Natural Anxiety and Panic Disorders Treatment Ebook

The 60 Second Panic Solution

The 60 Second Panic Solution' is a program created by Anna Gibson Steel to help sufferers of panic attacks triggered by their daily activities address and overcome them. In this program lies a method that when followed, you will be able to subdue your panic and in just a minute, you will attain a balanced emotional level. This program has undergone the test of time and in every situation, it has come out successful. It has been tested by various people of different backgrounds and age brackets and has produced a positive result in each case. As mentioned, with this program, it will be like you are seeing the fire burning and you calmly walk to a tank of water, fill up a bucket and gently quench the fire. So, all that is required of you is to simply follow the steps involved in this program as proposed by Anna and look forward to experiencing the best results. Use these steps to manipulate your brain into returning to its normal state. This program is available for purchase on their website at and is available in PDF format, videos and audio, whichever suits you. It is an awesome program meant mainly for those who suffer from these panic attacks. Although, if you are close to someone who has these attacks you can use this program to help them work their way through these attacks or better still introducing them to it for a firsthand experience. And then you can also follow the program and be enlightened for future purposes. Read more...

The 60 Second Panic Solution Summary


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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).

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 features that we...

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) have led to...

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 alcohol abuse...

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...

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...

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.

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.

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 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...

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...

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.

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...

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...

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 therapy for panic disorder....

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).

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)....

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

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.

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....

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.

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...

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.

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 related...


The pharmacological treatment of anxiety also began with a serendipitous discovery involving a compound synthesized for a completely different indication. Anti-infective research in the late 1940s produced a set of compounds with unexpected calming effects in rats and led quickly to the development of the meprobamate derivative introduced in 1955. Although not very effective, this compound played an important role in demonstrating the feasibility of pharmacological interventions in anxiety disorders. The discovery of the benzodiazepines, which act on GABA-A receptor ion channels, revolutionized the treatment of anxiety with the launch of Valium in 1963. Today, the SSRIs developed for depression represent first-line therapy for anxiety disorders, supporting shared molecular mechanisms underlying anxiety and depression. 148 Although GPCRs have not historically been targets for anxiolytic drugs, they are well represented in emerging therapies, where there is strong overlap with...


Benzodiazepines were widely prescribed in the 1960s and 1970s as anxiolytics and hypnotics. For a while, they were perceived as 'wonder drugs' against neurosis, with no side-effects or addiction potential, in contrast to their predecessors, the barbiturates. In the 1980s, however, because of concern about their inappropriate use for people with social and interpersonal problems rather than true psychiatric disorder, and because of the emerging risk of dependence, prescription of benzodiazepines was discouraged, psychological techniques of anxiety management being recommended as an alternative. Current CSM advice is that 1. Benzodiazepines are indicated for the short-term relief (2-4 weeks only) of anxiety that is severe, disabling, or subjecting the individual to unacceptable distress, occurring alone or in association with insomnia or short-term psychosomatic, organic, or psychotic illness. 2. The use of benzodiazepines to treat short-term 'mild' anxiety is inappropriate and...


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...

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.


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 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,...

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...

Causes and symptoms

Anti-anxiety drugs can be taken orally to bring about a general calming or drowsy effect, usually experienced as pleasant. Abuse of anti-anxiety medication can develop with prolonged use, as tolerance grows relatively quickly. Increasing amounts of the drug are then needed to produce the initial effect. It is possible to become addicted to anti-anxiety drugs even when they are medically prescribed. A second cause of anti-anxiety drug abuse is the use of these drugs, especially when combined with other drugs, such as cocaine. It is not uncommon for an addict to pair the use of a stimulant, such as cocaine or metham-phetamine, with a CNS depressant. This allows the user to feel alert for an extended period of time, and then be able to come down from the high, and even fall asleep.

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...

