Search

Anxiety-related diseases are more than twice as common in women than in men, and in women, symptoms may be exacerbated during the late luteal phase of the menstrual cycle. Despite this, most research into the underlying mechanisms, which drives drug development, have been carried out using male animals. In an effort to redress this imbalance, we compared responses of male and female Wistar rats during exposure to two unconditioned threatening stimuli that evoke panic-related defensive behaviours: confrontation with a predator (Bothrops alternatus) and acute exposure to hypoxia (7% O2 ). Threatened by venomous snake, male and female rats initially displayed defensive attention, risk assessment, and cautious interaction with the snake, progressing to defensive immobility to overt escape. Both males and females displayed higher levels of risk assessment but less interaction with the predator. They also spent more time in the burrow, displaying inhibitory avoidance, and more time engaged in defensive attention, and non-oriented escape behaviour. In females, anxiety-like behaviour was most pronounced in the oestrous and proestrus phases whereas panic-like behaviour was more pronounced during the dioestrus phase, particularly during late dioestrus. Acute hypoxia evoked panic-like behaviour (undirected jumping) in both sexes but in females, responsiveness in late dioestrus was significantly greater than at other stages of the cycle. The results reveal that females respond in a qualitatively similar manner to males during exposure to naturally occurring threatening stimuli, but the responses of females is oestrous cycle dependent with a significant exacerbation of panic-like behaviour in the late dioestrus phase.

The COVID‐19 pandemic may disproportionately impact parents of children with autism spectrum disorder (ASD). Loss of services and supports, heightened fears about increased infection rates, and disruption of daily routines likely adversely affect the well‐being of children with ASD and their families. The goal of this study was to examine differences in psychological distress–as defined by symptoms of anxiety, depression, loneliness, and hyperarousal–between parents raising a child with ASD and parents in the US as a whole during the early stages of the pandemic (March–April 2020). Parents raising a child with ASD (n = 3556) were recruited through SPARK, a national ASD research registry, whereas a representative sample of parents in the US (n = 5506) were recruited from the Pew Research Center's American Trends Panel. All data were captured via online surveys. Descriptive statistics and multivariable logistic regressions examined psychological distress at the item and summary score level. Parents of children with ASD reported higher levels of overall psychological distress (48% vs. 25%; aOR = 1.60, 95% CI: 1.32, 1.84, p

Background and purpose Functional neurological disorder (FND) is common, and symptoms can be severe. There have been no international large-scale studies of patient experiences of FND. Methods A patient questionnaire was created to assess FND patient characteristics, symptom comorbidities and illness perceptions. Respondents were recruited internationally through an open access questionnaire via social media and patient groups over a month-long period. Results In total, 1048 respondents from 16 countries participated. Mean age was 42 years (86% female). Median FND symptom duration was 5 years, and median time from first symptom to diagnosis was 2 years. Mean number of current symptoms (core FND and associated) was 9.9. Many respondents had associated symptoms, for example fatigue (93%), memory difficulties (80%) and headache (70%). Self-reported psychiatric comorbidities were relatively common (depression, 43%; anxiety, 51%; panic, 20%; and post-traumatic stress disorder, 22%). Most respondents reported that FND had multiple causes, including physical and psychological. Conclusions This large survey adds further evidence that people with FND typically have high levels of multiple symptom comorbidity with resultant distress. It also supports the notion that associated physical symptoms are of particular clinical significance in FND patients. Dualistic ideas of FND were not supported by respondents, who generally preferred to conceptualize the disorder as one at the interface of mind and brain. The need for a broad approach to this poorly served patient group is highlighted. Potential selection and response biases due to distribution of the survey online, mostly via FND patient groups, are a key limitation.

The worldwide spread of COVID‐19 has resulted in an enormous threat to public health, causing global panic, especially older adults suffering severe anxiety due to their vulnerability. With a questionnaire survey on 213 Chinese older adults in April 2020, we examined the role of community resilience in protecting older adults from anxiety during the COVID‐19 pandemic, and simultaneously considered the moderating role of trust in local government. The results indicated that community resilience was negatively associated with older adults' anxiety, and this association was weakened for older adults with low trust in local government. This study has implications for intervention designs that combine resilient factors related to communities and local governments to relieve older adults' anxiety during the pandemic. Please refer to the Supplementary Material section to find this article's Community and Social Impact Statement.

