Natural Anxiety and Panic Disorders Treatment Ebook

Panic Away End Anxiety and Panic Attacks

Psychologists agree that when a person has anxiety of a certain situation, he may suffer from a panic attack. This person then fears that specific location or event. When he find himself in a similar situation, he fears the onset of an attack and essentially cause himself to have an anxiety attack in the process. The One Move method teaches you how to conquer these fears and end this vicious cycle. The core of the program is the 21 7 Technique, which is made up of the 21 Second Countdown and the 7 Minute Exercise. This is then followed by C.A.L.M. Recovery, which helps to integrate this technique into your life. Panic Away aims to restore you back to your former care free self through eliminating panic attacks and reduce general anxiety fast. The best thing about this eBook is that its simple and detailed course. Moreover, audio series, video presentations, 60-Day money back Guarantee, members forum and the one on one coaching and counseling with Barry made this program very affordable for me. Read more...

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The Nature of Anxiety

Just as anxiety can impair cognitive and intellectual functioning, it can similarly interfere with the manner in which a person handles problems. This fact underscores the central role that anxiety plays in personality functioning, and its particular link to the presenting symptom complaint. If the anxiety is managed through somatization, for example, the patient tends toward preoccupations with problems of physical health. If the anxiety were to be impulsively acted on instead, then it would lead to traumatic behavioral and social problems such as those frequently encountered in school settings. If the anxiety cannot be channeled, panic and extreme discomfort can result in distressing personal experience such as the development of phobic behavior or free-floating anxiety. On the other hand, intense, diffusely global anxiety may be experienced in connection with fragmentation accompanying a psychotic break. In the event the anxiety is allayed by depression, its manifest quality may...

Cognitive Therapy for Anxiety Disorders

Cognitive therapy has been adapted for the full range of anxiety disorders generalised anxiety disorder (Beck & Emery with Greenberg, 1985) panic disorder (Clark, 1986 Craske & Barlow, 2001) social phobia (Heimberg & Becker, 2002) and obsessive-compulsive disorder (Frost & Steketee, 2002 Salkovskis, 1985). For generalised anxiety disorder, Chambless & Gillis (1993) computed effect sizes across five studies in which cognitive therapy was compared with one of several control conditions non-directive therapy (Borkovec & Costello, 1993) or waiting list (Butler etal., 1987, 1991). Substantial effect sizes (1.5-2) at post-test and follow up suggest that cognitive therapy is an efficacious intervention for generalised anxiety disorder. A review of 12 trials of cognitive therapy for panic suggested that 80 of patients achieved full remission at the end of treatment (Barlow & Lehman, 1996). De Rubeis & Crits-Christoph (1998) reviewed 11 outcome studies of cognitive...

Anxiety and stress related disorders

Anxiety and stress-related disorders can be considered as an exaggerated response to stress. In contrast to psychosis, such patients are free from delusions and hallucinations, and usually retain insight. These disorders include the following range of common, related, and overlapping conditions generalized anxiety states continuous, unfocused, 'free-floating' anxiety panic disorder episodes of acute, severe anxiety specific phobias anxiety related to specific objects (e.g. spiders) or situations (e.g. agoraphobia, social phobia) obsessive-compulsive disorder anxiety related to obsessional thoughts or compulsive ritual behaviours Anxiety is a feature of them all. Patients with a mixture of symptoms from several categories were sometimes said to have general neurotic syndrome, although the term is not in clinical use today.

Generalized anxiety disorder anxiety state

The prevalence of pure generalized anxiety disorder is about 3 per cent of the population, and a further 8 per cent have mixed anxiety and depressive disorder. Physical and or mental symptoms of anxiety, as listed above, are present most of the time in the absence of real danger, and are 'free-floating' rather than focused on any particular stimulus. If a specific treatment were required, the GP would have a choice of the medications outlined above a beta-blocker, an antihistamine, or a sedative antidepressant such as small doses of trimipramine or trazodone. SSRIs can make things worse. Benzodiazepines should be avoided in most cases.

Generalized Anxiety Disorder

Considerable cultural variations exist in the expression of anxiety. In some cultures, anxiety is expressed predominantly through somatic symptoms, in others through cognitive symptoms. The cultural context should be considered during the evaluation of worries about certain situations as excessive (1994, pp. 433-434). This DSM-IV disorder may resemble the culture-bound syndrome termed Ode-ori (Table I), which has been reported in Nigeria and includes excessive anxiety resulting from the sensation of insects crawling through the body (Castillo, 1997).

Anxiety as a Central Focus in the Report

For several reasons, anxiety plays a central role in the functioning of the personality. It not only can cause cognitive and intellectual impairments, but it also exerts a major influence in the development of emotional, behavioral, and somatic disturbances. Just as anxiety impedes smooth cognitive and intellectual functioning, it also interferes with efforts to utilize inner personality resources. The presence of anxiety and its effects reduce the person's ability to constructively manage challenges, problems, and opportunities. In addition, the manifestations of anxiety can signal the presence of underlying conflict and pathological processes. Consequently, a thorough analysis of anxiety leads to the uncovering of deeper conflicts and disturbances within the personality, the essential factors that are central in the development of the patient's symptoms and discomfort. Pathological processes that are revealed by analyzing and reporting the details of anxiety include symptoms, their...

What does the Term Anxiety Mean

Anxiety derives from the Greek word agon from which such words as anguish and agony are clearly derived. The Greek term described a sport contest and, in particular, the struggle between antagonists in such contests. The Greek agon also relates to the German word Angst, used in modern times by Kierkegaard and Nietzche, for example, to describe a painful feeling of terror. Freud ascribed a central role to anxiety in the pathology he studied, and few subsequent personality theorists fail to do the same in their studies of the genesis and meaning of psychopathology. The meaningfulness of Freud's observations about the anguish of people in conflict also has had a striking effect at the popular level. For instance, the phrase age of anxiety as an accepted characterization of the turbulent twentieth century is such an example. To appreciate the place of anxiety in the psychodiagnostic report, this brief historical perspective suggests the central significance and seriousness connected to...

The Patients Experience of Anxiety

Whether or not a person is aware of experiencing anxiety, the effects of tension are always affecting the person's behavior. Anxiety's influences may first appear in the person's reactions to its disrupting and debilitating effects. In such instances, the experience of anxiety may interfere with the patient's efforts to marshal cognitive and intellectual strengths. Thus, it is important to report the disruptive, interfering effects of anxiety when they are present. Failure to perform or reduced capacities for functioning in cognitive and intellectual areas that result from the interference of poorly managed anxiety also are significant to analyze and report, along with the impact of such a reduction in competence on the patient's tension and subjective distress. In this connection, the patient's ability to handle frustrating circumstances is of considerable interest. Anxiety that impedes performance and the additional stress that failure brings about can evoke a variety of reactions....

Is the Anxiety Acted Out

The issue of acting-out is crucial to understanding any problem behavior because of the many subtle forms it may take, its relationship to underlying conflict, and its widely prevalent use as a mode of handling anxiety. The patient who acts out usually does not consciously experience anxiety, primarily because the action is a substitute for the anxiety and accompanying frustration that cannot be tolerated. Acting-out usually is defined as the behavioral substitute for a conflict that is, a patient with problem behavior has not achieved insight with respect to the underlying conflict and therefore is unable to control, contain, or endure the frustration generated by it. Such a patient, then, is not likely to be in a position to begin to focus on or deal with the conflicts because the emergence into conscious thought of any aspect of the conflict would evoke anxiety resulting in an immediate flight into action. Instead of thinking about the problem, the patient engages in doing or...

Is the Anxiety Understood by the Patient

The key issue here refers to the most likely underpinning of the anxiety that is, is the anxiety representing another specific emotion Thus, which emotion other than the anxiety itself would be a likely candidate as the real emotional culprit The likely answer is that beneath the anxiety, propelling the anxiety, and covered over by the anxiety, is substantial anger. In addition, this likely store of underlying anger is always related to a person. When anger toward another person is repressed, then a replacement emotion for the anger is pushed up from beneath that of anxiety. The issue for the examiner is to assess the extent to which the patient is aware of a degree of anger toward another specific person. Consciousness of such a connection between anger toward another person and the relative state of the patient's anxiety will be an index of the patient's prognosis. As would be expected, greater consciousness corresponds to a better prognosis.

Sources of Anxiety in the Personality

As can be seen from the previous discussion, mobilizing and managing anxiety can assume several forms. For example, individuals readily experience anxiety when challenged with novel circumstances such as a testing situation. The patient can be observed to handle this source of tension by any number of approaches, including dedicated efforts at problem solving, impulsive acting-out, nonreflec-tive responding, avoidance and withdrawal, criticism of the test requirements, or complaints about feeling ill. Thus, the anxiety typically mobilized in new situations can be analyzed in the context of the patient's handling of the demands of the testing situation. This handling of anxiety provides valuable information for the test report because it reflects the person's characteristic response and is a sample of the patient's typical reaction to stress outside of the testing situation. At a deeper level, conflict between different aspects of personality, doubts about self-esteem, difficulties in...

