Ataques de nervios: culturally bound and distinct from panic attacks?

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Keough, Meghan E; Timpano, Kiara R; Schmidt, Norman B

2009-01-01

The Diagnostic and Statistical Manual of Mental Disorders [DSM-IV-TR; American Psychiatric Association [APA], 2000) has emphasized the importance of understanding psychopathology within a cultural framework by including culture-bound syndromes within its appendices. These syndromes are proposed to be bound to certain cultures and distinct from other psychological disorders. Included among the syndromes are ataques de nervios (ADN), which are reported to be bound to the Hispanic culture and closely resemble panic attacks. However, the cultural distinctiveness and phenomenology of ADN has not been adequately investigated. The current study employed an ethnically diverse study sample (N=342) of undergraduates. Participants completed a number of measures that assessed acculturation, syndrome and anxiety risk factors. In contrast to the DSM-IV's conceptualization of ADN, the rate of ADN did not significantly vary across the three main groups (African American, Caucasian, and Hispanic participants) nor did it vary based on acculturation. More consistent with the DSM-IV, the symptom comparisons indicated some differentiation between ADN and panic attacks. The present report provides data indicating that ADNs, as described by the DSM-IV, are not unique to the Hispanic culture and are experienced by non-Hispanic individuals at similar rates to Hispanic-endorsement. The findings are consistent with the DSM-IV assertion that ADNs and PAs are distinct syndromes. (c) 2008 Wiley-Liss, Inc.

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.

Association of Job Stressors With Panic Attack and Panic Disorder in a Working Population in Japan: A Cross-Sectional Study.

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Asai, Yumi; Imamura, Kotaro; Kawakami, Norito

2017-06-01

This study aimed to investigate associations of job stressors with panic attack (PA) and panic disorder (PD) among Japanese workers. A cross-sectional online questionnaire survey was conducted of 2060 workers. Job strain, effort/reward imbalance, and workplace social support were measured by the job content questionnaire and effort/reward imbalance questionnaire. These variables were classified into tertiles. PA/PD were measured by self-report based on the mini international neuropsychiatric interview (MINI). Multiple logistic regression was conducted, adjusting for demographic, lifestyle, and health-related covariates. Data from 1965 participants were analyzed. Adjusted odds ratio (OR) of PA/PD was significantly greater for the group with high effort/reward imbalance compared with the group with low effort/reward imbalance (ORs, 2.64 and 2.94, respectively, both P imbalance was associated with having PA/PD among Japanese workers.

Effect of Zuogui Pill () on monoamine neurotransmitters and sex hormones in climacteric rats with panic attack.

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Li, Xiao-Yu; Wang, Xiao-Yun

2017-03-01

To explore the effects of Chinese medicine prescription Zuogui Pill (, ZGP) on monoamine neurotransmitters and sex hormones in climacteric rats with induced panic attacks. Forty-eight climacteric female rats were randomized into 6 groups with 8 rats in each group: the control group, the model group, the low-, medium- and high-dose ZGP groups and the alprazolam group. Rats in the low-, medium- and high-dose ZGP groups were administered 4.725, 9.45, or 18.9 g/kg ZGP by gastric perfusion, respectively. The alprazolam group was treated by gastric perfusion with 0.036 mg/kg alprazolam. The control and model groups were treated with distilled water. The animals were pretreated once daily for 8 consecutive weeks. The behaviors of rats in the open fifield test and the elevated T-maze (ETM) were observed after induced panic attack, and the levels of brain monoamine neurotransmitters and the plasma levels of sex hormones were measured. Compared with the control group, the mean ETM escape time and the levels of 5-hydroxytryptamine (5-HT) and noradrenalin (NE) of the model group were signifificantly reduced (P<0.05), Compared with the model group, the mean ETM escape time and the 5-HT and NE levels of all the ZGP groups increased signifificantly (P<0.05 or P<0.01). However, no signifificant difference was observed in the levels of sex hormones between the groups. Pretreatment with ZGP in climacteric rats may improve the behavior of panic attack, which may be related to increased 5-HT and NE in the brain.

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

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

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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.

The diagnostic value of clinical EEG in detecting abnormal synchronicity in panic disorder.

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Adamaszek, Michael; Olbrich, Sebastian; Gallinat, Jürgen

2011-07-01

Electroencephalographic (EEG) findings repeatedly reported abnormal synchronous or even epileptiform discharges in panic disorder. Although less frequently occurring in patients with panic disorder, these deviant EEG features during panic attacks were also observed in intracranial EEG. For this purpose, our article reviews the consideration of abnormal synchronous neuronal activity in different neurocircuits, particularly limbic, as a suggested condition of panic attacks. Therapeutic approaches of anticonvulsants have shown reductions of symptoms and frequency of attacks in numerous patients suffering from panic disorder, supporting the presumption of underlying abnormal synchronous neuronal activity. Thus, scalp EEG recordings are still recommended for discovering indications of abnormal synchronous neuronal activity in panic patients.

Double-blind clonazepam vs placebo in panic disorder treatment

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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.

Ataque de nervios and panic disorder.

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Liebowitz, M R; Salmán, E; Jusino, C M; Garfinkel, R; Street, L; Cárdenas, D L; Silvestre, J; Fyer, A J; Carrasco, J L; Davies, S

1994-06-01

Ataque de nervios ("attack of nerves") is an illness category used frequently by Hispanic individuals to describe one or more particular symptom complexes. A review of the literature on ataque suggested some overlap with panic disorder. This study investigated the overlap with panic disorder as well as other DSM-III-R axis I disorders. Hispanic subjects seeking treatment at an anxiety disorders clinic (N = 156) were assessed with a specially designed questionnaire for self-report of ataque de nervios and panic symptoms and with structured or semistructured psychiatric interviews for axis I disorders. Seventy percent of the subjects reported at least one ataque de nervios; 80% of these were female, whereas 57% of the group without these attacks were female. There were no differences in DSM-III-R diagnoses between the groups with and without ataque de nervios. Ataque was frequently associated with one or more anxiety and affective disorders, including panic disorder, generalized anxiety disorder, recurrent major depression, and anxiety not otherwise specified. Of the 45 subjects with both ataque de nervios and primary panic disorder, 80% appeared to have labeled panic disorder as ataque. Ataque de nervios was associated with panic symptoms even in subjects without panic disorder, but the self-reporting of ataque conveyed additional clinical information about the subjects with panic disorder. Ataque de nervios was similar in frequency and symptoms among subjects of Dominican and Puerto Rican origin. Ataque de nervios overlaps with panic disorder but is a more inclusive construct. Further study of its interrelation with axis I disorders is needed.

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

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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.

Changes in central sodium and not osmolarity or lactate induce panic-like responses in a model of panic disorder.

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Molosh, Andre I; Johnson, Philip L; Fitz, Stephanie D; Dimicco, Joseph A; Herman, James P; Shekhar, Anantha

2010-05-01

Panic disorder is a severe anxiety disorder characterized by recurrent panic attacks that can be consistently provoked with intravenous (i.v.) infusions of hypertonic (0.5 M) sodium lactate (NaLac), yet the mechanism/CNS site by which this stimulus triggers panic attacks is unclear. Chronic inhibition of GABAergic synthesis in the dorsomedial hypothalamus/perifornical region (DMH/PeF) of rats induces a vulnerability to panic-like responses after i.v. infusion of 0.5 M NaLac, providing an animal model of panic disorder. Using this panic model, we previously showed that inhibiting the anterior third ventricle region (A3Vr; containing the organum vasculosum lamina terminalis, the median preoptic nucleus, and anteroventral periventricular nucleus) attenuates cardiorespiratory and behavioral responses elicited by i.v. infusions of NaLac. In this study, we show that i.v. infusions of 0.5 M NaLac or sodium chloride, but not iso-osmolar D-mannitol, increased 'anxiety' (decreased social interaction) behaviors, heart rate, and blood pressure responses. Using whole-cell patch-clamp preparations, we also show that bath applications of NaLac (positive control), but not lactic acid (lactate stimulus) or D-mannitol (osmolar stimulus), increases the firing rates of neurons in the A3Vr, which are retrogradely labeled from the DMH/PeF and which are most likely glutamatergic based on a separate study using retrograde tracing from the DMH/PeF in combination with in situ hybridization for vesicular glutamate transporter 2. These data show that hypertonic sodium, but not hyper-osmolarity or changes in lactate, is the key stimulus that provokes panic attacks in panic disorder, and is consistent with human studies.

Cross-national Epidemiology of Panic Disorder and Panic Attacks in the World Mental Health Surveys

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de Jonge, Peter; Roest, Annelieke M.; Lim, Carmen C.W.; Florescu, Silvia E.; Bromet, Evelyn; Stein, Dan; Harris, Meredith; Nakov, Vladimir; Caldas-de-Almeida, Jose Miguel; Levinson, Daphna; Al-Hamzawi, Ali O.; Haro, Josep Maria; Viana, Maria Carmen; Borges, Gui; O’Neill, Siobhan; de Girolamo, Giovanni; Demyttenaere, Koen; Gureje, Oye; Iwata, Noboru; Lee, Sing; Hu, Chiyi; Karam, Aimee; Moskalewicz, Jacek; Kovess-Masfety, Viviane; Navarro-Mateu, Fernando; Browne, Mark Oakley; Piazza, Maria; Posada-Villa, José; Torres, Yolanda; ten Have, Margreet L.; Kessler, Ronald C.; Scott, Kate M.

2016-01-01

Context The scarcity of cross-national reports and the changes in DSM-5 regarding panic disorder (PD) and panic attacks (PAs) call for new epidemiological data on PD and PAs and its subtypes in the general population. Objective To present representative data about the cross-national epidemiology of PD and PAs in accordance with DSM-5 definitions. Design and Setting Nationally representative cross-sectional surveys using the World Health Organization Composite International Diagnostic Interview version 3.0. Participants Respondents (n=142,949) from 25 high, middle and lower-middle income countries across the world aged 18 years or older. Main Outcome Measures PD and presence of single and recurrent PAs. Results Lifetime prevalence of PAs was 13.2% (s.e. 0.1%). Among persons that ever had a PA, the majority had recurrent PAs (66.5%; s.e. 0.5%), while only 12.8% fulfilled DSM-5 criteria for PD. Recurrent PAs were associated with a subsequent onset of a variety of mental disorders (OR 2.0; 95% CI 1.8–2.2) and their course (OR 1.3; 95% CI 1.2–2.4) whereas single PAs were not (OR 1.1; 95% CI 0.9–1.3 and OR 0.7; 95% CI 0.6–0.8). Cross-national lifetime prevalence estimates were 1.7% (s.e. 0.0%) for PD with a median age of onset of 32 (IQR 20–47). Some 80.4% of persons with lifetime PD had a lifetime comorbid mental disorder. Conclusions We extended previous epidemiological data to a cross-national context. The presence of recurrent PAs in particular is associated with subsequent onset and course of mental disorders beyond agoraphobia and PD, and might serve as a generic risk marker for psychopathology. PMID:27775828

Sertraline and Alprazolam in the Treatment of Panic Disorder

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Saida Fišeković

2005-05-01

Full Text Available A compared, 12 week, placebo controlled study, with fixed dose, outpatient study of patients diagnosed with panic disorder with and without agoraphobia according to ICD-10, was conducted to evaluate the efficacy and safety of sertraline and alprazolam. The study included 40 patients, divided in two groups. We evaluated number of ICD-10-defined panic attacks, agoraphobia and anticipatory anxiety. All patients were aged 18 year and older and were randomized to either sertraline or alprazolam. Sertraline applied in fixed doses of 20 mg/day and alprazolam in doses 1-1,5 mg/day significantly reduced the frequency of panic attacks in panic disorder patients, reduced symptoms of agoraphobia and anticipatory anxiety

Carbon dioxide test as an additional clinical measure of treatment response in panic disorder

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Valença Alexandre M.

2002-01-01

Full Text Available OBJECTIVE: We aim to determine if a treatment with a dose of clonazepam - 2 mg/day, for 6 weeks, blocks spontaneous panic attacks and the ones induced by the inhalation of 35% carbon dioxide (CO2 in panic disorder (PD patients. The CO2 challenge-test may be a useful addition tool for measuring the pharmacological response during the initial phase (6 weeks in the treatment of PD. METHOD: Eighteen PD patients drug free for a week participated in a carbon dioxide challenge test. Fourteen had a panic attack and were openly treated for a 6-week period with clonazepam. At the end of the 6-week period they were submitted again to the CO2 challenge test. RESULTS: After 6 weeks of treatment with clonazepam, 12 of 14 PD patients (85.7% did not have a panic attack after the CO2 challenge test. Just 2 of 14 patients (14.3% had a panic attack after the CO2 challenge test. Ten of 14 (71.4% PD patients had panic free status after clonazepam treatment. The 2 patients who had a panic attack in the sixth week, after the CO2 test, did not have panic free status after the treatment with clonazepam. CONCLUSION: The CO2-test may be a valid tool for testing and predicting the drug response.

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

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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.

Applied relaxation vs cognitive behavior therapy in the treatment of panic disorder.

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Ost, L G; Westling, B E

1995-02-01

The present study investigated the efficacy of a coping-technique, applied relaxation (AR) and cognitive behavior therapy (CBT), in the treatment of panic disorder. Thirty-eight outpatients fulfilling the DSM-III-R criteria for panic disorder with no (n = 30) or mild (n = 8) avoidance were assessed with independent assessor ratings, self-report scales and self-observation of panic attacks before and after treatment, and at a 1-yr follow-up. The patients were treated individually for 12 weekly sessions. The results showed that both treatments yielded very large improvements, which were maintained, or furthered at follow-up. There was no difference between AR and CBT on any measure. The proportion of panic-free patients were 65 and 74% at post-treatment, and 82 and 89% at follow-up, for AR and CBT, respectively. There were no relapses at follow-up, on the contrary 55% of the patients who still had panic attacks at post-treatment were panic-free at follow-up. Besides affecting panic attacks the treatments also yielded marked and lasting changes on generalized anxiety, depression and cognitive misinterpretations. The conclusion that can be drawn is that both AR and CBT are effective treatments for panic disorder without avoidance.

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

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Alexandre M Valença

2001-03-01

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

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

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

2014-01-01

Cognitive models of panic disorder (PD) with and without agoraphobia have stressed the role of catastrophic beliefs of bodily symptoms as a central mediating variable of the efficacy of cognitive behavioral therapy (CBT). Perceived ability to cope with or control panic attacks, panic self......-efficacy, has also been proposed to play a key role in therapeutic change; however, this cognitive factor has received much less attention in research. The aim of the present review is to evaluate panic self-efficacy as a mediator of outcome in CBT for PD using descriptive and meta-analytic procedures. We...... an association between change in panic self-efficacy and change in outcome during therapy (criterion 2); three tested, and one established formal statistical mediation of panic self-efficacy (criterion 3); while four tested and three found change in panic self-efficacy occurring before the reduction of panic...

Post- and peritraumatic stress in disaster survivors: an explorative study about the influence of individual and event characteristics across different types of disasters

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Anna Grimm

2012-05-01

Full Text Available Background : Examination of existing research on posttraumatic adjustment after disasters suggests that survivors’ posttraumatic stress levels might be better understood by investigating the influence of the characteristics of the event experienced on how people thought and felt, during the event as well as afterwards. Objective : To compare survivors’ perceived post- and peritraumatic emotional and cognitive reactions across different types of disasters. Additionally, to investigate individual and event characteristics. Design : In a European multi-centre study, 102 survivors of different disasters terror attack, flood, fire and collapse of a building were interviewed about their responses during the event. Survivors’ perceived posttraumatic stress levels were assessed with the Impact of Event Scale-Revised (IES-R. Peritraumatic emotional stress and risk perception were rated retrospectively. Influences of individual characteristics, such as socio-demographic data, and event characteristics, such as time and exposure factors, on post- and peritraumatic outcomes were analyzed. Results : Levels of reported post- and peritraumatic outcomes differed significantly between types of disasters. Type of disaster was a significant predictor of all three outcome variables but the factors gender, education, time since event, injuries and fatalities were only significant for certain outcomes. Conclusion : Results support the hypothesis that there are differences in perceived post- and peritraumatic emotional and cognitive reactions after experiencing different types of disasters. However, it should be noted that these findings were not only explained by the type of disaster itself but also by individual and event characteristics. As the study followed an explorative approach, further research paths are discussed to better understand the relationships between variables.

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.

[Compressive-spectral analysis of EEG in patients with panic attacks in the context of different psychiatric diseases].

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Tuter, N V; Gnezditskiĭ, V V

2008-01-01

Panic disorders (PD) which develop in the context of different psychiatric diseases (neurotic, personality disorder and schizotypal disorders) have their own clinical and neurophysiological features. The results of compressive-spectral analysis of EEG (CSA EEG) in patients with panic attack were different depending on the specifics of initial psychiatric status. EEG parameters in patients differed from those in controls. The common feature for all PD patients was the lower spectral density of theta-, alpha- and beta-bands as well as total spectral density without any alterations of region distribution. The decrease of electrical activity of activation systems was found in the groups with neurotic and schizotypal disorders and that of inhibition systems - in the group with schizotypal disorders. The EEG results did not suggest any depression of activation systems in patients with specific personality disorders. The data obtained with CSA EEG mirror the integrative brain activity which determinad of the appearance of PA as well as of nosology of psychiatre disease.

Exogenous factors in panic disorder: clinical and research implications.

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Roy-Byrne, P P; Uhde, T W

1988-02-01

Because panic disorder has an underlying biologic and probably genetic basis, the role of factors outside the organism in initiating and sustaining panic is often overlooked. The authors review certain exogenous factors that seem capable of triggering attacks and/or increasing their frequency and intensity: self-administered pharmacologic agents (caffeine, alcohol, nicotine, over-the-counter cold preparations, cannabis, cocaine); habits (sleep deprivation, diet, exercise, relaxation, hyperventilation); and aspects of the environment (fluorescent lighting, life stressors). There may be a specificity to the action of some of these factors, because certain factors previously thought to trigger panic attacks (e.g., pain, hypoglycemia) have been proved not to have this effect. Although the clinical significance of many of the exogenous factors discussed still awaits empirical confirmation, attention to such factors during the initial evaluation of a patient with panic disorder may be helpful in formulating a successful treatment plan.

Peritraumatic startle response predicts the vulnerability to develop PTSD-like behaviors in rats: a model for peritraumatic dissociation

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Xinwen eDong

2014-01-01

Full Text Available Peritraumatic dissociation, a state characterized by alteration in perception and reduced awareness of surroundings, is considered to be a risk factor for the development of post-traumatic stress disorder (PTSD. However, the predictive ability of peritraumatic dissociation is questioned for the inconsistent results in different time points of assessment. The startle reflex is an objective behavioral measurement of defensive response to abrupt and intense sensory stimulus of surroundings, with potential to be used as an assessment on the dissociative status in both humans and rodents. The present study examined the predictive effect of acoustic startle response (ASR in different time points around the traumatic event in an animal model of PTSD. The PTSD-like symptoms, including hyperarousal, avoidance, and contextual fear, were assessed 2-3 weeks post-trauma. The results showed that 1 the startle amplitude attenuated immediate after intense footshock in almost half of the stress animals, 2 the attenuated startle responses at 1 hour but not 24 hours after stress predicted the development of severe PTSD-like symptoms. These data indicate that the startle alteration at the immediate period after trauma, including 1 hour, is more important in PTSD prediction than 24 hours after trauma. Our study also suggests that the startle attenuation immediate after intense stress may serve as an objective measurement of peritraumatic dissociation in rats.

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.

Comorbid cannabis use and panic disorder: short term and long term follow-up study.

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Dannon, Pinhas N; Lowengrub, Katherine; Amiaz, Revital; Grunhaus, Leon; Kotler, Moshe

2004-03-01

The aim of the study was to compare the treatment of panic disorder in patients with or without cannabis use according to response, relapse and side effects. 66 panic disorder (PD) patients were included in our study. All the subjects met the DSM-IV diagnosis of panic disorder (n=45) or panic disorder with agoraphobia (n=21). Twenty four patients experienced their first panic attack within 48 h of cannabis use and then went on to develop PD. All the patients received pharmacologic treatment with paroxetine (gradually increased up to 40 mg/d). A masked rater that was blind to the group allocation, assessed patients in order to rate anxiety symptoms and medication side effects. Relapse was defined as the occurrence of a single panic attack after remission of panic symptoms. The instruments were administered at baseline and also at the 4, 8 and 12 weeks visits and at the 1 year visit. The two groups responded equally well to paroxetine treatment as measured at the 8 weeks and 12 months follow-up visits. There were no significant effects of age, sex and duration of illness as covariates with response rates between the two groups. Also PD or PDA diagnosis did not affect the treatment response in either group. There were no significant differences in weight gain, sexual side effects or relapse rates between patients according to gender or comorbid diagnosis. Acute cannabis use can be associated with the onset of panic attacks and panic disorder, and panic disorder which develops after cannabis use is responsive to pharmacotherapy. Copyright 2004 John Wiley & Sons, Ltd.

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

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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.

Carbon dioxide induced panic attacks and short term clonazepam treatment: preliminary study Ataques de pânico induzidos por dióxido de carbono e tratamento a curto prazo com clonazepam: estudo preliminar

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ANTONIO EGIDIO NARDI

1999-06-01

Full Text Available AIMS: 1. To verify the sensibility of panic patients to a mixture of 35% CO2 and 65% O2. 2. To determine if a ten days treatment with clonazepam attenuates the panic attacks induced by the inhalation of 35% carbon dioxide in panic disorder. METHOD: We randomly selected six panic disorder subjects, using the Structured Clinical Interview for DSM-IV. All subjects went double-blindly through an inhalation of 35% CO2 and compressed gas (atmospheric air on two occasions. First, at baseline, when they were drug free. Second, after a 10 days clonazepam treatment. RESULTS: Neither at baseline nor after treatment any patient had a panic attack during compressed gas inhalation. At the first test five patients (83.3% had a severe panic attack with high levels of subjective anxiety during carbon dioxide inhalation. After 9.6 (± 3.4 days of clonazepam treatment, only two (33.3% patients experienced a mild panic attack. CONCLUSION: This pilot study suggests the efficacy of the short term clonazepam therapy in attenuating panic attacks and supports the usefulness of the 35% carbon dioxide challenge test as an analogue method for study the efficacy of anti-panic drugs. Further placebo-controlled studies to pharmacological treatment are warranted.OBJETIVOS: 1. Verificar a sensibilidade de pacientes com transtorno do pânico ao teste de inalação com mistura de 35% de dióxido de carbono e 65% de oxigênio. 2. Determinar se o tratamento com clonazepam por período de dez dias bloqueia ou atenua os ataques de pânico induzidos pela inalação da mistura carbogênica, em pacientes com transtorno do pânico. METODOLOGIA: Foram selecionados randomicamente seis pacientes com transtorno do pânico (SCID-I, DSM-IV. Os pacientes foram submetidos de forma duplo-cega a testes de inalação com ar comprimido (gás atmosférico e dióxido de carbono em dois momentos. Primeiro, no início do estudo quando não estavam usando nenhuma medicação. Segundo, após período de

The norepinephrine transporter gene is a candidate gene for panic disorder

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Buttenschøn, Henriette Nørmølle; 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...

The therapeutic potential of escitalopram in the treatment of panic disorder

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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

Evaluation of JNJ-54717793 a Novel Brain Penetrant Selective Orexin 1 Receptor Antagonist in Two Rat Models of Panic Attack Provocation

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Pascal Bonaventure

2017-06-01

Full Text Available Orexin neurons originating in the perifornical and lateral hypothalamic area are highly reactive to anxiogenic stimuli and have strong projections to anxiety and panic-associated circuitry. Recent studies support a role for the orexin system and in particular the orexin 1 receptor (OX1R in coordinating an integrative stress response. However, no selective OX1R antagonist has been systematically tested in two preclinical models of using panicogenic stimuli that induce panic attack in the majority of people with panic disorder, namely an acute hypercapnia-panic provocation model and a model involving chronic inhibition of GABA synthesis in the perifornical hypothalamic area followed by intravenous sodium lactate infusion. Here we report on a novel brain penetrant, selective and high affinity OX1R antagonist JNJ-54717793 (1S,2R,4R-7-([(3-fluoro-2-pyrimidin-2-ylphenylcarbonyl]-N-[5-(trifluoromethylpyrazin-2-yl]-7-azabicyclo[2.2.1]heptan-2-amine. JNJ-54717793 is a high affinity/potent OX1R antagonist and has an excellent selectivity profile including 50 fold versus the OX2R. Ex vivo receptor binding studies demonstrated that after oral administration JNJ-54717793 crossed the blood brain barrier and occupied OX1Rs in the rat brain. While JNJ-54717793 had minimal effect on spontaneous sleep in rats and in wild-type mice, its administration in OX2R knockout mice, selectively promoted rapid eye movement sleep, demonstrating target engagement and specific OX1R blockade. JNJ-54717793 attenuated CO2 and sodium lactate induced panic-like behaviors and cardiovascular responses without altering baseline locomotor or autonomic activity. These data confirm that selective OX1R antagonism may represent a novel approach of treating anxiety disorders, with no apparent sedative effects.

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

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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.

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

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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

How study of respiratory physiology aided our understanding of abnormal brain function in panic disorder.

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Sinha, S; Papp, L A; Gorman, J M

2000-12-01

There is a substantial body of literature demonstrating that stimulation of respiration (hyperventilation) is a common event in panic disorder patients during panic attack episodes. Further, a number of abnormalities in respiration, such as enhanced CO2 sensitivity, have been detected in panic patients. This led some to posit that there is a fundamental abnormality in the physiological mechanisms that control breathing in panic disorder and that this abnormality is central to illness etiology. More recently, however, evidence has accumulated suggesting that respiratory physiology is normal in panic patients and that their tendency to hyperventilate and to react with panic to respiratory stimulants like CO2 represents the triggering of a hypersensitive fear network. The fear network anatomy is taken from preclinical studies that have identified the brain pathways that subserve the acquisition and maintenance of conditioned fear. Included are the amygdala and its brain stem projections, the hippocampus, and the medial prefrontal cortex. Although attempts to image this system in patients during panic attacks have been difficult, the theory that the fear network is operative and hyperactive in panic patients explains why both medication and psychosocial therapies are clearly effective. Studies of respiration in panic disorder are an excellent example of the way in which peripheral markers have guided researchers in developing a more complete picture of the neural events that occur in psychopathological states.

Anxiety and panic: from human studies to animal research and back.

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Battaglia, Marco; Ogliari, Anna

2005-02-01

The role of learning and conditioning varies across human anxiety disorders, and distinguishing between fear and panic is important to guide investigation in panic disorder. By reminding that some psychological and psychobiological theories view panic attacks as false alarms of unconditioned biological origin, we suggest that employing endophenotypes of biological and evolutionary relevance--such as the respiratory responses to suffocative stimuli--can be fruitful for both human research and animal models of panic, and can help keeping unconditioned components of the clinical picture separate from the conditioned components in the experimental setting. We present a review of a model of panic disorder by which idiosyncratic environmental adverse events can promote unconditioned and unexpected spells of physical alarm. Along the proposed causal pathway the alternative splicing expression of polymorphic genes of the cholinergic system play an important role. The overproduction of the Acetylcholinesterase readthrough splice variant after minor stress can promote passive avoidance and learning through action at the level of the corticolimbic circuitries, as well as heightened sensitivity to suffocative stimuli by action upon the cholinergic components of chemoception. When a component of anticipatory anxiety complicates the clinical picture of recurrent panic attacks, and the HPA becomes activated, the glucocorticoid response element 17 kb upstream of the Acetylcholinesterase gene transcription initiation site may sustain sensitivity to suffocative stimuli for prolonged time. Finally, we review how animal models of human panic based on unconditioned provocation of alarm reactions by the same respiratory panicogens that are employed in man are viable and promising.

Catastrophic misinterpretations as a predictor of symptom change during treatment for panic disorder.

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Teachman, Bethany A; Marker, Craig D; Clerkin, Elise M

2010-12-01

Cognitive models of panic disorder suggest that change in catastrophic misinterpretations of bodily sensations will predict symptom reduction. To examine change processes, we used a repeated measures design to evaluate whether the trajectory of change in misinterpretations over the course of 12-week cognitive behavior therapy is related to the trajectory of change in a variety of panic-relevant outcomes. Participants had a primary diagnosis of panic disorder (N = 43; 70% female; mean age = 40.14 years). Race or ethnicity was reported as 91% Caucasian, 5% African American, 2.3% biracial, and 2.3% "other." Change in catastrophic misinterpretations (assessed with the Brief Body Sensations Interpretation Questionnaire; Clark et al., 1997) was used to predict a variety of treatment outcomes, including overall panic symptom severity (assessed with the Panic Disorder Severity Scale [PDSS]; Shear et al., 1997), panic attack frequency (assessed with the relevant PDSS item), panic-related distress/apprehension (assessed by a latent factor, including peak anxiety in response to a panic-relevant stressor-a straw breathing task), and avoidance (assessed by a latent factor, which included the Fear Questionnaire-Agoraphobic Avoidance subscale; Marks & Mathews, 1979). Bivariate latent difference score modeling indicated that, as expected, change in catastrophic misinterpretations predicted subsequent reductions in overall symptom severity, panic attack frequency, distress/apprehension, and avoidance behavior. However, change in the various symptom domains was not typically a significant predictor of later interpretation change (except for the distress/apprehension factor). These results provide considerable support for the cognitive model of panic and speak to the temporal sequence of change processes during therapy. (c) 2010 APA, all rights reserved.

Personality disorder functioning styles are associated with the effects of the cognitive-behavioral therapy for panic disorder: a preliminary study.

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Chen, Wanzhen; Hu, Jing; Xu, Shaofang; Shen, Mowei; Chai, Hao; Wang, Wei

2014-06-01

The effect of the cognitive behavioral therapy (CBT) for panic disorder varies, but how personality disorder functioning style influences it remains unclear. In 30 healthy volunteers and 44 patients with panic disorder (22 treated and 22 waiting list), we administered the Parker Personality Measure (PERM) and the Plutchik-van Praag Depression Inventory (PVP). Before and during the CBT or waiting period, patients were asked to record their panic attacks using the Panic Attack Record (PAR). Patients scored significantly higher on PERM Antisocial, Borderline, Histrionic, Avoident, Dependent, and Passive-aggressive styles and on depression. After CBT, all PAR parameters were significantly reduced in the treated group. The Obsessive-compulsive style was positively correlated with the panic attack duration and the total-thought before CBT or waiting period in all patients. In treated patients, the decreased panic attack duration was positively correlated with Histrionic, Obsessive-compulsive and Passive-aggressive; the decreased total symptom number was positively correlated with Antisocial and Histrionic; the decreased total-sensation was positively correlated with antisocial; and the total-thought was positively correlated with Narcissistic style. The length and duration of CBT was short and mainly with behavioral strategies, how personality influenced the related cognition per se remains unknown here. However, our preliminary results indicate that personality disorder functioning styles related to the externalized behaviors and the Obsessive-compulsive style have positive effects on CBT for panic disorder, implying that CBT practitioners should note their personality styles when treating these patients.

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

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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.

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

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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.

Childhood separation anxiety disorder and adult onset panic attacks share a common genetic diathesis.

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Roberson-Nay, Roxann; Eaves, Lindon J; Hettema, John M; Kendler, Kenneth S; Silberg, Judy L

2012-04-01

Childhood separation anxiety disorder (SAD) is hypothesized to share etiologic roots with panic disorder. The aim of this study was to estimate the genetic and environmental sources of covariance between childhood SAD and adult onset panic attacks (AOPA), with the primary goal to determine whether these two phenotypes share a common genetic diathesis. Participants included parents and their monozygotic or dizygotic twins (n = 1,437 twin pairs) participating in the Virginia Twin Study of Adolescent Behavioral Development and those twins who later completed the Young Adult Follow-Up (YAFU). The Child and Adolescent Psychiatric Assessment was completed at three waves during childhood/adolescence followed by the Structured Clinical Interview for DSM-III-R at the YAFU. Two separate, bivariate Cholesky models were fit to childhood diagnoses of SAD and overanxious disorder (OAD), respectively, and their relation with AOPA; a trivariate Cholesky model also examined the collective influence of childhood SAD and OAD on AOPA. In the best-fitting bivariate model, the covariation between SAD and AOPA was accounted for by genetic and unique environmental factors only, with the genetic factor associated with childhood SAD explaining significant variance in AOPA. Environmental risk factors were not significantly shared between SAD and AOPA. By contrast, the genetic factor associated with childhood OAD did not contribute significantly to AOPA. Results of the trivariate Cholesky reaffirmed outcomes of bivariate models. These data indicate that childhood SAD and AOPA share a common genetic diathesis that is not observed for childhood OAD, strongly supporting the hypothesis of a specific genetic etiologic link between the two phenotypes. © 2012 Wiley Periodicals, Inc.

Panic disorder phenomenology in urban self-identified Caucasian-Non-Hispanics and Caucasian-Hispanics.

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Hollifield, Michael; Finley, M Rosina; Skipper, Betty

2003-01-01

The epidemiology of panic disorder is well known, but data about some phenomenological aspects are sparse. The symptom criteria for panic disorder were developed largely from rational expert consensus methods and not from empirical research. This fact calls attention to the construct validity of the panic disorder diagnosis, which may affect accuracy of epidemiological findings. Seventy self-identified Non-Hispanic-Caucasian (Anglo) and Hispanic-Caucasian (Hispanic) people who were diagnosed with DSM-III-R panic disorder with or without agoraphobia were invited to complete a Panic Phenomenological Questionnaire (PPQ), which was constructed for this study from the Hamilton Anxiety Scale Items and The DSM-III-R panic symptoms. Fifty (71%) subjects agreed to participate, and there was no response bias detected. Seven symptoms on the PPQ that are not in the DSM-IV diagnostic criteria were reported to occur with a high prevalence in this study. Furthermore, many symptoms that occurred with a high frequency and were reported to be experienced as severe are also not included in current nosology. A few of the DSM-IV criterion symptoms occurred with low prevalence, frequency, and severity. Cognitive symptoms were reported to occur with higher frequency and severity during attacks than autonomic or other symptoms. There were modest differences between ethnic groups with regard to panic attack phenomena. Further research using multiple empirical methods aimed at improving the content validity of the panic disorder diagnosis is warranted. This includes utilizing consistent methods to collect data that will allow for rational decisions about how to construct valid panic disorder criteria across cultures. Copyright 2003 Wiley-Liss, Inc.

[Comorbidity in panic disorders and alcoholism (II). Alcoholism in a sample of 148 patients with panic disorders].

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

1995-01-01

Among 148 patients presenting Panic Disorder (DSM-III-R), 18.9% have an alcohol disorder, 8.8% present abuse and 10.1% dependence. Mean age of onset of alcoholism was much earlier than panic disorder. Patients with alcoholism: a) are males more frequently (0.001); b) present more alcoholism in first grade relatives (0.05); c) use more often other drugs like: tobacco (0.01), coffee (p cannabis (p < 0.001), d) patients with alcoholism refer a greater severity of their panic attacks when drinking large amounts of alcohol (25%) than the group without these problems (2.5%) (x2:14.8) (p < 0.001) e) according to the GAS the overall level of performance is lower in alcoholics (p < 0.005); f) present more anxiety measured by the HARS (p < 0.01), and therefore have more comorbid anxiety disorders according to DSM-III-R (p < 0.01). The clinical significance of these findings is discussed.

A double-blind crossover comparison of clomipramine and desipramine in the treatment of panic disorder.

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Sasson, Y; Iancu, I; Fux, M; Taub, M; Dannon, P N; Zohar, J

1999-03-01

To compare the efficacy of clomipramine hydrochloride (CMI), a serotonin reuptake inhibitor with the noradrenergic tricyclic antidepressant agent, and desipramine hydrochloride (DMI) for patients with panic disorder (PD). Following a 2-week, single-blind placebo washout phase, 17 PD outpatients completed a 16-week, double-blind, crossover comparison of CMI and DMI. Key outcome measures included panic attacks frequency, the NIMH Global Scales for Anxiety, Depression and Impairment, Hamilton Anxiety Scale (Psychic and Somatic Subscales), Zung Anxiety Inventory (Raw and Index Subscales) and the Spielberger State Anxiety Scale. Both CMI and DMI led to significant improvement from baseline placebo state in panic attacks frequency and behavioral ratings (p<0.001). CMI led to a greater reduction in the frequency of panic attacks (p=0.028) and was superior to DMI on ratings of anxiety: NIMH Global Anxiety, Zung Anxiety Scale (Raw and Index) and the Spielberger Anxiety Scale. No difference was found between the drugs on the NIMH Global Impairment Scale and the Hamilton Somatic and Psychic Scales. Both drugs appeared to have significant therapeutic effects in patients with PD, but CMI appeared to be more effective. The effectiveness of the serotonergic drug suggests that the role of the serotonergic system in the pathogenesis of PD should be further explored.

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.

Sense of Threat as a Mediator of Peritraumatic Stress Symptom Development During Wartime: An Experience Sampling Study.

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Lapid Pickman, Liron; Greene, Talya; Gelkopf, Marc

2017-08-01

Exposure and sense of threat have been associated with stress symptoms, yet these relationships have not been clarified during the peritraumatic period. We investigated the mediating role of sense of threat in the link between exposure to rocket warning sirens and stress symptoms during wartime, and the effect of severe mental illness (SMI) status and gender on this mediation. A 30-day twice-daily smartphone-based intensive assessment of exposure to sirens, sense of threat, and peritraumatic stress symptoms was performed during the 2014 Israel-Gaza conflict. Participants included 182 highly exposed individuals with or without SMI. Multilevel structural equation modeling analysis was performed, with SMI status and gender as confounders. Exposure affected the level of peritraumatic stress symptoms both directly, b = 1.07, p development during the peritraumatic timeframe. Intervention and prevention efforts should start early and focus on promoting a sense of safety, particularly with people with SMI. Copyright © 2017 International Society for Traumatic Stress Studies.

Cognitive behavioral therapy versus eye movement desensitization and reprocessing for treating panic disorder : A randomized controlled trial

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Horst, F.; den Oudsten, B.L.; Zijlstra, W.P.; de Jongh, A.; Lobbestael, J.; de Vries, J.

2017-01-01

Objective: Cognitive Behavioral Therapy (CBT) is an effective intervention for patients with panic disorder (PD). From a theoretical perspective, Eye Movement Desensitization and Reprocessing (EMDR) therapy could also be useful in the treatment of PD because: (1) panic attacks can be experienced as

Cognitive Behavioral Therapy vs. Eye Movement Desensitization and Reprocessing for treating panic disorder : A randomized controlled trial

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Horst, F.; Den Oudsten, B.; Zijlstra, W.; de Jongh, A.; Lobbestael, J.; De Vries, J.

Objective: Cognitive Behavioral Therapy (CBT) is an effective intervention for patients with panic disorder (PD). From a theoretical perspective, Eye Movement Desensitization and Reprocessing (EMDR) therapy could also be useful in the treatment of PD because: (1) panic attacks can be experienced as

Lifelong opioidergic vulnerability through early life separation: a recent extension of the false suffocation alarm theory of panic disorder.

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Preter, Maurice; Klein, Donald F

2014-10-01

The present paper is the edited version of our presentations at the "First World Symposium On Translational Models Of Panic Disorder", in Vitoria, E.S., Brazil, on November 16-18, 2012. We also review relevant work that appeared after the conference. Suffocation-False Alarm Theory (Klein, 1993) postulates the existence of an evolved physiologic suffocation alarm system that monitors information about potential suffocation. Panic attacks maladaptively occur when the alarm is erroneously triggered. The expanded Suffocation-False Alarm Theory (Preter and Klein, 2008) hypothesizes that endogenous opioidergic dysregulation may underlie the respiratory pathophysiology and suffocation sensitivity in panic disorder. Opioidergic dysregulation increases sensitivity to CO2, separation distress and panic attacks. That sudden loss, bereavement and childhood separation anxiety are also antecedents of "spontaneous" panic requires an integrative explanation. Our work unveiling the lifelong endogenous opioid system impairing effects of childhood parental loss (CPL) and parental separation in non-ill, normal adults opens a new experimental, investigatory area. Copyright © 2014 Elsevier Ltd. All rights reserved.

Altered Olfactory Processing of Stress Related Body Odors and Artificial Odors in Patients with Panic Disorder

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Wintermann, Gloria-Beatrice; Donix, Markus; Joraschky, Peter; Gerber, Johannes; Petrowski, Katja

2014-01-01

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...

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

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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.

A possible association between panic disorder and a polymorphism in the preproghrelingene.

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Hansson, Caroline; Annerbrink, Kristina; Nilsson, Staffan; Bah, Jessica; Olsson, Marie; Allgulander, Christer; Andersch, Sven; Sjödin, Ingemar; Eriksson, Elias; Dickson, Suzanne L

2013-03-30

The aim of the study was to investigate whether polymorphisms in the preproghrelin gene are associated with anxiety disorders, such as panic disorder, in humans. Panic disorder is a severe anxiety disorder, characterized by sudden attacks of intense fear or anxiety in combination with somatic symptoms. The preproghrelin gene codes for two gut-derived circulating peptides that have been linked to anxiety-like behaviour in rodents: ghrelin (an orexigenic, pro-obesity hormone) and obestatin. In the present study, we genotyped three missense mutations in the preproghrelin gene in 215 patients suffering from panic disorder and in 451 controls. The A allele of the rs4684677 polymorphism was significantly associated with panic disorder, while there were no significant associations with the two other polymorphisms studied. We conclude that the rs4684677 (Gln90Leu) polymorphism in the preproghrelin gene may be associated with increased risk of panic disorder. It will be important to confirm these findings in additional panic disorder patient groups. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Acute Stress Symptoms in Seriously Injured Patients: Precipitating Versus Cumulative Trauma and the Contribution of Peritraumatic Distress.