This paper attempts to read the psychological and emotional impact of the COVID-19 pandemic through the archetypal images contained in patients' dreams. In these dreams, symbols related to the power of nature and to extreme danger are paired with feelings of detachment that seem to point to a traumatic dissociation, due to the archetypal experience that erupts in familiar surroundings. Through the humanization of the ineffable experience, dissociation, which in the beginning of the pandemic showed in high levels of anxiety, panic attacks and depersonalization, can be transformed into the overview needed for the search for meaning. The container for this process of transformation is the analyst, the real, virtual or imagined one, and his or her ability to relate and feel.Cet article propose une lecture de l’impact psychologique et émotionnel de la pandémie de COVID-19 à travers les images archétypales contenues dans les rêves des patients. Dans ces rêves, des symboles en lien avec la puissance de la nature et le danger extrême sont accompagnés de sentiments de détachement qui semblent indiquer une dissociation traumatique, due à l'expérience archétypale qui fait irruption dans des lieux familiers. Par l’humanisation de cette expérience ineffable, la dissociation - qui se montrait au début de la pandémie par de hauts niveaux d’anxiété, des attaques de panique et de la dépersonnalisation - peut se transformer en capacité à avoir une vue d’ensemble, qui est nécessaire à la quête de sens. Le contenant pour ce processus de transformation est l’analyste, réel, virtuel ou imaginé, et sa capacité à être en lien et à ressentir.In diesem Artikel wird versucht, die psychologischen und emotionalen Auswirkungen der COVID-19-Pandemie anhand der archetypischen Bilder zu erfassen, die in den Träumen der Patienten enthalten sind. In diesen Träumen werden Symbole, die sich auf die Kraft der Natur und auf extreme Gefahren beziehen mit Gefühlen der Distanzierung verbunden, die aufgrund der archetypischen Erfahrung, die in einer vertrauten Umgebung ausbricht, auf eine traumatische Dissoziation hinweisen. Durch die Humanisierung der unbeschreiblichen Erfahrung kann die Dissoziation, die sich zu Beginn der Pandemie in einem hohen Maß an Angst, Panikattacken und Depersonalisierung zeigte, in eine Übersichtlichkeit überführt werden, die für die Suche nach Bedeutung erforderlich ist. Der Container für diesen Transformationsprozeß ist der Analytiker, der reale, virtuelle oder imaginierte, und seine Fähigkeit, in Beziehung zu gehen und zu fühlen.Questo articolo propone una lettura dell'impatto psicologico ed emozionale della pandemia da COVID-19 attraverso le immagini archetipiche contenute nei sogni dei pazienti. In questi sogni, i simboli correlati alle forze della natura e a situazioni di estremo pericolo sono accompagnati da un senso di distacco che sembra indicare una dissociazione traumatica, dovuta all'esperienza archetipica che fa irruzione in luoghi e ambienti familiari. Attraverso l'umanizzazione dell'esperienza ineffabile, la dissociazione, che all'inizio della pandemia si è manifestata con alti livelli di ansia, attacchi di panico e depersonalizzazione, può essere trasformata nella visione d'insieme necessaria alla ricerca di senso. Il "recipiente" di questo processo di trasformazione è l'analista, quello reale, virtuale o immaginario, con la sua capacità di mettersi in relazione e di sentire.В статье представлена попытка определить психологическое и эмоциональное влияние пандемии коронавируса через призму архетипических образов в сновидениях пациентов. Символы, относящиеся к силе природы и экстремальной опасности, сопоставлялись с чувствами отрешенности, которые указывают на травматическую диссоциацию в силу переживания архетипического уровня, которое врывается в знакомую повседневную жизнь. Через очеловечивание невыразимого опыта диссоциация, которая в начале пандемии проявлялась в высоких уровнях тревоги, панических атаках и деперсонализации, может быть трансформирована в поиск смысла. Контейнером для этого процесса трансформации является аналитик, реальный, виртуальный или воображаемый, а также его или ее способность чувствовать и быть в отношениях.El presente trabajo intenta dar cuenta del impacto emocional y psicológico de la pandemia del COVID-19 a través de las imágenes arquetípicas contenidas en los sueños de los pacientes. En estos sueños, símbolos relacionados al poder de la naturaleza y al peligro extremo se combinan con sentimientos de desapego que parecieran indicar una disociación traumática, debido a la experiencia arquetípica que irrumpe en un contexto familiar. A través de la humanización de la experiencia de lo inefable, la disociación, que en el comienzo de la pandemia se expresó a través de altos grados de ansiedad, ataques de pánico y despersonalización, puede ser transformada en la necesidad de una nueva perspectiva en la búsqueda de sentido. El contenedor para este proceso de transformación es el o la analista, real, virtual o imaginado/a, y su habilidad para relacionarse o sentir.疫情的原型 这篇文章尝试通过病人梦境中的原型意象来理解新冠疫情所带来的心理与情感影响。 在这些梦中, 由于那些在日常环境中爆发出的原型性的经验, 那些与自然和特大危险相关的象征伴随着一种似乎指向创伤性分裂的剥离性的感觉, 一起出现。通过这一难以言喻的人性化经验, 那些疫情初期, 以高焦虑呈现的分裂、惊恐发作和人格解体, 可以转化为整体上对意义感探寻对需求。这一转化过程的容器是分析师, 是真实中的, 虚拟的或是想象中的他或她的联结与感受的能力。.