Anxiolytic And Sedative

Over the years, a number of studies involving rodents have suggested specific anxiolytic or sedative effects (Kennedy et al 2002, Soulimani et al 1991). More recently, a double-blind placebo-controlled study has confirmed anxiolytic activity is clinically significant for lemon balm essential oil (Ballard et al 2002). In 2005 a double-blind, placebo-controlled, randomised, crossover trial of a whole extract of lemon balm (300 and 600 mg) in 18 healthy adults found a significant reduction in 2007 Elsevier Australia

Conventional Antipsychotics versus Benzodiazepines

The few studies that compared antipsychotics to benzodiazepines suffered from methodological flaws, particularly with respect to sample selection and study design (Burgio et al., 1992 Covington, 1975 Kirven & Montero, 1973 Stotsky, 1984 Tewfik et al., 1970). The limited data available do not indicate superiority for benzodiazepines over antipsychotics in the treatment of behavioral complications in demented patients. Benzodiazepines can lead to tolerance and dependence, and worsening of cognition is a concern. Despite the known deleterious effects of benzodiazepines on learning and memory in normal subjects (Ghoneim, Mewaldt, Berie, & Hinrichs, 1981 Jones, Lewis, & Spriggs, 1978 Liljequist, Linnoila, & Mattila, 1978), particularly in the elderly (Pomara et al., 1990), side effect comparison studies of antipsychotics and benzodiazepines in demented patients have not been conducted.

Separation anxiety disorder

Like many childhood concerns, separation anxiety is normal at certain developmental stages. For example, when a child between the ages of eight and 14 months is separated from her mother or other primary caretaker, she may experience distress. This is normal. However, separation anxiety that occurs at later ages is considered a disorder because it is outside of normal developmental expectations, and because of the intensity of the child's emotional response. Separation anxiety disorder occurs most frequently from the ages of five to seven and from 11 to 14. Environmental stimuli and internal cues from the child himself interact in the presentation of separation anxiety disorder. Separation anxiety disorder is defined by the primary expression of excessive anxiety that occurs upon the actual or anticipated separation of the child from adult caregivers most often the parents. Significant problems in daily functioning for the child and parents can result from the disorder. Common fears...

Anxiety Disorders and Other Mental Disorders

Available data on the rates of anxiety, substance abuse, schizophrenia, and other mental disorders among minority elders is more limited. Using data from the ECA, Eaton, Dryman, and Weissman (1991) report lifetime rates of panic disorder of less than 1 among older African Americans and between 1 and 3 among older Hispanics, rates that are not substantially different from those found among older non-Hispanic whites. The lifetime rates of phobic disorder, however, were found to be considerably higher among older African Americans (15 to 24 ) than among older Hispanics (5 to 10 ) or non-Hispanic whites (7 to 13 ). Blazer, Hughes, George, Swartz, and Boyer (1991) reported that the rates of generalized anxiety disorder were 1 to 3 among older African Americans, and less than 1 among older Hispanics, rates comparable to those reported for older non-Hispanic whites. In a recent study of older Asian Americans, Harada and Kim (1995) reported rates of anxiety disorders ranging from 5 among the...

Mood Elevation And Reduced Anxiety

Considering that low dietary intakes of selenium have been linked with greater incidence of anxiety, depression and tiredness, several research groups have investigated whether higher dietary intakes or selenium supplementation will elevate mood and or reduce anxiety. Currently, results are equivocal however, it appears that selenium-replete individuals are most likely to respond to supplementation, if a response is observed. An early double-blind, crossover, study showed that short-term selenium supplementation (100 g day for 5 weeks) significantly elevated mood and decreased anxiety, depression and tiredness, with effects most marked in people with low dietary intake (Benton & Cook 1991). A study of 30 selenium replete men who were fed either a low (32.6 g day) or a high (226.5 g day) selenium diet for 1 5 weeks found that the mood of those with the higher selenium intake increased whereas mood worsened with low intake (Finley & Pen land 1998 as reported in Rayman 2005)....

Personal History of Untreated Depression or Anxiety or Prior Suicidal Ideation or Attempt

When cancer genetic counseling was first offered, there were few other adult onset conditions for which predisposition testing was available. One was Huntington's disease (HD), and as part of the testing protocol for HD, most centers involve mental health-care providers. However, suicidal ideation is part of the biology of HD, and studies have demonstrated that learning cancer mutation status can cause anxiety but not to the degree that requires professional referrals (57,58).

Other drugs for anxiety and insomnia

Various alternatives to the benzodiazepines are available as hypnotics and or anxiolytics, although all have unwanted effects of their own. Antidepressants are often used to treat chronic anxiety or anxiety mixed with depression. Trimipra-mine, trazadone, and mirtazepine are suitable. Some immediate benefit may occur due to the sedative action, and gradual further improvement should follow over several weeks. Other options include beta-blockers such as propranolol, effective mainly for the physical symptoms of anxiety antipsychotics such as chlorpromazine in low dose antihistamines such as promethazine, and newer preparations such as buspirone. Barbiturates, once widely used as hypnotics and anxiolytics before benzodiaz-epines became available, are now obsolete as psychotropic drugs because of the high risk of dependence and high toxicity in overdose.

Internalizing Disorders Anxiety Disorders

Internalizing disorders involve a core disturbance in emotions and moods such as worry, fear, sorrow, and guilt (Zahn-Waxler et al., 2000). The two major types of internalizing disorders are (a) mood disorders and (b) anxiety disorders. Children with mood disorders experience extreme, persistent, or poorly regulated emotional states such as excessive unhappiness or wide swings in mood from sadness to elation. The two most common mood disorders in childhood are major depressive disorder (MDD) and dysthymic disorder (DD APA, 2000). MDD and DD are related many children with DD eventually develop MDD, and some children may experience both disorders (Lewinsohn, Rohde, Seeley, & Hops, 1991). A third mood disorder, bipolar disorder, is rare in children, although there is growing interest in this problem in young people (Carlson, Bromet, & Sievers, 2000 Geller & Luby, 1997). In the sections to follow, we limit our discussion to anxiety disorders, highlighting many of the same...

Resolving the Role Anxiety Dilemma

The anxiety associated with anticipated reactions to a report can be caused by the presence of several individuals who may read or evaluate it. All those who have something to do with the final report, including the writer, are viewed as split off from each other and having divergent interests. These divergent interests or parts are further evaluated in positive and negative terms. For example, the patient, who is placed in a pathological role, may represent the bad part. The writer of the report, in order to avoid identification with the bad part the patient may need to construct a report that will please the supervisor, professional colleague, or referral source. The writer, therefore, imagines becoming the good part and gaining acceptance by the supervisor or fellow professionals. Accomplishing this goal can satisfy yearnings to be seen in purely good terms and to be praised. The difficulty in writing under such fantasy circumstances is that the report must become a praiseworthy...

Anxiety Impluse and Defensive Structure

The Problem of Anxiety. New York W.W. Norton. Izard, C. E. (1972). Patterns of Emotions A New Analysis of Anxiety and Depression. New York Academic Press. Lader, M. H., & Marks, I. (1971). Clinical Anxiety. London Heinemann. May, R. (1996). The Meaning of Anxiety. New York W. W. Norton.

Prevalence Of Latelife Depression And Anxiety

The Epidemiological Catchment Area Study (ECA) (Regier et al., 1988) was a major study investigating rates of depression and anxiety in the community carried out across five sites in the US. The ECA prevalence rates of major depressive disorder amongst older adults were lower than for younger adults (for review see Powers et al., 2002). In the UK, Lindesay, Brigs & Murphy (1989) reported prevalence rates of 4.3 for severe depression and 13.5 for mild moderate depression in a community dwelling urban sample. Beekman, Copeland & Prince (1999) carried out a systematic review of community-based studies examining prevalence of depression in older adults. Overall, Beekman, Copeland & Prince (1999) calculated prevalence rates of 13.5 for clinically relevant depression but concluded that major depression is relatively rare in later life (1.8 ) whereas minor depression is relatively more common (9.8 ). Similar figures reported by Copeland et al. (1987) and Livingston et al. (1990)...

Anxiety Disorders A Panic Disorder

Symptoms resembling panic attacks are common in cultures where members have strong beliefs in witchcraft or evil spirit attacks (Castillo, 1997 Kirmayer, Young, & Hayton, 1995). For example, trembling or shaking, chest pain, fear of dying, palpitations, and other symptoms for Panic Disorder are generally reported by Hispanics with intensive fears of malign magic, malevolent attacks by witchcraft, or evil spirit attacks. These symptoms resemble the culture-bound syndrome named ataques de nervios among Hispanics (DSM-IV, 1994 Kirmayer et al., 1995 see Table I). The DSM-IV (1994), however, pointed out that the association of most ataques with a precipitating event and the frequent absence of the hallmark symptoms of acute fear or apprehensions distinguish these ataques from Panic Disorder (p. 845). Another culture-bound syndrome resembling Panic Disorder is Ode-ori (Table I), which is often reported among the Nigerian culture and is characterized by sensations of parasites crawling in...

