimulator during stress. Copeptin (CoP), the C-terminal part of pre-pro-AVP, is released in an equimolar ratio to AVP. It is more stable in the circulation and easier to determine than AVP and it was found to closely mirror the production of AVP. So far, CoP secretion has not been characterized during panic provocation. In 30 healthy male human subjects, we repeatedly measured CoP in plasma during a panic challenge and studied its correlation to Acute Panic Inventory (API) ratings and plasma ACTH and cortisol. CoP levels correlated positively with the increase in API ratings (r=0.41, p=0.03), while ACTH or cortisol did not (r=0.08, p=0.68 and r=0.12, p=0.53, respectively). CoP levels correlated also positively with ACTH (r=0.48, p=0.009) and cortisol (r=0.48, p=0.01) concentrations throughout the CCK-4 challenge. As expected, we found a positive correlation between plasma ACTH and cortisol levels (r=0.57, p=0.001). A vasopressinergic activation during CCK-4 induced panic was demonstrated, which was correlated positively to panic symptoms and pituitary-adrenocortical release. Our findings suggest a role of CoP as a potential surrogate marker of CCK-4 panic symptoms. Further studies are needed to replicate our results and to further clarify the role of CoP as a stress-sensitive hormone in different panic paradigms as well as in panic patients.

  9. Lifestyle Changes for Heart Attack Prevention

    Science.gov (United States)

    ... symptoms of a heart attack. It presents one woman's real-life experience with heart attack symptoms, which started during her pregnancy. The video also explains how a heart attack occurs and encourages women to seek care right away for heart attack symptoms. For more information, ...

  10. How Is a Heart Attack Treated?

    Science.gov (United States)

    ... symptoms of a heart attack. It presents one woman's real-life experience with heart attack symptoms, which started during her pregnancy. The video also explains how a heart attack occurs and encourages women to seek care right away for heart attack symptoms. For more information, ...

  11. How Is a Heart Attack Diagnosed?

    Science.gov (United States)

    ... symptoms of a heart attack. It presents one woman's real-life experience with heart attack symptoms, which started during her pregnancy. The video also explains how a heart attack occurs and encourages women to seek care right away for heart attack symptoms. For more information, ...

  12. Analytical Characterization of Internet Security Attacks

    Science.gov (United States)

    Sellke, Sarah H.

    2010-01-01

    Internet security attacks have drawn significant attention due to their enormously adverse impact. These attacks includes Malware (Viruses, Worms, Trojan Horse), Denial of Service, Packet Sniffer, and Password Attacks. There is an increasing need to provide adequate defense mechanisms against these attacks. My thesis proposal deals with analytical…

  13. Personality disorders in heart failure patients requiring psychiatric management: comorbidity detections from a routine depression and anxiety screening protocol.

    Science.gov (United States)

    Tully, Phillip J; Selkow, Terina

    2014-12-30

    Several international guidelines recommend routine depression screening in cardiac disease populations. No previous study has determined the prevalence and comorbidities of personality disorders in patients presenting for psychiatric treatment after these screening initiatives. In the first stage 404 heart failure (HF) patients were routinely screened and 73 underwent structured interview when either of the following criteria were met: (a) Patient Health Questionnaire ≥10; (b) Generalized Anxiety Disorder Questionnaire ≥7); (c) Response to one item panic-screener. Or (d) Suicidality. Patients with personality disorders were compared to the positive-screen patients on psychiatric comorbidities. The most common personality disorders were avoidant (8.2%), borderline (6.8%) and obsessive compulsive (4.1%), other personality disorders were prevalent in less than Personality disorder patients had significantly greater risk of major depression (risk ratio (RR) 1.2; 95% confidence interval (CI) 1.2-13.3), generalized anxiety disorder (RR 3.2; 95% CI 1.0-10.0), social phobia (RR 3.8; 95% CI 1.3-11.5) and alcohol abuse/dependence (RR 3.2; 95% 1.0-9.5). The findings that HF patients with personality disorders presented with complex psychiatric comorbidity suggest that pathways facilitating the integration of psychiatric services into cardiology settings are warranted when routine depression screening is in place.

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

    Science.gov (United States)

    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.

  15. Trajectories of change across outcomes in intensive treatment for adolescent panic disorder and agoraphobia.

    Science.gov (United States)

    Gallo, Kaitlin P; Cooper-Vince, Christine E; Hardway, Christina L; Pincus, Donna B; Comer, Jonathan S

    2014-01-01

    Much remains to be learned about typical and individual growth trajectories across treatment for adolescent panic disorder with and without agoraphobia and about critical treatment points associated with key changes. The present study examined the rate and shape of change across an 8-day intensive cognitive behavioral therapy for adolescent panic disorder with and without agoraphobia (N = 56). Participants ranged in age from 12 to 17 (M = 15.14, SD = 1.70; 58.9% female, 78.6% Caucasian). Multilevel modeling evaluated within-treatment linear and nonlinear changes across three treatment outcomes: panic severity, fear, and avoidance. Overall panic severity showed linear change, decreasing throughout treatment. In contrast, fear and avoidance ratings both showed cubic change, peaking slightly at the first session of treatment, starting to decrease at the second session of treatment, and with large gains continuing then plateauing at the fourth session. Findings are considered with regard to the extent to which they may elucidate critical treatment components and sessions for adolescents with panic disorder with and without agoraphobia.

  16. 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.

  17. RESIST SRP AGAINST WORMHOLE ATTACK

    Directory of Open Access Journals (Sweden)

    Marjan Kuchaki Rafsanjani

    2013-06-01

    Full Text Available Ad-hoc networks refer to temporary or interim networks which form for special purposes. Actually they are wireless networks with mobile nodes. These networks use no network assisting element for path routing and in these networks available nodes are responsible for path routing. Therefore when malicious nodes want to find a way to interfere with the path routing then the existence of a secure route protocol (SRP can prevent the interference. SRP protocol is one of the secure algorithms of path routing protocol but it is notresistant against wormhole attack. Wormhole attack is considered as a subtle attack in which two malicious nodes make a short connection in network's topology through private or implicit connection and represent two non neighbor nodes as neighbors and prevent the correctoperation of path routing protocol by using this method. One of the methods of preventing wormhole attack is by using packet leashes. We try to decrease the wormhole attack occurrence in this routing protocol by a kind of packet leashes called temporal leashes. We alsowill minimize problems resulting from using temporal leashes by different methods and modifications in its structure.

