Natural Cure for Anxiety and Panic Attacks

Panic Away End Anxiety and Panic Attacks

Psychologists agree that when a person has anxiety of a certain situation, he may suffer from a panic attack. This person then fears that specific location or event. When he find himself in a similar situation, he fears the onset of an attack and essentially cause himself to have an anxiety attack in the process. The One Move method teaches you how to conquer these fears and end this vicious cycle. Panic Away provides a number of specific applications of the 21-7 Technique that relates to everyday life like how to deal with panic attacks while driving, leaving home, anxiety caused by the fear of flying and the fear of public speaking. If you have the fear of public speaking, fear of driving, or encounter panic disorders due to leaving your home than you may especially be fond of the segment dedicated to applying the One Move method to these particular problems. This Panic away technique is said to successfully fight the general anxiety disorder. Read more here...

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All the modules inside this ebook are very detailed and explanatory, there is nothing as comprehensive as this guide.

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Social phobia social anxiety disorder

Social phobia (American Psychiatric Association, 1994) is characterised by a marked or persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to the possible scrutiny of others (American Psychiatric Association, 1994). The individual fears that he or she will act in a way or show anxiety symptoms that will be humiliating or embarrassing. For example, some patients with hyperhydrosis and rosacea often perspire or blush more prominently in embarrassing situations and may develop a social phobia as a result. Exposure to the feared social situation almost always provokes anxiety, which may take the form of a situationally bound panic attack, which in turn also results in an exaggerated autonomic reactivity of the skin. In social phobia the individual recognises that the fear is excessive or unreasonable however, intense anxiety results if the feared situation is not avoided. The anxious anticipation or distress of the feared...

Idsmiv Diagnostic Criteria for Generalized Anxiety Disorder

Excessive anxiety or worry is present most days during at least a six-month period, and involves a number of life events. B. The anxiety is difficult to control. D. The focus of anxiety is not anticipatory anxiety about having a panic attack, as in panic disorder. E. The anxiety or physical symptoms cause significant distress or impairment in functioning.

Panic Disorder Obsessive Compulsive Disorder Social Phobia Hypochondriasis and Anorexia Nervosa

Many psychiatric disorders present with marked anxiety, and the diagnosis of GAD should be made only if the anxiety is unrelated to the other disorders. 2. For example, GAD should not be diagnosed in panic disorder if the patient has excessive anxiety about having a panic attack, or if an anorexic patient has anxiety about weight gain. C. Anxiety Disorder Due to a General Medical Condition. Hyperthyroidism, cardiac arrhythmias, pulmonary embolism, congestive heart failure, and hypoglycemia, may produce significant anxiety and should be ruled out as clinically indicated.

Clinical Features of Panic Disorder

Patients often believe that they have a serious medical condition. Marked anxiety about having future panic attacks (anticipatory anxiety) is common. B. In agoraphobia, the most common fears are of being outside alone or of being in crowds or traveling. The first panic attack often occurs without an acute stressor or warning. Later in the disorder, panic attacks may occur in relation to specific situations, and phobic avoidance to these situations can occur. C. Major Depression occurs in over fifty percent of patients. Agoraphobia may develop in patients with simple panic attacks. Elevation of blood pressure and tachycardia may occur during a panic attack.

Epidemiologyof Panic Disorder

The lifetime prevalence of panic disorder is between 1.5 and 3.5 . The female-to-male ratio is 3 1. Up to one-half of panic disorder patients have agoraphobia. B. Panic disorder usually develops in early adulthood with a peak onset in the mid twenties. Onset after age 45 years is unusual. C. First-degree relatives have an eightfold increase in panic disorder. D. The course of the illness is often chronic, but symptoms may wax and wane depending on the presence of stressors. Fifty percent of panic disorder patients are only mildly affected. Twenty percent have marked symptomatology.

Classification of Panic Disorder

These panic attacks occur spontaneously without any situational trigger. B. Situationally Bound Panic Attacks. These panic attacks occur immediately after exposure to the feared stimulus, such as being in a high place or after seeing a snake. C. Situationally Predisposed Panic Attacks. These panic attacks usually occur upon exposure to the feared stimulus, but they do not necessarily occur immediately after every exposure. For example, an individual may have panic attacks in crowded situations, but he may not have an attack in every situation, or the attack may occur only after spending a significant amount of time in a crowded location.

Differential Diagnosis of Panic Disorder

Anxiety is more constant than in panic disorder. Panic disorder is characterized by discrete episodes of severe anxiety along with physiologic symptoms. B. Substance-Induced Anxiety Disorder. Amphetamines, cocaine or caffeine can mimic panic attacks. Physiologic withdrawal from alcohol, benzodiazepines or barbiturates can also precipitate panic attacks. C. Anxiety Due to a General Medical Condition. Pheochromocytoma may mimic panic disorder and is characterized by markedly elevated blood pressure during the episodes of anxiety. It is excluded by a 24-hour urine assay for metanephrine or by serum catecholamines. Other medical conditions such as cardiac arrhythmias, hyperthyroidism, pulmonary embolism and hypoxia can present with symptoms similar to panic attacks.

Treatment of Panic Disorder

Mild cases of panic disorder can be effectively treated with cognitive behavioral psychotherapy with an emphasis on relaxation and instruction on misinterpretation of physiologic symptoms. panic attacks or are experiencing impairment in work or social functioning. 2. SSRIs are the first-line treatment for Panic disorder. A low dose, such as 5-10 mg of paroxetine (Paxil) or 12.5-25 mg of sertraline (Zoloft) is used initially. The dose may then be gradually increased up to 20-40 mg for paroxetine or 50 to 100 mg for sertraline. Fluoxetine (Prozac) may exacerbate panic symptoms unless begun at very low doses (2-5 mg). 3. When using a tricyclic antidepressant, the initial dose should also be low because of the potential for exacerbating panic symptoms early in treatment. Imipramine (Tofranil) is the best studied agent, and it should be started at 10-25 mg per day and increased slowly up to 100-200 mg per day as tolerated. 4. Benzodiazepines may be used adjunctively with TCAs or SSRIs...

Clinical Forms of Anxiety

Among the forms of pathological anxiety, the DSM-IV-TR 1 distinguishes, in addition to generalized anxiety, phobias, panic attacks, post-traumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD). There are some theories that since OCD involves structural and functional organic deficits, it is questionable whether it can be classified as an anxiety or depressive disorder 2 . The ICD-10 3 in fact classifies this disorder separately from the other manifestations often associated with it.

Affectionless Control and Anxiety

The caring environment can induce anxiety and depression. The Australian researcher Gordon Parker described a model of parental caring which involved emotional coldness and a tendency to control the children, termed affectionless control, which he maintained could induce depression in the infants 53-55 . He also devised a questionnaire, the parental bonding instrument (PBI), for administration to the children of these parents, asking them to describe their parents' attitude to them, on the basis of their recollections of care. He found a significant relation between affectionless control and depression among the children, and maintained that this was not a subjective interpretation by the children of their parents' behavior, but reflected the parents' actual characteristics. We subsequently extended the study to manifestations of anxiety, and found this too was significantly correlated with the parental attitude (Cappelli L, San Martini P Stile di accudimento genitoriale, ansia e...

Cytokines in depression and anxiety

There is mounting evidence that both depression and depressive symptoms can induce immune dysregulation by the production of proinflammatory cytokines including IL-6 (Maes et al., 1998). Similar responses in chronic anxiety with the production of IL-6 and reduced IL-2 receptor production (which is an essential cytokine to counter infection) was deemed a factor in increased URTI episodes (Ravindran, 1995). Persistent elevation of pro-inflammatory cytokines may lead to chronicity in disease, poor healing and increased disability (Leventhal et al., 1998). It seems, therefore, that negative emotions can directly affect the immune system to up or down regulate the response via inflammatory cytokines. This affects not only immediate reaction to the challenge of infection, but also the mechanisms of inflammatory disease.

Pathological and Normal Anxiety

Pathological anxiety is a weighty social problem. It is estimated that about 25 of the general population suffers, or has suffered, anxiety manifestations that significantly affect their mental equilibrium 4 . This is in fact the most widely encountered problem in mental pathology. If we then add that physiological anxiety can take a wide range of forms, there is no question that it is present throughout mental life. Both pathological and physiological anxiety, therefore, merit all the attention they can get from clinicians and researchers. A distinction between normal and abnormal anxiety is a useful basis for defining anxiety as such, since normal anxiety plays a role in adaptation, while the pathological form tends to lead to progressive dysfunction. Taking fear as a stimulus that usefully activates an organism's resources in response to a definite danger, then the nearer anxiety comes to fear, in its intensity and specificity, the more we can consider it useful for survival. Even...

