Most Effective Anxiety and Panic Attacks Cures

The Panic Miracle

The Only Holistic System In Existence That Will Teach You How To Permanently Cure Your Panic Attacks and General Anxiety, Regain Your Self Confidence, and Enjoy Life Without Fear! Panic Miracle System is a 250 page downloadable e-book, jam-packed cover to cover with all the secret natural set of panic attack cure techniques, unique powerful protocols and the step-by step holistic panic attack system I've discovered in over 14 years of panic attack and anxiety research. This program contains all the information you'll ever need to eliminate your panic attack permanently without drugs, without therapy and without any side effects. A Clinically Proven Holistic Plan for Quickly and Permanently Stopping Panic Attacks and Anxiety Naturally and Safely, Boosting Self Confidence, and Regaining Your Life Back. Successfully Used by 1,000s of Men and Women World-wide. Panic Miracle is Customizable for Your Unique Condition Every person is completely different. No two reasons for panic attacks are exactly the same. That's why the Panic Miracle system includes guidelines as to how you can customize the strategies and methods for your unique situation. You will be taught, step-by-step, how to be your own 'scientist' and detect subtle factors within your own body, lifestyle and environment that need attention while working with the plan to overcome your anxiety. Continue reading...

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Serotonin and aggression panic attack and related disorders

The possible overlap between anxiety, depression, panic attack, aggression and obsessive-compulsive disorders, and the involvement of serotonin in the symptoms of these disorders, has recently led to the investigation of various selective serotonin reuptake inhibitors (SSRIs) and selective 5-HT receptor agonists antagonists in the treatment of these conditions. In experimental studies, there is evidence that drugs such as eltoprazine, which binds with high affinity to 5-HT1A, 5-HT1B and 5-HT2c sites, are active antiaggressive agents, whereas selective 5-HT1A agonists and 5-HT2 and 5-HT3 antagonists are inactive. There is also preliminary evidence to suggest that SSRIs such as fluoxetine reduce impulsive behaviour which may contribute to their therapeutic action in the treatment of obsessive-compulsive disorders and possibly in reducing suicidal attempts. Zohar and Insel have suggested that the symptoms of obsessive-compulsive disorder are due to supersensitive 5-HT1-type receptors and...

Beta Blockers and Anxiety Fear

One class of drugs is an exception to the uncertainty about central versus peripheral effects. The beta-adrenergic blocking agents are specifically presumed to work peripherally in the body outside the central nervous system. These drugs act by interfering with the action of adrenalin at the peripheral neural sites, where adrenalin produces the characteristic visceral arousal symptoms. If Schachter is correct, then these antiadrenergic drugs that act peripherally should effectively reduce anxiety, anger, and perhaps other emotions. Once again, the evidence seems to be contradictory. In laboratory studies of the effects of beta-blockers, the effects seem to be difficult to demonstrate (Reisenzein, 1994). However, extensive reviews demonstrate successful practical uses of beta-blockers for some kinds of anxiety disorders (Noyes, 1985) and also for reducing performance anxiety (Dimsdale, Newton, & Joist, 1989). Despite the mixed results with experimental populations, little question...

Anxiolytics and the Treatment of Anxiety Disorders

Until the late 1960s, the symptoms of anxiety and insomnia were mainly treated with barbiturates. The barbiturates are known to cause dependence, and severe withdrawal effects were sometimes reported following the abrupt termination of their administration. Furthermore, their efficacy in the treatment of anxiety disorders was limited. The discovery of the benzodiazepine anxiolytic chlordiazepoxide some 30 years ago, and the subsequent development of numerous analogues with an essentially similar pharmacological profile, rapidly led to the replacement of the barbiturates with a group of drugs that have been widely used for the treatment of anxiety disorders, insomnia, muscle spasm and epilepsy and as a preoperative medication. The benzodiazepines have also been shown to have fewer side effects than the barbiturates, to be relatively safe in overdose and to be less liable to produce dependence than the barbiturates. They have now become the most widely used of all psychotropic drugs...

Anxiety and distress Table 173

Of the eight etiologic studies identified, four studies showed a lack of clear effect. Two papers, both published from the Israeli civil servant cohort, reported strong or moderate association between anxiety and the incidence of angina.39,40 The remaining two studies gave evidence for an association between phobic anxiety and fatal CHD, but did not show a clear effect on non-fatal CHD or of free-floating anxiety.41,42 Furthermore, the studies with longer follow up were less likely to find a positive association than the studies with less extended follow up. This is exemplified by the Northwick Park Heart Study where the association between anxiety and fatal CHD found after 10 years of follow up,41 disappeared when the follow up was extended by another decade.43 Hence, anxiety may be a result of preclinical CHD rather than a cause of fatal CHD. Of the 18 prognostic studies, half found a lack of clear association and one reported results significantly contrary to the hypothesis. Four...

TABLE 1581 Benzodiazepines Approved for Use in the United States

Benzodiazepines are frequently agents of accidental and intentional overdose. In the 1996 Annual Report of the American Association of Poison Control Centers Toxic Exposure Surveillance System, benzodiazepines accounted for 39,029 exposures, both as single agents and in combination with other drugs. 1 Although the ingestion of benzodiazepines alone appears to result in relatively few deaths, increased rates of morbidity and mortality do result from mixed overdose. Parenteral administration of benzodiazepines may also result in significant complications, particularly respiratory depression and hypotension.

Animal Research in Fear and Anxiety

Animal tests of fear and anxiety are used both to screen new compounds for potential anxiolytic action and to study their neural substrates. Until the mid-1970s, animal tests consisted of delivering shocks as a punishment, most often for an operant lever-press response. These tests were developed as screening tests for the pharmaceutical industry. Matching particular tests of fear and anxiety to particular anxiety disorders is an extremely difficult task. The social interaction test (placing rats in an unfamiliar or brightly lit environment), the elevated plus-maze (placing the animal on an elevated open arm), predator exposure stress, forced swim, and social defeat or subordination stress are models of fear and anxiety. In the wide range of approaches used to study fear and anxiety in animal studies, two sets of tests probe their responses. The first set uses models of conditioned fear the second uses models of unconditioned fear. Both models presuppose that aversive stimuli, such as...

Tranquilizer Withdrawal

Elsesser et al. compared the effect of complaints management training with that of anxiety management training, the treatment that had previously been shown to be effective in facilitating benzodiazepine withdrawal. Immediately after treatment, the abstinence rate was higher in the complaints than in the anxiety management group (Fig. 2a), and patients in the former were also less anxious and depressed (Fig. 2b). At followup, there was no longer a significant difference between groups in terms of abstinence rate (65 ). Complaints management training appears, however, to ease withdrawal and to lower anxiety and depression more rapidly than anxiety management training. The evaluation of the efficacy of a single-treatment mode presents some difficulty, for treatment trials usually combine a number of approaches in any condition and group. Caution must therefore be exercised when attempting to interpret the outcome of trials in terms of the effect of any single component of treatment....

Psychological studies of anxiety and attention

Most psychological studies of anxiety and attention have employed between-subjects designs comparing chronically-anxious and non-anxious individuals. The majority of these studies have focused on individuals suffering from a clinically-diagnosed anxiety disorder, although others have sampled anxiety across a more normal range by comparing individuals who are above and below the median in terms of the personality dimension of 'trait anxiety'. These are reasonable research strategies in that both clinical and trait measures of anxiety are assumed to reflect chronic activation in the brain's defensive circuitry. It should be kept in mind, however, that many of these studies do not directly manipulate the individuals level of state anxiety, and when they do, the manipulations tend to promote relatively mild states of anxiety. Many of the earliest studies provided evidence that anxiety produces a focused state of attention characterized by impaired processing of peripheral or secondary...

Major Tranquilizers Thorazine and Relatives

Major tranquilizers revolutionized psychiatry when they were first introduced in the early 1950s. They provided a new and easy way to manage schizophrenia and other severe mental diseases, making patients calm and emotionally quiet. In some cases the major tranquilizers have enabled psychotic persons to lead reasonably normal lives and function outside hospitals. More often, they make them more manageable and docile rather than less crazy. In addition to their use in treating mental illness, the major tranquilizers can be used to end bad reactions to psychedelic drugs and other states of confusion. Some of them are also used to treat purely physical problems, such as itching, dizziness, nausea, vomiting, and hiccups. In normal people, small doses of these compounds cause drowsiness, lethargy, and boredom hardly the kinds of effects that encourage recreational use. In addition, the major tranquilizers regularly produce uncomfortable physical effects, such as dryness of the mouth. In...