OBJECTIVE To investigate the relationship between anxiety symptoms and factors related to clinical control and quality of life of children with asthma aged 7-12 years. METHODS A cross-sectional comparative study involving children recruited from a reference center for asthma treatment in the city of Natal-RN. Diagnosis, control and severity were performed following GINA recommendations (2019). Sociodemographic information and spirometry results from a bronchodilator test were collected. Modified Fisher's scale, clinical control questionnaires (c-ACT and ACT), quality of life assessment (PAQLQ) (total score and domains) and anxiety symptoms assessment (SCAS) (total score and domains) were applied. RESULTS The sample consisted of 42 children with asthma. Symptoms of social phobia (as identified by SCAS), and household head education were related to clinical asthma control (p = .006; R 2 = .19). Total SCAS score, guardian's education and physical activity were related to total PAQLQ (p

Panic buying emerged as a significant phenomenon during the COVID-19 pandemic This study draws on the scarcity principle, crowd psychology and contagion theory to investigate the antecedents and consequences of panic buying The antecedents included in this study are government measures, media and peer influence and the fear of missing out The consequences are founded on a sense of security and guilt Retailer intervention is included as a moderator to the proposed main effects Data were collected from 341 consumers who engaged in panic buying and were residents of the United States and Australia during the COVID-19 pandemic Structural equation modelling was employed to test the proposed model The results show that the proposed antecedents (except fear of missing out) were significantly related to panic buying, which in turn had a significant influence on panic buyers' psychological outcomes The moderating effects of retailer intervention varied across different product categories Discussion and implications of these findings are provided for policy makers, customers and practitioners (PsycInfo Database Record (c) 2021 APA, all rights reserved)

Takotsubo cardiomyopathy has potentially lethal complications and can be caused by a media‐induced diffuse atmosphere of life threatening and panic in preconditioned patients.

The rapid shift to online teaching in spring 2020 meant most of us were teaching in panic mode. As we move forward with course planning for fall and beyond, we can invest more time and energy into improving the online experience for our students. We advocate that instructors use inclusive teaching practices, specifically through active learning, in their online classes. Incorporating pedagogical practices that work to maximize active and inclusive teaching concepts will be beneficial for all students, and especially those from minoritized or underserved groups. Like many STEM fields, Ecology and Evolution shows achievement gaps and faces a leaky pipeline issue for students from groups traditionally underserved in science. Making online classes both active and inclusive will aid student learning and will also help students feel more connected to their learning, their peers, and their campus. This approach will likely help with performance, retention, and persistence of students. In this paper, we offer broadly applicable strategies and techniques that weave together active and inclusive teaching practices. We challenge instructors to commit to making small changes as a first step to more inclusive teaching in ecology and evolutionary biology courses., We encourage instructors to use inclusive teaching practices and active learning in their online classes. Incorporating pedagogical practices that work to maximize active and inclusive teaching concepts will be beneficial for all students, and especially those from minoritized or underserved groups. In this paper, we offer strategies and techniques that weave together active and inclusive teaching practices and challenge faculty to commit to making small changes as a first step to more inclusive teaching in ecology and evolutionary.

Background The COVID-19 pandemic has powerfully shaped people's lives. The current work investigated the emotional and behavioral reactions people experience in response to COVID-19 through their internet searches. We hypothesised that when the prevalence rates of COVID-19 increase, people would experience more fear, which in turn would predict more searches for protective behaviors, health-related knowledge, and panic buying. Methods Prevalence rates of COVID-19 in the United States, the United Kingdom, Canada, and Australia were used as predictors. Fear-related emotions, protective behaviors, seeking health-related knowledge, and panic buying were measured using internet search volumes in Google Trends. Results We found that increased prevalence rates of COVID-19 were associated with more searches for protective behaviors, health knowledge, and panic buying. This pattern was consistent across four countries, the United States, the United Kingdom, Canada, and Australia. Fear-related emotions explained the associations between COVID-19 and the content of their internet searches. Conclusions Findings suggest that exposure to COVID-19 prevalence and fear-related emotions may motivate people to search for relevant health-related information so as to protect themselves from the pandemic.

