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Abstract Background Panic disorder (PD) is highly prevalent during the peripartum period. The aim of this systematic review was to summarize evidence on risk factors and course patterns of peripartum PD as well as maternal, infant or dyadic outcomes during the first three years after delivery. Methods A literature search was conducted according to PRISMA guidelines. Inclusion criteria were: (1) a diagnosis of PD or panic attacks during pregnancy, (2) risk factors and course as well as maternal, infant or dyadic outcomes measured in pregnancy and/or up to 3 years postpartum (3) peer-reviewed articles in English or German published between 1980 and April 2024. After screening of n = 2,740 records, n = 75 records based on n = 64 projects were eligible for this systematic review. Results Overall, n = 47 studies investigated the course of PD during the peripartum period, n = 23 studies examined the associations of PD and obstetric, neonatal or infant outcomes, and n = 5 studies focused on the associations of PD and characteristics of the mother-infant dyad. We found (1) no common trajectory, but heterogeneous courses of maternal PD in the peripartum period, (2) associations of maternal PD with birth complications and subsequent postpartum depression, and (3) evidence for associations of PD with infant and dyadic outcomes. Limitations Diverse outcome measures in recent original publications did not allow for a meta-analytic approach. Conclusion Heterogenous courses and outcomes of peripartum PD require comprehensive monitoring of affected mothers and their infants. There is a need for further longitudinal investigations into familial transmission of anxiety disorders.

Background: PTSD is comorbid with a number of other mental health difficulties and the link between voice hearing and PTSD has been explored in adult samples.Objective: To compare the trauma history, symptomatology, and cognitive phenotypes of children and adolescents with a PTSD diagnosis following exposure to multiple traumatic events presenting with voice hearing with those who do not report hearing voices.Methods: Participants (n = 120) were aged 8–17 years and had PTSD following exposure to multiple traumas. Three primary analyses were conducted, comparing PTSD symptom severity, prevalence of sexual trauma, and level of negative post-traumatic cognitions between the voice hearing and non-voice hearing groups. Participants were allocated to the voice hearing group if they reported hearing voices in the past two weeks. A range of mental health and cognitive–behavioural factors were considered in exploratory secondary analyses. All analyses were pre-registered.Results: The voice hearing group (n = 50, 41.7%) scored higher than the non-voice hearing group (n = 70, 58.3%) for negative post-traumatic cognitions, but not PTSD symptom severity or prevalence of sexual trauma. In secondary analyses, the voice hearing group had more sensory-based and fragmented memories and higher scores for panic symptoms than the non-voice hearing group. When participants whose voices were not distinguishable from intrusions or flashbacks were removed from the voice hearing group in a sensitivity analysis, the voice hearing group (n = 29, 24.2%) scored higher on negative post-traumatic cognitions and trauma memory quality, with similar effect sizes to the original analysis.Conclusions: Voice hearing is common among youth exposed to multiple traumas with PTSD and is related to cognitive mechanisms proposed to underpin PTSD (appraisals, memory quality) and more panic symptoms. Further research should seek to investigate the underlying mechanisms and directionality for these relationships.

The global outbreak of COVID-19 in 2020 became unprecedented and sent shockwaves through financial markets worldwide. This study investigates the impact of the pandemic on the performance of the U.S. financial market from March 1, 2020, to April 14, 2022. Utilizing Bai and Perron’s (1998) least squares with breaks during this period. The study’s test findings validate the existence of seven structural changes, signifying the occurrence of eight effects of independent factors on the S&P 500 index. The empirical findings demonstrate a substantial influence of COVID-19 pandemic on the performance of financial markets. Specifically, the impact of the number of COVID-19 cases and new fatalities on financial market performance, exhibits variations in terms of direction, nature, depth, and level. Based on an analysis of the structural changes, it can be inferred that the initial period exhibits the most pronounced negative impact on the number of new COVID-19 cases. Subsequently, the direction and nature of this impact undergo a transformation from the second to the eighth periods. Specifically, the impact of the number of new COVID-19 cases becomes positive in the second, third, sixth, seventh, and eighth periods, gradually diminishing until it reaches its lowest levels of impact in the eighth period. The research further identifies a detrimental impact on the occurrence of new fatalities. However, the periods spanning from the third to the fifth period exhibit very modest levels of influence, which then transition into a beneficial effect during the fifth period. Moreover, the research reveals that the impact of mortality rates on the performance of the United States stock market was greater than that of COVID-19 cases across all periods linked to structural changes. Additionally, the exchange rate of the dollar has a consistent and favorable impact, and the real interest rate has a pronounced negative impact, which gradually reduces over time and eventually transitions into a positive value by the eighth period.

Over the past few years, many research papers have referred to stock market volatility in relation to investor attention and sentiment and our article adds to the current literature on financial market reactions to the economic consequences of COVID-19. An event such as an outbreak of an infectious disease causes a negative change in investor sentiment, which strongly influences their investment decisions and, consequently, stock market prices. The subject of the study is the mutual influence of stock market characteristics and market sentiment, during a COVID-19 pandemic crisis. The purpose of the study is to provide empirical support for the hypothesis of indirect impact of uncertainty and panic under the COVID-19 pandemic on the dynamics of the stock market in Russia. The World Health Organization and experts forecast that the world will face more than one crisis related to the spread of infectious diseases in the future, so understanding the mechanisms of mutual influence of sentiment and financial markets remains relevant. In this study, we take a novel approach to deriving an indicator for panic that has not been used before. We perform econometric modeling using a Vector Autoregressive Model (VAR) and a Vector Error Correction Model (VECM), which allows us to describe in the model not only the long-term equilibrium but also the dynamics towards it. As a result, we got consistent and efficient estimates of the long-term and short-term effects of panic and mortality rates on the volatility of the RTS stock index and found that the market reaction to COVID-19 changed as the pandemic spread: the effects of uncertainty and panic, while having a significant impact at the beginning of the crisis, faded away. The conclusions obtained in the analysis of the Russian stock market dynamics coincide with those obtained by other authors in their analysis of markets in other countries over a similar period.

The study's significance lies in the multitude of challenges facing individuals today, such as the COVID-19 pandemic, military conflicts like the war in Ukraine, and the escalating rates of cancer morbidity and mortality. These factors contribute to the onset of anxiety and depressive disorders, disrupting various aspects of individuals' mental functioning and social interactions. Addressing these disorders effectively necessitates a comprehensive approach, combining pharmacological interventions with psychotherapeutic strategies under the guidance of specialized professionals. In this regard, the study is aimed at identifying aspects and features of the development of psychological problems and personality disorders in the modern world filled with various stressors. The leading methods of studying this problem are analysis, synthesis, induction, deduction, comparison, experiment and systematisation of approaches that will help determine a wide range of mental disorders. Theoretical methods were used to analyze the literature and summarize theoretical material on anxiety and depressive disorders. Diagnostic methods were used to assess the psychological state of the study population. The study examines significant clinical syndromes and vegetative disorders that disrupt normal lifestyle, hinder daily activities, and impede professional growth. It evaluates the roles of psychologists, psychiatrists, and social workers in assisting individuals with anxiety disorders. It outlines preventive measures for anxiety and depression, while also delving into various types of anxiety disorders. The research proposes diverse methods to prevent emotional anxiety and instability. It underscores the importance of devising novel strategies for diagnosis and therapy, emphasizing a comprehensive approach involving psychotherapeutic support, medical intervention, and adaptive behavioral techniques. The findings of the study hold both practical and theoretical significance for professionals in psychology, psychiatry, psychoanalysis, and sociology who provide support for individuals with anxiety and depressive disorders. Furthermore, the insights provided may be pertinent to researchers and scholars investigating the psychological well-being of contemporary society amidst adverse external circumstances.