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Briere, John; Dias, Colin P; Semple, Randye J; Scott, Catherine; Bigras, Noémie; Godbout, Natacha

2017-08-01

The relationship between type of trauma exposure, cumulative trauma, peritraumatic distress, and subsequent acute stress disorder (ASD) symptoms was examined prospectively in 96 individuals presenting with acute medical injuries to a Level 1 emergency/trauma department. Common precipitating traumas included motor vehicle-related events, stabbings, shootings, and physical assaults. At 2 to 3 weeks follow-up, 22.9% of participants had developed ASD. Univariate analysis revealed no relationship between type of precipitating trauma and ASD symptoms, whereas robust path analysis indicated direct effects of gender, lifetime cumulative trauma exposure, and peritraumatic distress. Peritraumatic distress did not mediate the association between cumulative trauma and symptoms, but did mediate the association between gender and symptomatology. These results, which account for 23.1% of the variance in ASD symptoms, suggest that ASD may be more due to cumulative trauma exposure than the nature of the precipitating trauma, but that cumulative trauma does not exert its primary effect by increasing peritraumatic distress to the most recent trauma. Copyright © 2017 International Society for Traumatic Stress Studies.

The Association Between Peritraumatic Dissociation and PTSD Symptoms: The Mediating Role of Negative Beliefs About the Self.

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Thompson-Hollands, Johanna; Jun, Janie J; Sloan, Denise M

2017-04-01

Peritraumatic dissociation, a term used to describe a complex array of reactions to trauma, including depersonalization, derealization, and emotional numbness, has been associated with posttraumatic stress disorder (PTSD) symptoms across a number of studies. Cognitive theory suggests that interpretations of traumatic events and reactions underlie the persistence of PTSD. The present study examined the associations among peritraumatic dissociation, posttraumatic cognitions, and PTSD symptoms in a group of trauma-exposed adults (N = 169). Results indicated that, after accounting for overall symptom severity and current dissociative tendencies, peritraumatic dissociation was significantly predictive of negative beliefs about the self (R 2 = .06, p < .001). Other categories of maladaptive posttraumatic cognitions did not show a similar relationship (R 2 = .01 to .02, nonsignificant). Negative thoughts about the self partially mediated the association between peritraumatic dissociation and PTSD severity (completely standardized indirect effect = .25). These findings lend support to cognitive theories of PTSD and point to an important area for clinical intervention. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.

Social phobia with sudden onset--post-panic social phobia?

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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...... recruited as part of an etiological study. Patients with SP with sudden onset did, as hypothesized, differ from patients with SP without sudden onset with regard to age of onset and extraversion, but not with regard to symptoms. They did not differ markedly from patients with comorbid SP and PD. The concept...

Cognitive Behavioral Therapy vs. Eye Movement Desensitization and Reprocessing for Treating Panic Disorder: A Randomized Controlled Trial

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Horst, F.; Den Oudsten, B.; Zijlstra, W.; de Jongh, Ad; Lobbestael, J.; De Vries, J.

2017-01-01

Objective: Cognitive Behavioral Therapy (CBT) is an effective intervention for patients with panic disorder (PD). From a theoretical perspective, Eye Movement Desensitization and Reprocessing (EMDR) therapy could also be useful in the treatment of PD because: (1) panic attacks can be experienced as life threatening; (2) panic memories specific to PD resemble traumatic memories as seen in posttraumatic stress disorder (PTSD); and (3) PD often develops following a distressing life event. The pr...

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

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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.

Psychoeducation in panic disorder patients: effect of a self-information booklet in a randomized, masked-rater study.

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Dannon, P N; Iancu, I; Grunhaus, L

2002-01-01

The aim of our study was to evaluate the effectiveness of a self-information booklet (SIB) in decreasing anxiety and panic attacks in Panic Disorder (PD) patients. Eighty-four patients attending an outpatient clinic due to panic disorder were randomly chosen to receive paroxetine with/without a friendly-designed brochure. Follow-up was done by a masked rater after 1, 3,and 12 weeks in order to evaluate whether the co-administration of paroxetine and the brochure (Group A) had a beneficial effect over the administration of paroxetine alone (Group B). After 3 weeks of therapy, Group A patients had significantly greater improvement and lower scores on the Hamilton Anxiety Scale, the Panic Self Questionnaire, and the Visual Analog Scale. After 12 weeks, the differential improvement was not statistically significant and both groups had improved as compared to baseline. The administration of a psychoeducational brochure (SIB) to PD patients at the initiation of therapy had beneficial effects during the first weeks of treatment. Although this effect fades away, the role of the SIB is overstressed in its ability to increase well being and compliance, and reduce anxiety and panic attacks. Copyright 2002 Wiley-Liss, Inc.

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

Common paths to ASD severity and PTSD severity

DEFF Research Database (Denmark)

Hansen, Maj; Armour, Cherie; Wittmann, Lutz

Numerous studies have identified risk factors for acute and long term posttraumatic symptoms following traumatic exposure. However, little is known about possible common pathways to the development of acute stress disorder (ASD) and posttraumatic stress disorder (PTSD). Research suggests that a c......Numerous studies have identified risk factors for acute and long term posttraumatic symptoms following traumatic exposure. However, little is known about possible common pathways to the development of acute stress disorder (ASD) and posttraumatic stress disorder (PTSD). Research suggests...... that a common pathway to ASD and PTSD may lie in peritraumatic responses and cognitions. Using structural equation modeling we examined the role of three peritraumatic factors (tonic immobility, panic and dissociation) and three cognitive factors (anxiety sensitivity, negative cognitions about the world......, and negative cognitions about self ) on the development of ASD and PTSD severity in a national study of Danish bank robbery victims (N = 450). Peritraumatic panic, anxiety sensitivity, and negative cognitions about self were found to be significant common risk factors, whereas peritraumatic dissociation...

Respiratory manifestations of panic disorder: causes, consequences and therapeutic implications.

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Sardinha, Aline; Freire, Rafael Christophe da Rocha; Zin, Walter Araújo; Nardi, Antonio Egidio

2009-07-01

Multiple respiratory abnormalities can be found in anxiety disorders, especially in panic disorder (PD). Individuals with PD experience unexpected panic attacks, characterized by anxiety and fear, resulting in a number of autonomic and respiratory symptoms. Respiratory stimulation is a common event during panic attacks. The respiratory abnormality most often reported in PD patients is increased CO2 sensitivity, which has given rise to the hypothesis of fundamental abnormalities in the physiological mechanisms that control breathing in PD. There is evidence that PD patients with dominant respiratory symptoms are more sensitive to respiratory tests than are those who do not manifest such symptoms, and that the former group constitutes a distinct subtype. Patients with PD tend to hyperventilate and to panic in response to respiratory stimulants such as CO2, triggering the activation of a hypersensitive fear network. Although respiratory physiology seems to remain normal in these subjects, recent evidence supports the idea that they present subclinical abnormalities in respiration and in other functions related to body homeostasis. The fear network, composed of the hippocampus, the medial prefrontal cortex, the amygdala and its brain stem projections, might be oversensitive in PD patients. This theory might explain why medication and cognitive-behavioral therapy are both clearly effective. Our aim was to review the relationship between respiration and PD, addressing the respiratory subtype of PD and the hyperventilation syndrome, with a focus on respiratory challenge tests, as well as on the current mechanistic concepts and the pharmacological implications of this relationship.

Paroxetine in panic disorder: clinical management and long-term follow-up.

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Dannon, Pinhas N; Lowengrub, Katherine; Iancu, I; Kotler, Moshe

2004-03-01

Panic disorder is one of the most common anxiety disorders and has a lifetime prevalence of 3-5%. Panic attacks can begin at any age, but commonly have their onset in early adulthood between the ages of 20 and 40 years. Naturalistic data has shown that panic disorder has a chronic and relapsing course. Panic disorder is reported to be associated with an increased risk of suicidal behavior and comorbid psychiatric diagnoses such as depression and substance abuse. Currently, recommended treatment modalities for panic disorder include the use of antidepressant pharmacotherapy and/or cognitive behavioral therapy. Paroxetine is unique among the selective serotonin reuptake inhibitors since, in addition to its effect on the CNS serotonergic neurotransmission, it also has mild noradrenergic properties demonstrated to be effective in the treatment of anxiety disorders and depression. Paroxetine treatment has the potential to cause weight gain and sexual dysfunction, primarily anorgasmia and ejaculatory dysfunction for the long term. In the short-term, treatment causes nausea, gastrointestinal disturbances, irritability, headaches and eating and sleeping difficulties. Paroxetine is an example of an selective serotonin reuptake inhibitor agent, which has been well studied in the treatment of panic disorder and is efficacious and well-tolerated. Paroxetine pharmacotherapy has been recommended to be continued for 1 year as specified in the treatment guidelines set by the American Psychiatric Association in the treatment of panic disorder.

Test of the role of nicotine dependence in the relation between posttraumatic stress disorder and panic spectrum problems.

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Feldner, Matthew T; Smith, Rose C; Babson, Kimberly A; Sachs-Ericsson, Natalie; Schmidt, Norman B; Zvolensky, Michael J

2009-02-01

Posttraumatic stress disorder (PTSD) frequently co-occurs with panic spectrum problems. Relatively little empirical work has tested possible mechanisms accounting for this association. Nicotine dependence often ensues subsequent to PTSD onset and research suggests smoking high numbers of cigarettes daily may lead to panic problems. The current study tested the hypotheses that nicotine dependence partially mediates the relations between PTSD and both panic attacks and panic disorder within a nationally representative sample of 5,692 (3,020 women; M(Age) = 45, SD = 18) adults from the National Comorbidity Survey-Replication. Results were consistent with hypotheses. These findings support the theory suggesting smoking among people with PTSD may be involved in the development of panic problems.

Peritraumatic dissociation and posttraumatic stress after pregnancy loss: A prospective study.

NARCIS (Netherlands)

Engelhard, I.M.; van den Hout, M.; Kindt, M.; Arntz, A.; Schouten, E.

2003-01-01

This study examined (1) predictors for peritraumatic dissociation, (2) its relations with acute and chronic symptoms of posttraumatic stress disorder (PTSD), and (3) pathways regarding these relations in response to pregnancy loss. In early pregnancy, about 1,370 women volunteers completed

A Novel Animal Model for Panic Disorder: Attempted Reproduction of the Fear of Fear

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1999-11-04

possibility of having another attack ( Barlow , 1988; American Psychological Association [AP A1. 1994). Pank attacks may lead to the development of agoraphobic...account for panic onset, such as biological vulnerability, psychological vulnerability, and agoraphobic avoidance ( Barlow , 1988). Within the Learned Alarm...Journal of Abnormal Psychology , 94, 96-10 1. Cohn , J.B. , & Wilcox, C.S. (1986). Low-sedation potential of buspironc compared with alprazolam and

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

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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.

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

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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.

The role of peri-traumatic stress and disruption distress in predicting symptoms of major depression following exposure to a natural disaster.

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Bell, Caroline J; Boden, Joseph M; Horwood, L John; Mulder, Roger T

2017-07-01

Few studies have examined the contribution of specific disaster-related experiences to symptoms of depression. The aims of this study were to do this by examining the roles of peri-traumatic stress and distress due to lingering disaster-related disruption in explaining linkages between disaster exposure and major depressive disorder symptoms among a cohort exposed to the 2010-2011 Canterbury (New Zealand) earthquakes. Structural equation models were fitted to data obtained from the Christchurch Health and Development Study at age 35 ( n = 495), 20-24 months following the onset of the disaster. Measures included earthquake exposure, peri-traumatic stress, disruption distress and symptoms of major depressive disorder. The associations between earthquake exposure and major depression were explained largely by the experience of peri-traumatic stress during the earthquakes (β = 0.180, p < 0.01) and not by disruption distress following the earthquakes (β = 0.048, p = 0.47). The results suggest that peri-traumatic stress has been under-recognised as a predictor of major depressive disorder.

An investigation of the differential effectiveness of bibliotherapy and self-regulatory treatments in individuals with panic attacks

OpenAIRE

Febbraro, Gregorio A. R.

1997-01-01

Several studies targeting individuals with panic disorder have demonstrated that Cognitive-behavioral treatment (CST) is the psychological treatment of choice. CST interventions that include exposure to panic symptoms, along with cognitive restructuring. breathing retraining, and relaxation training are more effective than any of these components administered alone. Past studies have demonstrated the efficacy of imparting the above CBT components in the form of bibliotherapy (BT) ...

Increased opioid dependence in a mouse model of panic disorder

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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.

Posttraumatic Anger, Recalled Peritraumatic Emotions, and PTSD in Victims of Violent Crime

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Kunst, M. J. J.; Winkel, F. W.; Bogaerts, S.

2011-01-01

A mixed cross-sectional and longitudinal design was employed to explore the association between posttraumatic anger and posttraumatic stress disorder (PTSD; symptoms) in victims of civilian violence. It was speculated that this relationship is mainly due to concurrent recalled peritraumatic emotions. Such emotions may be interpreted to result from…

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

Depersonalization and individualism: the effect of culture on symptom profiles in panic disorder.

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Sierra-Siegert, Mauricio; David, Anthony S

2007-12-01

It has been proposed that highly individualistic cultures confer vulnerability to depersonalization. To test this idea, we carried out a comprehensive systematic review of published empirical studies on panic disorder, which reported the frequency of depersonalization/derealization during panic attacks. It was predicted that the frequency of depersonalization would be higher in Western cultures and that a significant correlation would be found between the frequency of depersonalization and individualism scores of the participant countries. As predicted, the frequency of depersonalization during panic was significantly lower in nonwestern countries. There was also a significant correlation between frequency of depersonalization and Individualism (rho = 0.68, p individualism. These findings are interpreted in light of recent studies suggesting that individualistic cultures are characterized by hypersensitivity to threat and by an external locus of control. Two features may be relevant in the genesis of depersonalization.

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....

Panic Anxiety in Humans with Bilateral Amygdala Lesions: Pharmacological Induction via Cardiorespiratory Interoceptive Pathways.

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Khalsa, Sahib S; Feinstein, Justin S; Li, Wei; Feusner, Jamie D; Adolphs, Ralph; Hurlemann, Rene

2016-03-23

We previously demonstrated that carbon dioxide inhalation could induce panic anxiety in a group of rare lesion patients with focal bilateral amygdala damage. To further elucidate the amygdala-independent mechanisms leading to aversive emotional experiences, we retested two of these patients (B.G. and A.M.) to examine whether triggering palpitations and dyspnea via stimulation of non-chemosensory interoceptive channels would be sufficient to elicit panic anxiety. Participants rated their affective and sensory experiences following bolus infusions of either isoproterenol, a rapidly acting peripheral β-adrenergic agonist akin to adrenaline, or saline. Infusions were administered during two separate conditions: a panic induction and an assessment of cardiorespiratory interoception. Isoproterenol infusions induced anxiety in both patients, and full-blown panic in one (patient B.G.). Although both patients demonstrated signs of diminished awareness for cardiac sensation, patient A.M., who did not panic, reported a complete lack of awareness for dyspnea, suggestive of impaired respiratory interoception. These findings indicate that the amygdala may play a role in dynamically detecting changes in cardiorespiratory sensation. The induction of panic anxiety provides further evidence that the amygdala is not required for the conscious experience of fear induced via interoceptive sensory channels. We found that monozygotic twins with focal bilateral amygdala lesions report panic anxiety in response to intravenous infusions of isoproterenol, a β-adrenergic agonist similar to adrenaline. Heightened anxiety was evident in both twins, with one twin experiencing a panic attack. The twin who did not panic displayed signs of impaired cardiorespiratory interoception, including a complete absence of dyspnea sensation. These findings highlight that the amygdala is not strictly required for the experience of panic anxiety, and suggest that neural systems beyond the amygdala are also

"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

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

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

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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. Copyright © 2014 Elsevier Ltd. All rights reserved.

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

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Aline Sardinha

2009-03-01

Full Text Available OBJETIVO: Estresse e depressão já são considerados fatores de risco para o desenvolvimento e o agravamento de doenças cardiovasculares. Os transtornos de ansiedade têm sido fortemente associados às cardiopatias nos últimos anos. O transtorno de pânico em cardiopatas representa um desafio em termos de diagnóstico e tratamento. Atualizar o leitor quanto ao status da associação entre transtornos de ansiedade, especialmente transtorno de pânico, e cardiopatias. MÉTODO: Foi realizada uma busca nas bases de dados ISI e Medline, com as palavras-chave: "heart disease", "coronary disease", "anxiety", "panic disorder" e "autonomic function". Foram selecionados os artigos publicados a partir de 1998. DISCUSSÃO: O padrão autonômico encontrado em pacientes com transtorno de pânico, em particular a redução da variabilidade cardíaca, é apontado como o provável fator mediador do impacto cardiovascular do transtorno de pânico. CONCLUSÕES: Apesar de a associação entre transtornos de ansiedade e doenças cardiovasculares estar atualmente bastante estabelecida, existem ainda diversas lacunas no estado atual do conhecimento. São recomendadas a terapia cognitivo-comportamental e a prática de exercícios físicos supervisionados como potenciais coadjuvantes na intervenção terapêutica.OBJECTIVE: Psychosocial stress and depression have already been established as risk factors for developing and worsening cardiovascular diseases. Anxiety disorders are been strongly associated to cardiac problems nowadays. Panic disorder in cardiac patients represents a challenge for diagnose and treatment. Update the reader on the status of the association between anxiety disorders, particularly panic disorder, in cardiac patients. METHOD: Were retrieved papers published at ISI and Medline databases since 1998. Key-words used were: "heart disease", "coronary disease", "anxiety", "panic disorder" and "autonomic function". DISCUSSION: The characteristic

Predictors of PTSD symptoms in Brazilian police officers: the synergy of negative affect and peritraumatic dissociation

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Maia, Deborah B.; Marmar, Charles R.; Henn-Haase, Clare; Nóbrega, Augusta; Fiszman, Adriana; Marques-Portella, Carla; Mendlowicz, Mauro V.; Coutinho, Evandro S.F.; Figueira, Ivan

2013-01-01

Background Exposure to traumatic events is a necessary but not a sufficient condition for the development of posttraumatic stress disorder (PTSD). Pretrauma, peritrauma and posttrauma factors interact to impact on symptom severity. The aim of the present study is to determine risk factors for PTSD symptoms in Brazilian police officers. Method In a cross-sectional sample of active duty officers (n = 212), participants were asked to complete a socio-demographic questionnaire and self-report scales on affective traits, cumulative critical incident exposure, peritraumatic distress and dissociation, PTSD symptoms, and social support. Hierarchical linear regression analysis was conducted to examine predictors of PTSD symptoms. Results Variables related to negative affect, job duration, frequency of critical incident exposure, peritraumatic dissociation, and lack of social support remained significant in the final model and explained 55% of the variance in PTSD symptoms. When interaction terms were evaluated, a synergistic effect between negative affect and peritraumatic dissociation was found. Conclusions The risk factors found in this study provide clues on how to elaborate primary prevention strategies regarding PTSD symptoms in police officers. Such initiatives may lessen the impact of repeated exposure to traumatic events on police officers over the course of their careers. PMID:22189925

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

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A.M. Valença

2002-07-01

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

Radiological attacks and accidents. Medical consequences

International Nuclear Information System (INIS)

Sakuta, Hidenari

2007-01-01

Probability of the occurrence of radiological attacks appears to be elevated after the terrorist attacks against the United States on September 11 in 2001. There are a lot of scenarios of radiological attack: simple radiological device, radiological disperse device (RDD or dirty bomb), attacks against nuclear reactor, improvised nuclear device, and nuclear weapons. Of these, RDD attack is the most probable scenario, because it can be easily made and can generate enormous psychological and economic damages. Radiological incidents are occurring to and fro in the world, including several cases of theft to nuclear facilities and unsuccessful terrorist attacks against them. Recently, a former Russian spy has allegedly been killed using polonium-210. In addition, serious radiological accidents have occurred in Chernobyl, Goiania, and Tokai-mura. Planning, preparation, education, and training exercise appear to be essential factors to cope with radiological attacks and accidents effectively without feeling much anxiety. Triage and psychological first aid are prerequisite to manage and provide effective medial care for mass casualties without inducing panic. (author)

Heart Rate Variability and Cardiovascular Reactivity in Panic Disorder

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1999-04-01

Park, for his patience and personal assistance in setting up and operating the Vagal Tone Monitor. Io addition, I am grateful for the technical and...causes many patients to present initially to an emergency room or physician’s office upon onset of a panic attack (Beitman, Mukeiji, Aaker & Basha et...places make you afraid?" IIAre you considered a nervous person ?" UAre you constantly keyed up and jittery?" "Do you often become suddenly scared for

Evidence that the periaqueductal gray matter mediates the facilitation of panic-like reactions in neonatally-isolated adult rats.

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Jeyce Willig Quintino-dos-Santos

Full Text Available Plenty of evidence suggests that childhood separation anxiety (CSA predisposes the subject to adult-onset panic disorder (PD. As well, panic is frequently comorbid with both anxiety and depression. The brain mechanisms whereby CSA predisposes to PD are but completely unknown in spite of the increasing evidence that panic attacks are mediated at midbrain's dorsal periaqueductal gray matter (DPAG. Accordingly, here we examined whether the neonatal social isolation (NSI, a model of CSA, facilitates panic-like behaviors produced by electrical stimulations of DPAG of rats as adults. Eventual changes in anxiety and depression were also assessed in the elevated plus-maze (EPM and forced-swimming test (FST respectively. Male pups were subjected to 3-h daily isolations from post-natal day 2 (PN2 until weaning (PN21 allotting half of litters in individual boxes inside a sound-attenuated chamber (NSI, n = 26 whilst siblings (sham-isolated rats, SHAM, n = 27 and dam were moved to another box in a separate room. Non-handled controls (CTRL, n = 18 remained undisturbed with dams until weaning. As adults, rats were implanted with electrodes into the DPAG (PN60 and subjected to sessions of intracranial stimulation (PN65, EPM (PN66 and FST (PN67-PN68. Groups were compared by Fisher's exact test (stimulation sites, likelihood ratio chi-square tests (stimulus-response threshold curves and Bonferroni's post hoc t-tests (EPM and FST, for P<0.05. Notably, DPAG-evoked panic-like responses of immobility, exophthalmus, trotting, galloping and jumping were markedly facilitated in NSI rats relative to both SHAM and CTRL groups. Conversely, anxiety and depression scores either did not change or were even reduced in neonatally-handled groups relative to CTRL, respectively. Data are the first behavioral evidence in animals that early-life separation stress produces the selective facilitation of panic-like behaviors in adulthood. Most importantly, results implicate

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

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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.

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

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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

A clinical study of autogenic training-based behavioral treatment for panic disorder.

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Sakai, M

1996-03-01

The present study investigated the effect of autogenic training-based behavioral treatment for panic disorder and identified the predictors of treatment outcome. Thirty-four patients meeting DSM-III-R criteria for panic disorder received autogenic training-based behavioral treatment from October 1981 to December 1994. They were treated individually by the author. The medical records of the patients were investigated for the purpose of this study. The results showed that this autogenic training-based behavioral treatment had successful results. Fifteen patients were cured, nine much improved, five improved, and five unchanged at the end of the treatment. Improvement trends were found as for the severity of panic attack and the severity of agoraphobic avoidance. No consistent findings about predictors emerged when such pretreatment variables as demographics and severity of symptoms were used to predict the outcome. Also, three treatment variables showed useful predictive power. First, practicing the second standard autogenic training exercise satisfactorily predicted better outcomes. Second, application of in vivo exposure was found to be positively associated with the treatment outcome in patients with agoraphobic avoidance. Third, longer treatment periods were associated with better outcomes. These findings suggested that the autogenic training-based behavioral treatment could provide relief to the majority of panic disorder patients.

Exaggerated compensatory response to acute respiratory alkalosis in panic disorder is induced by increased lactic acid production.

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Ueda, Yoshiyasu; Aizawa, Masayo; Takahashi, Atsushi; Fujii, Masamitsu; Isaka, Yoshitaka

2009-03-01

In acute respiratory alkalosis, the severity of alkalaemia is ameliorated by a decrease in plasma [HCO(3)(-)] of 0.2 mEq/L for each 1 mmHg decrease in PaCO(2). Although hyperventilation in panic disorder patients is frequently encountered in outpatients, the drop in plasma [HCO(3)(-)] sometimes surpasses the expectation calculated from the above formula. The quantitative relationship between reduced PaCO(2) and plasma [HCO(3)(-)] in acute respiratory alkalosis has not been studied in panic disorder patients. Our objective was to provide reference data for the compensatory metabolic changes in acute respiratory alkalosis in panic disorder patients. In 34 panic disorder patients with hyperventilation attacks, we measured arterial pH, PaCO(2), plasma [HCO(3)(-)] and lactate on arrival at the emergency room. For each decrease of 1 mmHg in PaCO(2), plasma [HCO(3)(-)] decreased by 0.41 mEq/L. During hypocapnia, panic disorder patients exhibited larger increases in serum lactate levels (mean +/- SD; 2.59 +/- 1.50 mmol/L, range; 0.78-7.78 mmol/L) than previously reported in non-panic disorder subjects. Plasma lactate accumulation was correlated with PaCO(2) (P respiratory alkalosis is exaggerated by increased lactic acid production in panic disorder patients. Here, we call attention to the diagnosis of acid-base derangements by means of plasma [HCO(3)(-)] and lactate concentration in panic disorder patients.

Impact of childhood trauma on course of panic disorder: contribution of clinical and personality characteristics.

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De Venter, M; Van Den Eede, F; Pattyn, T; Wouters, K; Veltman, D J; Penninx, B W J H; Sabbe, B G

2017-06-01

To investigate the impact of childhood trauma on the clinical course of panic disorder and possible contributing factors. Longitudinal data of 539 participants with a current panic disorder were collected from the Netherlands Study of Depression and Anxiety (NESDA). Childhood trauma was assessed with a structured interview and clinical course after 2 years with a DSM-IV-based diagnostic interview and the Life Chart Interview. At baseline, 54.5% reported childhood trauma, but this was not predictive of persistence of panic disorder. Emotional neglect and psychological abuse were associated with higher occurrence of anxiety disorders other than panic disorder (social phobia) and with higher chronicity of general anxiety symptoms (anxiety attacks or episodes and avoidance). Baseline clinical features (duration and severity of anxiety and depressive symptoms) and personality traits (neuroticism and extraversion) accounted for roughly 30-60% of the total effect of childhood trauma on chronicity of anxiety symptoms and on occurrence of other anxiety disorders. After two years, childhood trauma is associated with chronicity of anxiety symptoms and occurrence of social phobia, rather than persistence of panic disorder. These relationships are partially accounted for by duration and severity of anxiety and depressive symptoms, and neuroticism and extraversion. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

The efficacy of reboxetine in the treatment-refractory patients with panic disorder: an open label study.

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Dannon, P N; Iancu, I; Grunhaus, L

2002-10-01

Selective serotonin reuptake inhibitors (SSRIs) are currently the first-line treatment for panic disorder, although up to 30% of patients either do not respond to SSRIs or withdraw due to adverse events. Reboxetine, a selective norepinephrine reuptake inhibitor (selective NRI), is effective in treating depression and may alleviate depression-related anxiety. This study aimed to investigate the efficacy of reboxetine in the treatment of patients with panic disorder who did not respond to SSRIs. In this 6-week, open-label study, 29 adult outpatients with panic disorder who had previously failed to respond to SSRI treatment received reboxetine 2 mg/day, titrated to a maximum of 8 mg/day over the first 10 days. Efficacy was assessed using the Panic Self-Questionnaire (PSQ), the Hamilton Rating Scale for Anxiety (HAM-A), the 17-item Hamilton Rating Scale for Depression (HRSD) and the Global Assessment of Functioning (GAF) Scale. The 24 patients who completed the study responded well to reboxetine treatment. Significant improvement (p < 0.001) was observed in the number of daily panic attacks, and on the scales measuring anxiety, depression and functioning. Reboxetine was generally well tolerated. Five patients withdrew due to adverse events. Reboxetine appears to be effective in the treatment of SSRI-refractory panic disorder patients and warrants further clinical investigation. Copyright 2002 John Wiley & Sons, Ltd.

Anger attacks in obsessive compulsive disorder

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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.

Differentiating hypochondriasis from panic disorder.

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Hiller, Wolfgang; Leibbrand, Rolf; Rief, Winfried; Fichter, Manfred M

2005-01-01

Hypochondriasis and panic disorder are both characterized by prevalent health anxieties and illness beliefs. Therefore, the question as to whether they represent distinct nosological entities has been raised. This study examines how clinical characteristics can be used to differentiate both disorders, taking the possibility of mixed symptomatologies (comorbidity) into account. We compared 46 patients with hypochondriasis, 45 with panic disorder, and 21 with comorbid hypochondriasis plus panic disorder. While panic patients had more comorbidity with agoraphobia, hypochondriasis was more closely associated with somatization. Patients with panic disorder were less pathological than hypochondriacal patients on all subscales of the Whiteley Index (WI) and the Illness Attitude Scales (IAS) except for illness behavior. These differences were independent of somatization. Patients with hypochondriasis plus panic had higher levels of anxiety, more somatization, more general psychopathology and a trend towards increased health care utilization. Clinicians were able to distinguish between patient groups based upon the tendency of hypochondriacal patients to demand unnecessary medical treatments. These results confirm that hypochondriasis and panic disorder are distinguishable clinical conditions, characterized by generally more psychopathology and distress in hypochondriasis.

Pindolol augmentation in patients with treatment-resistant panic disorder: A double-blind, placebo-controlled trial.

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Hirschmann, S; Dannon, P N; Iancu, I; Dolberg, O T; Zohar, J; Grunhaus, L

2000-10-01

The objective of this study was to determine the efficacy of pindolol as an augmentor of fluoxetine in treatment-resistant panic disorder (PD). Twenty-five outpatients having PD with or without agoraphobia were included. These patients had not responded to two different trials with antidepressants and an 8-week trial of fluoxetine 20 mg/day. Treatment-resistant PD was defined as a less than 20% reduction in score on the Panic Self-Questionnaire (number of attacks per week) (PSQ) and the Clinical Anxiety Scale With Panic Attacks (CAS+PA). These patients continued to receive fluoxetine 20 mg/day and were randomly assigned to additionally receive either pindolol (2.5 mg three times daily) or placebo for the following 4 weeks. Evaluations were performed weekly using the Hamilton Rating Scale for Anxiety, the Hamilton Rating Scale for Depression (HAM-D), the CAS+PA, the NIMH Anxiety Scale, the PSQ, and the Clinical Global Impression Scale. The data were analyzed using a repeated-measures analysis of variance (ANOVA) and a t-test for independent samples. Patients treated with the combination of pindolol and fluoxetine (N = 13) demonstrated a significant improvement over the patients treated with fluoxetine and placebo on all rating scales, with the exception of HAM-D. The statistical differences were shown using the repeated-measures ANOVA (baseline, week 2, week 4) and also with t-tests from the second week of the trial. These preliminary results demonstrate that pindolol has an augmenting effect on fluoxetine in patients with treatment-resistant PD.

Fear of body symptoms and sensations in patients with panic disorders and patients with somatic diseases

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Latas Milan

2009-01-01

Full Text Available Introduction. A cognitive model of aetiology of panic disorder assumes that people who experience frequent panic attacks have tendencies to catastrophically interpret normal and benign somatic sensations - as signs of serious illness. This arise the question: is this cognition specific for patients with panic disorder and in what intensity it is present in patients with serious somatic illness and in healthy subjects. Objective. The aim of the study was to ascertain the differences in the frequency and intensity of 'catastrophic' cognitions related to body sensations, and to ascertain the differences in the frequency and intensity of anxiety caused by different body sensations all related to three groups of subjects: a sample of patients with panic disorder, a sample of patients with history of myocardial infarction and a sample of healthy control subjects from general population. Methods. Three samples are observed in the study: A 53 patients with the diagnosis of panic disorder; B 25 patients with history of myocardial infarction; and C 47 healthy controls from general population. The catastrophic cognitions were assessed by the Agoraphobic Cognitions Questionnaire (ACQ and the Body Sensations Questionnaire (BSQ. These questionnaires assess the catastrophic thoughts associated with panic and agoraphobia (ACQ and the fear of body sensations (BSQ. All study subjects answered questionnaires items, and the scores of the answers were compared among the groups. Results. The results of the study suggest that: 1 There is no statistical difference in the tendency to catastrophically interpret body sensations and therefore to induce anxiety in the samples of healthy general population and patients with history of myocardial infarction; 2 The patients with panic disorder have a statistically significantly more intensive tendency to catastrophically interpret benign somatic symptoms and therefore to induce a high level of anxiety in comparison to the

Panic Disorder in Children and Adolescents

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... for Families - Vietnamese 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 ...

Panic Disorder among Adults

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... Disorder Among Adolescents Data Sources Share Panic Disorder Definition Panic Disorder is an anxiety disorder characterized by ... MSC 9663 Bethesda, MD 20892-9663 Follow Us Facebook Twitter YouTube Google Plus NIMH Newsletter NIMH RSS ...

Whole-exome sequencing implicates DGKH as a risk gene for panic disorder in the Faroese population

DEFF Research Database (Denmark)

Gregersen, Noomi; Lescai, Francesco; Liang, Jieqin

2016-01-01

attacks, and genetic factors have been estimated to explain around 40% of the risk. In this study the potential enrichment of PD risk variants was explored based on whole-exome sequencing of 54 patients with PD and 211 control individuals from the Faroese population. No genome-wide significant......The demographic history of the isolated population of the Faroe Islands may have induced enrichment of variants rarely seen in outbred European populations, including enrichment of risk variants for panic disorder (PD). PD is a common mental disorder, characterized by recurring and unprovoked panic...... mental disorders. Additionally, we found an enrichment of PD risk variants in the Faroese population; variants with otherwise low frequency in more outbreed European populations. © 2016 Wiley Periodicals, Inc....

Peritraumatic tonic immobility is associated with posttraumatic stress symptoms in undergraduate Brazilian students A imobilidade tônica peritraumática está associada aos sintomas do transtorno de estresse pós-traumático em estudantes brasileiros de graduação

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Liana Catarina L Portugal

2012-03-01

Full Text Available OBJECTIVE: Tonic immobility is a defensive reaction occurring under extreme life threats. Patients with posttraumatic stress disorder (PTSD reporting peritraumatic tonic immobility show the most severe symptoms and a poorer response to treatment. This study investigated the predictive falue of tonic immobility for posttraumatic stress symptoms in a non-clinical sample. METHODS: One hundred and ninety-eight college students exposed to various life threatening events were selected to participate. The Posttraumatic Stress Disorder Checklist - Civilian Version (PCL-C and tonic immobility questions were used. Linear regression models were fitted to investigate the association between peritraumatic tonic immobility and PCL-C scores. Peritraumatic dissociation, peritraumatic panic reactions, negative affect, gender, type of trauma, and time since trauma were considered as confounding variables. RESULTS: We found significant association between peritraumatic tonic immobility and PTSD symptoms in a non-clinical sample exposed to various traumas, even after regression controlled for confounding variables (β = 1.99, p = 0.017. CONCLUSIONS: This automatic reaction under extreme life threatening stress, although adaptive for defense, may have pathological consequences as implied by its association with PTSD symptoms.OBJETIVO: A imobilidade tônica é uma resposta defensiva que ocorre sob ameaça extrema à vida. Pacientes com transtorno de estresse pós-traumático (TEPT que relatam imobilidade tônica peritraumática são os que apresentam os sintomas mais graves e a pior resposta ao tratamento. Este estudo investigou o valor preditivo da imobilidade tônica para os sintomas de TEPT em uma amostra não clínica. MÉTODOS: Os participantes da pesquisa foram 198 estudantes universitários expostos a traumas diversos. A versão brasileira do Post-Traumatic Stress Disorder Checklist Civilian Version (PCL-C e questões referentes à imobilidade tônica foram

Focus is key: Panic-focused interpretations are associated with symptomatic improvement in panic-focused psychodynamic psychotherapy.

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Keefe, John R; Solomonov, Nili; Derubeis, Robert J; Phillips, Alexander C; Busch, Fredric N; Barber, Jacques P; Chambless, Dianne L; Milrod, Barbara L

2018-04-18

This study examines whether, in panic-focused psychodynamic psychotherapy (PFPP), interpretations of conflicts that underlie anxiety (panic-focused or PF-interpretations) are specifically associated with subsequent panic disorder (PD) symptom improvement, over and above the provision of non-symptom-focused interpretations. Technique use in Sessions 2 and 10 of a 24-session PFPP protocol was assessed for the 65 patients with complete outcome data randomized to PFPP in a two-site trial of psychotherapies for PD. Sessions were rated in 15-min segments for therapists' use of PF-interpretations, non-PF-interpretations, and PF-clarifications. Robust regressions were conducted to examine the relationship between these interventions and symptom change subsequent to the sampled session. Interpersonal problems were examined as a moderator of the relationship of PF-interpretations to symptom change. At Session 10, but not at Session 2, patients who received a higher degree of PF-interpretations experienced greater subsequent improvement in panic symptoms. Non-PF-interpretations were not predictive. Patients with more interpersonal distress benefitted particularly from the use of PF-interpretations at Session 10. By the middle phase of PFPP, panic-focused interpretations may drive subsequent improvements in panic symptoms, especially among patients with higher interpersonal distress. Interpretations of conflict absent a panic focus may not be especially helpful.

Particles and nuclei in PANIC

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Anon.

1987-07-15

PANIC is the triennal International Conference on Particles and Nuclei, and judging from the latest PANIC, held in Kyoto from 20-24 April there is no need for panic yet. Faced with two pictures – one of nuclei described in nucleon and meson terms, and another of nucleons containing quarks and gluons – physicists are intrigued to know what new insights from the quark level can tell us about nuclear physics, or vice versa.

Particles and nuclei in PANIC

International Nuclear Information System (INIS)

Anon.

1987-01-01

PANIC is the triennal International Conference on Particles and Nuclei, and judging from the latest PANIC, held in Kyoto from 20-24 April there is no need for panic yet. Faced with two pictures – one of nuclei described in nucleon and meson terms, and another of nucleons containing quarks and gluons – physicists are intrigued to know what new insights from the quark level can tell us about nuclear physics, or vice versa

Evaluation of Relationship between Schemas and Panic Disorder through a Case Treated with Schema Therapy

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Esra Yancar Demir

2014-08-01

Discussion: Early maladaptive schemas and inadaptive ways of behaviors that has been developed by patients to handle these schemas may underly the axis I disorder symptoms such as anxiety, depression, drug abuse and psychosomatic disorders. As we look have a look at our patient, it can be said that her seperation with parents before elementary school may have led to her schemas of desertion and distrust and also teacher being over guarding at the levels of harming sovereignty to compensate the absence of the parents forms the basis of schemas of dependence / incompatence, being harmed and weakness against ilnesses. These schemas may be the reason of the patient's inability to handle certain life problems that may be triggering her panic attack symptoms. Schema therapy led to awareness of the patient about her schemas. Patient who had been thought of more functional ways coping instead of inadaptive ways was free of her panic attack symptoms which were resistant to medical treatment. The schema therapy proceess that has been going on with our patient is a good example for schema therapy that was originally developed for treatment for axis II disorders may also be effective for axis 1 disorders. [JCBPR 2014; 3(2.000: 109-115

Is panic disorder a disorder of physical fitness? A heuristic proposal

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Perna, Giampaolo; Caldirola, Daniela

2018-01-01

Currently, panic disorder (PD) is considered a mental disorder based on the assumptions that panic attacks (PAs) are “false alarms” that arise from abnormally sensitive defense systems in the central nervous system and that PD is treated with therapies specifically acting on anxiety or fear mechanisms. This article aims to propose an alternative perspective based on the results of some experimental studies. Our heuristic proposal suggests not only that PD may be a mental disorder but also that patients with PD have real abnormal body functioning, mainly involving cardiorespiratory and balance systems, leading to a decline in global physical fitness. PAs, as well as physical symptoms or discomfort in some environmental situations, may be “real alarms” signaling that the adaptability resources of an organism are insufficient to respond appropriately to some internal or external changes, thus representing the transient conscious awareness of an imbalance in body functioning. The antipanic properties of several modern treatments for PD may include their beneficial effects on body functions. Although anxiety or fear mechanisms are evidently involved in PD, we hypothesize that a reduction of physical fitness is the “primum movens” of PD, while anxiety or fear is induced and sustained by repeated signals of impaired body functioning. We propose considering panic in a broader perspective that offers a central role to the body and to contemplate the possible role of somatic treatments in PD. PMID:29623195

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

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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

Recurrent spontaneous attacks of dizziness.

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Lempert, Thomas

2012-10-01

This article describes the common causes of recurrent vertigo and dizziness that can be diagnosed largely on the basis of history. Ninety percent of spontaneous recurrent vertigo and dizziness can be explained by six disorders: (1) Ménière disease is characterized by vertigo attacks, lasting 20 minutes to several hours, with concomitant hearing loss, tinnitus, and aural fullness. Aural symptoms become permanent during the course of the disease. (2) Attacks of vestibular migraine may last anywhere from minutes to days. Most patients have a previous history of migraine headaches, and many experience migraine symptoms during the attack. (3) Vertebrobasilar TIAs affect older adults with vascular risk factors. Most attacks last less than 1 hour and are accompanied by other symptoms from the posterior circulation territory. (4) Vestibular paroxysmia is caused by vascular compression of the eighth cranial nerve. It manifests itself with brief attacks of vertigo that recur many times per day, sometimes with concomitant cochlear symptoms. (5) Orthostatic hypotension causes brief episodes of dizziness lasting seconds to a few minutes after standing up and is relieved by sitting or lying down. In older adults, it may be accompanied by supine hypertension. (6) Panic attacks usually last minutes, occur in specific situations, and are accompanied by choking, palpitations, tremor, heat, and anxiety. Less common causes of spontaneous recurrent vertigo and dizziness include perilymph fistula, superior canal dehiscence, autoimmune inner ear disease, otosclerosis, cardiac arrhythmia, and medication side effects. Neurologists need to venture into otolaryngology, internal medicine, and psychiatry to master the differential diagnosis of recurrent dizziness.

Hypochondriacal concerns and somatization in panic disorder.

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Furer, P; Walker, J R; Chartier, M J; Stein, M B

1997-01-01

To clarify the relationship between panic disorder and the symptoms of hypochondriasis and somatization, we evaluated these symptoms and diagnoses in patients attending an Anxiety Disorders Clinic. Structured clinical interviews, self-report measures, and symptom diaries were used to assess 21 patients with panic disorder, 23 patients with social phobia, and 22 control subjects with no psychiatric disorders. Ten of the patients with panic disorder (48%) also met DSM-IV criteria for hypochondriasis, whereas only one of the patients with social phobia and none of the healthy control subjects met the criteria for this diagnosis. None of the participants met DSM-IV criteria for somatization disorder, even though both anxiety groups reported high levels of somatic symptoms. The panic disorder group reported higher levels of fear about illness and disease conviction and endorsed more somatic symptoms than did the other groups. A higher proportion of panic disorder patients reported previously diagnosed medical conditions (48%) as compared with patients with social phobia (17%) or healthy control subjects (14%). The panic disorder patients with DSM-IV hypochondriasis obtained higher scores on measures of hypochondriacal concerns, somatization, blood-injury phobia, and general anxiety and distress than did the panic disorder patients without hypochondriasis. The results suggest a strong association between panic disorder and hypochondriasis.