Testosterone plays a pivotal role in maintaining balance within the multi-dimensional psychological network of mood, behaviour, self-perception and perceived quality of life in men of any age. Apart from classical forms of hypogonadism, low testosterone concentrations can also be seen in older men, described as an age- and comorbidity-driven functional hypogonadism and might relate to depressive symptoms exhibiting a wide array of clinical pictures ranging from dysthymia and fatigue over inertia, listlessness to hopelessness and suicidal thoughts. Also, various traits of anxiety, from unfocussed fear to phobic anxiousness and open panic syndromes, are influenced by testosterone. Correspondingly, anxiolysis is likely to be modulated by testosterone via stress resilience, threat vigilance and reward processing. The steroid modulates pro-active and re-active dimensions of aggression, which has to be seen within the context of gaining or maintaining status. This may also include other strategies impacting the social position: heroic or parochial altruism and non-aggressive paths of assertiveness, such as posture and social vigilance. Independent rather than relationship-associated self-construal and self-esteem influence risk-taking traits under the modulation of testosterone. In addition, the genetic setting of the androgen receptor modulates the role of testosterone in aspects regarding mood and personality. Dimensions of sexuality are rather important in this context, but are not target of this article and covered in another part of this special edition. Overall, the quality of life in older hypogonadal men can be positively influenced by testosterone substitution, as has been demonstrated in large placebo-controlled trials.

Objective The present study examined the contribution of panic appraisal (PA) dimensions to the prediction of panic and agoraphobic symptoms, above and beyond anxiety sensitivity (AS), among patients with panic disorder. PA dimensions consist of anticipated panic, perceived panic consequences, and panic coping efficacy. Method Panic disorder patients (N = 84, 60.7% female, M = 38 years) completed self-report measures of panic and agoraphobic symptoms, three dimensions of PA, AS, anxiety, and depression symptoms. Results PA dimensions significantly contributed to the prediction of overall and all facets of panic and agoraphobic symptoms, as well as anxiety symptoms, but not depressive symptoms, above and beyond AS. Of the three PA dimensions, both anticipated panic and panic coping efficacy uniquely contributed to agoraphobic avoidance after controlling for AS and the other dimensions of PA. Conclusion PA dimensions may emerge as an important predictor of panic and agoraphobic or anxiety symptoms.

Notions of psychological frailty have been evident in comments by journalists, politicians and others on public responses to the Covid-19 pandemic. In particular, there is the argument that collective selfishness, thoughtless behaviour, and over-reaction would make the effects of Covid-19 much worse. The same kinds of claims have been made previously in relation to other kinds of emergencies, such as fires, earthquakes and sinking ships. We argue that in these cases as well as in the case of the Covid-19 pandemic, other factors are better explanations for fatalities -- namely under-reaction to threat, systemic factors, and mismanagement. Psychologizing disasters serves to distract from the real causes and thus from who might be held responsible. Far from being the problem, collective psychology in emergencies – including the solidarity and cooperation so commonly witnessed among survivors – is the solution, one that should be harnessed more effectively in policy and practice.

BACKGROUND AND OBJECTIVES Previous research has yielded equivocal findings regarding whether internalizing symptoms are risk factors for adolescent hazardous alcohol use (AU), specifically in the presence of externalizing symptoms. This may be due to the type of internalizing symptoms examined (ie, distress vs fear), and the use of primarily normative rather than clinical samples. Thus, we tested internalizing and externalizing symptom interactions as they relate to adolescent hazardous AU in a high-risk, clinical sample of adolescents. METHODS Adolescents (N = 101; 66% female; Mage = 15) were recruited from an inpatient psychiatric unit and assessed for current symptoms. Hypotheses were tested by running a series of moderation models regressing hazardous AU on a set of internalizing symptoms (ie, depression, generalized anxiety disorder [GAD], social anxiety, separation anxiety, school avoidance, and panic), each interacting with externalizing symptoms. RESULTS We observed significant interactions between several internalizing symptoms (depression, GAD, and panic symptoms) and externalizing symptoms predicting hazardous AU. These internalizing symptoms were unrelated to AU at low and average levels of externalizing symptoms, but were positively related to AU at high levels of externalizing symptoms. DISCUSSION AND CONCLUSIONS In this clinical sample, distress-related internalizing symptomatology was associated with risk for, and not protection against, hazardous AU, but only when accompanied by high externalizing symptoms. SCIENTIFIC SIGNIFICANCE Findings suggest that whether or not internalizing symptoms operate synergistically with externalizing symptoms to predict hazardous AU depends on the subdomain of internalizing symptoms (distress vs fear) and perhaps the type of sample (ie, clinical vs community). (Am J Addict 2019:00:00-00).