The Benzodiazepine System and GABA

There are specific receptor sites for both benzodiazepines and GABA in the brain that are widely distributed. Benzodiazepines enhance and extend the synaptic actions of the neurotransmitter GABA. Gamma-aminobutyric acid is seen as an inhibitory neurochemical in the brain. Benzodiazepine receptors and GABA receptors are often considered jointly in what is sometimes called the GABA-benzodiazepine receptor complex (Maksay & Ticku, 1985). Animal research has shown that when subjects are exposed to acute or chronic inescapable shock, there is a reduction in benzodiazepine binding in the frontal lobe, the hippocampus, and the hypothalamus. These decreases have been associated with changes in memory, deficits in learning, and decreased release of GABA.

Treating Anxiety

All theories of anxiety disorders attempt to explain and organize what is known about fear and anxiety. Some of the theories, including the ones described here, also have been applied in developing treatments for anxiety disorders. As might be expected, clinical psychologists with very different ideas about the cause of anxiety will recommend very different treatments to eliminate it. In the case of Little Hans, Freud thought that his anxiety about horses was caused by repressed sexual impulses toward his mother and hatred of his father. From this, it follows that these repressed impulses would need to be brought out into the open and resolved before his anxiety about horses DSM-IV-TR Criteria for Generalized Anxiety Disorder Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least six months, about a number of events or activities (such as work or school performance) Anxiety and worry associated with three or more of the following symptoms,...


Benzodiazepines can almost always relieve anxiety if given in adequate doses, and they have no delayed onset of action. b. Despite their effectiveness, long-term use should be reserved for patients who have failed to respond to venlafaxine (Effexor), buspirone (BuSpar) and other antidepressants or who are intolerant to their side effects. c. Benzodiazepines are very useful for treating anxiety during the period in which it takes buspirone or antidepressants to exert their effects. Benzodiazepines should then be tapered after several weeks. d. Benzodiazepines have few side effects other than sedation. Tolerance to their sedative effects develops, but not to their antianxiety properties. e. Since clonazepam (Klonopin) and diazepam (Valium) have long half-lives, they are less likely to result in interdose anxiety and are easier to taper. f. Drug dependency becomes a clinical issue if the benzodiazepine is used regularly for more than 2-3 weeks. A withdrawal syndrome occurs in 70 of...

Anxiety Disorders

Anxiety disorders, like the generalized anxiety disorder and phobic disorders, have been found to have a high prevalence among refugee groups. The prevalence rates have varied from 5 to 43 in a study done on Bhutanese refugees settled in India 23 . Somasundaram 30 found rates of 58 for phobic symptoms, 17 for panic disorder and 19 for generalized anxiety disorder in a group of Sri Lankan refugees surveyed 4-9 weeks after an attack of aerial bombing. Across studies, the prevalence rates have varied due to the latency of time and severity of trauma, as pointed out by Mollica et al. 47 . One study done by Silove et al. 50 found that anxiety


Alprazolam, a triazolobenzodiazepine anxiolytic agent, has also been studied in the treatment of premenstrual syndrome. Of five randomized controlled trials, four found alprazolam to be more effective than placebo. In positive studies, alprazolam was particularly effective for management of premenstrual anxiety. Clinicians should remain cautious when prescribing alprazolam given its risk of tolerance and dependence. Buspirone, a nonbenzodiazepine anxiolytic agent, has not been found to be better than placebo for the treatment of PMS.

Emotions and Anxiety

Morris et al. 16 , using PET, showed experimentally that the right-hand amygdala was functionally activated when a subject was faced with masked adverse stimuli, but was not aware of them. Only the left amygdala was functionally activated when the subject was aware of the stimulus. In line with these studies, two response pathways are described, mediated by the amygdala, to emotional and anxiety-producing stimuli one is rapid, subcortical and unconscious, and the other is slower, cortical and conscious 17-19 . It seems clear, therefore, that the right hemisphere has a role in processing unconscious elementary emotions, whether good or bad this helps explain the pattern of affective indifference and denial of hemiple-gia in patients with right-brain lesions. Patients with lesions to the left, on the other hand, show anxiety and depression about the neurological damage, which can be considered a normal reaction of alarm and despair at the functional loss, triggered by the intact right...

Anxiety Sensitivity

Anxiety sensitivity describes the tendency for individuals to fear sensations they associate with anxiety because of beliefs that anxiety may result in harmful consequences. Research in the development and assessment of this construct was pioneered by Steven Reiss and his associates in the late 1980's. They developed a sixteen-item questionnaire, the Anxiety Sensitivity Index (ASI), to measure anxiety sensitivity and found it to be both reliable and valid. Anxiety sensitivity has been most closely related to panic disorder, an anxiety disorder characterized by frequent, incapacitating episodes of extreme fear or discomfort. In fact, as a group, individuals with panic disorder score higher on the ASI than individuals with any other anxiety disorder. Furthermore, some researchers have demonstrated that individuals scoring high on the ASI are five times more likely to develop an anxiety disorder after a three-year follow-up. Research investigating responses to arithmetic, caffeine, and...

Basic anxiety

Generally children are thought of as defenseless and submissive, but Horney describes the earliest and primary response to parental indifference as basic hostility, feelings of rage and aggression. If the child experiences victory from this reaction, belligerent behavior may become the method of choice for coping with life situations. But Horney notes that aggression is not the usual reaction that sustains the neurotic person through life. Instead basic hostility is typically followed by basic anxiety, the fear of being helpless and abandoned as punishment for having had these angry feelings. In order to survive, the basic hostility felt must then be concealed, and every effort made to convince the indifferent parents that the child is worthy of their love. This is, according to Horney, the progression for the majority of these children. Despite their rage, if they experience success through making themselves pleasing and lovable, then this will be the fa ade they will present to the...

Buspirone BuSpar

Buspirone is a first-line treatment of GAD. Buspirone usually requires 3-6 weeks at a dosage of 10-20 mg tid for efficacy. It lacks sedative effects. Tolerance to the beneficial effects of buspirone does not seem to develop. There is no physiologic dependence or withdrawal syndrome. b. Combined benzodiazepine-buspirone therapy may be used for generalized anxiety disorder, with subsequent tapering of the benzodiazepine after 2-4 weeks. c. Patients who have been previously treated with benzodiazepines or who have a history of substance abuse have a decreased response to buspirone. d. Buspirone may have some antidepressant effects.

Anxiety and Phobias

The emotional state most directly affected by stress is anxiety. In fact, the term state anxiety is often used interchangeably with the terms fear and stress to denote a transitory emotional reaction to a dangerous situation. Stress, fear, and state anxiety are distinguished from trait anxiety, which is conceptualized as a relatively stable personality disposition or trait. According to psychologist Charles Spielberger, people high in trait or chronic anxiety interpret more situations as dangerous or threatening than do people who are low in trait anxiety, and they respond to them with more intense stress (state anxiety) reactions. Instruments that measure trait anxiety ask people to characterize how they usually feel, and thus they measure how people characteristically respond to situations. Measures of trait anxiety (such as the trait anxiety scale of the State-Trait Anxiety Inventory) are especially useful in predicting whether people will experience high levels of stress in...

Antianxiety Drugs

These drugs are central nervous system depressants. Many of these anti-anxiety drugs or anxiolytics are, in higher doses, also used as sedative-hypnotics, or calming and sleep-inducing drugs. They seem to act by enhancing the effect of GABA in the brain. The earliest of these depressant drugs included chloroform, chloral hydrate, and paraldehyde, and they were used for anesthesia and for sedation. Barbiturates were introduced in Germany in 1862 and were widely used for treatment of anxiety and sleep problems until the 1960's. Barbiturates are still available today, including pentobarbital, secobarbital, amobarbital, and phenobarbital. Their major adverse effect is respiratory depression, particularly when used in combination with alcohol, another central nervous system depressant. With the advent of the safer benzodiazepines, use of the barbiturates has declined steadily. Benzodiazepines are used for two major problems anxiety and insomnia. Anxiety disorders appropriate for this kind...

What Is Quality Of Life

Describing what they mean by QoL, and then letting the items (questions) in their questionnaire speak for themselves. Thus some questionnaires focus upon the relatively objective signs such as patient-reported toxicity, and in effect define the relevant aspects of QoL as being, for their purposes, limited to treatment toxicity. Other investigators argue that what matters most is the impact of toxicity, and therefore their questionnaires place greater emphasis upon psychological aspects such as anxiety and depression. Yet others try to allow for spiritual issues, ability to cope with illness, and satisfaction with life. Some QoL instruments focus upon a single concept, such as emotional functioning. Other instruments regard these individual concepts as aspects or dimensions of QoL, and therefore include items relating to several concepts. Although there is disagreement about what components should be evaluated, most investigators agree that a number of the above dimensions should be...