Recurrence of panic disorder during pregnancy: a 7-year naturalistic follow-up study.

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

2006-01-01

The aim of this naturalistic follow-up study was to examine the effect of pregnancy as a predicting factor of relapse in patients with panic disorder (PD). Eighty-five female patients with PD (between the ages of 20 and 35 years) were included in this study. They were divided into 2 groups based on whether the onset of PD had been during pregnancy (PD-pregnancy [PD-P]) or whether the onset of PD had been while not pregnant (PD-nonpregnant [PD-NP]). Patients were treated with paroxetine up to 40 mg/day for 12 months, and the full responders were tapered off their medication and were monitored for an additional 6 years. Treatment response was assessed using the Panic Self-Questionnaire (PSQ) with full response being defined as "0" panic attacks. Assessments using the PSQ were made at baseline and every 4 weeks for the first twelve months. During the 6-year drug-free follow-up period, patients were assessed using the PSQ every 3 months. Relapse was defined as the occurrence of a panic attack in any phase of the study. The effect of group membership (PD-P vs. PD-NP) and new pregnancies as risk factors for relapse were explored. Sixty-eight patients completed the 6-year follow-up, and each of the study groups (PD-P and PD-NP) was composed of 34 patients. Twenty-six of 34 (76.6%) patients in the PD-P group had another pregnancy, and 15/26 (57%) in this group experienced a relapse during the subsequent pregnancy. Three of 8 (37%) PD-P patients experienced a relapse without pregnancy. Among the second group (PD-NP), 18/34 (52.9%) became pregnant and 8/18 (44.4%) experienced a relapse at the time of pregnancy, whereas 4/16 (25%) experienced a relapse while not pregnant. Patients who relapsed during pregnancy had a more severe relapse (as defined by the severity of the PSQ score) compared with nonpregnant relapsers. Our naturalistic follow-up study demonstrated that pregnancy might confer an increased risk of relapse in PD. Moreover, when compared with patients who develop

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.

Hypochondriasis and panic disorder. Boundary and overlap.

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Barsky, A J; Barnett, M C; Cleary, P D

1994-11-01

To determine the nosological and phenomenological overlap and boundaries between panic disorder and hypochondriasis, we compared the symptoms, disability, comorbidity, and medical care of primary care patients with each diagnosis. Patients with DSM-III-R panic disorder were recruited by screening consecutive primary care clinic attenders and then administering a structured diagnostic interview for panic disorder. Patients also completed self-report questionnaires, and their primary care physicians completed questionnaires about them. They were then compared with patients with DSM-III-R hypochondriasis from the same setting who had been studied previously. One thousand six hundred thirty-four patients were screened; 135 (71.0% of the 190 eligible patients) completed the research battery; 100 met lifetime panic disorder criteria. Twenty-five of these had comorbid hypochondriasis. Those without comorbid hypochondriasis (n = 75) were then compared with patients with hypochondriasis without comorbid panic disorder (n = 51). Patients with panic disorder were less hypochondriacal (P somatized less (P somatization disorder symptoms (P hypochondriasis. While hypochondriasis and panic disorder co-occur to some extent in a primary care population, the overlap is by no means complete. These patients are phenomenologically and functionally differentiable and distinct and are viewed differently by their primary care physicians.

Ritalin®: Panic in the USA

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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.

Ritalin®: Panic in the USA

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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.

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

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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

[Panic disorder--psychobiological aspects of personality dimensions].

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Draganić-Rajić, Saveta; Lecić-Tosevski, Dusica; Paunović, Vladimir R; Cvejić, Vesna; Svrakić, Dragan

2005-01-01

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. 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. 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. 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. 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.

[Panic disorder and atrial fibrillation].

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Olazabal Eizaguirre, N; Chavez, R; González-Torres, M A; Gaviria, M

2013-10-01

This paper studies the relationship between atrial fibrillation and panic disorder. There are often doubts on the differential diagnosis in emergency services and general medical settings. Panic disorder prevalence rates have been found to be high in patients suffering from atrial fibrillation. Various studies have observed that patients diagnosed with anxiety disorders frequently have higher cardiovascular disease rates compared to the general population. Usually, patients suffering from panic disorder exhibit somatic complaints suggesting coronary disease, such as chest pain or palpitations. The aim is to make the correct diagnosis and treatment for these different illnesses, and to decrease the costs due to misdiagnosis. Copyright © 2012 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

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

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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. Copyright © 2015 Elsevier Ltd. All rights reserved.

Cognitive behavioral group therapy in panic disorder patients: the efficacy of CBGT versus drug treatment.

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Dannon, Pinhas N; Gon-Usishkin, M; Gelbert, A; Lowengrub, K; Grunhaus, L

2004-01-01

The aim of our study was to evaluate the effectiveness of Cognitive Behavioral Group Therapy (CBGT) in the treatment of Panic Disorder (PD) and to compare the treatment outcome of CBGT versus Paroxetine pharmacotherapy. Fifty seven patients referred to our anxiety disorder clinic for the treatment of PD were randomly allocated to receive either CBGT or Paroxetine. Follow up was done by a masked rater after four and twelve weeks of treatment in order to compare the efficacy of CBGT versus Paroxetine. CBGT and Paroxetine were both effective in the short-term treatment of PD. Assessments at weeks four and twelve of treatment showed no statistically significant differences between the two groups in terms of treatment outcome. Treatment with CBGT alone for the acute phase of PD appears to be equally efficacious to treatment with Paroxetine alone. Our study shows that CBGT produced beneficial results, for it was associated with a reduction in the number and frequency of panic attacks and with an improved feeling of well-being.

Panic disorder: Psychobiological aspects of personality dimensions

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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.

Panic disorder in patients with chronic heart failure.

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Müller-Tasch, Thomas; Frankenstein, Lutz; Holzapfel, Nicole; Schellberg, Dieter; Löwe, Bernd; Nelles, Manfred; Zugck, Christian; Katus, Hugo; Rauch, Bernhard; Haass, Markus; Jünger, Jana; Remppis, Andrew; Herzog, Wolfgang

2008-03-01

Our objective was to assess the prevalence of panic disorder, its influence on quality of life (QoL), and the presence of further anxiety and depressive comorbid disorders in outpatients with chronic heart failure (CHF). In a cross-sectional study, anxiety and depressive disorders were diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnostic criteria in patients with CHF who were aged > or =18 years and had New York Heart Association (NYHA) Functional Classes I-IV, using the Patient Health Questionnaire. Health-related QoL was evaluated using the Short-Form 36 Health Survey (SF-36). Of the 258 participating patients, 24 (9.3%) fulfilled diagnostic criteria for panic disorder. Seven of these (29.2%) were diagnosed with comorbid anxiety disorders, 11 (47.3%) were diagnosed with comorbid depressive disorder, and 5 (20.8%) were diagnosed with other anxiety disorders and any depressive disorder. Female gender [odds ratio (OR)=3.1; 95% confidence interval (95% CI)=1.2-7.8; P=.02] and a lower level of education (OR=0.3; 95% CI=0.1-0.9; P=.04) were associated with the presence of panic disorder. In patients with panic disorder, QoL was significantly more restricted on all subscales of the SF-36 as compared to those without panic disorder, even when age, gender, and NYHA functional class were controlled for (P=.05 to <.01). Approximately 1 of 10 patients with CHF suffers from panic disorder, many of whom also have additional anxiety or depressive comorbid disorders. Female gender and a low level of education are positively associated with the presence of panic disorder. QoL is severely limited by the presence of panic disorder. Diagnosis of mental disorders and treatment offers for affected patients should be available in patient care.

The influence of panic on the efficiency of escape

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Shen, Jia-Quan; Wang, Xu-Wen; Jiang, Luo-Luo

2018-02-01

Whenever we (such as pedestrians) perceive a high density or imminent danger in a confined space, we tend to be panic, which can lead to severe injuries even in the absence of real dangers. Although it is difficult to measure panics in real conditions, we introduced a simple model to study the collective behaviors in condition of fire with dense smoke. Owing to blocking the sight with dense smoke, pedestrians in this condition have two strategies to escape: random-walking or walking along the wall. When the pedestrians are in moderate panic that mean the two types of behaviors are mixed(random-walking and walking along the wall). Our simulation results show that moderate panic, meaning that two escape strategies are mixed, reduces the escape time. In addition, the results indicate that moderate panic can improve the efficiency of escape, this theory also can be useful in a real escape situation. We hope that our research provides the theoretical understanding of underlying mechanisms of panic escape in the condition of poor sight.

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

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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…

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.

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

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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

What is the effect on comorbid personality disorder of brief panic-focused psychotherapy in patients with panic disorder?

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Keefe, John R; Milrod, Barbara L; Gallop, Robert; Barber, Jacques P; Chambless, Dianne L

2018-03-01

No studies of psychotherapies for panic disorder (PD) have examined effects on comorbid personality disorders (PersD), yet half such patients have a PersD. In a randomized trial for PD with and without agoraphobia comparing Cognitive-Behavioral Therapy (CBT) and Panic-Focused Psychodynamic Psychotherapy (PFPP), PersD was assessed pre-to-post treatment with the Structured Clinical Interview for the Diagnosis of Axis-II Disorders (SCID-II). For patients completing therapy (n = 118, 54 with PersD), covariance between panic and SCID-II criteria improvements was analyzed. SCID-II diagnostic remission and recovery were evaluated. Comparative efficacy of PFPP versus CBT for improving PersD was analyzed both for the average patient, and as a function of PersD severity. 37 and 17% of PersD patients experienced diagnostic PersD remission and recovery, respectively. Larger reductions in PersD were related to more panic improvement, with a modest effect size (r = 0.28). Although there was no difference between treatments in their ability to improve PersD for the average patient (d = 0.01), patients meeting more PersD criteria did better in PFPP compared to CBT (P = .007), with PFPP being significantly superior at 11 criteria and above (d = 0.66; 3 more criteria lost). PersD presenting in the context of primary PD rarely resolves during psychotherapies focused on PD, and change in PersD only moderately tracks panic improvements, indicating non-overlap of the constructs. Patients receiving panic-focused psychotherapies may require additional treatment for their PersD. PFPP may be superior at improving severe PersD, but replication of this finding is required. © 2017 Wiley Periodicals, Inc.

Tryptophan Research in Panic Disorder

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Eduard Maron

2008-01-01

Full Text Available A considerable body of evidence suggests the involvement of serotonin neurotransmission in the pathogenesis of panic disorder. Research on pathways and functions of tryptophan, an essential amino acid converted into serotonin, may advance our understanding of serotonergic actions in panic disorder and related phenomena. The investigative approaches in this field include manipulations of tryptophan availability as well as genetic association and functional brain imaging studies. In this review we examine the principle findings of these studies and propose further research directions.

Agent Based Modeling and Simulation of Pedestrian Crowds In Panic Situations

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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.

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

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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

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

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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

Daily maternal separations during stress hyporesponsive period decrease the thresholds of panic-like behaviors to electrical stimulation of the dorsal periaqueductal gray of the adult rat.

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Borges-Aguiar, Ana Cristina; Schauffer, Luana Zanoni; de Kloet, Edo Ronald; Schenberg, Luiz Carlos

2018-05-15

The present study examined whether early life maternal separation (MS), a model of childhood separation anxiety, predisposes to panic at adulthood. For this purpose, male pups were submitted to 3-h daily maternal separations along postnatal (PN) days of either the 'stress hyporesponsive period' (SHRP) from PN4 to PN14 (MS11) or throughout lactation from PN2 to PN21 (MS20). Pups were further reunited to conscious (CM) or anesthetized (AM) mothers to assess the effect of mother-pup interaction upon reunion. Controls were subjected to brief handling (15 s) once a day throughout lactation (BH20). As adults (PN60), rats were tested for the thresholds to evoke panic-like behaviors upon electrical stimulation of dorsal periaqueductal gray matter and exposed to an elevated plus-maze, an open-field, a forced swim and a sucrose preference test. A factor analysis was also performed to gain insight into the meaning of behavioral tests. MS11-CM rather than MS20-CM rats showed enhanced panic responses and reductions in both swimming and sucrose preference. Panic facilitations were less intense in mother-neglected rats. Although MS did not affect anxiety, MS11-AM showed robust reductions of defecation in an open-field. Factor analysis singled out anxiety, hedonia, exploration, coping and gut activity. Although sucrose preference and coping loaded on separate factors, appetite (adult weight) correlated with active coping in both forced swim and open-field (central area exploration). Concluding, whereas 3h-daily maternal separations during SHRP increased rat's susceptibility to experimental panic attacks, separations throughout lactation had no effects on panic and enhanced active coping. Copyright © 2018 Elsevier B.V. All rights reserved.

Cognitive Behavioral Therapy vs. Eye Movement Desensitization and Reprocessing for Treating Panic Disorder: A Randomized Controlled Trial

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Horst, Ferdinand; Den Oudsten, Brenda; Zijlstra, Wobbe; de Jongh, Ad; Lobbestael, Jill; De Vries, Jolanda

2017-01-01

Objective: Cognitive Behavioral Therapy (CBT) is an effective intervention for patients with panic disorder (PD). From a theoretical perspective, Eye Movement Desensitization and Reprocessing (EMDR) therapy could also be useful in the treatment of PD because: (1) panic attacks can be experienced as life threatening; (2) panic memories specific to PD resemble traumatic memories as seen in posttraumatic stress disorder (PTSD); and (3) PD often develops following a distressing life event. The primary objective of this Randomized Controlled Trial (RCT), was to compare EMDR therapy with CBT for PD and determine whether EMDR is not worse than CBT in reducing panic symptoms and improving Quality Of Life (QOL). Methods: Two-arm (CBT and EMDR) parallel RCT in patients with PD (N = 84). Patients were measured at baseline (T1), directly after the last therapy session (T2), and 3 months after ending therapy (T3). Non-inferiority testing (linear mixed model with intention-to-treat analysis) was applied. Patients were randomly assigned to 13 weekly 60-min sessions of CBT (N = 42) or EMDR therapy (N = 42). Standard protocols were used. The primary outcome measure was severity of PD at T3, as measured with the Agoraphobic Cognitions Questionnaire (ACQ), the Body Sensations Questionnaire (BSQ), and the Mobility Inventory (MI). The secondary outcome measure was QOL, as measured with the World Health Organization Quality of Life short version (WHOQOL-Bref), at T3. Results: The severity of PD variables ACQ and BSQ showed non-inferiority of EMDR to CBT, while MI was inconclusive (adjusted analyses). Overall QOL and general health, Psychological health, Social relationships, and Environment showed non-inferiority of EMDR to CBT, while Physical health was inconclusive. Conclusion: EMDR therapy proved to be as effective as CBT for treating PD patients. Trial Registration: Dutch Trial Register, Nr. 3134 http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=3134 PMID:28868042

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

Electroencephalographic findings in panic disorder

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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.

Recalled Peritraumatic Reactions, Self-Reported PTSD, and the Impact of Malingering and Fantasy Proneness in Victims of Interpersonal Violence Who Have Applied for State Compensation

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Kunst, Maarten; Winkel, Frans Willem; Bogaerts, Stefan

2011-01-01

The present study explores the associations between three types of peritraumatic reactions (dissociation, distress, and tonic immobility) and posttraumatic stress disorder (PTSD) symptoms in a sample of 125 victims of interpersonal violence who had applied for compensation with the Dutch Victim Compensation Fund (DCVF). In addition, the…

Panic Attack or Heart Attack?

Science.gov (United States)

... When in doubt about symptoms, seek care without delay to rule out heart disease. Heart disease affects your heart's ... which cause you concern, see your doctor without delay and ask for testing to rule out heart disease. 1 Gadolinium side effects could ...

A pilot study on peritraumatic dissociation and coping styles as risk factors for posttraumatic stress, anxiety and depression in parents after their child's unexpected admission to a Pediatric Intensive Care Unit

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Last Bob F

2009-10-01

Full Text Available Abstract Aim To study the prevalence of posttraumatic stress disorder (PTSD, anxiety and depression in parents three months after pediatric intensive care treatment of their child and examine if peritraumatic dissocation and coping styles are related to these mental health problems. Methods This is a prospective cohort study and included parents of children unexpectedly admitted to the Pediatric Intensive Care Unit (PICU from January 2006 to March 2007. At three months follow-up parents completed PTSD (n = 115, anxiety and depression (n = 128 questionnaires. Immediately after discharge, parents completed peritraumatic dissocation and coping questionnaires. Linear regression models with generalized estimating equations examined risk factors for mental health problems. Results Over 10% of the parents were likely to meet criteria for PTSD and almost one quarter for subclinical PTSD. Respectively 15% to 23% of the parents reported clinically significant levels of depression and anxiety. Peritraumatic dissocation was most strongly associated with PTSD, anxiety as well as depression. Avoidance coping was primarily associated with PTSD. Conclusion A significant number of parents have mental health problems three months after unexpected PICU treatment of their child. Improving detection and raise awareness of mental health problems is important to minimize the negative effect of these problems on parents' well-being.

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

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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.

Evoked Potential in Panic Disorder Patients: A Systematic Review.

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Di Giorgio, Luiza Medeiros Wanick; Velasques, Bruna Brandao; Ribeiro, Pedro; Nardi, Antonio Egidio; de Carvalho, Marcele Regine

2015-01-01

Researchers have been using the electroencephalogram to better understand the cognitive and neurobiological bases of panic disorder (PD) through the P300 component; this is an electric potential of the cerebral cortex that is generated in response to external sensorial stimuli and which involves more complex neurophysiological processes related to stimulus interpretation; it is then used to investigate possible alterations in the information processing and attention of patients suffering from this disorder. Aiming to verify the results found by experimental articles already published about P300 in PD patients and the information processing differences between PD patients and healthy controls, a systematic review of the PubMed and Institute for Scientific Information databases was conducted. The selection criterion involved those articles, written in English, which referred to an experimental research that focused on the P300 component, with a sample composed of PD (or panic attacks) patients. Seven articles were found that fit the selected criteria. Most of the articles show that these patients suffer from: impaired information processing and attention, an inability to automatically respond to new stimuli, and impaired interpretation of internal and external stimuli related to the disorder. Such impairment may be related to an unspecified dysfunction in the limbic-reticular structures, which would affect: active, focused and short-term attention, working and short-term memory, recognition and decision making. Some limitations were highlighted, such as the use of small samples and possible comorbidity with other disorders, which did not allow clearer results. This research can contribute to understand the neurobiological differences of PD patients and develop treatments based on such evidence.

Common paths to ASD and PTSD

DEFF Research Database (Denmark)

Hansen, Maj; Armour, Cherie; Wittmann, Lutz

Numerous studies have investigated the prediction of acute and long term posttraumatic symptoms following traumatic exposure. As a result several factors have been shown to be predictive of Acute Stress Disorder (ASD) and Posttraumatic Stress Disorder (PTSD) respectively. Furthermore, research...... suggests a strong relationship between ASD severity and subsequent PTSD severity. However, little is known in relation to whether there are common pathways to the development of ASD and PTSD. Peritraumatic responses to trauma are found to be associated with both the development of ASD and PTSD. Although...... of peritraumatic factors such as symptoms of tonic immobility, panic, and dissociation on the development of ASD (N = 458) and PTSD (n = 378) symptoms in a national study of Danish bank robbery victims. The estimated ASD rate was 11.1 % (n = 41) and the estimated PTSD rate was 6.2 % (n = 23). The results...

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

International Nuclear Information System (INIS)

Camplesi, M. Jr.; Bortoli, V.C. de; Paula Soares, V. de; Nogueira, R.L.; Zangrossi, H. Jr.

2012-01-01

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 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

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.

PANIC at Heidelberg

Energy Technology Data Exchange (ETDEWEB)

Anon.

1984-12-15

Earlier this year in Heidelberg there was PANIC - short for Particle and Nuclei International Conference. This is the new name which has been adopted for a series which in fact began in 1963, the aim being to cover the common ground between the physics of nuclei and of elementary particles.

Comorbid panic disorder as an independent risk factor for suicide attempts in depressed outpatients.

Science.gov (United States)

Nam, Yoon-Young; Kim, Chan-Hyung; Roh, Daeyoung

2016-05-01

Although comorbid panic disorder is associated with more severe symptoms and poorer therapeutic response in depressive patients, the relationship between panic disorder and risk of suicide attempt has not been confirmed. This study aimed to examine the relationship between comorbid panic disorder and clinical characteristics associated with suicidal risk as well as the likelihood of suicide attempt. A total of 223 outpatients with current major depressive disorder participated in the study. Both subjects with panic disorder (33%) and those without panic disorder (67%) were compared based on history of suicide attempts, current psychopathologies, and traits of impulsivity and anger. Subjects with panic disorder had higher levels of impulsivity, depression, and hopelessness and were more likely to report a history of suicide attempts. Subjects with panic disorder were younger at the time of first suicide attempt than those without panic disorder. Logistic regression analyses indicated that comorbid panic disorder was significantly associated with a history of suicide attempts after adjusting for other clinical correlates (odds ratio = 2.8; p depressive disorder may be associated with a more severe burden of illness and may independently increase the likelihood of suicide attempt. Copyright © 2016 Elsevier Inc. All rights reserved.

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...

Cerebral glucose metabolic differences in patients with panic disorder

Energy Technology Data Exchange (ETDEWEB)

Nordahl, T.E.; Semple, W.E.; Gross, M.; Mellman, T.A.; Stein, M.B.; Goyer, P.; King, A.C.; Uhde, T.W.; Cohen, R.M. (NIMH, Bethesda, MD (USA))

1990-08-01

Regional glucose metabolic rates were measured in patients with panic disorder during the performance of auditory discrimination. Those regions examined by Reiman and colleagues in their blood flow study of panic disorder were examined with a higher resolution positron emission tomography (PET) scanner and with the tracer (F-18)-2-fluoro-2-deoxyglucose (FDG). In contrast to the blood flow findings of Reiman et al., we did not find global gray metabolic differences between patients with panic disorder and normal controls. Consistent with the findings of Reiman et al., we found hippocampal region asymmetry. We also found metabolic decreases in the left inferior parietal lobule and in the anterior cingulate (trend), as well as an increase in the metabolic rate of the medial orbital frontal cortex (trend) of panic disorder patients. It is unclear whether the continuous performance task (CPT) enhanced or diminished findings that would have been noted in a study performed without task.

Cerebral glucose metabolic differences in patients with panic disorder

International Nuclear Information System (INIS)

Nordahl, T.E.; Semple, W.E.; Gross, M.; Mellman, T.A.; Stein, M.B.; Goyer, P.; King, A.C.; Uhde, T.W.; Cohen, R.M.

1990-01-01

Regional glucose metabolic rates were measured in patients with panic disorder during the performance of auditory discrimination. Those regions examined by Reiman and colleagues in their blood flow study of panic disorder were examined with a higher resolution positron emission tomography (PET) scanner and with the tracer [F-18]-2-fluoro-2-deoxyglucose (FDG). In contrast to the blood flow findings of Reiman et al., we did not find global gray metabolic differences between patients with panic disorder and normal controls. Consistent with the findings of Reiman et al., we found hippocampal region asymmetry. We also found metabolic decreases in the left inferior parietal lobule and in the anterior cingulate (trend), as well as an increase in the metabolic rate of the medial orbital frontal cortex (trend) of panic disorder patients. It is unclear whether the continuous performance task (CPT) enhanced or diminished findings that would have been noted in a study performed without task

Cognitive Behavioral Therapy vs. Eye Movement Desensitization and Reprocessing for Treating Panic Disorder: A Randomized Controlled Trial

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Ferdinand Horst

2017-08-01

Full Text Available Objective: Cognitive Behavioral Therapy (CBT is an effective intervention for patients with panic disorder (PD. From a theoretical perspective, Eye Movement Desensitization and Reprocessing (EMDR therapy could also be useful in the treatment of PD because: (1 panic attacks can be experienced as life threatening; (2 panic memories specific to PD resemble traumatic memories as seen in posttraumatic stress disorder (PTSD; and (3 PD often develops following a distressing life event. The primary objective of this Randomized Controlled Trial (RCT, was to compare EMDR therapy with CBT for PD and determine whether EMDR is not worse than CBT in reducing panic symptoms and improving Quality Of Life (QOL.Methods: Two-arm (CBT and EMDR parallel RCT in patients with PD (N = 84. Patients were measured at baseline (T1, directly after the last therapy session (T2, and 3 months after ending therapy (T3. Non-inferiority testing (linear mixed model with intention-to-treat analysis was applied. Patients were randomly assigned to 13 weekly 60-min sessions of CBT (N = 42 or EMDR therapy (N = 42. Standard protocols were used. The primary outcome measure was severity of PD at T3, as measured with the Agoraphobic Cognitions Questionnaire (ACQ, the Body Sensations Questionnaire (BSQ, and the Mobility Inventory (MI. The secondary outcome measure was QOL, as measured with the World Health Organization Quality of Life short version (WHOQOL-Bref, at T3.Results: The severity of PD variables ACQ and BSQ showed non-inferiority of EMDR to CBT, while MI was inconclusive (adjusted analyses. Overall QOL and general health, Psychological health, Social relationships, and Environment showed non-inferiority of EMDR to CBT, while Physical health was inconclusive.Conclusion: EMDR therapy proved to be as effective as CBT for treating PD patients.Trial Registration: Dutch Trial Register, Nr. 3134 http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=3134

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.

Assessing DSM-5 latent subtypes of acute stress disorder dissociative or intrusive?

Science.gov (United States)

Armour, Cherie; Hansen, Maj

2015-02-28

Acute Stress Disorder (ASD) was first included in the DSM-IV in 1994. It was proposed to account for traumatic responding in the early post trauma phase and to act as an identifier for later Posttraumatic Stress Disorder (PTSD). Unlike PTSD it included a number of dissociative indicators. The revised DSM-5 PTSD criterion included a dissociative-PTSD subtype. The current study assessed if a dissociative-ASD subtype may be present for DSM-5 ASD. Moreover, we assessed if a number of risk factors resulted in an increased probability of membership in symptomatic compared to a baseline ASD profile. We used data from 450 bank robbery victims. Latent profile analysis (LPA) was used to uncover latent profiles of ASD. Multinomial logistic regression was used to determine if female gender, age, social support, peritraumatic panic, somatization, and number of trauma exposures increased or decreased the probability of profile membership. Four latent profiles were uncovered and included an intrusion rather than dissociative subtype. Increased age and social support decreased the probability of individuals being grouped into the intrusion subtype whereas increased peritraumatic panic and somatization increased the probability of individuals being grouped into the intrusion subtype. Findings are discussed in regard to the ICD-11 and the DSM-5. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Moral panic in Icelandic society: Arrival of ecstasy to Iceland

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Jónas 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.

The investigation on the public panic caused from the Fukushima nuclear accident

International Nuclear Information System (INIS)

Liao Li; Wang Yilong; He Xu

2012-01-01

March 11, 2011, a huge earthquake and tidal waves in Japan lead to dangerous levels of nuclear leakage at Fukushima nuclear plant, the nuclear accident also cause public panic m many countries. To investigate the reason of the public panic, we employ the theories of sociology and psychology, analyzed that the public panic come from Ignorant Panic. Herd Behavior, Primacy Effect, Stereotype Activation Effect, and the superposition of these effects. In addition, we proposed three measures to the public panic: First, we should emphasize the safety of nuclear power and establish the positive image of nuclear power Second, we should emphasize the popular science of nuclear power so that nu clear power can be accepted in the public; Third, we should enhance the psychological intervention system for nuclear safe emergency and improve the effect of psychological intervention

The effect of prolonged exposure to war-related stress among hospital personnel with different affect types: lessons from the Second Lebanon War and the Gaza "Cast Lead" operation.

Science.gov (United States)

Palgi, Yuval; Ben-Ezra, Menachem; Shrira, Amit

2012-01-01

Two studies examined peritraumatic symptoms due to war-related stress among hospital personnel with different affect types. In Study 1, we examined 80 Israeli hospital personnel during the period they were exposed to frequent missile attacks in the Second Lebanon War. In Study 2, we examined 67 and 74 Israeli hospital personnel during the time they were exposed and were not exposed, respectively, to missile attacks in the Gaza "Cast Lead" operation. In both studies, hospital personnel completed measures of posttraumatic stress disorder symptoms as well as of positive- and negative-affect items (PA and NA, respectively). Exposed personnel with a positive congruent (high PA and low NA) or a deflated incongruent (low PA and low NA) affective types had a lower level of peritraumatic symptoms compared to those with a negative congruent (low PA and high NA) or an inflated incongruent (high PA and NA) affective types. Study 2 further showed that among non-exposed personnel, only personnel with a negative congruent affective type had a higher level of peritraumatic symptoms compared to personnel with other affective types. Clinical implications and required future studies are discussed.

Health Anxiety in Panic Disorder, Somatization Disorder and Hypochondriasis

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Özgün Karaer KARAPIÇAK

2012-03-01

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

Novel Psychological Formulation and Treatment of "Tic Attacks" in Tourette Syndrome.

Science.gov (United States)

Robinson, Sally; Hedderly, Tammy

2016-01-01

onset and maintenance of tic attacks. These cases provide support for the view that tic attacks are triggered and maintained by psychological factors, thereby challenging the view that tic attacks merely reflect extended bouts of tics. As such, we propose that the movements seen in tic attacks may resemble a combination of tics and functional neurological movements, with tic attacks reflecting episodes of panic and anxiety for individuals with TS.

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

Science.gov (United States)

Wintermann, Gloria-Beatrice; Donix, Markus; Joraschky, Peter; Gerber, Johannes; Petrowski, Katja

2013-01-01

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. 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. 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. 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-network which is associated with an increased severity of the psychopathology.

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 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.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.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.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-network which is associated with an increased severity of the

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

OpenAIRE

Mustafa Ozkan; Abdurrahman Altindag

2003-01-01

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

A pilot study on peritraumatic dissociation and coping styles as risk factors for posttraumatic stress, anxiety and depression in parents after their child's unexpected admission to a Pediatric Intensive Care Unit

NARCIS (Netherlands)

Bronner, Madelon B.; Kayser, Anne-Marie; Knoester, Hendrika; Bos, Albert P.; Last, Bob F.; Grootenhuis, Martha A.

2009-01-01

ABSTRACT: Aim: To study the prevalence of posttraumatic stress, anxiety and depression in parents three months after pediatric intensive care treatment of their child and examine if peritraumatic dissocation and coping styles are related to these mental health problems. METHODS: This is a

The Gay Panic Defense: Legal Defense Strategy or Reinforcement of Homophobia in Court?

Science.gov (United States)

Tomei, Jenna; Cramer, Robert J; Boccaccini, Marcus T; Panza, Nancy Ryba

2017-06-01

Gay panic refers to a heterosexual man violently responding to unwanted sexual advances from a gay man. In court, the defendant may argue he was provoked or temporarily insane. This study utilized 352 jury-eligible citizens to assess differences across mediums of gay panic. Participants were asked to read vignettes depicting a control, gay panic as provocation, or gay panic as insanity condition and provide verdicts and ratings of blame and responsibility. Participants also completed measures assessing political orientation and homonegativity. Data were analyzed via a MANCOVA, a chi-square goodness-of-fit test, and general linear modeling. Verdicts, victim blame, and ratings of responsibility differed across vignette conditions, with an observed leniency effect when gay panic was claimed in either context. Homonegativity also exacerbated patterns of prodefendant views, as participants higher in homonegativity assigned higher victim blame, lower defendant responsibility, and more lenient verdicts in the gay panic conditions. The effect of political orientation was nuanced, as only republicans in the provocation condition followed the anticipated pattern in rendering more lenient verdicts. Results provide additional support for the notion gay panic defenses may be, in part, fueled by political beliefs and prejudicial beliefs against persons of sexual minority status. Drawing from a justification-suppression model, it may be that in cases of gay panic, a context is created in which prejudiced ideologies can be openly expressed via leniency on the defendant. Implications may be relevant to future criminal law policies and practices, particularly advocacy and policy efforts, judicial training, and trial consultation to attorneys for juror selection and development of trial strategy.

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

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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.

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

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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)

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

International Nuclear Information System (INIS)

Uchida, R.R.; Del-Ben, C.M.; Araujo, D.; Crippa, J.A.; Graeff, F.G.; Santos, A.C.; Guimaraes, F.S.

2003-01-01

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 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 21 = 1.99, P = 0.06), right amygdala (8%, t 21 = 1.83, P = 0.08), left amygdala (5%, t 21 = 1.78, P 0.09) and left hippocampus (9%, t 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)

Screening for generalized anxiety disorder symptoms in the wake of terrorist attacks: a study in primary care.

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

2009-06-01

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.

Cognitive functions in patients with panic disorder: a literature review

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Mariana Rodrigues Poubel Alves

2013-06-01

Full Text Available Objective: To conduct a review of the literature on the possible neuropsychological deficits present in patients with panic disorder. Methods: We performed a systematic review and search of the PubMed, ISI and PsycInfo scientific databases, with no time limits, using the following key words: cognitive, function, panic, and disorder. Of the 971 articles found, 25 were selected and 17 were included in this review. The inclusion criterion was at least one neuropsychological assessment task in patients with panic disorder. Results: The number of publications has grown gradually, especially those assessing executive functions, corresponding to the neurobiological model most widely accepted. Of all the functions evaluated, these patients had lower performance in memory tasks and higher performance in affective processing tasks related to the disorder. However, these data require further investigation due to the high rate of comorbidities, the small sample sizes of the included studies and little standardization of instruments used. Conclusion: The results showed a greater occurrence of deficits in memory and enhanced affective processing related to panic disorder.

Health Anxiety in Panic Disorder, Somatization Disorder and Hypochondriasis

OpenAIRE

Özgün Karaer KARAPIÇAK; Selçuk ASLAN; Çisem UTKU

2012-01-01

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 ...

Patterns of headache in panic disorder: a survey of members of the ...

African Journals Online (AJOL)

Adele

2004-02-17

. Panic Disorder Support Group. A history of migraine at baseline increased fourfold the risk for major depression, and the risk of panic by a factor of 12. In another study, males were 7 times more likely to have migraines if they.

Gender differences in the associations between childhood trauma and parental bonding in panic disorder.

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Seganfredo, Ana Carolina Gaspar; Torres, Mariana; Salum, Giovanni Abrahão; Blaya, Carolina; Acosta, Jandira; Eizirik, Cláudio; Manfro, Gisele Gus

2009-12-01

The aim of this study is to evaluate the association between childhood trauma and the quality of parental bonding in panic disorder compared to non-clinical controls. 123 patients and 123 paired controls were evaluated with the Mini International Neuropsychiatric Interview, the Childhood Trauma Questionnaire and the Parental Bonding Instrument. The Parental Bonding Instrument and the Childhood Trauma Questionnaire were highly correlated. Panic disorder patients presented higher rates of emotional abuse (OR = 2.54, p = 0.001), mother overprotection (OR = 1.98, p = 0.024) and father overprotection (OR = 1.84, p = 0.041) as compared to controls. Among men with panic disorder, only mother overprotection remained independently associated with panic disorder (OR = 3.28, p = 0.032). On the other hand, higher father overprotection (OR = 2.2, p = 0.017) and less father warmth (OR = 0.48, p = 0.039) were independently associated with panic disorder among female patients. Higher rates of different types of trauma, especially emotional abuse, are described in panic disorder patients as compared to controls. The differences regarding gender and parental bonding could be explained in the light of the psychodynamic theory.

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

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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.

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

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José Maria Montiel

2014-12-01

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

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

The psychological development of panic disorder: implications for neurobiology and treatment.

Science.gov (United States)

Cosci, Fiammetta

2012-06-01

The aim of this study was to survey the available literature on psychological development of panic disorder with or without agoraphobia [PD(A)] and its relationship with the neurobiology and the treatment of panic. Both a computerized (PubMed) and a manual search of the literature were performed. Only English papers published in peer-reviewed journals and referring to PD(A) as defined by the diagnostic classifications of the American Psychiatric Association or of the World Health Organization were included. A staging model of panic exists and is applicable in clinical practice. In a substantial proportion of patients with PD(A), a prodromal phase and, despite successful treatment, residual symptoms can be identified. Both prodromes and residual symptoms allow the monitoring of disorder evolution during recovery via the rollback phenomenon. The different stages of the disorder, as well as the steps of the rollback, have a correspondence in the neurobiology and in the treatment of panic. However, the treatment implications of the longitudinal model of PD(A) are not endorsed, and adequate interventions of enduring effects are missing.

Predictors of Broad Dimensions of Psychopathology among Patients with Panic Disorder after Cognitive-Behavioral Therapy.

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Ogawa, Sei; Kondo, Masaki; Ino, Keiko; Imai, Risa; Ii, Toshitaka; Furukawa, Toshi A; Akechi, Tatsuo

2018-01-01

Many patients with panic disorder meet criteria for at least one other diagnosis, most commonly other anxiety or mood disorders. Cognitive-behavioral therapy is the best empirically supported psychotherapy for panic disorder. There is now evidence indicating that cognitive-behavioral therapy for panic disorder yields positive benefits upon comorbid disorders. The present study aimed to examine the predictors of broad dimensions of psychopathology in panic disorder after cognitive-behavioral therapy. Two hundred patients affected by panic disorder were treated with manualized group cognitive-behavioral therapy. We examined if the baseline personality dimensions of NEO Five Factor Index predicted the subscales of Symptom Checklist-90 Revised at endpoint using multiple regression analysis based on the intention-to-treat principle. Conscientiousness score of NEO Five Factor Index at baseline was a predictor of four Symptom Checklist-90 Revised subscales including obsessive-compulsive ( β = -0.15, P cognitive-behavioral therapy. For the purpose of improving a wide range of psychiatric symptoms with patients affected by panic disorder, it may be useful to pay more attention to this personal trait at baseline.

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

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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.

Practising of radiological emergency caused by a terrorist attack

International Nuclear Information System (INIS)

Racana, R.; Terrado, C.

2006-01-01

After the events of September 11, 2001 terrorist working has become an important factor in the forecasts to adopt in the face of the possibility of confronting different radiological emergencies. The not wanted events of exposure to ionizing radiations can take place by flaws of systems or accidents, or also by criminal voluntary actions. These malevolent actions can include attacks or sabotages in nuclear plants, detonation of manufactured nuclear devices or acquired under ground, robbery of radioactive sources to manufacture the calls dirty bombs or to cause damage, panic or threats. In the scenarios in that the radiological emergency is voluntarily provoked the moment and place of the attack are chosen by the aggressors, therefore the ionizing radiations will be in not prepared atmospheres neither equipped to the effect. This increases the confusion, the panic and the damage not only caused by the radiation effects but also by the uncertainty and consequent reactions. To diminish the effects of this type of threats it is necessary to make forecasts and to train the personnel that it can be direct or indirectly involved. During 2005, an exercise in which it was outlined the robbery by part of a group command of a source of Co 60 of 5000 Ci that it was transported to make a decanting in a medical center of The Pampa county, Argentina. It was about a cabinet exercise, planned and executed jointly among the Nuclear Regulatory Authority and the Secretary of Interior Safety, in which participated the professionals of the nuclear area that by law are the responsible ones of coordinating the actions in the event of an emergency of this type, and the safety forces that depend of the Secretary of Interior Safety, Federal and Provincial Policemen, Naval Prefecture and National Gendarmerie. The exercise last one day during which 9 main situations were approached that were unchained after having produced the attack and initial robbery. For each situation it was checked the

Predictors of Broad Dimensions of Psychopathology among Patients with Panic Disorder after Cognitive-Behavioral Therapy

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Sei Ogawa

2018-01-01

Full Text Available Background. Many patients with panic disorder meet criteria for at least one other diagnosis, most commonly other anxiety or mood disorders. Cognitive-behavioral therapy is the best empirically supported psychotherapy for panic disorder. There is now evidence indicating that cognitive-behavioral therapy for panic disorder yields positive benefits upon comorbid disorders. Objectives. The present study aimed to examine the predictors of broad dimensions of psychopathology in panic disorder after cognitive-behavioral therapy. Methods. Two hundred patients affected by panic disorder were treated with manualized group cognitive-behavioral therapy. We examined if the baseline personality dimensions of NEO Five Factor Index predicted the subscales of Symptom Checklist-90 Revised at endpoint using multiple regression analysis based on the intention-to-treat principle. Results. Conscientiousness score of NEO Five Factor Index at baseline was a predictor of four Symptom Checklist-90 Revised subscales including obsessive-compulsive (β=-0.15, P<0.01, depression (β=-0.13, P<0.05, phobic anxiety (β=-0.15, P<0.05, and Global Severity Index (β=-0.13, P<0.05. Conclusion. Conscientiousness at baseline may predict several dimensions of psychopathology in patients with panic disorder after cognitive-behavioral therapy. For the purpose of improving a wide range of psychiatric symptoms with patients affected by panic disorder, it may be useful to pay more attention to this personal trait at baseline.

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.

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.

Effects of Attentional Focus on Emotional Responding to a Biological Challenge in Panic Disorder

Science.gov (United States)

1996-08-26

van der Molen , G. M. (1987). CO2 vulnerability in panic disorder. Psychiatry Research. 20, 87-96. Griez, E., Zandbergen, J., Pols, H., de Loof, C...panic disorder patients (Griez, 7 Lousberg, van den Hou!, & van den Molen ~ 1987). A single vital capacity inhalation of 35% CO2/65% O2 produces...mixture immediately reproduces the physical symptoms of panic in both patients and healthy control subjects ( van den Hout, 1988), but triggers fear in

Preliminary Evidence for Cognitive Mediation During Cognitive–Behavioral Therapy of Panic Disorder

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Hofmann, Stefan G.; Suvak, Michael K.; Barlow, David H.; Shear, M. Katherine; Meuret, Alicia E.; Rosenfield, David; Gorman, Jack M.; Woods, Scott W.