Is the Anxiety Consciously Experienced

The question of whether anxiety is consciously experienced concerns the patient's reaction to his or her own behavior, personality, and character traits. Is the patient's reaction one of acceptance, or are the traits viewed as being foreign When the patient perceives such behavior or traits in an accepting or benign fashion, they are considered to be ego-syntonic, and no particular anxiety is experienced. On the other hand, when the person experiences internal qualities as foreign or unusual, they are considered to be ego-alien or ego-dystonic. The ego-alien nature of the behavior or functioning generates discomfort and leads to varying degrees of anxiety. Within the report, it is helpful for the psychologist to communicate the extent to which the patient is experiencing anxiety, if at all. If the patient is indeed experiencing anxiety, it is extremely useful to specify the features in the person's functioning that are instrumental to the anxiety. This means that the patient...

Social Anxiety In Children And Adolescents

Social anxiety is often evident early in life and may be diagnosed in children as young as eight years old (Beidel & Turner, 1998). Furthermore, when the social fears of children continue to be expressed through late adolescence they are more likely to be associated with a poor prognosis for recovery (Davidson et al., 1993 Mannuzza et al., 1995). The clinical presentation of social anxiety in children is similar to that of adults, with comparable somatic symptoms and feared situations. However, because of the limited cognitive development of younger children, they may not report specific negative cognitions (Beidel & Turner, 1998). Social anxiety in children is also associated with significant distress and impairment, including poor school achievement, greater loneliness, and difficulties with social relationships (Albano, Chorpita & Barlow, 1996a). Socially anxious children and adolescents may also suffer from elevated rates of general anxiety, depression, and secondary...

Is the Anxiety Somatized

One of the most distressing ways in which patients attempt to manage anxiety without directly experiencing it involves channeling it to aspects of their own body. Parts of the body, internal organs, and physiologial functioning become the transformation equivalents of this anxiety. Somatizers are variably referred to as persons with psychophysiological, psychosomatic, conversion symptoms, or somatoform disorders. The somatizer attempts to manage anxiety by binding it or containing it with the aid of physical processes. This sort of person should be distinguished from the hypochondriacal patient who is preoccupied with thoughts about bodily functions, fantasied impairments, and overall ruminations frequently without actual organic involvement. Hypochondriacal patients actually experience substantial anxiety and for the most part do not bind it somatically. Instead, such patients refocus anxiety from psychological conflicts to bodily preoccupations. It is important for the psychologist...

The Central Role of Anxiety in the Psychodiagnostic Evaluation

An extremely complex and shifting network of factors occurs in the process of experiencing the discomfort of anxiety. When the problem finally surfaces and begins to cause intense concern and confusion, those involved in the referral process, from the patient to the referring source and even the testing psychologist, invariably become enmeshed in a sense of urgency, desperation, and duress to produce the report. This flurry of expectation and activity will not solve the problem, but instead can become something of a problem in its own right. The psychologist needs to realize that almost everyone connected with the patient is tense and unclear about the patient's difficulties. To bring clarity to the abundance of tension and confusion that accompanies the referral process, the psychologist must try to pinpoint the nature of the subject's anxiety without becoming caught up in it. Anxiety is of central importance because it can impair work, relationships, and other vital pursuits. There...

Anxiety And Psychological Stress States

Less investigation has taken place to determine the role of valerian as a treatment for anxiety states. The few studies published thus far have produced encouraging results, but are hampered by methodological problems and well conducted trials are still required. A randomised study found that low-dose valerian (100 mg) reduced situational anxiety without causing sedation (Kohnen & Oswald 1988). Positive results were also obtained in a smaller open study of 24 patients suffering from stress-induced insomnia who found treatment (valerian 600 mg day for 6 weeks) significantly reduced symptoms of stress and insomnia (Wheatley 2001). Another randomised trial compared the effects of a preparation of valepotriates (mean daily dose 81.3 mg) with diazepam (mean daily dose 6.5 mg) and placebo in 36 outpatients with GAD under double-blind conditions (Andreatini et al 2002). After 4 weeks' treatment, all groups had significant reductions in Hamilton anxiety (HAM-A) scale scores however, only...


Wogonin, baicalein, scutellarein and baicalin (in reducing order of potency), which all contain a certain flavonoid phenylbenzopyrone nucleus, have been shown in vitro to bind with the benzodiazepine site of the GABA-A receptor (Hui et al 2000). Oral administration of wogonin (7.5-30 mg kg) has been shown to interact with GABA-A receptors and produce an anxiolytic response that was similar to diazepam in the elevated plus-maze. Unlike benzodiazepines, wogonin was able to reduce anxiety without causing sedation or myorelaxation (Hui et al 2002, Kwok et al 2002). Baicalin (10 mg kg IP) and balcalln (20 mg kg IP) have also been shown In vivo to produce an anxiolytic effect, mediated through activation of the benzodiazepine binding sites of GABA-A receptors (Liao et al 2003). Two other flavones, 5,7-dihydroxy-6-methoxyflavone (oroxylin A) and 5,7,2'-trihydroxy-6,8-dimethoxyflavone (K36), also act as antagonist at the GABA-A recognition site and have demonstrated anxiolytic activity in...


Anxiety disorders are seen in approximately 40 of patients with PD (109). Despite their frequent occurrence and contribution to morbidity and caregiver burden (11), anxiety symptoms in PD have received relatively little attention, perhaps because they overlap with symptoms of depression, PD, and medication effects, and are thus difficult to measure (110). The relationship between anxiety and cognition in PD has received virtually no attention. Ryder et al. (111) found that self-reported symptoms of anxiety, but not depression, were related to cognitive functioning in a small sample of male patients with PD. Self-reported trait anxiety was negatively related to performance on a neuropsychological screening battery, accounting for approximately 70 of the variance. The authors posit that anxiety may partly explain the association between depression and cognition in PD, although replication of their findings and additional large-scale studies are needed.

Anxiety in PD

There is a significant interaction between anxiety and depression in IPD with 92 of anxiety disorder patients also manifesting depression. In one study (Menza, Robertson-Hoffman, & Bonapace, 1993), patients with IPD had significantly more anxiety than medical controls, with 28 of the IPD patients having an anxiety disorder diagnosis compared to 5 of controls. Another 40 of the patients with IPD exhibited more minor anxiety symptoms. These investigators also found that 43 of IPD patients had a depressive disorder an additional 14 had depressive symptoms. It has been suggested that anxiety may be secondary in part to the antiparkinson-ian medications. A study by Maricle, Nutt, and Carter (1995) investigated mood and anxiety fluctuations associated with L-dopa infusion therapy in a small series of patients and found that mood and anxiety symptoms slightly preceded but temporarily paralleled fluctuations in motor tapping scores. The effects of L-dopa on mood and anxiety were not...

Anxiety Epidemiology

In James Parkinson's original monograph, An Essay on the Shaking Palsy, little mention was made of the nonmotor symptoms of anxiety and depression (14). However, it is now known that clinically significant anxiety symptoms occur in 20 to 52 of PD patients, a frequency greater than that found in community dwelling age-matched controls (1,15-17). Menza et al. (18) reported a depressive disorder in 92 of PD patients diagnosed with an anxiety disorder, and an anxiety disorder was present in 67 of depressed PD patients. This is consistent with results by Starkstein et al. (16), reporting depression in 76 of patients with PD and anxiety. In addition to generalized anxiety disorder (GAD), patients with PD regardless of sex also experience panic disorders and social phobias with a prevalence of approximately 30 . (17,19,20). The presence of anxiety not only contributes to mental and somatic discomfort, but may also contribute to existing motor symptoms or fluctuations (7). For example,...


Although benzodiazepines are commonly used in the management of anxiety, only one randomized controlled trial addressed this in the PD population (40). Bromazepam, a long-acting benzodiazepine, was reported to improve psychic and somatic (i.e., tremor) symptoms of anxiety. Anecdotally, other benzodiazepines have also been noted to be effective. Clonazepam was reported to be effective in a patient with anxiety and panic attacks that were refractory to alprazolam, lorazepam, and numerous antidepressants (45). Although benzodiazepines may be effective, its long-term use, especially in the elderly or frail patient, may be associated with unfavorable effects on alertness, cognition, and gait, and an increased risk of falls (46-48). Therefore, benzodiazepines should be used judiciously with careful evaluation of potential risks and benefits.

Anxiolytic drugs

Anxiolytic drugs such as benzodiazepine are best taken only when symptoms actually occur, or shortly before the patient has to face an anxiety-provoking situation. Regular medication encourages tolerance and dependence, and for this reason benzodiazepines are recommended for short-term use only. Unfortunately, because of fears of addiction, these drugs may now be in danger of being underused. In patients with stable personality, with a likely short-term situation such as acute distress following bereavement to deal with, they can be a safe and effective treatment. For the small minority of chronic severe sufferers who have tried and failed with other treatments, long-term benzodiazepine treatment may be the least problematic therapeutic option.