Exacerbating and alleviating anxiety

A frequent criticism of the publicity surrounding hereditary cancer risk is that it simply promotes anxiety while doing nothing practical to counter it. Setting aside the fact that publicity is generated largely by the popular media, over which cancer geneticists have no control, several studies of patients who have made use of cancer family clinical services provide a measure of reassurance. They have, in the main, confirmed that perceptions of risk before clinic attendance are often unrealistic, that there is some improvement in accuracy after attendance and that levels of anxiety tend to decline, at least in the short term, regardless of changes in risk perception. Hence there is some justification for the claim that cancer family clinics are responding to a pre-existing and hitherto unmet need and that they fulfil a useful function, even before they have been shown to influence cancer morbidity or mortality (Evans et al., 1994 Lloyd et al., 1996 Cull et al., 1999).

Sources of Information on Test Anxiety

Test takers who want help in coping with test anxiety will find a wealth of materials available in bookstores and on the Internet. Examples include the following Taking the anxiety out of taking tests A step-by-step guide, by S.Johnson. New York Barnes & Noble Books, 2000. No more test anxiety Effective steps for taking tests and achieving better grades, by E. Newman (available with audio CD). Los Angeles Learning Skills Publications, 1996. The Test Anxiety Scale (Saranson, 1980), which provides a quick way to gauge the extent to which one may be prone to experience test anxiety and is available free of charge from Learning Skills Publications (at http www.learning test.html) and several other Internet sites. Many Web sites sponsored by university counseling centers are accessible by searching for test anxiety on the Internet these sites provide tips on study habits and other information on coping with test anxiety. test anxiety, the following works are recommended Sapp,...

Tranquilizer Rescinnamine

Rauwolfia alkaloids include reserpine, the first tranquilizer, rescinnamine, and deserpidine. Reserpine is a sedative and tranquilizer useful in treating hypertension. It is also used as a rodenticide. Hyperventilation, hypertension, hypotension (cat) LD50 (mouse, intraperitoneal) 350 mg kg Piperine black pepper (Piper nigrum) No information No information

Generalized Anxiety Disorder

Generalized anxiety disorder (GAD) is characterized by psychic and somatic tension. Although the DSM has focused increasingly on the cognitive aspects of GAD, this disorder often presents with somatic symptoms, and indeed it is the most common anxiety disorder in primary care settings 6 . Although GAD has at times been considered a residual disorder, there is growing evidence that it is in fact an independent disorder, characterized by specific symptomatology, high prevalence and significant disability 7 . GAD is associated with a good deal of psychiatric comorbidity, but no more so than is major depression 8 . The condition has a later onset than most other anxiety disorders, but it tends to precede other comorbid disorders, especially major depression 9 . Other important comorbidities in GAD include somatization disorder, other anxiety disorders, and substance use disorders. The disability that is associated with comorbid GAD and depression is significantly higher than the...

Panic Disorder And Agoraphobia

Panic disorder is characterized by unexpected panic attacks. These may be followed by panic attacks in response to particular stimuli, and by agoraphobia. Panic disorder with or without agoraphobia is a prevalent and disabling disorder. Panic-depression is a particularly common comorbidity, and contributes to the potentially negative impact of panic disorder 28 . Alcohol and substance abuse and dependence are also frequent comorbidities in panic and other anxiety disorders. A biological perspective suggests that there are multiple risk factors for the onset of panic disorder 29 , including both biological risk factors (e.g. family history) and environmental ones (e.g. separation). Genetic variants may well be important in the pathogenesis of panic, but at present are not clinically useful as risk markers. Long-term studies of anxiety disorders are relatively few, but these provide additional information about resilience and vulnerability factors 30 . Anxiety sensitivity is a trait...

Social Anxiety Disorder

Social anxiety disorder (SAD) is characterized by fear of embarrassing oneself in social or performance situations. Subjects with generalized SAD fear several different social situations. SAD is a particularly prevalent and disabling anxiety disorder 59,60 . Thus, subjects with SAD are more likely to be single, are less likely to complete high school or tertiary studies, and are more likely to be unemployed and receive a lower income 6 . It seems reasonable to argue that early intervention for SAD, even in childhood and adolescence, may prevent the negative impact of this disorder. Long-term studies are, however, needed in this area. SAD has a relatively early onset, and can persist for many years. Comorbid disorders often begin later on 61 . These include major depression, other anxiety disorders and substance use disorders. Simple screening questions 62 or scales, such as the Liebowitz Social Anxiety Scale (LSAS) and the Mini-Social Phobia Inventory (SPIN), are useful for screening...

Screening For Anxiety Disorders

In the above discussion of each of the major anxiety disorders, there are overlapping themes. These are highly prevalent, disabling and costly conditions. Despite the availability of effective pharmacotherapy and psychotherapy, they remain underdiagnosed and undertreated 74-77 . Cross-sectional studies of rates of appropriate diagnosis are partly flawed insofar as prevalence of psychiatric disorders is higher in follow-up patients nevertheless, underdiagnosis is a real problem 78,79 . Thus, there is clearly need for more widespread screening to maximize the chance of early detection and management. Screening would seem to be particularly relevant in primary care settings 80 , although there are also important opportunities for screening in other contexts, including direct screening of the public 81 . A range of screening instruments for anxiety disorders is available for use in primary care 82 . A number have also been studied in more specialized populations, settings and cultures...

Prevention Of Anxiety Disorders

As our understanding of the pathogenesis of anxiety disorders becomes increasingly sophisticated, it may also be possible to develop effective interventions to help prevent their onset 73,103 . In addition, screening strategies discussed above may yield a group of individuals who do not yet have an anxiety disorder, but who are nevertheless at risk should they not receive help. Thus, there is increasing interest in the prevention of childhood anxiety disorders by child-focused methods, parent-focused methods and environmental restructuring methods. Such strategies can be universal, selective or indicated 104 . We discuss each of them in turn. Universal prevention strategies are provided to entire populations. Lowry-Webster et al. 105 assigned 594 children aged 10-13 to CBT conducted by classroom teachers or to assessment only. Barrett and Turner 106 assigned 489 children aged 10-12 years to a psychologist-led programme, a teacher-led programme or to usual care. In both studies,...

Relationship between plasma anxiolytic concentrations and the therapeutic response

While the individual drugs in the benzodiazepine group differ in potency, all benzodiazepines in common use have anxiolytic, sedative-hypnotic, anticonvulsant and muscle-relaxant activity in ascending order of dose. The main clinical difference between the individual drugs lies in the time of onset of their therapeutic effect, and the intensity and duration of their clinical activity. All benzodiazepines are derived from weak organic acids and some, such as midazolam, form water-soluble salts at a low pH. However, at normal physiological pHs, all benzodiazepines are lipophilic, the lipid solubility varying from highly lipophilic in the case of drugs like midazolam, flurazepam, diazepam and triazolam to slightly lipophilic for drugs such as clonazepam, bromazepam and lormetazepam. The benzodiazepines are also highly protein bound, so that at the plasma pH the proportion of the drug in the free form will vary from only 2 in the case of diazepam to about 30 with alprazolam. However, for...

Application Of The Model Of The Neural Circuitry Of Anxiety And Fear To Anxiety Disorders

The primary goal of research in the clinical neuroscience of anxiety disorders is to apply findings related to the effects of stress on the brain in animals to patients with anxiety disorders. Different methods contributed to the working model of the neural circuitry of anxiety and anxiety disorders that is presented here. The neural circuits mediating symptoms of anxiety disorders can be studied by measuring neurotransmitters and hormone levels in blood, urine, and saliva by assessing behavioral and biochemical responses to pharmacological challenge to specific neurochemical systems by measuring key brain structures with structural neuroimaging by provoking Among the most characteristic features of anxiety disorders such as PTSD and PD is that anxiogenic memories (e.g., of the traumatic experience or first panic attack) can remain indelible for years or decades and can be easily reawakened by all sorts of stimuli and stressors. The strength of traumatic memories relates, in part, to...

Neural Circuits In Anxiety And Fear

The major afferent arm of neural circuitry includes exteroceptive sensory systems of the brain, consisting of serially organized relay channels that convey directly or through multisynaptic pathways information relevant to the experience of fear. The sensory information contained in a fear- or anxiety-inducing stimulus is transmitted from peripheral receptor cells in the eyes, ears, nose, skin, the body's own visceral information (e.g., blood glucose, arterial pressure, and CO2 levels), or any combination of these. Except for olfactory information, which goes directly to amygdala and enthorhinal cortex, these sensory inputs are relayed through the dorsal thalamus to amygdala and cortical brain areas, such as primary visual (occipital), auditory (temporal), or tactile (postcentral gyrus) cortical areas. Input from peripheral visceral organs As this primary sensory input comes into the brain stem and midbrain, it is matched against previously stored patterns of activation and if...