Prioritization of Treatment Strategies

Behavioural couple therapy (BCT) is as effective as individual CBT not only with alcohol abuse but also with depression and anxiety disorders (Emmelkamp & Vedel, 2002). Because of Mick's early retirement and the consequences this was going to have on their relationship, and taking into account their overall low marital satisfaction, we decided to offer Dianne and her husband BCT, focusing on the drinking problem as well as their relationship. If still needed, the spouse-aided therapy for alcohol abuse could be supplemented by spouse-aided therapy for depression or anxiety. Because Dianne had already started using Acamprostate, we agreed that she would continue using the anti-craving agent during the course of our treatment.

Clinical features of FRAXE disease

Patients with the expanded FRAXE repeats show mild to borderline mental retardation, with delays in language development a common problem. Some FRAXE patients also exhibit behavioral abnormalities, such as attention deficit, hyperactivity, autistic-like behavior, even schizophrenia and obsessive-compulsive disorder (OCD) (Gecz 2000b Wang et al. 2003). Most patients with FRAXE are not easily distinguished from the general population as there are no consistent physical features in these patients, and FRAXE is considered to be a non-syndromic form of mental retardation. However, among FRAXE patients, reports of a long, narrow face, mild facial hypoplasia, a high-arched palate, irregular teeth, hair abnormalities, angiomata, clin-odactyly, thick lips and nasal abnormalities can be found (Barnicoat et al. 1997 Biancalana et al. 1996 Carbonell et al. 1996 Hamel et al. 1994 Knight et al. 1996 Mulley et al. 1995 Russo et al. 1998). In addition, in some families, the FRAXE fragile site does...

Personology And Psychotherapeutic Approaches

In this way, its methods differed dramatically from the psychoanalytic methods of free association. Later, behavioral approaches were applied to clinical treatment of anxiety and other clinical syndromes but not to personality disorders. Behavioral approaches continue to offer empirically sound methods and techniques such as systematic desensitization and anxiety reduction techniques that are useful to incorporate into treatment.

Classification of Quantitative Text Analysis Approaches

Instrumental analyses focus mainly on latent content. Independent of the author's intention, a message is analyzed for occurrences of a set of themes (e.g., hostility, anxiety, need for power). The linguistic analysis at the beginning of the chapter, for instance, was instrumental because rather than representing what the students intended to say it focused on selected psychological aspects of language use (e.g., words hinting at emotional and social functioning).

The Theoretical Basis For

When Marsha Linehan is asked to tell the story of her development of dialectical behaviour therapy (DBT) she says that she did not set out to invent a theoretical orientation for the treatment of borderline personality disorder (BPD). Linehan was treating suicidal clients, attempting to use standard behaviour therapy with them. However, it was not successful for many of the clients. They would present at an individual psychotherapy session with one problem, such as panic disorder and Linehan would choose an empirically supported treatment for that problem. When the clients returned for the next session they would not have completed the prescribed homework because other problems would have surfaced. Linehan realized that standard treatments were not working because the problems of the clients changed from session to session and moment to moment. Her laboratory developed DBT from an attempt to find a means of prioritizing the multiple problems presented by clients who engaged in...

Xivsomatoform Disorders A Somatization Disorder

Burning hands and feet as well as nondelusional experiences of worms in the head or ants crawling under the skin in comparison to individuals from North America. In cultures in which semen loss is a great concern for their people, symptoms associated with male reproductive function tends to be more prevalent (DSM-IV, 1994, p. 447). In India, Sri Lanka, and China, severe anxiety associated with that concern is known as dhat (see Table I). Symptoms resembling Somatization Disorder have also been reported in the case of the culture-bound syndromes Susto and Ataques de Nervios (Table I DSM-IV, 1994, p. 845 Escobar, 1995).