Pharmaceutical Therapy

Pharmaceutical agents used to slow the progression of AD include acetylcholinesterase inhibitors (tacrine, donepezil, rivastigmine, and galanta-mine). These agents block the breakdown of neurotransmitters in the brain and are used to lessen symptoms of mild to moderate AD. Their action extends cognitive function and improves behavioral symptoms for twelve months up to two years. Vitamin E or selegiline delays the progression of AD. Estrogen has been associated with a decreased risk of AD and enhanced cognitive functioning. Its antioxidant and anti-inflammatory effects enhance the growth of neuron processes for memory function. Ginkgo biloba has provided moderate cognitive improvement with few ill effects. Delusions and hallucinations often develop in moderately impaired patients. In the absence of agitation or combativeness, the best treatment is reassurance and distraction. Delusions and hallucinations accompanied by agitation and combativeness can be treated with low doses of...

The psychological impact of skin disease

Research into the manifestations of psychocutaneous disorders has led to an increasing awareness of the psychosocial effects associated with skin disease. These include depression, a decreased sense of body image and self-esteem, sexual and relationship difficulties, and a general reduction in quality of life (Dungey & Busselmeir, 1982 Obermeyer, 1985 Porter et al., 1987 Papadopoulos et al., 1999). Indeed, research has shown that people with skin disease experience higher levels of psychological and social distress (Root et al., 1994), poorer body image and lower self-esteem than the general population (Papadopoulos et al., 1999) and higher avoidance of situations where their skin may be exposed (Rubinow et al., 1987). Leary and colleagues (1998) suggest that the degree of social anxiety depends on a person's confidence regarding their ability to successfully manage the impression they make and it has been shown that social anxiety is a mediating factor between the severity of a...

Instruments For Specific Aspects Of

The instruments described above purport to measure general QoL, and include at least one general question about overall QoL or health. In many trials this may be adequate for treatment comparison, but sometimes the investigators will wish to explore particular issues in greater depth. We describe four instruments that are widely used in clinical trials to explore anxiety and depression, physical functioning, pain, and fatigue. These domains of QoL are particularly important to patients with chronic or advanced diseases. Many other instruments are available, both for these areas and others. Additional examples are coping (Hiirney et al., 1993), satisfaction (Baker and Intagliata, 1982), existential beliefs (Salmon, Mauzi and Valori, 1996) and self-esteem (Rosenberg, 1965). Since these questionnaires evaluate specific aspects of QoL, in order for a patient assessment to be called quality of life these instruments would normally be used in conjunction with more general questionnaires.

Impact on Field of Psychology

Just as most theories in psychology have a view of anxiety, anxiety is an important concept in many areas of psychology. Obviously, anxiety is very important in the fields of psychopathology and psychotherapy. It also has been very important in learning theory experiments with conditioned fear have advanced knowledge about Pavlovian and operant conditioning. Anxiety is also an important trait in theories of personality, and it figures in theories of motivation. It might be said that anxiety is everywhere in psychology. Theoretical developments in anxiety have been incorporated into other areas of psychology. For example, in the early 1960's, Peter Lang described fear and anxiety as being composed of three systems that is, there are three systems in which fear is expressed verbal (saying I'm anxious ), behavioral (avoiding or running away from a feared object), and physiological (experiencing an increase in heart rate or sweating). An important point in understanding the three systems...

Treatment of Brief Psychotic Disorder

A brief course of a neuroleptic such as risperidone (Risperdal) 2-4 mg per day is often indicated, and adjunctive benzodiazepines may be useful. Short-acting benzodiazepines such as lorazepam 1-2 mg every 4 to 6 hours can be used as needed for associated agitation and anxiety.

Crisis Acute Stress Disorder and PTSD

Acute Stress Disorder is a formal mental disorder identified in the DSM-IV-TR. If someone meets criteria A1 and A2 and experiences qualified symptoms, he or she may meet criteria for ASD. Their symptoms have to last a minimum of 2 days and a maximum of 4 weeks, after which PTSD will be diagnosed. Three of the following dissociative symptoms must be present a subjective sense of numbing, detachment, or absence of emotional responsiveness a reduction in awareness of his or her surroundings (e.g., being in a daze) derealization deper-sonalization or dissociative amnesia (an inability to recall an important aspect of the trauma). They must also have at least one reexperiencing symptom, one avoidance symptom, and marked symptoms of anxiety or arousal, such as difficulty sleeping, irritability, poor concentration, or exaggerated startle. Research has shown that as much as 80 percent of those who suffer from ASD will develop PTSD (Brewin, Andrews, Rose, & Kirk, 1999).

Capitalizing on Context

Ceci and Bronfenbrenner (1985) conducted a time-based study in which children were asked to monitor the passage of time needed to bake cupcakes or to charge a motorcycle battery. Both tasks lasted 30 minutes. The important result for the present purposes was that strategic monitoring of a clock depended on whether the children were tested in the laboratory or in their home context. In the home context, children were less anxious and were able to check the clock less frequently. By contrast, in the unfamiliar context, clock checking was more frequent. Ceci and Bronfenbrenner attributed the difference in clock checking to a difference in the level of anxiety that the children had about the task. Twenty years later, we may reinterpret this finding as having been a consequence of the perceived importance of the task that depended on the context in which the ongoing task was performed (Kliegel, Martin, McDaniel, & Einstein, 2001, 2004). After all, 21 children (out of 96) were late at...

Mental Disorders and Public Health

For the clinical psychiatrist, the most disabling and important conditions are schizophrenia, other functional psychoses and dementia. However, from the perspective of public health, depression and anxiety are very common and, though less disabling for the patients, lead in aggregate to more disability in the population as a whole. Of course, there is much evidence for a strong association between depression and disability in both developed and less developed countries 3-5 . Common mental disorders have also been linked to diminished productivity and sickness absence. These statistics reflect observations all too familiar to practising clinicians in primary care and psychiatry. In the following sections of the chapter we shall discuss the influence of globalization on socio-economic status and then gender, and its implications for mental health. In particular, we shall discuss some of the empirical findings in relation to depression and anxiety, as these are the most important...

Example from the literature

Zigmond and Snaith (1983) asked 100 patients from a general medical outpatient clinic to complete the HADS questionnaire. Following this, they used a 20-minute psychiatric interview to assess anxiety and depression. A summary of the results is shown in Table 3.2, with patients grouped into three categories according to whether they were psychiatric cases, doubtful cases or non-cases of anxiety and depression. For diagnosing psychiatric cases, the depression scale gave 1 false positives and 1 false negatives, and the anxiety scale 5 false positives and 1 false negatives.

Major Issues And Future Directions

Experiments are needed along these lines to ascertain whether our anecdote about returning to the room where one formed an intention indeed increases the probability of recollection. Further experiments are needed that go beyond the environmental context at encoding. There are a variety of internal contexts that, whether reinstated or not during a performance interval, may affect intention completion. One's mood or prevailing emotional state has not been investigated in any detail (but see Harris & Menzies, 1999). In unpublished work, we have tested obsessive-compulsive individuals and discovered that with an intention about neutral material they are disadvantaged in cue detection, but with an intention related to bodily fluids (e.g., mucus and urine) they are not. The idea there is that individuals with obsessive-compulsive disorder behave as cognitively distracted for material other than that related to their compulsion. Work along these lines...

Therapeutic Techniques

Cognitive therapy has been successfully applied to panic disorder, resulting in practically complete reduction of panic attacks after twelve to sixteen weeks of treatment. Additionally, cognitive therapy has been successfully applied to generalized anxiety disorder, eating disorders, and inpatient depression.

Followup of Benign Thyroid Nodules

Some authors recommend that a benign FNAB should be confirmed by a second FNAB 6-12 months later, because of a false-negative rate of up to 6 of the initial FNAB 59 . The decision to subject patients to a second FNA has to be balanced against the probability of nondiagnostic aspirate,false-positive results (e.g. Thy3 in up to 7 of cases) necessitating surgery, reduction in cost-effectiveness, and heightened patient anxiety 35 . A small proportion of patients will develop new nodules or enlargement of their existing nodule, and some will develop thyroid dysfunction therefore some form of follow-up seems appropriate, although the optimal means of achieving this is unknown.