The purpose of this study is to determine the effect of panic on evacuation time. Evacuation is the movement of individuals from a place in danger to a safer place. Evacuation is usually done when there is an emergency such as an earthquake, fire or attack, which will make the movement of individuals difficult. Individuals who are in an emergency will feel panic. The panic that occurs will cause individuals to lose their way to a safer place such as an exit. This research is a basic or theoretical research. The evacuation model uses cellular automata that simulates the behavior of individuals in cells for the evacuation process. This model considers the panic factor in the evacuation process which will affect the steps taken by individuals. Individual steps based on transition probabilities will obtain evacuation time. The parameters used are static coefficient, dynamic coefficient, and panic coefficient. Simulation using software by entering the grid size, obstacle position, exit position, individual position and parameters. Based on the simulation results, it is obtained that the increase in individual panic, the longer the evacuation time

Abstract Background Whether the positive associations of blood lipids with psychiatric disorders are causal is uncertain. We conducted this two-sample Mendelian randomization (MR) analysis to comprehensively investigate associations of blood lipids with psychiatric disorders. Methods Univariable and multivariable models were established for MR analyses. Inverse variance-weighted (IVW) MR was employed as the main approach; weighted median and MR-Egger were used as sensitivity analysis methods. The possibility of violating MR assumptions was evaluated utilizing several sensitivity analyses, including heterogeneity statistics, horizontal pleiotropy statistics, single SNP analysis, leave-one-out analysis and MR-PRESSO analysis. As instrumental variables, we screened 362 independent single-nucleotide polymorphisms (SNP) related to blood lipids from a recent genome-wide association study involving 76,627 individuals of European ancestry, with a genome-wide significance level of p

Difficulty in appropriately responding to threats is a key feature of psychiatric disorders, especially fear-related conditions such as panic disorder (PD) and posttraumatic stress disorder (PTSD). Most prior work on threat and fear regulation involves exposure to external threatful cues. However, fear can also be triggered by aversive, within-the-body, sensations. This interoceptive signaling of fear is highly relevant to PD and PTSD but is not well understood, especially in the context of sex. Using female and male mice, the current study investigated fear-associated spontaneous and conditioned behaviors to carbon dioxide (CO2) inhalation, a potent interoceptive threat that induces fear and panic. We also investigated whether behavioral sensitivity to CO2 is associated with delayed PTSD-relevant behaviors. CO2 evoked heterogenous freezing behaviors in both male and female animals. However, active, rearing behavior was significantly reduced in CO2-exposed male but not female mice. Interestingly, behavioral sensitivity to CO2 was associated with compromised fear extinction, independent of sex. However, in comparison to CO2-exposed males, females elicited less freezing and higher rearing during extinction suggesting an engagement of active versus passive defensive coping. Persistent neuronal activation marker ΔFosB immuno-mapping revealed attenuated engagement of infralimbic-prefrontal areas in both sexes but higher activation of brain stem locus coeruleus (LC) area in females. Inter-regional co-activation mapping revealed sex-independent disruptions in the infralimbic-amygdala associations but altered LC associations only in CO2-exposed female mice. Lastly, dopamine β hydroxylase positive (DβH + ve) noradrenergic neuronal cell counts in the LC correlated with freezing and rearing behaviors during CO2 inhalation and extinction only in female but not male mice. Collectively, these data provide evidence for higher active defensive responding to interoceptive threat CO2-associated fear in females that may stem from increased recruitment of the brainstem noradrenergic system. Our findings reveal distinct contributory mechanisms that may promote sex differences in fear and panic associated pathologies.

Background: Panic Disorder is a serious anxiety disorder, and one of the severe mental problems that impacts mothers’ mental health and fetal health as well. Aim: The current scoping review aims to provide a wide overview of the literature regarding panic disorder during pregnancy. Methods: Twenty-five eligible articles were selected for full review from SAGE, CINAHL, PubMed, Medline, Research Gate, Science Direct, and Google Scholar literature searches. This review followed the framework suggested by Arksey and O'Malley for a scoping review. Results: Content analysis of the studies was done, and five categories have been identified: Panic disorder course during pregnancy; prevalence of panic disorder during pregnancy; factors associated with pregnancy panic disorder; impact of panic disorder during pregnancy; and treatment of panic disorder during pregnancy. Conclusion: A significant gap in the literature, and inconsistent and mixed findings regarding prevalence, impact, associated factors, and treatment of PD during pregnancy exist. This scoping review revealed that more studies need to be conducted to further understand and examine PD during pregnancy.

Abstract Background The existing literature on the association between brain‐derived neurotrophic factor (BDNF) protein levels and panic disorder presents inconsistent findings. This systematic review and meta‐analysis aim to synthesize the available evidence and determine the overall effect of BDNF protein levels in individuals diagnosed with panic disorder. Methods A comprehensive literature search was conducted using electronic databases (PubMed, Embase, Scopus, PsycINFO, and Web of Science) from inception to April 21, 2023. The search strategy included relevant keywords and medical subject headings terms related to BDNF, panic disorder, and protein levels. A random‐effects model was used for the meta‐analysis, and subgroup analyses were performed to explore heterogeneity. Publication bias was assessed using funnel plots and statistical tests. Results A total of 12 studies met the inclusion criteria. The meta‐analysis demonstrated a significant decrease in BDNF protein levels in individuals with panic disorder (SMD = −.53, 95% CI: −1.02 to −.04, p

Background: No study has yet to simultaneously compare generalized anxiety disorder (GAD), panic disorder (PD), and social anxiety disorder (SAD) with respect to restingstate functional connectivity (rsFC) and anxiety symptom severity. Methods: We collected articles from PubMed, PsycINFO, and ScienceDirect and subjected articles to seven eligibility criteria to be considered for inclusion. Included articles were screened using the QUADAS-2 to assess article quality. Articles were also subjected to a forest plot, activation likelihood estimation (ALE) meta-analysis, and a multiple regression to measure the effect of anxiety symptom severity and rsFC between conditions. We also subjected our sample to a funnel plot with Egger's test to determine publication bias. Results: Our initial search yielded 1022 studies. After eligibility criteria we retained 30 articles. Quality assessment indicated no major issues with bias or applicability. Our forest plot indicated that all conditions showed a robust effect on anxiety symptom severity when compared with controls. Our ALE meta-analysis showed convergent intranetwork rsFC within the default mode network (DMN) across conditions. Our multiple regression indicated that all conditions exhibited very strong correlations between DMN connectivity and anxiety symptom severity. Funnel plot and Egger's test indicated no presence of publication bias. Limitations: Our sample was limited by the following: No longitudinal data, no specific time series neuroimaging data, some biased demographic data, and the possibility that some studies might have been missed during review. Conclusion: GAD, PD, and SAD appear to exhibit increased intranetwork connectivity in the DMN which correlates with increased severity of anxiety symptoms.