A safe diagnostic strategy

The discipline of general practice is probably the most difficult, complex and challenging of the healing arts. Our field of endeavour is at the very front line of medicine and as practitioners we shoulder the responsibility of the early diagnosis of very serious, perhaps life-threatening, illness in addition to the recognition of anxiety traits in our patients. Our area is characterised by a wide kaleidoscope of presenting problems, often foreign to the classical textbook presentation and sometimes embellished by a 'shopping list' of seemingly unconnected problems or vague symptoms the so-called undifferentiated illness syndrome. 1 Common undifferentiated symptoms include tiredness or fatigue, sleeping problems, anxiety and stress, dizziness, headache, indigestion, anorexia and nausea, sexual dysfunction, weight loss, loss of interest, flatulence, abdominal discomfort and chest discomfort. 2 It is important, especially in a busy practice, to adopt a fail-safe strategy to analyse such...

Is the patient trying to tell me something

The doctor has to consider, especially in the case of undifferentiated illness, whether the patient has a 'hidden agenda' for the presentation. 3 Of course, the patient may be depressed (overt or masked) or may have a true anxiety state. However, a presenting symptom such as tiredness may represent a 'ticket of entry' to the consulting room. It may represent a plea for help in a stressed or anxious patient. We should be sensitive to patients' needs and feelings, and as listening, caring, empathetic practitioners provide the right opportunity for the patient to communicate freely. Deep sexual anxieties and problems, poor self-esteem, and fear of malignancy or some other medical catastrophe are just some of the reasons patients present to doctors. The author has another checklist (Table 15.6) to help identify the psychosocial reasons for a patient's malaise. In the author's experience of counselling patients and families the number of problems caused by interpersonal conflict is quite...

Recommended dosage

For panic disorder, the initial recommended dose is 0.25 mg twice daily. This dose can be increased every three days in increments of 0.125-0.25 mg twice daily. The target dose for panic disorder is 1.0 mg per day, although some people benefit from doses up to a maximum of 4 mg per day. When a person stops taking clonazepam, the drug should be gradually discontinued by decreasing the dose by 0.125 mg twice daily every three days. Although clonazepam is not FDA-approved for the treatment of post-traumatic stress disorder, doses in the range of 0.25-3 mg daily appears to help treat symptoms of this disorder. Daily dosages for the treatment of social Women who are pregnant should not use clonazepam, because it may harm the developing fetus. Clonazepam should never be taken by people who have had an allergic reaction to it or another benzodiazepine drug such as diazepam (Valium). People with narrowangle glaucoma or severe liver disease should not take clonazepam. People who have kidney...

Depression in children

Major depression in children and adolescents may be diagnosed using the same criteria as for adults, namely loss of interest in usual activities and the presence of a sad or irritable mood, persisting for 2 weeks or more. 6 The other constellation of depressive symptoms including somatic complaints may be present. Examples include difficulty in getting to sleep, not enjoying meals, poor concentration and low self-esteem. It can present as antisocial behaviour or as a separation anxiety, e.g. school refusal. Although suicidal thoughts are common, suicide is rare before adolescence. Depressed adolescents are a serious suicide risk. Referral of these patients to an experienced child psychiatrist is advisable.

To the Psychosocial Environment and Level of Functioning

Examples include (a) interpretation of social stressors in cultural terms and (b) social supports. For example, the individual's perception of racial discrimination could represent a major stressor leading to symptoms involving depression and anxiety. The extended family is a crucial social support among many clients from culturally diverse groups. For example, among Hispanics the compadre (cofather) and comadre (comother) are often available to take care of children when their parents are absent the priest is another important social support in this group. In the case of African Americans, the church is crucial in providing emotional supports. Among American Indians, the medicine man woman is often consulted when the family is experiencing difficulties and in the case of Southeast refugees, welfare agencies and community supports are examples of social supports in this group (Gaw, 1993).