Buspirone is an anti-anxiety (anxiolytic) drug sold in the United States under the brand name of BuSpar. It is also available under its generic name. Buspirone is used for the treatment of generalized anxiety disorders and for short term relief of symptoms of anxiety. Buspirone's mechanism of action is unclear but probably involves actions on such central nervous system chemicals as dopamine, serotonin, acetylcholine, and norepinephrine. These chemicals are called neurotrans-mitters and are involved in the transmission of nervous impulses from cell to cell. Mental well-being is partially dependent on maintaining a balance among different neu-rotransmitters. Buspirone's actions are different from a common class of sedatives called benzodiazepines. The primary action of benzodiazepines is to reduce anxiety, relax skeletal muscles, and induce sleep. The earliest drugs in this class were chlordiazepoxide (Librium) and diazepam (Valium). Buspirone also acts through a different mechanism...

Acute stress disorder

Acute stress disorder (ASD) is an anxiety disorder characterized by a cluster of dissociative and anxiety symptoms that occur within a month of a traumatic stressor. It is a relatively new diagnostic category and was added to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) in 1994 to distinguish time-limited reactions to trauma from the farther-reaching and longer-lasting post-traumatic stress disorder (PTSD). Published by the American Psychiatric Association, the DSM contains diagnostic criteria, research findings, and treatment information for mental disorders. It is the primary reference for mental health professionals in the United States. Adjustment disorder A disorder defined by the development of significant emotional or behavioral symptoms in response to a stressful event or series of events. Symptoms may include depressed mood, anxiety, and impairment of social and occupational functioning. Exposure therapy A form of...

Classification systems

Classification systems include categorical, dimensional, and multiaxial types. In the categorical type of classification, each case is allocated to one of several mutually exclusive groups. This simple method is the most suitable one for clinical settings. Categorical systems are usually used in a hierarchical way, so that each case receives only one main diagnosis. Organic psychoses take precedence over functional psychoses, and functional psychoses over neuroses. This can lead to oversimplification of complex cases, and does not take account of 'comorbidity', in which two psychiatric diagnoses (for example, anxiety state and alcohol misuse) or a physical and a psychiatric diagnosis (for example, diabetes and depression) coexist.

Alcohol and related disorders

Alcoholism is defined as alcohol seeking and consumption behavior that is harmful. Long-term and uncontrollable harmful consumption can cause alcohol-related disorders that include antisocial personality disorder, mood disorders (bipolar and major depression) and anxiety disorders. . 2 cles). People with anxiety, depression, or bipolar disor- The goal of detoxification is to rid the patient's body of the toxic effects of alcohol. Because the person's body has become accustomed to alcohol, the person will need to be supported as he or she goes through withdrawal. Withdrawal will be different for different patients, depending on the severity of the alcoholism, as measured by the quantity of alcohol ingested daily and the length of time the patient has been dependent on alcohol. Withdrawal symptoms can range from mild to life-threatening. Mild withdrawal symptoms include nausea, achi-ness, diarrhea, difficulty sleeping, sweatiness, anxiety, and trembling. This phase is usually over in...

Mental Illness and Substance Abuse

Homeless adolescents also have very high rates of mental health problems and substance abuse. In a study from Seattle, 83 of street youths had been physically and or sexually victimized after leaving home, and 18 met criteria for posttraumatic stress disorder (Stewart, et al., 2004). Across the U.S., 55 of street youth and 34 of shelter youth had used illicit drugs other than marijuana since leaving home, in comparison to 13 of youth who had never been runaway or homeless (Greene, et al., 1997). Street youth use a wide range of drugs, including hallucinogens, amphetamines, sedative tranquilizers, inhalants, cocaine, and opiates. Unfortunately, the initiation of injection drug use is quite common, with an incidence rate of 8.2 per 100 person-years among street youth in Montreal (Roy, et al., 2003).

Context of the Referral

The reason for the referral is the symptomatic behavior or distressing experience that the person displays. This may be acting-out behavior in school, at home, or on the job grossly bizarre behavior behavior reflecting anxiety conditions or the appearance of troublesome moods. The point is that either the problematic behavior may be causing personal difficulty, or its effects may be disturbing a larger system such as the classroom, family, or workplace. The psychologist must constantly focus on the nature and extent of the tension that is involved with the symptom. The problem behavior is a statement of anxiety or distress that is either visible and directly experienced by someone, or disguised and expressed in a particular behavior. The disturbance of the person who is displaying difficulty or the disruption to those who are affected by it leads to contact with a person whose role is to help in some way. This helping person may be a teacher, counselor, nurse, therapist, or hospital...

What is relevant in practice

On the other hand, while obtaining valid consent is important, this does not always require in-depth discussions about risk factors, consequences etc. Instead, pre-test counselling should be adequate for the individual's situation. One should avoid causing unnecessary anxiety and psychological distress.

Structured interviews and questionnaires

A widely used questionnaire is the General Health Questionnaire (GHQ), a self-rating instrument used to detect probable cases of psychiatric disorder in general practice settings or community surveys. Many other questionnaires, both self-rating and observer rating, exist for specific parameters such as depression, anxiety, or cognitive impairment.

Cognitive Therapy Draws on a Wide Range of Cognitive and Behavioural Techniques to Change Thinking Beliefs Emotions and

Development of a wide range of cognitive and behavioural therapeutic strategies on which a cognitive therapist can potentially draw. The main cognitive approaches involve teaching clients to be able to identify, evaluate and challenge cognitive distortions (such as all-or-nothing thinking) and maladaptive beliefs ('I have to be upbeat and bubbly at all times to be liked'). The main behavioural approaches involve increasing positively reinforcing behaviours (for example, behaviours that are pleasurable and generate a sense of mastery in people diagnosed with depression) and extinguishing or replacing negative behaviours (such as 'safety behaviours' that maintain a fear in people diagnosed with an anxiety disorder).

Suggested Outline of Sections The Clinical Interview

The first section of the report concerns an evaluation of the functioning of the person as the person appears clinically. As discussed previously, the patient's behavior calls attention to a problem that creates anxiety, suffering, and distress for the patient or those around the individual. Thus, the observation of behavior by the psychologist in both the interviewing and testing phases of the psychological evaluation is an essential source of highly pertinent clinical information. The behavior the tester observes is a sample of the patient's overall behavior and can reveal the problems that led to the referral and evaluation in the first place. Above all, the clinical interview section is a discussion of the patient's coping and relating style. This information is vital in understanding the patient's problem behavior because it relates social functioning to the presence of undercurrents of anxiety or conflict. The next section of the report considers how attuned the patient is to...

Causes and symptoms

Of the head and neck in relation to the body, spasms of the jaw muscles, impaired swallowing, speaking or breathing, thickened or slurred speech due to a slow movement of the tongue, tongue protrusion or tongue dysfunction, eyes deviated up, down, or sideways, and abnormal positioning of the limbs or trunk. Patients experience pain and cramps in the affected muscles. In addition, many patients experiencing dystonia due to the neuroleptic treatment also experience fear and anxiety. This is especially present in patients who are not aware of the possibility of developing dystonia and who mistakenly associate these side effects as part of their mental illness. mittent in the affected limbs or joints. Bradykinesia includes decreased arm movements related to walking, as well as difficulty initiating movement. Drooling may occur due to a decrease in pharyngeal motor activity. People experiencing neuroleptic-induced akathisia usually feel anxious, agitated, and unable to relax. They also may...

Identifying Psychosocial Barriers to Success

There are a variety of bio-psychosocial obstacles to be recovered that contribute to treatment complexity. All of these variables impact compliance and sex lives substantially, in addition to the role of organic etiology (20). There are multiple sources of patient and partner psychological resistance, which may converge to sabotage treatment (i) What is the mental status of both the patient and the partner and how will this impact treatment, regardless of the approach utilized What is the nature and degree of patient and partner psychopathology (such as depression) What are the attitudinal distortions causing unrealistic expectations, as well as endpoint performance anxiety (ii) What is the nature of patient and partner readiness for treatment When and how should treatment begin, and be introduced into the couple's sex life What is his approach to treatment seeking What should be the pacing of intimacy resumption The average man with ED waits 2-3 years, before seeking...

Intellectual Functioning

Evaluation of component aspects of cognitive and intellectual functioning also must be related to hypotheses about personality dynamics being developed in the test report. Thus, evaluations of memory, planning, judgment, frustration tolerance, the influence of anxiety on performance, abstraction capacity, reasoning, and degree of empathy can all be assessed independently. These components also need to be integrated and related to the core understanding of the person and his or her difficulties that the overall report explains. A crucial aspect of this integration concerns the way in which anxiety is managed in the personality, because cognitive and intellectual skills are strikingly sensitive to interference from anxiety. Thus, anxiety and its vicissitudes are evaluated as a logical next step because, frequently, anxiety is largely responsible for the initial problem behavior or experience. The nature of the anxiety, its quality and quantity, is important for understanding both the...