Abstract Background The purpose of this study is to analyze the long terms trends in public attitudes toward the COVID-19 pandemic and compliance with self-quarantine regulations. Methods Repeated cross-sectional studies looking into data collected from nationally representative samples (N = 2568) of the adult population in Israel at five points in time representing the five morbidity waves of the COVID-19 pandemic. This study examined public trust in Israeli health regulations, levels of public panic, feelings of personal worry, and compliance with health regulations, specifically self-quarantine. Results Public trust in health regulations in January 2022 is at an all-time low (25%) compared to the maximum value of nearly 75% measured in March 2020. While reported worry is steadily reducing, the perception of public panic is increasing. In earlier rounds, public compliance with self-quarantine was reported close to 100%; however, it has dropped to 38% by January 2022 when compensation is not assumed. Regression analysis suggests that trust is a major predictor of compliance with health regulations. Conclusions The “fifth wave” of the COVID-19 pandemic brought about an all-time low in public trust in health regulations. The Israeli public, normally a highly compliant one, is showing signs of crumbling conformity.

Panic buying poses significant challenges for individuals and societies. This paper provides a literature review on the process by which a pandemic crisis evolves into panic buying behavior. The review offers a comprehensive perspective on studies related to panic buying and mitigation efforts, categorizing them based on their contributions in three stages: factors influencing panic buying, the process of transforming panic into increased demand and stockpiling, and applicable intervention strategies to mitigate panic situations. The paper introduces the Socio-Economic Framework of Panic (SEFP) to illustrate the interaction between demand and supply during a panic. The review identifies a lack of quantitative models explicitly correlating influencing factors with panic and estimating panic demand. Additionally, it reveals that suggested intervention strategies often lack practical implementation guidelines. Using the SEFP, the importance of considering interventions at various stages is highlighted, ranging from controlling influencing factors and panic demands to overseeing stockpiling and supply-related activities. The paper also identifies research gaps in both qualitative and quantitative modeling, policymaking, and governance.

During infectious disease outbreaks, some infected individuals may spread the disease widely and amplify risks in the community. People whose daily activities bring them in close proximity to many others can unknowingly become superspreaders. The use of contact tracking based on social networks, GPS, or mobile tracking data can help to identify superspreaders and break the chain of transmission. We propose a model that aims at providing insight into risk factors of superspreading events. Here, we use a social force model to estimate the superspreading potential of individuals walking in a bidirectional corridor. First, we applied the model to identify parameters that favor exposure to an infectious person in scattered crowds. We find that low walking speed and high body mass both increase the expected number of close exposures. Panic events exacerbate the risks while social distancing reduces both the number and duration of close encounters. Further, in dense crowds, pedestrians interact more and cannot easily maintain the social distance between them. The number of exposures increases with the density of person in the corridor. The study of movements reveals that individuals walking toward the center of the corridor tend to rotate and zigzag more than those walking along the edges, and thus have higher risks of superspreading. The corridor model can be applied to designing risk reduction measures for specific high volume venues, including transit stations, stadiums, and schools.

The Covid-19 pandemic has caused widespread concern and apprehension among individuals globally, including those residing in Indonesia. This infectious disease primarily affects the respiratory system. This investigation uses psychopragmatic analysis to analyze various types of discourse that may contribute to the propagation of Covid-19 or coronavirus. Specifically, the study will focus on panic and anxiety speech, which are influenced by the speaker's psychological state. The theoretical framework employed in this research is based on Capano (2013). The utilized research methodology is founded on Sudaryanto's (2015) perspective, employing a distribution approach. The findings of this research indicate that a speaker's psychology can impact the development of Covid-19 in other speakers, as evidenced by the influence of panic and anxiety speech. This phenomenon arises from the experience of panic and anxiety, resulting in an excessive manifestation of fear and anxiety. Abstrak Pandemi Covid-19 telah menimbulkan kekhawatiran dan ketakutan yang meluas di kalangan individu secara global, termasuk mereka yang berada di Indonesia. Penyakit menular ini terutama memengaruhi sistem pernapasan. Investigasi ini bertujuan untuk menganalisis berbagai jenis wacana yang dapat berkontribusi pada penyebaran Covid-19 atau virus corona dengan menggunakan analisis psikopragmatik. Secara khusus, penelitian ini akan berfokus pada pidato panik dan kecemasan yang dipengaruhi oleh keadaan psikologis pembicara. Kerangka teori yang digunakan dalam penelitian ini didasarkan pada Capano (2013). Metodologi penelitian yang digunakan didasarkan pada perspektif Sudaryanto (2015), dengan menggunakan pendekatan distribusi. Temuan penelitian ini menunjukkan bahwa psikologi seorang pembicara dapat berdampak pada perkembangan Covid-19 pada pembicara lain, terbukti dengan pengaruh pidato panik dan kecemasan. Fenomena ini muncul dari pengalaman panik dan kecemasan, yang mengakibatkan manifestasi ketakutan dan kecemasan yang berlebihan.

The paper analyses the economic impact that the war in Ukraine has on the Romanian economy and the way citizens have acted when faced with a high rise in product prices. By exploring people’s behaviour, the essay finds that people did not only exhibit normally expected reactions, such as decreasing private consumption, but their actions were influenced by the ample spread of fake news and led to mass panic, queuing and buying large quantities of certain products which were erroneously believed to experience a sudden and sharp increase in price. The paper then examines potential aspects explaining why Romanians become victims of price-related disinformation, such as historical aspects, past experiences, their media diet, low trust in institutions, and the malign narratives circulating in Romania’s informational space.

This paper delves into the notion of emergency situations, alongside the human behavioral responses associated with these events. It unravels the significance of psychological elements and human conduct in emergencies, as these factors are pivotal in ensuring preparedness for mindful, resolute, and assertive responses during crisis scenarios.