  18. Construction of War Discourse on International News Agencies: Case Study Terrorist attacks November 13th 2015

    Directory of Open Access Journals (Sweden)

    Ángel TORRES-TOUKOUMIDIS

    2017-01-01

    Full Text Available This study analyzes warmongering rhetoric presented by international agencies Reuters, Al Arabiya, Al Jazeera and Associated Press (AP of the information related to the terrorist attacks in Paris on November 13th, 2015 for 15 days after the event. We have started from a quantitative and qualitative analysis of 550 information units using the software MAXQDA (v. 11.0.11. Subsequently, the semantic criteria of media discourse: functionality, significance and direction of the goal was applied on the selected sample. The results demonstrate the prevailing demonization of Islam, the exaltation of fear and panic in the discursive construction and it highlighted the spectacle of the information as a communicative strategy on the rhetorical guidance.

  19. Network robustness under large-scale attacks

    CERN Document Server

    Zhou, Qing; Liu, Ruifang; Cui, Shuguang

    2014-01-01

    Network Robustness under Large-Scale Attacks provides the analysis of network robustness under attacks, with a focus on large-scale correlated physical attacks. The book begins with a thorough overview of the latest research and techniques to analyze the network responses to different types of attacks over various network topologies and connection models. It then introduces a new large-scale physical attack model coined as area attack, under which a new network robustness measure is introduced and applied to study the network responses. With this book, readers will learn the necessary tools to evaluate how a complex network responds to random and possibly correlated attacks.

  20. Migraine and Central Sensitization: Clinical Features, Main Comorbidities and Therapeutic Perspectives.

    Science.gov (United States)

    de Tommaso, Marina; Sciruicchio, Vittorio

    2016-01-01

    Migraine is a very common neurologic disorder, characterized by recurrent attacks of severe headache, autonomic nervous system dysfunction and in some patients by an aura. Migraine is a very common neurologic disorder of neuro-vascular origin, being amongst the 20 most disabling diseases. Migraine attacks are characterized by severe headache, associated to autonomic nervous system dysfunction and in some patients by aura. Pathophysiology and Role of Central Sensitization: Abnormal neuronal excitability may subtend altered processing of sensory stimuli, leading to cortical spreading depression and trigeminal activation. A dysfunction of pain modulation enhances central sensitization phenomena, contributing to acute allodynia and headache persistence. The peculiarity of migraine pain facilitates the use of analgesics, and causes an adjunctive invalidating tendency toward drug over-use. Comorbidity: Chronic migraine patients are frequently affected by diffuse pain, framed in fibromyalgia diagnosis. This comorbidity seems to be supported by common pathophysiological mechanisms. It may aggravate migraine invalidity being worth of consideration for therapeutic management. Migraine Management: Acute and preventive treatments need to be tailored to single cases. Main comorbidity and factors facilitating central sensitization should be taken into account. The management of migraine patients should include a link between headache centers and general practitioner, in order to provide for a better patient information and treatment just at the onset of the disease. Despite its high epidemiologic impact, migraine is frequently underestimated and destined to evolve into chronic form and drugs abuse. A more focused attention to factors facilitating central sensitization and invalidating comorbidities, should reduce the global burden of the disease. migraine, pathophysiology, central sensitization, fibromyalgia comorbidity, acute and preventive therapy, patients - centered approach.

  1. Attacks and countermeasures on AES and ECC

    DEFF Research Database (Denmark)

    Tange, Henrik; Andersen, Birger

    2013-01-01

    AES (Advanced Encryption Standard) is widely used in LTE and Wi-Fi communication systems. AES has recently been exposed to new attacks which have questioned the overall security of AES. The newest attack is a so called biclique attack, which is using the fact that the content of the state array...... side-channels attacks can be applied to ECC. This paper reflects an ongoing research in the field of countermeasures against the attacks mentioned above....

  2. 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…

  3. Global Mapping of Cyber Attacks

    Science.gov (United States)

    2014-01-01

    permutations of rows and columns. 3 Related Work Most prior empirical cyber security work is interested in characterizing the mode of operation of attack...The attribute networks (ICT att, bandwidth att, bribes att, ICT vie and ICT % diff) have all 1 component, and density and clustering coefficient...attnlrutes or attackers and victims ICT att x ICT vie 0.19*** 0.23*** 0.51*** 0.47*** Bribes att x ICT vie 0.21• 0.21* -0.26* -0.27 Bandwidth att

  4. Automated Generation of Attack Trees

    DEFF Research Database (Denmark)

    Vigo, Roberto; Nielson, Flemming; Nielson, Hanne Riis

    2014-01-01

    Attack trees are widely used to represent threat scenarios in a succinct and intuitive manner, suitable for conveying security information to non-experts. The manual construction of such objects relies on the creativity and experience of specialists, and therefore it is error-prone and impractica......Attack trees are widely used to represent threat scenarios in a succinct and intuitive manner, suitable for conveying security information to non-experts. The manual construction of such objects relies on the creativity and experience of specialists, and therefore it is error...

  5. What fMRI can tell as about panic disorder: bridging the gap between neurobiology and psychotherapy.

    Science.gov (United States)

    Grambal, Aleš; Hluštík, Petr; Praško, Ján

    2015-01-01

    Fifty years ago, when the effect of antidepressants on panic disorder was described, a significant progress in understanding this anxiety disorder has been made. Theoretical mechanisms and models of fear and panic disorder were proposed and tested in animal models and humans. With growing possibilities of non-invasive neuroimaging techniques, there is an increasing amount of information on the panic disorder. Unfortunately, a number of circumstances lead to inconsistent findings and its interpretations. In our review, we focused on functional MRI in panic disorder, limitations of current studies, possible interpretations and proposals for future direction. In our opinion, the current findings support the neuroanatomical model of panic disorder at the level of group data analysis. But at the same time, the results suggest significant inter-individual differences across the patients, which may be related to each patient's individual history, woven into their neural network and affecting the individual symptoms and response to therapy.

  6. Brazilian Medical Association guidelines for the diagnosis and differential diagnosis of panic disorder

    Directory of Open Access Journals (Sweden)

    Michelle Nigri Levitan

    2013-12-01

    Full Text Available Objective: To present the most relevant findings regarding the Brazilian Medical Association guidelines for the diagnosis and differential diagnosis of panic disorder. Methods: We used the methodology proposed by the Brazilian Medical Association for the Diretrizes Project. The MEDLINE (PubMed, Scopus, Web of Science, and LILACS online databases were queried for articles published from 1980 to 2012. Searchable questions were structured using the PICO format (acronym for “patient” [or population], “intervention” [or exposure], “comparison” [or control], and “outcome”. Results: We present data on clinical manifestations and implications of panic disorder and its association with depression, drug abuse, dependence and anxiety disorders. In addition, discussions were held on the main psychiatric and clinical differential diagnoses. Conclusions: The guidelines are proposed to serve as a reference for the general practitioner and specialist to assist in and facilitate the diagnosis of panic disorder.

  7. [Affective disorders: endocrine and metabolic comorbidities].