Key Brain Structures Mediating Fear And Anxiety Behaviors

The brain structures that constitute a neural circuit of fear and anxiety should have the following features 1. There is sufficient afferent sensory input to permit assessment of the fear- or anxiety-provoking nature of the external threat or internal stress. 3. Efferent projections from the brain structures should be able to mediate an individual's neuroendocrine, autonomic, and motor response to threat as well account for the pathological reactions that result in anxiety-related signs and symptoms. To underscore its survival importance, many brain areas with redundant circuits are involved to subserve this important constellation of behaviors. Critical brain structures capable of incorporating an individual's prior experience or memory into the appraisal of stimuli are amygdala, LC, hippocampus, thalamus, hypothalamus, periaqueductal grey (PAG), and pre-frontal cortex. Alterations in neurochemical and neurotransmitter systems that mediate the stress response also play a role in...

History of Neuroanatomical Modeling of Fear and Anxiety

There has been a long history of hypotheses related to the neurobiology of human anxiety. The central role of a subcortical network of brain structures in emotion in general was hypothesized by Papez in 1937. In 1949, MacLean coined the term limbic system, integrating Papez's original circuit (hypothalamus, anterior thalamus, cingulate gyrus, and hippocampus) and other anatomically and functionally related areas (amygdala, septum, and orbitofrontal cortex). Over the years, various regions have been added or removed from this emotion processing circuit. Papez hypothesized that several telencephalic and diencephalic structures which form a border (limbic border) around the diencephalon constituted a circuit, which controlled the emotions. He suggested that blockage of information flow at any point along this circuit would cause disorders of affect (i.e., mood). Removal of the cerebral cortex of the cat, leaving only subcortical regions including amygdala, thalamus, hippocampus, and...

Observation of Early Signs of Anxiety

In order for applied relaxation to work optimally patients must use the relaxation technique as early as possible in the response to an anxiety reaction or a panic attack. Reacting quickly to the first signs of anxiety greatly increases the patients' ability to employ AR effectively. In order to increase the patient's awareness of the initial signs of anxiety, homework assignments involve observing and recording these reactions. In the panic diary the patient records the situation, the symptoms of the panic attack, and the severity of the attack (0-100), as well as the very first signs that were experienced. Therapist and patient examine the panic diary and focus on identifying the earliest signs of the onset of the panic attacks. An attempt is made to determine what the patient felt, thought about, or did just before the first symptom occurred. Sometimes it can be advantageous to let patients imagine their most recent panic attack. This procedure often assists patients in remembering...

Special Section on Drugs Anxiolytic of choice

A common anxiolytic that is used is lorazepam (Ativan), a benzodiazepine with rapid onset and moderate duration 0.5-2 mg IV is the recommended dose, but start with 0.5 mg at first and then give additional 0.5 mg doses every 5-10 min until the total dose is reached. Midazolam (versed), which is commonly used for procedures such as colonoscopy, is not ideal because it is too short acting and requires frequent dosing.

Working Model For The Neural Circuitry Of Anxiety Disorders

Neural Circuits Anxiety Disorders

Anxiety disorders are characterized by dysfunction of an interrelated neurochemical and neuroanatomical system. PTSD and PD share many biological and phenomenological similarities that allow them to be considered related. Phobic disorders and GAD are still in early stages of investigation. Although phenomen-ologically they are similar to PTSD and PD, it is premature to include them in a model for human anxiety disorders. PTSD is related more to the deleterious effects of environmental stress, whereas PD is not as clearly related to stress and may be related more to genetic variability in anxiety. In stress-related anxiety disorders (i.e., PTSD), PTSD symptoms as well as cognitive dysfunction associated with PTSD may be linked to hippocampal dysfunction. A model can be created which incorporates informatiom from animal and clinical research relevant to these disorders, keeping in mind that working models are subject to modification with new information, and that generalizations...

Social Avoidance And Anxiety

Beliefs about being defective and the importance of appearance to the self will drive varying degrees of social anxiety and avoidance. Thus, depending on the nature of their beliefs, patients will tend to avoid a range of public or social situations or intimate relationships because of the fear of negative evaluation of the imagined defects. Many patients endure social situations only if they use camouflage (for example, excessive makeup) and various safety behaviors. These are often idiosyncratic and depend on the perceived defect and cultural norms. Behaviors such as avoidance of eye contact or using long hair or excessive makeup for camouflage are obvious but others are subtler and are more difficult to detect unless the patient is asked or observed as to how they behave in social situations. For example, a BDD patient preoccupied by his nose avoided showing his profile in social situations and only stood face on to an individual. A patient preoccupied by blemishes under her eye...

Misattribution and Fear Anxiety

Schachter's misattribution studies were followed by a multitude of other misattribution studies, in which subjects were induced to attribute their natural arousal to various pills and procedures, such as white noise, strange rooms, and the lights or ventilation of a room (for reviews, see Ross & Olson, 1981 Reisenzein, 1983). The feelings that were successfully reduced by these procedures include anxiety, anger, cognitive dissonance, and the discomfort of social comparison (Tesser, Pilkington, & Mcintosh, 1989). Olson, both by himself (1988) and in conjunction with Ross (Olson & Ross, 1988), tested predictions of this model by inducing participants to misattribute the arousal of speech anxiety. Speech anxiety is a particularly good test of the analysis because three previous studies (Cotton, Baron, & Borkovec, 1980 Singerman, Borkovec, & Baron, 1976 Slivken & Buss, 1984) had failed to find misattribution effects, in studies that failed to meet Ross and Olson's...

Conditioning of Anxiety Relief

In his monograph Psychotherapy by Reciprocal Inhibition published in 1958, which stimulated the widespread introduction of behavioral modification procedures to psychiatry and psychology, Wolpe suggested that anxiety-relief responses might be directly conditioned to convenient stimuli and subsequently used to counter anxiety. He based the suggestion on the observation that if a stimulus was repeatedly presented to an eating animal just before withdrawing its food, that stimulus acquired the property of inhibiting feeding even when the animal was in the middle of a meal. Wolpe argued that by analogy it might be expected that a stimulus that consistently coincided with the termination of a noxious stimulus might acquire anxiety-inhibiting effects. He pointed out the possibility was supported by experiments showing that approach responses were conditioned to a stimulus repeatedly presented at the moment of termination of an electric shock, in contrast to the avoidance that is conditioned...

Serotonin and anxiolytic activity

Although the benzodiazepine anxiolytics primarily interact with the GABA receptor complex, there is ample experimental evidence to show that secondary changes occur in the turnover, release and firing of 5-HT neurons as a consequence of the activation of the GABA-benzodiazepine receptor. Similar changes are observed in the raphe nuclei where a high density of 5-HT1A receptors occurs. Such findings suggest that 5-HT may play a key role in anxiety disorders. Undoubtedly one of the most important advances implicating serotonin in anxiety has been the development of the azaspirodecanone derivatives buspirone, gepirone and ipsapirone as novel anxiolytics. All three agents produce a common metabolite, namely 1-(2-pyrimidinyl) piperazine or 1-PP, which may contribute to the anxiolytic activity of the parent compounds. It soon became apparent that these anxiolytic agents do not act via the benzodiazepine or GABA receptors but show a relatively high affinity for the 5-HT1A sites the 1-PP...

Mood Anxiety and Somatoform Disorders

The cooccurrence of migraine and psychiatric disorders has been studied extensively in several population-based and longitudinal surveys. Migraine is associated with both affective and anxiety disorders. Breslau and colleagues reported on the association of International Headache Society (IHS)-defined migraine with higher lifetime rates of affective disorder, anxiety disorder, illicit drug use disorder, and nicotine dependence. Migraine with aura was associated with an increased lifetime prevalence of both suicidal ideation and suicide attempts, controlling for sex, major depression, and other concurring psychiatric disorders. The relative risk for the first onset of major depression in migraineurs after the onset of migraine versus no prior migraine was 4.1 (95 CI, 2.2-7.4), whereas the relative risk for the first onset of migraine in persons with prior major depression versus no history of major depression was 3.3 (95 CI, 1.6-6.6). These data indicate that the lifetime association...

Alterations in Neurochemical Stress Response Systems in Patients with Anxiety Disorders

Anxiety disorder patients have long-term alterations in neurochemical systems that are involved in mediating the stress response and are sensitive to chronic stress. The findings in PTSD and PD (most extensively studied of the anxiety disorders) are summarized in Table II. There is extensive evidence indicating that NE plays a role in human anxiety and is dysregulated in anxiety disorders. PTSD and PD seem to have similar alterations in noradrenergic function. However, the causes of the two syndromes may differ, with PD associated more with genetic factors and PTSD with the effects of severe psychological trauma.

Prevalence Of Anxiety Disorders

The American Psychiatric Association first recognized anxiety disorders in 1980 as a separate group of psychiatric disorders. The concept of neurosis (neurasthenic neurosis, anxiety neurosis, phobic neurosis, and obsessive-compulsive neurosis) in previous classifications was abandoned because it was considered too vague. Anxiety disorders now include PD, PTSD, social phobia, specific phobia, OCD, and GAD. Anxiety disorders are by far the most common of psychiatric disorders (25 ), followed by affective disorders (17 ). In the past decade, large epidemiological studies have provided information about the prevalence of anxiety disorders in the general population. A landmark epidemiological study in the United States in 1994 found lifetime prevalence rates for all anxiety disorders combined to be 19.2 for men and 30.5 for women. Phobic disorders are the most common diagnosis in broad-based assessments of psychiatric disorders in the community (affecting about 13 of individuals at any...