BackgroundOn February 26, 2020, the first case of coronavirus disease 2019 (COVID-19) was detected in Israel. The Ministry of Health (MoH) instructed people to take isolation measures and restrict their movement. Similarly, there was a gradual decrease in the number of visits to our emergency department (ED). ObjectivesTo describe the decline in the referrals to the ED and in-hospital beds occupancy during the COVID-19 pandemic and to compare it to the H1N1 2009 pandemic. MethodsEmploying a cross-sectional epidemiologic study, the pattern of visits to the ED during the COVID-19 was compared with the pattern of visits during the 2009 H1N1 pandemic, as well as a year without a pandemic. The data was adjusted to consider changes in population size. The Welch t test for unpaired, unequal samples was used to analyze the data. ResultsWithin 2 months of the COVID-19 outbreak, the average number of visits to the ED dropped by 30.2% and the hospital occupancy by 29.2% (a minimum of 57%), compared to the same period, the year before. In comparison to the same period during the H1N1 outbreak, we witnessed a significant decline in the number of visits to the ED during the COVID-19 outbreak. ConclusionThe behavior of people during the COVID-19 pandemic was different from their behavior during the H1N1 pandemic. People seemed to avoid visiting the ED. The boundary between precaution and panic in the generation of the media could be very thin. Decision-makers must take this into account.

This paper examines the convergence of carbon dioxide (CO2) emissions in OECD countries. Specifically, we are interested in examining to what extent the per capita emissions of different countries tend to draw closer over time. This issue is important since this question is associated with fairness regarding the distribution of per capita emissions. In this context, we examine the stochastic convergence of per capita carbon dioxide emissions for 30 OECD countries from 1960 to 2018. We adopt a newly developed test by Payne et al. (2022), which allows for two structural breaks and cross-correlations in a factor structure. Our results accounting for breaks and factors jointly show that per capita CO2 emissions do not converge, implying that the differences in CO2 emissions exist and are persistent.

Introduction: The COVID-19 pandemic is an unprecedented and unique fallout worldwide and creates colossal disruption in human survival. During the pandemic, social networking sites (SNS) played a significant role in disseminating news related to the pandemic. Methods: This research is based on primary data collected from 400 successful respondents via online Google Form. Bivariate Pearson's Chi-square and multivariate binary logistic regression analysis were performed to determine the impact of the explanatory variables on the study variables. Results: This study reveals that most respondents (n = 360, 90 %) use SNS to get up-to-date news, and 72.5 % (n = 290) read health-related information. The highest number of participants (n = 386, 96.5 %) were Facebook users. Multivariate binary logistic regression reveals that “reading news on SNS” and “sharing information related to COVID-19 on social media” significantly influence the spread of awareness of COVID-19. “Unauthentic news sources” and “stop using social media to stay away from panic” also have a substantial impact on the spread of panic during the COVID-19 pandemic. Conclusion: SNS has become an inevitable medium of information carrier nowadays. Social media users are found significantly aware of the COVID-19 pandemic. The findings of this study might assist the concerned persons in taking the necessary steps to propagate authentic news and regulate appropriate policies to prevent spreading misinformation.

Panic disorder (PD) is unique among anxiety disorders in that the emotional symptoms (e.g., fear and anxiety) associated with panic are strongly linked to body sensations indicative of threats to physiological homeostasis. For example, panic attacks often present with feelings of suffocation that evoke hyperventilation, breathlessness, or air hunger. Due to the somatic underpinnings of PD, a major focus has been placed on interoceptive signaling and it is recognized that dysfunctional body-to-brain communication pathways promote the initiation and maintenance of PD symptomatology. While body-to-brain signaling can occur via several pathways, immune and humoral pathways play an important role in communicating bodily physiological state to the brain. Accumulating evidence suggests that neuroimmune mediators play a role in fear and panic-associated disorders, although this has not been systematically investigated. Currently, our understanding of the role of immune mechanisms in the etiology and maintenance of PD remains limited. In the current review, we attempt to summarize findings that support a role of immune dysregulation in PD symptomology. We compile evidence from human studies and panic-relevant rodent paradigms that indicate a role of systemic and brain immune signaling in the regulation of fear and panic-relevant behavior and physiology. Specifically, we discuss how immune signaling can contribute to maladaptive body-to-brain communication and conditioned fear that are relevant to spontaneous and conditioned symptoms of PD and identify putative avenues warranting future investigation.

Background: COVID-19 pandemic is one of the rarest health crises the world has ever encountered. As mental health professionals; we need to consider the psychological impact of the pandemic. There are certain groups of people that are largely more vulnerable to pernicious effects on mental health including frontline healthcare workers. Hence, the current study was undertaken look into the minds of our covid warriors. Aims and Objectives: This study aims to assess psychological impact of COVID-19 pandemic among health care professionals, with the primary objectives being to study: 1. Perceived stress regarding COVID-19 pandemic among health care professionals. 2. Stigma associated with the pandemic, faced by health care professionals in their surroundings as well as in the society. 3. Obsessive-Compulsive symptoms among the health care professionals. The secondary objective of the study is to compare between High and Low exposure groups on the basis of different variables. Materials and Methods: This study is an observational, cross-sectional study wherein the sample size is 410, taken by consequent sampling. Data was collected from health care professionals all over India, by manual or digital interview. Health care professionals of a tertiary care hospital were taken up for the study including doctors, nurses and other hospital staff. Results: On K10 scale, 369 (90%) of the subjects had scores below 25, meaning they reported to have no or mild perceived stress, whereas 41 of them (10%) had scores 25 or above, meaning to have moderate or severe perceived stress. Forty (9.8%) subjects reported to be experiencing panic symptoms at the time of the interview. One hundred twenty-eight (31.2%) admitted to have faced stigma from the society in at least one of the facets of the questionnaire based on SARI stigma scale. 39 people (9.5%) reported to be experiencing OC symptoms at the time of interview. Conclusion: With this research we conclude that owing to the ongoing COVID-19 pandemic, the health care professionals are under a lot of stress, many of them have also experienced panic like symptoms. Large scale screenings should be carried out at regular intervals at hospitals to keep a check on the mental health of health care workers. Mental health should be given a priority by the government officials and sufficient awareness campaigns should be rolled out.

Introduction: Social media platforms play an important role in the dissemination of information on the COVID-19 pandemic. Fake news had spread more rapidly on social media during the pandemic. Frequent exposure to fake news on coronavirus disease in social media creates panic and affects people's mental health. Aim: This study aims to assess the effect of social media on spreading panic over COVID–19 among dental students in Nellore city of Andhra Pradesh. Methodology: A descriptive cross-sectional study was conducted over a period of 1 month on 534 dental students of Nellore city of Andhra Pradesh. A specially designed and validated 20-item questionnaire was used to collect the data. SPSS version 21.0 was used for the statistical analysis. The Chi-square test used for categorical data. P < 0.05 was considered statistically significant. Results: Majority of the subjects used Instagram (50.3%) and Whatsapp (79.4%) to obtain and share information related to COVID-19 respectively. There was statistically significant association between the BDS and MDS dental students' responses on the questions relating to panic created over COVID-19 in social media. 54.2% of subjects felt that filters need to be set up for social media during a humanitarian crisis. Conclusion: The study concluded that the panic created in social media over COVID-19 had an impact on dental students.