2007-01-01

Cognitive–behavioral therapy (CBT) and pharmacotherapy are similarly effective for treating panic disorder with mild or no agoraphobia, but little is known about the mechanism through which these treatments work. The present study examined some of the criteria for cognitive mediation of treatment change in CBT alone, imipramine alone, CBT plus imipramine, and CBT plus placebo. Ninety-one individuals who received 1 of these interventions were assessed before and after acute treatment, and after a 6-month maintenance period. Multilevel moderated mediation analyses provided preliminary support for the notion that changes in panic-related cognitions mediate changes in panic severity only in treatments that include CBT. PMID:17563154

Distinct phasic and sustained brain responses and connectivity of amygdala and bed nucleus of the stria terminalis during threat anticipation in panic disorder.

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Brinkmann, L; Buff, C; Feldker, K; Tupak, S V; Becker, M P I; Herrmann, M J; Straube, T

2017-11-01

Panic disorder (PD) patients are constantly concerned about future panic attacks and exhibit general hypersensitivity to unpredictable threat. We aimed to reveal phasic and sustained brain responses and functional connectivity of the amygdala and the bed nucleus of the stria terminalis (BNST) during threat anticipation in PD. Using functional magnetic resonance imaging (fMRI), we investigated 17 PD patients and 19 healthy controls (HC) during anticipation of temporally unpredictable aversive and neutral sounds. We used a phasic and sustained analysis model to disentangle temporally dissociable brain activations. PD patients compared with HC showed phasic amygdala and sustained BNST responses during anticipation of aversive v. neutral stimuli. Furthermore, increased phasic activation was observed in anterior cingulate cortex (ACC), insula and prefrontal cortex (PFC). Insula and PFC also showed sustained activation. Functional connectivity analyses revealed partly distinct phasic and sustained networks. We demonstrate a role for the BNST during unpredictable threat anticipation in PD and provide first evidence for dissociation between phasic amygdala and sustained BNST activation and their functional connectivity. In line with a hypersensitivity to uncertainty in PD, our results suggest time-dependent involvement of brain regions related to fear and anxiety.

Predictors of Broad Dimensions of Psychopathology among Patients with Panic Disorder after Cognitive-Behavioral Therapy

Science.gov (United States)

Kondo, Masaki; Ino, Keiko; Imai, Risa; Ii, Toshitaka; Furukawa, Toshi A.; Akechi, Tatsuo

2018-01-01

Background Many patients with panic disorder meet criteria for at least one other diagnosis, most commonly other anxiety or mood disorders. Cognitive-behavioral therapy is the best empirically supported psychotherapy for panic disorder. There is now evidence indicating that cognitive-behavioral therapy for panic disorder yields positive benefits upon comorbid disorders. Objectives The present study aimed to examine the predictors of broad dimensions of psychopathology in panic disorder after cognitive-behavioral therapy. Methods Two hundred patients affected by panic disorder were treated with manualized group cognitive-behavioral therapy. We examined if the baseline personality dimensions of NEO Five Factor Index predicted the subscales of Symptom Checklist-90 Revised at endpoint using multiple regression analysis based on the intention-to-treat principle. Results Conscientiousness score of NEO Five Factor Index at baseline was a predictor of four Symptom Checklist-90 Revised subscales including obsessive-compulsive (β = −0.15, P cognitive-behavioral therapy. For the purpose of improving a wide range of psychiatric symptoms with patients affected by panic disorder, it may be useful to pay more attention to this personal trait at baseline. PMID:29721499

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

Psychopathology in adolescent offspring of parents with panic disorder, major depression, or both: a 10-year follow-up.

Science.gov (United States)

Hirshfeld-Becker, Dina R; Micco, Jamie A; Henin, Aude; Petty, Carter; Faraone, Stephen V; Mazursky, Heather; Bruett, Lindsey; Rosenbaum, Jerrold F; Biederman, Joseph

2012-11-01

The authors examined the specificity and course of psychiatric disorders from early childhood through adolescence in offspring of parents with confirmed panic disorder and major depressive disorder. The authors examined rates of psychiatric disorders at 10-year-follow-up (mean age, 14 years) in four groups: offspring of referred parents with panic and depression (N=137), offspring of referred parents with panic without depression (N=26), offspring of referred parents with depression without panic (N=48), and offspring of nonreferred parents with neither disorder (N=80). Follow-up assessments relied on structured interviews with the adolescents and their mothers; diagnoses were rated present if endorsed by either. Parental panic disorder, independently of parental depression, predicted lifetime rates in offspring of multiple anxiety disorders, panic disorder, agoraphobia, social phobia, and obsessive-compulsive disorder. Parental depression independently predicted offspring bipolar, drug use, and disruptive behavior disorders. Parental panic and depression interacted to predict specific phobia and major depressive disorder. Phobias were elevated in all at-risk groups, and depression was elevated in both offspring groups of parents with depression (with or without panic disorder), with the highest rates in the offspring of parents with depression only. Parental depression independently predicted new onset of depression, parental panic disorder independently predicted new onset of social phobia, and the two interacted to predict new onset of specific phobia and generalized anxiety disorder. At-risk offspring continue to develop new disorders as they progress through adolescence. These results support the need to screen and monitor the offspring of adults presenting for treatment of panic disorder or major depressive disorder.

Underachievement, Failing Youth and Moral Panics

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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…

Lives in isolation: stories and struggles of low-income African American women with panic disorder.

Science.gov (United States)

Johnson, Michael; Mills, Terry L; Deleon, Jessica M; Hartzema, Abraham G; Haddad, Judella

2009-01-01

Research evidence points to the existence of racial-ethnic disparities in both access to and quality of mental health services for African Americans with panic disorder. Current panic disorder evaluation and treatment paradigms are not responsive to the needs of many African Americans. The primary individual, social, and health-care system factors that limit African Americans' access to care and response to treatment are not well understood. Low-income African American women with panic disorder participated in a series of focus-group sessions designed to elicit (1) their perspectives regarding access and treatment barriers and (2) their recommendations for designing a culturally consistent panic treatment program. Fear of confiding to others about panic symptoms, fear of social stigma, and lack of information about panic disorder were major individual barriers. Within their social networks, stigmatizing attitudes toward mental illness and the mentally ill, discouragement about the use of psychiatric medication, and perceptions that symptoms were the result of personal or spiritual weakness had all interfered with the participants' treatment seeking efforts and contributed to a common experience of severe social isolation. None of the focus-group members had developed fully effective therapeutic relationships with either medical or mental health providers. They described an unmet need for more interactive and culturally authentic relationships with treatment providers. Although the focus-group sessions were not intended to be therapeutic, the women reported that participation in the meetings had been an emotionally powerful and beneficial experience. They expressed a strong preference for the utilization of female-only, panic disorder peer-support groups as an initial step in the treatment/recovery process. Peer-support groups for low-income African American women with panic disorder could address many of the identified access and treatment barriers.

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

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Albina Rodrigues Torres

2002-09-01

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

Interoceptive hypersensitivity and interoceptive exposure in patients with panic disorder: specificity and effectiveness

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Funayama Tadashi

2006-08-01

Full Text Available Abstract Background Interoceptive exposure has been validated as an effective component of cognitive behavioral therapy (CBT for the treatment of panic disorder but has hitherto received little research attention. We examined the effectiveness of various interoceptive exposure exercises using the Body Sensations Questionnaire (BSQ (Chambless et al., 1984. Methods We first performed an exploratory principal factor analysis of all the items contained in the BSQ to obtain meaningful dimensions of interoceptive fears. Next, we examined the correlations between each interoceptive exposure task's degree of similarity to panic attacks and each BSQ factor and then examined whether the BSQ factor scores decreased in comparison with the baseline values when the corresponding exposure tasks were successfully completed by the subjects. Results The factor analyses revealed four factors, which we named "pseudoneurological fears", "gastrointestinal fears", "cardiorespiratory fears" and "fears of dissociative feelings." Among the nine interoceptive exposure tasks, 'hyperventilation', 'shaking head', 'holding breath' and 'chest breathing' were considered to reproduce pseudoneurological symptoms, 'breathing through a straw' was considered to reproduce gastrointestinal symptoms, and 'spinning' was considered to reproduce both pseudoneurological and dissociative symptoms; none of the interoceptive exercises were found to reproduce cardiorespiratory symptoms. Among each group of patients for whom 'hyperventilation', 'holding breath', 'spinning' or 'chest breathing' was effective, a significant improvement in the BSQ pseudoneurological fears factor scores was observed. On the other hand, no significant difference between the baseline and endpoint values of the BSQ gastrointestinal fears or the BSQ fears of dissociative feelings factor scores were observed among the patients for whom 'spinning' or 'breathing through a straw' was effective. Conclusion Several

Pharmacological management of panic disorder

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Carlo Marchesi

2008-03-01

Full Text Available Carlo MarchesiPsychiatric Section, Department of Neuroscience, University of Parma, Parma, ItalyAbstract: Panic disorder (PD is a disabling condition which appears in late adolescence or early adulthood and affects more frequently women than men. PD is frequently characterized by recurrences and sometimes by a chronic course and, therefore, most patients require longterm treatments to achieve remission, to prevent relapse and to reduce the risks associated with comorbidity. Pharmacotherapy is one of the most effective treatments of PD. In this paper, the pharmacological management of PD is reviewed. Many questions about this effective treatment need to be answered by the clinician and discussed with the patients to improve her/his collaboration to the treatment plan: which is the drug of choice; when does the drug become active; which is the effective dose; how to manage the side effects; how to manage nonresponse; and how long does the treatment last. Moreover, the clinical use of medication in women during pregnancy and breastfeeding or in children and adolescents was reviewed and its risk-benefit balance discussed.Keywords: panic disorder, pharmacological treatment, treatment guidelines

Sudden gains in group cognitive-behavioral therapy for panic disorder.

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Clerkin, Elise M; Teachman, Bethany A; Smith-Janik, Shannan B

2008-11-01

The current study investigates sudden gains (rapid symptom reduction) in group cognitive-behavioral therapy for panic disorder. Sudden gains occurring after session 2 of treatment predicted overall symptom reduction at treatment termination and some changes in cognitive biases. Meanwhile, sudden gains occurring immediately following session 1 were not associated with symptom reduction or cognitive change. Together, this research points to the importance of examining sudden gains across the entire span of treatment, as well as the potential role of sudden gains in recovery from panic disorder.

Pharmacotherapy of panic disorder

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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.

Associations between disaster exposures, peritraumatic distress, and posttraumatic stress responses in Fukushima nuclear plant workers following the 2011 nuclear accident: the Fukushima NEWS Project study.

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Shigemura, Jun; Tanigawa, Takeshi; Nishi, Daisuke; Matsuoka, Yutaka; Nomura, Soichiro; Yoshino, Aihide

2014-01-01

The 2011 Fukushima Daiichi Nuclear Power Plant accident was the worst nuclear disaster since Chernobyl. The nearby Daini plant also experienced substantial damage but remained intact. Workers for the both plants experienced multiple stressors as disaster victims and workers, as well as the criticism from the public due to their company's post-disaster management. Little is known about the psychological pathway mechanism from nuclear disaster exposures, distress during and immediately after the event (peritraumatic distress; PD), to posttraumatic stress responses (PTSR). A self-report questionnaire was administered to 1,411 plant employees (Daiichi, n = 831; Daini, n = 580) 2-3 months post-disaster (total response rate: 80.2%). The socio-demographic characteristics and disaster-related experiences were assessed as independent variables. PD and PTSR were measured by the Japanese versions of Peritraumatic Distress Inventory and the Impact of Event Scale-Revised, respectively. The analysis was conducted separately for the two groups. Bivariate regression analyses were performed to assess the relationships between independent variables, PD, and PTSR. Significant variables were subsequently entered in the multiple regression analyses to explore the pathway mechanism for development of PTSR. For both groups, PTSR highly associated with PD (Daiichi: adjusted β, 0.66; pdisaster-related variables were likely to be associated with PD than PTSR. Among the Fukushima nuclear plant workers, disaster exposures associated with PD. PTSR was highly affected by PD along with discrimination/slurs experience.

Don't Panic! | NIH MedlinePlus the Magazine

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... 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. ...

Cognitive-Behavior Therapy (CBT) for Panic Disorder: Relationship of Anxiety and Depression Comorbidity with Treatment Outcome

OpenAIRE

Allen, Laura B.; White, Kamila S.; Barlow, David H.; Shear, M. Katherine; Gorman, Jack M.; Woods, Scott W.

2009-01-01

Research evaluating the relationship of comorbidity to treatment outcome for panic disorder has produced mixed results. The current study examined the relationship of comorbid depression and anxiety to treatment outcome in a large-scale, multi-site clinical trial for cognitive-behavior therapy (CBT) for panic disorder. Comorbidity was associated with more severe panic disorder symptoms, although comorbid diagnoses were not associated with treatment response. Comorbid generalized anxiety disor...

Treating panic symptoms within everyday clinical settings: the feasibility of a group cognitive behavioural intervention

DEFF Research Database (Denmark)

Austin, S.F.; Sumbundu, A.D.; Lykke, J.

2008-01-01

of significant clinical change displayed and resources required to carry out the intervention. A small sample of GP-referred patients displaying panic symptoms completed a 2-week intensive cognitive-behavioural intervention. Results collected post-intervention revealed significant clinical reductions in panic......Panic disorder is a common and debilitating disorder that has a prevalence rate of 3-5% in the general population. Cognitive-behavioural interventions have been shown to be an efficacious treatment for panic, although a limited number of studies have examined the effectiveness of such interventions...... implemented in everyday clinical settings. The aim of the following pilot study was to examine the feasibility of a brief group cognitive-behavioural intervention carried out in a clinical setting. Salient issues in determining feasibility include: representativeness of patient group treated, amount...

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

. 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...

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

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

2014-01-01

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

Construction of War Discourse on International News Agencies: Case Study Terrorist attacks November 13th 2015

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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.

Liquidity provision vs. deposit insurance : preventing bank panics without moral hazard?

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Antoine Martin

2001-01-01

In this paper I ask whether a central bank policy of providing liquidity to banks during panics can prevent bank runs without causing moral hazard. This kind of policy has been widely advocated, most notably by Bagehot (1873). To analyze such a policy, I build a model with three key features: 1) bank panics can occur in equilibrium, 2) there can be moral hazard, 3) the central bank can create money which is willingly held. I show that a particular central bank repurchase policy provides liqui...

Major depressive disorder, panic disorder, and post-traumatic stress disorder in Korean subway drivers.

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Kim, Hyoung-Ryoul; Yim, Hyeon Woo; Jo, Sun-Jin; Choi, Bongkyoo; Jeong, Seung Hee; Lee, Kang Sook; Park, Jong-Ik; Chang, Sung Man

2013-05-01

The purposes of this study are to investigate the prevalence of major depressive disorder, panic disorder, and post-traumatic stress disorder (PTSD) in Korean subway drivers, and find the association between these disorders and the drivers' person-under-train (PUT) experiences. A total of 826 subway drivers who participated in a cross-sectional work and health survey were included for this study. The Korean version of the Composite International Diagnostic Interview 2.1 was applied to assess major depressive disorder, panic disorder, and PTSD. The date of PUT, whether victim died, and how many PUTs the drivers experienced were asked using a structured questionnaire. The standardized prevalence ratios (SPRs) for lifetime prevalence of panic disorder and PTSD in subway drivers were 13.3 (95 % confidence interval [CI] 6.6-22.4) and 2.1 (95 % CI 1.1-3.4), respectively. In lifetime prevalence, after adjusting for age, education, income, and working career, the drivers who experienced PUT had significantly higher risks for panic disorder (odds ratio [OR] = 4.2, 95 % CI 1.2-16.6) and PTSD (OR = 4.4, 95 % CI 1.3-16.4). In 1-year prevalence, the drivers who experienced PUT had a significantly higher risk for PTSD (OR = 11.7, 95 % CI 1.9-225.8). There was no significant value of SPR and OR in major depressive disorder. This study suggests that Korean subway drivers are at higher risk for panic disorder and PTSD compared to the general population, and PUT experience is associated with panic disorder and PTSD. Drivers who have experienced PUT should be treated quickly, sympathetically, and sensitively by a psychological professional and their colleagues, so they can return to work soon.

The aftermath of terrorism: posttraumatic stress and functional impairment after the 2011 Oslo bombing.

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Solberg, Øivind; Blix, Ines; Heir, Trond

2015-01-01

In the present study we wanted to investigate the link between exposure, posttraumatic stress symptomatology, and functional impairment in the aftermath of terrorism. Posttraumatic stress symptomatology and functional impairment related to the Oslo bombing 22nd of July, 2011, in directly and indirectly exposed individuals (N = 1927) were assessed together with demographics, exposure, peri-traumatic reactions, and event centrality approximately 1 year after the attack. Directly and indirectly exposed individuals qualifying for posttraumatic stress disorder (PTSD) reported similar peri-traumatic reactions, event centrality, and functional impairment. However, clusters within the PTSD symptomatology were differentially associated with impairment as a function of their exposure. In the directly exposed group, all clusters within the PTSD symptomatology were associated with impairment in function, while only emotional numbing was associated with impairment within the indirectly exposed group. Considering that terror attacks frequently involve directly exposed individuals and a larger population of indirectly exposed individuals, this finding is of importance, especially in the design of intervention programs and the development of treatment policies.

New segregation analysis of panic disorder

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Vieland, V.J.; Fyer, A.J.; Chapman, T. [Columbia Univ., New York, NY (United States)] [and others

1996-04-09

We performed simple segregation analyses of panic disorder using 126 families of probands with DSM-III-R panic disorder who were ascertained for a family study of anxiety disorders at an anxiety disorders research clinic. We present parameter estimates for dominant, recessive, and arbitrary single major locus models without sex effects, as well as for a nongenetic transmission model, and compare these models to each other and to models obtained by other investigators. We rejected the nongenetic transmission model when comparing it to the recessive model. Consistent with some previous reports, we find comparable support for dominant and recessive models, and in both cases estimate nonzero phenocopy rates. The effect of restricting the analysis to families of probands without any lifetime history of comorbid major depression (MDD) was also examined. No notable differences in parameter estimates were found in that subsample, although the power of that analysis was low. Consistency between the findings in our sample and in another independently collected sample suggests the possibility of pooling such samples in the future in order to achieve the necessary power for more complex analyses. 32 refs., 4 tabs.

Exploring the Relationship of Exit Flow and Jam Density in Panic Scenarios Using Animal Dynamics

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Sobhani, A.; Sarvi, M.; Duives, D.C.; Ejtemai, O.; Aghabayk, K.; Hoogendoorn, S.P.

2014-01-01

There are few studies investigating crowd dynamics in panic situations. They used measures such as exit flow rate to explore the exit performance in evacuation scenarios. However, there is limited research exploring the relationship of exit flow rate and density behind the exit for panic scenarios.

Moral Panic over Youth Violence: Wilding and the Manufacture of Menace in the Media.

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Welch, Michael; Price, Eric A.; Yankey, Nana

2002-01-01

Describes moral panic over wilding (sexual violence committed by a group of urban teens), examining elements of race, class, and fear of crime, especially as manifested in the media. Suggests that wilding is a distinctive form of moral panic that symbolizes a threat to society at large and to a political economy that reproduces racial and social…

Panic disorder and health-related quality of life: the predictive roles of anxiety sensitivity and trait anxiety.

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Kang, Eun-Ho; Kim, Borah; Choe, Ah Young; Lee, Jun-Yeob; Choi, Tai Kiu; Lee, Sang-Hyuk

2015-01-30

Panic disorder (PD) is a very common anxiety disorder and is often a chronic disabling condition. However, little is known about the factors that predict health-related quality of life (HRQOL) other than sociodemographic factors and illness-related symptomatology that explain HRQOL in only small to modest degrees. This study explored whether anxiety-related individual traits including anxiety sensitivity and trait anxiety can predict independently HRQOL in panic patients. Patients with panic disorder with or without agoraphobia (N=230) who met the diagnostic criteria in the Structured Clinical Interview for DSM-IV were recruited. Stepwise regression analysis was performed to determine the factors that predict HRQOL in panic disorder. HRQOL was assessed by the 36-item Short-Form Health Survey (SF-36). Anxiety sensitivity was an independent predictor of bodily pain and social functioning whereas trait anxiety independently predicted all of the eight domains of the SF-36. Our data suggests that the assessment of symptomatology as well as individual anxiety-related trait should be included in the evaluation of HRQOL in panic patients. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

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 .... behaviour therapy (CBT) may have the advantage of ... approaches.4 A trained therapist, who may be a ... Post-traumatic stress disorder.

Crisis de pánico en un paciente con acné tratado con isotretinoína: Caso clínico

OpenAIRE

Poblete A,Catalina; Herskovic M,Viviana; Eva C,Pedro

2006-01-01

The use of isotretinoin as a treatment for acne is related to psychiatric syndromes such as psychosis and depression. On the other hand, several drugs have been identified as causing panic attacks. A relationship between dermatologic and psychiatric disease has also been established. We report a 20 year-old male who started to suffer panic attacks after using isotretinoin for acne

Adaptação para a língua portuguesa do Questionário de Experiências Dissociativas Peritraumáticas (QEDP numa amostra de bombeiros Portuguese adaptation of the Peritraumatic Dissociation Experiences Questionnaire (PDEQ in a sample of ambulance personal

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Ângela Costa Maia

2009-01-01

Full Text Available CONTEXTO: A dissociação peritraumática é uma resposta no momento da exposição a uma situação ameaçadora que tem se mostrado um preditor significativo de perturbação psicológica a longo prazo, nomeadamente perturbação pós-estresse traumático. OBJETIVOS: Fazer a adaptação para português do Peritraumatic Dissociation Experiences Questionnaire numa população altamente exposta a situações traumáticas, como é o caso dos bombeiros. MÉTODO: Após a tradução e o estudo dos itens, fizeram-se a aplicação e a análise psicométrica com uma amostra de 170 bombeiros, que relataram exposição traumática e que também preencheram uma escala de Perturbação de Pós-Estresse Traumático. RESULTADOS: Os dados indicam que se trata de um instrumento com uma boa consistência interna (alfa de Cronbach = 0,87 e cuja validade de construto o torna adequado para a avaliação das respostas dessa população no exercício da sua profissão. Para além disso, a correlação elevada com os sintomas de perturbação pós-estresse traumático sugere ainda uma boa validade convergente. DISCUSSÃO: Atendendo ao fato de que a dissociação peritraumática prevê PPST, o recurso a um instrumento que revela boas capacidades psicométricas pode ajudar a identificar as pessoas que desenvolverão perturbação após exposição a trauma.BACKGROUND: Peritraumatic dissociation is a reaction that occurs in the moment someone is exposed to a threatening situation and has shown to be an important predictor of long term psychological disorder, including post traumatic stress disorder. OBJECTIVES: To make the psychometric adaptation of Peritraumatic Dissociation Experiences Questionnaire in Portuguese ambulance personnel that report high exposure to trauma. The instrument has been widely used in research, and was initially designed to analyse peritraumatic dissociation in emergency personnel. METHODS: After items translation and study, 170 ambulance

The impact of disaster work on community volunteers: The role of peri-traumatic distress, level of personal affectedness, sleep quality and resource loss, on post-traumatic stress disorder symptoms and subjective health.

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Thormar, Sigridur B; Gersons, Berthold P R; Juen, Barbara; Djakababa, Maria Nelden; Karlsson, Thorlakur; Olff, Miranda

2014-12-01

Disaster work has shown to cause PTSD symptoms and subjective health complaints in professional emergency personnel. However, very little is known about how disaster work affects community volunteers. This first time longitudinal study examined factors contributing to post-traumatic stress disorder symptoms (PTSD) and subjective health complaints in volunteers working in an earthquake setting. At six and eighteen months post disaster, a sample of 506 Indonesian Red Cross volunteers were assessed using the Impact of Event Scale-Revised and the Subjective Health Complaints Inventory. Factors analyzed in relation to the outcomes included: peri-traumatic distress, level of personal affectedness by the disaster, sleep quality and loss of resources as a consequence of the disaster. At 18 months post-disaster the findings showed high levels of PTSD symptoms and subjective health complaints. Quality of sleep was related to both outcomes but resource loss only to PTSD symptoms. Neither peri-traumatic distress nor level of affectedness by the disaster (external versus directly affected volunteers), were predictive of symptoms. This study indicates that characteristics of disaster work e.g. low quality of sleep, may be an important contributor to PTSD symptoms and subjective health complaints in volunteers. Copyright © 2014 Elsevier Ltd. All rights reserved.

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

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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.

Panic and comorbid depression and their associations with stress reactivity, interoceptive awareness and interoceptive accuracy of various bioparameters.

Science.gov (United States)

Limmer, Jan; Kornhuber, Johannes; Martin, Alexandra

2015-10-01

While current theories on perception of interoceptive signals suggest impaired interoceptive processing in psychiatric disorders such as panic disorder or depression, heart-rate (HR) interoceptive accuracy (IAc) of panic patients under resting conditions is superior to that of healthy controls. Thus, in this study, we chose to assess further physiological parameters and comorbid depression in order to get information on how these potentially conflicting findings are linked together. We used a quasi-experimental laboratory design which included multi-parametric physiological data collection of 40 panic subjects and 53 matched no-panic controls, as well as experimental induction of stress and relaxation over a time-course. Stress reactivity, interoceptive awareness (IAw; from the Body Perception Questionnaire (BPQ)) and IAc (as correlation between self-estimation and physiological data) were major outcome variables. Self-estimation of bioparametrical change was measured via numeric rating scales. Panic subjects had stronger HR-reaction and more accurate HR-interoception. Concurrently, though, their IAc of skin conductance level, pulse amplitude and breathing amplitude was significantly lower than that of the control group. Interestingly, comorbid depression was found to be associated with increased IAw but attenuated IAc. Demand characteristics and a categorical approach to panic confine the results. The potentially conflicting findings coalesce, as panic was associated with an increase of the ability to perceive the fear-related parameter and a simultaneous decrease of the ability to perceive other parameters. The superordinate integration of afferent signals might be impaired. Copyright © 2015 The Authors. Published by Elsevier B.V. All rights reserved.

Perceived parental characteristics of patients with obsessive compulsive disorder, depression, and panic disorder.

Science.gov (United States)

Merkel, W T; Pollard, C A; Wiener, R L; Staebler, C R

1993-01-01

It has been hypothesized that parents of patients with obsessive compulsive disorder exhibit specific traits. 320 consecutive inpatient admissions who met criteria for OCD, depression, and panic disorder checked a list of adjectives to describe their parents. Patients with OCD were 1) less likely to perceive their mothers as disorganized than depressives, 2) more likely to perceive their mothers as overprotective than depressives and 3) less likely to perceive their fathers as demanding than patients with panic.

Brazilian Medical Association guidelines for the diagnosis and differential diagnosis of panic disorder

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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.

GANGGUAN PANIK DENGAN AGORAFOBIA

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Yaslinda Yaunin

2012-09-01

Full Text Available AbstrakSerangan Panik ditandai dengan gejala anxietas yang berat seperti: berdebar-debar, nyeri dada, sesak nafas, tremor, pusing, merasa dingin atau panas, ada depersonalisasi atau derealisasi, gejala mencapai puncaknya dalam 10 menit. Gangguan Panik merupakan serangan panik yang berulang-ulang dengan onset cepat dan durasi sangat singkat. Karena adanya keluhan fisik berat pada waktu serangan, pasien menjadi ketakutan mereka akan mendapat serangan jantung, stroke dan lain-lain. Kadang pasien berfikir mereka akan kehilangan kontrol atau menjadi gila. Lama-lama pasien akan menghindari tempat-tempat atau situasi serangan paniknya pernah terjadi terutama tempat kegiatan sosial atau tempat yang susah untuk menyelamatkan diri, hal ini dianggap sebagai penyebab terjadinya Agorafobia. Gangguan Panik bisa disebabkan faktor biologik,genetik atau psikososial. Penatalaksanaan sebaiknya kombinasi Psikofarmaka dan Psikoterapi. Pada kasus ini seorang wanita 26 tahun datang dengan keluhan seperti serangan panik berulang sejak 6 bulan sebelumnya, yang tidak mendapat pengobatan adekuat sehingga jatuh menjadi Gangguan Panik dengan Agorafobia. Kalau dilihat etilogi sesuai teori psikososial: pasien ini mengalami cukup banyak trauma pada masa anak yaitu dengan perceraian orangtua, hidup penuh stresor bersama tante serta ibu tiri pada masa-masa sekolah. Ketika tinggal bersama ibu kandung pasien sering menyaksikan pertengkaran ibu dan bapak tirinya. Dengan pemberian Psikofarmaka yang dikombinasi dengan Psikoterapi memberi hasil yang cukup baik.Kata kunci: Serangan Panik,Gangguan Panik, AgorafobiaAbstractPanic Attack is characterized by severe anxiety symptoms: palpitation, chest pain, dyspnoe, tremor, dizziness, chills or hot, depersonalization or derealization, the symptoms reached a peak within 10 minutes. Panic Disorder is several time got Panic Att.ack with rapid onset and short very duration. Because of the physical symptoms during the attack, patient become

Evaluation of therapeutic effects of cognitive-behavioral therapy in patients with panic disorder using serial 99mTc-ECD brain perfusion

International Nuclear Information System (INIS)

Kim, Jung Hee; Song, Ho Chun; Yang, Jong Chul; Lee, Byeong Il; Heo, Young Jun; Bom, Hee Seung; Min, Jung Joon; Park, Tae Jin

2006-01-01

Although several neuroanatomical models of panic disorder have been proposed, little is known regarding the neurological mechanisms underlying cognitive-behavioral therapy (CBT) in patients with panic disorder. This study was performed to identify the brain structures that show changes of regional cerebral blood flow (rCBF) after CBT in patients with panic disorder. Seven patients who were diagnosed as panic disorder by DSM-IV were treated with CBT for 8 weeks and twelve healthy volunteers joined in this study. Serial 99m Tc-ECD brain perfusion SPECT images were aquisited and PDSS-SR (Self-Report version of Panic Disorder Severity Scale) and ACQ (Agoraphobic Cognitive Question) scores were measured just before and after CBT in all patients. Data were analyzed using SPM2. Subjective symptoms were improved, and PDSS-SR and ACQ scores were significantly reduced (14.9 ± 3.9 vs. 7.0 ± 1.8, ρ < 0.05; 30.3 ± 8.5 vs. 21.6 ± 3.4, ρ < 0.05, respectively) after CBT in panic patients. Before CBT, a significant increase of rCBF was found in the cingulate gylus, thalamus, midbrain, both medial frontal and temporal lobes of the panic patients compared to the normal volunteers. After CBT, we observed a significant rCBF decrease in the left parahippocamus, right insula and cingulate gyrus, both frontal and temporal lobes, and a significant rCBF increase in both the occipital lobes, left insula, both frontal and left parietal lobes. These data suggested that CBT is effective for panic disorder and diminish the activity of the brain areas associated with fear in panic disorder

Agoraphobia

Science.gov (United States)

... because of the fear, anxiety or avoidance Your phobia and avoidance usually lasts six months or longer ... for agoraphobia include: Having panic disorder or other phobias Responding to panic attacks with excessive fear and ...

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

Changes in anxiety sensitivity with pharmacotherapy for panic disorder

NARCIS (Netherlands)

Simon, N.M.; Otto, M.W.; Smits, J.A.J.; Nicolaou, D.C.; Reese, H.E.; Pollack, M.H.

2004-01-01

Fear of anxiety symptoms (anxiety sensitivity) has been implicated in the etiology and maintenance of panic disorder, and has been shown to improve with cognitive-behavioral treatment. The impact of pharmacotherapy on anxiety sensitivity is less clear. We administered the Anxiety Sensitivity Index

In the Name of ‘Childhood Innocence’: A Discursive Exploration of the Moral Panic Associated with Childhood and Sexuality

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Kerry Robinson

2011-04-01

Full Text Available This article critically examines moral panic as a political strategy in maintaining the hegemony of the nuclear family, the sanctity of hetereosexual relationships and the heteronormative social order. It focuses on the moral panic associated with children and sexuality, particularly that which is manifested around non-heterosexual subjectivities. The discussion is based on media representations of the moral panic associated with the Play School saga, The Tillman Child Care Centre / Learn to Include booklets and the We’re Here resource. It explores the hegemonic discourses around childhood innocence, sexuality and the construction of the homosexual as ‘folk devil’ and shows how these discourses are mobilised by conservative politicians and moral entrepreneurs to strategically instigate a moral panic at critical points in time.

OREXIN 1 AND 2 RECEPTOR INVOLVEMENT IN CO2-INDUCED PANIC-ASSOCIATED BEHAVIOR AND AUTONOMIC RESPONSES

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Johnson, Philip L.; Federici, Lauren M.; Fitz, Stephanie D.; Renger, John J.; Shireman, Brock; Winrow, Christopher J.; Bonaventure, Pascal; Shekhar, Anantha

2016-01-01

Background The neuropeptides orexin A and B play a role in reward and feeding and are critical for arousal. However, it was not initially appreciated that most prepro-orexin synthesizing neurons are almost exclusively concentrated in the perifornical hypothalamus, which when stimulated elicits panic-associated behavior and cardiovascular responses in rodents and self-reported “panic attacks” and “fear of dying” in humans. More recent studies support a role for the orexin system in coordinating an integrative stress response. For instance, orexin neurons are highly reactive to anxiogenic stimuli, are hyperactive in anxiety pathology, and have strong projections to anxiety and panic-associated circuitry. Although the two cognate orexin receptors are colocalized in many brain regions, the orexin 2 receptor (OX2R) most robustly maps to the histaminergic wake-promoting region, while the orexin 1 receptor (OX1R) distribution is more exclusive and dense in anxiety and panic circuitry regions, such as the locus ceruleus. Overall, this suggests that OX1Rs play a critical role in mobilizing anxiety and panic responses. Methods Here, we used a CO2-panic provocation model to screen a dual OX1/2R antagonist (DORA-12) to globally inhibit orexin activity, then a highly selective OX1R antagonist (SORA1, Compound 56) or OX2R antagonist (SORA2, JnJ10397049) to assess OX1R and OX2R involvement. Results All compounds except the SORA2 attenuated CO2-induced anxiety-like behaviors, and all but the SORA2 and DORA attenuated CO2-induced cardiovascular responses. Conclusions SORA1s may represent a novel method of treating anxiety disorders, with no apparent sedative effects that were present with a benzodiazepine. PMID:26332431

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

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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…

Evaluation of therapeutic effects of cognitive-behavioral therapy in patients with panic disorder using serial {sup 99m}Tc-ECD brain perfusion

Energy Technology Data Exchange (ETDEWEB)

Kim, Jung Hee; Song, Ho Chun; Yang, Jong Chul; Lee, Byeong Il; Heo, Young Jun; Bom, Hee Seung; Min, Jung Joon [Chonnam National University Hospital, Gwangju (Korea, Republic of); Park, Tae Jin [Chonnam National University, Gwangju (Korea, Republic of)

2006-12-15

Although several neuroanatomical models of panic disorder have been proposed, little is known regarding the neurological mechanisms underlying cognitive-behavioral therapy (CBT) in patients with panic disorder. This study was performed to identify the brain structures that show changes of regional cerebral blood flow (rCBF) after CBT in patients with panic disorder. Seven patients who were diagnosed as panic disorder by DSM-IV were treated with CBT for 8 weeks and twelve healthy volunteers joined in this study. Serial {sup 99m}Tc-ECD brain perfusion SPECT images were aquisited and PDSS-SR (Self-Report version of Panic Disorder Severity Scale) and ACQ (Agoraphobic Cognitive Question) scores were measured just before and after CBT in all patients. Data were analyzed using SPM2. Subjective symptoms were improved, and PDSS-SR and ACQ scores were significantly reduced (14.9 {+-} 3.9 vs. 7.0 {+-} 1.8, {rho} < 0.05; 30.3 {+-} 8.5 vs. 21.6 {+-} 3.4, {rho} < 0.05, respectively) after CBT in panic patients. Before CBT, a significant increase of rCBF was found in the cingulate gylus, thalamus, midbrain, both medial frontal and temporal lobes of the panic patients compared to the normal volunteers. After CBT, we observed a significant rCBF decrease in the left parahippocamus, right insula and cingulate gyrus, both frontal and temporal lobes, and a significant rCBF increase in both the occipital lobes, left insula, both frontal and left parietal lobes. These data suggested that CBT is effective for panic disorder and diminish the activity of the brain areas associated with fear in panic disorder.

Associations between disaster exposures, peritraumatic distress, and posttraumatic stress responses in Fukushima nuclear plant workers following the 2011 nuclear accident: the Fukushima NEWS Project study.

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Jun Shigemura

Full Text Available BACKGROUND: The 2011 Fukushima Daiichi Nuclear Power Plant accident was the worst nuclear disaster since Chernobyl. The nearby Daini plant also experienced substantial damage but remained intact. Workers for the both plants experienced multiple stressors as disaster victims and workers, as well as the criticism from the public due to their company's post-disaster management. Little is known about the psychological pathway mechanism from nuclear disaster exposures, distress during and immediately after the event (peritraumatic distress; PD, to posttraumatic stress responses (PTSR. METHODS: A self-report questionnaire was administered to 1,411 plant employees (Daiichi, n = 831; Daini, n = 580 2-3 months post-disaster (total response rate: 80.2%. The socio-demographic characteristics and disaster-related experiences were assessed as independent variables. PD and PTSR were measured by the Japanese versions of Peritraumatic Distress Inventory and the Impact of Event Scale-Revised, respectively. The analysis was conducted separately for the two groups. Bivariate regression analyses were performed to assess the relationships between independent variables, PD, and PTSR. Significant variables were subsequently entered in the multiple regression analyses to explore the pathway mechanism for development of PTSR. RESULTS: For both groups, PTSR highly associated with PD (Daiichi: adjusted β, 0.66; p<0.001; vs. Daini: adjusted β, 0.67; p<0.001. PTSR also associated with discrimination/slurs experience (Daiichi: 0.11; p<0.001; vs. Daini, 0.09; p = 0.005 and presence of preexisting illness(es (Daiichi: 0.07; p = 0.005; vs. Daini: 0.15; p<.0001. Other disaster-related variables were likely to be associated with PD than PTSR. CONCLUSION: Among the Fukushima nuclear plant workers, disaster exposures associated with PD. PTSR was highly affected by PD along with discrimination/slurs experience.

[Cognitive therapy has been shown to be effective in panic disorder].

Science.gov (United States)

d'Elia, G; Holsten, F

1998-10-28

Cognitive therapists suggest panic disorder to result from 'catastrophic' misinterpretation of bodily sensations. The patient suffering from panic disorder consistently misinterprets normal anxiety responses, such as racing heart, breathlessness or dizziness, as indicating impending disaster. Cognitive therapists, who challenge the traditional view of anxiety as 'free-floating' and irrational, argue that the patient's anxiety is an understandable response to their misinterpretations, and advocate a treatment method based on the patient's specific cognitive make-up and on the principle of collaborative empiricism. The patient is gently guided to identify and challenge idiosyncratic cognitions, and to consider alternative interpretations of danger signs. The article provides an outline of the treatment method and its empirical support.

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

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Marco Andre Mezzasalma

2011-04-01

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

Subjective and neurovegetative changes in healthy volunteers and panic patients performing simulated public speaking.

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Parente, Alexandre C B V; Garcia-Leal, Cybele; Del-Ben, Cristina M; Guimarães, Francisco S; Graeff, Frederico G

2005-12-01

Drug-free symptomatic panic patients, drug-treated nonsymptomatic patients and healthy controls were submitted to simulated public speaking. Subjective anxiety, cognitive impairment and discomfort measured by the visual analog mood scale as well as skin conductance level were higher in symptomatic patients than in controls at the beginning of the experimental session, nonsymptomatic patients lying in between. Subjective sedation, spontaneous fluctuations of skin conductance, heart rate and blood pressure were similar in the three groups. Preparation and performance of speech decreased sedation while increasing anxiety, cognitive impairment, level and fluctuations of skin conductance, heart rate and blood pressure. Anxiety, cognitive impairment and conductance level were less increased in symptomatic patients than in controls. Electrodermal activity, but not cardiovascular measures of sympathetic arousal correlated with anticipatory anxiety. Chronic treatment with serotonin uptake inhibitors attenuated the differences between panic patients and controls, supporting the participation of serotonin in panic disorder.

Carbon dioxide induces erratic respiratory responses in bipolar disorder.

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Mackinnon, Dean F; Craighead, Brandie; Lorenz, Laura

2009-01-01

CO(2) respiration stimulates both anxiety and dyspnea ("air hunger") and has long been used to study panic vulnerability and respiratory control. High comorbidity with panic attacks suggests individuals with bipolar disorder may also mount a heightened anxiety response to CO(2). Moreover, problems in the arousal and modulation of appetites are central to the clinical syndromes of mania and depression; hence CO(2) may arouse an abnormal respiratory response to "air hunger". 72 individuals (34 bipolar I, 25 depressive and bipolar spectrum, 13 with no major affective diagnosis) breathed air and air with 5% CO(2) via facemask for up to 15 min each; subjective and respiratory responses were recorded. Nearly half the subjects diverged from the typical response to a fixed, mildly hypercapneic environment, which is to increase breathing acutely, and then maintain a hyperpneic plateau. The best predictors of an abnormal pattern were bipolar diagnosis and anxiety from air alone. 25 individuals had a panic response; panic responses from CO(2) were more likely in subjects with bipolar I compared to other subjects, however the best predictors of a panic response overall were anxiety from air alone and prior history of panic attacks. Heterogeneous sample, liberal definition of panic attack. Carbon dioxide produces abnormal respiratory and heightened anxiety responses among individuals with bipolar and depressive disorders. These may be due to deficits in emotional conditioning related to fear and appetite. Although preliminary, this work suggests a potentially useful test of a specific functional deficit in bipolar disorder.