    Science.gov (United States)

    Cermolacce, M; Belzeaux, R; Adida, M; Azorin, J-M

    2014-12-01

    Links between affective and endocrine-metabolic disorders are numerous and complex. In this review, we explore most frequent endocrine-metabolic comorbidities. On the one hand, these comorbidities imply numerous iatrogenic effects from antipsychotics (metabolic side-effects) or from lithium (endocrine side-effects). On the other hand, these comorbidities are also associated with affective disorders independently from medication. We will successively examine metabolic syndrome, glycemic disturbances, obesity and thyroid disorders among patients with affective disorders. Endocrinemetabolic comorbidities can be individually encountered, but can also be associated. Therefore, they substantially impact morbidity and mortality by increasing cardiovascular risk factors. Two distinct approaches give an account of processes involved in these comorbidities: common environmental factors (iatrogenic effects, lifestyle), and/or shared physiological vulnerabilities. In conclusion, we provide a synthesis of important results and recommendations related to endocrine-metabolic comorbidities in affective disorders : heavy influence on morbidity and mortality, undertreatment of somatic diseases, importance of endocrine and metabolic side effects from main mood stabilizers, impact from sex and age on the prevalence of comorbidities, influence from previous depressive episodes in bipolar disorders, and relevance of systematic screening for subclinical (biological) disturbances.

  8. Indirect Comorbidity in Childhood and Adolescence

    Directory of Open Access Journals (Sweden)

    William eCopeland

    2013-11-01

    Full Text Available Objective: Comorbidity between psychiatric disorders is common, but pairwise associations between two disorders may be explained by the presence of other diagnoses that are associated with both disorders or indirect comorbidity. Method: Comorbidities of common childhood psychiatric disorders were tested in three community samples of children ages 6 to 17 (8931 observations of 2965 subjects. Psychiatric disorder status in all three samples was assessed with the Child and Adolescent Psychiatric Assessment. Indirect comorbidity was defined as A-B associations that decreased from significance to nonsignificance after adjusting for other disorders. Results: All tested childhood psychiatric disorders were positively associated in bivariate analyses. After adjusting for comorbidities, many ssociations involving a behavioral disorder and an emotional disorder were attenuated suggesting indirect comorbidity. Generalized anxiety and depressive disorders displayed a very high level of overlap (adjusted OR=37.9. All analyses were rerun with depressive disorders grouped with generalized anxiety disorder in a single distress disorders category. In these revised models, all associations between and emotional disorder and a behavior disorder met our criteria for indirect comorbidity except for the association of oppositional defiant disorder with distress disorders (OR=11.3. Follow-up analyses suggested that the indirect associations were primarily accounted for by oppositional defiant disorder and the distress disorder category. There was little evidence of either sex differences or differences by developmental period Conclusions: After accounting for the overlap between depressive disorders with generalized anxiety disorder, direct comorbidity between emotional and behavioral disorders was uncommon. When there was evidence of indirect comorbidity, ODD and distress disorders were the key intermediary diagnoses accounting for the apparent associations.

  9. Navigating the Zika panic [version 1; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Nathan D. Grubaugh

    2016-08-01

    Full Text Available The epidemics of Ebola virus in West Africa and Zika virus in America highlight how viruses can explosively emerge into new territories. These epidemics also exposed how unprepared we are to handle infectious disease emergencies. This is also true when we consider hypothesized new clinical features of infection, such as the associations between Zika virus infection and severe neurological disease, including microcephaly and Guillain-Barré syndrome. On the surface, these pathologies appear to be new features of Zika virus infection, however, causal relationships have not yet been established. Decades of limited Zika virus research are making us scramble to determine the true drivers behind the epidemic, often at the expense of over-speculation without credible evidence. Here we review the literature and find no conclusive evidence at this time for significant biological differences between the American Zika virus strains and those circulating elsewhere. Rather, the epidemic scale in the Americas may be facilitated by an abnormally warm climate, dense human and mosquito populations, and previous exposure to other viruses. Severe disease associated with Zika virus may therefore not be a new trait for the virus, rather it may have been overlooked due to previously small outbreaks. Much of the recent panic regarding Zika virus has been about the Olympics in Brazil. We do not find any substantial evidence that the Olympics will result in a significant number of new Zika virus infections (~10 predicted or that the Olympics will promote further epidemic spread over what is already expected. The Zika virus epidemic in the Americas is a serious situation and decisions based on solid scientific evidence - not hyped media speculations - are required for effective outbreak response.

  10. Psoriasis and comorbid diseases: Implications for management.

    Science.gov (United States)

    Takeshita, Junko; Grewal, Sungat; Langan, Sinéad M; Mehta, Nehal N; Ogdie, Alexis; Van Voorhees, Abby S; Gelfand, Joel M

    2017-03-01

    As summarized in the first article in this continuing medical education series, the currently available epidemiologic data suggest that psoriasis may be a risk factor for cardiometabolic disease. Emerging data also suggest associations between psoriasis and other comorbidities beyond psoriatic arthritis, including chronic kidney disease, inflammatory bowel disease, hepatic disease, certain malignancies, infections, and mood disorders. Recognizing the comorbid disease burden of psoriasis is essential for ensuring comprehensive care of patients with psoriasis. The clinical implications of the comorbid diseases that are associated with psoriasis and recommendations for clinical management are reviewed in this article. Copyright © 2016 American Academy of Dermatology, Inc. All rights reserved.

  11. Bipolar Disorder and Obsessive Compulsive Disorder Comorbidity

    Directory of Open Access Journals (Sweden)

    Necla Keskin

    2014-08-01

    Full Text Available The comorbidity of bipolar disorder and anxiety disorders is a well known concept. Obsessive-compulsive disorder is the most commonly seen comorbid anxiety disorder in bipolar patients. Some genetic variants, neurotransmitters especially serotonergic systems and second-messenger systems are thought to be responsible for its etiology. Bipolar disorder alters the clinical aspects of obsessive compulsive disorder and is associated with poorer outcome. The determination of comorbidity between bipolar disorder and obsessive compulsive disorder is quite important for appropriate clinical management and treatment. [Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry 2014; 6(4.000: 429-437

  12. Performance of attack strategies on modular networks

    CERN Document Server

    da Cunha, Bruno Requião

    2016-01-01

    Vulnerabilities of complex networks have became a trend topic in complex systems recently due to its real world applications. Most real networks tend to be very fragile to high betweenness adaptive attacks. However, recent contributions have shown the importance of interconnected nodes in the integrity of networks and module-based attacks have appeared promising when compared to traditional malicious non-adaptive attacks. In the present work we deeply explore the trade-off associated with attack procedures, introducing a generalized robustness measure and presenting an attack performance index that takes into account both robustness of the network against the attack and the run-time needed to obtained the list of targeted nodes for the attack. Besides, we introduce the concept of deactivation point aimed to mark the point at which the network stops to function properly. We then show empirically that non-adaptive module-based attacks perform better than high degree and betweenness adaptive attacks in networks ...