Studies from the Published Literature

One explanation for these findings is that living in the city, coupled with living within a lower income stratification often involves navigating an increased number of stressful life experiences which include increased conflict with interpersonal relations, increased sensory stimulation, noise, stress, and anxiety associated with citylife, which can often encompass situations involving increased exposure to crime and violence (Yonas, 2004 Fischer, 1984 House, 1978 Milgram, 1970). City residents often experience limited access to and ability to engage institutional resources such as nutritious food resources, healthcare, mental health counseling, and or social support networks necessary for successfully negotiating the stresses of living in

The Privileged Structure Approach

The discovery of the benzolactams demonstrated that potent nonpeptide GH secreta-gogue agonists could be discovered in the 500-600 Kda molecular weight range. This was quite a breakthrough. Although there were many nonpeptide antagonists known at the time, the only precedent for non-peptide agonists were the opioid peptide mimetics including morphine and the analgesic benzodiazepine tifluadom. Compound screening continued after the benzolactam discovery in an effort to find different core structures that might more easily be converted to an orally active drug. There was precedent for additional leads in numerous structural variants of morphine especially since GHRP-6 was itself derived from enkephalin. Nevertheless, the discovery of this camphorsulfonamide series was important. It demonstrated that GH secretagogue agonist activity need not be limited to a narrowly defined pharmacophore and it contributed to the selection of the spiroindanylpiperidine nucleus for use in a privileged...

The Child with Impaired Consciousness GCS

Rapid assessment of neurological function should include an assessment of the conscious level (AVPU or Children's GCS scale are adequate), pupillary size and reaction to light, in addition to observation of the child's posture and convulsive movements, if present. Other CNS infections or intracranial haemorrhage should be considered as an alternative diagnosis in a child with neck stiffness or a full fontanelle. The presentation of an acute neurological syndrome characterised by impaired consciousness, convulsions, abnormal neurological signs, and opisthotonic posturing are cardinal features of cerebral malaria (2000). However, these features may also suggest raised ICP in a small proportion of children (Newton et al., 1991a Walker et al., 1992 Waller et al., 1991b). Initial management should include maintenance of the airway, support of breathing and immediate correction of hypogly-caemia and volume deficits. These interventions will correct hypoxia, hypoglycaemia or shock, which...

Impulse versus Control

Consideration of the issue of impulse versus control brings focus from a new perspective to the presenting behavior problem. This point of view provides an elaboration of the patient's dynamic forces through an analysis and discussion of the interplay between impulse and controls. Consequently, conclusions from the section on cognition and reality testing can be linked to broader aspects of the individual. For example, problems with issues of judgment, perception, and thinking can be related to strains in the relative balance between impulse expression and the extent of control over such expressions. Findings regarding the way in which anxiety operates in the functioning of the personality can now also be applied to the mechanisms that regulate impulses. Cognitive elements, anxiety, and control over impulses constitute an important sequence in understanding the struggle or conflict that underlies the more manifest behaviors and experiences of the patient. The dynamics of impulse...

Acculturative Stress

Acculturative stress, like stress, is defined as either an exogenous factor (stressor) or as an endogenous consequence (e.g., anxiety) of an exogenous process. Acculturative stress is considered to be a significant contributor to risk of illness. In contextual environments in which people live, work, play, and interact socially or digitally with others, there are bound to be acculturative changes at both the societal and the individual level. An important step in understanding acculturative stress was taken by Cervantes, Padilla, and de Snyder (1991) in their development of the Hispanic Stress Inventory. This measure helps partition added stress that comes about by virtue of being Hispanic and living in the United States.

Cognitive Therapy Areas Of Application

The last few decades have seen cognitive therapy adapted for mood, anxiety, personality, eating and substance misuse disorders. As well as these formal psychiatric disorders, cognitive therapy has been adapted for relationship problems and the psychological aspects of a range of medical disorders. Most recently cognitive therapy has been applied to the problem of anger generally and its manifestations in conflict specifically, while colleagues, mainly in England, have applied cognitive therapy to people with psychosis. A thorough review of these applications is beyond the scope of this chapter, but a brief overview is provided for the main areas of application. Interested readers may wish to follow up the references describing these adaptations and the following excellent reviews of evidence-based psy-chotherapies (Compas et al., 1998 De Rubeis & Crits-Cristoph, 1998 Fonagy et al., 2002 Kazdin & Weisz, 1998 Rector & Beck, 2001).

Sex Counseling Tips For Clinicians

Clearly, clinicians treating SD must consider the psychological and behavioral aspects of their patient's diagnosis and management, as well as organic causes and risk factors. Integrating sex therapy and other psychological techniques into their office practice will improve effectiveness in treating SD. Psychological forces of patient and partner resistance, which impact patient compliance and sex lives beyond organic illness and mere performance anxiety must be understood. The following key areas of therapeutic integration will be highlighted Focusing the sex history sexual scripts and pharmaceutical choice follow-up and therapeutic probe to manage noncompliance partner issues relapse prevention and referral.

Identity and Interpersonal Behavior

The major focus of each section of the report after the referral and interview has been largely on intrapersonal concerns, including reality testing, cognitive functioning, anxiety, impulse control, and defensive structure. At this point it is necessary to crystallize the information so that its impact on the person's life can be appreciated. Thus, the conflicts within the personality must be viewed as they affect relations with others. Another way of saying this is that what was previously analyzed in terms of intrapersonal organization will now be viewed in terms of interpersonal expression. Interpersonal difficulty is primarily determined by the nature of intrapersonal development in relation to ego strength and identity. The idea is that the subject's intrapersonal conflicts and deficiencies lead to corresponding interpersonal problems. In the report, this connection has to be clearly maintained. Previously, implications may have been drawn about the potential for interpersonal...

Discussing psychological profile

A psychological profile is built up which furnishes the counsellor with important information about how the individual is likely to cope under the stress of genetic knowledge. It addresses resilience, coping style and whether these will successfully sustain and provide the support needed. The discussion will possibly include previous experience of stressful events and their management by the individual. In addition, it is useful to know the family's reaction to its genetic potential or history, and whether the individual has found that helpful or not. In the Huntington's disease protocol, the counsellor may suggest to the individual that they imagine taking different decisions or having different test results. This exercise helps the individual mentally rehearse the different scenarios and explore and consider their possible future reactions. In this way the counsellor is helping the individual prepare to confront any future anxiety or grief. Soldan et al. (2000) refer to this...

Diagnosis and Prognosis

This method implies a system of diagnostic levels that are used for increasing refinement. Diagnostic understanding is developed from broader levels to deeper, latent dimensions. Thus, the diagnosis starts with a problematic behavior that may be specified as a clinical syndrome such as a phobia, sexual disturbance, or compulsion. If manifestations of anxiety are associated with these symptoms, a neurotic level of difficulty such as an anxiety disorder or obsessive-compulsive disorder can be specified. Underlying this level is the character formation in which the symptom is embedded. At this point the diagnosis is addressed to the character organization that produces symptomatic outgrowths. If there is a stable, deeply ingrained maladaptive pattern, a personality disorder can be specified for example, a schizoid or passive-aggressive personality disorder. Intellectual Functioning. Integrate I.Q. scores and intellectual functioning with cultural variables to contribute to a greater...

Environmental Strategiesmodifications

Occupational therapists in ways to simplify the home environment, such as eliminating clutter, breaking down tasks into component parts, and educating the caregiver about dementia and behavioral management. For example, clothing may be laid out according to the order in which it is placed on the body, resulting in reduced anxiety and agitation in patients. A modest effect was seen in patient dependency over time, and caregivers reported improved self-efficacy and reduced disturbance during caregiving activities.

Gender Role Conflict Related to Perceived Expectations of the Majority Cultures Gender Role Norms

Bowman (1992) studied gender-role strain in Black men who were both husbands and fathers. Specifically, Bowman assessed provider role strain, which was operationally defined to include such domains as father-role discouragement, husband-role discouragement, primary provider discouragement, objective employment barriers, and familial subsistence anxiety. The results showed that provider role strain reduced the men's global family satisfaction. Interestingly, two cultural resources were found to mitigate the negative impact of provider role strain, namely, family closeness and religious belief. That is, husband-fathers whose families were very close reported greater global family satisfaction compared to those whose families were less close. Similarly, husband-fathers who were very religious reported greater global family satisfaction than those who were less religious.

Uncertainty and the effects of knowledge

Uncertainty is part of every day life experience, a normal anxiety about what might happen in the future. This is always the unknown territory of the imagination onto which the individual projects long-standing personal ideas and attitudes. When there is a genetically determined illness in a family, this existential anxiety may become exacerbated and the fear then becomes focused on the unpredictable genetic element of the illness. Some people will project their good luck and certainty that they are free from the genetic change, or that they will not be affected by illness. In contrast, others will project their fearful fantasies and dread of illness. Having a genetic history changes the existential worry of the future unknown into an uncertainty In a review of adult-onset disorders, Meiser et al. (2000) commented that there is limited data on the impact of testing for the hereditary cancers. One study of hereditary breast-ovarian cancer showed a reduction in depressive symptoms in...

Gender Role Conflict Related to Gender Role Norms of a Particular Racial and Ethnic Minority Group

Heavy cultural pressures face Latinas too, whether they are Mexican American, Cuban, or Puerto Rican. These pressures can be summed up with one commandment Be a good girl (Garcia-Preto, 1998). Being a good girl means making motherhood one's major objective in life, protecting one's virginity, living at home with one's parents until marriage or college, acting like a lady, and caring for children or the elderly. Garcia-Preto provides several case studies based on therapy with clients presenting a variety of gender-role issues. For example, a young Latina wanted to play sports after school. Initially, the parents would not allow the young girl to do so because of their cultural beliefs that girls should sit sedately, be quiet, and not be tomboys. On the other hand, at school the daughter was being encouraged to try out for sports because of her obvious talent and interest. In another study, Claudia, a 24-year-old Cuban, was the youngest daughter living with her parents. Although she...