Benzodiazepine Abuse And Dependence

Genuine physiologic addiction to benzodiazepines may occur, particularly with prolonged and high doses. 37 However, the abuse potential of benzodiazepines appears to be low in comparison with that of agents such as alcohol, cocaine, opiates, and barbiturates. 89 Benzodiazepine abuse usually occurs in individuals with a history of abuse of other psychoactive drugs. Primary drug abuse with benzodiazepines is not common. Benzodiazepine withdrawal may occur on abrupt discontinuation and is more likely in patients with prolonged use and high doses. Because of the long biologic half-life of several derivatives, withdrawal manifestations may not occur for several days to over 1 week after the benzodiazepine has been discontinued. Unfortunately, it is often difficult to distinguish between withdrawal and underlying symptoms for which the drugs were prescribed initially. Reported withdrawal manifestations include anxiety, irritability, insomnia, nausea, vomiting, tremor, sweating, and...

Cognitivebehavioral Therapy For Anxiety Disorders

Cognitive-behavioral therapy is the most empirically supported psychosocial treatment for anxiety disorders. The cognitive-behavioral understanding of anxiety disorders is largely based on learning theory. Mowrer's two-factor theory suggests that anxiety disorders are created initially via classical conditioning, and then maintained via operant conditioning. According to this theory, anxiety develops when a neutral stimulus becomes paired with an aversive response. For example, someone who was bitten by a spider begins to pair the concept of spider with anxious feelings through classical conditioning. The person then realizes that he or she feels better by avoiding spiders, and the drop in anxiety that follows that avoidance acts as a negative reinforcer, Cognitive factors can also play a large role in the development and maintenance of anxiety disorders, because in addition to learned associations, anxiety can also result from people's perceptions of a given situation. For example,...


The Expression of Fear and Anxiety II. Prevalence of Anxiety Disorders III. Etiology of Anxiety and Anxiety Disorders IV. Functional Neuroanatomical Models of Fear and Anxiety V. Key Brain Structures Mediating Fear and Anxiety Behaviors VI. Neural Circuits in Anxiety and Fear VIII. Application of the Model of the Neural Circuitry of Anxiety and Fear to Anxiety Disorders IX. A Working Model for the Neural Circuitry of Anxiety Disorders


Alterations in Bz receptor function are involved in the stress response and anxiety. Animals exposed to stress develop a decrease in Bz receptor binding in different brain sites. Decreases in Bz receptor binding are also associated with alterations in memory. Bz receptors are present throughout the brain, with the highest concentration in cortical grey matter. Bzs potentiate and prolong the synaptic actions of the inhibitory neurotransmitter g-aminobutyric acid (GABA). Central Bz receptors and GABA receptors are part of the same macromolecular complex. These receptors have distinct binding sites, although they are functionally coupled and regulate each other in an allosteric manner. Administration of inverse agonists of Bz receptors results in behavioral and biological effects similar to those seen in anxiety and stress. These effects are blocked by administration of Bzs or pretreatment with the Bz antagonist flumazenil.


The prototypical anxiolytics in common use for CS in the ED are the benzodiazepines, which potentiate the inhibitory activity of g-aminobutyric acid (GABA) in the CNS by binding to benzodiazepine-specific receptors on the GABAA-benzodiazepine receptor complex, which induces a conformational change that potentiates GABA-mediated chloride influx. This activity results in sedation, amnesia, anxiolysis, and anticonvulsant effects, as well as respiratory depression. The benzodiazepine most commonly used for CS in the ED is midazolam, which produces earlier sedation, more frequent amnesia, less pain on injection, and improved 90-min alertness and readiness for discharge when compared with diazepam.18 Midazolam has a number of characteristics favorable for use in ED CS. Its diazepine ring opens at pH values of less than 4, in which form it is quite water soluble. At physiologic pH, the ring closes, rendering midazolam highly lipid soluble, with associated rapid CNS uptake producing peak...


Hyperventilation induces rapid, transient reductions in ICP because substantial decreases in CO2 cause vasoconstriction and decreased cerebral blood flow. Autoregulatory capability is required for this response. This measure is effective in many forms of edema, although there is a theoretical risk of causing injury due to hypoxia associated with excessively diminished cerebral blood flow. A target CO2 of 2530 mm Hg is recommended when hyperventilation is employed.


Benzodiazepines provide anxiolysis and amnesia but not anesthesia. They can be used alone as a sedative, or in conjunction with a narcotic or local anesthetic for a painful procedure. Midazolam (Versed) is a short-acting benzodiazepine that has an onset of action within 5 min and a duration of action of 30 to 45 min. Midazolam is safe and effective for use in the ED in children undergoing laceration repair, fracture reduction, and other painful procedures. 10 Adverse effects include respiratory depression and paradoxical inconsolability.11 Anecdotally, this latter effect appears to happen with increased frequency in children with attention deficit hyperactivity disorder, and is reversible with flumazenil. Diazepam is a longer-acting benzodiazepine that has been used extensively as a sedative for children and has amnestic properties. Diazepam can be used for extended diagnostic procedures and for muscle relaxation for orthopedic reductions. It has been largely replaced by midazolam.


Buspirone is a prototype anxiolytic drug from the azapirone family introduced in 1984. The agent is not chemically or pharmacologically related to the other sedative-hypnotics, although its efficacy profile is comparable with that of the benzodiazepines. Clinical indications for buspirone are not fully delineated however, it appears most useful in the treatment of conditions such as chronic anxiety, especially in the elderly, and mixed anxiety-depression states. It does not affect GABA or benzodiazepine receptors and therefore produces less sedation, euphoria, psychomotor impairment, and ethanol potentiation. It does affect CNS serotonergic, dopaminergic, and noradrenergic neurotransmission, but the mechanisms are not fully understood. Buspirone appears to have several merits when compared with the other sedative-hypnotics. It exhibits a virtual absence of potential for addiction, a wide margin of therapeutic safety, and no documented delayed toxicity or withdrawal reactions with...

Anxiety Disorders

Perfectionism has been posited to play a central role in cognitive models of social phobia (Heimberg, Juster, Hope, & Mattia, 1995) and the development of obsessive-compulsive disorder (Obsessive Compulsive Cognitions Working Group, 1997). Indeed, research supports the hypothesis that both social phobia and obsessive-compulsive disorder (as well as panic disorder) are associated with higher than normal levels of perfectionism (e.g., Antony, Liss, Summerfeldt, & Swinson,

Panic Disorder

A number of different techniques have been employed to bring under control somatic responses that are related to panic. The most frequently used technique is respiratory training. David H. Barlow and his associates have termed this approach panic control training. Eleven sessions of a combination of cognitive restructuring with breathing retraining und interoceptive exposure constitute a highly effective treatment in panic disorder. This treatment worked equally well with and without imipramine, a tricyclic antidepressant, and appeared more durable than imipramine alone six months after treatment cessation. Psychological treatments of panic disorder have previously been shown to be more effective than alprazolam, a benzodiazepine. In 1988, Gudrun Sartory and Deli Olajide compared breathing retraining with Valsalva, a vagal innervation technique, and found a slight advantage of the latter. Both groups received progressive relaxation and the instruction that panic could be brought under...

Azopirones buspirone

As with most medications in the therapy of dyspnoea, there are limited data to inform the use of buspirone in clinical practice. Buspirone is a non-sedating anxiolytic with a gradual onset of action after it is commenced. There are two double-blind, RCTs that explore the effect of buspirone in people with COPD. The first of these explored in a placebo-controlled study the use of 10-20mg of buspirone three times daily on dyspnoea measured on Borg scale and physiological parameters of exercise. The cohort of 11 males had moderate to severe COPD and anxiety. Neither dyspnoea scores nor anxiety scores (measured on the State Trait Anxiety Inventory) dropped by the end of the six-week study. There was no improvement in exercise workload including 12-minute walking distance.41 A study that was reported the same year explored the use of 20mg of buspirone per day in 16 people for 2 weeks. All had moderate to severe COPD with FEV1 of 1.15 + -0.42 and FEV1 FVC of 50.7 + -15.0 per cent. At the...

Phase 1 Anxiety

The first level of behavior seen in a potentially violent patient is anxiety. This may not only occur with the patient. Family and visitors waiting long periods in the emergency department waiting room may also exhibit anxiety and should be dealt with before visiting the patient so as not to intensify the patient's behavior. In general, the signs of increasing anxiety are indicated by body language. Movements that seem to have no purpose other than to expend energy may be the first clue. These may include pacing, wringing of hands, clenching of fists, unwillingness to stay in the treatment area, or a disheveled appearance. Speech may be pressured and loud. Questions such as Why am I here or How long is this going to take may be asked. It is not necessarily what is said, but the manner of speech that gives a clue to the presence of anxiety. One of the most common reasons that a patient's condition may evolve beyond anxiety is that the staff ignores these signals, rather than...