Verbal Subtests Wechsler Scales

This subtest is often highly correlated with overall intelligence, particularly when the subject has had ample exposure to verbal stimulation. Low scores on Vocabulary generally indicate deficiencies in educational exposure or in motivation to absorb material presented in an educational setting. Low scores may also reflect diagnoses in which repression is pervasive, as blockages interfere with knowledge learned in the past that has to be called to mind currently. Tendencies toward concrete functioning with poor abstracting ability will reduce performance on the Vocabulary subtest. Lowered Vocabulary scores may reflect a wide variety of particular cultural influences. The psychologist needs to analyze specific items to determine the level of conceptualization and quality of response. Lowered scores may diagnostically reveal the intrusion of anxiety because of its effects on memory and precision of definition. A high score on this subtest may reflect ambitiousness and...

Results Of Bias Research Jensens Review

Jensen's (1980) term situational bias refers to influences in the test situation, but independent of the test itself, that may bias test scores (p. 377). These influences may include, among others, characteristics of the test setting, the instructions, and the examiners themselves. Examples include anxiety, practice and coaching effects, and examiner dialect and ethnic group (Jensen, 1984). As Jensen (1980) observed, sit-uational influences would not constitute test bias, because they are not attributes of the tests themselves. Nevertheless, they should emerge in studies of construct and predictive bias. Jensen concluded that the situational variables reviewed did not influence group differences in scores.

Histamine2receptor blockers H2Bs

Concomitant administration of antacids reduces the bioavailability of most H2 blockers by 20-25 35 , 74 . Excretion of these drugs occurs through the kidneys, and they are all partially metabolized by the liver, with the degree of liver involvement varying by drug 74 . Cimetidine, and less frequently raniti-dine, can alter serum concentrations of drugs using microsomal enzymes, such as phenytoin and theo-phylline, benzodiazepines, certain beta-blockers,

Analysis of Artistic Change Martindales Regressive Imagery Dictionary

Martindale's Regressive Imagery Dictionary has been translated into several languages (e.g., French, German, and Portuguese). The English version is composed of about 3,200 words and word stems that fall into 29 categories of primary process cognition (e.g., regressive cognition, Icarian imagery), 7 categories of secondary process cognition (e.g., abstraction, social behavior), and 7 emotion categories (e.g., positive affect, anxiety).

The Effectiveness Of Counselling

Counsellors have been employed in primary care settings in the UK since the 1980s, generally receiving referrals from GPs for patients reporting problems in such areas as relationship difficulties, moderate depression, anxiety and stress. Counselling is available in more than 50 of GP practices in England (Mellor-Clark, 2000) and protocols have been developed which define the role and of counsellors in primary care (National Primary Care Research and Development Centre, 2001). A Scottish Office report conducted in the 1990s noted the potential value of counselling in primary care but called for further research to establish its effectiveness (National Medical Advisory Committee, 1998). A number of investigations of the effectiveness of counselling in primary care have been published, encompassing both controlled trials, and naturalistic studies. Early randomised trials have compared the effectiveness of counselling with treatment as usual from the GP (Ashurst & Ward, 1983 Boot et al.,...

Etiology And Psychopathology

Research findings have pointed to the prevalence among patients with borderline pathology of early traumatic experiences, such as prolonged, painful physical illness, experience or witnessing of physical or sexual abuse, severe early loss and abandonment, or a chaotic family structure (Kernberg, 1994). A biological predisposition to the activation of excessive aggressive and depressive affects because of dysfunctional biochemical neurotransmitter systems, particularly the serotoner-gic system (but also the adrenergic, noradrenergic, and dopaminergic systems) may be reflected in abnormal activation of negative affects and hyperreactivity to stimuli that would ordinarily generate anxiety or depression, thus fostering the distortion of early affective experiences in the direction of aggressively invested relations with significant others that are internalized as such. Thus, biological determinants in the predisposition to negative affect activation reflected in temperament and the...