Pharmacological Toxicological Effects 51 Neurological Effects

A randomized, 25-week, placebo-controlled study by Volz and Kieser showed a significant benefit from the use of kava-kava extract WS 1490 over placebo in treating anxiety disorders of nonpsychotic origin. The study included 101 patients suffering from agoraphobia, specific phobia, generalized anxiety disorder, or adjustment disorder with anxiety as per the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised who were randomized to placebo or WS 1490 containing 90-100 mg dry extract per capsule three times daily. The main outcome criterion, the patients' score on the Hamilton Anxiety Scale, was significantly better (p < 0.001) for the WS 1490 patients compared to placebo at 24 weeks. Few adverse effects were judged to be related or possibly related to kava administration. Two patients in the WS 1490 group experienced stomach upset, two noted vertigo, and one experienced vertigo and palpitations. These results support use of kava as an alternative to...

Discussion And Conclusions

Women, it may have little behavioral impact on their life insurance purchasing behavior. Consistent with this argument is the research finding that women of all ages who test positive for the BRCA1 mutation experience little change in psychological well-being (as measured by anxiety, intrusion, and avoidance scales) between the pre- and post-test interviews because for many it only serves to affirm what they already suspected (Croyle, et al., 1997).

Case Study Jon and Linda

Jon and Linda were referred to the author by Jon's current psychopharmacolo-gist. Jon is a 62 years old financier who has been married to Linda (53 years old) for over 20 years. She began HRT 4 years ago, which successfully stopped her hot flashes. This is his second marriage and her first marriage. They had three teenage children together. Their marriage was marked by periods of disharmony secondary to multiple etiologies. Jon and Linda had a symbiotic relationship where she dominated much of their daily life. She tended to be explicitly critical of him, which he resented but managed passive-aggressively. This, of course, merely exacerbated their marital tension. Linda was particularly sensitive to rejection, and was considerably upset when Jon withdrew from her in response to her criticism. This infuriated her and she provoked confrontations. He eventually responded, becoming loud and aggressive, which initially dissipated his tension. He then felt guilty as she expressed hurt and...

Health Issues Affecting Lgbt Populations

Sexual orientation is not intrinsically linked to mental health problems however, stigma, homophobia, and prejudice may negatively impact the mental health of LGBT individuals (Meyer, 2003). Furthermore, estrangement from family members, adjusting to a LGBT identity, lack of support for relationships and families may be additional stressors. Unfortunately, population-based estimates of prevalence of mental disorders among LGBT people are lacking (Dean, et al., 2000). The few probability based studies that have been done found higher rates of depression, panic attacks syndrome, and psychological distress among MSM (Cochran and Mays, 2000 Cochran, et al., 2003 Mills, et al., 2004), especially among those who had experienced anti-gay harassment (Mills, et al., 2004). Lesbian and bisexual women appear to have higher prevalence of general anxiety disorder compared to heterosexual women (Cochran, et al., 2003). HIV (Bing, et al., 2001 Dickey, et al., 1999) as well as the stress of caring...

Rapid Eye Movement Behavior Disorder and Restless Legs Syndrome

The treatment of choice for RBD is clonazepam, a benzodiazepine, although the mechanism is unknown and there are no controlled trials (13). Other drugs thought to be helpful for RBD include pramipexole, levodopa, carbamazepine, donepezil, and melatonin (64,89-91). Caution needs to be exercised with the use of clonazepam, as in some cases, RBD may be confused with sleep apnea, which can be worsened by clonazepam. Nighttime dosing with drugs such as selegiline may aggravate RBD. Others have reported a paradoxical worsening of RBD with deep brain stimulation (DBS) of the subthalamic nucleus (STN) (92).

Current Cancer Biomarkers

Currently, hundreds of tumor markers exist, yet most of them fall short of expectation. Clinicians expect that a marker should be beneficial to their patients in terms of improved morbidity, mortality, and quality of life. To illustrate the point, even if a biomarker is able to detect relapse a few months prior to clinical symptoms, if effective treatment does not exist, this information does not necessarily translate into improved outcome. Moreover, knowledge of tumor marker elevation may be potentially harmful since it shortens disease-free survival and adds to patient anxiety.

Genetic Counseling and Genetic Testing

Improvements in our understanding of human heredity and the identification of numerous disease-causing genes have led to the development of hundreds of tests for genetic conditions. The ultimate goal of genetic testing is to recognize the potential for a genetic condition at an early stage. In some cases, genetic testing allows early intervention that may lessen or even prevent the development of the condition. In other cases, genetic testing allows people to make informed choices about reproduction. For those who know that they are at risk for a genetic condition, genetic testing may help alleviate anxiety associated with the uncertainty of their situation. Genetic testing includes newborn screening, heterozygote screening, presymptomatic diagnosis, and prenatal testing.

Interviewing Those Suspected Of Crime

Gudjonsson (2002) is one of the few researchers who has successfully contended, in court cases, that interviewees have been adversely affected by tactics. However, almost no research has gathered information about this from suspects themselves. Holmberg and Christianson (in press) recently conducted a pioneering study involving a questionnaire completed by men who were in prison for murder or for serious sexual offences. This postal questionnaire involved the prisoners rating, on seven-point scales, their judgements perceptions of the behaviour manner attitudes of the police officers who had interviewed them during the (relevant) investigation. The questionnaire also asked the prisoners to rate their emotional reactions to the interviewers' behaviour. The data revealed that only a few 'perceived their interviewers as having shown a great personal interest and having tried to create a personal conversation' or 'perceived their interviewers as highly sympathetic and empathetic' (p. 10)....

Cholinesterase Inhibitors

McKeith and colleagues (McKeith, Del Ser, et al., 2000) performed a randomized, placebo-controlled, double-blind trial using rivastigmine to treat behavioral disturbances in DLB. This was a large multicenter trial involving 120 patients. Nearly 63 in the treatment group showed at least a 30 improvement on the Neuropsychiatric Inventory (NPI Cummings et al., 1994). Functionally, this equated to less apathy, less anxiety, and fewer delusions and hallucinations. Cognitive improvements, in particular, in measures of attention and memory also occurred. Cholinergic side effects (nausea, vomiting, and anorexia) were reported in some patients. Grace et al. (2001) reported on a smaller pilot trial of open-label treatment with rivastigmine in 29 DLB patients who were followed over a period of 96 weeks. No detectable declines in cognition as measured by the MMSE

Types of Web Based Methods

Web-based psychological testing constitutes one specific subtype of Web surveying (unless an experimental component is part of the design, see Erdfelder & Musch, this volume, chap. 15). Buchanan and Smith (1999), Buchanan (2001), Preckel and Thiemann (2003), and Wilhelm and McKnight (2002), among others, have shown that Web-based testing is possible if the particularities of the Internet situation are considered (e.g., computer anxiety may keep certain people from responding to a Web-based questionnaire). Buchanan and Smith found that an Internet-based self-monitoring test not only showed similar psychometric properties to its conventional equivalent but compared favorably as a measure of self-monitoring. Their results support the notion that Web-based personality assessment is possible. Similarly, Buchanan, Johnson, and Goldberg (2005) showed that a modified International Personality Item Pool (IPIP) inventory they evaluated appears to have satisfactory psychometric properties as...

Individual perception of the stress of genetic counselling

It has already been stated that although there is a potential for stress in addressing a genetic problem, the individual's appraisal will determine how it is perceived and whether it is construed as stressful. McConkie-Rosell and Sullivan (1999) have adapted Lazarus and Folkman's Theory of Stress and Coping (1984) for genetic counselling and consider that the factors influencing perception in the primary appraisal of genetic counselling are environmental, personal and social. The environmental factors refer to the disease, the severity of the disorder, availability of treatment, number of affected individuals in the family and the amount of contact with affected or carrier family members. The individual's personal experience of these facts is an important factor in establishing their meaning. The personal and social variables include self-concept, comprehensive family characteristics, the amount of social support and desire for children or grandchildren. The interaction between the...

Drug Use Epidemiology

Polydrug use is a common occurrence that is generally not assessed in national datasets which instead tend to report on drugs separately. Compared to using specific drugs by themselves, polydrug use has been associated with more traffic accidents (Bo, et al., 1975), increased toxicity (Hearn, et al., 1991), and higher risk of death from overdose (Coffin, et al., 2002a). Data are consistent in showing that polydrug use in general contributes substantially to overdose mortality. Up to 90 of overdoses presenting to an emergency department in Switzerland were shown to be positive for multiple drugs (Cook, et al., 1998) and 84 of cocaine overdose deaths in Spain also involved heroin (Lora-Tamayo, et al., 1994). Among injection drug users (IDUs), benzodiazepine use was associated with increased risk of both death from all causes and death preceding AIDS diagnosis (Van Haastrecht, et al., 1996). In a study of the relative contributions of different drug combinations of opiates, cocaine and...