Sources for Further Study

Cognitive Therapy and the Emotional Disorders. New York International Universities Press, 1976. An easy-to-read book that presents a general overview of the cognitive model and illustrates the cognitive model of different psychological disorders. Beck, Aaron T., and Gary Emery. Anxiety Disorders and Phobias A Cognitive Perspective. Reprint. New York Basic Books, 1990. Presents the cognitive theory and model of anxiety disorders, as well as the clinical techniques used with anxious patients. Beck, Aaron T., A.J. Rush, B. F. Shaw, and Gary Emery. Cognitive Therapy of Depression. Reprint. New York Guilford Press, 1987. Presents the cognitive theory of depression and actual techniques used with depressed patients. Makes a theoretical contribution and serves as a clinical handbook on depression.

Effects of Liver Disease on Patient Response

The relationship between drug concentration and response also can be altered in patients with advanced liver disease. Of greatest concern is the fact that customary doses of sedatives may precipitate the disorientation and coma that are characteristic of portal-systemic or hepatic encephalopathy. Experimental hepatic encephalopathy is associated with increased g-aminobutyric acid-mediated inhibitory neurotransmission, and there has been some success in using the benzodiazepine antagonist flumazenil to reverse this syndrome (50). This provides a theoretical basis for the finding that brain hypersensitivity, as well as impaired drug elimination, is responsible for the exaggerated sedative response to diazepam that is exhibited by some patients with chronic liver disease (51). Bakti et al. (52) conducted a particularly well-controlled demonstration of benzodiazepine hypersensitivity by showing that central nervous system (CNS) performance in cirrhotic patients was impaired when compared...

Organizational Aspects of a Thyroid Nodule Service

Performing a biopsy implies suspicion of cancer and most patients experience anxiety about the procedure and the outcome. Before the biopsy the reason for performing this test should be discussed openly with the patient and informed consent obtained. Patients should understand that the result of the biopsy may not provide a definitive answer and that further tests (including surgery) may be required. It is good practice to give patients the opportunity to discuss these issues, and to arrange prospec-tively a time and place for the communication of the result of the biopsy. This may include breaking bad news, in which case a relative and a nurse should be present. It is preferable therefore for the discussion of the results of the biopsy to take place in person. Informing patients of a diagnosis of cancer by letter or by telephone is an unsatisfactory approach, in the author's opinion, except in specific circumstances and only if that is the patient's own preference.

Emotional Responses and Affective States

Anxiety The early research on psychosocial risk factors for preterm delivery and low birth weight focused on maternal anxiety (Gorsuch and Key, 1974). Other studies over the years have focused on the role of general distress. Determination of whether either depression or anxiety is a risk factor for preterm delivery has, however, been difficult for many reasons. Among these is the fact that the two emotional states are often comorbid, although they are distinguishable clinically. However, the questionnaire measures used in obstetric research to assess anxiety and depression are not well suited to their differentiation. Thus, many studies have investigated general distress by using the General Health Questionnaire (Hedegaard et al., 1993, 1996 Perkin et al., 1993) or the Hopkins Symptom Checklist (Paarlberg et al., 1996). General emotional distress may not be as clear-cut a risk factor as the potentially separable effects of either anxiety or depression. Recent studies suggest that...

The Aim Of Clinical Genetics

In the UK there is a network of genetic centres, distributed on a regional basis, each of which is usually composed of integrated clinical, molecular and cytogenetic teams (Raeburn et al., 1997 Harper et a ., 1996). Most GC services are organized within a clinical genetic department where pre-counselling issues, diagnostic confirmation, discussion of and informing about appropriate tests and assessment of family history are all performed. It is helpful to split up GC into stages based on the likely sequence, from first diagnosis in the family to the completion of all relevant counselling. However, experiences in other areas of genetics show that the processes that would be ideal for a couple may frequently be short-circuited by several, partly unplanned, events. The media may focus on a particular story and raise expectations for all affected individuals and their families. The unanticipated death of an affected person may trigger anxiety and even panic for other members of a family...

Gender Differences in Prevalence of Common Mental Disorders

One of the most robust findings in the psychiatric epidemiology literature is the observation that the prevalence of depression is higher in women than men. This subject has been reviewed on a number of occasions and has led to a considerable debate about the possible causes. A recent WHO publication comprehensively reviewed the literature confirming the consistency of this relationship 56 . For example, the most recent large-scale community surveys carried out in the USA 57 , the UK 58 and Australia 59 all found an increased risk of depression and anxiety in women. For example, in the UK data, the odds ratio for women compared with men was 1.76 (95 CI 1.57-1.97) 58 and this association persisted after adjustment for a number of other variables.

Explanations for Difference in Prevalence by Gender

There are a number of possible explanations for the apparent association between gender and the prevalence of depression and anxiety. The main explanations that have been suggested could be classified as follows response bias, biological and psychological vulnerability, and social role. Some authors have suggested that there is a response bias such that women are more likely to give a positive response when asked about all symptoms, including those of depression and anxiety. There is evidence that women are more likely than men to report physical symptoms as well as psychological ones, despite the fact that women live longer. A study in Recife, Brazil, also found a bias in that women were more likely to report symptoms on the Symptom-Reporting Questionnaire (SRQ) than on a psychiatric interview, when compared with men 65 . However, even in that study women had a higher prevalence of common mental disorders with the psychiatric interview. It would seem unlikely that response bias could...

Benefits of Meditation

Research on the physiological effects of meditation led to the application of meditative techniques as a treatment to combat stress-related illnesses. Meditators have often experienced significant decreases in such problems as general anxiety, high blood pressure, alcoholism, drug addiction, insomnia, and other stress-related problems. Researchers have also found that the scores of meditators on various psychological tests have indicated general mental health, self-esteem, and social openness. Many psychologists argue, however, that these effects are not unique to meditation and can be produced by means of other relaxation techniques. Meditation researcher Robert Ornstein has suggested that the long-term practice of meditation may induce a relative shift in hemispheric dominance in the brain from the left hemisphere, which is associated with such linear processes as language and logical reasoning, to the right hemisphere, which is associated with nonlinear processes such as music...

Individual Processes and Variables

According to Buckley, Blanchard, and Neill (2000), in PTSD, attentional resources are allocated toward threatening stimuli. Research, done with the broad class of Anxiety Disorders and not PTSD specifically, have led some to believe that Anxiety Disorder patients process negative information more quickly than positive or neutral information. They also do this faster than nonanxiety-disordered patients.

Support of Patients During Treatment and Followup

The most common forms of thyroid cancer -follicular and papillary - have excellent survival rates, even when there has been spread beyond the thyroid 14 . GPs can therefore be very optimistic when talking to most patients about prognosis. While patients will accept this outlook, the emotional response to suffering cancer needs to be considered. Anxiety will rise with every follow-up check and will not abate until news that no recurrence has been found is delivered. Moreover, the physical symptoms related to thyroid hormone withdrawal required prior to reassessment are profound, severe, and debilitating. Dow and colleagues found that patients with thyroid cancer had to learn through their own personal experiences what physical limitations were imposed during the period of surveillance testing. As well, the physical changes and anticipation of body scanning exerted a profound effect on their psychological and social wellbeing. Feelings of loss, anxiety, depression, and loss of...

Pharmaceutical Therapies

Nerve growth factor, antioxidant therapy, and other drugs are being investigated for the management of dementia. Psychotrophic medications such as carbamazepine, desipramine, haloperidol, lorazepam, and thioridazine are used to control symptoms of agitation, anxiety, confusion, delusions, depression, and hallucinations in patients with dementia. Unfortunately, some of the medications used to improve patients' quality of life may not work, may worsen memory deficits, or cause neurological effects such as irreversible tremors (tardive diskinesia).

Endocrinological Aspects

Thyroid disorders also strongly affect mood. A study to evaluate the prevalence of mental disorders in 93 inpatients affected by different thyroid diseases during their lifetimes, by means of standardized instruments, showed higher rates of panic disorder, simple phobia, obsessive-compulsive disorder, MDD, bipolar disorder and cyclothymia in thyroid patients than in the general population 54 . These findings may suggest either that thyroid abnormalities effect secondary mood changes, or that the co-occurrence of mental and thyroid diseases may be the result of common biochemical abnormalities.

Placental ischemiareperfusion and preeclampsia

Clearly demonstrated in the rhesus monkey, in which the intravenous administration of epineph-rine or norepinephrine causes a severe reduction in placental perfusion, to the point that high doses can result in fetal asphyxia and death (Adamsons and Myers, 1975 Adamsons et al., 1971). Evidence that the unconverted segment of the vessel is indeed flow-limiting is provided by the fact that despite the systemic hypertension induced the pressure in the dilated mouth of the spiral artery is decreased after administration. It has been suggested that a similar mechanism underlies the high rate of fetal loss during the second and third trimesters in women suffering from pheochromo-cytoma (Adamsons and Myers, 1975). Spontaneous changes in maternal catecholamine release, for example in response to stress, may therefore also influence the caliber of these vessels and hence perfusion of the intervillous space. Epidemiologically, there is an association between maternal anxiety and low birthweight,...