Although some studies recently address the association between COVID-19 sentiment and returns, volatility, or stock trading volume, no one conducts an analysis to measure the impact of investor rationality or irrationality on the influence on countries and sectors’ returns. This work creates a text media sentiment and combines its influence with the outbreak cases on the stock market sector returns of the US, Europe, and their main countries most affected by the pandemic. This allows us to perceive the ranking impact of rationality or irrationality on country and sector stock returns. This work applies a random-effects robust panel estimation, with an M-estimator. This paper concludes that US returns are more sensitive to sentiment, and thus more prone to irrational factors than confirmed cases compared to Europe and that country factors influence the returns differently. In Italy and Spain as the most punished countries in Europe apart from the UK, present sector indexes return more reactive to verified cases, or rationality, namely, tourism, real estate, and the automobile (this last one in Italy). The importance of this work resides in providing a new in-depth analysis of irrational behavioral metrics among countries, which allows for comparison. Moreover, it allows observing which sectors’ and which countries’ asset returns are most sensitive to rational or irrational expressions of events, allowing for arbitraging, financial planning for investors, decision-makers, and academia on an in and out of pandemic context. AcknowledgmentThis work is funded by National Funds through the FCT – Foundation for Science and Technology, I.P., within the scope of the project Refª UIDB/05583/2020. Furthermore, we would like to thank the Research Centre in Digital Services (CISeD) and the Polytechnic Institute of Viseu for their support.

As a result of the spread of infection with the new Coronavirus (COVID-19) throughout the world, the social impact can create more problems than the virus itself. The outbreak of panic is the essential element in the spate of problems. Disruptions in international trade, availability of resources and goods lead to disruptions in international relations. COVID-19 demonstrated the limitations of political systems in addressing such outbreaks.

The scientific community has a sustained history of issuing warnings to society’s leaders and policy-makers. In such cases, scientists take on the task of alerting those in power to issues they may not notice or not wish to see. A distinctive thing about environmental warnings authored by leading scientists is that they are addressed to “humanity.” This paper argues that attempts to “speak truth to humanity”—despite the undoubted quality of the data and analyses—face three sorts of problem. There is firstly the difficulty that humanity is not a unified entity in the way that is often assumed and that, in practice, citizens may not be in a position to act in the way that is presupposed by those who issues the warnings. Secondly, though the declaration of a climate emergency may appear to be a desirable corollary of speaking truth to humanity, there are good reasons from political science to think that such declarations will be made for messier and complex reasons. Finally, even the more technical aspects of the warning documents may contain normative or social scientific components; they are not exclusively technical. Together these points argue for the engagement of humanities and socials sciences scholars in future attempts to offer compressive, integrated warnings to humankind.

Background and Objective: Anxiety disorders are one of the most common childhood disorders. Researchers are trying to identify the factors that contribute to the development of children's anxiety disorders. One of the most recently highlighted issues is the role of emotion regulation in anxiety disorders. The purpose of this study was to investigate the prevalence of anxiety disorders in first grade students and its relationship with emotional dysregulation. Materials and Methods: The research method is descriptive-correlational. The population of the study consisted of all male and female students of first grade students in Malayer which was selected as a cluster sample of 498 people. The research instruments were Spence anxiety disorder, an emotional regulation checklist, and a structured clinical interview for axis I disorders (SCID-I). Results: According to the results of the Spence anxiety disorder questionnaire, 26% of the first grade students had at least one anxiety disorder. In a clinical interview, 22.1% of the cases were diagnosed with anxiety disorders. There was also a significant relationship between emotional dysregulation and anxiety problems in children (P

BackgroundCoronavirus Disease-19 (COVID-19), a rising global pandemic, has triggered psychological crises among the public. Panic, a severe symptom of mental disorders, is increasing in the public in China and it is urgent to provide research for intervention development.ObjectivesThis study aimed to assess the prevalence of public panic in China during the earliest stage of the COVID-19 pandemic and to explore the associated psychological behavioral responses and public's risk perception of the pandemic.MethodsA cross-sectional study using a web-based survey with convenience sampling was conducted with 2,484 participants nationally from February 11 to February 24, 2020 in China. A self-developed questionnaire was applied to assess the prevalence of public panic and its associated factors. Multivariable logistic regression analysis was applied to assess the risk and protective factors of public panic.ResultsThere were 23.39% (581/2,484) of the participants who reported experiencing panic during the earliest stage of the COVID-19 pandemic. Taking temperature repeatedly, being nervous in a crowd, being suspicious of infection in the family, being worried about the future, and worries about high infectivity of the COVID-19, lack of effective therapies, and wide impact of the COVID-19 pandemic increased the odds of public panic. Whereas, avoiding gatherings during holidays was negatively associated with the odds of public panic.ConclusionsPsycho-behavioral responses were closely associated with public panic during the earliest stage of the COVID-19 pandemic in China. Defusing excessive health-related worries, the guidance of appropriate self-protective behaviors, strengthening of health education in communities, and available treatment for mental disorders should be adopted to monitor the psychological responses and to guide the behaviors of the public.

Anxiety and stress-related disorders are both common and disabling psychiatric conditions. There are a number of hypotheses suggesting the underlying pathophysiology of these disorders, however, the exact mechanism is unknown. Inflammation has previously been linked with depression and has more recently been suggested as a possible link to anxiety aetiology. The objectives of this study are to assess the relationship between different anxiety/stress-related disorders and inflammation (measured by C-reactive protein) using the UK Biobank, and also determine whether any relationship between anxiety/stress disorders and inflammation is explained by depressive symptoms and other social and health-related factors. We utilised the UK Biobank for the sample of this study. Our sample included 353,136 participants of which 12,759 (3.61%) had a history of an anxiety (phobic, obsessive-compulsive, or other anxiety disorder including generalised anxiety and panic disorders) or stress-related disorder (including acute stress reaction, post-traumatic stress disorder and adjustment disorders). Four logistic regression models were calculated in which we tested the association between anxiety/stress disorders and C-reactive protein (CRP) >3 ​mg/L, adjusting for covariates (including age, sex, ethnicity, education level, socioeconomic deprivation, depressive symptoms, body mass index (BMI) and multimorbidity). An association was observed between other anxiety disorders (including panic and generalised anxiety disorders) and CRP (OR: 1.164 [95% CI: 1.096–1.236]). This was attenuated in models after the addition of BMI, multimorbidity and depressive symptoms. Stress/adjustment disorders followed a similar pattern of results (OR: 1.107 [95% CI: 1.040, 1.178]), with the association attenuated with the addition of BMI and multimorbidity). Phobic anxiety disorders (OR: 1.059 [95% CI: 0.896, 1.251]) and obsessive-compulsive disorders (OR: 1.299 [95% CI: 0.973, 1.733]) both showed no statistically significant results in any of the models. Our results support the hypothesis that some anxiety and stress-related disorders may be associated with high levels of inflammatory markers, as measured by CRP. Further studies are required to untangle the potential causal relationships involved.