Background Prospective cohorts have suggested that physical activity (PA) can decrease the risk of incident anxiety. However, no meta-analysis has been conducted. Aims To examine the prospective relationship between PA and incident anxiety and explore potential moderators. Methods Searches were conducted on major databases from inception to October 10, 2018 for prospective studies (at least 1 year of follow-up) that calculated the odds ratio (OR) of incident anxiety in people with high PA against people with low PA. Methodological quality was assessed using the Newcastle-Ottawa Scale (NOS). A random-effects meta-analysis was conducted and heterogeneity was explored using subgroup and meta-regression analysis. Results Across 14 cohorts of 13 unique prospective studies (N = 75,831, median males = 50.1%) followed for 357,424 person-years, people with high self-reported PA (versus low PA) were at reduced odds of developing anxiety (adjusted odds ratio [AOR] = 0.74; 95% confidence level [95% CI] = 0.62, 0.88; crude OR = 0.80; 95% CI = 0.69, 0.92). High self-reported PA was protective against the emergence of agoraphobia (AOR = 0.42; 95% CI = 0.18, 0.98) and posttraumatic stress disorder (AOR = 0.57; 95% CI = 0.39, 0.85). The protective effects for anxiety were evident in Asia (AOR = 0.31; 95% CI = 0.10, 0.96) and Europe (AOR = 0.82; 95% CI = 0.69, 0.97); for children/adolescents (AOR = 0.52; 95% CI = 0.29, 0.90) and adults (AOR = 0.81; 95% CI = 0.69, 0.95). Results remained robust when adjusting for confounding factors. Overall study quality was moderate to high (mean NOS = 6.7 out of 9). Conclusion Evidence supports the notion that self-reported PA can confer protection against the emergence of anxiety regardless of demographic factors. In particular, higher PA levels protects from agoraphobia and posttraumatic disorder.

With the rise in fluorinated pharmaceuticals, it is becoming increasingly important to develop new 19F NMR-based methods to assist in their analysis. Crucially, obtaining information regarding the conformational dynamics of a molecule in solution can aid the design of strongly binding therapeutics. Herein, we report the development of a 2D 1H–19F Heteronuclear Overhauser Spectroscopy (HOESY) experiment to measure 1H–19F internuclear distances, with accuracies of ~5% when compared with 1H–19F internuclear distances calculated by quantum chemical methods. We demonstrate that correcting for cross-relaxation of 1H, using the diagonal peaks from the 2D 1H–1H Nuclear Overhauser Enhancement Spectroscopy (NOESY), is critical in obtaining accurate values for 1H–19F internuclear distances. Finally, we show that by using the proposed method to measure 1H–19F internuclear distances, we are able to determine the relative stereochemistry of two fluorinated pharmaceuticals.

Objectives This article highlights the prevalence of symptom frequencies in Nagaland, India, with a focus on depressed mood and hot flashes. We also examine how symptoms cluster together among Naga women and identify factors associated with symptom experience. We hypothesized an elevated frequency of depressed mood because of the stresses associated with social responsibilities within a patriarchal culture, and a low frequency of hot flashes because of the thinness of the population. Methods Standardized questionnaires with close-ended questions were used to determine the frequency of symptoms and sociodemographic and health parameters among women aged 35 to 65 years (n = 352). Factor analysis was used to examine the relations among symptoms. Bivariate analyses and linear regressions were also employed to identify sociodemographic and health factors associated with symptoms. Results Menopausal symptoms, such as feeling dizzy or faint, anxiety or panic, and excitable, were significantly higher in premenopausal women; hot flashes in perimenopausal women; and feeling tired or lack in energy, headaches, difficulty in sleeping, and muscle or joint pain in postmenopausal women. Four symptom factors were identified: symptoms related to the loss of estradiol, psychosomatic symptoms, uneasiness, and depressed mood. After adjusting for menopausal status, socioeconomic status, education, and self-reported health status, body mass index was observed to be inversely associated with the depressed mood factor but not other factors. Conclusion In the context of Nagaland, India, having extra weight may contribute to emotional well-being; however, further research is warranted.

Similarities exist between our past experience of viral diseases and COVID-19 concerning the mental health issues of sufferers of an epidemic, frontline health workers and the social and psychological impact on society. There is significant evidence that a novel illness such as COVID-19 can cause widespread fear, panic, anxiety and xenophobia. Dr Chakraborty explores the latest literature and what it means for mental health.

BACKGROUND/OBJECTIVES: The COVID-19 pandemic has massively disrupted essential clinical research. Many regulatory organizations have rightfully advocated to temporarily halt enrollment and curtail all face-to-face interactions. Views and opinions of patients and their caregivers are seldom considered while making such decisions. The objective was to study older participants' and their caregivers' perspectives to participate in ongoing clinical research during the COVID-19 pandemic. DESIGN: Cross-sectional. SETTING: VISN-16/Geriatric Research, Education and Clinical Center (GRECC), Department of Veterans Affairs. PARTICIPANTS: Older participants and their caregivers (N = 51) enrolled in ongoing clinical research studies. MEASUREMENTS: Questions about perceptions of safety to attend research visit, the level of panic among the general public, and medical center's preparedness in handling the pandemic. Other questions identified the source of pandemic information and the preference of a phone or in-person visit. RESULTS: Mean age was 69.3 (±9.4) years, 53% were male, 39% were caregivers, and 65% were Caucasian. Majority (78%) of the participants felt safe/very safe attending the scheduled research appointment; 63% felt that the extra screening made them feel safe/very safe; 82% felt that the medical center was prepared/very prepared for the pandemic. Participants split evenly on their preference for phone versus in-person visits. Family members and television news media were the commonly used sources of pandemic information irrespective of their education. Perceptions were influenced by gender and source of information, not by age or education. Females perceived higher level of panic compared to males (P = .02). Those relying on news media felt safer compared to those that relied on family members (P = .008). CONCLUSION: Even though informants felt that the medical center was prepared to handle the pandemic, only half the participants preferred the in-person visit. Pandemic information was obtained from family members or the television news media. Knowing patients' perspectives may help researchers be better prepared for future pandemics. J Am Geriatr Soc 68:E14-E18, 2020.