Clinical Comorbidity Underlined by Overlapping Biological Mechanisms

From an evolutionary standpoint, anxiety is probably a signal of alarm to the organism in uncertain and potentially dangerous situations. While pure, or, more precisely, mainly anxiety disorders may exist, there is an emerging recognition that there are significant interactions and impact with both mood and cognition. In terms of interactions with mood, anxiety and low mood may translate as fear, whereas anxiety and high mood may translate as irritability and anger. In terms of interactions with cognition, high anxiety may be a component of paranoid ideation, and lack of anxiety a component of antisocial psychotic acts.

Temperament and Environment

Some types of anxiety, particularly panic attacks, can be traced back to the sufferer's separation from the parents while still an infant, which predisposes them to pathological anxiety. Kendler et al. 6 , in a study of a series of 1018 twin-pairs, showed that separation from parents, or their death, was correlated with the onset of panic attacks in the children 7 . Gabbard also notes that Kagan et al. 8 described a type of child that showed fear and behavioral inhibition when faced with the unknown. These infants tend to ask their parents repeatedly for reassurance, and throw temper tantrums if their demands are not satisfied. The anger aggravates the problem, because it is likely to produce negative reactions in the parents, and a sense of guilt in the children, who fear they may damage the bond with these significant figures in their lives. This therefore develops into a condition of hostile, fearful dependence which is the ideal terrain for pathological anxiety to flourish on...

Historical Perspective

Another characteristic of the conceptual model underlying EFA is that intelligence tests, like most psychological tests, should follow the basic pattern shown in Figure 5.1. Hence, if the person being assessed has a high intelligence (anxiety or depression in our example) we would expect this to be reflected in corresponding high scores for each of the individual items comprising the test. Any item in the test that does not satisfy this requirement would, under psychometric theory of tests, be regarded as a poor test-item and would be a candidate for removal from the questionnaire. Psychological, psychometric and educational tests are all typically constructed with the intention of measuring a few, possibly as few as one or two, subscales and contain a number of items that are expected to be homogeneous within each subscale. The HADS instrument is thus fully representative of such a test. This is rather different from many QoL instruments, which may contain a few items for each of...

Linking Hazards and Public Health Communication and Environmental Health1

Disasters are the destructive forces that overwhelm a given region or community. These disasters can be natural or human-induced and require external assistance and coordination of services in order to address the myriad of effects and needs, including housing needs, transportation disruption, and health care needs. Disasters pose a variety of health risks, including physical injury, premature death, increased risk of communicable diseases, and psychological effects such as anxiety, neuroses, and depression. Destruction of local health infrastructure hospitals, doctor's offices, clinics is also likely to impact the delivery of health care services. A second wave of health care needs may occur due to food and water shortages and shifts of large populations to other areas.

Advances and Insights from Pharmacological Studies

A preclinical pharmacological study measured changes in extracellular concentrations of catecholamines and indoleamines in the hippocampus or the PFC in rats in response to administration of the CRF1 antagonist CP-154, 526 by using in vivo microdialysis 68 , and found that this CRH1 receptor antagonist suppresses the release of norepinephrine and serotonin in the hippocampus, which may be of relevance to understanding and treating anxiety and mood disorders. study was carried in a double-blind, placebo-controlled fashion in monkeys exposed to an intense social stressor namely, placement of two unfamiliar males in adjacent cages separated only by a transparent Plexiglas screen. Antalarmin significantly inhibited a repertoire of behaviours associated with anxiety and fear such as body tremors, grimacing, teeth gnashing, urination and defecation. In contrast, antalarmin increased exploratory and sexual behaviours that are normally suppressed during stress. Moreover, antalar-min...

Both 1 and 2 are Required

Recurrent unexpected panic attacks occur, during which four of the following symptoms begin abruptly and reach a peak within 10 minutes in the presence of intense fear 1. Anxiety about being in places or situations where escape might be difficult or embarrassing, or in which help might not be available. 2. Situations are avoided or endured with marked distress, or these situations are endured with anxiety about developing panic symptoms, or these situations require the presence of a companion. 3. The anxiety is not better accounted for by another disorder such as social phobia, where phobic avoidance is only limited to social situations. C. Panic attacks are not due to the effects of a substance or medical condition. D. The panic attacks are not caused by another mental disorder such as panic on exposure to social situations in social phobia, or panic in response to stimuli of a severe stressor, such as with post-traumatic stress disorder. II. DSM-IV Criteria for Panic Disorder...

Recollections and Forecasts

The normal form of fear can thus develop into survival anxiety, in the face of the danger of attack from outside, or of a separation, or of bodily malfunctioning. The emotive brain develops before the cognitive one, and fears learned and archived early in the procedural memory tend to persist over the years, even if development of the cortical functions inhibits their manifestation to outsiders 4 . We also know that our brain tends to anticipate events, in order to be ready to assess and respond to a danger it does this by drawing on an outline of previous experience as applicable to current perception of the situation, without waiting to specifically assess the Drawing on this knowledge of brain function, it becomes clear that the mind is quite capable of suffering persecutory and depressive anxiety that is detached from the appropriate context and can become generalized, superimposing itself on subsequent perceptions and altering them. Hypothetically, therefore, unfavorable or...

Why does stigmatisation matter

A very useful approach in this respect has been provided by Baumeister's (Baumeister & Tice, 1990 Leary, 1990) Social Exclusion Theory (SET). SET holds that a primary source of anxiety is potential exclusion from important social groups. It is based on three propositions that In a similar fashion, Hagerty and colleagues (Hagerty & Patusky, 1995 Hagerty et al., 1996 Hagerty & Williams, 1999) argue that the experience of personal involvement in a group, a sense of belonging, is a significant determinant of well-being. In their model, belonging has two attributes being valued or needed by others and being congruent with others through shared characteristics. Depressed mood is a likely result when a sense of belonging is absent. Lee and Robbins (1995 1998) have explored the role of social connectedness, defined as beliefs about enduring relationships with other people in general, rather than with particular individuals. It seems that stigmatisation matters to people because the rejection,...

Clinical Considerations

This process, with its greater detail, is more fluid and distinctly divided, therefore slower, and is hard to set in motion in conditions of anxiety. But our memory can still offer the speedy, automatic, well-trodden pathway that tends to take priority in states of alarm. With specific reference to anxiety, we can speculate that some clinical forms of neurosis or psychosis, not traceable to recognizable current causes, and thus not reactive, are in fact closely bound up with the unconscious memory. This is where traces of experience remain, not repressed and not remembered, but acted out in symptomatic manifestations, obscuring the higher functions of thought.

Attention to Quality of Life

The physician in charge of the continuity in care of the thyroid cancer patient (likely the endocri-nologist) is instrumental in promoting compliance with the long-term follow-up and the required repeat investigations. Compliance can be enhanced by giving attention to many details which - although not determining the main outcome of the disease - may severely affect the patient's life. The cost of care should not be forgotten, as patients may have no or insufficient insurance 44 . The incidence of chronic xerostomia as a result of 131I-induced sialadenitis may decrease considerably with amifostine pretreat-ment 45 . During thyroid hormone withdrawal, hypothyroid symptoms are common such as fatigue, weight gain, peripheral edema, muscle cramps, skin dryness, anxiety, constipation, cold, depression, and impairment of memory and concentration these complaints are more pronounced in the elderly than in younger patients 45 . It is thus not surprising that quality-of-life questionnaires...

How might stigmatisation be reduced

Other approaches are more psychologically based. Some aim to help people forestall stigmatisation. In social skills training people are encouraged to develop ways of displaying their social competence to others, so that the stigmatising condition is less pertinent to social interactions. Robinson et al. (1996) assessed the effects of a social skills workshop on the well-being of patients with a variety of disfiguring conditions. The package included instruction, modelling, role-play, feedback and discussion. Although there were improvements in levels of anxiety and social avoidance, again there were no measures of stigmatisation. Other approaches aim to help people to cope with stigmatisation when it occurs. Papadopoulous et al. (1999) used

Treatment of Social Phobia

SSRIs, such as paroxetine (Paxil) 20-40 mg day or sertraline (Zoloft) 50100 mg day, are the first-line medication for social phobia. Benzodiazepines, such as clonazepam (Klonopin) 0.5 - 2 mg per day, may be used if SSRIs are ineffective. B. Social phobia with performance anxiety responds well to beta blockers, such as propranolol. The effective dosage can be very low, such as 10-20 mg qid. It may also be used on a prn basis 20-40 mg given 30-60 minutes prior to the anxiety provoking event.