Breaking the News The Role of the Physician

When Janet arrived for the appointment, everything seemed easy enough. She filled out the routine medical information and was brought into the examining room. The doctor came in, introduced himself, and asked Janet some questions about Brian's development and about the pregnancy. As Brian was being examined, Janet began to feel twinges of anxiety. Brian was screaming. For the doctor to get a good look at his eyes, he explained to Janet that he would have to put a speculum in Brian's eyes to keep them open and in position. Unprepared for the papoose board they placed him on, or for the torturous-

The Vicissitudes of Impulse

Clarifying the source of anxiety in the patient's personality involves consideration of the patient's underlying conflicts. To illuminate the fundamental conflicts within the personality, it is necessary to examine the impulses that strive for expression along with the efforts toward control that both oppose and attempt to manage such expression. This dynamic opposition amounts to an ongoing but variable struggle that is reflected in the presence, manifestations, and nature of the patient's anxiety. Thus, in the psychodiagnostic report, it is logical to have a section dealing with impulse versus control follow the section that analyzes anxiety especially since anxiety is frequently a particular derivative of underlying anger.

What Do Children And Young People Need

Just attachments, and within these relationships the child needs to be valued and respected. The important task for the parent or carer is that of containment. The adult needs to be able to accept the child's hopes, fears, anxiety, longing, omnipotence, arrogance, self-doubt, terror and aggression. These feelings may be communicated verbally, non-verbally or unconsciously. The adult needs to be able to tolerate the feelings, reflect on the process, and help the child by reducing the intensity and showing that he or she is bearable and can be understood. The adult has to avoid retaliation or acting out by becoming caught up in the child's emotional state while remaining sensitive and thoughtful. Slowly, children manage to take in this capacity to bear the feeling and reflect, and can then 'contain' themselves, but they can only do this if they have had a relationship with such an adult for sufficient duration. Where parents never had this experience themselves, it may be that a nursery...

Theoretical Formulations Behavioural And Cognitive Models

In the behavioural model for OCD neutral internal stimuli, such as thoughts and images, become paired with an anxiety-provoking stimulus as the result of learning experiences. Because these previously neutral stimuli now cause anxiety, the patient develops avoidance behaviours, which result in an immediate reduction in anxiety. This encourages further use of the avoidance behaviours, which in time become more stereotyped and develop into a compulsive ritual. The ritual limits exposure to the initial stimulus and therefore there is no opportunity for the anxiety associated with it to be extinguished. The behavioural model is supported by evidence that obsessions cause anxiety and that compulsions reduce it (Hodgson & Rachman, 1972). Behavioural treatment involves exposure to the initial stimulus (which is now feared), while encouraging the patient not to carry out any behaviours to avoid this exposure and is known as exposure and response prevention (ERP). Beck's (1976) cognitive model...

The Interplay Between Impulses and Controls

Inappropriate and maladaptive behavior may follow the experience of tension or anxiety that is generated by awkward or uncontrollable shifts in the interaction of impulse and control. In a similar manner, inappropriate behavior may be immediately initiated and engaged in to prevent the development of tension that would occur were impulses not transformed into action. When a flexible balance between impulse and control cannot be maintained, rigid patterns of personality functioning develop that are inadequately suited to ongoing reality circumstances. Such rigid and poorly adaptive modes of dealing with the conflict that is emerging between impulse and control may take two forms. There may be an overemphasis on

Thyroid and other endocrine disorders

Thyroid disorders can be a diagnostic trap in family practice and early diagnosis is a real challenge. A family practice of 2500 patients can expect one new case of thyroid disorder each year and ten 'cases' in the practice with a slight preponderance of hyperthyroid patients compared with hypothyroid patients. 1 The diagnosis of an overactive or underactive thyroid can be difficult as the early clinical deviations from normality can be subtle. The clinical diagnosis of classical Graves' disease is usually obvious with the features of exophthalmos, hyperkinesis and a large goitre but if the eye and neck signs are absent it can be misdiagnosed as an anxiety state. Elderly patients may present with only cardiovascular signs such as atrial fibrillation and tachycardia or with unexplained weight loss.