There are indications that Covid-19 is a zoonotic disease but, as yet, no proof. As researchers across the globe are busy interrogating this hypothesis in a race to find out more, the stakes couldn’t be higher. The Covid-19 infection was declared a pandemic on 11 March by the World Health Organization (WHO) and since then has spread rapidly. > This invisible enemy has become our new obsession This invisible enemy which is causing fear and panic, shocking levels of suffering and death as well as significant social disruption and economic damage has become our new obsession. So what do we know so far about virus SARS-CoV2’s presence in animals and its transferability across species? Current evidence suggests that the SARS-CoV2 virus emerged from an animal source, according …

Problem Previous research suggests that the adult-focussed Clark and Wells (1995) model of social anxiety disorder (SAD) can be used to guide clinic-based treatment for adolescents. This single-case study (N = 1) investigated whether this model could also guide community-based outreach work for a 16-year-old female who was unable to attend clinic-based appointments due to social anxiety comorbid with panic and agoraphobia. Methods An experimental A-B-A design was used with three assessment-formulation sessions and 12 intervention sessions, focussing on exposure, cognitive restructuring, attention training, behavioural experiments and imagery rescripting. The Revised Child Anxiety and Depression Scale (RCADS), the Session Rating Scale (SRS) and the Goal Based Outcome form were administered at regular intervals. Findings and conclusions Social anxiety and panic scores reduced below the clinical threshold and the young person was able to leave home, travel independently (short-term goal) and re-engage with her social-family life (medium-term goal). SRS scores suggest that the intervention was acceptable and the therapeutic alliance was maintained throughout. In summary, this case study suggests that the Clark and Wells (1995) model of SAD can be used to guide community-based outreach work with adolescents unable to leave their home. Limitations and ideas for future research are discussed.

After 5 years of treatment with levodopa, approximately 40% to 50% of patients with Parkinson's disease (PD) develop motor complications such as dyskinesias or motor fluctuations. These are often accompanied by nonmotor fluctuations, such as fluctuations in mood symptoms. The aim of this systematic review is to assess the frequency of such mood fluctuations in PD patients with motor fluctuations and to explore the association between these mood fluctuations and motor fluctuations. We performed a systematic literature search in PubMed, Medline, and the Cochrane Library. This search yielded 10 studies, of which 9 were included after quality assessment. The frequency of anxiety fluctuations in PD patients with motor fluctuations ranged from 3.1% to 67.7% with a weighted mean of 35.4%. The frequency of fluctuations in depressive symptoms ranged from 2.1% to 71.4%, with a weighted mean of 34.9%. The frequency of fluctuations in symptoms of panic ranged from 3.1% to 54.5%, with a weighted mean of 37.1%. Symptoms of anxiety and depression are mostly present in the "off" state. We conclude that mood fluctuations occur frequently in PD patients with motor fluctuations. The methodology used to assess mood fluctuation varies widely and there is a lack of a generally accepted assessment procedure for fluctuating symptoms. Research would benefit from a more uniform approach to assessment of nonmotor fluctuations. © 2018 International Parkinson and Movement Disorder Society.

Purpose To document the prevalence of the nursing diagnosis of anxiety in hospital patients, based on its level of severity, defining characteristics (DCs), and other related factors, and to identify the key DCs that serve as predictors of clinically significant anxiety (CSA). Design Cross-sectional study. We enrolled 116 consecutive adult patients hospitalized from October 10 to 16, 2016, in medical-surgical wards within the first 48 hr of admission. Methods The potential DCs and related factors of anxiety were collected based on the NANDA International terminology. Anxiety was considered clinically significant when presenting at moderate, severe, or panic level. The differences in DC prevalence among patients having or not having CSA were analyzed by unpaired student's t-test. Multivariate analysis was used to examine the independent association between the DCs and CSA. Findings The prevalence of CSA was 36.2% and was significantly higher in patients who were older, female, and taking anxiolytic drugs, and among those who had cancer. The most frequent related factor for CSA was major change in health status. In the logistic regression, the presence of the DCs helplessness, altered attention or concentration, and anguish independently increased the odds of having CSA, whereas subjects presenting with Diminished ability to problem-solve had about a 96% reduction in the likelihood to suffer from such a condition. Conclusions A high prevalence of CSA among medical-surgical patients was shown. Furthermore, a critical cluster of DCs useful to identify CSA was found. Clinical relevance The ability to accurately diagnose CSA should help prescribe and deliver the appropriate nursing interventions.