Questionnaire Development and Scoring

Interviews with healthcare workers, and discussions with patients. It is essential to have exhaustive coverage of all symptoms that patients rate as being severe or important. After identifying all of the relevant issues, items can be generated to reflect these issues. Some issues, such as anxiety, are often assessed using several items in order to increase the reliability of the measurement. The two principal approaches for selecting items for this purpose are Likert summated scales using parallel tests, or item response theory (IRT) models. On the other hand, symptoms or other causal variables are more commonly assessed using single items.

Regulation of GABAa receptor function by neuromodulators the role of kinases and phosphatases

Given that dopamine is a key neurotransmitter ne-uromodulator in many parts of the basal ganglia and that dopamine receptors couple to G-protein-linked second messenger systems to alter kinase and phosphatase activity, it is appropriate to consider how GABAA receptor function is regulated by phosphorylation initiated by dopamine receptor activation (e.g., Chen et al., 2006). There has been one intriguing report that dopamine D5 receptors directly crosslink with GABAA receptors by using the TM3-TM4 loop of the g2 subunit (Liu et al., 2000) so far this finding has not been followed up, but it should not be dismissed too prematurely. But more conventionally, phosphorylation is the common way to regulate ion channels (Kittler and Moss, 2003). This is underlined by studies on, for example, PKC e knockout mice these mice show increased anxiety and have impaired GABAA receptor function (Hodge et al., 1999). For the GABAA receptor, the intracellular loops of the p and g2 subunits in...

ACT as an Early Intervention Strategy

Many researchers have speculated that reducing an individual's DUP will result in improved short-term and long-term outcomes (e.g., McGlashan, 1999 Meller et al., 2004). Intervening to halt the psychotic process should reduce neurotoxicity, reduce the individual's suffering due to fear, anxiety, and stress, and improve performance socially, on the job, and in the family. There is fairly good evidence that, at least in the short term, shorter DUP is related to better outcomes (Malla & Norman, 2002). Several studies report that shorter DUP is related to longer remissions and lower symptom rates in the future, whereas longer DUP is related to increased negative symptoms and poorer quality of life. These relationships become weaker as the length of the research follow-up periods increase.

Noting the impact of time on created reality

For example, when you are in an experience like anxiety, it feels like it will never end. By noticing, however, its place in the time continuum you are put outside of the effect of time. This frees you and frees the experience to not appear time frozen. Whenyou fuse with an experience, you feel time. Why Because all experiences occur in time. Therefore, when you move from being the observer of an experience (the observer of a time-bound experience is not in time) to being an experience, you feel like you are in time and frozen. Observing experiences moves you into a no-time space, and allows for the movement of an experience.

Coping and adjustment

Consequently, most individuals strive to manipulate their appearance in some way, so as to present themselves in the best possible light to prospective or current partners (Rumsey & Harcourt, 2004). The inability to enhance appearance due to skin disease creates an emotional reality that impacts on individual functioning, and can alter the matrix of social interaction (Koblenzer, 1987 Bradbury, 1996 Landsdown, 1997). Feelings of shame and increased self-consciousness may challenge an individual's sense of self, alter how they approach new romantic encounters or jeopardise emotional security in existing relationships. Research on coping and adjustment has identified clusters of difficulties that individuals commonly face, but there is no neat list of problems encountered by all patients (James, 1989). While skin disease can severely disrupt the lives of some individuals (Jowett & Ryan, 1985 Porter et al., 1990), the extent of disability and distress varies,...

Changes in social networks

In the course of their relationship, couples create substantial social contexts that involve sharing domestic, recreational or occupational activities. When skin disease changes companionship in any one of these areas, the maintenance or nature of the relationship may be threatened (Lyons & Sullivan, 1998). Changes in a couple's social network may occur through reduced interactions with others and an increase in companionate activities at home (Morgan et al., 1984). More than often, withdrawal is a response to the damaging effects of social stigma. Porter et al. (1990) reported that vitiligo patients experienced embarrassment and anxiety when meeting strangers and that many had been victims of rude remarks in the face of public ignorance. In the short term, avoidance may serve a protective function, but it may also lead to loss of friendships and activities that would typically increase a couple's social network. In an early survey, Jobling (1976) asked 186 members of the British...

Relationshipfocused coping

Thus it is under these conditions that differences in attachment behaviour are likely to be more pronounced (Simpson et al., 1992). If the disease spreads, or worsens, secure individuals are able to seek the support or reassurance they need from partners. 'Active engagement' in such couples entails coping jointly with difficulties by discussing feelings or engaging in interpersonal problem-solving (Coyne & Smith, 1991). In contrast, avoidant adults are more likely to become distant or withdrawn. Simpson et al. (1992) argue that in reality, avoidant individuals want to be physically and emotionally close to their partners but are afraid of this intimacy. It is theorised that at lower levels of distress (maybe during remission), avoidant individuals can display behaviours and emotions that achieve greater intimacy and relationship satisfaction. However, as levels of anxiety increase they become fearful and cannot tolerate closeness. This explains, perhaps, why avoidant individuals are...

Issues in Treatment Planning

Also consider whether the person coming to you wants treatment for PTSD or trauma. This may sound like a strange point, but if someone comes to you for test-taking anxiety and you start digging into their past for trauma and how it is currently affecting them, you may be guilty of psychological voyeurism. What are the patient's expectations Does he or she expect you to heal or cure him or her Are you simply going to ameliorate the patient's symptoms Addressing these issues from the very beginning will facilitate communication and empathy and serve as a good foundation to work from when the inevitable ruptures in the working alliance between patient and clinician develop. Be cautious of going where you are not invited. Also, a patient's personality, current level of functioning, and both internal and external supports and coping resources should be important features of your treatment plan. Is the prospective patient motivated to enter into treatment, to face their trauma, or to make...

Other Altituderelated Conditions

Sleep disturbance is very common at high altitude. There is a decrease in both deep and rapid eye movement (REM) sleep, with frequent arousals. Some of these arousals are due to periodic breathing (Cheyne-Stokes respirations), which is surprisingly common at high altitude, and does not appear to be related to AMS. Some people are unaware that they have periodic breathing, while others wake in a panicked state following an ap-noeic episode, thinking that they are being suffocated. A low dose of acetazolamide (125-250 mg) taken before bedtime is effective in relieving periodic breathing and maintaining arterial oxygen saturation during sleep. The use of benzodiazepines to facilitate sleep at high altitude has been generally discouraged because of the theoretical risks of respiratory depression. However, recent preliminary data suggest that short-acting benzodiazepines are actually associated with improved nocturnal oxygen saturation, although this needs to be confirmed.

The Activation Theory of Motivation

Hebb, however, takes a more sanguine view of motivation, particularly in humans. In his activation theory, he contends that a middle ground between lethargy at one extreme and incapacitating anxiety at the other produces the most desirable level of motivation. This theory accounts

Prescribing And Adverse Events

One in 10 admissions to acute geriatric units were caused or partly caused by adverse drug reactions. The drugs involved most commonly were benzodiazepines, warfarin, digoxin, and non-steroid antiinflammatories (Deaham and Barnett 1998). Tam-blyn (1996), in his review article, cited reports of adverse events causing 5-23 of hospitalizations, nearly 2 of ambulatory visits and 1 in 1000 deaths in the general population. These rates increase in the elderly. Errors in prescribing accounted for 19-36 of hospital admissions due to drug-related adverse events.

Other Aspects of Psychological Control

Burlew et al. (1995) studied a sample of 121 African Americans with sickle cell disease to determine the relationship between an internal locus of control orientation (along with other variables) and psychosocial adjustment (measured by anxiety and depression). Findings indicated that an internal health locus of control orientation was inversely related to anxiety. That is, persons who felt they had control over their health and associated outcomes were more anxious than those without this perception of internal control. The authors speculated that the episodic and unpredictable nature of sickle cell disease may offer an explanation for this inverse relationship. In the case of such a chronic illness as sickle cell disease, the belief and expectation that one has control may not be borne out in reality. People who expect to have control but do not may in fact become even more frustrated and anxious under conditions where there is little possibility for control.