  13. Mitigating Higher Ed Cyber Attacks

    Science.gov (United States)

    Rogers, Gary; Ashford, Tina

    2015-01-01

    In this presentation we will discuss the many and varied cyber attacks that have recently occurred in the higher ed community. We will discuss the perpetrators, the victims, the impact and how these institutions have evolved to meet this threat. Mitigation techniques and defense strategies will be covered as will a discussion of effective security…

  14. Television journalism during terror attacks

    DEFF Research Database (Denmark)

    Mogensen, Kirsten

    2008-01-01

    This article views television news coverage of ongoing terrorist attacks and their immediate aftermath as a special genre within journalism, and describes norms connected with the genre. The description is based on qualitative analyses of the coverage on major American networks the first 24 hours...

  15. FLOODING ATTACK AWARE SECURE AODV

    Directory of Open Access Journals (Sweden)

    S. Madhavi

    2013-01-01

    Full Text Available Providing security in a Mobile Ad hoc Network (MANET is a challenging task due to its inherent nature. Flooding is a type of Denial of Service (DoS attack in MANET. Intentional flooding may lead to disturbances in the networking operation. This kind of attack consumes battery power, storage space and bandwidth. Flooding the excessive number of packets may degrade the performance of the network. This study considers hello flooding attack. As the hello packets are continuously flooded by the malicious node, the neighbor node is not able to process other packets. The functioning of the legitimate node is diverted and destroys the networking operation. Absence of hello packet during the periodical hello interval may lead to wrong assumption that the neighbor node has moved away. So one of the intermediate neighbor nodes sends Route Error (RERR message and the source node reinitiates the route discovery process. In a random fashion the hello interval values are changed and convey this information to other nodes in the network in a secured manner. This study identifies and prevents the flooding attack. This methodology considers the performance parameters such as packet delivery ratio, delay and throughput. This algorithm is implemented in Secure AODV and tested in ad hoc environment. The result of the proposed algorithm decreases the control overhead by 2%.

  16. Television Journalism During Terror Attacks

    DEFF Research Database (Denmark)

    Mogensen, Kirsten

    This article views television news coverage of ongoing terrorist attacks and their immediate aftermath as a special genre within journalism, and describes norms connected with the genre. The description is based on qualitative analyses of the coverage on the major American networks in the fi rst 24...

  17. Terrorist attacks escalate in frequency and fatalities preceding highly lethal attacks.

    Science.gov (United States)

    Martens, Andy; Sainudiin, Raazesh; Sibley, Chris G; Schimel, Jeff; Webber, David

    2014-01-01

    Highly lethal terrorist attacks, which we define as those killing 21 or more people, account for 50% of the total number of people killed in all terrorist attacks combined, yet comprise only 3.5% of terrorist attacks. Given the disproportionate influence of these incidents, uncovering systematic patterns in attacks that precede and anticipate these highly lethal attacks may be of value for understanding attacks that exact a heavy toll on life. Here we examined whether the activity of terrorist groups escalates--both in the number of people killed per attack and in the frequency of attacks--leading up to highly lethal attacks. Analyses of terrorist attacks drawn from a state-of-the-art international terrorism database (The Global Terrorism Database) showed evidence for both types of escalation leading up to highly lethal attacks, though complexities to the patterns emerged as well. These patterns of escalation do not emerge among terrorist groups that never commit a highly lethal attack.

  18. Attack Vulnerability of Network Controllability.

    Science.gov (United States)

    Lu, Zhe-Ming; Li, Xin-Feng

    2016-01-01

    Controllability of complex networks has attracted much attention, and understanding the robustness of network controllability against potential attacks and failures is of practical significance. In this paper, we systematically investigate the attack vulnerability of network controllability for the canonical model networks as well as the real-world networks subject to attacks on nodes and edges. The attack strategies are selected based on degree and betweenness centralities calculated for either the initial network or the current network during the removal, among which random failure is as a comparison. It is found that the node-based strategies are often more harmful to the network controllability than the edge-based ones, and so are the recalculated strategies than their counterparts. The Barabási-Albert scale-free model, which has a highly biased structure, proves to be the most vulnerable of the tested model networks. In contrast, the Erdős-Rényi random model, which lacks structural bias, exhibits much better robustness to both node-based and edge-based attacks. We also survey the control robustness of 25 real-world networks, and the numerical results show that most real networks are control robust to random node failures, which has not been observed in the model networks. And the recalculated betweenness-based strategy is the most efficient way to harm the controllability of real-world networks. Besides, we find that the edge degree is not a good quantity to measure the importance of an edge in terms of network controllability.

  19. Comorbidities associated with epilepsy and headaches

    Directory of Open Access Journals (Sweden)

    Thalles P. Ferreira

    2012-04-01

    Full Text Available Comorbidities are often associated with chronic neurological diseases, such as headache and epilepsy. OBJECTIVES: To identify comorbidities associated with epilepsy and headaches, and to determine possible drug interactions. METHODS: A standardized questionnaire with information about type of epilepsy/headache, medical history, and medication was administered to 80 adult subjects (40 with epilepsy and 40 with chronic headache. RESULTS: Patients with epilepsy had an average of two comorbidities and those with headache of three. For both groups, hypertension was the most prevalent. On average, patients with epilepsy were taking two antiepileptic medications and those with headache were taking only one prophylactic medication. Regarding concomitant medications, patients with epilepsy were in use, on average, of one drug and patients with headache of two. CONCLUSIONS: Patients with chronic neurological diseases, such as epilepsy and headaches, have a high number of comorbidities and they use many medications. This may contribute to poor adherence and interactions between different medications.

  20. Obsessive compulsive disorder comorbidity in DBA

    Directory of Open Access Journals (Sweden)

    Innocenti Alice

    2008-03-01

    Full Text Available Abstract Diamond-Blackfan Anemia (DBA is a congenital erythroid aplasia characterized as a normochromic macrocytic anemia with a selective deficiency in red blood cell precursors in otherwise normocelullar bone marrow. DBA is known to be associated with mental retardation and learning disabilities. Although comorbidities with other psychiatric conditions have not been reported in the existing literature, we report in this paper a case of a DBA patient with previously undiagnosed comorbidity of obsessive compulsive disorder (OCD, successfully treated with sertaline 200 mg/day and valproic acid 600 mg/day. This case of comorbid presentation has clinical, therapeutic and pathophysiological implications. Given the difficulty of distinguishing among mental retardation, learning disabilities and OCD and the importance of precocious diagnosis in treating OCD especially since there are treatment methods interfering with anemia symptoms, physicians should adapt an adequate screening tool treating a child with DBA and comorbid mental disorder.

  1. Conversion Disorder Comorbidity and Childhood Trauma

    National Research Council Canada - National Science Library

    Fatma Akyüz; Peykan G Gökalp; Sezgin Erdıman; Serap Oflaz; Çağatay Karşidağ

    2017-01-01

    ABSTRACT Introduction: The aim of this study is to examine the socio-demographic and clinical characteristics, the presence of comorbidity, and the link with childhood traumatic experiences in patients with conversion disorder (CD...