Kinds of Stress Response

There are four kinds of stress response. Some reduce an animal's state of being others enhance it. Understress occurs in simple environments that lack certain features (social companions, play items) (stimulus underload). Sometimes animals give behavioral signs of understress (lethargy exaggerated, repetitive activity apparently devoid of purpose (stereotypy) some other disturbed behavior). Eustress (good stress) situations of extraordinary responses, but which the animal finds tolerable or even enjoyable. Overstress environmental situations that provoke minor stress responses. Distress (bad stress) circumstances that provoke major stress responses. Judging from signs of negative emotions (anxiety, fear, frustration, pain), distress causes an animal to suffer, but to what extent is not yet known.

Aims and scope of the volume

There has been considerable anxiety, ethical debate, and regulatory and legislative intervention on both national and international scales in response to the advent of culturable hES cells, and to the far-reaching ideas for their application in future cell-based therapies. Although undoubtedly appropriate and necessary, much of this debate has far outrun both the present and potential scientific and medical realities. Moreover, some of it is based on misconception and misinterpretation. I have elsewhere discussed scientific and medical possibilities, which might lead towards more rational and considered approaches to regulating the derivation and use of hES cells (5).

Ethics And Personal Responsibility

Fearing that formal review agencies will hold us accountable after the fact stresses and distresses some of us. Some agencies, such as local, state, and national professional ethics committees, focus specifically on the ethical aspects of our work. Others, such as state licensing boards and the civil courts, enforce professional standards of care that may reflect ethical responsibilities. The prospect of review agencies second-guessing us with the benefit of hindsight can make difficult judgments a nightmare for some therapists. They may suffer a debilitating performance anxiety, dread going to work, and discover that the focus of their work has changed from helping people to avoiding a malpractice suit.

Mechanical Ventilation

Require hyperventilation, then the respiratory rate should be started at 2 the normal rate for age (20 breaths min for infants, 15 breaths min for young children, and 10 breaths min for older children and adolescents). Children should be adequately sedated and paralyzed during mechanical ventilation until definitive care is started in a pediatric intensive care unit.

Preparation for Anaesthesia

As more day surgery is performed and more patients are admitted to hospital close to the scheduled time of surgery, premedication has become less common. The main indication for premedication remains anxiety, for which a benzodiazepine is usually prescribed, sometimes with metoclopramide to promote absorption. Premedication serves several purposes anxiolysis smoother induction of anaesthesia reduced requirement for intravenous induction agents and possibly reduced likelihood of awareness. Intramuscular opioids are now rarely prescribed as premedication. The prevention of aspiration pneumonitis in patients with reflux requires premedication with an H2 antagonist, the evening before and morning of surgery, and sodium citrate administration immediately prior to induction of anaesthesia. Topical local anaesthetic cream over two potential sites for venous cannulation is usually prescribed for children. Anti-cholinergic agents may be prescribed to dry secretions or to prevent bradycardia,...

Summary Of Management Guidelines

The age-related differences are difficult to remember and cause major problems in pediatric resuscitation. One should not have to memorize numbers such as drug doses, tube sizes, or cardiac compression ratios. The proper organization of equipment, the posting of pediatric CPR data and equipment sheets, and the use of a length-based system (TableJ 0.-.5) can eliminate the need to commit many variables to memory and can reduce the possibility of errors. This eliminates much of the general anxiety connected with pediatric resuscitation and leaves clinicians free to apply the principles of resuscitation to the children as presented.

Description Of Treatment

Applied behavior analysis is a specific area of research and intervention within behavior modification. Several characteristics of behavior modification include an emphasis on overt behavior, a focus on current determinants of behavior, and reliance on the psychology of learning as the basis for conceptualizing clinical problems (e.g., anxiety, depression) and their treat

Interventions With Family Caregivers

For example, a person who asks to see her deceased mother might be feeling lonely or in need of reassurance. Providing comfort or talking with her about her mother will be more effective than telling her that her mother is dead, which will only increase her anxiety. The patient's cognitive errors are part of the disease and cannot usually be corrected, but the feelings that are associated with their beliefs can be addressed.

Overlap of Personality Emotion and Psychopathology

The same is true for depression and anxiety. Personality and emotion may be discriminated in terms of their causality and their time frame, with emotions being regarded as situationally dependent reactive states and personality characteristics as enduring traits. Plutchik (1980, pp. 173-198) defined personality in terms of the characteristic emotions displayed and experienced in interpersonal interactions. In this view, the emotions we tend to feel and or express most often when interacting with other human beings are our personality a timid or shy person feels and expresses fear most often in her or his interactions with others, while a friendly person feels and expresses friendliness or trust. Working in the opposite direction (from personality to emotion), Cffend Moskowitz (1998) demonstrated the validity of personality descriptors as predictors of affect. As well, Yik and Russell (2001) indicated the presence of relationships between momentary affects described...

Sex Differences in Emotion Emotion Inventories

Affect Adjective Check List (MAACL-R) (Zuckerman & Lubin, 1985) and the Profile of Mood States (POMS) (McNair, Lorr, & Droppleman, 1992). Sex differences are evident for both these instruments. The manual for the MAACL-R (Zuckerman & Lubin, 1985, p. 6) reports higher mean scores for women on scales representing Anxiety, Depression, and Positive Affect, and higher mean scores for men on the scale representing Sensation Seeking. In the POMS sex differences for a college sample show females scoring higher on the factors of Tension Anxiety, Depression Dejection, and Confusion (McNair et al., 1992, p. 21). A study of outpatients showed similar patterns of sex differences, with male outpatients additionally scoring higher on Vigor (McNair et al., 1992, p. 18). The state-trait distinction between personality and emotionality is parallelled in two Spielberger instruments, the State-Trait Anger Expression Inventory (STAXI-2) (Spielberger, 1999) and the State-Trait Anxiety Inventory...

Innovations And Future Directions

It is important to conduct research designed to identify the differential cognitive and behavioral deficits associated with irritable moods and anger attacks. Research on cognitive- behavioral therapeutic efficacy has outpaced efforts in this realm. The benefits of identifying cognitive and behavioral processes unique to different anxiety disorders have resulted in significant advances in their treatment of these disorders. Similar advances could be experienced in the realm of anger disorders. Finally, advances in cognitive neuroscience are contributing to the development of a better understanding of the role of biological factors in a variety of behavioral disorders, including anger problems. These advances neither mandate the use of pharmacological interventions nor preclude the use of cognitive-behavioral therapy. However, they do indicate that some people with anger problems may benefit from pharmacological interventions. Cognitive-behavioral therapists have developed treatment...

Sex Differences in Psychopathology

Women are also more likely to be diagnosed with several types of Anxiety Disorder, for example, Panic Attacks (DSM-IV, p. 399), Phobias (pp. 408, 414), and Generalized Anxiety Disorder (p. 534), though Obsessive-Compulsive disorder is equally evident in both sexes (p. 421). Again, this is an extension of the finding that women scored higher on Anxiety-related personality scales and emotions. Males were more likely than females to be diagnosed as having Conduct Disorder (p. 88) and Oppositional Defiant Disorder (p. 92). Both these diagnoses involve behavior related to anger and aggression, although both also belong to the category of problems usually first diagnosed before adulthood. An adult diagnosis of Intermittent Explosive Disorder (one which reflects the existence of bursts of aggressive impulses) is also more frequent in males than in females (p. 616). one sex at the emotional level (e.g., Anger in men or Anxiety in women), is more likely to be a personality characteristic...

Substrate Specificity

NAT1 and NAT2 have different but overlapping substrate specificities, although no substrate is exclusively acetylat-ed by one isozyme or the other, and no clear structural motif that determines substrate specificity for the different isoforms has been identified. Substrates preferentially N-acetylated by human NAT1 are p-aminobenzoic acid, p-aminosalicylic acid, sulfamethoxazole, and the folate catabolite p-aminobenzoyl glutamate. Substrates primarily N-acetylated by human NAT2 include a number of sul-fonamides (sulfamethazine, sulfapyridine, sulfadiazine, sulfameridine, and sulfadoxine), isoniazid, aminoglutethi-mide, amonafide, procainamide, dapsone, dipyrone, endra-lazine, hydralazine, prizidilol, batracylin, and metabolites of clonazepam and caffeine. Some compounds, such as the carcinogenic aromatic amines 2-aminofluorene, ben-zidine, 4-aminobiphenyl, 4,4-dichloroaniline and 2-naph-thylamine, and the food-derived heterocyclic amines and are N-acetylated to varying degrees by both...