Background and objectives Carbon monoxide is one of the most common causes of fatal intoxications in the United States, and multiple previous studies have demonstrated that cigarette smokers have higher levels of carbon monoxide in their blood. However, the potential negative effects due to acute carbon monoxide poisoning from excessive cigarette smoking have not been well established. Methods This is a single patient case report. Results In this case report, a 40-year-old male with a past medical history of depression, anxiety, panic attacks, and substance use disorder developed symptomatic, acute carbon monoxide poisoning secondary to heavy cigarette smoking in a confined space. In this patient, the cessation of clonazepam therapy coincided with increasing anxiety and panic disorder with agoraphobia triggering an escalation in his cigarette smoking. The patient smoked three packs of cigarettes in 3 hours and developed worsening of his symptoms. He required inpatient treatment with benzodiazepines and hyperbaric oxygen. Discussion and conclusions Therefore, it is important to recognize cigarette smoke as a significant source of carbon monoxide exposure. Scientific significance While the negative effects of cigarette smoking are often perceived as being chronic and only coming to fruition after numerous years of exposure, it is important for both physicians and patients to recognize the possibility for potentially life-threatening acute toxicity secondary to carbon monoxide exposure. (Am J Addict 2019;28:413-415).

Many stressors cause an increase in ventilation in humans. This is predominantly reported as an increase in minute ventilation (VE). But, the same VE can be achieved by a wide variety of changes in the depth (tidal volume, VT ) and number of breaths (respiratory frequency, ƒR ). This review investigates the impact of stressors including: cold, heat, hypoxia, pain and panic on the contributions of ƒR and VT to VE to see if they differ with different stressors. Where possible we also consider the potential mechanisms that underpin the responses identified, and propose mechanisms by which differences in ƒR and VT are mediated. Our aim being to consider if there is an overall differential control of ƒR and VT that applies in a wide range of conditions. We consider moderating factors, including exercise, sex, intensity and duration of stimuli. For the stressors reviewed, as the stress becomes extreme VE generally becomes increased more by ƒR than VT . We also present some tentative evidence that the pattern of ƒR and VT could provide some useful diagnostic information for a variety of clinical conditions. In The Physiological Society's year of 'Making Sense of Stress', this review has wide-ranging implications that are not limited to one discipline, but are integrative and relevant for physiology, psychophysiology, neuroscience and pathophysiology.

This paper examines reflections about researcher emotions and the experience of having panic attacks and panic disorder as a result of fieldwork. Anxiety and panic are sparsely discussed in methodological appendices and handbooks about qualitative research, and the embodiment of mental health in the field has received even less attention. I have two aims in the paper: to describe the experience of panic attacks and to open a discussion about panic and anxiety attacks in the field. The failure to address mental health problems as a result of fieldwork can negatively impact expert and fledgling ethnographers, and should be remedied.

In the context of psychological treatment, a sudden gain is a large and enduring improvement in symptom severity that occurs between two single therapy sessions. The influence of sudden gains on long-term outcomes and functional impairment in anxiety disorders is not well understood, and little is known with regard to panic disorder in particular. In addition, previous research on patients with anxiety disorders has produced inconsistent results regarding the relationship between sudden gains and cognitive change. We examined the incidence of sudden gains in a large sample (n = 116) of panic disorder patients undergoing exposure-focused cognitive-behavioral group therapy, and compared panic severity, functional impairment, and cognitive change in patients with and without sudden gains at posttreatment and 6-month follow-up. Participants who experienced sudden gains displayed lower levels of panic severity and functional impairment at posttreatment and 6-month follow-up than those who did not experience sudden gains. However, we observed no difference in cognitive changes between groups, either at posttreatment or at follow-up. Our results demonstrate that the beneficial effects of sudden gains on therapeutic outcomes not only extend to long-term and functional outcome measures but are also evident in less cognitive (i.e., exposure-focused) forms of psychological treatment. Key Practitioner Message Sudden gains are common in panic disorder patients undergoing exposure-based cognitive-behavioral group therapy. Sudden gains during exposure-focused therapy are linked to greater improvement in panic disorder severity and functional impairment. The positive impact of sudden gains on panic disorder severity and functional impairment is maintained in the long term.

We examine the relation between microfinance institution (MFI) interest rates, loan loss rates, and regulations. Our results suggest that a positive and causal association exists where loan loss rates drive MFI interest rates after controlling for confounding factors. This positive association holds after accounting for potential endogeneity based on various econometric methods and quasi-natural experiment. Although endogeneity cannot be ruled out fully, the results of our tests suggest it plays a limited role. Our results support the price-rationing proposition that MFIs ration credit and there is unmet demand at the market-clearing price. This positive relation is more pronounced in countries with individualistic and uncertainty avoiding cultures.