The Evidence Base For Behaviour Therapy

Behaviour therapy has been shown to reduce symptoms compared with relaxation (Abramowitz, 1997) and anxiety management training (Lindsay, Crino & Andrews, 1997). Foa & Kozak (1996) reviewed 12 outcome studies and found 83 of patients who completed exposure and response prevention treatment were post-treatment responders. Stanley & Turner (1995) concluded that about 75 of OCD patients show substantial improvement after 12 to 15 sessions of behaviour therapy. O'Sullivan & Marks (1991) reviewed nine follow-up studies of OCD exposure and response prevention treatment completers. The follow-up duration was between one and six years with a mean follow up of three years. Seventy-nine per cent of patients had improved or were much improved and symptom improvement was maintained irrespective of the length of follow up. However, these results are for treatment completers. About 25 of OCD patients offered ERP refuse it (Kozak, 1999) and others drop out or do not improve with ERP. Hiss, Foa &...

Modifications And Variants Of Behaviour Therapy

Foa et al. (1984) showed that concurrent exposure and response prevention had superior outcome to using either component alone. To be effective the exposure must continue until there is a reduction in anxiety and urge to ritualise. Studies have shown that this takes approximately 90 minutes (Foa & Chambless, 1978 Rachman, Desilva & Roper, 1976) which can act as a guide. There is no clear evidence about the necessary frequency of exposure sessions but, in general, patients with more severe symptoms and those who have more difficulty complying with the treatment and homework may need more intensive treatment. Abramowitz, Foa & Franklin (2003) compared 15 sessions over three weeks (daily treatment) or eight weeks (twice-weekly treatment), with 20 patients in each group. Both treatment programmes were effective, with a trend towards more improvement in the intensive group at post treatment but no differences at follow up. A meta-analysis by Abramowitz (1996), found that...

Impulse and Action Orientation

When substantial signs of impulses are seen in the test data but action orientation is not indicated, the psychologist needs to evaluate the presumed internal struggle that exists between these impulses and controls. By clarifying the pressure of the conflict, the psychologist's discussion reveals important sources of anxiety. Another source of anxiety is generated from the nature of the impulses and controls that are in conflict. For example, hostility, confused psychosexual identity, or a problematic fragility of control may emerge as specific sources of anxiety following analysis of the impulses and controls in conflict. When the indicators of impulse in the test protocol are abundant and signs of an action orientation are also present, an acting-out probability is high. In such cases, the presence and experience of anxiety is likely to be diminished although such reduced anxiety occurs as a result of a pathological process. As discussed in the previous chapter, acting-out the...

Management of head injury

Intracranial pressure (ICP) monitoring for appropriate indications (e.g. Glasgow coma scale less than 9 and abnormal CT scan of the head) and the ability to treat raised ICP through such means as sedation, osmotic diuresis (with mannitol), paralysis, cerebrospinal fluid (CSF) drainage and hyperventilation are deemed desirable at the tertiary care level. They are also desirable at the specialist-level hospital if a neurosurgeon is present. They are also desirable at the specialist-level hospital if a general surgeon with considerable neurosurgical expertise is available, in a setting in which facilities for referral to a tertiary centre are limited.

In Search Of Depressogenic Thought Processes

A variety of studies using a variety of cognitive methods have sought to discover the depressogenic thought processes responsible for depression (for reviews, see MacLeod & Mathews, 1994 Segal, 1988 Segal & Ingram, 1994). However, one problematic result emerges from this research. Specifically, it is extremely difficult to distinguish formerly depressed participants from never depressed participants on measures of cognitive bias (e.g., Segal & Ingram, 1994). That is, depressive biases in cognition seem to be more statelike than traitlike. The reader will note that such findings are parallel to those involving anxiety disorders and attentional threat bias, in that successful psychotherapy eliminates the attentional threat bias (MacLeod, 1999).

Thoracic pain of lower cervical origin

Physical therapy to the spine can be dramatically effective when used appropriately. Unfortunately, many of us associate it with quackery. It is devastating for patients to create doubts in their minds about having a 'heart problem' or an 'anxiety neurosis' when the problem is spinal and it can be remedied simply ( Chapter 34 ).