Morphology Classification and Immunoreactivity

For a long time, the demonstration of resting and activated microglia only succeeded due to silver techniques. Selective immunohistochemical staining is only possible because of the expression of specific surface proteins in microglia. Visualization in vivo is possible (Banati 2002) using nC-labeled li-gands for the peripheral benzodiazepine binding site (PBBS), which binds to activated but not resting microglia with relatively cellular selectivity.

Future Directions

Cognitive-behavioral treatments for anxiety disorders have been empirically supported as effective in reducing anxiety symptoms. While these treatments have generally been targeted to specific disorders, a more recent trend has been to focus on commonalities among anxiety disorders, so that treatments can address these commonalities across diagnoses rather than using a different treatment package for each disorder. Clinical researchers have also been making strides in expanding the CBT packages that are available to additional populations, such as tailoring them to children, or to people with multiple diagnoses (such as those with both anxiety and substance abuse problems), and in disseminating these treatments to a broader range of clinicians. See also Anxiety anger management training (AMT), Anxiety Children, Anxiety in Children FRIENDS program, Exposure therapy, Generalized anxiety disorder, Social anxiety disorder 1, Social anxiety disorder 2

Settings For Plastic Surgery

Once the method of anesthesia is chosen it must be delivered in the appropriate setting. Patients undergoing facial plastic surgery rarely require an overnight stay. Most procedures are performed in an accredited ambulatory care center or in an office-based facility. Only low-risk surgical procedures should be performed in an office setting. Categorization of surgical procedures based on their complexity and requirements for anesthesia is one method to stratify risk. The Board of Medicine classifies surgeries as level I, II, and III. Level I surgery is considered minor and is performed using topical or local infiltrative anesthesia with or without a mild tranquilizer. Level II surgery may involve a minor or relatively superficial procedure that is performed with intravenous consciousness-altering medication. Monitoring of vital signs is required and supplemental oxygen is often needed. Level III surgery entails a moderate-to-complex surgical procedure usually performed under general...

Consciousness and Thinking

However, it was plain to Charles Darwin,* and to his valued colleague George Romanes, that if anatomical and physiological traits were evolutionary continuous* (see CONTINUITY) between nonhuman animals and humans, so too were mental ones. This was true not only of intelligence, but also of emotion and feeling, the most morally relevant aspect of thinking, since, as the philosopher Jeremy Bentham claimed, the ability to experience pain,* fear,* anxiety, hunger, thirst, pleasure, and so on is surely what makes a being worthy of moral concern, since what we do to it matters to it. Darwin made his position on animal feeling clear in his book The Expression of the Emotions in Man and Animals, and Romanes gathered and critically evaluated stories (anecdotes) about animal thought in his books Animal Intelligence and Mental Evolution in Animals. The strongest reason for the return of talk about animal mind has been moral (see MORAL STANDING OF ANIMALS). Since the 1960s, society has grown...

Control of the Work of Breathing

Control of breathing is required when tachypnea accompanies shock. Respiratory muscles are significant consumers of precious D o2 during shock and contribute to lactic acid production. Mechanical ventilation and sedation and decrease the work of breathing in shock and have been shown to improve survival. In the absence of a full shock picture, arterial blood-gas analysis can assist in the decision to perform intubation and mechanical ventilation. Sa o2 should be restored to greater than 93 percent and ventilation controlled to maintain a Pa co2 of 35 to 40 mmHg. Attempts to normalize pH above 7.3 by hyperventilation are not beneficial. Mechanical ventilation not only provides oxygenation and corrects hypercapnia, but assists, controls, and synchronizes ventilation, which ultimately decreases the work of breathing.

Contemporary Views Of Cbt With Children

In addition to a child's social network, the family is considered to be a favorable environment for effecting change in the child's dysfunctional cognition. Therefore, CBT-based family anxiety management (FAM) training programs have also been developed to incorporate family-directed problemsolving strategies. In addition to helping parents recognize and effectively manage their own emotional distress, and identify behaviors that may advance or sustain their child's anxiety, parents are taught to utilize their own strengths as care-providers by assisting their children to practice newly developed coping skills, facilitate new experiences for children to test dysfunctional beliefs, and provide positive reinforcement. While parents typically participate in FAM training as a supplement to their child's ICBT or GCBT involvement, FAM can also be conducted without child participation (parents only) or with the family unit as a whole (parents and children participating as a collaborative...

Contemporary Contributors

FRIENDS has a reputation as the only clinically validated early intervention program for anxiety and depression in Australia, and has been distributed nationally under the Mental Health Strategy (satisfying federal guidelines for evidence-based research). Its strong evidence base has encouraged international demand, with the program now being used, validated, and translated in different languages around the world. While culturally sensitive supplements to FRIENDS have also been developed (Barrett, Sonderegger, & Sonderegger, 2001b), recent studies (e.g., Barrett, Moore, & Sonderegger, 2000 Barrett, Sonderegger, & Sonderegger, 2001a Barrett, Sonderegger, & Xenos, in press) have shown FRIENDS in its current format to also be effective in reducing anxiety and stress among culturally diverse migrants and refugee youth. For more information on FRIENDS, see

Empirical Basis For Cbt With Children

Although high parental control, parental anxiety, and parental reinforcement of avoidant coping strategies have been associated with children's anxiety symptoms (Shortt, Barrett, Dadds, & Fox, 2001), parents can also be a valuable resource in bringing about positive change in their children. Howard and Kendall (1996) were the first to evaluate the effectiveness of ICBT plus parent involvement using a multiple baseline design. Six clinically anxious children (aged 9-13) and their families participated in treatment that was initiated following baseline assessment periods of 2, 4, or 6 weeks (during which time diagnostic criteria was maintained). Four of six clients experienced treatment gains from pre- to posttreatment as indicated by self-, parent, and teacher reports, and diagnostic ratings by clinicians who were blind to participants' treatment status. The remaining two clients also showed treatment gains on most measures, and for five of the six participants, improvements were...

Initial Baseline Assessment

Transcranial Doppler measurements enable the noninvasive evaluation of blood flow velocities of some cerebral arteries. Investigations have suggested that the monitoring cerebral blood flow is vital in critically ill patients. In particular, the risks of cerebral vasoconstriction induced by hyperventilation, and the sepsis-induced nonhomogenous cerebral blood flow seen in some patients with sepsis, may place certain patients at risk for cerebral ischemia.

Recommended Readings

R., & Rapee, R. M. (1996). Family treatment of childhood anxiety A controlled trial. Journal of Consulting and Clinical Psychology, 64, 333-342. Barrett, P. M., Sonderegger, R., & Xenos, S. (2004). Using FRIENDS to combat anxiety and adjustment problems among young migrants to Australia A national trial. Clinical Child Psychology and Psychiatry. Kendall, P. C. (1994). Treating anxiety disorders in children Results of a randomized clinical trial. Journal of Consulting and Clinical Psychology, 62, 100-110.

Empirical Studies

This prediction is supported by studies by McCabe and her colleagues that employed imagery training to enhance sexual arousal among inorgasmic. Imagery training was used in both of these studies to desenzitize inorgasmic women to the anxiety and fears that they held regarding sexual arousal and orgasmic responding. This process of desentitization was designed to enhance both physiological arousal and subjective levels of arousal. It was, therefore, a form of arousal training that was designed to operate at both the physiological and subjective level. The data from both studies demonstrated some level of effectiveness using these techniques.

Measurement of dyspnea

Non-pharmacological treatments may offer relief for the extreme distress but not for the actual intensity of dyspnea. Therefore, if possible the 'anxiety' or 'distress' associated with dyspnea should be measured. The changes in intensity and distress associated with dyspnea can be measured over time to evaluate treatment modalities and fluctuations that will predict changes in the patient's activities and care needs.

TABLE 333 Equipment for Intravenous Analgesia and Sedation

The use of pulse oximetry during CS is important. By 1990, more than 80 deaths had been reported following the use of midazolam, commonly in conjunction with an opioid, for sedation.11 Coadministration of midazolam (0.05 mg kg) and fentanyl (2.0 pg kg) to 12 healthy volunteers produced hypoxemia (Sa o2 < 90 percent for longer than 10 s) in 11 and apnea in 6.11 A study of pulse oximetry and nasal end-tidal CO2 values in 27 ED patients who were sedated with benzodiazepines and or opiates

Hardware and Software

The internal video circuit had to be adapted for Internet video streaming. An encoder transformed the analogue signal of the internal video circuit into a digital video stream. The encoding was done on-line in real time with a delay (buffer) of five seconds, and the frame rate was ten frames per second. A 56K modem on an average bandwidth network was able to adequately handle the data flow. A higher-quality modem did not provide a better image of the newborn, because the load of encoded data was relatively low changes in light intensity were few, the newborn hardly moved, and movement around the crib was limited. Sound was not encoded because of privacy considerations rather than technical limitations the microphone of a newborn in one crib could transmit speech from physicians or nurses providing care to another nearby newborn. Furthermore, it is was feared that parents might misinterpret sounds on the ward, such as the audio control signals from respiratory equipment, thus raising...