Panic buying is a common phenomenon that occurs during public emergencies and has a significant undesirable impact on society. This research explored the effect of scarcity on panic buying and the role of perceived control and panic in this effect through big data, an online survey and behavior experiments in a real public emergency (i.e., COVID-19) and simulative public emergencies. The findings showed that scarcity aggravates panic buying (Studies 1–3), and this aggravation effect is serially mediated by perceived control and panic (Studies 2–3). Moreover, this serial mediation model is more suitable for public health emergencies (Study 3). These findings enrich the understanding of panic buying and provide important enlightenment for guiding rational public behavior and managing public opinion during public emergencies.

Objectives: Sweating, hot flushes, and blushing are symptoms frequently reported by individuals with anxiety disorders. They represent important reinforcers of anxiogenic cognitions and behaviours. One system that may be involved in the manifestation of these symptoms is the thermosensory/thermoregulatory system. The aim of the present study was to investigate to what extent individuals with anxiety disorders are characterised by alterations in this system.Methods: PubMed and PsycINFO were systematically searched. Studies were eligible if they (i) assessed individuals with anxiety disorders, (ii) thermosensation or thermoregulatory effectors/outcomes, and (iii) used a case-control design.Results:N = 86 studies were identified. There was no evidence of altered thermosensation in individuals with anxiety disorders. Regarding thermoregulatory effectors, individuals with social anxiety disorder exhibited altered cutaneous vasodilation upon pharmacological challenge; individuals with specific phobia showed increased sweating upon confrontation with phobic stimuli; individuals with panic disorder showed increased daily sweating as well as increased sweating in response to non-phobic and phobic stimuli. Regarding thermoregulatory outcomes, there was evidence for altered skin temperature in all subtypes of anxiety.Conclusion: Whereas there was no evidence of altered thermoregulation in specific phobia, a subgroup of individuals with social anxiety and panic disorder appears to exhibit altered vasodilation and sweating, respectively. Longitudinal research is warranted to investigate whether this represents a vulnerability to anxiety/panic.

The present study examines the relationship between smoking and panic, depression, and anxiety over time and across two cultures, using data from the BOOM studies. The relationship between smoking and anxiety disorders, including panic requires further exploration, in order to reconcile inconsistent, contradictory findings and cross-cultural differences. Participants in the present study included 5,416 Chinese university students and 282 German university students. Participants completed surveys assessing smoking, panic, depression, and anxiety. Multiple logistic regressions were used to examine predict later mental health from smoking, as well as later smoking from mental health. In sum, across the regressions, smoking at baseline did not predict higher panic or depression at follow-up in either German or Chinese students. It did predict lower anxiety in German students. Anxiety at baseline, but not depression, predicted increased likelihood of smoking at follow-up in German students. The relationship between smoking and anxiety disorders is one that will require further exploration, in order to reconcile inconsistent, contradictory findings and cross-cultural differences. The present data point to a relationship between anxiety and later smoking, and also to a negative, though small, relationship between smoking and later anxiety in German students, and no prospective relationship in either direction in Chinese students.

Escape from threats has paramount importance for survival. However, it is unknown if a single circuit controls escape vigor from innate and conditioned threats. Cholecystokinin (cck)-expressing cells in the hypothalamic dorsal premammillary nucleus (PMd) are necessary for initiating escape from innate threats via a projection to the dorsolateral periaqueductal gray (dlPAG). We now show that in mice PMd-cck cells are activated during escape, but not other defensive behaviors. PMd-cck ensemble activity can also predict future escape. Furthermore, PMd inhibition decreases escape speed from both innate and conditioned threats. Inhibition of the PMd-cck projection to the dlPAG also decreased escape speed. Intriguingly, PMd-cck and dlPAG activity in mice showed higher mutual information during exposure to innate and conditioned threats. In parallel, human functional magnetic resonance imaging data show that a posterior hypothalamic-to-dlPAG pathway increased activity during exposure to aversive images, indicating that a similar pathway may possibly have a related role in humans. Our data identify the PMd-dlPAG circuit as a central node, controlling escape vigor elicited by both innate and conditioned threats.

Daniela Caldirola1,2, Giampaolo Perna1–41Humanitas University, 20090 Pieve Emanuele, Milan, Italy; 2Department of Clinical Neurosciences, Hermanas Hospitalarias, Villa San Benedetto Menni Hospital, 22032 Albese Con Cassano, Como, Italy; 3Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6200 Maastricht, The Netherlands; 4Department of Psychiatry and Behavioral Sciences, Leonard Miller School of Medicine, Miami University, Miami, FL 33136 -1015, USAAbstract: Although several treatment options for panic disorder (PD) are available, the best intervention for each individual patient remains uncertain and the use of a more personalized therapeutic approach in PD is required. In clinical practice, clinicians combine general scientific information and personal experience in the decision-making process to choose a tailored treatment for each patient. In this sense, clinicians already use a somehow personalized medicine strategy. However, the influence of their interpretative personal models may lead to bias related to personal convictions, not sufficiently grounded on scientific evidence. Hence, an effort to give some advice based on the science of personalized medicine could have positive effects on clinicians’ decisions. Based on a narrative review of meta-analyses, systematic reviews, and experimental studies, we proposed a first-step attempt of evidence-based personalized therapy for PD. We focused on some phenomenological profiles, encompassing symptoms during/outside panic attacks, related patterns of physiological functions, and some aspects of physical health, which might be worth considering when developing treatment plans for patients with PD. We considered respiratory, cardiac, vestibular, and derealization/depersonalization profiles, with related implications for treatment. Given the extensiveness of the topic, we considered only medications and some somatic interventions. Our proposal should be considered neither exhaustive nor conclusive, as it is meant as a very preliminary step toward a future, robust evidence-based personalized therapy for PD. Clearly much more work is needed to achieve this goal, and recent technological advances, such as wearable devices, big data platforms, and the application of machine learning techniques, may help obtain reliable findings. We believe that combining the efforts of different research groups in this work in progress can lead to largely shared conclusions in the near future.Keywords: pharmacotherapy, somatic, evidence-based, panic

This paper provides an account of three artists’ exploration, together with a psychotherapist, of the ways in which they are engaging with the irreversible harm of the Capitalocene and its palpable manifestations within the body, as part of the world. Through polyvocality and poly-positionality, as well as being taken through the performance itself, this paper traces the development and presentation of the artwork Rupture, an interdisciplinary and collaborative work which brought together photo, video and sound artist Jessie Boylan, researcher, writer and performer Virginia Barratt, digital media artist Linda Dement and trauma-informed psychotherapist Jenna Tuke. Their collaboration and conversation, included in this account, inhabit how anxiety, as a warning system, is constantly triggered—not just at a bodily level, but also at a social and global ecological level—by daily messages of danger and catastrophe. Yet, by seeing anxiety’s capacity as a productive force, the authors ask : can we work together with the dead and dying, can we hold the pain of the earth/body and reconfigure the traumas beneath the surface to move us on from stasis ? Locating the work at the beginning of Australia’s worst-ever fire season, in late 2019, this paper provides the artists’ reflections on the process of making-with our catastrophic times.