  2. Pain and depression comorbidity: a preclinical perspective

    OpenAIRE

    Li, Jun-Xu

    2014-01-01

    Pain and depression are two highly prevalent and deleterious disorders with significant socioeconomic impact to society. Clinical observations have long recognized the co-existence and interactions of pain and depression. However, the underlying mechanisms of pain-depression comorbidity and their dynamic interactions remain largely unknown. Preclinical animal studies may provide critical information for the understanding of this important comorbidity. This review analyzed the current preclini...

  3. Perfection of Recent Attacks using IP

    Directory of Open Access Journals (Sweden)

    A. RENGARAJAN

    2012-02-01

    Full Text Available The Internet threat monitoring (ITM systems have been deployed to detect widespread attacks on the Internet in recent years. However, the effectiveness of ITM systems critically depends on the confidentiality of the location of their monitors. If adversaries learn the monitor locations of an ITM system, they can bypass the monitors and focus on the uncovered IP address space without being detected. In this paper, we study a new class of attacks, the invisible LOCalization (iLOC attack. The iLOC attack can accurately and invisibly localize monitors of ITM systems. In the iLOC attack, the attacker launches low-rate port-scan traffic, encoded with a selected pseudo noise code (PN-code, to targeted networks. While the secret PN-code is invisible to others, the attacker can accurately determine the existence of monitors in the targeted networks based on whether the PN-code is embedded in the report data queried from the data center of the ITM system. We formally analyze the impact of various parameters on attack effectiveness. We implement the iLOC attack and conduct the performance evaluation on a real-world ITM system to demonstrate the possibility of such attacks. We also conduct extensive simulations on the iLOC attack using real-world traces. Our data show that the iLOC attack can accurately identify monitors while being invisible to ITM systems. Finally, we present a set of guidelines to counteract the iLOC attack.

  4. DSM-5 illness anxiety disorder and somatic symptom disorder: Comorbidity, correlates, and overlap with DSM-IV hypochondriasis.

    Science.gov (United States)

    Newby, Jill M; Hobbs, Megan J; Mahoney, Alison E J; Wong, Shiu Kelvin; Andrews, Gavin

    2017-10-01

    To investigate the reliability, validity and utility of DSM-5 illness anxiety disorder (IAD) and somatic symptom disorder (SSD), and explore their overlap with DSM-IV Hypochondriasis in a health anxious sample. Treatment-seeking patients with health anxiety (N=118) completed structured diagnostic interviews to assess DSM-IV Hypochondriasis, DSM-5 IAD, SSD, and comorbid mental disorders, and completed self-report measures of health anxiety, comorbid symptoms, cognitions and behaviours, and service utilization. IAD and SSD were more reliable diagnoses than Hypochondriasis (kappa estimates: IAD: 0.80, SSD: 0.92, Hypochondriasis: 0.60). 45% of patients were diagnosed with SSD, 47% with IAD, and 8% with comorbid IAD/SSD. Most patients with IAD fluctuated between seeking and avoiding care (61%), whereas care-seeking (25%) and care-avoidant subtypes were less common (14%). Half the sample met criteria for DSM-IV Hypochondriasis; of those, 56% met criteria for SSD criteria, 36% for IAD, and 8% for comorbid IAD/SSD. Compared to IAD, SSD was characterized by more severe health anxiety, somatic symptoms, depression, and higher health service use, and higher rates of major depressive disorder, panic disorder and agoraphobia. DSM-5 IAD and SSD classifications reliably detect more cases of clinically significant health anxiety than DSM-IV Hypochondriasis. The differences between IAD and SSD appear to be due to severity. Future research should explore the generalizability of these findings to other samples, and whether diagnostic status predicts treatment response and long-term outcome. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Zika Attacks Nerves, Muscles, Other Tissues

    Science.gov (United States)

    ... page: https://medlineplus.gov/news/fullstory_164010.html Zika Attacks Nerves, Muscles, Other Tissues Monkey study may ... 2017 (HealthDay News) -- Scientists have learned where the Zika virus attacks the body in monkeys. In their ...

  6. Classification of cyber attacks in South Africa

    CSIR Research Space (South Africa)

    Van Heerden, R

    2016-05-01

    Full Text Available This paper introduces a classification scheme for the visual classification of cyber attacks. Through the use of the scheme, the impact of various cyber attacks throughout the history of South Africa are investigated and classified. The goal...

  7. Using an ontology for network attack planning

    CSIR Research Space (South Africa)

    Van Heerden, R

    2016-09-01

    Full Text Available The modern complexity of network attacks and their counter-measures (cyber operations) requires detailed planning. This paper presents a Network Attack Planning ontology which is aimed at providing support for planning such network operations within...

  8. Stochastic Model of TCP SYN Attacks

    Directory of Open Access Journals (Sweden)

    Simona Ramanauskaitė

    2011-08-01

    Full Text Available A great proportion of essential services are moving into internet space making the threat of DoS attacks even more actual. To estimate the real risk of some kind of denial of service (DoS attack in real world is difficult, but mathematical and software models make this task easier. In this paper we overview the ways of implementing DoS attack models and offer a stochastic model of SYN flooding attack. It allows evaluating the potential threat of SYN flooding attacks, taking into account both the legitimate system flow as well as the possible attack power. At the same time we can assess the effect of such parameters as buffer capacity, open connection storage in the buffer or filte­ring efficiency on the success of different SYN flooding attacks. This model can be used for other type of memory depletion denial of service attacks.Article in Lithuanian

  9. Social engineering attack examples, templates and scenarios

    CSIR Research Space (South Africa)

    Mouton, Francois

    2016-06-01

    Full Text Available link. A social engineering attack targets this weakness by using various manipulation techniques to elicit sensitive information. The field of social engineering is still in its early stages with regard to formal definitions, attack frameworks...