The Ethics and Goals of Advertising

Youth, power, beauty, sex, and affluence), associating the product with images of attractive people in beautiful surroundings. The consumer is left to feel tremendous anxiety about the possible consequences of making the wrong choice of detergent, antiperspirant, or health plan.

Biochemical Mechanisms of Action

In the plasma, increased levels of -endorphin, epinephrine, norepinephrine, corticosterone, ACTH, renin, and angiotensin I and decreased levels of growth hormone, thyroxine, triiodothyronine, and thyrotropin were reported with high caffeine doses. The mechanisms responsible for these various effects are largely unknown, and the mediation of adenosine receptors is suggested. The antagonism of benzodiazepine at the receptor level is observed at lower caffeine concentrations (0.5-0.7mM) than those required for phosphodiesterase inhibition.

Phase II cardiac rehabilitation

This is the initial post-discharge stage, and can tend to be rather low key, although it is a time when patients may feel isolated and somewhat insecure, and when high levels of anxiety may be present. Thus, it is important that patients and their families significant others have access to appropriate health care professionals. Depending on the service available, contact with the cardiac rehabilitation team may be by phone or home visit, with primary care also involved. This is the stage where modification of risk factors will start and goals set in phase I CR should start to be realised. For patients issued with the heart manual post-MI, this can be used immediately (Lewin, et al., 1992), and for other patients an individualised walking programme may be started at this stage. The use of pedometers can help patients and CR staff monitor home walking programmes.

Psychodynamic Approaches

Initial attempts to account for variations in patterns of marital interaction across cultures focused in particular on marital aloofness. The goal was to explain why husbands and wives in some societies tended to avoid one another and to devalue the importance of their relationship. The most influential explanations of marital aloofness, in turn, relied on a prior commitment to psychodynamic theory, which assumes that human motivation is influenced by unconscious mechanisms meant to minimize anxiety. With regard to marital interaction, the assumption was that aloof marriages prevail in societies where men are anxious about sex and or women. To deal with their anxiety, men simply avoid their wives. As is characteristic of psycho-dynamic theory, the source of male anxiety was traced to childhood.

Assessment And Differential Diagnosis

BDD is regularly associated with comorbid or secondary disorders, including major depression (approximately 60-80 ), social phobia (lifetime rate of 38 ), substance use disorder (lifetime rate of 36 ), and obsessive-compulsive disorder (lifetime rate of 30 ) (Phillips & Diaz, 1997). Individuals with BDD may hold their preoccupations with a delusional intensity, which would warrant the added diagnosis of delusional disorder, somatic type (APA, 2000). However, recent theory suggests that adding the delusional diagnosis has little value and contradicts current etiopathol-ogy and treatment response indications (Castle & Phillips, 2002).

The Therapeutic Environment Animals as an Aspect of Milieu Therapy

For example, Aaron Katcher, Arline Segal, and Alan Beck reported, in their study on anxiety and discomfort before and during dental surgery, that subjects viewing the aquarium appeared more comfortable and less anxious than those subjects in a control group not viewing an aquarium. Watching a school of fish can be quite relaxing for some. With proper lighting and an attractively designed tank, clients can feel more at ease when they enter an office or while in therapy.

Exposure Hierarchy and Response Prevention

A hierarchy of graded imaginal and in vivo exposures is collaboratively constructed in the early stages of treatment. For clients with BDD concerns, exposure therapy is helpful in decreasing self-consciousness and body-related anxiety and minimizing the avoidance of feared body image situations (Rosen et al., 1995). Hierarchy items can be adjusted by modifying situations with respect to familiarity of people, physical proximity to others, and type of social interaction (Rosen et al., 1995).

Psychological factors

Effort to protect the heart) and further preoccupation with symptoms. Reduced activity leads to physical deconditioning, often producing more fatigue, more time to dwell on any symptoms or bodily sensations, and therefore generates further anxiety. Other patients become trapped in a downward spiral of increasing disability, and a very small number will succumb to a restricted and fearful lifestyle that has been labelled in many different ways over the years for example cardiac neurosis, neurocirculatory asthenia or effort syndrome. These patients are currently described as demonstrating undue illness behaviour. They demonstrate high levels of anxiety, physical deconditioning, a dependent attitude towards medical care, and often an almost obsessional preoccupation with the details of their medical history.

Evidence For Cognitive Behavior Therapy

Preliminary evidence for the efficacy of cognitive behavior therapy (CBT) in BDD comes from two randomized controlled trials (RCT) (Rosen, Reiter, & Orosan, 1995 Veale, Gournay et al., 1996). There are also several case series of behavioral and cognitive therapy (Geremia & Neziroglu, 2001 Gomez Perez, Marks, & Gutierrez Fisac, 1994 Marks & Mishan, 1988 Neziroglu & Yaryura Tobias, 1993 Wilhelm, Otto, Lohr, & Deckersbach, 1999). In the first RCT, Rosen et al. (1995) randomly allocated 54 patients diagnosed as having BDD to either group CBT or a waiting list. After treatment, 82 (22 out of 27 subjects) of the CBT group were clinically improved and no longer met the criteria for BDD compared to 7 (2 out of 27 subjects) in the waiting list group. The subjects were, however, different from those described at other centers for example, they were all female, 38 were preoccupied by their weight and shape alone, and they tended to be much less socially avoidant and handicapped...

Psychosocial Deprivation

The process inhibiting normal growth in PSD is likely to be multifactorial and to vary with individual circumstances. In some cases, affected children have not received sufficient food for normal growth. In other cases, food may have been offered but misery and fear prevented the children eating it thus subjecting them to further ridicule or punishment because of unfinished meals. Some children, who appear to have been given adequate food and yet fail to grow, may have elevated metabolic rates and increased energy needs secondary to anxiety and

Transgenderism and Transsexualism in Portugal

Some important issues concerning the Portuguese transsexual population were identified in a recent study (Bernardo et al., 1998). These authors conducted a small-sample study involving of 50 transsexual individuals, most of whom were sex workers (86 ). The great majority of the sample came from rural parts of the country (72 ), and many individuals had moved away from their birthplace because of their sexual orientation (28 ). Some started to work as early as age 11. Additionally, the study identified some serious health problems in this sample. For example, 30 of these transsexuals knew they were HIV positive, although only 61 always used a condom. More on the subject of HIV AIDS in trans-gender transsexual populations can be found in Warren (1999) and Bockting, Rosser, and Coleman (1999). A significant percentage (70 ) of the sample abused alcohol, tranquilizers, or heroin on a regular basis.

Cognitivebehavioral Model Of Bulimia Nervosa Precipitation And Maintenance

And manipulation of body weight and shape. BN-related dysfunctional beliefs occur in several domains, including (a) body weight expectation, (b) meaning of body weight and shape, and (c) food and eating pattern. In particular, persons with BN often hold unrealistic expectations for how low their own body weight should be, and believe that acquiring a specific (usually thin) body appearance will result in a host of desired consequences (e.g., increased interpersonal popularity and prowess, increased self-esteem, decreased negative emotion). Thus, obtaining the ideal body is viewed as a principal strategy for achieving idiosyncratically defined positive life outcomes and coping with or solving life problems. Dietary restriction is employed in an attempt to conform the body to ideal specifications. Dietary restriction typically includes restricting how often food is eaten, how much food is eaten, and what types of foods are eaten. This restrictive eating pattern results in both...

Organisation of services

A six week, home based rehabilitation programme, the Heart Manual, delivered by a specially trained nurse has been found to be effective in reducing anxiety and depression, visits to the general practitioner and hospital readmissions up to six months after an MI.13 Other forms of home and community based rehabilitation may be as effective and as safe as hospital based programmes, but more research is needed.

Arthur M Nezu and Christine Maguth Nezu

During the past several decades, considerable medical progress has been made in treating cancer. Many forms are curable and there is a sustained decline in the overall death rate from this set of diseases when assessing the impact on the total population. Because of improvements in medical science, more people are living with cancer than ever before. However, psychosocial and emotional needs are frequently overlooked by the traditional health care team, and despite improved medical prognoses, cancer patients often continue to experience significant emotional distress. For example, compared to the general population, cancer patients experience a fourfold increase in the rate of depression. Other significant psychological problems include pain, anxiety, suicide, delirium, body image difficulties, and sexual dysfunctions. Various psychological and physical symptoms frequently occur as a function of the cancer treatment itself (e.g., fear, nausea). Even for people who historically have...

The central perception of dyspnoea

Dyspnoea is often described as 'air hunger' and the perception of dyspnoea is heightened when patients believe it to be dangerous. This in turn exacerbates the situation and a vicious cycle ensues. Anxiety and depression are increasingly recognized in patients with heart failure.