Impact of alcohol intoxication and withdrawal syndrome on social phobia and panic disorder in alcoholic inpatients Impacto das fases de intoxicação e de abstinência de álcool sobre a fobia social e o transtorno de pânico em pacientes alcoolistas hospitalizados

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Mauro Barbosa Terra

2004-01-01

Full Text Available PURPOSE: To investigate the impact of alcohol intoxication and withdrawal on the course of social phobia and panic disorder. METHOD: A group of 41 alcoholic inpatients undergoing detoxification therapy were interviewed using the SCID-I (DSM-IV and questions to detect fluctuations in the course of social phobia and panic disorder as a function of the different phases in alcohol dependence (intoxication, withdrawal, and lucid interval. RESULTS: Only 1 (2.4% patient presented panic disorder throughout life, and 9 (21.9% had panic attacks during alcohol intoxication or during the withdrawal syndrome. Sixteen (39% alcoholic patients showed social phobia with onset prior to drug use. However, drinking eventually became unable to alleviate social phobia symptoms or worsened such symptoms in 31.2% of social-phobic patients. While patients with social phobia reported a significant improvement in psychiatric symptoms during alcohol intoxication, patients experiencing panic attacks worsened significantly during intoxication. In the withdrawal phase, patients with social phobia tended to have more and more intense phobic symptoms. CONCLUSION: Our findings indicate that the impact of alcohol intoxication is different for social phobia as compared to panic disorder, at first decreasing the social-phobic symptoms but later aggravating them. In panic disorder, the impact of intoxication by alcohol is more harmful, at least in the short term.OBJETIVO: Estudar o impacto das fases de intoxicação e de abstinência do uso de álcool sobre o curso da fobia social e do transtorno de pânico. MÉTODO: Um grupo de 41 pacientes hospitalizados por dependência de álcool foi entrevistado com o SCID-I (DSM-IV, adicionado de perguntas para detectar as flutuações no curso da fobia social e do transtorno do pânico em função das diferentes fases do uso da droga (intoxicação, abstinência e intervalo lúcido. RESULTADOS: Apenas um (2,4% paciente, apresentou transtorno

Extinction of conflict behaviour in rats, a model which may have predictive value for drugs active in anxiety disorders

NARCIS (Netherlands)

C.E.J. Ketelaars

1990-01-01

textabstractThe anxiety syndrom "panic disorder" is at the moment subject of intensive biological psychiatrical research. The syndrom consists of panic attacks (intense fear) with several somatic symptoms (dizziness, palpitations, hyperventilation). Most patients develop some degree of

Cortisol awakening response in drug-naïve panic disorder

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Jakuszkowiak-Wojten K

2016-06-01

Full Text Available Katarzyna Jakuszkowiak-Wojten, Jerzy Landowski, Mariusz S Wiglusz, Wiesław Jerzy Cubała Department of Psychiatry, Medical University of Gdansk, Gdansk, Poland Background: It is unclear whether hypothalamic–pituitary–adrenal axis is involved in the pathophysiology of panic disorder (PD. The findings remain inconsistent. Cortisol awakening response (CAR is a noninvasive biomarker of stress system activity. We designed the study to assess CAR in drug-naïve PD patients.   Materials and methods: We assessed CAR in 14 psychotropic drug-naïve outpatients with PD and 14 healthy controls. The severity of PD was assessed with Panic and Agoraphobia Scale. The severity of anxiety and depression was screened with Hospital Anxiety and Depression Scale.   Results: No significant difference in CAR between PD patients and control group was found. No correlations were observed between CAR and anxiety severity measures in PD patients and controls.   Limitations: The number of participating subjects was relatively small, and the study results apply to nonsuicidal drug-naïve PD patients without agoraphobia and with short-illness duration. There was a lack of control on subjects’ compliance with the sampling instructions.  Conclusion: The study provides no support for elevated CAR levels in drug-naïve PD patients without agoraphobia. Keywords: panic disorder, PD, CAR, cortisol awakening response, HPA axis, hypothalamic–pituitary–adrenal axis

Serum hepatocyte growth factor levels and the effects of antidepressants in panic disorder.

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Kanehisa, Masayuki; Ishitobi, Yoshinobu; Ando, Tomoko; Okamoto, Shizuko; Maruyama, Yoshihiro; Kohno, Kentaro; Ninomiya, Taiga; Higuma, Haruka; Tanaka, Yoshihiro; Tsuru, Jusen; Hanada, Hiroaki; Kodama, Kensuke; Akiyoshi, Jotaro

2010-10-01

Previous animal studies have suggested that hepatocyte growth factor (HGF) could be associated with depression- and anxiety-related behaviors. Our aim was to relate serum HGF levels with State-Trait Anxiety Inventory (STAI), Profile of Mood State (POMS), and Revised NEO Personality Inventory (NEO-PI-R) scores in patients with panic disorder (with or without agoraphobia) and healthy controls. We examined 67 patients with panic disorders and 97 controls. Patients were split into two groups according to whether they exhibited a 50% improvement in test scores (good/high response group: n = 26) or not (poor/low response group: n = 41). In both healthy control and panic disorder individuals, there were no significant associations between HGF serum levels and STAI or NEO-PI-R scores. However, there was a significant correlation between serum HGF levels and fatigue in healthy control subjects in as scored by POMS testing. HGF concentration in the good/high response group was significantly elevated compared to both the low/poor response group (p disorders. 2010. Published by Elsevier Ltd. All rights reserved.

A review of self-management interventions for panic disorders, phobias and obsessive-compulsive disorders.

Science.gov (United States)

Barlow, J H; Ellard, D R; Hainsworth, J M; Jones, F R; Fisher, A

2005-04-01

To review current evidence for the clinical and cost-effectiveness of self-management interventions for panic disorder, phobias and obsessive-compulsive disorder (OCD). Papers were identified through computerized searches of databases for the years between 1995 and 2003, manual searches and personal contacts. Only randomized-controlled trials were reviewed. Ten studies were identified (one OCD, five panic disorder, four phobias). Effective self-management interventions included cognitive-behavioural therapy (CBT) and exposure to the trigger stimuli for phobias and panic disorders. All involved homework. There was evidence of effectiveness in terms of improved symptoms and psychological wellbeing when compared with standard care, waiting list or relaxation. Brief interventions and computer-based interventions were effective for most participants. In terms of quality, studies were mainly based on small samples, lacked long-term follow-up, and failed to address cost-effectiveness. Despite the limitations of reviewed studies, there appears to be sufficient evidence to warrant greater exploration of self-management in these disorders. Copyright 2005 Blackwell Munksgaard.

Are TMEM genes potential candidate genes for panic disorder?

DEFF Research Database (Denmark)

NO, Gregersen; 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...

Panic disorder in rural Tanzania: an explorative study | Nordgreen ...

African Journals Online (AJOL)

... patients as especially useful. Conclusion: A manual for brief interventions for PD may be adapted to a rural Tanzanian setting, also taking into consideration the limited financial and human resources in a rural low-income country setting. Keywords: Panic disorder; Culture; Cognitive behaviour therapy; Low-income country ...

Effects of ayahuasca on psychometric measures of anxiety, panic-like and hopelessness in Santo Daime members.

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Santos, R G; Landeira-Fernandez, J; Strassman, R J; Motta, V; Cruz, A P M

2007-07-25

The use of the hallucinogenic brew ayahuasca, obtained from infusing the shredded stalk of the malpighiaceous plant Banisteriopsis caapi with the leaves of other plants such as Psychotria viridis, is growing in urban centers of Europe, South and North America in the last several decades. Despite this diffusion, little is known about its effects on emotional states. The present study investigated the effects of ayahuasca on psychometric measures of anxiety, panic-like and hopelessness in members of the Santo Daime, an ayahuasca-using religion. Standard questionnaires were used to evaluate state-anxiety (STAI-state), trait-anxiety (STAI-trait), panic-like (ASI-R) and hopelessness (BHS) in participants that ingested ayahuasca for at least 10 consecutive years. The study was done in the Santo Daime church, where the questionnaires were administered 1h after the ingestion of the brew, in a double-blind, placebo-controlled procedure. While under the acute effects of ayahuasca, participants scored lower on the scales for panic and hopelessness related states. Ayahuasca ingestion did not modify state- or trait-anxiety. The results are discussed in terms of the possible use of ayahuasca in alleviating signs of hopelessness and panic-like related symptoms.

A Comparison of Sexual Dysfunctions in Female Patients with Major Depressive Disorder and Panic Disorder

OpenAIRE

Tonguç Demir Berkol; Süheyla Doðan Bulut; Esra Alataþ; Dicle Görkem; Esra Çavdar; Ýlker Özyýldýrým

2014-01-01

Objective: The aim of this study is assessment of sexual dysfunction in female patients with major depressive disorder and panic disorder and compare the two groups. Methods: Total 76 female patients with primary diagnosis of major depressive disorder ( 46 patients) and panic disorder ( 30 patients) according to DSM-IV, who is sexually active and not use psychotropic medication were inclued. Sociodemographic data aqcusition form and the Arizona Sexual Experiences Scale (ASEX) were adminis...

Don't panic. A guide to tryptophan depletion with disorder-specific anxiety provocation.

Science.gov (United States)

Hood, S D; Bell, C J; Argyropoulos, S V; Nutt, D J

2016-11-01

The 2002 paper "Does 5-HT restrain panic? A tryptophan depletion study in panic disorder patients recovered on paroxetine" by Bell and colleagues - reprinted in this issue of the Journal - reports on a study undertaken in the halcyon days of David Nutt's Psychopharmacology Unit at the University of Bristol, England. In this invited commentary authors of the original work discuss the impact of this paper on the field of acute tryptophan depletion research (especially in the field of clinical anxiety disorders) and the development of disorder-specific anxiogenic provocations over the past decade. © The Author(s) 2016.

The Interaction of Motivation and Therapist Adherence Predicts Outcome in Cognitive Behavioral Therapy for Panic Disorder: Preliminary Findings

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Huppert, Jonathan D.; Barlow, David H.; Gorman, Jack M.; Shear, M. Katherine; Woods, Scott W.

2006-01-01

This report is a post-hoc, exploratory examination of the relationships among patient motivation, therapist protocol adherence, and panic disorder outcome in patients treated with cognitive behavioral therapy within the context of a randomized clinical trial for the treatment of panic disorder (Barlow, Gorman, Shear, & Woods, 2000). Results…

Panic disorder in rural Tanzania: an explorative study | Nordgreen ...

African Journals Online (AJOL)

This article examines cultural based interpretations of the diagnosis of panic disorder (PD) in a rural Tanzanian hospital setting through clinical work. It also examines how to adapt and apply brief cognitive behaviour therapy (CBT) interventions to this setting. Method: A qualitative analysis of clinical data from ten participants ...

Man and his panic prone environment: theoretical and policy ...

African Journals Online (AJOL)

... more efficient panic – oriented agencies. The agencies like the National Emergency Relief Agency and the Nigerian Red Cross are already there. It is recommended that the Federal government should adequately fund them to make them more efficient and efficacious. (Global Journal of Social Sciences: 2003 2 (1): 15-20) ...

Non-disruptive tactics of suppression are superior in countering terrorism, insurgency, and financial panics.

Science.gov (United States)

Siegel, David A

2011-04-13

Suppressing damaging aggregate behaviors such as insurgency, terrorism, and financial panics are important tasks of the state. Each outcome of these aggregate behaviors is an emergent property of a system in which each individual's action depends on a subset of others' actions, given by each individual's network of interactions. Yet there are few explicit comparisons of strategies for suppression, and none that fully incorporate the interdependence of individual behavior. Here I show that suppression tactics that do not require the removal of individuals from networks of interactions are nearly always more effective than those that do. I find using simulation analysis of a general model of interdependent behavior that the degree to which such less disruptive suppression tactics are superior to more disruptive ones increases in the propensity of individuals to engage in the behavior in question. Thus, hearts-and-minds approaches are generally more effective than force in counterterrorism and counterinsurgency, and partial insurance is usually a better tactic than gag rules in quelling financial panics. Differences between suppression tactics are greater when individual incentives to support terrorist or insurgent groups, or susceptibilities to financial panic, are higher. These conclusions have utility for policy-makers seeking to end bloody conflicts and prevent financial panics. As the model also applies to mass protest, its conclusions provide insight as well into the likely effects of different suppression strategies undertaken by authoritarian regimes seeking to hold on to power in the face of mass movements seeking to end them.

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

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Rodney A. Lambert

2012-07-01

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

Mechanisms of change in cognitive behavioral therapy for panic disorder: The unique effects of self-efficacy and anxiety sensitivity

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

2013-01-01

The present study examined temporal dependencies of change of panic symptoms and two promising mechanisms of change (self-efficacy and anxiety sensitivity) during an 11-session course of cognitive-behavior therapy (CBT) for Panic Disorder (PD). 361 individuals with a principal diagnosis of PD completed measures of self-efficacy, anxiety sensitivity, and PD symptoms at each session during treatment. Effect size analyses indicated that the greatest changes in anxiety sensitivity occurred early in treatment, whereas the greatest changes in self-efficacy occurred later in treatment. Results of parallel process latent growth curve models indicated that changes in self-efficacy and anxiety sensitivity across treatment uniquely predicted changes in PD symptoms. Bivariate and multivariate latent difference score models indicated, as expected, that changes in anxiety sensitivity and self-efficacy temporally preceded changes in panic symptoms, and that intraindividual changes in anxiety sensitivity and self-efficacy independently predicted subsequent intraindividual changes in panic symptoms. These results provide strong evidence that changes in self-efficacy and anxiety sensitivity during CBT influence subsequent changes in panic symptoms, and that self-efficacy and anxiety sensitivity may therefore be two distinct mechanisms of change of CBT for PD that have their greatest impact at different stages of treatment. PMID:24095901

Paedophiles, panics, and protests: understanding penal populism

OpenAIRE

Williams, Andrew

2006-01-01

In recent years the criminal justice response to sex offenders in the United Kingdom has become progressively punitive, with extended sentences and increased supervision and surveillance upon release from prison. As well as raising an number of issues regarding the human rights of such offenders, it has been argued that this 'upward spiral of punitiveness' (Nash, 2006:105) has been fuelled by media induced moral panics, which have generated fear and concern within the general public, thereby ...

Belief disconfirmation versus habituation approaches to situational exposure in panic disorder with agoraphobia: a pilot study.

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Salkovskis, Paul M; Hackmann, Ann; Wells, Adrian; Gelder, Michael G; Clark, David M

2007-05-01

Exposure therapy and cognitive behaviour therapy (CBT) are both effective in the treatment of panic disorder with agoraphobia. Cognitive theories suggest that the way in which exposure to avoided situations is implemented in either treatment may be crucial. In particular, it is suggested that clinical improvement will be greatest if opportunities for disconfirmation of feared catastrophes are maximized. In a small pilot study, 16 patients with panic disorder and (moderate or severe) agoraphobia were randomly allocated to either habituation based exposure therapy (HBET) or exposure planned as a belief disconfirmation strategy and accompanied by dropping of safety-seeking behaviours. Both treatments were brief (total of 3.25 h of exposure) and were similar in terms of expectancy of change. Patients in the CBT condition showed significantly greater improvements in self-report measures of anxiety, panic and situational avoidance. They also completed significantly more steps in a standardized behavioural walk, during which they experienced significantly less anxiety. The controlled effect sizes for CBT were substantial (range 1.7-2.7), which suggests it may be a particularly efficient way of managing therapeutic exposure to feared situations in panic disorder with agoraphobia. Further research is needed to clarify the mechanism of change involved.

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.

Psychological therapies for panic disorder with or without agoraphobia in adults: a network meta-analysis.

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Pompoli, Alessandro; Furukawa, Toshi A; Imai, Hissei; Tajika, Aran; Efthimiou, Orestis; Salanti, Georgia

2016-04-13

Panic disorder is characterised by the presence of recurrent unexpected panic attacks, discrete periods of fear or anxiety that have a rapid onset and include symptoms such as racing heart, chest pain, sweating and shaking. Panic disorder is common in the general population, with a lifetime prevalence of 1% to 4%. A previous Cochrane meta-analysis suggested that psychological therapy (either alone or combined with pharmacotherapy) can be chosen as a first-line treatment for panic disorder with or without agoraphobia. However, it is not yet clear whether certain psychological therapies can be considered superior to others. In order to answer this question, in this review we performed a network meta-analysis (NMA), in which we compared eight different forms of psychological therapy and three forms of a control condition. To assess the comparative efficacy and acceptability of different psychological therapies and different control conditions for panic disorder, with or without agoraphobia, in adults. We conducted the main searches in the CCDANCTR electronic databases (studies and references registers), all years to 16 March 2015. We conducted complementary searches in PubMed and trials registries. Supplementary searches included reference lists of included studies, citation indexes, personal communication to the authors of all included studies and grey literature searches in OpenSIGLE. We applied no restrictions on date, language or publication status. We included all relevant randomised controlled trials (RCTs) focusing on adults with a formal diagnosis of panic disorder with or without agoraphobia. We considered the following psychological therapies: psychoeducation (PE), supportive psychotherapy (SP), physiological therapies (PT), behaviour therapy (BT), cognitive therapy (CT), cognitive behaviour therapy (CBT), third-wave CBT (3W) and psychodynamic therapies (PD). We included both individual and group formats. Therapies had to be administered face-to-face. The

Lack of association between joint hyperlaxity and, I: panic disorder, and II: reactivity to carbon dioxide in healthy volunteers.

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Benjamin, Jonathan; Ben-Zion, Itzhak Z; Dannon, Pinhas; Schreiber, Shaul; Meiri, Gal; Ofek, Andre; Palatnik, Alex

2001-03-01

This study attempted to replicate previous reports of associations between panic disorder and joint hyperlaxity. The authors also examined possible associations between reacitivity to carbon dioxide (CO(2)), a model for panic vulnerability, and hyperlaxity in healthy volunteers. One hundred and one patients with DSM-IV panic disorder and 39 healthy volunteers were assessed for hyperlaxity by Beighton's criteria. Healthy volunteers also received two vital capacity inhalations of CO(2). Thirteen (13%) patients had five or more hyperlax joints. This rate did not differ from that in the healthy volunteers. Anxiety in healthy volunteers, as measured by the NIMH self-rating scale, DSM-IV panic symptom scores, and 100 mm visual analog scales of anxiety, increased after CO(2) from a mean of 1.8 to 2.8 (not significant); from 0.5 to 4 ( p < 0.001) and from 8.7 to 11.6 mm ( p < 0.1), respectively. There were no associations between responses to CO(2) and hyperlaxity. Copyright 2001 John Wiley & Sons, Ltd.

Changes in cerebral blood flow after cognitive behavior therapy in patients with panic disorder: a SPECT study

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Seo, Ho-Jun; Choi, Young Hee; Chung, Yong-An; Rho, Wangku; Chae, Jeong-Ho

2014-01-01

Aim Inconsistent results continue to be reported in studies that examine the neural correlates of cognitive behavioral therapy (CBT) in patients with panic disorder. We examined the changes in regional cerebral blood flow (rCBF) associated with the alleviation of anxiety by CBT in panic patients. Methods The change in rCBF and clinical symptoms before and after CBT were assessed using single photon emission computed tomography and various clinical measures were analyzed. Results Fourteen subjects who completed CBT showed significant improvements in symptoms on clinical measures, including the Panic and Agoraphobic Scale and the Anxiety Sensitivity Index-Revised. After CBT, increased rCBF was detected in the left postcentral gyrus (BA 43), left precentral gyrus (BA 4), and left inferior frontal gyrus (BA 9 and BA 47), whereas decreased rCBF was detected in the left pons. Correlation analysis of the association between the changes in rCBF and changes in each clinical measure did not show significant results. Conclusion We found changes in the rCBF associated with the successful completion of CBT. The present findings may help clarify the effects of CBT on changes in brain activity in panic disorder. PMID:24790449

Takotsubo Cardiomyopathy and Psychiatric Illness: Redefining the Relationship

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Hannah Masoud

2016-01-01

Full Text Available Physicians who encounter patients in the emergency department with chest pain, palpitations, or shortness of breath may often find it difficult to differentiate diagnosis of panic attacks from acute coronary syndrome or Takotsubo Cardiomyopathy. Redefining and understanding the pathophysiological relationship of psychiatric illness including anxiety, depression, or panic attacks and Takotsubo Cardiomyopathy may help clinicians implement a more effective and beneficial model of care for this affliction that is being found to be increasingly more common in today’s age.

Non-disruptive tactics of suppression are superior in countering terrorism, insurgency, and financial panics.

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David A Siegel

Full Text Available BACKGROUND: Suppressing damaging aggregate behaviors such as insurgency, terrorism, and financial panics are important tasks of the state. Each outcome of these aggregate behaviors is an emergent property of a system in which each individual's action depends on a subset of others' actions, given by each individual's network of interactions. Yet there are few explicit comparisons of strategies for suppression, and none that fully incorporate the interdependence of individual behavior. METHODS AND FINDINGS: Here I show that suppression tactics that do not require the removal of individuals from networks of interactions are nearly always more effective than those that do. I find using simulation analysis of a general model of interdependent behavior that the degree to which such less disruptive suppression tactics are superior to more disruptive ones increases in the propensity of individuals to engage in the behavior in question. CONCLUSIONS: Thus, hearts-and-minds approaches are generally more effective than force in counterterrorism and counterinsurgency, and partial insurance is usually a better tactic than gag rules in quelling financial panics. Differences between suppression tactics are greater when individual incentives to support terrorist or insurgent groups, or susceptibilities to financial panic, are higher. These conclusions have utility for policy-makers seeking to end bloody conflicts and prevent financial panics. As the model also applies to mass protest, its conclusions provide insight as well into the likely effects of different suppression strategies undertaken by authoritarian regimes seeking to hold on to power in the face of mass movements seeking to end them.

A Serious Cause of Panic Attack

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O'Connell, Michael; Bernard, Aaron

2012-01-01

We report on a case of a patient with atrial fibrillation in the setting of Wolff-Parkinson-White syndrome. The patient underwent synchronized electrical cardioversion, typically considered safe and effective, which resulted in a dangerous complication for the patient (degeneration into ventricular fibrillation). Discussion of common rhythm disturbances in WPW and management strategies are reviewed. PMID:23326712

A Serious Cause of Panic Attack

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Michael O'Connell

2012-01-01

Full Text Available We report on a case of a patient with atrial fibrillation in the setting of Wolff-Parkinson-White syndrome. The patient underwent synchronized electrical cardioversion, typically considered safe and effective, which resulted in a dangerous complication for the patient (degeneration into ventricular fibrillation. Discussion of common rhythm disturbances in WPW and management strategies are reviewed.

The casualty chain inventory: a new scale for measuring peritraumatic responses: a cross-sectional study

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Sandvik Leiv

2011-05-01

Full Text Available Abstract Background Peritraumatic psychological- and sensory impressions in victims of civilian accidents are only partly understood. This study scrutinizes the level and duration of perceived psychological threat at scene of injury as well as in hospital (the casualty chain measured by the Casualty Chain Inventory (CCI. The purpose of the study was to assess and validate the CCI, and to examine the correlations between the new instrument and stress responses measured by the Impact of Event Scale (IES and the Post-traumatic Stress Scale-10 (PTSS-10 Methods Three hundred and fifteen injured, conscious, hospitalised patients were assessed with a self-report questionnaire. The CCI consists of eight items including sensory impressions and well-known psychological responses to trauma. Results The internal consistency of the CCI was solid (Cronbach's alpha: .83-.85. A factor analysis revealed two components, "perception" and "dissociation". The instrument correlates significantly with the Impact of Event Scale (r = 0.47 - 0.54 and the Posttraumatic Stress Scale-10 (r = 0.32 - 0.50. The explained variance is high both at the scene of injury (61% and in the hospital (65%. Dissociation and perception either used as a two-factor solution or as a sum score measured in the hospital, gave the strongest prediction for later psychological distress. Conclusions The CCI appears to be a useful screening instrument for, at an early state, identifying patients hospitalized after a physical incident at risk for subsequent psychological distress.

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

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

2004-06-11

This naturalistic open label follow-up study had three objectives: 1) To observe the course of illness in Panic Disorder patients receiving long-term versus intermediate-term paroxetine treatment, 2) To compare the relapse rates and side-effect profile after long-term paroxetine treatment between patients with Panic Disorder and Panic Disorder with Agoraphobia, 3) To observe paroxetine's tolerability over a 24 month period. 143 patients with panic disorder (PD), with or without agoraphobia, successfully finished a short-term (ie 12 week) trial of paroxetine treatment. All patients then continued to receive paroxetine maintenance therapy for a total of 12 months. At the end of this period, 72 of the patients chose to discontinue paroxetine pharmacotherapy and agreed to be monitored throughout a one year discontinuation follow-up phase. The remaining 71 patients continued on paroxetine for an additional 12 months and then were monitored, as in the first group, for another year while medication-free. The primary limitation of our study is that the subgroups of patients receiving 12 versus 24 months of maintenance paroxetine therapy were selected according to individual patient preference and therefore were not assigned in a randomized manner. Only 21 of 143 patients (14%) relapsed during the one year medication discontinuation follow-up phase. There were no significant differences in relapse rates between the patients who received intermediate-term (up to 12 months) paroxetine and those who chose the long-term course (24 month paroxetine treatment). 43 patients (30.1%) reported sexual dysfunction. The patients exhibited an average weight gain of 5.06 kg. All patients who eventually relapsed demonstrated significantly greater weight increase (7.3 kg) during the treatment phase. The extension of paroxetine maintenance treatment from 12 to 24 months did not seem to further decrease the risk of relapse after medication discontinuation. Twenty-four month paroxetine

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

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Lowengrub Katherine

2004-06-01

Full Text Available Abstract Background This naturalistic open label follow-up study had three objectives: 1 To observe the course of illness in Panic Disorder patients receiving long-term versus intermediate-term paroxetine treatment 2 To compare the relapse rates and side-effect profile after long-term paroxetine treatment between patients with Panic Disorder and Panic Disorder with Agoraphobia. 3 To observe paroxetine's tolerability over a 24 month period. Methods 143 patients with panic disorder (PD, with or without agoraphobia, successfully finished a short-term (ie 12 week trial of paroxetine treatment. All patients then continued to receive paroxetine maintenance therapy for a total of 12 months. At the end of this period, 72 of the patients chose to discontinue paroxetine pharmacotherapy and agreed to be monitored throughout a one year discontinuation follow-up phase. The remaining 71 patients continued on paroxetine for an additional 12 months and then were monitored, as in the first group, for another year while medication-free. The primary limitation of our study is that the subgroups of patients receiving 12 versus 24 months of maintenance paroxetine therapy were selected according to individual patient preference and therefore were not assigned in a randomized manner. Results Only 21 of 143 patients (14% relapsed during the one year medication discontinuation follow-up phase. There were no significant differences in relapse rates between the patients who received intermediate-term (up to 12 months paroxetine and those who chose the long-term course (24 month paroxetine treatment. 43 patients (30.1% reported sexual dysfunction. The patients exhibited an average weight gain of 5.06 kg. All patients who eventually relapsed demonstrated significantly greater weight increase (7.3 kg during the treatment phase. Conclusions The extension of paroxetine maintenance treatment from 12 to 24 months did not seem to further decrease the risk of relapse after

Social phobia, panic disorder and suicidality in subjects with pure and depressive mania.

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Dilsaver, Steven C; Chen, Yuan-Who

2003-11-01

The objective of this study is to ascertain the rates of social phobia, panic disorder and suicidality in the midst of the manic state among subjects with pure and depressive mania. Subjects received evaluations entailing the use of serial standard clinical interviews, the Schedule for Affective Disorders and Schizophrenia (SADS) and a structured interview to determine whether they met the criteria for intra-episode social phobia (IESP) and panic disorder (IEPD). The diagnoses of major depressive disorder and mania were rendered using the Research Diagnostic Criteria. The diagnoses of IESP and IEPD were rendered using DSM-III-R criteria. Categorization as being suicidal was based on the SADS suicide subscale score. Twenty-five (56.8%) subjects had pure and 19 (43.2%) subjects had depressive mania. None of the subjects with pure and 13 (68.4%) with depressive mania had IESP (Pdepressive mania had IEPD (Pdepressive were suicidal. Twelve of 13 (92.3%) subjects with depressive mania met the criteria for IESP and IEPD concurrently (Pdepressive but not pure mania exhibited high rates of both IESP and IEPD. Concurrence of the disorders is the rule. The findings suggest that databases disclosing a relationship between panic disorder and suicidality merit, where possible, reanalysis directed at controlling for the effect of social phobia.

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

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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.

Perception of early parenting in panic and agoraphobia.

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

1991-07-01

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

Prediction and moderation of improvement in cognitive-behavioral and psychodynamic psychotherapy for panic disorder.

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Chambless, Dianne L; Milrod, Barbara; Porter, Eliora; Gallop, Robert; McCarthy, Kevin S; Graf, Elizabeth; Rudden, Marie; Sharpless, Brian A; Barber, Jacques P

2017-08-01

To identify variables predicting psychotherapy outcome for panic disorder or indicating which of 2 very different forms of psychotherapy-panic-focused psychodynamic psychotherapy (PFPP) or cognitive-behavioral therapy (CBT)-would be more effective for particular patients. Data were from 161 adults participating in a randomized controlled trial (RCT) including these psychotherapies. Patients included 104 women; 118 patients were White, 33 were Black, and 10 were of other races; 24 were Latino(a). Predictors/moderators measured at baseline or by Session 2 of treatment were used to predict change on the Panic Disorder Severity Scale (PDSS). Higher expectancy for treatment gains (Credibility/Expectancy Questionnaire d = -1.05, CI 95% [-1.50, -0.60]), and later age of onset (d = -0.65, CI 95% [-0.98, -0.32]) were predictive of greater change. Both variables were also significant moderators: patients with low expectancy of improvement improved significantly less in PFPP than their counterparts in CBT, whereas this was not the case for patients with average or high levels of expectancy. When patients had an onset of panic disorder later in life (≥27.5 years old), they fared as well in PFPP as CBT. In contrast, at low and mean levels of onset age, CBT was the more effective treatment. Predictive variables suggest possibly fruitful foci for improvement of treatment outcome. In terms of moderation, CBT was the more consistently effective treatment, but moderators identified some patients who would do as well in PFPP as in CBT, thereby widening empirically supported options for treatment of this disorder. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Paroxetine

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... extended-release (long-acting) tablets are used to treat depression, panic disorder (sudden, unexpected attacks of extreme fear and worry about these attacks), and social anxiety disorder (extreme fear of interacting with others or ...

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...

Features of microscopic pedestrian movement in a panic situation based on cellular automata model

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Ibrahim, Najihah; Hassan, Fadratul Hafinaz

2017-10-01

Pedestrian movement is the one of the subset for the crowd management under simulation objective. During panic situation, pedestrian usually will create a microscopic movement that lead towards the self-organization. During self-organizing, the behavioral and physical factors had caused the mass effect on the pedestrian movement. The basic CA model will create a movement path for each pedestrian over a time step. However, due to the factors immerge, the CA model needs some enhancement that will establish a real simulation state. Hence, this concept paper will discuss on the enhanced features of CA model for microscopic pedestrian movement during panic situation for a better pedestrian simulation.

Calculating Adversarial Risk from Attack Trees: Control Strength and Probabilistic Attackers

NARCIS (Netherlands)

Pieters, Wolter; Davarynejad, Mohsen

2015-01-01

Attack trees are a well-known formalism for quantitative analysis of cyber attacks consisting of multiple steps and alternative paths. It is possible to derive properties of the overall attacks from properties of individual steps, such as cost for the attacker and probability of success. However, in

Quarantine after an international biological weapons attack: medical and public health requirements for containment.

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Oren, Meir

2004-11-01

The world now faces the dreadful possibility of biological weapons attacks by terrorists. Healthcare systems would have to cope with such emergencies should all preemptive measures fail. Information gained from the Global Mercury exercise and the SARS outbreak has shown that containing an outbreak at the start is more effective than reacting to it once it has spread and that containment should be treated both nationally and internationally. On the national level this entails developing rapid and effective methods to detect and identify infected cases, and implementing isolation and control measures to lower the risk of further transmission of the disease while assuring the safety of medical teams and laboratory workers. Strategic contingency plans should incorporate well-defined procedures for hospitalization and isolation of patients, providing regional backup of medical personnel and equipment and maintaining close cooperation between the various bodies in the healthcare system. Quarantine is an effective containment measure, especially if voluntarily imposed. Modern communication systems can help by sending professional teams timely instructions and providing the public with information to reduce panic and stress during quarantine procedures. Informing the public poses a dilemma: finding a balance between giving advance warning of an imminent epidemic outbreak and ascertaining the likelihood of its occurrence. Containment of international bioterrorist attacks depends entirely on close international cooperation to implement national and international strategic contingency plans with free exchange of information and recognition of procedures.

Relations among symptoms of social phobia subtypes, avoidant personality disorder, panic, and depression.

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Carter, Shawn A; Wu, Kevin D

2010-03-01

This study's primary goal was to examine relations between symptoms of specific social phobia (SSP), generalized social phobia (GSP), avoidant personality disorder (APD), and panic and depression. Past research has suggested a single social phobia continuum in which SSP displays less symptom severity than GSP or APD. We found SSP symptoms correlated less strongly with depression but more strongly with panic relative to both GSP and APD symptoms. These findings challenge a unidimensional model of social phobia, suggesting a multidimensional model may be more appropriate. These findings also inform current research aimed at classifying mood and anxiety disorders more broadly by identifying that the different factors of fear versus distress appear to underlie different subtypes of social phobia. 2008. Published by Elsevier Ltd.

The moral panic about the socializing of young people in Minangkabau

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Lyn Parker

2013-04-01

Full Text Available This paper analyses the discourse surrounding the perceived threat of free seks and pergaulan bebas (free socializing to the moral health of young Minangkabau people, and in particular, young women, in West Sumatra. It uses the sociological frame of “moral panic” to examine contemporary discussions about globalization and the influence of “the West” in West Sumatra. The paper examines the way in which “the authorities” in West Sumatra (media, such as teen magazines and newspapers, academics, government and law, teachers, and community leaders present the threat, and the way in which young people, who are the target of the moral panic onslaught, see themselves in relation to the threat. I argue that, unlike the original “folk devils” of the moral panics in Britain, young people in Minangkabau broadly give their consent to the authorities, displaying a striking commitment to social conservatism, local culture, and Islamic values.

Applying the Quadruple Process model to evaluate change in implicit attitudinal responses during therapy for panic disorder.

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Clerkin, Elise M; Fisher, Christopher R; Sherman, Jeffrey W; Teachman, Bethany A

2014-01-01

This study explored the automatic and controlled processes that may influence performance on an implicit measure across cognitive-behavioral group therapy for panic disorder. The Quadruple Process model was applied to error scores from an Implicit Association Test evaluating associations between the concepts Me (vs. Not Me) + Calm (vs. Panicked) to evaluate four distinct processes: Association Activation, Detection, Guessing, and Overcoming Bias. Parameter estimates were calculated in the panic group (n = 28) across each treatment session where the IAT was administered, and at matched times when the IAT was completed in the healthy control group (n = 31). Association Activation for Me + Calm became stronger over treatment for participants in the panic group, demonstrating that it is possible to change automatically activated associations in memory (vs. simply overriding those associations) in a clinical sample via therapy. As well, the Guessing bias toward the calm category increased over treatment for participants in the panic group. This research evaluates key tenets about the role of automatic processing in cognitive models of anxiety, and emphasizes the viability of changing the actual activation of automatic associations in the context of treatment, versus only changing a person's ability to use reflective processing to overcome biased automatic processing. Copyright © 2013 Elsevier Ltd. All rights reserved.

Bluetooth security attacks comparative analysis, attacks, and countermeasures

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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.

Health Anxiety in Panic Disorder, Somatization Disorder and Hypochondriasis

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Özgün Karaer KARAPIÇAK

2012-04-01

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. [JCBPR 2012; 1(1.000: 43-51

Long-term outcome of patients with dysthymia and panic disorder: a naturalistic 9-year follow-up study.

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Svanborg, Cecilia; Wistedt, Anna Aberg; Svanborg, Pär

2008-01-01

The highly prevalent psychiatric disorders dysthymia and panic disorder have often a chronic or recurrent course with superimposed major depression. The prominent comorbidity between these diagnoses constitutes a confounding factor in the study of long-term outcome. We performed a 9-year follow-up of 38 patients with "pure" diagnoses, i.e. without comorbid dysthymia and panic disorder, selected from two 2-year naturalistic treatment studies with psychotherapy and antidepressant medication. The aims of the present study were to investigate 1) the stability of change, and 2) the impact of comorbid personality disorders (PDs) on long-term outcome. Patients were reassessed with SCID-I and SCID-II interviews, SCL-90/BSI and a detailed, modified life-charting interview, investigating course and treatment over time. About 50% of patients showed substantial improvement, of whom about half were in remission. Comorbid PD was a negative prognostic factor independently of Axis I diagnosis. Although patients with panic disorder had a lower frequency of comorbid PD, later onset, shorter duration of illness and better outcome after the original studies, there was no difference in the long-term outcome. The less stable outcome among panic patients suggests that standard treatments are not resulting in enduring remission. In order to achieve remission, it is necessary to 1) address comorbid PDs, 2) perform careful assessments of all comorbid diagnoses, and 3) build routines for the follow-up and augmentation of treatments.

Distinguishing attack and second-preimage attack on encrypted message authentication codes (EMAC)

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Ariwibowo, Sigit; Windarta, Susila

2016-02-01

In this paper we show that distinguisher on CBC-MAC can be applied to Encrypted Message Authentication Code (EMAC) scheme. EMAC scheme in general is vulnerable to distinguishing attack and second preimage attack. Distinguishing attack simulation on AES-EMAC using 225 message modifications, no collision have been found. According to second preimage attack simulation on AES-EMAC no collision found between EMAC value of S1 and S2, i.e. no second preimage found for messages that have been tested. Based on distinguishing attack simulation on truncated AES-EMAC we found collision in every message therefore we cannot distinguish truncated AES-EMAC with random function. Second-preimage attack is successfully performed on truncated AES-EMAC.

Can pill placebo augment cognitive-behavior therapy for panic disorder?

Directory of Open Access Journals (Sweden)

Churchill Rachel

2007-12-01

Full Text Available Abstract Background In a number of drug and psychotherapy comparative trials, psychotherapy-placebo combination has been assumed to represent psychotherapy. Whether psychotherapy plus pill placebo is the same as psychotherapy alone is an empirical question which however has to date never been examined systematically. Methods We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs that directly compared cognitive-behavior therapy (CBT alone against CBT plus pill placebo in the treatment of panic disorder. Results Extensive literature search was able to identify three relevant RCTs. At the end of the acute phase treatment, patients who received CBT plus placebo had 26% (95%CI: 2 to 55% increased chances of responding than those who received CBT alone. At follow-up the difference was no longer statistically significant (22%, 95%CI: -10% to 64%. Conclusion The act of taking a pill placebo may enhance the placebo effect already contained in the effective psychotherapeutic intervention during the acute phase treatment. Theoretically this is an argument against the recently claimed null hypothesis of placebo effect in general and clinically it may point to some further room for enhancing the psychotherapeutic approach for panic disorder.

The animal body, violence and moral panic: The case of Mila the dog

Directory of Open Access Journals (Sweden)

Žakula Sonja

2014-01-01

Full Text Available In April of 2010 Serbia was rocked by the news that a dog whose paws had been cut off was found in the Medakovic neighborhood of Belgrade. Miraculously, the dog was still alive, but in bad condition. The news media named the dog Mila (which, aside from being a Serbian female name, can also mean “dear one” or “gentle one” and the Serbian public followed the story of Mila’s plight and subsequent recovery with great interest and much comment, so much so that the event became a trigger for a moral panic of sorts. In this paper I have attempted to point out how the Serbian public, with reference to the case of Mila the dog, conceptualizes violence against animals, as well as to point out that folk classifications of living creatures - such as the one which distinguishes animals from meat (see Mullin 1999 - influence the understanding and conceptualization of violence as a phenomenon. Secondly, I have attempted to uncover which elements of the event in question caused a moral panic in Serbia, and which had inhibited the development of a serious public discussion of the issue of animal suffering. In that sense, the object of this paper is twofold - on the one hand it aims to point out why a discussion of the systematic and systemic violence against animals did not occur, and on the other, it serves to point out those elements of the event which caused the panic.

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…

Phobic, panic, and major depressive disorders and the five-factor model of personality.

Science.gov (United States)

Bienvenu, O J; Nestadt, G; Samuels, J F; Costa, P T; Howard, W T; Eaton, W W

2001-03-01

This study investigated five-factor model personality traits in anxiety (simple phobia, social phobia, agoraphobia, and panic disorder) and major depressive disorders in a population-based sample. In the Baltimore Epidemiologic Catchment Area Follow-up Study, psychiatrists administered the Schedules for Clinical Assessment in Neuropsychiatry to 333 adult subjects who also completed the Revised NEO Personality Inventory. All of the disorders except simple phobia were associated with high neuroticism. Social phobia and agoraphobia were associated with low extraversion. In addition, lower-order facets of extraversion, agreeableness, and conscientiousness were associated with certain disorders (i.e., low positive emotions in panic disorder; low trust and compliance in certain phobias; and low competence, achievement striving, and self-discipline in several disorders). This study emphasizes the utility of lower-order personality assessments and underscores the need for further research on personality/psychopathology etiologic relationships.

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.

Crony Attack: Strategic Attack’s Silver Bullet

Science.gov (United States)

2006-11-01

physical assets or financial assets. The form of crony attack that most closely resembles classic strategic attack is to deny, degrade, or destroy a money...February 1951. Reprinted in Airpower Studies Coursebook , Air Command and Staff College, Maxwell AFB, AL, 2002, 152–58. Hirsch, Michael. “NATO’s Game of

Decreased gray matter volume of the medial orbitofrontal cortex in panic disorder with agoraphobia: a preliminary study.

Science.gov (United States)

Na, Kyoung-Sae; Ham, Byung-Joo; Lee, Min-Soo; Kim, Leen; Kim, Yong-Ku; Lee, Heon-Jeong; Yoon, Ho-Kyoung

2013-08-01

Patients with panic disorder with agoraphobia (PDA) have clinical symptoms such as the fear of being outside or of open spaces from which escape would be difficult. Although recent neurobiological studies have suggested that fear conditioning and extinction are associated with PDA, no study has examined the possible structural abnormalities in patients with PDA. This preliminary study compares the gray matter volume among patients with PDA, those with panic disorder without agoraphobia (PDW), and healthy controls (HC) using high-resolution 3.0 T magnetic resonance imaging (MRI) with voxel-based morphometry (VBM). Compared with HC, patients with PDA showed decreased gray matter volume in their left medial orbitofrontal gyrus. However, differences were not found in the gray matter volumes of patients with PDW and whole panic disorder compared with HC. These findings suggest that the phobic avoidance found in patients with PDA arise from abnormalities in the medial orbitofrontal cortex, which plays an important role in fear extinction. Future studies should investigate the neuroanatomical substrates of PDA and distinguish them from those of PDW. Copyright © 2013 Elsevier Inc. All rights reserved.