  10. Two-Day, Intensive Cognitive-Behavioral Therapy for Panic Disorder: A Case Study

    Science.gov (United States)

    Deacon, Brett

    2007-01-01

    Cognitive-behavioral therapy (CBT) is a highly effective treatment for panic disorder. However, few patients have access to this treatment, particularly those living in rural areas. In a pilot study, the author previously described the efficacy of a 2-day, intensive, exposure-based CBT intervention that was developed for the purpose of delivering…

  11. Impact of Cognitive-Behavioral Treatment on Quality of Life in Panic Disorder Patients.

    Science.gov (United States)

    Telch, Michael J.; And Others

    1995-01-01

    Patients (n=156) meeting criteria for panic disorder with agoraphobia were randomly assigned to group cognitive-behavioral treatment (CBT) or a delayed-treatment control. Compared with the control group, CBT-treated patients showed significant reductions in impairment that were maintained at follow-up. Anxiety and phobic avoidance were…

  12. Face-Emotion Processing in Offspring at Risk for Panic Disorder.

    Science.gov (United States)

    Pine, Daniel S.; Klein, Rachel G.; Mannuzza, Salvatore; Moulton, John L., III; Lissek, Shmuel; Guardino, Mary; Woldehawariat, Girma

    2005-01-01

    Objective: Panic disorder (PD) has been linked to perturbed processing of threats. This study tested the hypotheses that offspring of parents with PD and offspring with anxiety disorders display relatively greater sensitivity and attention allocation to fear provocation. Method: Offspring of adults with PD, major depressive disorder (MDD), or no…

  13. Consensus statement on panic disorder from the International Consensus Group on Depression and Anxiety

    NARCIS (Netherlands)

    Ballenger, JC; Lecrubier, Y; Nutt, DJ; Baldwin, DS; den Boer, JA; Kasper, S; Shear, MK

    1998-01-01

    Objective: To provide primary care clinicians with a better understanding of management issues in panic disorder and guide clinical practice with recommendations for appropriate pharmacotherapy. Participants: The 4 members of the International Consensus Group on Depression and Anxiety were James C.

  14. Causes and Management of Treatment-Resistant Panic Disorder and Agoraphobia: A Survey of Expert Therapists

    Science.gov (United States)

    Sanderson, William C.; Bruce, Timothy J.

    2007-01-01

    Cognitive behavior therapy (CBT) is recognized as an effective psychological treatment for panic disorder (PD). Despite its efficacy, some clients do not respond optimally to this treatment. Unfortunately, literatures on the prediction, prevention, and management of suboptimal response are not well developed. Considering this lack of empirical…

  15. Sensation-Focused Intensive Treatment for Panic Disorder with Moderate to Severe Agoraphobia

    Science.gov (United States)

    Morissette, Sandra Baker; Spiegel, David A.; Heinrichs, Nina

    2005-01-01

    The current article presents a detailed description of an intensive treatment program for panic disorder with moderate to severe levels of agoraphobia (PDA), called Sensation-Focused Intensive Treatment (SFIT). Although the efficacy of traditional CBT treatment programs has been well established for the treatment of PDA, patients with moderate to…

  16. At the Eye of the Storm: An Academic('s) Experience of Moral Panic

    Science.gov (United States)

    Sikes, Pat

    2008-01-01

    The climate of moral panic that pertains around child abuse is such that any research that touches on children and sex is almost seen in itself to be abusive, with identity and career consequences for those who engage in it. In November 2005, an article that I had written some years earlier, "Scandalous Stories and Dangerous Liaisons: When Female…

  17. Monoamine oxidase A gene DNA hypomethylation - a risk factor for panic disorder?

    Science.gov (United States)

    Domschke, Katharina; Tidow, Nicola; Kuithan, Henriette; Schwarte, Kathrin; Klauke, Benedikt; Ambrée, Oliver; Reif, Andreas; Schmidt, Hartmut; Arolt, Volker; Kersting, Anette; Zwanzger, Peter; Deckert, Jürgen

    2012-10-01

    The monoamine oxidase A (MAOA) gene has been suggested as a prime candidate in the pathogenesis of panic disorder. In the present study, DNA methylation patterns in the MAOA regulatory and exon 1/intron 1 region were investigated for association with panic disorder with particular attention to possible effects of gender and environmental factors. Sixty-five patients with panic disorder (44 females, 21 males) and 65 healthy controls were analysed for DNA methylation status at 42 MAOA CpG sites via direct sequencing of sodium bisulfate treated DNA extracted from blood cells. The occurrence of recent positive and negative life events was ascertained. Male subjects showed no or only very minor methylation with some evidence for relative hypomethylation at one CpG site in intron 1 in patients compared to controls. Female patients exhibited significantly lower methylation than healthy controls at 10 MAOA CpG sites in the promoter as well as in exon/intron 1, with significance surviving correction for multiple testing at four CpG sites (p≤0.001). Furthermore, in female subjects the occurrence of negative life events was associated with relatively decreased methylation, while positive life events were associated with increased methylation. The present pilot data suggest a potential role of MAOA gene hypomethylation in the pathogenesis of panic disorder particularly in female patients, possibly mediating a detrimental influence of negative life events. Future studies are warranted to replicate the present finding in independent samples, preferably in a longitudinal design.

  18. Adding cognitive-behavioral therapy to pharmacotherapy for panic disorder: Issues and strategies

    NARCIS (Netherlands)

    Otto, M.W.; Powers, M.B.; Smits, J.A.J.

    2005-01-01

    Despite ample evidence of the efficacy of cognitive-behavioral therapy (CBT) for the treatment of patients with panic disorder (PD), dissemination of this evidence is proceeding slowly. This article highlights some of the issues surrounding the dissemination of CBT for PD and suggests strategies for

  19. Concordance between Measures of Anxiety and Physiological Arousal Following Treatment of Panic Disorder in Adolescence

    Science.gov (United States)

    Bacow, Terri Landon; May, Jill Ehrenreich; Choate-Summers, Molly; Pincus, Donna B.; Mattis, Sara G.

    2010-01-01

    This study examined the concordance (or synchrony/desynchrony) between adolescents' self-reports of anxiety and physiological measures of arousal (heart rate) both prior to and after treatment for panic disorder. Results indicated a decline in reported subjective units of distress (SUDS) for the treatment group only at the post-treatment…

  20. After the Moral Panic? Reframing the Debate about Child Safety Online

    Science.gov (United States)

    Facer, Keri

    2012-01-01

    This paper examines the initial "moral panic" surrounding children's access to the Internet at the end of the last century by analysing more than 900 media articles and key government documents from 1997 to 2001. It explores the ambiguous settlements that this produced in adult-child relations and children's access to the Internet. The…

  1. A National History Curriculum, Racism, a Moral Panic and Risk Society Theory

    Science.gov (United States)

    Rodwell, Grant

    2017-01-01

    With a proposed Australian national history curriculum, many Australians began to question what historical content would be taught in the nation's schools and colleges. While pressure for a national history curriculum had been building for many years, the final impetus came from a moral panic that gripped Australian society during late 2005,…

  2. Methylation of the SLC6a2 gene promoter in major depression and panic disorder.

    Directory of Open Access Journals (Sweden)

    Richard Bayles

    Full Text Available Reduced function of the noradrenaline transporter (NET has been demonstrated in patients with major depressive disorder (MDD and panic disorder. Attempts to explain NET dysfunction in MDD and panic disorder by genetic variation in the NET gene SLC6a2 have been inconclusive. Transcriptional silencing of the SLC6a2 gene may be an alternative mechanism which can lead to NET dysfunction independent of DNA sequence. The objective of this study was to characterise the DNA methylation state of the SLC6a2 gene promoter in patients with MDD and panic disorder. SLC6a2 promoter methylation was also analysed before and after antidepressant treatment. This study was performed with DNA from blood, using bisulphite sequencing and EpiTYPER methylation analyses. Patients with MDD or panic disorder were not found to differ significantly from healthy controls in the pattern of methylation of the SLC6a2 gene promotor. While significant correlations between methylation levels at some CpG sites and physiological measures were identified, overall the variation in DNA methylation between patients was small, and the significance of this variation remains equivocal. No significant changes in SLC6a2 promoter methylation were observed in response to antidepressant treatment. Further in-depth analysis of alternative mechanisms of transcriptional regulation of the SLC6a2 gene in human health and disease would be of value.