Involvement of family

Evidence is accumulating that the success of rehabilitation may depend to a large extent upon the involvement of the patient's family, particularly the partner. Arguments for including the partner in the rehabilitation process are both practical and therapeutic. The partner can be incorporated in the programme with little additional effort or cost. It is likely that the partner's attitudes to the patient's MI can affect recovery through, for example, being over concerned and protective. Perhaps as important as the potential health gains for patients are those for partners. As one might expect, partners are often distressed after an MI. Indeed, they often report levels of anxiety and depression that are at least as comparable to, and often higher than, those of patients. Therefore, they may well benefit from the support, information and enhanced feeling of control that they are likely to experience by being included in rehabilitation. The presence of the partner in rehabilitation can...

Generalized Social Phobia

This cognitive approach is more intensive, and requires more therapist skill and experience, than BGT for PDA. Groups are smaller (e.g., six members) and of longer duration (12 sessions). Wi thin-session exposure sessions (role playing) accompanied by cognitive strategies are a major focus of the therapy Individuals with severe social deficits are more appropriate for behavioral social skills training. Some individuals will have high levels of criticism toward others in addition to self-criticism, and their interpersonal style may be inappropriate for this type of group approach. Prior to the formal group treatment, one or two individual sessions with each member is conducted in order to explain the cognitive behavioral model and rationale, and to help alleviate anticipatory anxiety surrounding group therapy. Session 1 The introduction and orientation is similar to BGT for PDA except that the state anxiety in the group is generally much higher. The therapist therefore takes a go slow...

Clinical Presentation

Objects lodged in the esophagus generally produce anxiety and discomfort. Adult patients often complain of retrosternal pain. Patients are likely to retch or vomit and experience dysphagia, resulting in choking, coughing, or aspiration if they attempt to wash down the object. Eventually, patients may be unable to swallow their own secretions. In the adult, the history often provides all the pertinent information necessary for diagnosis and treatment. However, this is often not true in the pediatric population. In the 16-and-under age group, symptoms include refusal to eat, vomiting (with or without hematemesis), gagging, choking, stridor (pseudoasthma), neck or throat pain, inability to swallow, increased salivation, and foreign body sensation in the chest. Physical examination must include careful evaluation of the nasopharynx, oropharynx, neck, and subcutaneous tissues for air resulting from perforation of a hollow viscus. Laryngoscopy, either direct or indirect, should be done,...

Respiratory alkalosis

Respiratory alkalosis is caused by alveolar hyperventilation -the opposite of respiratory acidosis. The kidneys take 2-5 days to compensate fully by excreting bicarbonate in the urine and retaining hydrogen ions. Many people tend to think that hyperventilation means hysteria. This is incorrect. Hyperventilation is a sign, not a diagnosis, and it has many causes psychogenic causes (pain, anxiety).

TABLE 762 Differential Considerations in Groin Hernia

Before an attempt is made to reduce the hernia, the patient should be placed in the Trendelenburg position and given some mild sedation. A variety of sedating agents can be used, with the benzodiazepines most commonly employed. A warm compress over the area may make the task easier by reducing the swelling and relaxing the abdominal musculature. Only gentle compression of the hernia should be used, and nothing should be forced back. Attempts at reduction should be limited in time and force.

TABLE 114 Drugs Used for Induction of Anesthesiax

KETAMINE Unlike any of the other induction agents, ketamine tends to increase heart rate, blood pressure, and cardiac output. These effects appear to be mediated through central sympathetic stimulation, since ketamine appears to be a weak myocardial depressant in isolated heart preparations. Such effects enhance its attractiveness in settings such as trauma with hypovolemia. It is also a bronchodilator with no suppression of ventilatory drive, making it an excellent choice for patients with known reactive airway disease. In addition, it has significant analgesic and amnestic properties. It can be given intramuscularly in a dose of 4 to 6 mg kg with onset of anesthesia within 5 min. This may be desirable in the combative patient in whom intravenous access has not been secured. Unfortunately, it also carries a number of undesirable side effects. Despite the bronchodilatation, there are marked increases in upper airway secretions, which can occur briskly and complicate airway management....

R6X3 Postoperative Stomach

Double-balloon endoscopy substantially reduces patient discomfort compared with conventional push enteroscopy because it allows insertion while avoiding intestinal stretching, but it is still not an entirely noninvasive procedure. The whole procedure takes 1-2 h, and insertion and shortening cause some discomfort in the abdomen or the throat. Despite adequate information before the examination, patients are more likely to experience anxiety than with conventional endoscopy because many of them have not undergone this examination. It is the responsibility of the endoscopist to perform painless, comfortable endoscopy on patients, and it is therefore important to administer appropriate sedation. The optimal level of sedation for endoscopy is conscious sedation, which is defined as a sedative condition where the patient retains the ability to communicate verbally with the physician 1 . Conscious sedation is advantageous in that the drugs exert anxiolytic and amnesic effects, the endoscopy...

Practice Of Clinical Health Psychology

Growing attention has been paid to the influence of health behaviors, which may prevent or exacerbate chronic illness. Advances in the physiology of stress and its role in the development of physical disorders combined with behavioral change have influenced our management of chronic illness. Research demonstrating the preoperative psychological state (anxiety, depression, coping styles) influencing the postoperative outcomes of surgery encouraged the use of brief, structured psychosocial interventions for surgery patients. All of this evidence points to the imperative need to assess and treat patients with medical illness from a biopsychosocial perspective.

Requirements For Improved Care

In addition there is a need for research into the use and actions of opioids in chronic left ventricular failure. This should include the evaluation of different treatment regimens, the use of alternative opioid delivery systems (for example, nasal sprays which have been shown to relieve anxiety rapidly), and the role of newer opioids such as

Radical Behaviorist Approaches to Behavior Therapy

Radical behaviorist approaches to treatment place strong emphasis on the role of an individual's linguistic community and language structure in guiding behavior. Cognition per se is irrelevant, except to the degree that thought is a part of the client's use of language. Behavior change is brought about by teaching new linguistic structures that lead to less affective upset. This is accomplished by attempting to alter the way in which clients use language to form attributions about the causes and meanings of their emotional experience. Most often, this involves teaching clients that emotions are not experiences that can or should be avoided. Rather, they are to be viewed as natural accompaniments to the process of living. Clients are taught to accept and utilize in a positive fashion affective and other inner experiences that their linguistic community has taught them should be avoided or eliminated (e.g., anxiety). Clients are also shown how to alter the contexts (contingencies) that...

Organophosphates and carbamates

These compounds represent a common source of poisoning to cats, due in no small part to the multitude of potential sources available. Intoxication usually follows the application or ingestion of organophosphates (OPs) or carbamates used as insecticides, either intentionally or accidentally. Although the cat is considered particularly sensitive to OP compounds, collars, spot-ons and sprays incorporating these active ingredients are still commercially available. Both OPs and carbamates act by inhibiting the key enzyme acetylcholinesterase (AChE). This results in marked cholinergic stimulation owing to the ineffective degradation of acetylcholine at receptor level. Clinical signs therefore arise through overstimulation of nicotinic receptors in skeletal muscle, autonomic preganglionic junctions, parasympathetic postganglionic junctions and a small number of sites in the CNS. The initial clinical picture in the cat is often characterised by anxiety, hyperexcitability and muscle twitching....

Benefits Of Knowledge Of Cognitive Vulnerability

Such research offers the promise to clinical practitioners of better identifying specific mechanisms that help to maintain psychological problems and create a susceptibility for first and repeated episodes of disorders. This can lead to more refined treatment strategies in the future. Finally, knowledge of cognitive vulnerability research provides the practitioner with direction for understanding lack of progress in treatment, or of subsequent relapse, even though the practitioner has addressed automatic thoughts. Unless the underlying mechanisms are altered (e.g., the depressive attributional style or dysfunctional attitudes, the anxiety sensitivity), patients' disturbing ideation is likely to persist or recur in the face of future precipitating stress.

Male Genital Problems

One of the most anxiety-provoking problems presenting to an emergency department is the male with acute genital pain. Ihe extensive sensory innervation of this area produces severe symptoms, and the close relationships of the abdominal and genital sensory afferent pathways in the male account for the common association of abdominal pain with some acute genitourinary disorders.

Theoretical Bases

Unassertive clients to stand up for their rights. He emphasized that unlike Moreno's original psychodrama, it did not consist of encouraging clients to act out their underlying attitudes in relationships. Instead, with the therapist playing the role of someone to whom the client ordinarily reacted with excessive anxiety, he or she was directed to behave in a new, usually assertive manner. Wolpe's assumption was that this outward display of new (assertive) behavior would reciprocally inhibit the anxiety. He stressed that when the client is able to deal successfully with the play situations in the office, it is a steppingstone toward dealing with the real-life situation. Instead of calling this process psychodrama, I pointed out that the play-acting of prescribed behavior might better be called behavior rehearsal, and this became the accepted term. This perspective opened the door for behavior rehearsal to be construed as a process of social influence that transcended the reciprocal...

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