Patient And Family Education

Patients and families require factual information regarding their particular diagnosis, treatment options, managing their medications, handling common symptoms and side effects, and recognizing medical emergencies. The key is to empower patients and families to effectively manage their own care. Also important are specific details on the likely course(s) of their illness and the supportive resources available to them over the course of their disease. The key is to provide accurate information so that patient and families can make informed decisions. Desperate families who have not been given adequate information may make decisions based on misinformation in the media, on the Internet, and from well-intentioned friends and family members. Information provided should be easy to understand and accurate. Adequate education can decrease anxiety and sustain confidence. Ideally, patient education materials need to be written at a ninth grade level or below...

Channel Structure And Allosteric Modulators

Ion channels are typically homomeric or heteromeric assemblies of subunits. Transmembrane peptide segments determine ion selectivity, and terminal peptide domains often serve to inactivate the channel by blocking the transmembrane pore. Channel subunits typically exist as structurally related members of a large gene family, e.g., K+ channels 14 , but also neurotransmitter receptors for GABA 15 , acetylcholine 16 , and glutamate 17 . Highly diverse arrays of potential channel configurations can result from either structural variants generated by alternative mRNA splicing or the assembly of different subunits into heteromeric channels. Furthermore, the various combinations of subunits often differ pharmacologically or functionally, exhibiting differences in channel conductance properties or desensitization 18 . In addition, phosphorylation by cytoplasmic kinases is a major post-translational mechanism for regulating channel function. The multisubunit composition of ion channels and the...

The Nature of Control Mechanisms

There are several distinct kinds of controls in the personality structure. As discussed in the previous chapters, these controls are employed in the individual's effort to regulate impulses and the corresponding anxiety associated with such impulses. For example, cognitive controls, including intellectual approaches, are quite different in their operation and consequences from the integrating effects of ego controls, which, in turn, are different in their quality and influence from the effects of control exerted by conscience, which are also different from the effects of individual defense mechanisms that are utilized for control purposes. Defense mechanisms also differ significantly from character traits, in that defense mechanisms largely manage the transitory nature of emotions while character traits as a type of control within the personality persist in a stable and enduring form. Another control function in the personality structure is the use of fantasy that is, control over...

Psychosocial And Ethical Implications Of Germ Line P53 Mutation Testing

As genetic counseling and testing for cancer susceptibility has become more common, guidelines for testing have been updated. Current ASCO guidelines support genetic testing in the setting of pre- and posttest counseling if the individual has a personal or family history suggestive of a cancer susceptibility syndrome, the test can be adequately interpreted, and results will affect medical management (93). The increasing integration of p53 mutation status into medical management as evidenced by the recommendation for breast MRI screening and for relative avoidance of radiation therapy provides a more compelling rationale for genetic testing than previously available. As new therapies are developed that target specific lesions in the p53 pathway, additional benefits from knowledge of the p53 status may accrue. Others benefits of knowing one's genotype may come from the opportunity to make informative reproductive choices (94). For those at risk, the benefits also lie in the relief of...

Siblings And Other Relatives

Siblings usually have more in common with each other than with any other member of the immediate family. This is particularly true when siblings are of the same sex and close in age. In families in which parents express a great deal of dissatisfaction and hostility toward each other and or the children, or when a parent has been lost by death, separation, or divorce, siblings are likely to turn to each other and develop their own little social world or subfamily. Brothers and sisters may be intensely loyal toward each other, a loyalty and closeness that deepens with age (Dunn, 1984 Mosatche, Brady, & Noberini, 1983). Long after they have left their parents' home and even after the parents have died, siblings who were close as children continue to provide emotional and material support to each other in times of crisis (Matthews, Werkner, & Delaney, 1990 Rosenthal, 1985). Anxiety and depression are lifted when a brother or sister shows concern and an eagerness to be of help.