  3. Bipolar and panic disorders may be associated with hereditary defects in the innate immune system

    DEFF Research Database (Denmark)

    Foldager, Leslie; Köhler, Karl Ole; Steffensen, Rudi;

    2014-01-01

    Background: Mannan-binding lectin (MBL) and mannan-binding lectin-associated serine protease-2 (MASP-2) represent important arms of the innate immune system, and different deficiencies may result in infections or autoimmune diseases. Both bipolar and panic disorders are associated with increased...

  4. Nomophobia: the mobile phone in panic disorder with agoraphobia: reducing phobias or worsening of dependence?

    Science.gov (United States)

    King, Anna Lucia S; Valença, Alexandre M; Nardi, Antonio Egidio

    2010-03-01

    In this report, we present and discuss a hypothesis for the development, in individuals with panic disorder and agoraphobia, of dependence on his or her mobile phone (MP). This disorder, termed nomophobia, is a result of the development of new technologies. Nomophobia is considered a disorder of the modern world and refers to discomfort or anxiety caused by being out of contact with a MP or computer. It is the pathologic fear of remaining out of touch with technology. We present, the case report of a patient who has continuously kept his MP with him since 1995 because of his overwhelming need to feel safe and to be able to immediately call emergency services and people he trusts should he feel sick. The patient was treated with medication and cognitive-behavior psychotherapy. He has remained asymptomatic for 4 years. The patient showed significant medical improvement in his panic disorder and phobias, but there has been no change in his nomophobia. The case presented here illustrates the dependence of an individual with panic disorder on his MP. A specific approach for this dependence should be used in some panic disorder patients.

  5. A Study of Gaps in Attack Analysis

    Science.gov (United States)

    2016-10-12

    at- tack analysis as opposed to analyzing individual attacks; making detection sensors temporally and spatially dynamic; making attack identification...and Analysis Environment Asymmetry 22 3.5 Legacy Support Requirements 27 3.6 Sensors are Static Spatially and Temporally , While Attacks are Dynamic 28...or analysis, typically due to a lack of context from the points of attack. 2. Systems are designed for expressiveness and flexibility a. Many languages

  6. Terror attacks influence driving behavior in Israel

    Science.gov (United States)

    Stecklov, Guy; Goldstein, Joshua R.

    2004-01-01

    Terror attacks in Israel produce a temporary lull in light accidents followed by a 35% spike in fatal accidents on Israeli roads 3 days after the attack. Our results are based on time-series analysis of Israeli traffic flows, accidents, and terror attacks from January 2001 through June 2002. Whereas prior studies have focused on subjective reports of posttraumatic stress, our study shows a population-level behavioral response to violent terror attacks. PMID:15448203

  7. Sybil attack in Wireless Sensor Network

    Directory of Open Access Journals (Sweden)

    Abirami.K

    2013-04-01

    Full Text Available Wireless network is very susceptible to different types of attack. The main attack is Sybil attack, which allows forming other attacks on the network. Security is very important to the wireless network. In wireless sensor network, to verify node identities by cryptographic authentication but this is not easy because sensor node which contains limited resources. Therefore the current research is going on how to handling the situation of different traffic levels and transmission power for security.

  8. New Multi-step Worm Attack Model

    OpenAIRE

    Robiah, Y.; Rahayu, S. Siti; Shahrin , S.; M. FAIZAL A.; Zaki, M. Mohd; Marliza, R.

    2010-01-01

    The traditional worms such as Blaster, Code Red, Slammer and Sasser, are still infecting vulnerable machines on the internet. They will remain as significant threats due to their fast spreading nature on the internet. Various traditional worms attack pattern has been analyzed from various logs at different OSI layers such as victim logs, attacker logs and IDS alert log. These worms attack pattern can be abstracted to form worms' attack model which describes the process of worms' infection. Fo...

  9. Biomechanics of knife stab attacks.

    Science.gov (United States)

    Chadwick, E K; Nicol, A C; Lane, J V; Gray, T G

    1999-10-25

    Equipment, materials and methods for the measurement of the biomechanical parameters governing knife stab attacks have been developed and data have been presented that are relevant to the improvement of standards for the testing of stab-resistant materials. A six-camera Vicon motion analysis system was used to measure velocity, and derive energy and momentum during the approach phase of the attack and a specially developed force-measuring knife was used to measure three-dimensional forces and torque during the impact phase. The body segments associated with the knife were modelled as a series of rigid segments: trunk, upper arm, forearm and hand. The velocities of these segments, together with knowledge of the mass distribution from biomechanical tables, allowed the calculation of the individual segment energy and momentum values. The instrumented knife measured four components of load: axial force (along the length of the blade), cutting force (parallel to the breadth of the blade), lateral force (across the blade) and torque (twisting action) using foil strain gauges. Twenty volunteers were asked to stab a target with near maximal effort. Three styles of stab were used: a short thrust forward, a horizontal style sweep around the body and an overhand stab. These styles were chosen based on reported incidents, providing more realistic data than had previously existed. The 95th percentile values for axial force and energy were 1885 N and 69 J, respectively. The ability of current test methods to reproduce the mechanical parameters measured in human stab attacks has been assessed. It was found that current test methods could reproduce the range of energy and force values measured in the human stab attacks, although the simulation was not accurate in some respects. Non-axial force and torque values were also found to be significant in the human tests, but these are not reproduced in the standard mechanical tests.

  10. Attack Tree Generation by Policy Invalidation

    DEFF Research Database (Denmark)

    Ivanova, Marieta Georgieva; Probst, Christian W.; Hansen, Rene Rydhof;

    2015-01-01

    through brainstorming of experts. In this work we formalize attack tree generation including human factors; based on recent advances in system models we develop a technique to identify possible attacks analytically, including technical and human factors. Our systematic attack generation is based...