Role of Neurotransmitters

Certain neurotransmitters serve in the inhibition of neuronal activity. The most common of these is gamma-aminobutyric acid (GABA), found primarily in the diencephalon region of the brain. Here GABA acts to reduce the activity within the region. Antianxiety drugs such as valium or lib-rium appear to work by enhancing the activity of GABA, resulting in the relaxation of skeletal muscles. Antidepression compounds such as Prozac and Zoloft appear to function through blockage of serotonin uptake by neurons.

Develop Personal Skills

Reduced transmission of infectious diseases reduced anxiety and depression lower violence rates improved diet reduced obesity better family functioning postrelease No overcrowding, lower violence rates and incidences of sexual assault in jails and prisons lowered anxiety for corrections staff

Etiology and Treatments

Because of the distressing yet fascinating nature of the symptoms, several theoretical positions have attempted to explain how obsessive-compulsive disorder develops. From an applied perspective, each theoretical position has evolved into a treatment or intervention strategy for eliminating the problems caused by obsessions and compulsions. According to psychoanalytic theory, as outlined by Sigmund Freud in 1909, obsessive-compulsive rituals are the product of overly harsh toilet training which leaves the patient with considerable unconscious hostility, primarily directed toward an authoritarian caregiver. In a sense, as uncomfortable and disconcerting as the obsessions and compulsive behaviors are, they are preferable to experiencing the intense emotions left from these childhood incidents. Obsessions and compulsions permit the patient to avoid experiencing these emotions. Furthermore, obsessive-compulsive symptoms force the patient to become preoccupied with anxiety-reduction...

Prevalence and Research

Obsessions and compulsions represent human phenomena that have been a topic of interest for several centuries for example, William Shakespeare's characterization of the hand-washing Lady Macbeth has entertained audiences for hundreds of years. Prior to the first therapeutic analysis of obsessive-compulsive disorder, then called a neurosis Freud's description of the rat man obsessive thoughts were commonly attributed to demoniac influence and treated with exorcism. Freud's major contribution was delivering the phenomenon from the spiritual into the psychological realm. Although initial case reports employing psychoanalysis were promising, subsequent developments using behavioral and pharmacological formulations have more rapidly advanced the understanding of the phenomenology and treatment of this unusual condition. In addition, with the public revelation that certain prominent individuals, such as the aircraft designer and film producer Howard Hughes, suffered from this condition, the...

Sex Differences in Metabolic Pathways

The assumption that structurally related compounds exhibiting a similar mechanism of action are also pharmacokinetically similar should not be made. Perhaps the best example of this complexity is provided by the benzodiazepines. Among the members of this group, a wide variety of findings has been reported. Oxidation is reported to be greater in women than in men for alprazolam, diazepam, and dimethyl-diazepam. Reduction is reported to be the same for men and women for bromazepam, lorazepam, nitrazepam, and triazolam. Conjugation is reported to be greater in men than in women for chlordiazepox-ide, oxazepam, and temazepam. Some clarification can be provided by focusing on whether sex differences occur in the specific Phase I and Phase II metabolic pathways that were described in Chapter 11.

Some Practical Applications

While this study induced a phobic reaction in the subject, systematic de-sensitization is a procedure designed to eliminate phobias and anxieties. The procedure was largely developed and named by South African-born therapist Joseph Wolpe. Noting that it is very difficult to have pleasant and anxious feelings simultaneously, Wolpe fashioned a systematic technique to teach clients to engage in behavior (relaxation) that competes with anxiety. In the hands of a skillful therapist, systematic desensitization is an effective technique for reducing a wide variety of fears. Its Pavlovian features involve pairing imagined fearful scenes with relaxation. When relaxation successfully competes with fear, it becomes a new CR to the imagined scenes. As relaxation becomes sufficiently strong as a CR, anxiety is replaced by calmness in the face of earlier aversive stimuli.

The Necessity to Exclude Psychopathological Symptoms from Quality of Life Measures

A third methodological issue that becomes especially salient in the mental health field is the fact that most quality of life instruments used in medical patients also contain emotional items, like depression and anxiety. Some authors even speak of an emotional-function domain. Here, the psychological tradition of measuring quality of life by well-being measures'' becomes tautological, since quality of life measures are necessarily correlated with measures of psychopathology, if the item content of both measures is largely overlapping a clear case of measurement redundancy 46, 102 .

Marriage and family life

It is true I am sociable and like to teach or to take part in meetings of all kinds, but I feel a compelling need for solitude and contact with nature. . . .As soon as vacation time comes, I withdraw to the mountains in the wild regions of the Valais and write for weeks on end. . . .It is this dissociation between myself as a social being and as a man of nature which has enabled me to surmount a permanent fund of anxiety and transform it into a need for working.

The Object of This Work Lacks a Key Feature of Repression

One might object to calling the object of the current work repression because it is lacking some additional quality viewed as essential to match Freud's concept. For instance, the current experiments used neutral, nonemotional stimuli, and the materials were simple word pairs. One might argue that repression is entirely about psychological defense and is, by definition, tied to personal trauma or to psychological discomfort thus, any research that does not include these critical ingredients, though it may be interesting, has little to do with Freudian repression. This view endorses the idea that repression is a special-purpose mechanism dedicated to helping the individual cope with psychological conflict, anxiety, or pain. Alternatively, one might insist that repressed contents continue to influence behavior after they are banished into the unconscious, or that the repressed contents should be recoverable over time. I consider these objections in turn.

HPA Axis Alterations in Other Psychiatric Disorders

When depression is comorbid with a variety of other disorders, such as multiple sclerosis, Alzheimer's disease, multi-infarct dementia, Hunting-ton's disease, and others, both CRF hypersecretion and HPA axis hyper-activity are common. In contrast, HPA axis dysfunction has rarely been reported in schizophrenia. Consistent with the role of CRF in both depression-like and anxiety-like behaviours in preclinical animal studies, increased CSF concentrations of CRF have been reported in post-traumatic stress disorder (PTSD) 95 . A recent elegant study that used an in-dwelling cannula in the lumbar space, allowing repeated sampling of CSF several hours after the initial, and presumably stressful, lumbar puncture, demonstrated elevated CSF levels of CRF in combat veterans suffering from PTSD 96 . In contrast, low serum cortisol and urinary free cortisol levels have been repeatedly, yet unexpectedly, detected in PTSD. One possible mechanism that has been proposed by Yehuda et al. 97 suggests...

The Dimensions Of The Problem

The effects of war, torture, and disaster on the mental health problem of refugees are manifested in several ways, including adjustment problems, depression, anxiety disorders or post-traumatic stress disorder (PTSD). The stressful condition of a refugee could even worsen any underlying mental disorders such as psychotic illnesses.

Studies Conducted in Areas Where Refugees Have Settled

Mollica et al. 4 , studying an Indo-Chinese group of patients in their clinic, found that 36 suffered from affective disorders, 1.9 from PTSD, 58 from affective disorders and PTSD, and 7.3 from other psychiatric disorders. Kinzie et al. 5 found that, out of 322 Indo-Chinese patients surveyed, 81 suffered from depression, 16 suffered from schizophrenia and 75 fulfilled a current diagnosis of PTSD. Lavik et al. 6 found PTSD in 48 , affective disorders in 16 , adjustment disorders in 10 and anxiety disorder in 6 of the group of refugees surveyed by them in an outpatient clinic in Oslo, Norway. These studies have been summarized in Table 8.1. depression) 10 (adjustment disorder) 6 (anxiety disorder) 20 (other mental disorder) Diagnostic Interview for Children and Adolescents (DICA) 10 and the Schedule for Affective Disorders and Schizophrenia for School Age Children (KSADS) 11 , it was found that, whereas among the youths the point prevalence was 18.2 for PTSD and 11 for depressive...

Hypothalamicprolactin Axis

Excess circulating prolactin can lead to a number of clinical symptoms. Hyperprolactinemia often leads to reduced testosterone secretion in men and a decreased libido in both men and women. Patients may also complain of depression, stress intolerance, anxiety and increased irritability, which usually resolve following treatments that reduce serum prolactin levels. Despite these effects, alterations in the hypothalamic-prolactin axis have not been clearly demonstrated in psychiatric disorders 111 . Hyperprolac-tinemia also frequently occurs following treatment with conventional anti-psychotic medications, because of their potent blockade of dopamine receptors. Because prolactin release is inhibited by dopamine, the prolactin response to infusions of dopaminergic agonists has also been used to estimate CNS dopaminergic tone, though it probably only reflects hypothal-amic dopamine neuronal function.