Multivariate analysis of anxiety disorders yields further evidence of linkage to chromosomes 4q21 and 7p in panic disorder families.

Science.gov (United States)

Logue, Mark W; Bauver, Sarah R; Knowles, James A; Gameroff, Marc J; Weissman, Myrna M; Crowe, Raymond R; Fyer, Abby J; Hamilton, Steven P

2012-04-01

Replication has been difficult to achieve in linkage studies of psychiatric disease. Linkage studies of panic disorder have indicated regions of interest on chromosomes 1q, 2p, 2q, 3, 7, 9, 11, 12q13, 12q23, and 15. Few regions have been implicated in more than one study. We examine two samples, the Iowa (IA) and the Columba panic disorder families. We use the fuzzy-clustering method presented by Kaabi et al. [Kaabi et al. (2006); Am J Hum Genet 78: 543-553] to summarize liability to panic disorder, agoraphobia, simple phobia, and social phobia. Kaabi et al. applied this method to the Yale panic disorder linkage families and found evidence of linkage to chromosomes 4q21, 4q32, 7p, and 8. When we apply the same method to the IA families, we obtain overlapping evidence of linkage to chromosomes 4q21 and 7p. Additionally, we find evidence of linkage on chromosomes 1, 5, 6, 16, and 22. The Columbia (CO) data does not indicate linkage to any of the Kaabi et al. peaks, instead implicating chromosomes 2 and 22q11 (2 Mb from COMT). There is some evidence of overlapping linkage between the IA and CO datasets on chromosomes 1 and 14. While use of fuzzy clustering has not produced complete concordance across datasets, it has produced more than previously seen in analyses of panic disorder proper. We conclude that chromosomes 4q21 and 7p should be considered strong candidate regions for panic and fear-associated anxiety disorder loci. More generally, this suggests that analyses including multiple aspects of psychopathology may lead to greater consistency across datasets. Copyright © 2012 Wiley Periodicals, Inc.

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.

Heart Attack Recovery FAQs

Science.gov (United States)

... recommendations to make a full recovery. View an animation of a heart attack . Heart Attack Recovery Questions ... Support Network Popular Articles 1 Understanding Blood Pressure Readings 2 Sodium and Salt 3 Heart Attack Symptoms ...

Collective behavior of mice passing through an exit under panic

Science.gov (United States)

Zhang, Teng; Zhang, Xuelin; Huang, Shenshi; Li, Changhai; Lu, Shouxiang

2018-04-01

Collective movement of animal in emergency condition has attracted growing attentions among researchers. However, many rules still need to be confirmed with adequate explanation. Study of collective behavior of mice can improve our understanding about the dynamics of pedestrian movement. However, its rules still need to be confirmed with adequate explanation. In this paper, collective behavior of mice passing through an exit under panic was investigated. The results showed that the total evacuation time decreased with exit width increasing in a certain range. Based on the different tendency of the curve in temporal evolution, the process of mice flow was divided into three stages. The density of mice near the exit peaks at a certain horizontal offset and starts to decrease over time. With the increase of the exit width, the duration of the higher density state decreased. We found that the frequency of time intervals obeyed a lognormal distribution or an exponential decay for different exit widths. In addition, the relationship between the group size and the group flow rate in different scenarios was analyzed. The phenomena found in our experiments show the collective behavioral characteristic of mice under panic. Our analysis in this paper will deepen our understanding of crowd dynamics in emergency condition.

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,…

Interaction of Stress and Anxiogenic Drugs on Behaviors of Rats and Antagonism with Indomethacin

Science.gov (United States)

2001-10-19

also produces panic attacks. Hyperventilation produces respi ratory alkalosis and hypocapnea 22 (reduced CO2 tension in arterial blood) . and...minute stressor hyperventilated, a result would be hypocapnia and alkalosis (Guyton & Hall, 1996). Alkalosis is known to increase the binding of...neuroanatomical hypothesis for panic disorder. American Journal of Psychology, 146, 148-161 . Gorman, J.M., & Papp, LA (1990). Respiratory

Respiratory manifestations of panic disorder: causes, consequences and therapeutic implications Manifestações respiratórias do transtorno de pânico: causas, consequências e implicações terapêuticas

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Aline Sardinha

2009-07-01

Full Text Available Multiple respiratory abnormalities can be found in anxiety disorders, especially in panic disorder (PD. Individuals with PD experience unexpected panic attacks, characterized by anxiety and fear, resulting in a number of autonomic and respiratory symptoms. Respiratory stimulation is a common event during panic attacks. The respiratory abnormality most often reported in PD patients is increased CO2 sensitivity, which has given rise to the hypothesis of fundamental abnormalities in the physiological mechanisms that control breathing in PD. There is evidence that PD patients with dominant respiratory symptoms are more sensitive to respiratory tests than are those who do not manifest such symptoms, and that the former group constitutes a distinct subtype. Patients with PD tend to hyperventilate and to panic in response to respiratory stimulants such as CO2, triggering the activation of a hypersensitive fear network. Although respiratory physiology seems to remain normal in these subjects, recent evidence supports the idea that they present subclinical abnormalities in respiration and in other functions related to body homeostasis. The fear network, composed of the hippocampus, the medial prefrontal cortex, the amygdala and its brain stem projections, might be oversensitive in PD patients. This theory might explain why medication and cognitive-behavioral therapy are both clearly effective. Our aim was to review the relationship between respiration and PD, addressing the respiratory subtype of PD and the hyperventilation syndrome, with a focus on respiratory challenge tests, as well as on the current mechanistic concepts and the pharmacological implications of this relationship.Múltiplas anormalidades respiratórias podem ser encontradas em pacientes com transtornos de ansiedade, particularmente no transtorno de pânico (TP. Indivíduos com TP experimentam ataques de pânico inesperados, caracterizados por ansiedade, medo e diversos sintomas auton

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

Reward and loss anticipation in panic disorder: An fMRI study.

Science.gov (United States)

Held-Poschardt, Dada; Sterzer, Philipp; Schlagenhauf, Florian; Pehrs, Corinna; Wittmann, Andre; Stoy, Meline; Hägele, Claudia; Knutson, Brian; Heinz, Andreas; Ströhle, Andreas

2018-01-30

Anticipatory anxiety and harm avoidance are essential features of panic disorder (PD) and may involve deficits in the reward system of the brain, in particular in the ventral striatum. While neuroimaging studies on PD have focused on fearful and negative affective stimulus processing, no investigations have directly addressed deficits in reward and loss anticipation. To determine whether the ventral striatum shows abnormal neural activity in PD patients during anticipation of loss or gain, an event-related functional magnetic resonance imaging experiment using a monetary incentive delay task was employed in 10 patients with PD and 10 healthy controls. A repeated-measures ANOVA to identify effects of group (PD vs. Control) and condition (anticipation of loss vs. gain vs. neutral outcome) revealed that patients with PD showed significantly reduced bilateral ventral striatal activation during reward anticipation but increased activity during loss anticipation. Within the patient group, the degree of activation in the ventral striatum during loss-anticipation was positively correlated with harm avoidance and negatively correlated with novelty seeking. These findings suggest that behavioural impairments in panic disorder may be related to abnormal neural processing of motivational cues. Copyright © 2017 Elsevier B.V. All rights reserved.

Changes in cerebral blood flow after cognitive behavior therapy in patients with panic disorder: a SPECT study

Directory of Open Access Journals (Sweden)

Seo HJ

2014-04-01

Full Text Available Ho-Jun Seo,1 Young Hee Choi,2 Yong-An Chung,3 Wangku Rho,1 Jeong-Ho Chae11Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, South Korea; 2Metta Institute of Cognitive Behavior Therapy, Seoul, South Korea; 3Department of Radiology, Nuclear Medicine, College of Medicine, The Catholic University of Korea, Seoul, South KoreaAim: Inconsistent results continue to be reported in studies that examine the neural correlates of cognitive behavioral therapy (CBT in patients with panic disorder. We examined the changes in regional cerebral blood flow (rCBF associated with the alleviation of anxiety by CBT in panic patients.Methods: The change in rCBF and clinical symptoms before and after CBT were assessed using single photon emission computed tomography and various clinical measures were analyzed.Results: Fourteen subjects who completed CBT showed significant improvements in symptoms on clinical measures, including the Panic and Agoraphobic Scale and the Anxiety Sensitivity Index-Revised. After CBT, increased rCBF was detected in the left postcentral gyrus (BA 43, left precentral gyrus (BA 4, and left inferior frontal gyrus (BA 9 and BA 47, whereas decreased rCBF was detected in the left pons. Correlation analysis of the association between the changes in rCBF and changes in each clinical measure did not show significant results.Conclusion: We found changes in the rCBF associated with the successful completion of CBT. The present findings may help clarify the effects of CBT on changes in brain activity in panic disorder.Keyword: single photon emission computed tomography (SPECT, anxiety, neural correlate, brain activity

Financial news and market panics in the age of high frequency trading algorithms

NARCIS (Netherlands)

Kleinnijenhuis, J.; Schultz, F.; Oegema, D.; van Atteveldt, W.H.

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 that

Comorbidity, systemic inflammation and outcomes in the ECLIPSE cohort

DEFF Research Database (Denmark)

Miller, Joy; Edwards, Lisa D; Agustí, Alvar

2013-01-01

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...

Blocking of Brute Force Attack

OpenAIRE

M.Venkata Krishna Reddy

2012-01-01

A common threat Web developers face is a password-guessing attack known as a brute-force attack. A brute-force attack is an attempt to discover a password by systematically trying every possible combination of letters, numbers, and symbols until you discover the one correct combination that works. If your Web site requires user authentication, you are a good target for a brute-force attack. An attacker can always discover a password through a brute-force attack, but the downside is that it co...

Cost-effectiveness of CBT, SSRI, and CBT+SSRI in the treatment for panic disorder

NARCIS (Netherlands)

van Apeldoorn, F. J.; Stant, A. D.; van Hout, W. J. P. J.; Mersch, P. P. A.; den Boer, J. A.

Objective The objective of this study was to assess the cost-effectiveness of three empirically supported treatments for panic disorder with or without agoraphobia: cognitive behavioral therapy (CBT), pharmacotherapy using a selective serotonin reuptake inhibitor (SSRI), or the combination of both

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.

Solidarity under Attack

DEFF Research Database (Denmark)

Meret, Susi; Goffredo, Sergio

2017-01-01

https://www.opendemocracy.net/can-europe-make-it/susi-meret-sergio-goffredo/solidarity-under-attack......https://www.opendemocracy.net/can-europe-make-it/susi-meret-sergio-goffredo/solidarity-under-attack...

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....

Are there subtypes of panic disorder? An interpersonal perspective.

Science.gov (United States)

Zilcha-Mano, Sigal; McCarthy, Kevin S; Dinger, Ulrike; Chambless, Dianne L; Milrod, Barbara L; Kunik, Lauren; Barber, Jacques P

2015-10-01

Panic disorder (PD) is associated with significant personal, social, and economic costs. However, little is known about specific interpersonal dysfunctions that characterize the PD population. The current study systematically examined these interpersonal dysfunctions. The present analyses included 194 patients with PD out of a sample of 201 who were randomized to cognitive-behavioral therapy, panic-focused psychodynamic psychotherapy, or applied relaxation training. Interpersonal dysfunction was measured with the Inventory of Interpersonal Problems-Circumplex (Horowitz, Alden, Wiggins, & Pincus, 2000). Individuals with PD reported greater levels of interpersonal distress than that of a normative cohort (especially when PD was accompanied by agoraphobia), but lower than that of a cohort of patients with major depression. There was no single interpersonal profile that characterized PD patients. Symptom-based clusters (with vs. without agoraphobia) could not be discriminated on core or central interpersonal problems. Rather, as revealed by cluster analysis based on the pathoplasticity framework, there were 2 empirically derived interpersonal clusters among PD patients that were not accounted for by symptom severity and were opposite in nature: domineering-intrusive and nonassertive. The empirically derived interpersonal clusters appear to be of clinical utility in predicting alliance development throughout treatment: Although the domineering-intrusive cluster did not show any changes in the alliance throughout treatment, the nonassertive cluster showed a process of significant strengthening of the alliance. Empirically derived interpersonal clusters in PD provide clinically useful and nonredundant information about individuals with PD. (c) 2015 APA, all rights reserved).

Are There Subtypes of Panic Disorder? An Interpersonal Perspective

Science.gov (United States)

Zilcha-Mano, Sigal; McCarthy, Kevin S.; Dinger, Ulrike; Chambless, Dianne L.; Milrod, Barbara L.; Kunik, Lauren; Barber, Jacques P.

2015-01-01

Objective Panic disorder (PD) is associated with significant personal, social, and economic costs. However, little is known about specific interpersonal dysfunctions that characterize the PD population. The current study systematically examined these interpersonal dysfunctions. Method The present analyses included 194 patients with PD out of a sample of 201 who were randomized to cognitive-behavioral therapy, panic-focused psychodynamic psychotherapy, or applied relaxation training. Interpersonal dysfunction was measured using the Inventory of Interpersonal Problems–Circumplex (Horowitz, Alden, Wiggins, & Pincus, 2000). Results Individuals with PD reported greater levels of interpersonal distress than that of a normative cohort (especially when PD was accompanied by agoraphobia), but lower than that of a cohort of patients with major depression. There was no single interpersonal profile that characterized PD patients. Symptom-based clusters (with versus without agoraphobia) could not be discriminated on core or central interpersonal problems. Rather, as revealed by cluster analysis based on the pathoplasticity framework, there were two empirically derived interpersonal clusters among PD patients which were not accounted for by symptom severity and were opposite in nature: domineering-intrusive and nonassertive. The empirically derived interpersonal clusters appear to be of clinical utility in predicting alliance development throughout treatment: While the domineering-intrusive cluster did not show any changes in the alliance throughout treatment, the non-assertive cluster showed a process of significant strengthening of the alliance. Conclusions Empirically derived interpersonal clusters in PD provide clinically useful and non-redundant information about individuals with PD. PMID:26030762

Catastrophic Misinterpretations as a Predictor of Symptom Change during Treatment for Panic Disorder

Science.gov (United States)

Teachman, Bethany A.; Marker, Craig D.; Clerkin, Elise M.

2010-01-01

Objective: Cognitive models of panic disorder suggest that change in catastrophic misinterpretations of bodily sensations will predict symptom reduction. To examine change processes, we used a repeated measures design to evaluate whether the trajectory of change in misinterpretations over the course of 12-week cognitive behavior therapy is related…

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

Directory of Open Access Journals (Sweden)

Anna Lucia Spear King

2012-01-01

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

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

A naturalistic long-term comparison study of selective serotonin reuptake inhibitors in the treatment of panic disorder.

Science.gov (United States)

Dannon, Pinhas N; Iancu, Iulian; Lowengrub, Katherine; Gonopolsky, Yehudit; Musin, Ernest; Grunhaus, Leon; Kotler, Moshe

2007-01-01

12, however, there were no statistically significant differences between the 4 groups in relapse rates (defined as the occurrence of 1 or more panic attacks during the previous week of treatment) (F1,127 = 0.17; P = 0.13 [not statistically significant]). At the 12th month end point, patients in all 4 treatment groups had a statistically significant increase in body weight. Body weight among the study population increased by 6.1 + 4.9 kg from a mean weight of 72.4 + 7.3 kg at the onset of treatment. Reports of sexual adverse effects at the 12th month visit were similar in the citalopram, fluoxetine, and paroxetine groups, but the fluvoxamine patient group reported fewer sexual adverse effects at the 12th month visit. Most of our PD patients responded well to 12-month treatment with either citalopram, fluoxetine, fluvoxamine, or paroxetine, and the overall response rate was equal after the first 4 weeks of treatment. Although patients treated with paroxetine had the lowest dropout rates during the initiation phase, they had the highest rate of adverse effects as measured at the 12th month visit. Conversely, patients in the fluvoxamine group had the highest dropout rate (which was primarily caused by adverse effects in the initiation phase of treatment.); however, patients who were able to tolerate fluvoxamine throughout the full course of the study were observed to have lower rates of sexual dysfunction and weight gain compared with patients treated with the other agents. Overall, when measured at the 12th month visit, monotherapy with paroxetine and citalopram was associated with a higher rate of sexual adverse effects than was treatment with fluoxetine or fluvoxamine. In addition, monotherapy with paroxetine, citalopram, and fluoxetine seemed to cause more weight gain than did treatment with fluvoxamine.

Whispering through DDoS attack

OpenAIRE

Miralem Mehic; Jiri Slachta; Miroslav Voznak

2016-01-01

Denial of service (DoS) attack is an attempt of the attacker to disable victim's machine by depleting network or computing resources. If this attack is performed with more than one machine, it is called distributed denial of service (DDoS) attack. Covert channels are those channels which are used for information transmission even though they are neither designed nor intended to transfer information at all. In this article, we investigated the possibility of using of DDoS attack for purposes o...

Agoraphobia Related to Unassertiveness in Panic Disorder.

Science.gov (United States)

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

2016-05-01

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

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.

Protecting Cryptographic Memory against Tampering Attack

DEFF Research Database (Denmark)

Mukherjee, Pratyay

In this dissertation we investigate the question of protecting cryptographic devices from tampering attacks. Traditional theoretical analysis of cryptographic devices is based on black-box models which do not take into account the attacks on the implementations, known as physical attacks. In prac......In this dissertation we investigate the question of protecting cryptographic devices from tampering attacks. Traditional theoretical analysis of cryptographic devices is based on black-box models which do not take into account the attacks on the implementations, known as physical attacks....... In practice such attacks can be executed easily, e.g. by heating the device, as substantiated by numerous works in the past decade. Tampering attacks are a class of such physical attacks where the attacker can change the memory/computation, gains additional (non-black-box) knowledge by interacting...... with the faulty device and then tries to break the security. Prior works show that generically approaching such problem is notoriously difficult. So, in this dissertation we attempt to solve an easier question, known as memory-tampering, where the attacker is allowed tamper only with the memory of the device...

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

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.

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.

Exploiting Hardware Vulnerabilities to Attack Embedded System Devices: a Survey of Potent Microarchitectural Attacks

Directory of Open Access Journals (Sweden)

Apostolos P. Fournaris

2017-07-01

Full Text Available Cyber-Physical system devices nowadays constitute a mixture of Information Technology (IT and Operational Technology (OT systems that are meant to operate harmonically under a security critical framework. As security IT countermeasures are gradually been installed in many embedded system nodes, thus securing them from many well-know cyber attacks there is a lurking danger that is still overlooked. Apart from the software vulnerabilities that typical malicious programs use, there are some very interesting hardware vulnerabilities that can be exploited in order to mount devastating software or hardware attacks (typically undetected by software countermeasures capable of fully compromising any embedded system device. Real-time microarchitecture attacks such as the cache side-channel attacks are such case but also the newly discovered Rowhammer fault injection attack that can be mounted even remotely to gain full access to a device DRAM (Dynamic Random Access Memory. Under the light of the above dangers that are focused on the device hardware structure, in this paper, an overview of this attack field is provided including attacks, threat directives and countermeasures. The goal of this paper is not to exhaustively overview attacks and countermeasures but rather to survey the various, possible, existing attack directions and highlight the security risks that they can pose to security critical embedded systems as well as indicate their strength on compromising the Quality of Service (QoS such systems are designed to provide.

Carbon dioxide inhalation induces dose-dependent and age-related negative affectivity.

Directory of Open Access Journals (Sweden)

Eric J Griez

Full Text Available BACKGROUND: Carbon dioxide inhalation is known to induce an emotion similar to spontaneous panic in Panic Disorder patients. The affective response to carbon dioxide in healthy subjects was not clearly characterized yet. METHODOLOGY/PRINCIPAL FINDINGS: Sixty-four healthy subjects underwent a double inhalation of four mixtures containing respectively 0, 9, 17.5 and 35% CO(2 in compressed air, following a double blind, cross-over, randomized design. Affective responses were assessed according to DSM IV criteria for panic, using an Electronic Visual Analogue Scale and the Panic Symptom List. It was demonstrated that carbon dioxide challenges induced a dose dependent negative affect (p<0.0001. This affect was semantically identical to the DSM IV definition of panic. Older individuals were subjectively less sensitive to Carbon Dioxide (p<0.05. CONCLUSIONS/SIGNIFICANCE: CO(2 induced affectivity may lay on a continuum with pathological panic attacks. Consistent with earlier suggestions that panic is a false biological alarm, the affective response to CO(2 may be part of a protective system triggered by suffocation and acute metabolic distress.

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

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

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.

Parental Bonds in Children at High and Low Familial Risk for Panic Disorder

Science.gov (United States)

Koszycki, Diana; Bilodeau, Cynthia; Zwanzger, Peter; Schneider, Barry H.; Flament, Martine F.; Bradwejn, Jacques

2013-01-01

A rejecting and overprotective parenting style is considered to be an important risk factor for the development of anxiety disorders. This study examined the role of perceived parental bonding as a potential environmental risk factor for panic disorder (PD) in unaffected offspring with parental PD. Children with a biological parent with PD (n =…

Pânico e desamparo na atualidade Panic and helplessness in contemporary society

Directory of Open Access Journals (Sweden)

Lucianne Sant'Anna de Menezes

2005-12-01

Full Text Available Procura-se articular o que Freud denominou "mal-estar na civilização" às psicopatologias contemporâneas, examinando-se a relação da incidência do pânico com as modalidades subjetivas emergentes. Diante do deslocamento da ordem paterna como referencial central, o desamparo do sujeito contemporâneo tornou-se agudo. Na tentativa de proteção contra o desamparo, o sujeito pode fazer uso de modalidades subjetivas que privilegiam o masoquismo. O pânico seria efeito do desamparo na contemporaneidade, uma forma de padecimento em que está em jogo o masoquismo como figura da servidão.Pretends to articulate what Freud called "civilization and its discontents" to contemporary psychopathologies, examining the relationship between the incidence of panic symptoms and contemporary ways of subjectivity construction. In face of current displacement of paternal order as a central reference, the helplessness of the subject became severe, acute. To protect himself from a radical helplessness, masochist ways may be privileged. The panic is an effect a helplessness in contemporary society, a suffering form where masochism appears as a figure of servitude.

Whispering through DDoS attack

Directory of Open Access Journals (Sweden)

Miralem Mehic

2016-03-01

Full Text Available Denial of service (DoS attack is an attempt of the attacker to disable victim's machine by depleting network or computing resources. If this attack is performed with more than one machine, it is called distributed denial of service (DDoS attack. Covert channels are those channels which are used for information transmission even though they are neither designed nor intended to transfer information at all. In this article, we investigated the possibility of using of DDoS attack for purposes of hiding data or concealing the existing covert channel. In addition, in this paper we analyzed the possibility of detection of such covert communication with the well-known statistical method. Also, we proposed the coordination mechanisms of the attack which may be used. A lot of research has been done in order to describe and prevent DDoS attacks, yet research on steganography on this field is still scarce.

Análisis PANIC del desempleo español

Directory of Open Access Journals (Sweden)

Alejandro C. García-Cintado

2016-01-01

Full Text Available Este artículo estudia las propiedades estocásticas de las tasas regionales de desempleo español usando datos trimestrales del periodo 1976(1-2013(2. Para ello, se emplean los métodos Panel Analysis of Nonstationarity in Idiosyncratic and Common components (PANIC de Bai y Ng (2004 y 2010, que permiten la descomposición de las series observadas de tasas de desempleo en un componente común y un componente idiosincrásico. Esto nos permite identificar con precisión la fuente subyacente en el comportamiento no estacionario del desempleo regional español. Nuestro análisis ofrece evidencia clara de la hipótesis de histéresis, que parece estar causada por una tendencia estocástica común que impulsa a las series de desempleo regionales. Estos resultados están respaldados por los obtenidos de la estimación insesgada en la mediana del parámetro de persistencia, que arroja un valor unitario para el factor común, y en menor medida por la estimación de la vida media obtenida a partir de funciones impulso-respuesta, que arroja un valor de 12.5 para el caso de las perturbaciones que afectan a la tendencia común. Este análisis de persistencia también ofrece evidencia de estacionariedad para la mayoría de las series idiosincrásicas (salvo para dos regiones, en la línea del análisis PANIC.

Treatment of internet addiction in patient with panic disorder and obsessive compulsive disorder: a case report.

Science.gov (United States)

Santos, Veruska; Nardi, Antonio Egidio; King, Anna Lucia Spear

2015-01-01

Problematic Internet use is a worldwide social issue and it can be found in any age, social, educational, or economic range. In some countries like China and South Korea internet addiction (IA) is considered a public health condition and this governments support research, education and treatment. Internet addiction has been associated with others psychiatric disorders. Panic disorder (PD) and Obsessive Compulsive Disorder (OCD) are anxiety disorders that involve a lot of damages in patient's life. We report a treatment of a patient with Panic Disorder and Obsessive Compulsive Disorder and internet addition involving pharmacotherapy and Cognitive Behavioral Therapy (CBT). The Cognitive Behavioral Therapy was conducted 1 time per week during 10 weeks and results suggest that the treatment was an effective treatment for the anxiety and for the internet addiction.

Heart attack - discharge

Science.gov (United States)

... and lifestyle Cholesterol - drug treatment Controlling your high blood pressure Deep vein thrombosis - discharge Dietary fats explained Fast food tips Heart attack - discharge Heart attack - what to ask your doctor Heart bypass ... pacemaker - discharge High blood pressure - what to ask your doctor How to read ...

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 Nora

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...

Attack Trees for Practical Security Assessment: Ranking of Attack Scenarios with ADTool 2.0

NARCIS (Netherlands)

Gadyatskaya, Olga; Jhawar, Ravi; Kordy, P.T.; Lounis, Karim; Mauw, Sjouke; Trujillo-Rasua, Rolando

2016-01-01

In this tool demonstration paper we present the ADTool2.0: an open-source software tool for design, manipulation and analysis of attack trees. The tool supports ranking of attack scenarios based on quantitative attributes entered by the user; it is scriptable; and it incorporates attack trees with

Effects of baseline problematic alcohol and drug use on internet-based cognitive behavioral therapy outcomes for depression, panic disorder and social anxiety disorder.

Science.gov (United States)

Gajecki, Mikael; Berman, Anne H; Sinadinovic, Kristina; Andersson, Claes; Ljótsson, Brjánn; Hedman, Erik; Rück, Christian; Lindefors, Nils

2014-01-01

Patients' problematic substance use prevalence and effects were explored in relation to internet-based cognitive behavioral therapy (ICBT) outcomes for depression, panic disorder and social anxiety disorder. At baseline and treatment conclusion, 1601 ICBT patients were assessed with self-rated measures for alcohol and drug use (AUDIT/DUDIT), depressive symptoms (MADRS-S), panic disorder symptoms (PDSS-SR) and social anxiety symptoms (LSAS-SR). Problematic substance use (AUDIT ≥ 8 for men, ≥ 6 for women; DUDIT ≥ 1) occurred among 32.4% of the patients; 24.1% only alcohol, 4.6% only drugs, and 3.7% combined alcohol and drug use. Hazardous alcohol use and probable alcohol dependence negatively affected panic disorder outcomes, and hazardous drug use led to worse social anxiety outcomes. Depression outcomes were not affected by substance use. Treatment adherence was negatively affected by problematic drug use among men and 25-34 year olds; combined substance use negatively affected adherence for women and 35-64 year olds. Problematic substance use does not preclude ICBT treatment but can worsen outcomes, particularly problematic alcohol use for panic disorder patients and hazardous drug use for social anxiety patients. ICBT clinicians should exercise particular caution when treating men and younger patients with problematic drug use, and women or older patients with combined substance use.

The COMTval158met polymorphism is associated with symptom relief during exposure-based cognitive-behavioral treatment in panic disorder

Directory of Open Access Journals (Sweden)

Bergström Jan

2010-11-01

Full Text Available Abstract Background Cognitive behavioral therapy (CBT represents a learning process leading to symptom relief and resulting in long-term changes in behavior. CBT for panic disorder is based on exposure and exposure-based processes can be studied in the laboratory as extinction of experimentally acquired fear responses. We have recently demonstrated that the ability to extinguish learned fear responses is associated with a functional genetic polymorphism (COMTval158met in the COMT gene and this study was aimed at transferring the experimental results on the COMTval158met polymorphism on extinction into a clinical setting. Methods We tested a possible effect of the COMTval158met polymorphism on the efficacy of CBT, in particular exposure-based treatment modules, in a sample of 69 panic disorder patients. Results We present evidence that panic patients with the COMTval158met met/met genotype may profit less from (exposure-based CBT treatment methods as compared to patients carrying at least one val-allele. No association was found with the 5-HTTLPR/rs25531 genotypes which is presented as additional material. Conclusions We were thus able to transfer findings on the effect of the COMTval158met polymorphism from an experimental extinction study obtained using healthy subjects to a clinical setting. Furthermore patients carrying a COMT val-allele tend to report more anxiety and more depression symptoms as compared to those with the met/met genotype. Limitations of the study as well as possible clinical implications are discussed. Trial registration Clinical Trial Registry name: Internet-Versus Group-Administered Cognitive Behavior Therapy for Panic Disorder (IP2. Registration Identification number: NCT00845260, http://www.clinicaltrials.gov/ct2/show/NCT00845260

The work-averse cyber attacker model : theory and evidence from two million attack signatures

NARCIS (Netherlands)

Allodi, L.; Massacci, F.; Williams, J.

The typical cyber attacker is assumed to be all powerful and to exploit all possible vulnerabilities. In this paper we present, and empirically validate, a novel and more realistic attacker model. The intuition of our model is that an attacker will optimally choose whether to act and weaponize a new

rCBF differences between panic disorder patients and control subjects during anticipatory anxiety and rest

NARCIS (Netherlands)

Boshuisen, ML; Ter Horst, GJ; Paans, AMJ; Reinders, AATS; den Boer, JA

2002-01-01

Background: Our goal was to identify brain structures involved in anticipatory anxiety in panic disorder (PD) patients compared to control subjects. Methods: Seventeen PD patients and 21 healthy control subjects were studied with H, 150 positron emission oil tomography scan, before and after a

Web server attack analyzer

OpenAIRE

Mižišin, Michal

2013-01-01

Web server attack analyzer - Abstract The goal of this work was to create prototype of analyzer of injection flaws attacks on web server. Proposed solution combines capabilities of web application firewall and web server log analyzer. Analysis is based on configurable signatures defined by regular expressions. This paper begins with summary of web attacks, followed by detection techniques analysis on web servers, description and justification of selected implementation. In the end are charact...

Panic Disorder: When Fear Overwhelms

Science.gov (United States)

... Download ePub Order a free hardcopy En Español Introduction Do you sometimes have sudden attacks of anxiety ... and our publications may not be used for advertising or endorsement purposes. NIMH does not provide specific ...

Network Protection Against DDoS Attacks

Directory of Open Access Journals (Sweden)

Petr Dzurenda

2015-03-01

Full Text Available The paper deals with possibilities of the network protection against Distributed Denial of Service attacks (DDoS. The basic types of DDoS attacks and their impact on the protected network are presented here. Furthermore, we present basic detection and defense techniques thanks to which it is possible to increase resistance of the protected network or device against DDoS attacks. Moreover, we tested the ability of current commercial Intrusion Prevention Systems (IPS, especially Radware DefensePro 6.10.00 product against the most common types of DDoS attacks. We create five scenarios that are varied in type and strength of the DDoS attacks. The attacks intensity was much greater than the normal intensity of the current DDoS attacks.

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......Attacks on systems and organisations increasingly exploit human actors, for example through social engineering, complicating their formal treatment and automatic identification. Formalisation of human behaviour is difficult at best, and attacks on socio-technical systems are still mostly identified...... on invalidating policies in the system model by identifying possible sequences of actions that lead to an attack. The generated attacks are precise enough to illustrate the threat, and they are general enough to hide the details of individual steps....

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.

Voice Based City Panic Button System

Science.gov (United States)

Febriansyah; Zainuddin, Zahir; Bachtiar Nappu, M.

2018-03-01

The development of voice activated panic button application aims to design faster early notification of hazardous condition in community to the nearest police by using speech as the detector where the current application still applies touch-combination on screen and use coordination of orders from control center then the early notification still takes longer time. The method used in this research was by using voice recognition as the user voice detection and haversine formula for the comparison of closest distance between the user and the police. This research was equipped with auto sms, which sent notification to the victim’s relatives, that was also integrated with Google Maps application (GMaps) as the map to the victim’s location. The results show that voice registration on the application reaches 100%, incident detection using speech recognition while the application is running is 94.67% in average, and the auto sms to the victim relatives reaches 100%.

Terrorists and Suicide Attacks

National Research Council Canada - National Science Library

Cronin, Audrey K

2003-01-01

Suicide attacks by terrorist organizations have become more prevalent globally, and assessing the threat of suicide attacks against the United States and its interests at home and abroad has therefore...

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

Panic disorder and the respiratory system: clinical subtype and challenge tests Transtorno do pânico e sistema respiratório: subtipo clínico e testes de provocação

Directory of Open Access Journals (Sweden)

Rafael C. Freire

2012-06-01

Full Text Available INTRODUCTION: Respiratory changes are associated with anxiety disorders, particularly panic disorder (PD. The stimulation of respiration in PD patients during panic attacks is well documented in the literature, and a number of abnormalities in respiration, such as enhanced CO2 sensitivity, have been detected in PD patients. Investigators hypothesized that there is a fundamental abnormality in the physiological mechanisms that control breathing in PD. METHODS: The authors searched for articles regarding the connection between the respiratory system and PD, more specifically papers on respiratory challenges, respiratory subtype, and current mechanistic concepts. CONCLUSIONS: Recent evidences support the presence of subclinical changes in respiration and other functions related to body homeostasis in PD patients. The fear network, comprising the hippocampus, medial prefrontal cortex, amygdala and its brainstem projections, may be abnormally sensitive in PD patients, and respiratory stimulants like CO2 may trigger panic attacks. Studies indicate that PD patients with dominant respiratory symptoms are particularly sensitive to respiratory tests compared to those who do not manifest dominant respiratory symptoms, representing a distinct subtype. The evidence of changes in several neurochemical systems might be the expression of the complex interaction among brain circuitsINTRODUÇÃO: As anormalidades respiratórias estão associadas a transtornos de ansiedade, especialmente ao transtorno do pânico (TP. A estimulação respiratória em pacientes com TP durante os ataques de pânico está bem documentada na literatura, e vários problemas respiratórios como uma elevada sensibilidade ao CO2 foram detectados em pacientes com TP. Os pesquisadores levantam a hipótese de que existe um distúrbio fundamental nos mecanismos fisiológicos que controlam a respiração no TP. MÉTODOS: Os autores pesquisaram artigos sobre a conexão entre o sistema respirat

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

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 ...

Investigating the Possibility to Individualize Asthma Attack Therapy Based on Attack Severity and Patient Characteristics

Directory of Open Access Journals (Sweden)

Sárkány Zoltán

2016-03-01

Full Text Available Introduction: The objective of this study was to investigate with the help of a computerized simulation model whether the treatment of an acute asthma attack can be individualized based on the severity of the attack and the characteristics of the patient. Material and Method: A stochastic lung model was used to simulate the deposition of 1 nm - 10 μm particles during a mild and a moderate asthma attack. Breathing parameters were varied to maximize deposition, and simulation results were compared with those obtained in the case of a severe asthma attack. In order to investigate the effect of height on the deposition of inhaled particles, another series of simulations was carried out with identical breathing parameters, comparing patient heights of 155 cm, 175 cm and 195 cm. Results: The optimization process yielded an increase in the maximum deposition values of around 6-7% for each type of investigated asthma attack, and the difference between attacks of different degree of severity was around 5% for both the initial and the optimized values, a higher degree of obstruction increasing the amount of deposited particles. Conclusions: Our results suggest that the individualization of asthma attack treatment cannot be based on particles of different size, as the highest deposited fraction in all three types of attacks can be obtained using 0.01 μm particles. The use of a specific set of breathing parameters yields a difference between a mild and a moderate, as well as a moderate and a severe asthma attack of around 5%.

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…

[MRI for brain structure and function in patients with first-episode panic disorder].

Science.gov (United States)

Zhang, Yan; Duan, Lian; Liao, Mei; Yang, Fan; Liu, Jun; Shan, Baoci; Li, Lingjiang

2011-12-01

To determine the brain function and structure in patinets with first-episode panic disorder (PD). All subjects (24 PD patients and 24 healthy subjects) received MRI scan and emotional counting Stroop task during the functional magnetic resonance imaging. Blood oxygenation level dependent functional magnetic resonance imaging and voxel-based morphometric technology were used to detect the gray matter volume. Compared with the healthy controls, left thalamus, left medial frontal gyrus, left anterior cingulate gyrus, left inferior frontal gyrus, left insula (panic-related words vs. neutral words) lacked activation in PD patients, but the over-activation were found in right brain stem, right occipital lobe/lingual gyrus in PD patients. Compared with the healthy controls, the gray matter volume in the PD patients significantly decreased in the left superior temporal gyrus, right medial frontal gyrus, left medial occipital gyrus, dorsomedial nucleus of left thalamus and right anterior cingulate gyrus. There was no significantly increased gray matter volume in any brain area in PD patients. PD patients have selective attentional bias in processing threatening information due to the depression and weakening of the frontal cingulated gyrus.

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

Effects of baseline problematic alcohol and drug use on internet-based cognitive behavioral therapy outcomes for depression, panic disorder and social anxiety disorder.

Directory of Open Access Journals (Sweden)

Mikael Gajecki

Full Text Available PURPOSE: Patients' problematic substance use prevalence and effects were explored in relation to internet-based cognitive behavioral therapy (ICBT outcomes for depression, panic disorder and social anxiety disorder. METHODS: At baseline and treatment conclusion, 1601 ICBT patients were assessed with self-rated measures for alcohol and drug use (AUDIT/DUDIT, depressive symptoms (MADRS-S, panic disorder symptoms (PDSS-SR and social anxiety symptoms (LSAS-SR. RESULTS: Problematic substance use (AUDIT ≥ 8 for men, ≥ 6 for women; DUDIT ≥ 1 occurred among 32.4% of the patients; 24.1% only alcohol, 4.6% only drugs, and 3.7% combined alcohol and drug use. Hazardous alcohol use and probable alcohol dependence negatively affected panic disorder outcomes, and hazardous drug use led to worse social anxiety outcomes. Depression outcomes were not affected by substance use. Treatment adherence was negatively affected by problematic drug use among men and 25-34 year olds; combined substance use negatively affected adherence for women and 35-64 year olds. CONCLUSION: Problematic substance use does not preclude ICBT treatment but can worsen outcomes, particularly problematic alcohol use for panic disorder patients and hazardous drug use for social anxiety patients. ICBT clinicians should exercise particular caution when treating men and younger patients with problematic drug use, and women or older patients with combined substance use.

Pericarditis - after heart attack

Science.gov (United States)

... include: A previous heart attack Open heart surgery Chest trauma A heart attack that has affected the thickness of your heart muscle Symptoms Symptoms include: Anxiety Chest pain from the swollen pericardium rubbing on the ...

The effect of fear on paralinguistic aspects of speech in patients with panic disorder with agoraphobia

NARCIS (Netherlands)

Hagenaars, M.A.; Minnen, A. van

2005-01-01

The present study investigated the effect of fear on paralinguistic aspects of speech in patients suffering from panic disorder with agoraphobia (N = 25). An experiment was conducted that comprised two modules: Autobiographical Talking and Script Talking. Each module consisted of two emotional

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.

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...... AES or similar algorithms in virtualized environments. This paper applies variants of this cache timing attack to Intel's latest generation of microprocessors. It enables a spy-process to recover cryptographic keys, interacting with the victim processes only over TCP. The threat model is a logically...... separated but CPU co-located attacker with root privileges. We report successful and practically verified applications of this attack against a wide range of microarchitectures, from a two-core Nehalem processor (i5-650) to two-core Haswell (i7-4600M) and four-core Skylake processors (i7-6700). The attack...

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...

[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, R(2)=.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.

Forensics Investigation of Web Application Security Attacks

OpenAIRE

Amor Lazzez; Thabet Slimani

2015-01-01

Nowadays, web applications are popular targets for security attackers. Using specific security mechanisms, we can prevent or detect a security attack on a web application, but we cannot find out the criminal who has carried out the security attack. Being unable to trace back an attack, encourages hackers to launch new attacks on the same system. Web application forensics aims to trace back and attribute a web application security attack to its originator. This may significantly reduce the sec...

SECOND-STAGE TREATMENTS FOR RELATIVE NONRESPONDERS TO COGNITIVE BEHAVIORAL THERAPY (CBT) FOR PANIC DISORDER WITH OR WITHOUT AGORAPHOBIA-CONTINUED CBT VERSUS SSRI: A RANDOMIZED CONTROLLED TRIAL.

Science.gov (United States)

Payne, Laura A; White, Kamila S; Gallagher, Matthew W; Woods, Scott W; Shear, M Katherine; Gorman, Jack M; Farchione, Todd J; Barlow, David H

2016-05-01

Cognitive behavioral therapy (CBT) and pharmacotherapy are efficacious for the short-term treatment of panic disorder. Less is known about the efficacy of these therapies for individuals who do not respond fully to short-term CBT. The current trial is a second-step stratified randomized design comparing two treatment conditions-selective serotonin reuptake inhibitor (SSRI; paroxetine or citalopram; n = 34) and continued CBT (n = 24)-in a sample of individuals classified as treatment nonresponders to an initial course of CBT for panic disorder. Participants were randomized to 3 months of treatment and then followed for an additional 9 months. Only treatment responders after 3 months were maintained on the treatment until 12-month follow-up. Data analysis focused on panic disorder symptoms and achievement of response status across the first 3 months of treatment. Final follow-up data are presented descriptively. Participants in the SSRI condition showed significantly lower panic disorder symptoms as compared to continued CBT at 3 months. Results were similar when excluding individuals with comorbid major depression or analyzing the entire intent-to-treat sample. Group differences disappeared during 9-month naturalistic follow-up, although there was significant attrition and use of nonstudy therapies in both arms. These data suggest greater improvement in panic disorder symptoms when switching to SSRI after failure to fully respond to an initial course of CBT. Future studies should further investigate relapse following treatment discontinuation for nonresponders who became responders. Clinicaltrials.gov Identifier: NCT00000368; https://clinicaltrials.gov/show/NCT00000368. © 2015 Wiley Periodicals, Inc.