  11. On Mitigating Distributed Denial of Service Attacks

    Science.gov (United States)

    Gao, Zhiqiang

    2006-01-01

    Denial of service (DoS) attacks and distributed denial of service (DDoS) attacks are probably the most ferocious threats in the Internet, resulting in tremendous economic and social implications/impacts on our daily lives that are increasingly depending on the well-being of the Internet. How to mitigate these attacks effectively and efficiently…

  12. Automated classification of computer network attacks

    CSIR Research Space (South Africa)

    Van Heerden, R

    2013-11-01

    Full Text Available In this paper we demonstrate how an automated reasoner, HermiT, is used to classify instances of computer network based attacks in conjunction with a network attack ontology. The ontology describes different types of network attacks through classes...

  13. 47 CFR 76.1612 - Personal attack.

    Science.gov (United States)

    2010-10-01

    ... 47 Telecommunication 4 2010-10-01 2010-10-01 false Personal attack. 76.1612 Section 76.1612... CABLE TELEVISION SERVICE Notices § 76.1612 Personal attack. (a) When, during origination cablecasting of issues of public importance, an attack is made upon the honesty, character, integrity, or like...

  14. Cache timing attacks on recent microarchitectures

    DEFF Research Database (Denmark)

    Andreou, Alexandres; Bogdanov, Andrey; Tischhauser, Elmar Wolfgang

    2017-01-01

    Cache timing attacks have been known for a long time, however since the rise of cloud computing and shared hardware resources, such attacks found new potentially devastating applications. One prominent example is S$A (presented by Irazoqui et al at S&P 2015) which is a cache timing attack against...

  15. Cyberprints: Identifying Cyber Attackers by Feature Analysis

    Science.gov (United States)

    Blakely, Benjamin A.

    2012-01-01

    The problem of attributing cyber attacks is one of increasing importance. Without a solid method of demonstrating the origin of a cyber attack, any attempts to deter would-be cyber attackers are wasted. Existing methods of attribution make unfounded assumptions about the environment in which they will operate: omniscience (the ability to gather,…

  16. On Mitigating Distributed Denial of Service Attacks

    Science.gov (United States)

    Gao, Zhiqiang

    2006-01-01

    Denial of service (DoS) attacks and distributed denial of service (DDoS) attacks are probably the most ferocious threats in the Internet, resulting in tremendous economic and social implications/impacts on our daily lives that are increasingly depending on the well-being of the Internet. How to mitigate these attacks effectively and efficiently…

  17. Attacks and countermeasures on AES and ECC

    DEFF Research Database (Denmark)

    Tange, Henrik; Andersen, Birger

    2013-01-01

    AES (Advanced Encryption Standard) is widely used in LTE and Wi-Fi communication systems. AES has recently been exposed to new attacks which have questioned the overall security of AES. The newest attack is a so called biclique attack, which is using the fact that the content of the state array...

  18. Panic disorder cases in Japanese-Brazilians in Japan: their ethnic and cultural confusion.

    Science.gov (United States)

    Tsuji, K; Miyasaka, L S; Otsuka, K; Honda, G; Kato, S; Abe, Y

    2001-04-01

    The comparatively high salaries made in Japan are attractive to many Japanese-Brazilians. The number of individuals from this ethnic group being treated in Japanese mental hospitals has increased. We hypothesized that Japanese-Brazilian patients with panic disorders adjusted better to Japanese society and culture than those with other mental disorders. The subjects in the present study are 40 Japanese-Brazilian patients undergoing treatment at the Department of Psychiatry at Jichi Medical School, Japan, from May 1990 to September 1998. Patients were divided into a panic disorder group, a schizophrenic group, a mood disorder group and a neurosis group. Demographic data (Japanese language ability, duration of residence in Japan etc.) were collected. A comparison was made among the four groups. Patients in the panic disorder group showed a significant tendency to be fluent speakers of Japanese. Patients in the panic disorder group also had been in Japan for a significantly longer period of time than those in the other three groups. Japanese ability and length of residence in Japan rule out exacerbating factors due to a foreign living environment. Panic disorder patients usually have resolved the problems inherent in living and working in a foreign country. In general, Japanese-Brazilians are more comfortable both financially and socially in Japan than other foreign laborers because of their cultural and family background. The emotional conflict experienced by such patients may result from concern over whether to live in Brazil or Japan in the future. Their ethnic and cultural identity may be confused, fluctuating between identifying with Brazil and with Japan, and this may cause vague feelings of anxiety.

  19. COMORBIDITY IN PATIENTS WITH RHEUMATOID ARTHRITIS

    Directory of Open Access Journals (Sweden)

    N. M. Nikitina

    2015-01-01

    Full Text Available Objective: to study the pattern and rate of comorbid diseases in patients with rheumatoid  arthritis (RA in the Saratov Region.Subjects and methods. The investigation enrolled 328 RA patients treated at the Rheumatology Unit, Saratov Regional   Clinical Hospital,  in 2011 to 2013. RA was diagnosed using the 1987 ACR criteria and the 2010 ACR/EULAR ones. The investigation included the patients receiving disease-modifying antirheumatic drugs (DMARD at a stable dose for 3 months or longer. A questionnaire  survey and objective examination  were made in the patients; data from their medical records were taken into account.Results and discussion. Comorbidities  were identified in 86.6% of the patients; 57.9% had a concurrence of two or more comorbid conditions.  Osteoarthritis,  hypertension, and coronary heart disease were detected in 50.7, 57.7, and 30.9% of the RA patients, respectively. Out of the inflammatory diseases, gastrointestinal  tract lesion was most common (80.3%; urinary tract infections were slightly less common  (19.7%.Conclusion. The high rate of comorbidity was noted in patients with RA. The pattern of comorbidities shows a preponderance  of hypertension  and osteoarthritis  and an exacerbation of gastrointestinal  and urinary tract diseases frequently makes the choice of DMARD  difficult.

  20. Co-morbidities of vertiginous diseases

    Directory of Open Access Journals (Sweden)

    Ferrari Uta

    2009-07-01

    Full Text Available Abstract Background Co-morbidities of vertiginous diseases have so far not been investigated systematically. Thus, it is still unclear whether the different vertigo syndromes (e.g. benign paroxysmal positional vertigo (BPPV, Meniere's disease (MD, vestibular migraine and phobic vertigo (PPV have also different spectrums of co-morbidities. Methods All patients from a cohort of 131 participants were surveyed using a standardised questionnaire about the co-morbidities hypertension, diabetes mellitus, BMI (body mass index, migraine, other headache, and psychiatric diseases in general and the likelihood of a depression in particular. Results We noted hypertension in 29.0% of the cohort, diabetes mellitus in 6.1%, migraine in 8.4%, other headache in 32.1%, psychiatric diseases in 16.0%, overweight and obesity in 33.6% and 13.7% respectively, as well as a clinical indication for depression in 15.9%. Conclusion In general, we did not detect an increased prevalence of the co-morbidities diabetes mellitus, arterial hypertension, migraine, other headache and obesity compared to the general population. There was an increased prevalence of psychiatric co-morbidity in patients with PPV, and the prevalence of hypertension was elevated in patients with MD.