Often we have to decide on difficult problems and conflicts. For this, a certain level of moral competence is needed, in order to solve them as quickly and adequately as possible. Otherwise these problems and conflicts can overwhelm us, triggering a feeling of fear and panic, and making us react too slowly or inadequately, or both. Fear and panic can make us ignore problems and conflicts, attempt to “solve” them through brute force or deceit, or declare them to be beyond our responsibility and let an authority decide what to do. Often such makeshift solutions seem to work, but, more often, they have damaging effects. Therefore, society tries to curb criminal and anti-democratic activities through coercion, that is, through laws, law-enforcing institutions, and correction facilities – at high costs, and often with little efficacy. In this article I show that such coercion would not be needed if we gave all citizens an opportunity to develop their ability to solve conflicts and problems through thinking and discus-sion. Moral competence would immunize us against fear and panic, and thus also against immoral practices. Moral competence is not inborn in us, and it does not develop unless it is fostered through proper learning opportunities. Therefore, if we want to live together peace¬fully in a democratic society, we need to provide proper learning opportunities for everyone, not only of a few people. If the masses are infected by panic, a few rational people cannot stop this pandemic.

The present study investigated the (i) socio-demographic predictors of psychological distress, (ii) socio-demographic predictors of satisfaction from online classes, and (iii) the relationship between psychological distress and satisfaction from online classes among university students of Pakistan during the COVID-19 pandemic. An online questionnaire-based survey was conducted. A total of 2220 respondents that was enrolled at the University of the Punjab (PU), University of Management and Technology (UMT), and the University of Central Punjab (UCP) were involved in the current study. Data were collected at a 64% response rate and analyzed with SPSS IBM Version 21.0. Results revealed that approximately 41% of the students were facing severe psychological distress while about 65% were found unsatisfied with online classes. Besides, a linear negative relationship between the independent variable, i.e. psychological distress and the dependent variable, i.e. satisfaction from online classes was found. Therefore, to minimize the level of psychological distress and increase students’ satisfaction with online classes it is highly recommended to take precautionary measures by the relevant stakeholders.

The coronavirus disease 2019 (COVID-19) pandemic has been regarded as a public health emergency that caused a considerable degree of public panic (such as anxiety and insomnia) during its early stage. Some irrational behaviors (such as excessive search for information related to the pandemic and excessive hoarding of supplies) were also triggered as a result of such panic. Although there has been plenty of news coverage on public panic due to the outbreak, research on this phenomenon has been limited. Since panic is the main psychological reaction in the early stage of the pandemic, which largely determines the level of psychological adaptation, time of psychological recovery, and the incidence of PTSD, there exists a demand to conduct investigation on it. From a public governance perspective, the government’s assessment of public panic may affect the efficiency and effectiveness of pandemic prevention and control. Therefore, it is of obvious practical significance to investigate public panic during the COVID-19 pandemic and analyze its influential factors. The self-compiled COVID-19 Social Mentality Questionnaire was used to collect data from a total of 16,616 participants online, and 13,511 valid responses were received. The results from the chi-square test showed that there were differences in gender, educational level, age, pandemic-related knowledge, self-efficacy, risk level, and objective social support. Furthermore, multiple linear regression analysis results showed that self-efficacy, gender, educational level, age, risk level, pandemic-related knowledge, and objective social support were significant predictors of public panic. Among the research variables, self-efficacy, gender, educational level, and age were negative predictors of panic while risk level, pandemic-related knowledge, and objective social support were positive predictors of panic.

Test anxiety refers to the tendency to appraise tests and test-like situations, where performance is evaluated, as threatening and respond with high levels of state anxiety. High levels of test anxiety are associated with lower performance on test and examinations, and may also meet diagnostic criteria for clinical anxiety. In this paper we review: (i), the importance of the test anxiety construct and consider whether test anxiety may constitute a risk factor for clinical anxiety, (ii), the theoretical antecedents of test anxiety, with a specific focus on the Self-Regulatory Executive Function (S-REF) Processing Model, and (iii), interventions for test anxiety in adolescents, with a specific focus on one cognitive-behavioural intervention, Strategies to Tackle Exam Pressure and Stress (STEPS). We bring the review to a close with a consideration of what the next steps might fruitfully be for research, theory, and intervention, and conclude there is much work still yet to be done in the field of test anxiety.

Anxiety disorders are the most prevalent psychiatric disorders and a leading cause of disability. While there continues to be expansive research in posttraumatic stress disorder (PTSD), depression and schizophrenia, there is a relative dearth of novel medications under investigation for anxiety disorders. This review's first aim is to summarize current pharmacological treatments (both approved and off-label) for panic disorder (PD), generalized anxiety disorder (GAD), social anxiety disorder (SAD), and specific phobias (SP), including selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), azapirones (e.g., buspirone), mixed antidepressants (e.g., mirtazapine), antipsychotics, antihistamines (e.g., hydroxyzine), alpha- and beta-adrenergic medications (e.g., propranolol, clonidine), and GABAergic medications (benzodiazepines, pregabalin, and gabapentin). Posttraumatic stress disorder and obsessive-compulsive disorder are excluded from this review. Second, we will review novel pharmacotherapeutic agents under investigation for the treatment of anxiety disorders in adults. The pathways and neurotransmitters reviewed include serotonergic agents, glutamate modulators, GABAergic medications, neuropeptides, neurosteroids, alpha- and beta-adrenergic agents, cannabinoids, and natural remedies. The outcome of the review reveals a lack of randomized double-blind placebo- controlled trials for anxiety disorders and few studies comparing novel treatments to existing anxiolytic agents. Although there are some recent randomized controlled trials for novel agents including neuropeptides, glutamatergic agents (such as ketamine and d-cycloserine), and cannabinoids (including cannabidiol) primarily in GAD or SAD, these trials have largely been negative, with only some promise for kava and PH94B (an inhaled neurosteroid). Overall, the progression of current and future psychopharmacology research in anxiety disorders suggests that there needs to be further expansion in research of these novel pathways and larger-scale studies of promising agents with positive results from smaller trials.

Fire is the closest disaster to us, a person who put cigarettes around flammable objects could burn one to dozens of houses. The last thing that happens was a mass panic. In this kind of situation, panic is one of the keys to determine how much probability someone will survive. However, detecting someone's panic during a fire is impossible. This leads some scientists to assume that mass panic was never happening and some studies use simple functions to determine someone when panic. Currently, thanks to technological advances we can easily build virtual worlds that resemble real events. To build a virtual world that could evoke panic we still need the right stimulus. In this paper, we will discuss with terms of fire disaster stimulus that possible to impel someone to feel panic. While some stimulus datasets that already exist have more broad categories, we wanted to focus on a specific problem. The determined parameters are considered through several elements that could cause a person to panic, either before or during a fire. By using the Self-Assessment Manikin system to obtain valance and arousal matrix, we conduct a test to see how much influence the fire categories stimulus provided.