Adaptive cyber-attack modeling system

Science.gov (United States)

Gonsalves, Paul G.; Dougherty, Edward T.

2006-05-01

The pervasiveness of software and networked information systems is evident across a broad spectrum of business and government sectors. Such reliance provides an ample opportunity not only for the nefarious exploits of lone wolf computer hackers, but for more systematic software attacks from organized entities. Much effort and focus has been placed on preventing and ameliorating network and OS attacks, a concomitant emphasis is required to address protection of mission critical software. Typical software protection technique and methodology evaluation and verification and validation (V&V) involves the use of a team of subject matter experts (SMEs) to mimic potential attackers or hackers. This manpower intensive, time-consuming, and potentially cost-prohibitive approach is not amenable to performing the necessary multiple non-subjective analyses required to support quantifying software protection levels. To facilitate the evaluation and V&V of software protection solutions, we have designed and developed a prototype adaptive cyber attack modeling system. Our approach integrates an off-line mechanism for rapid construction of Bayesian belief network (BN) attack models with an on-line model instantiation, adaptation and knowledge acquisition scheme. Off-line model construction is supported via a knowledge elicitation approach for identifying key domain requirements and a process for translating these requirements into a library of BN-based cyber-attack models. On-line attack modeling and knowledge acquisition is supported via BN evidence propagation and model parameter learning.

Predicting Factors of Zone 4 Attack in Volleyball.

Science.gov (United States)

Costa, Gustavo C; Castro, Henrique O; Evangelista, Breno F; Malheiros, Laura M; Greco, Pablo J; Ugrinowitsch, Herbert

2017-06-01

This study examined 142 volleyball games of the Men's Super League 2014/2015 seasons in Brazil from which we analyzed 24-26 games of each participating team, identifying 5,267 Zone 4 attacks for further analysis. Within these Zone 4 attacks, we analyzed the association between the effect of the attack carried out and the separate effects of serve reception, tempo and type of attack. We found that the reception, tempo of attack, second tempo of attack, and power of diagonal attack were predictors of the attack effect in Zone 4. Moreover, placed attacks showed a tendency to not yield a score. In conclusion, winning points in high-level men's volleyball requires excellent receptions, a fast attack tempo and powerfully executed of attacks.

Risk factors for DSM 5 PTSD symptoms in Israeli civilians during the Gaza war.

Science.gov (United States)

Gil, Sharon; Weinberg, Michael; Or-Chen, Keren; Harel, Hila

2015-04-01

In light of the current modifications presented in the diagnostic criteria of posttraumatic stress disorder (PTSD) in the DSM 5, this study aimed at revalidating well-known PTSD risk factors, including gender, peritraumatic dissociation, social support, level of threat, and trait tendency for forgiveness. Five hundred and one Israeli civilians were assessed during real-time exposure to missile and rocket fire at the eruption of the Gaza war. Assessments took place approximately one to 2 weeks after the beginning of this military operation, relying on web administration of the study, which allowed simultaneous data collection from respondents in the three regions in Israel that were under attack. A structural equation model design revealed that higher levels of forgiveness toward situations were associated with fewer PTSD symptoms, whereas peritraumatic dissociation and high levels of objective and subjective threat were positively associated with PTSD symptoms. Additionally, females were at higher risk for PTSD symptoms than males. The findings of this study provide further evidence for the importance of directing preventive attention to those vulnerable to the development of elevated levels of PTSD symptoms. Theoretical and clinical implications of the findings are discussed.

The Anxiolytic Properties of Vernonia Amygdalina

African Journals Online (AJOL)

Dr Olaleye

itself in form of phobia, panic attacks, post‐traumatic stress disorder, social anxiety disorder or generalized anxiety disorder. Moreover ... MATERIALS AND METHODS. Plant preparation ... like behavior in laboratory animals. The apparatus is.

Attack Potential Evaluation in Desktop and Smartphone Fingerprint Sensors: Can They Be Attacked by Anyone?

Directory of Open Access Journals (Sweden)

Ines Goicoechea-Telleria

2018-01-01

Full Text Available The use of biometrics keeps growing. Every day, we use biometric recognition to unlock our phones or to have access to places such as the gym or the office, so we rely on the security manufacturers offer when protecting our privileges and private life. It is well known that it is possible to hack into a fingerprint sensor using fake fingers made of Play-Doh and other easy-to-obtain materials but to what extent? Is this true for all users or only for specialists with a deep knowledge on biometrics? Are smartphone fingerprint sensors as reliable as desktop sensors? To answer these questions, we performed 3 separate evaluations. First, we evaluated 4 desktop fingerprint sensors of different technologies by attacking them with 7 different fake finger materials. All of them were successfully attacked by an experienced attacker. Secondly, we carried out a similar test on 5 smartphones with embedded sensors using the most successful materials, which also hacked the 5 sensors. Lastly, we gathered 15 simulated attackers with no background in biometrics to create fake fingers of several materials, and they had one week to attack the fingerprint sensors of the same 5 smartphones, with the starting point of a short video with the techniques to create them. All 5 smartphones were successfully attacked by an inexperienced attacker. This paper will provide the results achieved, as well as an analysis on the attack potential of every case. All results are given following the metrics of the standard ISO/IEC 30107-3.

Managing burn victims of suicide bombing attacks: outcomes, lessons learnt, and changes made from three attacks in Indonesia.

Science.gov (United States)

Chim, Harvey; Yew, Woon Si; Song, Colin

2007-01-01

Terror attacks in Southeast Asia were almost nonexistent until the 2002 Bali bomb blast, considered the deadliest attack in Indonesian history. Further attacks in 2003 (Jakarta), 2004 (Jakarta), and 2005 (Bali) have turned terrorist attacks into an ever-present reality. The authors reviewed medical charts of victims evacuated to the Singapore General Hospital (SGH) Burns Centre during three suicide attacks involving Bali (2002 and 2005) and the Jakarta Marriott hotel (2003). Problems faced, lessons learnt, and costs incurred are discussed. A burns disaster plan drawing on lessons learnt from these attacks is presented. Thirty-one patients were treated at the SGH Burns Centre in three attacks (2002 Bali attack [n = 15], 2003 Jakarta attack [n = 14], and 2005 Bali attack [n = 2]). For the 2002 Bali attack, median age was 29 years (range 20 to 50 years), median percentage of total burn surface area (TBSA) was 29% (range 5% to 55%), and median abbreviated burn severity index (ABSI) was 6 (range 3 to 10). Eight of 15 patients were admitted to the intensive care unit. For the 2003 Jakarta attack, median age was 35 years (range 24 to 56 years), median percentage of TBSA was 10% (range 2% to 46%), and median ABSI was 4 (range 3 to 9). A large number of patients had other injuries. Problems faced included manpower issues, lack of bed space, shortage of blood products, and lack of cadaver skin. The changing nature of terror attacks mandates continued vigilance and disaster preparedness. The multidimensional burns patient, complicated by other injuries, is likely to become increasingly common. A burns disaster plan with emphasis on effective command, control, and communication as well as organisation of health care personnel following a 'team concept' will do much to ensure that the sudden onset of a crisis situation at an unexpected time does not overwhelm hospital manpower and resources.

Overview of DOS attacks on wireless sensor networks and experimental results for simulation of interference attacks

Directory of Open Access Journals (Sweden)

Željko Gavrić

2018-01-01

Full Text Available Wireless sensor networks are now used in various fields. The information transmitted in the wireless sensor networks is very sensitive, so the security issue is very important. DOS (denial of service attacks are a fundamental threat to the functioning of wireless sensor networks. This paper describes some of the most common DOS attacks and potential methods of protection against them. The case study shows one of the most frequent attacks on wireless sensor networks – the interference attack. In the introduction of this paper authors assume that the attack interference can cause significant obstruction of wireless sensor networks. This assumption has been proved in the case study through simulation scenario and simulation results.

Securing internet by eliminating DDOS attacks

Science.gov (United States)

Niranchana, R.; Gayathri Devi, N.; Santhi, H.; Gayathri, P.

2017-11-01

The major threat caused to the authorised usage of Internet is Distributed Denial of Service attack. The mechanisms used to prevent the DDoS attacks are said to overcome the attack’s ability in spoofing the IP packets source addresses. By utilising Internet Protocol spoofing, the attackers cause a consequential load over the networks destination for policing attack packets. To overcome the IP Spoofing level on the Internet, We propose an Inter domain Packet Filter (IPF) architecture. The proposed scheme is not based on global routing information. The packets with reliable source addresses are not rejected, the IPF frame work works in such a manner. The spoofing capability of attackers is confined by IPF, and also the filter identifies the source of an attack packet by minimal number of candidate network.

Plants under dual attack

NARCIS (Netherlands)

Ponzio, C.A.M.

2016-01-01

Though immobile, plants are members of complex environments, and are under constant threat from a wide range of attackers, which includes organisms such as insect herbivores or plant pathogens. Plants have developed sophisticated defenses against these attackers, and include chemical responses

New attacks on Wi-Fi Protected Setup

OpenAIRE

Hamed Mohtadi; Alireza Rahimi

2015-01-01

Wi-Fi Protected Setup (WPS) is a network security standard that is used to secure networks in home and office, introduced in 2006 by the Wi-Fi Alliance. It provides easier configuration setup and is used in almost all recent Wi-Fi devices. In this paper we propose two attacks on this standard. The first attack is an offline brute force attack that uses imbalance on registration protocol. This attack needs user action, but it is more efficient than previous attacks. The second attack uses weak...

A Game Theoretic Approach to Cyber Attack Prediction

Energy Technology Data Exchange (ETDEWEB)

Peng Liu

2005-11-28

The area investigated by this project is cyber attack prediction. With a focus on correlation-based prediction, current attack prediction methodologies overlook the strategic nature of cyber attack-defense scenarios. As a result, current cyber attack prediction methodologies are very limited in predicting strategic behaviors of attackers in enforcing nontrivial cyber attacks such as DDoS attacks, and may result in low accuracy in correlation-based predictions. This project develops a game theoretic framework for cyber attack prediction, where an automatic game-theory-based attack prediction method is proposed. Being able to quantitatively predict the likelihood of (sequences of) attack actions, our attack prediction methodology can predict fine-grained strategic behaviors of attackers and may greatly improve the accuracy of correlation-based prediction. To our best knowledge, this project develops the first comprehensive framework for incentive-based modeling and inference of attack intent, objectives, and strategies; and this project develops the first method that can predict fine-grained strategic behaviors of attackers. The significance of this research and the benefit to the public can be demonstrated to certain extent by (a) the severe threat of cyber attacks to the critical infrastructures of the nation, including many infrastructures overseen by the Department of Energy, (b) the importance of cyber security to critical infrastructure protection, and (c) the importance of cyber attack prediction to achieving cyber security.

Cushing's Support and Research Foundation

Science.gov (United States)

... high blood pressure, type II diabetes, polycystic ovarian syndrome, endometriosis, obesity, adult acne, metabolic disease, and panic attacks, but not Cushing's. After diagnosis and treatment, my weight is back to normal, and I ...

Invisible Trojan-horse attack

DEFF Research Database (Denmark)

Sajeed, Shihan; Minshull, Carter; Jain, Nitin

2017-01-01

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...

Script-viruses Attacks on UNIX OS

Directory of Open Access Journals (Sweden)

D. M. Mikhaylov

2010-06-01

Full Text Available In this article attacks on UNIX OS are considered. Currently antivirus developers are concentrated on protecting systems from viruses that are most common and attack popular operating systems. If the system or its components are not often attacked then the antivirus products are not protecting these components as it is not profitable. The same situation is with script-viruses for UNIX OS as most experts consider that it is impossible for such viruses to get enough rights to attack. Nevertheless the main conclusion of this article is the fact that such viruses can be very powerful and can attack systems and get enough rights.

Dor torácica no transtorno de pânico: sintoma somático ou manifestação de doença arterial coronariana? Chest pain and panic disorder: physical symptom or coronary heart disease presentation?

Directory of Open Access Journals (Sweden)

Gastão Luiz Fonseca Soares Filho

2007-01-01

Full Text Available O transtorno do pânico (TP pertence ao grupo dos transtornos de ansiedade caracterizado por repetidos e inesperados ataques de pânico, nos quais predominam os sintomas somáticos e intensa apreensão relacionada à idéia de perda de controle ou morte iminente. Entre os sintomas somáticos que o paciente pode apresentar, a dor torácica exerce papel preponderante, reforçando a idéia de que ele esteja desenvolvendo problema cardiovascular grave, ameaçador à vida, levando à repetida busca por atendimento em unidades cardiológicas ou outros serviços de emergência. A isquemia miocárdica desenvolve-se quando o fluxo de sangue coronariano se torna inadequado para alcançar as exigências metabólicas miocárdicas e manter a função cardíaca adequada. Sua principal causa é a doença arterial coronariana (DAC e a mais comum manifestação clínica da isquemia miocárdica é a dor torácica. Este relato de caso ilustra a comorbidade do TP com a DAC, discutindo como lidar com essa complexa situação clínica. O diagnóstico de transtorno de pânico raramente é feito e graves conseqüências podem decorrer disso, inclusive na evolução do transtorno psiquiátrico.Panic disorder is a mental disorder that belongs to the group of the anxiety disorders, characterized by repeated and unexpected panic attacks, in which the somatic symptoms are associated to intense apprehension related to the idea of "loosing control" or an imminent death sensation. Amongst somatic symptoms that patients can present, chest pain plays an important role, reinforcing the idea that the patient is threatened by a serious cardiovascular problem, leading to repeated search for attendance in cardiologic or other emergency rooms. Myocardial ischemia develops when coronary blood flow becomes inadequate to meet the requirements of the myocardium for oxygen and metabolic substrates to maintain adequate cardiac function. Coronary stenosis is considered the main cause of

Is the efficacy of antidepressants in panic disorder mediated by adverse events? A mediational analysis.

Directory of Open Access Journals (Sweden)

Irene Bighelli

Full Text Available It has been hypothesised that the perception of adverse events in placebo-controlled antidepressant clinical trials may induce patients to conclude that they have been randomized to the active arm of the trial, leading to the breaking of blind. This may enhance the expectancies for improvement and the therapeutic response. The main objective of this study is to test the hypothesis that the efficacy of antidepressants in panic disorder is mediated by the perception of adverse events. The present analysis is based on a systematic review of published and unpublished randomised trials comparing antidepressants with placebo for panic disorder. The Baron and Kenny approach was applied to investigate the mediational role of adverse events in the relationship between antidepressants treatment and efficacy. Fourteen placebo-controlled antidepressants trials were included in the analysis. We found that: (a antidepressants treatment was significantly associated with better treatment response (ß = 0.127, 95% CI 0.04 to 0.21, p = 0.003; (b antidepressants treatment was not associated with adverse events (ß = 0.094, 95% CI -0.05 to 0.24, p = 0.221; (c adverse events were negatively associated with treatment response (ß = 0.035, 95% CI -0.06 to -0.05, p = 0.022. Finally, after adjustment for adverse events, the relationship between antidepressants treatment and treatment response remained statistically significant (ß = 0.122, 95% CI 0.01 to 0.23, p = 0.039. These findings do not support the hypothesis that the perception of adverse events in placebo-controlled antidepressant clinical trials may lead to the breaking of blind and to an artificial inflation of the efficacy measures. Based on these results, we argue that the moderate therapeutic effect of antidepressants in individuals with panic disorder is not an artefact, therefore reflecting a genuine effect that doctors can expect to replicate under real-world conditions.

Deporting "Ah Sin" to save the white race: moral panic, racialization, and the extension of Canadian drug laws in the 1920s.

Science.gov (United States)

Carstairs, C

1999-01-01

This article argues that a Vancouver anti-drug campaign was critical to the extension of Canada's drug laws in the early 1920s. The highly racialized drug panic resulted in extraordinarily severe drug legislation including six-month sentences for possession. This had particularly devastating effects on Chinese-Canadians who were targeted by enforcement officials and faced the possibility of deportation. However, the drug panic also affected drug users of all backgrounds who for long afterwards faced lengthy sentences for possession as well as civil liberties violations such as extraordinary search legislation and restrictions on the right to an appeal.

Hybrid attacks on model-based social recommender systems

Science.gov (United States)

Yu, Junliang; Gao, Min; Rong, Wenge; Li, Wentao; Xiong, Qingyu; Wen, Junhao

2017-10-01

With the growing popularity of the online social platform, the social network based approaches to recommendation emerged. However, because of the open nature of rating systems and social networks, the social recommender systems are susceptible to malicious attacks. In this paper, we present a certain novel attack, which inherits characteristics of the rating attack and the relation attack, and term it hybrid attack. Furtherly, we explore the impact of the hybrid attack on model-based social recommender systems in multiple aspects. The experimental results show that, the hybrid attack is more destructive than the rating attack in most cases. In addition, users and items with fewer ratings will be influenced more when attacked. Last but not the least, the findings suggest that spammers do not depend on the feedback links from normal users to become more powerful, the unilateral links can make the hybrid attack effective enough. Since unilateral links are much cheaper, the hybrid attack will be a great threat to model-based social recommender systems.

Preliminary Validation of a Screening Tool for Adolescent Panic Disorder in Pediatric Primary Care Clinics

Science.gov (United States)

Queen, Alexander H.; Ehrenreich-May, Jill; Hershorin, Eugene R.

2012-01-01

This study examines the validity of a brief screening tool for adolescent panic disorder (PD) in a primary care setting. A total of 165 participants (ages 12-17 years) seen in two pediatric primary care clinics completed the Autonomic Nervous System Questionnaire (ANS; Stein et al. in Psychosomatic Med 61:359-364, 40). A subset of those screening…

[An exploratory study of 'blended' cognitive behavioural therapy (CBT) for patients with a panic disorder: results and patients' experiences].

Science.gov (United States)

Bruinsma, A; Kampman, M; Exterkate, C C; Hendriks, G J

2016-01-01

Digital technology (e-health or 'blended' care), combined with evidence-based face-to-face CBT, is becoming increasingly implemented into mental health care and is expected to result in improved effectiveness and efficiency. To explore the feasibility of blended CBT for patients with a panic disorder. Nine face-to-face sessions of blended CBT (n = 18), supplemented with the digital support of a tabletcomputer and three e-mail contacts, were compared with 12 weekly sessions of regular CBT (n = 18). Primary outcomes were panic frequency and avoidance behaviour; the secondary outcome was general functioning. Patients' experiences of the treatment were collected in the form of a structured interview. The effect sizes found in both the regular and the blended CBT were medium to high (Cohen's d 0.42-1.60). In both types of treatment there was a significant reduction in patients' symptoms. There were no big differences in patient satisfaction regarding the treatment received. The therapists registered 39 face-to-face minutes in the blended treatment but they registered in total 41 fewer face-to-face minutes; this represented a time reduction of 4%. Blended CBT with help of a tablet computer seems to be a suitable method for treating panic disorder psychologically, although the time saved is only moderate. Much more research is needed to ascertain the feasibility and the cost effectiveness of blended CBT.

Pan, Syrinx and syringomyelia.

Science.gov (United States)

Palacios-Sánchez, Leonardo; Botero-Meneses, Juan Sebastián; Vélez-Flórez, María Camila

2017-12-01

Many myths and legends have had a deep influence on modern language, and on modern medical vernacular. The terms "syrinx" and "panic"are two of the most characteristic examples and their use in neurology and other specialties is well known. This article reviews the history of these words in Greek mythology and their use in modern medicine. It is known by very few that clinical symptoms or conditions, such as syringomyelia and panic attacks, have a mythological origin in their definition and naming.

An Analysis of Attacks on Blockchain Consensus

OpenAIRE

Bissias, George; Levine, Brian Neil; Ozisik, A. Pinar; Andresen, Gavin

2016-01-01

We present and validate a novel mathematical model of the blockchain mining process and use it to conduct an economic evaluation of the double-spend attack, which is fundamental to all blockchain systems. Our analysis focuses on the value of transactions that can be secured under a conventional double-spend attack, both with and without a concurrent eclipse attack. Our model quantifies the importance of several factors that determine the attack's success, including confirmation depth, attacke...

Automated classification of computer network attacks

CSIR Research Space (South Africa)

Van Heerden, R

2013-11-01

Full Text Available according to the relevant types of attack scenarios depicted in the ontology. The two network attack instances are the Distributed Denial of Service attack on SpamHaus in 2013 and the theft of 42 million Rand ($6.7 million) from South African Postbank...

Cyber Attacks and Combat Behavior

Directory of Open Access Journals (Sweden)

Carataș Maria Alina

2017-01-01

Full Text Available Cyber terrorism is an intangible danger, a real over the corner threat in the life of individuals,organizations, and governments and is getting harder to deal with its damages. The motivations forthe cyber-attacks are different, depending on the terrorist group, from cybercrime to hacktivism,attacks over the authorities’ servers. Organizations constantly need to find new ways ofstrengthening protection against cyber-attacks, assess their cyber readiness, expand the resiliencecapacity and adopts international security regulations.

Attacks on public telephone networks: technologies and challenges

Science.gov (United States)

Kosloff, T.; Moore, Tyler; Keller, J.; Manes, Gavin W.; Shenoi, Sujeet

2003-09-01

Signaling System 7 (SS7) is vital to signaling and control in America's public telephone networks. This paper describes a class of attacks on SS7 networks involving the insertion of malicious signaling messages via compromised SS7 network components. Three attacks are discussed in detail: IAM flood attacks, redirection attacks and point code spoofing attacks. Depending on their scale of execution, these attacks can produce effects ranging from network congestion to service disruption. Methods for detecting these denial-of-service attacks and mitigating their effects are also presented.

Defense and attack of complex and dependent systems

International Nuclear Information System (INIS)

Hausken, Kjell

2010-01-01

A framework is constructed for how to analyze the strategic defense of an infrastructure subject to attack by a strategic attacker. Merging operations research, reliability theory, and game theory for optimal analytical impact, the optimization program for the defender and attacker is specified. Targets can be in parallel, series, combined series-parallel, complex, k-out-of-n redundancy, independent, interdependent, and dependent. The defender and attacker determine how much to invest in defending versus attacking each of multiple targets. A target can have economic, human, and symbolic values, subjectively assessed by the defender and attacker. A contest success function determines the probability of a successful attack on each target, dependent on the investments by the defender and attacker into each target, and on characteristics of the contest. The defender minimizes the expected damage plus the defense costs. The attacker maximizes the expected damage minus the attack costs. Each agent is concerned about how his investments vary across the targets, and the impact on his utilities. Interdependent systems are analyzed where the defense and attack on one target impacts all targets. Dependent systems are analyzed applying Markov analysis and repeated games where a successful attack on one target in the first period impacts the unit costs of defense and attack, and the contest intensity, for the other target in the second period.

Defense and attack of complex and dependent systems

Energy Technology Data Exchange (ETDEWEB)

Hausken, Kjell, E-mail: kjell.hausken@uis.n [Faculty of Social Sciences, University of Stavanger, N-4036 Stavanger (Norway)

2010-01-15

A framework is constructed for how to analyze the strategic defense of an infrastructure subject to attack by a strategic attacker. Merging operations research, reliability theory, and game theory for optimal analytical impact, the optimization program for the defender and attacker is specified. Targets can be in parallel, series, combined series-parallel, complex, k-out-of-n redundancy, independent, interdependent, and dependent. The defender and attacker determine how much to invest in defending versus attacking each of multiple targets. A target can have economic, human, and symbolic values, subjectively assessed by the defender and attacker. A contest success function determines the probability of a successful attack on each target, dependent on the investments by the defender and attacker into each target, and on characteristics of the contest. The defender minimizes the expected damage plus the defense costs. The attacker maximizes the expected damage minus the attack costs. Each agent is concerned about how his investments vary across the targets, and the impact on his utilities. Interdependent systems are analyzed where the defense and attack on one target impacts all targets. Dependent systems are analyzed applying Markov analysis and repeated games where a successful attack on one target in the first period impacts the unit costs of defense and attack, and the contest intensity, for the other target in the second period.

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......-prone and impracticable for large systems. Nonetheless, the automated generation of attack trees has only been explored in connection to computer networks and levering rich models, whose analysis typically leads to an exponential blow-up of the state space. We propose a static analysis approach where attack trees...... are automatically inferred from a process algebraic specification in a syntax-directed fashion, encompassing a great many application domains and avoiding incurring systematically an exponential explosion. Moreover, we show how the standard propositional denotation of an attack tree can be used to phrase...

Pareto Efficient Solutions of Attack-Defence Trees

DEFF Research Database (Denmark)

Aslanyan, Zaruhi; Nielson, Flemming

2015-01-01

Attack-defence trees are a promising approach for representing threat scenarios and possible countermeasures in a concise and intuitive manner. An attack-defence tree describes the interaction between an attacker and a defender, and is evaluated by assigning parameters to the nodes, such as proba......Attack-defence trees are a promising approach for representing threat scenarios and possible countermeasures in a concise and intuitive manner. An attack-defence tree describes the interaction between an attacker and a defender, and is evaluated by assigning parameters to the nodes......, such as probability or cost of attacks and defences. In case of multiple parameters most analytical methods optimise one parameter at a time, e.g., minimise cost or maximise probability of an attack. Such methods may lead to sub-optimal solutions when optimising conflicting parameters, e.g., minimising cost while...... maximising probability. In order to tackle this challenge, we devise automated techniques that optimise all parameters at once. Moreover, in the case of conflicting parameters our techniques compute the set of all optimal solutions, defined in terms of Pareto efficiency. The developments are carried out...

Creditor Panic, Asset Bubbles and Sharks: Three Views of the Asian Crisis

OpenAIRE

Marcus Miller; Lei Zhang

1999-01-01

How are we to understand the East Asian crisis? There are two popular explanations: first that it was just like a nineteenth century British bank panic, calling for prompt action by a 'lender of last resort', namely the IMF; second that it was much worse —nothing less than the bursting of a modern-day South Sea Bubble. Jeffrey Sachs of Harvard University is closely associated with the first view. He stresses the liquidity crisis facing the emerging East Asian economies as foreign short-term c...

Cross-site scripting attacks procedure and Prevention Strategies

Directory of Open Access Journals (Sweden)

Wang Xijun

2016-01-01

Full Text Available Cross-site scripting attacks and defense has been the site of attack and defense is an important issue, this paper, the definition of cross-site scripting attacks, according to the current understanding of the chaos on the cross-site scripting, analyzes the causes and harm cross-site scripting attacks formation of attacks XXS complete process XSS attacks made a comprehensive analysis, and then for the web program includes Mobility there are cross-site scripting filter laxity given from ordinary users browse the web and web application developers two the defense cross-site scripting attacks effective strategy.

Heart Attack Symptoms in Women

Science.gov (United States)

... fat, cholesterol and other substances (plaque). Watch an animation of a heart attack . Many women think the ... Support Network Popular Articles 1 Understanding Blood Pressure Readings 2 Sodium and Salt 3 Heart Attack Symptoms ...

On the anatomy of social engineering attacks : A literature-based dissection of successful attacks

NARCIS (Netherlands)

Bullee, Jan-Willem; Montoya, L.; Pieters, Wolter; Junger, Marianne; Hartel, Pieter H.

The aim of this studywas to explore the extent towhich persuasion principles are used in successful social engineering attacks. Seventy-four scenarioswere extracted from 4 books on social engineering (written by social engineers) and analysed. Each scenariowas split into attack steps, containing

DDOS ATTACK DETECTION SIMULATION AND HANDLING MECHANISM

Directory of Open Access Journals (Sweden)

Ahmad Sanmorino

2013-11-01

Full Text Available In this study we discuss how to handle DDoS attack that coming from the attacker by using detection method and handling mechanism. Detection perform by comparing number of packets and number of flow. Whereas handling mechanism perform by limiting or drop the packets that detected as a DDoS attack. The study begins with simulation on real network, which aims to get the real traffic data. Then, dump traffic data obtained from the simulation used for detection method on our prototype system called DASHM (DDoS Attack Simulation and Handling Mechanism. From the result of experiment that has been conducted, the proposed method successfully detect DDoS attack and handle the incoming packet sent by attacker.

Model checking exact cost for attack scenarios

DEFF Research Database (Denmark)

Aslanyan, Zaruhi; Nielson, Flemming

2017-01-01

Attack trees constitute a powerful tool for modelling security threats. Many security analyses of attack trees can be seamlessly expressed as model checking of Markov Decision Processes obtained from the attack trees, thus reaping the benefits of a coherent framework and a mature tool support....... However, current model checking does not encompass the exact cost analysis of an attack, which is standard for attack trees. Our first contribution is the logic erPCTL with cost-related operators. The extended logic allows to analyse the probability of an event satisfying given cost bounds and to compute...... the exact cost of an event. Our second contribution is the model checking algorithm for erPCTL. Finally, we apply our framework to the analysis of attack trees....

"This Modern Day Slavery": Sex Trafficking and Moral Panic in the United Kingdom

OpenAIRE

Hill, Angela

2011-01-01

The dissertation analyzes the discourse and development of the British anti-sex trafficking movement. Following the European Union's largest expansion in 2004, the United Kingdom experienced a surge in immigration from Eastern Europe, which was greeted by fears about losing British culture, stolen jobs, and rising criminal activity. From this welter of concerns, I argue, the issue of sex trafficking coalesced into a moral panic about the dangers of immigration and the sexual exploitation of w...

Neuropeptide S Receptor (NPSR) Gene - Converging Evidence for a Role in Panic Disorder

OpenAIRE

Domschke , Katharina; Reif , Andreas; Weber , Heike; Richter , Jan; Hohoff , Christa; Ohrmann , Patricia; Pedersen , Anya; Bauer , Jochen; Suslow , Thomas; Kugel , Harald; Heindel , Walter L; Baumann , Christian; Klauke , Benedikt; Jacob , Christian; Maier , Wolfgang

2010-01-01

Abstract Animal studies have suggested neuropeptide S (NPS) and its receptor (NPSR) to be involved in the pathogenesis of anxiety-related behavior. In the present 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 an...

A "superstorm": When moral panic and new risk discourses converge in the media

OpenAIRE

Howarth, A

2013-01-01

This is an Author's Accepted Manuscript of an article published in Health, Risk and Society, 15(6), 681-698, 2013, copyright Taylor & Francis, available online at: http://www.tandfonline.com/10.1080/13698575.2013.851180. There has been a proliferation of risk discourses in recent decades but studies of these have been polarised, drawing either on moral panic or new risk frameworks to analyse journalistic discourses. This article opens the theoretical possibility that the two may co-exist a...

NETWORK SECURITY ATTACKS. ARP POISONING CASE STUDY

Directory of Open Access Journals (Sweden)

Luminiţa DEFTA

2010-12-01

Full Text Available Arp poisoning is one of the most common attacks in a switched network. A switch is a network device that limits the ability of attackers that use a packet sniffer to gain access to information from internal network traffic. However, using ARP poisoning the traffic between two computers can be intercepted even in a network that uses switches. This method is known as man in the middle attack. With this type of attack the affected stations from a network will have invalid entries in the ARP table. Thus, it will contain only the correspondence between the IP addresses of the stations from the same network and a single MAC address (the station that initiated the attack. In this paper we present step by step the initiation of such an attack in a network with three computers. We will intercept the traffic between two stations using the third one (the attacker.

What Is Psychiatry?

Medline Plus

Full Text Available ... as a panic attack, frightening hallucinations, thoughts of suicide, or hearing "voices." Or they may be more ... After Disaster, Trauma Internet Gaming Share Your Story Suicide Prevention Warning Signs of Mental Illness What is ...

Analysis of a case of drug-resistant childhood absence epilepsy concurrent with mysophobia

Directory of Open Access Journals (Sweden)

V. A. Karlov

2017-01-01

Full Text Available The article presents a case of childhood absence epilepsy concurrent with mysophobia, panic attacks, and the development of alternative psychosis in an accentuated girl with drug-induced remission of absence seizures and EEG changes.

What Is Psychiatry?

Medline Plus

Full Text Available ... seek psychiatric help for many reasons. The problems can be sudden, such as a panic attack, frightening ... control. Diagnosing Patients Because they are physicians, psychiatrists can order or perform a full range of medical ...

What Is Psychiatry?

Medline Plus

Full Text Available ... as a panic attack, frightening hallucinations, thoughts of suicide, or hearing "voices." Or they may be more ... Expert Coping After Disaster, Trauma Share Your Story Suicide Prevention Warning Signs of Mental Illness What is ...

What Is Psychiatry?

Medline Plus

Full Text Available ... addressed to individuals in the European Economic Area. As described in the Privacy Policy, this website utilizes ... many reasons. The problems can be sudden, such as a panic attack, frightening hallucinations, thoughts of suicide, ...

Understanding How Components of Organisations Contribute to Attacks

DEFF Research Database (Denmark)

Gu, Min; Aslanyan, Zaruhi; Probst, Christian W.

2016-01-01

Attacks on organisations today explore many different layers, including buildings infrastructure, IT infrastructure, and human factor – the physical, virtual, and social layer. Identifying possible attacks, understanding their impact, and attributing their origin and contributing factors is diffi......Attacks on organisations today explore many different layers, including buildings infrastructure, IT infrastructure, and human factor – the physical, virtual, and social layer. Identifying possible attacks, understanding their impact, and attributing their origin and contributing factors...... is difficult. Recently, system models have been used for automatically identifying possible attacks on the modelled organisation. The generated attacks consider all three layers, making the contribution of building infrastructure, computer infrastructure, and humans (insiders and outsiders) explicit. However......, this contribution is only visible in the attack trees as part of the performed steps; it cannot be mapped back to the model directly since the actions usually involve several elements (attacker and targeted actor or asset). Especially for large attack trees, understanding the relations between several model...

Attack Graph Construction for Security Events Analysis

Directory of Open Access Journals (Sweden)

Andrey Alexeevich Chechulin

2014-09-01

Full Text Available The paper is devoted to investigation of the attack graphs construction and analysis task for a network security evaluation and real-time security event processing. Main object of this research is the attack modeling process. The paper contains the description of attack graphs building, modifying and analysis technique as well as overview of implemented prototype for network security analysis based on attack graph approach.

Automated Discovery of Mimicry Attacks

National Research Council Canada - National Science Library

Giffin, Jonathon T; Jha, Somesh; Miller, Barton P

2006-01-01

.... These systems are useful only if they detect actual attacks. Previous research developed manually-constructed mimicry and evasion attacks that avoided detection by hiding a malicious series of system calls within a valid sequence allowed by the model...

Amygdala activation and its functional connectivity during perception of emotional faces in social phobia and panic disorder

NARCIS (Netherlands)

Demenescu, L.R.; Kortekaas, R.; Cremers, H.R.; Renken, R.J.; van Tol, M.J.; van der Wee, M.J.A.; Veltman, D.J.; den Boer, J.A.; Roelofs, K.; Aleman, A.

Social phobia (SP) and panic disorder (PD) have been associated with aberrant amygdala responses to threat-related stimuli. The aim of the present study was to examine amygdala function and its connectivity with medial prefrontal cortex (mPFC) during emotional face perception in PD and SP, and the

A proposal for prevention of acute radiation hazard and social panic regarding orphan sources in Japan

Energy Technology Data Exchange (ETDEWEB)

Takahash, T. [Research Reactor Institute, Kyoto Univ., Osaka (Japan); Kai, M. [Oita Univ., of Nursing and Health Sciences, Oita (Japan); Yamazaki, K. [Chiyoda Technol Corporation, Tokyo (Japan); Gomi, K. [Japan Radioisotope Association, Tokyo (Japan); Nakazato, K. [School of Medicine, Keio univ., Tokyo (Japan); Iida, T. [Nagoya Univ., Nagoya (Japan)

2002-07-01

To respond to an increase of social problems concerning orphan sources in Japan, a working group was formed in the Japan Health Physics Society. In this working group, we investigated how to prevent acute radiation hazard or social panic regarding orphan sources in scrap metal and detection system for orphan sources brought into scrap yards before recycle. For detection system in a scrap yard we conducted an experiment on detectability of monitoring instrument using a radiation source mixed in scrap metal on a truck. The result showed that it was not easy to detect even a high-level source if it was shielded by scrap metal. We also estimated detection limits for radioactive materials in scrap metal by calculation that was validated with experimental data. We summarized present status about orphan sources in Japan and proposed a categorization of orphan sources according to dose rates to deal with unknown sources in a scrap yard. Our report includes some proposals to the government, industry and academic world for preventing acute radiation hazard and social panic.

A proposal for prevention of acute radiation hazard and social panic regarding orphan sources in Japan

International Nuclear Information System (INIS)

Takahash, T.; Kai, M.; Yamazaki, K.; Gomi, K.; Nakazato, K.; Iida, T.

2002-01-01

To respond to an increase of social problems concerning orphan sources in Japan, a working group was formed in the Japan Health Physics Society. In this working group, we investigated how to prevent acute radiation hazard or social panic regarding orphan sources in scrap metal and detection system for orphan sources brought into scrap yards before recycle. For detection system in a scrap yard we conducted an experiment on detectability of monitoring instrument using a radiation source mixed in scrap metal on a truck. The result showed that it was not easy to detect even a high-level source if it was shielded by scrap metal. We also estimated detection limits for radioactive materials in scrap metal by calculation that was validated with experimental data. We summarized present status about orphan sources in Japan and proposed a categorization of orphan sources according to dose rates to deal with unknown sources in a scrap yard. Our report includes some proposals to the government, industry and academic world for preventing acute radiation hazard and social panic

Transforming Graphical System Models to Graphical Attack Models

DEFF Research Database (Denmark)

Ivanova, Marieta Georgieva; Probst, Christian W.; Hansen, Rene Rydhof

2016-01-01

Manually identifying possible attacks on an organisation is a complex undertaking; many different factors must be considered, and the resulting attack scenarios can be complex and hard to maintain as the organisation changes. System models provide a systematic representation of organisations...... approach to transforming graphical system models to graphical attack models in the form of attack trees. Based on an asset in the model, our transformations result in an attack tree that represents attacks by all possible actors in the model, after which the actor in question has obtained the asset....

When Sinuses Attack! (For Kids)

Science.gov (United States)

... First Aid & Safety Doctors & Hospitals Videos Recipes for Kids Kids site Sitio para niños How the Body Works ... Search English Español When Sinuses Attack! KidsHealth / For Kids / When Sinuses Attack! What's in this article? What ...

Heart Attack

Science.gov (United States)

... properly causes your body's blood sugar levels to rise, increasing your risk of heart attack. Metabolic syndrome. This occurs when you have obesity, high blood pressure and high blood sugar. Having metabolic ...

[Styles of interpersonal conflict in patients with panic disorder, alcoholism, rheumatoid arthritis and healthy controls: a cluster analysis study].

Science.gov (United States)

Eher, R; Windhaber, J; Rau, H; Schmitt, M; Kellner, E

2000-05-01

Conflict and conflict resolution in intimate relationships are not only among the most important factors influencing relationship satisfaction but are also seen in association with clinical symptoms. Styles of conflict will be assessed in patients suffering from panic disorder with and without agoraphobia, in alcoholics and in patients suffering from rheumatoid arthritis. 176 patients and healthy controls filled out the Styles of Conflict Inventory and questionnaires concerning severity of clinical symptoms. A cluster analysis revealed 5 types of conflict management. Healthy controls showed predominantely assertive and constructive styles, patients with panic disorder showed high levels of cognitive and/or behavioral aggression. Alcoholics showed high levels of repressed aggression, and patients with rheumatoid arthritis often did not exhibit any aggression during conflict. 5 Clusters of conflict pattern have been identified by cluster analysis. Each patient group showed considerable different patterns of conflict management.

Helpful and hindering factors for remission in dysthymia and panic disorder at 9-year follow-up: A mixed methods study

Directory of Open Access Journals (Sweden)

Lützen Kim

2008-07-01

Full Text Available Abstract Background A better understanding is needed of factors behind the long-term outcome of dysthymic and panic disorders. Combining patients' perceptions of factors that help and hind remission with objective assessments of outcome may give greater insight into mechanisms for maintaining recovery. Methods Twenty-three dysthymic and 15 panic disorder patients participated in a 9-year follow-up investigation of a naturalistic study with psychotherapy and antidepressants. Degree of remission was determined by reassessments with SCID-I & II interviews, self-reported symptoms and life-charting (aided by case records. Qualitative content analysis of in-depth interviews with all 38 patients was done to examine the phenomenon of enduring remission by exploring: 1 perceived helpful and hindering factors, 2 factors common to and specific for the diagnostic groups, 3 convergence between patients' subjective views on remission with objective diagnostic assessments. Results About 50% of the patients were in full or partial remission. Subjective and objective views on degree of remission generally converged, and remission was perceived as receiving 'Tools to handle life'. Common helpful factors were self-understanding, enhanced flexibility of thinking, and antidepressant medication, as well as confidence in the therapist and social support. The perceived main obstacle was difficulty in negotiating treatments. Remitted had overcome the obstacles, whereas many non-remitted had problems expressing their needs. Patients with dysthymia and panic disorder described specific helpful relationships with the therapist: 'As a parent' versus 'As a coach', and specific central areas for change: self-acceptance and resolution of relational problems versus awareness and handling of feelings. Conclusion A general model for recovery from dysthymic and panic disorders is proposed, involving: 1 understanding self and illness mechanisms, 2 enhanced flexibility of thinking

Helpful and hindering factors for remission in dysthymia and panic disorder at 9-year follow-up: a mixed methods study.