Discussion and Concluding Remarks

It has been demonstrated that myocardial blood flow can be studied by dynamic SPECT imaging of 99mTc-teboroxime 109,110 . Another interesting application of dynamic cardiac SPECT is the measurement of perfusion and the distribution volume in the heart using 201Tl 111, 112 . Other applications include brain imaging with 99mTc and 123I flow agents and some neuroreceptor studies, such as 123I iomazenil for benzodiazepine receptors 115 , 123I iododexetimide for cholinergic muscarinic neuroreceptors 114 , and 123I iodo-A-85380 for central neuronal nicotinic acetylcholine receptors 115,116 , etc., both in human and nonhuman primates.

Different coping responses

In their analysis of stress and genetic testing for disease risk Baum et al. (1997) explored the relationship between the disease and the individual's coping. They considered that the extent to which genetic testing for disease causes significant distress varies as a function of the following factors the test results, the characteristics of the disease, the uncertainty remaining after testing, the degree of uncertainty reduction, the availability of active coping option and personal factors such as social support, optimism, perceived risk and beliefs about disease and disability. As a consequence, the interaction of all these factors results in a range of coping responses which have been described in varying ways. These include adaptive or maladaptive (McConkie-Rosell and Sullivan, 1999), or resilient, normal stress and pathological stress response (Horowitz et al., 2001). However, in this text the terminology adopted by Tibben (1993) is used - that of mature, defensive and...

Psychological Treatments

Recent outcome studies include one in 2001 of 74 couples randomized to 12 weeks of CBT or an untreated control group (81). Of the women receiving CBT who met the criteria of hypoactive sexual desire pretreatment, 26 continued to do so at the end of treatment and 36 met the criteria 1 year later. The CBT group experienced significant improvements in sexual satisfaction, perception of sexual arousal, dyadic adjustment, improved self-repertoire, sexual pleasure, and perceived self-esteem, as well as general increase in motivation, mood, and lessening of anxiety. In a noncontrolled study of the same year (82), CBT was assessed in 54 women having a broad spectrum of sexual dysfunction. Fifty-four percent of the women still had the same sexual complaints after treatment, although the overall levels of sexual dysfunction were reduced and there were more positive attitudes towards sex and increased sexual enjoyment and less perception of being a sexual failure. A study of 39 women with low...

From Philosophy To Theory

The evolutionary thesis may also be seen to provide a basis for deriving the so-called clinical syndromes of Axis-II, as well. To illustrate briefly, consider the anxiety disorders. Without explicating its several variants, a low pain threshold on the pleasure-pain polarity would dispose such individuals to be sensitive to punishments that, depending on covariant polarity positions, might result in the acquisition of complex syndromal characteristics, such as ease of discouragement, low self-esteem, cautiousness, and social phobias. Similarly, a low pleasure threshold on the same polarity might make such individuals prone to experience joy and satisfaction with great ease again, depending on covariant polarity positions, such persons might be inclined toward impulsiveness and hedonic pursuits, be intolerant of frustration and delay, and, at the clinical level, give evidence of a susceptibility to manic episodes. To use musical metaphors again, DSM-IV's Axis I clinical syndromes are...

Relevance for vertebrate systems

To link sexual karyotype to the development of sex-specific characteristics. Arnold has proposed that regulatory genes on the X (that escape dosage compensation) and Y chromosomes may directly organize sex-specific CNS characteristics (Arnold, 2004). Indeed, there is some evidence that the Y-chromosome sex-determining gene Sry has such a role in the nervous system (Dewing et al., 2006). However, such a model may capture only one aspect of this process. It is also quite possible that sexual karyotype controls much more complex regulatory networks, such as those characteristic of C. elegans and Drosophila sex determination, that read the sex-determining signal and set into motion a cascade of interactions that only very indirectly lead to sex-specific gene expression. The potential existence of such a pathway in the mammalian nervous system has intriguing implications for the mechanisms that bring about sex differences in neuroanatomy and neural function moreover, genes in such a...

Mental features of depression

There are those in psychiatry who feel that depression can be diagnosed without depression of mood being obvious to the patient or readily apparent to the psychiatrist. It is just conceivable that this may apply to prodromal or very mild cases of depression, or to patients with a mixture of anxiety and depression symptoms. However, generally speaking, it is necessary to do violence to the idea of clinical depression to consider that any significant case of depressive illness can exist without depression of mood.

Nervous System Effects

Anxiolytic effects have been demonstrated in animal models. The effect of Zingicomb (Mattern et Partner, Starnberg, Germany), a combination product containing 24 ginkgo flavonoids and 23.5 gingerols, administered orally to rats at a dose of 0.5-100 mg kg was compared with the effects of placebo and diazepam administered intraperitoneally at a dose of 1 mg kg on anxiety-associated behaviors (4). The rats were subjected to an elevated plus-maze consisting of enclosed and open arms. The 0.5 mg kg dose of Zingicomb was associated with rats spending more time in the open arms and with more excursions toward the ends of the open arms as compared to placebo. At a dose of 100 mg kg, excursions to the ends of the open arms and scanning (protruding the head over the edge of an open arm and looking around) were fewer. These results were interpreted to mean that the preparation exhibited anxiolytic effects at a dose of 0.5 mg kg, but anxiogenic effects at 100 mg kg. Both the herbal product at a...

Glycocholate Breath Test

Breath test is a simple, inexpensive, and noninvasive technique to diagnose SBBO. The lactulose breath test is performed after 12 hours fasting previous to the test. Hydrogen breath samples are taken at baseline, and subsequently every 10-30 minutes after the test meal that contains 10-12 g of lactulose. The hydrogen breath samples are analyzed gas chromatographically (81). Baseline samples average 7.1 +5 parts per million (ppm) of H2 and 0-7 ppm for CH4 (82). Values of the baseline sample over 20 ppm H2 are suspect for bacterial overgrowth. Values between 10 and 20 suggest incomplete fasting before the test or ingestion of slowly digested foods the day before the test, the colon being the source of the elevated levels (82). Slowly digested foods like beans, bread, pasta, and fiber must not be consumed the night before the test because these foods produce prolonged hydrogen excretion (82). The patient is not allowed to eat during the complete test. Antibiotics and laxatives must be...

Differential Therapeutics

As a clinician, when might you think of using IPT As a psychiatrist decides which antide-pressant medication to prescribe based on a patient's symptom constellation and research findings, so too should clinicians consider when to use IPT. The research to date supports that IPT works best for depressed patients who face distressing life events ranging from medical illness to job and relationship changes and conflicts. Patients with interpersonal deficits who report no recent life events or changes will probably fare better in CBT. Interpersonal therapy may also work well for patients with anxiety and personality disorders who report recent life events, but research is in these areas, although promising, is still in the early stages. Interpersonal therapy may be a good option for patients who want to augment

Clinical classification of depression

Mild depression is more common, and the symptoms are more like an exaggeration of ordinary unhappiness. Somatic symptoms are not prominent, and delusions and hallucinations do not occur. There may be marked tearfulness, anxiety, irritability, and difficulty getting to sleep. It is, however, probably an over-diagnosed condition these days, especially in general practice. This is not to criticize our colleagues in primary care. Patients have been encouraged to take their emotional difficulties to doctors in previous eras, they might have been seen as tired and given a tonic, and in later times as anxious, and given benzodiazepines. Currently, the social and medical culture guides doctors and patients toward a diagnosis of depression and the prescription of an antidepressant.

Rorschach Comprehensive System

In the United States, the Rorschach inkblots are relatively well known, particularly among middle-class persons who recognize the implicit social expectations for accommodating their responses to the inkblots. This is also true in Europe, where large populations of middle-class, highly educated, and intellectually sophisticated persons are well informed about the Rorschach as a clinical method. In Latin America, by contrast, the test is more novel, anxiety-producing, and lacking specific rules that could lead to an anticipation of what may consti tute acceptable responses. Moreover, Latin Americans live in more authoritarian, nonegalitarian, and frequently inherently unstable societies with much smaller percentages of middle-class and educated persons in the population and infinitely greater differences in income levels. The power differentials between ordinary citizens and authority figures, especially persons representing government in any capacity, are more extreme. The testing...

Psychosocial health promotion

The preceding health goals and targets focus mainly on physical illness and do not emphasise mental health. However, this area represents an enormous opportunity for anticipatory guidance. It includes the important problems of stress and anxiety, chronic pain, depression, crisis and bereavement, sexual problems, adolescent problems, child behavioural problems, psychotic disorders and several other psychosocial problems.

Guidelines for Survivorship Care

Guidelines can still be useful even when based more on consensus than evidence, however. Clinical practice guidelines can decrease variation in care, particularly overuse of investigations8 that can lead to inefficiencies in health care delivery. For example, breast cancer guidelines recommend against imaging studies and tumor markers to look for metastases,6,7 and colorectal surveillance guidelines caution against the overuse of nonspecific blood work.4 In addition to economic costs, overused surveillance tests and visits often lead to false positive results and further investigations, with inherent physical and psychological risk.9,10 Indeed, randomized trials have not been able to consistently find positive psychological effects associated with surveillance.10,11 While being told that there is no sign of cancer recurrence can understandably decrease anxiety,12 the stress leading up to it, inconvenience and often discomfort of testing, and not infrequent detection of incidental...