Abstract Background Anxiety disorders are common, yet treatment options in general practice are often limited to medication or CBT. There is a lack of evidence for the effectiveness of exercise in the treatment of anxiety in patients who present to general practice and also about the intensity of exercise required to lead to improvement. The aim of this systematic review was to assess the use of exercise versus waiting list control groups in the treatment of anxiety and also to assess the benefit of high intensity exercise vs low intensity exercise. Long term follow up scores were also analysed. We included patients who met diagnostic criteria for anxiety disorders or had clinically raised anxiety levels on a validated rating scale and performed a subgroup analysis of the outcomes between the two groups. The intervention was any aerobic exercise programme carried out for at least two weeks, or exercise carried out at high intensity for at least two weeks. The comparison groups were either a waiting list control group or low intensity exercise. Method Systematic review of randomised controlled trials. Three databases were searched; CENTRAL, Medline and Embase. Outcome assessment was based on validated anxiety rating scales. The quality of the studies was appraised according to the Cochrane Risk of Bias tool. Effect sizes were calculated using the standardised mean difference. Results Fifteen studies were identified with a total of 675 patients. Nine trials had participants with diagnosed anxiety disorders and six trials had participants with raised anxiety on a validated rating scale. Aerobic exercise was effective in the treatment of raised anxiety compared to waiting list control groups (effect size − 0.41, 95% CI = − 0.70 to − 0.12). High intensity exercise programmes showed greater effects than low intensity programmes. There was no significant difference in outcomes between groups of patients with diagnosed anxiety disorders and patients who had raised anxiety on a rating scale. Conclusions were limited by the small number of studies and wide variation in the delivery of exercise interventions. Conclusion Exercise programmes are a viable treatment option for the treatment of anxiety. High intensity exercise regimens were found to be more effective than low intensity regimens. The results have implications for the use of exercise schemes in General Practice.

The “pandemic” has come with “panic” embedded within it. The panic among health care workers is enormous. There is a fear of being infected and carrying the infection home to their children and to the extended family. There is a constant tussle between overcoming these fears and stepping forward to take up responsibilities and duties. The article is a narrative of an ophthalmologist trying to think right and doing what best she can in times of the pandemic.

Individuals with anorexia nervosa (AN) typically display anxious traits prior to the onset of food avoidance and weight loss that characterize the disorder. Meal associated anxiety is an especially common clinical feature in these patients, and heightened sensitivity to sympathetically mediated interoceptive sensations has also been observed. However, it remains unclear how heightened interoceptive sensitivity relates to experiences of anxiety before and after meals. To investigate this relationship, we experimentally induced anxiety and panic symptoms with isoproterenol, a peripheral sympathetic agonist similar to adrenaline, across several different conditions: during panic provocation, during anticipation of a 1,000 Calorie meal, and after meal consumption. Fifteen AN and 15 age- and sex-matched healthy comparisons received bolus infusions of isoproterenol and saline in a double-blinded, randomized design. Participants rated anxiety symptoms after each infusion, completed panic rating scales, and traced the location of perceived palpitations on a manikin to index interoceptive “body map” representation. The AN group reported significantly elevated anxiety relative to healthy comparisons during infusions before and after the meal, but surprisingly, not during panic provocation. These symptoms were accompanied by geographical differences in patterns of perceived heartbeat sensations across each condition. In particular, the AN group localized heartbeat sensations disproportionately to the chest during meal related saline infusions, when no cardiorespiratory modulation actually occurred. The AN group also showed a trend toward higher panic attack rates during the meal anticipation period. Correcting for anxiety levels reported during saline infusions abolished group differences in anxiety change across all conditions, suggesting a significant contribution of anxious traits in AN. The observation of meal related “visceral illusions” provides further evidence that AN is associated with abnormal interoceptive representation of the heartbeat and suggests that meal consumption, particularly when anticipated, preferentially alters the processing of interoception related signals in AN.

Introduction: Panic Disorder (PD) is characterised by sudden episodic attacks of anxiety that are extremely disabling for the patients. It is usually associated with agoraphobia and several other psychiatric comorbid disorders. These not only tend to escalate the severity of primary illness however, also worsen the long term prognosis. An association has also been noticed between presence of stress and severity of PD. In the current study we have tried to include as many factors as possible that affect common and disabling illness like PD. Aim: To compare the severity of illness in the patients of PD with and without agoraphobia, and to further find the association, if any, of psychiatric comorbidities and stress on the severity of symptoms in these two groups. Materials and Methods: A cross-sectional observational study was carried out in a tertiary care psychiatry centre, from November 2013 to January 2015. Patients between 18 and 65 years with PD were divided into two groups PD (Panic Disorder without Agoraphobia) and PDAG (Panic Disorder with Agoraphobia) which were compared for difference in severity of anxiety {Panic Disorder Severity Scale (PDSS) and Hamilton Rating Scale for Anxiety (HAM-A) were used}, presence of comorbidity and stress, and their effect on severity of symptoms. SPSS 22.0 was used for all statistical analyses. Continuous variables were presented on mean, Standard Deviation (SD) or median if data is unevenly distributed. Categorical variables were expressed as frequencies and percentages. The comparison of normally distributed continuous variables between groups has been performed using ANOVA. Nominal categorical data between groups were compared using chi-squared test or fisher’s exact test as appropriate. Non-normal distribution continuous variables have been compared using Kruskal-Wallis test. For all statistical tests a p-value of less than 0.05 has been taken to indicate significant difference. Results: Mean PDSS and HAM-A scores were higher in PDAG group (21.30±3.46 and 23.37±2.91) than in PD group (13.50±4.1 and 18.50±5.070). 43 (71.67%) of the total patients (60) suffered from another psychiatric disorder. Comorbidity was higher in PDAG group with more than 83.3% (n=25) suffering from another mental health condition apart from PD. Depression was the most common comorbidity while Generalised Anxiety Disorder (GAD), alcohol use disorder and Obsessive Compulsive Disorder (OCD) were others. Almost all individuals reported, some stress rated on Perceived Stress Scale (PSS). In individuals experiencing stress, panic and anxiety symptoms were found to be more severe. Conclusion: There was significant difference in the two groups in terms of severity of symptoms as measured on corresponding scale for PD (PDSS score of 21.3 in PDAG, 13.5 in PD group; p=0.035), presence of comorbidity (83.3% in PDAG group, 60% in PD group) and stress {all individual in PDAG group (n=30) reported moderate to high stress levels}. Presence of agoraphobia; comorbid psychiatric disorders and stress were associated with more severe illness, increased severity of panic and other anxiety symptoms.

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

It was reported with praise by the worldwide media that victims of the 2011 Great East Japan Earthquake and tsunami disaster endured the aftermath in a civil manner. We analyzed official crime statistics and investigated data that were collected from residents in disaster-stricken areas. Official statistics showed that crime decreased during the disaster period. Collected data suggest that criminal and deviant behavior were extremely rare, and that the victims helped each other, apparently altruistically. Further research on actual behavior in post-disaster environments is necessary in order to sufficiently prepare for future disasters.