Psychoanalytic Treatment

Psychoanalysis is a method for helping people with symptoms that result from emotional conflict. Common symptoms in the modern era include anxiety (fear that is not realistic), depression (excessive sadness that is not due to a current loss), frequent unhealthy choices in relationships, and trouble getting along well with peers or family members. For example, some people may feel continuously insecure and worried about doing well in school or work despite getting good grades or reviews. Other people may be attracted to sexual and emotional partners who treat them poorly. Others may experience loneliness and isolation because of fears about close relationships. Others may sabotage their success by always changing direction

Cognitivebehavioural therapy

CBT focuses on examining and trying to challenge dysfunctional beliefs and appraisals, which may be implicated in a person's low mood or avoidance of certain situations or behaviours. Consequently, targeting cognitions and maladaptive behaviour are the key areas of CBT interventions for facilitating change. According to this approach, beliefs are considered as hypotheses to be tested rather than assertions to be uncritically accepted. Therapist and client take the role of'investigators' and develop ways to test beliefs, such as 'Others do not like me because of my eczema' or 'I won't be happy anymore because of my vitiligo'. Success at challenging these beliefs involves providing evidence that they are erroneous, and underscored by anxiety and depression (Beck, 1993). CBT has been successfully applied to various skin conditions. For example, Horne et al. (1989) used cognitive-behavioural therapy along with standard medical treatment in treating three patients suffering with atopic...

Psychoanalytic psychotherapy and hypnosis

Psychoanalytic psychotherapeutic approaches place emphasis in psychodynamics and in particular to unconscious processes. Transference and counter-transference phenomena as well as patients' resistance are all dynamic aspects of the therapeutic relationship and important clinical concepts for this model. The basic goal of this type of therapy is to make the unconscious conscious and to create meaning where there is anxiety or confusion.

Historical Context

In fact, much of the controversy surrounding Benjamin Rush had nothing to do with psychiatry. He was a strong believer in the popular remedy of bleeding people, regardless of their diagnosis many of his colleagues in Philadelphia, however, disagreed with his use of bleeding as a treatment for yellow fever. It is unknown if his blood-letting of mentally ill persons caused any debate. Certainly his observations regarding Diseases of the Mind evoked little stir. Yet Rush's book brought new thinking to an America that was considered a primitive, uncivilized backwater. Rush's observations closely mirrored those of fellow physicians Phillipe Pinel in France and Quaker William Tuke in England, who both advocated enlightened and more humane treatment for the mentally ill. Unfortunately Rush's book was flawed in two ways. It leaned heavily on astrology, a belief common in his time. But more important, it also subscribed to one of the two false theories about the cause of mental illness then in...

Treatment of Comorbid Disorders and Associated Symptoms

More often than not, PTSD sufferers are plagued by comorbid or other association symptoms and conditions. Matthew Friedman states, people with PTSD exhibit abnormalities in almost every psychobiological system (p. 95). Kessler et al. (1995) estimate that more than 80 percent of individuals with PTSD have a comorbid psychiatric condition. Such disorders and related conditions as depression, Generalized Anxiety Disorder, Panic Disorder, psychosis, substance abuse, and irritability and anger should be addressed with their respective and indicated medications, with proper attention paid to interaction effects and how the treatment of these issues ties into the overall clinical picture. Selective serotonin reuptake inhibitors are implicated for treatment of depression and Anxiety Disorders as well. Effective medications for psychotic symptoms include Zyprexa and Seroquel. Methadone has been effectively used in the treatment of Opioid Dependence. Fluoxetine has been used successfully in the...

Central Nervous System

Although a substantially lower dose of these drugs is needed to induce anesthesia or the same degree of sedation in older than in younger individuals, this is the result of the pharmacokinetic changes of aging. When drug effect is normalized to arterial drug concentration, the concentration-effect relationship is similar in the young and the elderly. For ambulatory elderly patients, the clinical consequences of increased exposure to benzodiazepines due to decreased Phase I metabolic clearance can be devastating, with an increased incidence of hip fracture noted in older patients taking long half-life benzodiazepines (27). These drugs (e.g., flurazepam and diazepam) undergo Phase I biotransformation, and the decreased clearance seen in the elderly results in markedly greater drug accumulation, even when taken once daily as a sedative-hypnotic (28, 29).

Psychopharmacological Prevention of PTSD

Part of effective treatment of PTSD involves prevention of full-blown PTSD from developing by intervening as immediately posttrauma as one can with debriefing, crisis intervention, and psychological first aid. This is particularly true in cases of Acute Stress Disorder. Interventions that can reduce immediate and acute posttrauma levels of arousal, such as relaxation training and utilizing social supports, are often effective. Can pharmacological treatment play a role in prevention or early intervention Stahl (2005) suggests that medications can be given to disrupt the psychobiological processes that lead to PTSD, ideally preventing the disorder but conservatively attenuating its severity. Two studies suggest that administration of propranolol may be effective as its effects on suppressing epinephrine may interfere with the formation of strong traumatic memories. Still other research is suggesting that early use of benzodiazepines and SSRIs, too, may be helpful. More research needs to...

Clinical Symptoms and History

Premenstrual syndrome is characterized by mood swings, depressed mood, irritability and or anxiety, which may be accompanied by physical symptoms. These symptoms occur exclusively during the luteal phase of the menstrual cycle. Common physical symptoms observed in PMS are breast tenderness, abdominal bloating, headache, and joint and muscle aches. The diagnosis of PMDD requires marked mood disturbance (depression, irritability, mood swings) as well as the presence of other emotional and or physical symptoms. Additionally, a significant

Diagnosis and Treatment

Diagnosis of a need for psychosurgery is based on observation of symptoms supporting abnormal psychological behavior. Examples are extremes of aggression, anxiety, obsession, or compulsiveness as well as psychoses other than schizophrenia. The exclusion of schizophrenics, except for those having marked anxiety and tension, is based on data supporting poor responses by schizophrenics to lobotomy and other leucotomies. Surveys have shown that good surgical outcomes were only obtained in 18 percent of schizophrenics who underwent lobotomy, as compared with 50 percent of depressives.

Therapeutic Relationships

Psychotherapists have recognized that many patients have difficulty with changing their patterns of living because of anxiety or lack of skill and experience in behaving differently. Behavioral therapy techniques are especially useful in such cases. In cases of anxiety, the patient can be taught to relax through relaxation training exercises. The patient gradually imagines performing new, difficult behaviors while relaxing. Eventually, the patient learns to stay relaxed while performing these behaviors with the psychotherapist and other people. This process is called desensitization, and it was originally developed to treat persons with extreme fears of particular objects or situations, termed phobias. New behavior is sometimes taught through modeling techniques in which examples of the behavior are first demonstrated by others. Behavioral psychotherapists have also shown the importance of rewarding small approximations to the new behavior that is the goal. This shaping technique...

Anaesthesia or sedation

Not all patients require general anaesthesia or sedation infants may sleep through relatively long examinations, if the study is performed after a feed and they are well wrapped up to keep them warm. Play therapy has been effective in persuading children over the age of 4 years to undergo MRI without anaesthesia or sedation. Adults who suffer from severe anxiety or claustrophobia can be positioned prone in the magnet bore, reassured and if necessary counselled before anaesthesia or sedation is attempted.

Endocrine laboratory findings

The progesterone-mediated hyperventilation of pregnancy produces a characteristic partially compensated respiratory alkalosis. Importantly, pregnancy does not produce a metabolic alkalosis. A metabolic alkalosis should raise suspicions of hyperaldosteronism, particularly when associated with refractory hypertension.

Sleep Disordered Breathing

Patients with SDB may, however, present with sudden and anxious nocturnal awakenings and recall dreams. In such cases, differentiation from nightmares and nocturnal panic attacks may be difficult and require polysomnographic evaluation. In addition, Iranzo and Santamaria have recently reported the occurrence of agitated, violent dreams with abnormal motor behaviors mimicking RBD in patients with severe SDB 103 .

Knowledge Psychiatric Diagnostic Comorbidity and Modern Neuropsychiatry

Mental disorders that occur related to body disorders such as stroke and depression, hyperthyroidism and anxiety, or traumatic brain injury and personality change, While not every case needs all of this information, complex cases with hints of or flagrant presentations of not one but two or more coexisting psychiatric disorders need extensive data collection and high-level clinical judgment. My personal clinical observations in the last two decades suggest that a presentation of substance abuse dependence or ADHD in adults carries a high comorbidity for anxiety spectrum disorders (such as generalized anxiety, obsessive compulsive disorder, panic disorder, and or posttraumatic stress disorder), bipolar disorder, major depression, and a history of traumatic brain injury (TBI). Conversely, a history of TBI means one must rule out any and all of these Axis I disorders. These details of history cannot be done by questionnaires or screening instruments in the hands of persons unschooled in...

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