Behavior modification

Behavior modification is used to treat a variety of problems in both adults and children. Behavior modification has been successfully used to treat obsessive-compulsive disorder (OCD), attention-deficit hyperactiv-ity disorder (ADHD), phobias, enuresis (bed-wetting), generalized anxiety disorder, and separation anxiety disorder, among others.

Psychiatric conditions

Dilemma, although sometimes they are present together. Both depressive and manic symptoms may occur in combination with symptoms of schizophrenia schizo-affective disorder. Agitated depression and mixed depressive anxiety neurosis are easily mistaken for pure anxiety states. Antisocial personality disorder may be confused with mania.

Complex Syndrome Treatment Goals

Parallel Behavior Therapies As written previously, behaviorists contend that other therapeutic approaches are method-oriented rather than problem-oriented. Non-behaviorists are seen to proceed in a uniform and complicating fashion regardless of the particular character of the patient's difficulty, utilizing the same psychoanalytic or cognitive procedure with all forms and varieties of pathology. Not only do they claim that behavioral approaches are flexible and problem-oriented, but there is no fixed technique in pure behavior therapy. As we see it, behavioral techniques are extremely useful in counteracting simple clinical reactions that manifest themselves in overt behaviors. They distinguish the elements of each simple reaction and then fashion a procedure designed specifically to effect changes only in that problem. For example, if the patient complains of acute anxiety attacks, procedures are designed to eliminate just that symptom, and therapy is completed when the symptom has...

Questionnaires Selfmonitoring and Observation of Behaviour

Questionnaires are often useful to generate a first impression of the problem behaviour. Depending on the problem behaviour (for example, anxiety, depression, substance abuse) the therapist can select from a number of questionnaires that collect domain-specific information. When the domain is depression, the therapist can administer the Beck Depression Inventory (Beck et al., 1996), which is developed to assess the behavioural manifestations of depression, as well as for example the Pleasant Events Schedule (MacPhillamy & Lewinsohn, 1976), which aims to assess to what extent the patient still initiates pleasant activities that may serve as reinforcers. In regards to substance use disorders, the Time Line Follow-Back (TLFB) method gives a good impression of the quantity and frequency of drinking drug taking during the past six months, as well as more detailed information on pattern of substance use (Sobell, Toneatto & Sobell, 1994). For a comprehensive review of behavioural...

Genetic Counseling Provider Roles Service Delivery And Informed Consent

Given the complex nature of interpreting family histories and test results and the evolving literature about cancer risks and management options as well as the potentially life-changing implications of testing, comprehensive pre- and post-test genetic counseling is recommended when testing for a highly penetrant cancer syndrome is considered (16,17). Counseling can help to ensure that patients make autonomous decisions that are based on adequate information and which are consistent with their values and preferences (3,4,10,13). Anxiety and inflated risk perceptions sometimes drive patient interest in testing (18,19). Even if the objective risk of cancer or carrying a gene mutation is low, patients may still benefit from genetic counseling to gain a better understanding of their risk and available options. In general, research has demonstrated that genetic counseling results in improved knowledge and does not have significant adverse psychological effects (20). However, one of the...

Electroconvulsive therapy ECT see Chapter

As previously indicated, ECT has a place in emergency treatment, and when other treatments have failed. It is currently infrequently used, but tends to have good results in the more severe cases in which it is utilized. ECT is effective in about 80 per cent of patients with severe depression, notably in psychotic cases with delusions or hallucinations. Mild depression seldom responds well to ECT. Prescribing an antidepressant alongside ECT is usually recommended. Benzodi-azepines, used for insomnia or anxiety, should be stopped before ECT is started, as their anticonvulsant properties will interfere with the effectiveness of ECT in producing a convulsion.

Detection and Recognition

No standardized tool or method has been specifically developed to detect and assess anxiety in the PD population. Detection may be problematic, because several symptoms of anxiety overlap with mental and somatic symptoms commonly associated with PD. The Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) criteria for GAD in the general population includes a period of at least six months with prominent tension, worry, and feelings of apprehension about everyday events and problems, along with the presence of at least four of 22 accompanying autonomic, psychic, and somatic symptoms (36). However, several of these accompanying symptoms, such as tremor, concentration difficulties, dizziness, muscle aches, and numbness or tingling, are also commonly attributed to PD and may not be recognized as components of an anxiety disorder. Given that anxiety appears to be common over the course of PD, periodic assessment would significantly enhance detection. In the absence...

Reality Testing and Cognitive Functioning

Additional material relevant to the cognitive organization section of the psychodiagnostic report is presented in this chapter. The ego functions described here pertain to the analysis of cognitive organization involving diagnostic formulations of nonpsychotic character or personality problems, neuroses, and normalcy. Neurosis here is referred to as corresponding to the DSM categories of anxiety, somato-form, dissociative, and other nonpsychotic disorders not classified as personality disorders that are based on sustained difficulty with anxiety and symptoms.

Understanding individual difference in genetic counselling using attachment theory

The last chapter clarified how individuals differ in their management of anxiety and grief and linked it to the perception of genetic counselling and whether it was seen as stressful or not. In addition, individuals were shown to differ in their coping responses and to fall broadly into one of three groups mature, defensive and symptomatic. This is particularly relevant to the counsellor as it explains different approaches and responses to genetic counselling. There are however individual differences in a number of other areas which have relevance for genetic counselling. These differences relate to the way a genetic family story is told, the thinking behind decision-making and the nature and pattern of relationship with the counsellor. All these differences of individual behaviour can be understood by referring to the concepts contained in attachment theory. The theory provides a framework which explains how these differences have arisen and how they are played out in genetics. Armed...

Selective Serotonin Reuptake Inhibitors

Results from uncontrolled studies suggest that SSRIs are effective for anxiety in PD (42-44). In an open-label study (n 10), Menza et al. (42) reported that citalopram (mean dose 19mg d) improved anxiety in depressed PD patients. In a study of 30 patients, paroxetine (20 mg twice daily) reduced psychic and somatic anxiety symptoms, as well as depressive symptoms after six weeks (43). Sertraline was also found to have anxiolytic effects in PD patients (44). Although these data are derived from uncontrolled studies, many specialists prefer to use SSRIs for managing anxiety and depression in PD (49).

Neurotransmitters mental disorders and medications

Generalized anxiety disorder e People with generalized anxiety disorder (GAD) experience excessive worry that causes problems at work ra and in the maintenance of daily responsibilities. s Alcohol is one of the depressant drugs in widest use, and is believed to cause its effects by interacting with the GABA receptor. Initially anxiety is controlled, but greater amounts reduce muscle control and delay reaction time due to impaired thinking.

The Therapeutic Relationship

Arnold openly discusses a multitude of problems that bother him, cooperatively registers his problem behaviours (panic attacks), but consistently sabotages his homework assignments. The first session he forgot his assignments, the second session the neighbour visited, and the third session he spent five minutes on the scheduled exercise instead of the agreed upon 90 minutes. When something like this happens, the therapist should collaboratively re-examine the problem analysis with the patient. In this case it demonstrated that Arnold thought that the treatment approach was far too simplistic for his problems. How were a couple of homework assignments going to cure him of his anxiety attacks that had been haunting him for more than 10 years A 46 year-old woman suffered from social anxiety and agoraphobia. Initially, treatment (exposure in vivo) appeared to be going smoothly, but as the exercises progressed treatment halted. The patient started cancelling appointments and when she did...

Integrative Function of the

The integrative function of the ego regulates anxiety, thinking, perception, and feeling to promote effective pursuit of goals. The integrative function involves the level of cognitive functioning at which even if impaired essential ego integrity and the capacity for reality contact are no longer in question. In terms of reality testing and cognitive organization, the assumption of nonpsychosis has been established and reality testing is considered intact. In considering this ego function, it is important to evaluate the regulation of instinctual drives and feelings, the management of anxiety, and the extent to which there is adaptation to realistically perceived, external demands. Impairment of the integrative function of the ego means that the person, although essentially intact and in touch with reality, may nevertheless misapprehend, distort, act-out, and become labile. Such distortions can occur on the basis of less than adequate defensive control over impulses and needs, but not...

Communicating Findings

Impairments at this level have great difficulty focusing in a constructive manner on impersonal, external, and task-oriented requirements or on the realistic activities required to develop satisfying personal relationships. Rather, personal worries, narcissistic preoccupations, and unsettling inner conflicts replace action and drain significant energy away from external challenges and opportunities. These inner conflicts may appear as sexual preoccupations, masturbatory compulsions, dependency needs and avoidance of anxiety associated with risk-taking, and involvement in fantasies related to these preoccupations. Such findings are appropriate to discuss in reporting the impairments related to the patient's integrative aspect of cognitive functioning. It should be clear that impairment of this ego function does not involve gross or basic impairment of the patient's capacity for reality testing, or fragmentation of the patient's cognitive organization. Instead, extra demands are placed...

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