Science.gov (United States)

Svanborg, Cecilia; Bäärnhielm, Sofie; Aberg Wistedt, Anna; Lützen, Kim

2008-07-01

A better understanding is needed of factors behind the long-term outcome of dysthymic and panic disorders. Combining patients' perceptions of factors that help and hind remission with objective assessments of outcome may give greater insight into mechanisms for maintaining recovery. Twenty-three dysthymic and 15 panic disorder patients participated in a 9-year follow-up investigation of a naturalistic study with psychotherapy and antidepressants. Degree of remission was determined by reassessments with SCID-I & II interviews, self-reported symptoms and life-charting (aided by case records). Qualitative content analysis of in-depth interviews with all 38 patients was done to examine the phenomenon of enduring remission by exploring: 1) perceived helpful and hindering factors, 2) factors common to and specific for the diagnostic groups, 3) convergence between patients' subjective views on remission with objective diagnostic assessments. About 50% of the patients were in full or partial remission. Subjective and objective views on degree of remission generally converged, and remission was perceived as receiving 'Tools to handle life'. Common helpful factors were self-understanding, enhanced flexibility of thinking, and antidepressant medication, as well as confidence in the therapist and social support. The perceived main obstacle was difficulty in negotiating treatments. Remitted had overcome the obstacles, whereas many non-remitted had problems expressing their needs. Patients with dysthymia and panic disorder described specific helpful relationships with the therapist: 'As a parent' versus 'As a coach', and specific central areas for change: self-acceptance and resolution of relational problems versus awareness and handling of feelings. A general model for recovery from dysthymic and panic disorders is proposed, involving: 1) understanding self and illness mechanisms, 2) enhanced flexibility of thinking, and 3) change from avoidance coping to approach coping; and

Internet-versus group-administered cognitive behaviour therapy for panic disorder in a psychiatric setting: a randomised trial

Directory of Open Access Journals (Sweden)

Karlsson Andreas

2010-07-01

Full Text Available Abstract Background Internet administered cognitive behaviour therapy (CBT is a promising new way to deliver psychological treatment, but its effectiveness in regular care settings and in relation to more traditional CBT group treatment has not yet been determined. The primary aim of this study was to compare the effectiveness of Internet-and group administered CBT for panic disorder (with or without agoraphobia in a randomised trial within a regular psychiatric care setting. The second aim of the study was to establish the cost-effectiveness of these interventions. Methods Patients referred for treatment by their physician, or self-referred, were telephone-screened by a psychiatric nurse. Patients fulfilling screening criteria underwent an in-person structured clinical interview carried out by a psychiatrist. A total of 113 consecutive patients were then randomly assigned to 10 weeks of either guided Internet delivered CBT (n = 53 or group CBT (n = 60. After treatment, and at a 6-month follow-up, patients were again assessed by the psychiatrist, blind to treatment condition. Results Immediately after randomization 9 patients dropped out, leaving 104 patients who started treatment. Patients in both treatment conditions showed significant improvement on the main outcome measure, the Panic Disorder Severity Scale (PDSS after treatment. For the Internet treatment the within-group effect size (pre-post on the PDSS was Cohen's d = 1.73, and for the group treatment it was d = 1.63. Between group effect sizes were low and treatment effects were maintained at 6-months follow-up. We found no statistically significant differences between the two treatment conditions using a mixed models approach to account for missing data. Group CBT utilised considerably more therapist time than did Internet CBT. Defining effect as proportion of PDSS responders, the cost-effectiveness analysis concerning therapist time showed that Internet treatment had superior cost

Teaching Us to Fear: The Violent Video Game Moral Panic and The Politics of Game Research

Science.gov (United States)

Markey, Patrick M.; Ferguson, Christopher J.

2017-01-01

In this excerpt from their new book, "Moral Combat: Why the War on Violent Video Games Is Wrong" (BenBella Books, 2017), the authors present an argument in defense of video games while dispelling the myth that such games lead to real-world violence. The authors define and examine moral panics and provide guidelines for identifying and…

Software-based Microarchitectural Attacks

OpenAIRE

Gruss, Daniel

2017-01-01

Modern processors are highly optimized systems where every single cycle of computation time matters. Many optimizations depend on the data that is being processed. Software-based microarchitectural attacks exploit effects of these optimizations. Microarchitectural side-channel attacks leak secrets from cryptographic computations, from general purpose computations, or from the kernel. This leakage even persists across all common isolation boundaries, such as processes, containers, and virtual ...

Integrating cyber attacks within fault trees

International Nuclear Information System (INIS)

Nai Fovino, Igor; Masera, Marcelo; De Cian, Alessio

2009-01-01

In this paper, a new method for quantitative security risk assessment of complex systems is presented, combining fault-tree analysis, traditionally used in reliability analysis, with the recently introduced Attack-tree analysis, proposed for the study of malicious attack patterns. The combined use of fault trees and attack trees helps the analyst to effectively face the security challenges posed by the introduction of modern ICT technologies in the control systems of critical infrastructures. The proposed approach allows considering the interaction of malicious deliberate acts with random failures. Formal definitions of fault tree and attack tree are provided and a mathematical model for the calculation of system fault probabilities is presented.

Integrating cyber attacks within fault trees

Energy Technology Data Exchange (ETDEWEB)

Nai Fovino, Igor [Joint Research Centre - EC, Institute for the Protection and Security of the Citizen, Ispra, VA (Italy)], E-mail: igor.nai@jrc.it; Masera, Marcelo [Joint Research Centre - EC, Institute for the Protection and Security of the Citizen, Ispra, VA (Italy); De Cian, Alessio [Department of Electrical Engineering, University di Genova, Genoa (Italy)

2009-09-15

In this paper, a new method for quantitative security risk assessment of complex systems is presented, combining fault-tree analysis, traditionally used in reliability analysis, with the recently introduced Attack-tree analysis, proposed for the study of malicious attack patterns. The combined use of fault trees and attack trees helps the analyst to effectively face the security challenges posed by the introduction of modern ICT technologies in the control systems of critical infrastructures. The proposed approach allows considering the interaction of malicious deliberate acts with random failures. Formal definitions of fault tree and attack tree are provided and a mathematical model for the calculation of system fault probabilities is presented.

Attack and Vulnerability Penetration Testing: FreeBSD

Directory of Open Access Journals (Sweden)

Abdul Hanan Abdullah

2013-07-01

Full Text Available Computer system security has become a major concern over the past few years. Attacks, threasts or intrusions, against computer system and network have become commonplace events. However, there are some system devices and other tools that are available to overcome the threat of these attacks. Currently, cyber attack is a major research and inevitable. This paper presents some steps of penetration in FreeBSD operating system, some tools and new steps to attack used in this experiment, probes for reconnaissance, guessing password via brute force, gaining privilege access and flooding victim machine to decrease availability. All these attacks were executed and infiltrate within the environment of Intrusion Threat Detection Universiti Teknologi Malaysia (ITD UTM data set. This work is expected to be a reference for practitioners to prepare their systems from Internet attacks.

Superposition Attacks on Cryptographic Protocols

DEFF Research Database (Denmark)

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

2011-01-01

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......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 several primitives in this model. We show that a secret-sharing scheme that is secure with threshold $t$ in the standard model is secure against superposition attacks if and only if the threshold is lowered to $t/2$. We use this result to give zero-knowledge proofs for all of NP in the common reference...

Anxiety and Hysterical Symptoms in Schizophrenia

African Journals Online (AJOL)

QuickSilver

2003-05-07

May 7, 2003 ... panic attacks as well as in obsessive-compulsive disorder.4. The co-existence ... fixation occurring at an earlier stage of development than in those cases where .... It is most common in women with hysterical personality traits.

Interpersonal Factors Are Associated with Lower Therapist Adherence in Cognitive-Behavioural Therapy for Panic Disorder.

Science.gov (United States)

Zickgraf, Hana F; Chambless, Dianne L; McCarthy, Kevin S; Gallop, Robert; Sharpless, Brian A; Milrod, Barbara L; Barber, Jacques P

2016-05-01

The contributions of disorder severity, comorbidity and interpersonal variables to therapists' adherence to a cognitive-behavioural treatment (CBT) manual were tested. Thirty-eight patients received panic control therapy (PCT) for panic disorder. Trained observers watching videotapes of the sixth session of a 24-session protocol rated therapists' adherence to PCT and their use of interventions from outside the CBT model. Different observers rated patients' behavioural resistance to therapy in the same session using the client resistance code. Interview measures obtained before treatment included the Panic Disorder Severity Scale, the anxiety disorders interview schedule for Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV and the structured clinical interview for DSM-IV, Axis II. Questionnaire measures were the anxiety sensitivity index at intake, and, at session 2, the therapist and client versions of the working alliance inventory-short form. The higher the patients' resistance and the more Axis II traits a patient had, the less adherent the therapist. Moreover, the more resistant the client, the more therapists resorted to interventions from outside the CBT model. Stronger therapist and patient alliance was also generally related to better adherence, but these results were somewhat inconsistent across therapists. Pretreatment disorder severity and comorbidity were not related to adherence. Interpersonal variables, particularly behavioural resistance to therapy, are related to therapists' ability to adhere to a treatment manual and to their use of interventions from outside of the CBT model. Copyright © 2015 John Wiley & Sons, Ltd. Patients' behavioural resistance to therapy may make it more difficult for cognitive-behavioural clinicians to adhere to a structured treatment protocol and more likely for them to borrow interventions from outside the CBT model. Patients' Axis II traits may make adherence to treatment CBT protocol more difficult

Shark Attack Project - Marine Attack at Towed Hydrophone Arrays

National Research Council Canada - National Science Library

Kalmijn, Adrianus J

2005-01-01

The original objective of the SIO Marine Attack project was to identify the electric and magnetic fields causing sharks to inflict serious damage upon the towed hydrophone arrays of US Navy submarines...

Novel Method For Low-Rate Ddos Attack Detection

Science.gov (United States)

Chistokhodova, A. A.; Sidorov, I. D.

2018-05-01

The relevance of the work is associated with an increasing number of advanced types of DDoS attacks, in particular, low-rate HTTP-flood. Last year, the power and complexity of such attacks increased significantly. The article is devoted to the analysis of DDoS attacks detecting methods and their modifications with the purpose of increasing the accuracy of DDoS attack detection. The article details low-rate attacks features in comparison with conventional DDoS attacks. During the analysis, significant shortcomings of the available method for detecting low-rate DDoS attacks were found. Thus, the result of the study is an informal description of a new method for detecting low-rate denial-of-service attacks. The architecture of the stand for approbation of the method is developed. At the current stage of the study, it is possible to improve the efficiency of an already existing method by using a classifier with memory, as well as additional information.

Heart Attack

Science.gov (United States)

... family history of heart attack race – African Americans, Mexican Americans, Native Americans, and native Hawaiians are at ... Your doctor will prescribe the medicines that are right for you. If you have had a heart ...

Automatic Classification of Attacks on IP Telephony

Directory of Open Access Journals (Sweden)

Jakub Safarik

2013-01-01

Full Text Available This article proposes an algorithm for automatic analysis of attack data in IP telephony network with a neural network. Data for the analysis is gathered from variable monitoring application running in the network. These monitoring systems are a typical part of nowadays network. Information from them is usually used after attack. It is possible to use an automatic classification of IP telephony attacks for nearly real-time classification and counter attack or mitigation of potential attacks. The classification use proposed neural network, and the article covers design of a neural network and its practical implementation. It contains also methods for neural network learning and data gathering functions from honeypot application.

Further attacks on Yeung-Mintzer fragile watermarking scheme

Science.gov (United States)

Fridrich, Jessica; Goljan, Miroslav; Memon, Nasir D.

2000-05-01

In this paper, we describe new and improved attacks on the authentication scheme previously proposed by Yeung and Mintzer. Previous attacks assumed that the binary watermark logo inserted in an image for the purposes of authentication was known. Here we remove that assumption and show how the scheme is still vulnerable, even if the binary logo is not known but the attacker has access to multiple images that have been watermarked with the same secret key and contain the same (but unknown) logo. We present two attacks. The first attack infers the secret watermark insertion function and the binary logo, given multiple images authenticated with the same key and containing the same logo. We show that a very good approximation to the logo and watermark insertion function can be constructed using as few as two images. With color images, one needs many more images, nevertheless the attack is still feasible. The second attack we present, which we call the 'collage-attack' is a variation of the Holliman-Memon counterfeiting attack. The proposed variation does not require knowledge of the watermark logo and produces counterfeits of superior quality by means of a suitable dithering process that we develop.

Pareto Efficient Solution of Attack-Defence Trees

NARCIS (Netherlands)

Aslanyan, Zaruhi; Nielson, Flemming

Attack-defence trees are a promising approach for representing threat scenarios and possible countermeasures in a concise and intuitive manner. An attack-defence tree describes the interaction between an attacker and a defender, and is evaluated by assigning parameters to the nodes, such as

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.

Genetic attack on neural cryptography

International Nuclear Information System (INIS)

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

2006-01-01

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

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.

Controlled cross-over study in normal subjects of naloxone-preceding-lactate infusions; respiratory and subjective responses: relationship to endogenous opioid system, suffocation false alarm theory and childhood parental loss.

Science.gov (United States)

Preter, M; Lee, S H; Petkova, E; Vannucci, M; Kim, S; Klein, D F

2011-02-01

The expanded suffocation false alarm theory (SFA) hypothesizes that dysfunction in endogenous opioidergic regulation increases sensitivity to CO2, separation distress and panic attacks. In panic disorder (PD) patients, both spontaneous clinical panics and lactate-induced panics markedly increase tidal volume (TV), whereas normals have a lesser effect, possibly due to their intact endogenous opioid system. We hypothesized that impairing the opioidergic system by naloxone could make normal controls parallel PD patients' response when lactate challenged. Whether actual separations and losses during childhood (childhood parental loss, CPL) affected naloxone-induced respiratory contrasts was explored. Subjective panic-like symptoms were analyzed although pilot work indicated that the subjective aspect of anxious panic was not well modeled by this specific protocol. Randomized cross-over sequences of intravenous naloxone (2 mg/kg) followed by lactate (10 mg/kg), or saline followed by lactate, were given to 25 volunteers. Respiratory physiology was objectively recorded by the LifeShirt. Subjective symptomatology was also recorded. Impairment of the endogenous opioid system by naloxone accentuates TV and symptomatic response to lactate. This interaction is substantially lessened by CPL. Opioidergic dysregulation may underlie respiratory pathophysiology and suffocation sensitivity in PD. Comparing specific anti-panic medications with ineffective anti-panic agents (e.g. propranolol) can test the specificity of the naloxone+lactate model. A screen for putative anti-panic agents and a new pharmacotherapeutic approach are suggested. Heuristically, the experimental unveiling of the endogenous opioid system impairing effects of CPL and separation in normal adults opens a new experimental, investigatory area.

Controlled cross-over study in normal subjects of naloxone-preceding-lactate infusions; respiratory and subjective responses: relationship to endogenous opioid system, suffocation false alarm theory and childhood parental loss

Science.gov (United States)

Preter, M.; Lee, S. H.; Petkova, E.; Vannucci, M.; Kim, S.; Klein, D. F.

2015-01-01

Background The expanded suffocation false alarm theory (SFA) hypothesizes that dysfunction in endogenous opioidergic regulation increases sensitivity to CO2, separation distress and panic attacks. In panic disorder (PD) patients, both spontaneous clinical panics and lactate-induced panics markedly increase tidal volume (TV), whereas normals have a lesser effect, possibly due to their intact endogenous opioid system. We hypothesized that impairing the opioidergic system by naloxone could make normal controls parallel PD patients' response when lactate challenged. Whether actual separations and losses during childhood (childhood parental loss, CPL) affected naloxone-induced respiratory contrasts was explored. Subjective panic-like symptoms were analyzed although pilot work indicated that the subjective aspect of anxious panic was not well modeled by this specific protocol. Method Randomized cross-over sequences of intravenous naloxone (2 mg/kg) followed by lactate (10 mg/kg), or saline followed by lactate, were given to 25 volunteers. Respiratory physiology was objectively recorded by the LifeShirt. Subjective symptomatology was also recorded. Results Impairment of the endogenous opioid system by naloxone accentuates TV and symptomatic response to lactate. This interaction is substantially lessened by CPL. Conclusions Opioidergic dysregulation may underlie respiratory pathophysiology and suffocation sensitivity in PD. Comparing specific anti-panic medications with ineffective anti-panic agents (e.g. propranolol) can test the specificity of the naloxone + lactate model. A screen for putative anti-panic agents and a new pharmacotherapeutic approach are suggested. Heuristically, the experimental unveiling of the endogenous opioid system impairing effects of CPL and separation in normal adults opens a new experimental, investigatory area. PMID:20444308

Experience sampling and ecological momentary assessment for studying the daily lives of patients with anxiety disorders : A systematic review

NARCIS (Netherlands)

Walz, Laura C; Nauta, Maaike H; Aan Het Rot, Marije

2014-01-01

Anxiety disorders are highly prevalent. Symptoms may occur unpredictably (e.g., panic attacks) or predictably in specific situations (e.g., social phobia). Consequently, it may be difficult to assess anxiety and related constructs realistically in the laboratory or by traditional retrospective

Intimate Partner Violence and Welfare Participation: A Longitudinal Causal Analysis

Science.gov (United States)

Cheng, Tyrone C.

2013-01-01

This longitudinal study examined the temporal-ordered causal relationship between intimate partner violence (IPV), five mental disorders (depression, generalized anxiety disorder, social phobia, panic attack, posttraumatic stress disorder [PTSD]), alcohol abuse/dependence, drug abuse/ dependence, treatment seeking (from physician, counselor, and…

Attacks on the AJPS Mersenne-based cryptosystem

NARCIS (Netherlands)

K. de Boer (Koen); L. Ducas (Léo); S. Jeffery (Stacey); R. M. de Wolf (Ronald)

2018-01-01

textabstractAggarwal, Joux, Prakash and Santha recently introduced a new potentially quantum-safe public-key cryptosystem, and suggested that a brute-force attack is essentially optimal against it. They consider but then dismiss both Meet-in-the-Middle attacks and LLL-based attacks. Very soon after

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.

Robust Detection of Stepping-Stone Attacks

National Research Council Canada - National Science Library

He, Ting; Tong, Lang

2006-01-01

The detection of encrypted stepping-stone attack is considered. Besides encryption and padding, the attacker is capable of inserting chaff packets and perturbing packet timing and transmission order...

A Framework for Attack-Resilient Industrial Control Systems : Attack Detection and Controller Reconfiguration

OpenAIRE

Paridari, Kaveh; O'Mahony, Niamh; Mady, Alie El-Din; Chabukswar, Rohan; Boubekeur, Menouer; Sandberg, Henrik

2017-01-01

Most existing industrial control systems (ICSs), such as building energy management systems (EMSs), were installed when potential security threats were only physical. With advances in connectivity, ICSs are now, typically, connected to communications networks and, as a result, can be accessed remotely. This extends the attack surface to include the potential for sophisticated cyber attacks, which can adversely impact ICS operation, resulting in service interruption, equipment damage, safety c...

An Adaptive Approach for Defending against DDoS Attacks

Directory of Open Access Journals (Sweden)

Muhai Li

2010-01-01

Full Text Available In various network attacks, the Distributed Denial-of-Service (DDoS attack is a severe threat. In order to deal with this kind of attack in time, it is necessary to establish a special type of defense system to change strategy dynamically against attacks. In this paper, we introduce an adaptive approach, which is used for defending against DDoS attacks, based on normal traffic analysis. The approach can check DDoS attacks and adaptively adjust its configurations according to the network condition and attack severity. In order to insure the common users to visit the victim server that is being attacked, we provide a nonlinear traffic control formula for the system. Our simulation test indicates that the nonlinear control approach can prevent the malicious attack packets effectively while making legitimate traffic flows arrive at the victim.

Countermeasures for unintentional and intentional video watermarking attacks

Science.gov (United States)

Deguillaume, Frederic; Csurka, Gabriela; Pun, Thierry

2000-05-01

These last years, the rapidly growing digital multimedia market has revealed an urgent need for effective copyright protection mechanisms. Therefore, digital audio, image and video watermarking has recently become a very active area of research, as a solution to this problem. Many important issues have been pointed out, one of them being the robustness to non-intentional and intentional attacks. This paper studies some attacks and proposes countermeasures applied to videos. General attacks are lossy copying/transcoding such as MPEG compression and digital/analog (D/A) conversion, changes of frame-rate, changes of display format, and geometrical distortions. More specific attacks are sequence edition, and statistical attacks such as averaging or collusion. Averaging attack consists of averaging locally consecutive frames to cancel the watermark. This attack works well for schemes which embed random independent marks into frames. In the collusion attack the watermark is estimated from single frames (based on image denoising), and averaged over different scenes for better accuracy. The estimated watermark is then subtracted from each frame. Collusion requires that the same mark is embedded into all frames. The proposed countermeasures first ensures robustness to general attacks by spread spectrum encoding in the frequency domain and by the use of an additional template. Secondly, a Bayesian criterion, evaluating the probability of a correctly decoded watermark, is used for rejection of outliers, and to implement an algorithm against statistical attacks. The idea is to embed randomly chosen marks among a finite set of marks, into subsequences of videos which are long enough to resist averaging attacks, but short enough to avoid collusion attacks. The Bayesian criterion is needed to select the correct mark at the decoding step. Finally, the paper presents experimental results showing the robustness of the proposed method.

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

Science.gov (United States)

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

2000-01-01

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

Link-layer Jamming Attacks on S-MAC

NARCIS (Netherlands)

Law, Y.W.; Hartel, Pieter H.; den Hartog, Jeremy; Havinga, Paul J.M.

2004-01-01

We argue that among denial-of-service (DoS) attacks, link-layer jamming is a more attractive option to attackers than radio jamming is. By exploiting the semantics of the link-layer protocol (aka MAC protocol), an attacker can achieve better efficiency than blindly jamming the radio signals alone.

Link-layer jamming attacks on S-MAC

NARCIS (Netherlands)

Law, Y.W.; Hartel, Pieter H.; den Hartog, Jeremy; Havinga, Paul J.M.

We argue that among denial-of-service (DoS) attacks, link-layer jamming is a more attractive option to attackers than radio jamming is. By exploiting the semantics of the link-layer protocol (aka MAC protocol), an attacker can achieve better efficiency than blindly jamming the radio signals alone.

A computer network attack taxonomy and ontology

CSIR Research Space (South Africa)

Van Heerden, RP

2012-01-01

Full Text Available of the attack that occur after the attack goal has been achieved, and occurs because the attacker loses control of some systems. For example, after the launch of a DDOS (Distributed Denial of Service) attack, zombie computers may still connect to the target...-scrap- value-of-a-hacked-pc-revisited/ . Lancor, L., & Workman, R. (2007). Using Google Hacking to Enhance Defense Strategies. ACM SIGCSE Bulletin, 39 (1), 491-495. Lau, F., Rubin, S. H., Smith, M. H., & Trajkovic, L. (2000). Distributed Denial of Service...

Health anxiety and fear of fear in panic disorder and agoraphobia vs. social phobia: A prospective longitudinal study

NARCIS (Netherlands)

Rudaz, M.; Craske, M.G.; Becker, E.S.; Ledermann, T.; Margraf, J.

2010-01-01

Background: This study is aimed to evaluate the role of two vulnerability factors, health anxiety and fear of :Par in the prediction of the onset of panic disorder/agoraphobia (PDA) relative to a comparison anxiety disorder Methods: Young women, aged between 18 and 24 years, were investigated at

Unified communications forensics anatomy of common UC attacks

CERN Document Server

Grant, Nicholas Mr

2013-01-01

Unified Communications Forensics: Anatomy of Common UC Attacks is the first book to explain the issues and vulnerabilities and demonstrate the attacks, forensic artifacts, and countermeasures required to establish a secure (UC) environment. This book is written by leading UC experts Nicholas Grant and Joseph W. Shaw II and provides material never before found on the market, including: analysis of forensic artifacts in common UC attacks an in-depth look at established UC technologies and attack exploits hands-on understanding of UC attack vectors and associated countermeasures

Working Memory Load and Negative Picture Processing: Neural and Behavioral Associations With Panic, Social Anxiety, and Positive Affect.

Science.gov (United States)

MacNamara, Annmarie; Jackson, T Bryan; Fitzgerald, Jacklynn M; Hajcak, Greg; Phan, K Luan

2018-04-22

Internalizing disorders such as anxiety may be characterized by an imbalance between bottom-up (stimulus-driven) and top-down (goal-directed) attention. The late positive potential (LPP) can be used to assess these processes when task-irrelevant negative and neutral pictures are presented within a working memory paradigm. Prior work using this paradigm has found that working memory load reduces the picture-elicited LPP across participants; however, anxious individuals showed a reduced effect of working memory load on the LPP, suggesting increased distractibility. The current study assessed transdiagnostic associations between specific symptom dimensions of anxiety, the LPP, and behavior in a clinically representative, heterogeneous group of 76 treatment-seeking patients with internalizing disorders, who performed a working memory task interspersed with negative and neutral pictures. As expected, negative pictures enhanced the LPP, and working memory load reduced the LPP. Participants with higher social anxiety showed increased LPPs to negative stimuli during early and late portions of picture presentation. Panic symptoms were associated with reduced LPPs to negative pictures compared with neutral pictures as well as a reduced effect of working memory load on the LPP during the late time window. Reduced positive affect was associated with greater behavioral interference from negative pictures. Hypervigilance for negative stimuli was uniquely explained by social anxiety symptoms, whereas panic symptoms were associated with the opposing effect-blunted processing/avoidance of these stimuli. Panic symptoms were uniquely associated with reduced top-down control. Results reveal distinct associations between neural reactivity and anxiety symptom dimensions that transcend traditional diagnostic boundaries. Copyright © 2018 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

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...

Classifying network attack scenarios using an ontology

CSIR Research Space (South Africa)

Van Heerden, RP

2012-03-01

Full Text Available ) or to the target?s reputation. The Residue sub-phase refers to damage or artefacts of the attack that occur after the attack goal has been achieved, and occurs because the attacker loses control of some systems. For example after the launch of a DDOS..., A. (1995). Hacking theft of $10 million from citibank revealed. Retrieved 10/10, 2011, from http://articles.latimes.com/1995-08-19/business/fi-36656_1_citibank-system Hurley, E. (2004). SCO site succumbs to DDoS attack. Retrieved 10/10, 2011, from...

Modelling Social-Technical Attacks with Timed Automata

DEFF Research Database (Denmark)

David, Nicolas; David, Alexandre; Hansen, Rene Rydhof

2015-01-01

. In this paper we develop an approach towards modelling socio-technical systems in general and socio-technical attacks in particular, using timed automata and illustrate its application by a complex case study. Thanks to automated model checking and automata theory, we can automatically generate possible attacks...... in our model and perform analysis and simulation of both model and attack, revealing details about the specific interaction between attacker and victim. Using timed automata also allows for intuitive modelling of systems, in which quantities like time and cost can be easily added and analysed....

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.

Quantitative Verification and Synthesis of Attack-Defence Scenarios

DEFF Research Database (Denmark)

Aslanyan, Zaruhi; Nielson, Flemming; Parker, David

2016-01-01

analysis of quantitative properties of complex attack-defence scenarios, using an extension of attack-defence trees which models temporal ordering of actions and allows explicit dependencies in the strategies adopted by attackers and defenders. We adopt a game-theoretic approach, translating attack...... which guarantee or optimise some quantitative property, such as the probability of a successful attack, the expected cost incurred, or some multi-objective trade-off between the two. We implement our approach, building upon the PRISM-games model checker, and apply it to a case study of an RFID goods...

Situational awareness of a coordinated cyber attack

Science.gov (United States)

Sudit, Moises; Stotz, Adam; Holender, Michael

2005-03-01

As technology continues to advance, services and capabilities become computerized, and an ever increasing amount of business is conducted electronically the threat of cyber attacks gets compounded by the complexity of such attacks and the criticality of the information which must be secured. A new age of virtual warfare has dawned in which seconds can differentiate between the protection of vital information and/or services and a malicious attacker attaining their goal. In this paper we present a novel approach in the real-time detection of multistage coordinated cyber attacks and the promising initial testing results we have obtained. We introduce INFERD (INformation Fusion Engine for Real-time Decision-making), an adaptable information fusion engine which performs fusion at levels zero, one, and two to provide real-time situational assessment and its application to the cyber domain in the ECCARS (Event Correlation for Cyber Attack Recognition System) system. The advantages to our approach are fourfold: (1) The complexity of the attacks which we consider, (2) the level of abstraction in which the analyst interacts with the attack scenarios, (3) the speed at which the information fusion is presented and performed, and (4) our disregard for ad-hoc rules or a priori parameters.

Anti-discrimination Analysis Using Privacy Attack Strategies

KAUST Repository

Ruggieri, Salvatore

2014-09-15

Social discrimination discovery from data is an important task to identify illegal and unethical discriminatory patterns towards protected-by-law groups, e.g., ethnic minorities. We deploy privacy attack strategies as tools for discrimination discovery under hard assumptions which have rarely tackled in the literature: indirect discrimination discovery, privacy-aware discrimination discovery, and discrimination data recovery. The intuition comes from the intriguing parallel between the role of the anti-discrimination authority in the three scenarios above and the role of an attacker in private data publishing. We design strategies and algorithms inspired/based on Frèchet bounds attacks, attribute inference attacks, and minimality attacks to the purpose of unveiling hidden discriminatory practices. Experimental results show that they can be effective tools in the hands of anti-discrimination authorities.

Alexithymia and suicidality in panic disorder.

Science.gov (United States)

Iancu, I; Dannon, P N; Poreh, A; Lepkifker, E; Grunhaus, L

2001-01-01

To evaluate the prevalence of suicidal behavior in patients with panic disorder (PD) and to study the role of alexithymia (AL), an affect component, as a predictor of suicidal behavior in PD, we compared 42 patients with PD with or without agoraphobia with 24 healthy controls with regards to depression, AL and suicide risk. Only 5% of the PD patients reported previous suicide attempts. A higher frequency of positive AL (score > 73) was found among the PD patients (39% v 4% among the controls). PD patients had a higher suicide risk and AL as compared to controls, but only the increased suicide risk reached statistical significance. AL subjects had higher suicide risk scores as compared to non-AL subjects. Significant correlations were found between the AL score and suicide risk, although the most significant correlation was, as expected, between the depression level and the suicide risk. A low rate of previous suicide attempts was found in the PD group, perhaps reflecting the low comorbidity in our sample. We suggest that AL may have a role in the causation of suicidal behavior in PD patients, although further studies should re-examine this issue with larger samples. Copyright 2001 by W.B. Saunders Company

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,…

Simulation of Attacks for Security in Wireless Sensor Network.

Science.gov (United States)

Diaz, Alvaro; Sanchez, Pablo

2016-11-18

The increasing complexity and low-power constraints of current Wireless Sensor Networks (WSN) require efficient methodologies for network simulation and embedded software performance analysis of nodes. In addition, security is also a very important feature that has to be addressed in most WSNs, since they may work with sensitive data and operate in hostile unattended environments. In this paper, a methodology for security analysis of Wireless Sensor Networks is presented. The methodology allows designing attack-aware embedded software/firmware or attack countermeasures to provide security in WSNs. The proposed methodology includes attacker modeling and attack simulation with performance analysis (node's software execution time and power consumption estimation). After an analysis of different WSN attack types, an attacker model is proposed. This model defines three different types of attackers that can emulate most WSN attacks. In addition, this paper presents a virtual platform that is able to model the node hardware, embedded software and basic wireless channel features. This virtual simulation analyzes the embedded software behavior and node power consumption while it takes into account the network deployment and topology. Additionally, this simulator integrates the previously mentioned attacker model. Thus, the impact of attacks on power consumption and software behavior/execution-time can be analyzed. This provides developers with essential information about the effects that one or multiple attacks could have on the network, helping them to develop more secure WSN systems. This WSN attack simulator is an essential element of the attack-aware embedded software development methodology that is also introduced in this work.

Simulation of Attacks for Security in Wireless Sensor Network

Science.gov (United States)

Diaz, Alvaro; Sanchez, Pablo

2016-01-01

The increasing complexity and low-power constraints of current Wireless Sensor Networks (WSN) require efficient methodologies for network simulation and embedded software performance analysis of nodes. In addition, security is also a very important feature that has to be addressed in most WSNs, since they may work with sensitive data and operate in hostile unattended environments. In this paper, a methodology for security analysis of Wireless Sensor Networks is presented. The methodology allows designing attack-aware embedded software/firmware or attack countermeasures to provide security in WSNs. The proposed methodology includes attacker modeling and attack simulation with performance analysis (node’s software execution time and power consumption estimation). After an analysis of different WSN attack types, an attacker model is proposed. This model defines three different types of attackers that can emulate most WSN attacks. In addition, this paper presents a virtual platform that is able to model the node hardware, embedded software and basic wireless channel features. This virtual simulation analyzes the embedded software behavior and node power consumption while it takes into account the network deployment and topology. Additionally, this simulator integrates the previously mentioned attacker model. Thus, the impact of attacks on power consumption and software behavior/execution-time can be analyzed. This provides developers with essential information about the effects that one or multiple attacks could have on the network, helping them to develop more secure WSN systems. This WSN attack simulator is an essential element of the attack-aware embedded software development methodology that is also introduced in this work. PMID:27869710

Sexual obsessions and suicidal behaviors in patients with mood disorders, panic disorder and schizophrenia

Directory of Open Access Journals (Sweden)

Dell’Osso Liliana

2012-10-01

Full Text Available Abstract Background The topic of sexual obsessions as a psychiatric symptom has not been well investigated. The aim of this study was twofold: 1 to explore the presence of sexual obsessions in patients with mood disorders (n=156, panic disorder (n=54 and schizophrenia (n=79, with respect to non-psychiatric subjects (n=100; 2 to investigate the relationship between sexual obsessions and suicidal behaviors, taking into account socio-demographic variables ad mental disorders. Methods 289 psychiatric patients with mood disorders, panic disorder or schizophrenia, were recruited at the Italian University departments of psychiatry along with 100 non-psychiatric subjects, who presented for a routine eye exam at the ophthalmology department of the same Universities. The assessments included: the Structured Clinical Interview for DSM-IV-TR, the Brief Psychiatric Rating Scale (BPRS, the Obsessive-Compulsive Spectrum Self-Report (OBS-SR, for sexual obsession, and the Mood Spectrum-Self Report lifetime version (MOODS-SR. Suicidality was assessed by means of 6 items of the MOODS-SR. Results Sexual obsessions were more frequent in schizophrenia (54.4%, followed by mood disorders (35.9%. Among schizophrenia patients, males reported more sexual obsessions than females (P Conclusions Special attention should be given to investigate and establish effective strategies of treatment for sexual obsessions, especially those with comorbid mood disorders or schizophrenia.

Consensus statement on panic disorder from the International Consensus Group on Depression and Anxiety.

Science.gov (United States)

Ballenger, J C; Davidson, J R; Lecrubier, Y; Nutt, D J; Baldwin, D S; den Boer, J A; Kasper, S; Shear, M K

1998-01-01

To provide primary care clinicians with a better understanding of management issues in panic disorder and guide clinical practice with recommendations for appropriate pharmacotherapy. The 4 members of the International Consensus Group on Depression and Anxiety were James C. Ballenger (chair), Jonathan R. T. Davidson, Yves Lecrubier, and David J. Nutt. Four faculty invited by the chairman also participated: David S. Baldwin, Johan A. den Boer, Siegfried Kasper, and M. Katherine Shear. The consensus statement is based on the 6 review papers that are published in this supplement and on the scientific literature relevant to these issues. There were group meetings held during a 2-day period. On day 1, the group discussed each review paper and the chairman and discussant (Dr. Kasper) identified key issues for further debate. On day 2, the group discussed these key issues to arrive at a consensus view. After the group meetings, the consensus statement was drafted by the chairman and approved by all attendees. The consensus statement provides standard definitions for response and remission and identifies appropriate strategy for the management of panic disorder in a primary care setting. Serotonin selective reuptake inhibitors are recommended as drugs of first choice with a treatment period of 12 to 24 months. Pharmacotherapy should be discontinued slowly over a period of 4 to 6 months.

Negative autobiographical memories in social anxiety disorder: A comparison with panic disorder and healthy controls.

Science.gov (United States)

O'Toole, Mia Skytte; Watson, Lynn A; Rosenberg, Nicole K; Berntsen, Dorthe

2016-03-01

Empirical interest in mental imagery in social anxiety disorder (SAD) has grown over the past years but still little is known about the specificity to SAD. The present study therefore examines negative autobiographical memories in participants with social anxiety disorder (SAD), compared to patients with panic disorder (PD), and healthy controls (HCs). A total of 107 participants retrieved four memories cued by verbal phrases associated with either social anxiety (SA) or panic anxiety (PA), with two memories for each cue category. PA-cued memories were experienced with stronger imagery and as more traumatic. They were also rated as more central to identity than SA-cued memories, but not among participants with SAD, who perceived SA-cued memories as equally central to their identity. When between-group effects were detected, participants with anxiety disorders differed from HCs, but not from each other. Central limitations include reliance on self-report measures, comorbidity in the anxiety disorder groups, and lack of a neutrally cued memory comparison. The findings align with models of SAD suggesting that past negative social events play a central role in this disorder. Future research is suggested to further explore the function of negative memories, not only in SAD, but also in other anxiety disorders. Copyright © 2015 Elsevier Ltd. All rights reserved.

Using agility to combat cyber attacks.

Science.gov (United States)

Anderson, Kerry

2017-06-01

Some incident response practitioners feel that they have been locked in a battle with cyber criminals since the popular adoption of the internet. Initially, organisations made great inroads in preventing and containing cyber attacks. In the last few years, however, cyber criminals have become adept at eluding defence security technologies and rapidly modifying their exploit strategies for financial or political gains. Similar to changes in military combat tactics, cyber criminals utilise distributed attack cells, real-time communications, and rapidly mutating exploits to minimise the potential for detection. Cyber criminals have changed their attack paradigm. This paper describes a new incident response paradigm aimed at combating the new model of cyber attacks with an emphasis on agility to increase the organisation's ability to respond rapidly to these new challenges.

Web-based therapist-assisted cognitive behavioral treatment of panic symptoms : a randomized controlled trial with a three-year follow-up

NARCIS (Netherlands)

Ruwaard, Jeroen; Broeksteeg, Janneke; Schrieken, Bart; Emmelkamp, Paul; Lange, Alfred

BACKGROUND: Internet-delivered treatment may reduce barriers to care in those unwilling or unable to access traditional forms of treatment. OBJECTIVE: To assesses the efficacy of web-based therapist-assisted cognitive behavioral treatment (web-CBT) of panic symptoms. DESIGN: A randomized

Women's Heart Disease: Heart Attack Symptoms

Science.gov (United States)

... of this page please turn JavaScript on. Feature: Women's Heart Disease Heart Attack Symptoms Past Issues / Winter ... most common heart attack symptom in men and women is chest pain or discomfort. However, women also ...

A novel proposed network security management approach for cyber attacks

International Nuclear Information System (INIS)

Ahmed, Z.; Nazir, B.; Zafar, M.F.; Anwar, M.M.; Azam, K.; Asar, A.U.

2007-01-01

Network security is a discipline that focuses on securing networks from unauthorized access. Given the Escalating threats of malicious cyber attacks, modern enterprises employ multiple lines of defense. A comprehensive defense strategy against such attacks should include (I) an attack detection component that deter- mines the fact that a program is compromised, (2) an attack identification and prevention component that identifies attack packets so that one can block such packets in the future and prevents the attack from further propagation. Over the last decade, a significant amount of research has been vested in the systems that can detect cyber attacks either statically at compile time or dynamically at run time, However, not much effort is spent on automated attack packet identification or attack prevention. In this paper we present a unified solution to the problems mentioned above. We implemented this solution after the forward engineering of Open Source Security Information Management (OSSIM) system called Preventive Information Security management (PrISM) system that correlates input from different sensors so that the resulting product can automatically detect any cyber attack against it and prevents by identifying the actual attack packet(s). The PrISM was always able to detect the attacks, identify the attack packets and most often prevent by blocking the attacker's IP address to continue normal execution. There is no additional run-time performance overhead for attack prevention. (author)

Adaptive optimisation-offline cyber attack on remote state estimator

Science.gov (United States)

Huang, Xin; Dong, Jiuxiang

2017-10-01

Security issues of cyber-physical systems have received increasing attentions in recent years. In this paper, deception attacks on the remote state estimator equipped with the chi-squared failure detector are considered, and it is assumed that the attacker can monitor and modify all the sensor data. A novel adaptive optimisation-offline cyber attack strategy is proposed, where using the current and previous sensor data, the attack can yield the largest estimation error covariance while ensuring to be undetected by the chi-squared monitor. From the attacker's perspective, the attack is better than the existing linear deception attacks to degrade the system performance. Finally, some numerical examples are provided to demonstrate theoretical results.

Cyber-physical attacks a growing invisible threat

CERN Document Server

Loukas, George

2015-01-01

Cyber-Physical Attacks: A Growing Invisible Threat presents the growing list of harmful uses of computers and their ability to disable cameras, turn off a building's lights, make a car veer off the road,  or a drone land in enemy hands. In essence, it details the ways cyber-physical attacks are replacing physical attacks in crime, warfare, and terrorism. The book explores how attacks using computers affect the physical world in ways that were previously only possible through physical means. Perpetrators can now cause damage without the same risk, and without the political, social, or moral

Use of Attack Graphs in Security Systems

Directory of Open Access Journals (Sweden)

Vivek Shandilya

2014-01-01

Full Text Available Attack graphs have been used to model the vulnerabilities of the systems and their potential exploits. The successful exploits leading to the partial/total failure of the systems are subject of keen security interest. Considerable effort has been expended in exhaustive modeling, analyses, detection, and mitigation of attacks. One prominent methodology involves constructing attack graphs of the pertinent system for analysis and response strategies. This not only gives the simplified representation of the system, but also allows prioritizing the security properties whose violations are of greater concern, for both detection and repair. We present a survey and critical study of state-of-the-art technologies in attack graph generation and use in security system. Based on our research, we identify the potential, challenges, and direction of the current research in using attack graphs.

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

International Nuclear Information System (INIS)

Won, K. S.; Jun, S. K.; Kim, J. B.; Jang, E. J.

2003-01-01

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

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

Energy Technology Data Exchange (ETDEWEB)

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

2003-07-01

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

A fatal elephant attack.

Science.gov (United States)

Hejna, Petr; Zátopková, Lenka; Safr, Miroslav

2012-01-01

A rare case of an elephant attack is presented. A 44-year-old man working as an elephant keeper was attacked by a cow elephant when he tripped over a foot chain while the animal was being medically treated. The man fell down and was consequently repeatedly attacked with elephant tusks. The man sustained multiple stab injuries to both groin regions, a penetrating injury to the abdominal wall with traumatic prolapse of the loops of the small bowel, multiple defects of the mesentery, and incomplete laceration of the abdominal aorta with massive bleeding into the abdominal cavity. In addition to the penetrating injuries, the man sustained multiple rib fractures with contusion of both lungs and laceration of the right lobe of the liver, and comminuted fractures of the pelvic arch and left femoral body. The man died shortly after he had been received at the hospital. The cause of death was attributed to traumatic shock. © 2011 American Academy of Forensic Sciences.

Cyber Attacks, Information Attacks, and Postmodern Warfare

Directory of Open Access Journals (Sweden)

Valuch Jozef

2017-06-01