Aim The aim of the present study was to examine whether depression and anxiety disorder manifest different autonomic dysregulations using heart-rate variability (HRV) and heart rate (HR) measurements. Methods HRV and HR were recorded both at rest and during task execution (random-number generation) in first-onset drug-naive patients with major depressive disorder (MDD, n = 14) and generalized anxiety disorder (GAD, n = 11) as well as in healthy controls (n = 41). The patients showed no comorbidity of depression and anxiety disorder. GAD patients did not exhibit panic or phobic symptoms at the time of measurement. Following power spectrum analysis of HR trend, the high- (HF) and low-frequency (LF) components, the sum (LF + HF), and the LF/HF ratio were compared among the groups. Results In the MDD patients, as previously reported, HF was low and the LF/HF ratio was high during the initial-rest condition, and HF was less reactive to the task. In contrast, GAD patients showed significantly high HF, although autonomic reactivity was not impaired. Conclusion The results indicate that baseline autonomic activity and its reactivity to behavioral changes are different between MDD and GAD in the early stage of illness. High parasympathetic tone in GAD may reflect responses of the parasympathetic system to anxiety. MDD is accompanied by an autonomic shift toward sympathetic activation and a reduced reactivity to task.

The world has been preparing for a pandemic, most likely to be caused by a novel strain of influenza or a newly emerged respiratory virus, for decades.1 However, the unpredictable nature of a pandemic means that, when it does occur, it tends to induce panic. Tellingly, the letters spelling ‘panic’ form the beginning and end of the word pandemic. A pandemic also raises multiple ethical considerations. The COVID‐19 pandemic illustrates many features of a pandemic, such as uncertainty, shifting circumstances and rapidly changing recommendations. The responsible planning and allocation of resources becomes a major consideration if the health service is unable to sufficiently cope with the number of sick patients to give them all optimum care.

The article focuses on the news of the COVID-19 outbreak hit the mainstream media It mentions that students identify claims in the media regarding the coronavirus;and also mentions that that there is a tendency to over estimate risk when outcomes are dreadful or impact a lot of people in a short period of time

Fear and anxiety are conceptualized as responses to acute or potential threat, respectively. Adult twin studies found substantial interplay between genetic and environmental factors influencing fear disorders (phobias) and anxiety disorders. Research in children, however, has largely examined these factors independently. Thus, there exists a substantial knowledge gap regarding the underlying etiologic structure of these closely-related constructs during development. Symptom counts for five fear (criticism, the unknown, death, animal, medical) and four anxiety (generalized, panic, separation, social) dimensions were obtained for 373 twin pairs ages 9-14. Multivariate twin modeling was performed to elucidate the genetic and environmental influences distributed amongst these dimensions. The best fitting model contained one genetic, two familial environmental, and two unique environmental factors shared between fear and anxiety symptoms plus dimension-specific genetic and unique environmental factors. Although several environmental factors were shared between fear and anxiety dimensions, one latent factor accounted for genetic influences across both domains. While adult studies find somewhat distinct etiological differences between anxiety and phobic disorders, the current results suggest that their relative genetic and environmental influences are not as clearly demarcated in children. These etiological distinctions are more nuanced, likely contributing to the highly diffuse symptom patterns seen during development.

OBJECTIVE: The objective of this study is to assess the contribution of mental comorbidity to role impairment among college students. METHODS: Web-based self-report surveys from 14,348 first-year college students (Response Rate [RR] = 45.5%): 19 universities, eight countries of the World Mental Health International College Student Initiative. We assessed impairment (Sheehan Disability Scales and number of days out of role [DOR] in the past 30 days) and seven 12-month DSM-IV disorders. We defined six multivariate mental disorder classes using latent class analysis (LCA). We simulated population attributable risk proportions (PARPs) of impairment. RESULTS: Highest prevalence of role impairment was highest among the 1.9% of students in the LCA class with very high comorbidity and bipolar disorder (C1): 78.3% of them had severe role impairment (vs. 20.8%, total sample). Impairment was lower in two other comorbid classes (C2 and C3) and successively lower in the rest. A similar monotonic pattern was found for DOR. Both LCA classes and some mental disorders (major depression and panic, in particular) were significant predictors of role impairment. PARP analyses suggest that eliminating all mental disorders might reduce severe role impairment by 64.6% and DOR by 44.3%. CONCLUSIONS: Comorbid mental disorders account for a substantial part of role impairment in college students. ispartof: Int J Methods Psychiatr Res vol:28 issue:2 pages:1-12 ispartof: location:United States status: Published online