Past medical history and functional enquiry

Establish the history and current situation regarding liver disease, pancreatitis, gastritis, GI haemorhage, jaundice, abdominal pain or swelling. Assess the history and current situation regarding hypertension, arrythmias or cardiomyopathy. Establish the history and current situation regarding neuropathy, memory difficulties, cognitive impairment, psychosis or hallucinations. Establish the history and current situation regarding blackouts or fits and anxiety. Consider fetal alcohol syndrome.

The Gamma Knife Nurse

Centers offering gamma knife radiosurgery usually have at least one nurse whose sole responsibility is caring for patients undergoing this unique procedure. The gamma knife nurse is the patient liaison from the pretreatment to the follow up visit. Nurses in this setting educate the patient on the procedure, what to expect, time frames, and help to reduce anxiety over the course of the day-long treatment. Hands-on care may include head frame application and removal, transport to scanning, medication administration, and patient monitoring throughout

Hormonereplacement Therapy

Both prophylactic mastectomy and prophylactic oophorectomy are options available to a known carrier of a mutation in BRCA1 or BRCA2. The uptake of prophylactic mastectomy is greater in the United Kingdom and Holland61,62 than in the United States.63 The efficacy of this procedure has now been evaluated retrospectively in BRCA1 2 carriers. Two studies have found at least 90 reduction in the incidence of breast cancer in women with BRCA1 or BRCA2 mutations. Further evidence for a reduction in breast cancer risk following breast removal was found in a study that examined the incidence of breast cancer following surgical breast reduction.65 Women who had breast reduction had a relative risk of 0.61 of developing breast cancer (95 confidence interval 0.42-0.86). The relative risk was related to the amount of breast tissue removed those who had a greater amount of breast tissue removed had a lower relative risk of developing breast cancer. There is a report of a male having a prophylactic...

Psychodynamic psychotherapy

While many patients benefit from individual psychotherapy alone, some instances call for such additional therapies as family therapy, couples therapy, or group therapy in combination with individual treatment. A second treatment modality might be recommended when the patient's progress in individual treatment is highly dependent on relationships with significant others or with interpersonal relationships in general. Psychotropic (mood- or behavior-altering) medication may also be prescribed as an adjunct (help) to treatment in order to manage disturbances in anxiety level, mood or thinking. Whether additional treatments are recommended is based on the needs of the individual. People seek psychodynamic psychotherapy for a variety of reasons that include but are not limited to the following prolonged sadness, anxiety, sexual difficulties, physical symptoms without physical basis, persistent feelings of isolation and loneliness, and the desire to be more successful in work or love....

Mature Balance of Impulse and Controls

The next chapter discusses the various levels of defenses and types of character patterns. This presentation corresponds to the sequence of sections in the report that lead from an analysis of the phenomenon of anxiety to consideration of impulses and controls as a deeper configuration of the expression of anxiety. An analysis of the various types of defenses and defensive syndromes is an inextricable part of this sequence of sections in the report. Table 10.1 presents the main features of the vicissitudes of controls in the personality. Cognitive Controls. Concentration, attention, and consistent functioning are seen. Intellectual functioning is aligned with strivings and goals. Anxiety is well managed. The achievement drive is also consistent with the ability to implement goal-directed behavior. Cognitive control is usually seen in terms of specific intellectual functions and capacities. Defense Mechanisms. Defense mechanisms are designed to manage, regulate, or control specific...

Rational emotive therapy

The primary focus of this treatment approach is to suggest changes in thinking that will lead to changes in behavior, thereby alleviating or improving symptoms. The therapy emphasizes changing irrational thinking patterns that cause emotional distress into thoughts that are more reasonable and rational. RET can be used to treat people affected from disorders such as anxiety, depression and stess.

Individual Defense Mechanisms

An important aspect of the operation of defenses in the personality can be appreciated by considering the experience of impulse, emotion, or anxiety that occurs within the person as a response to either an internal or external stimulus. Such a stimulus phenomenon can trigger tension, especially when an emotion is experienced as threatening so that the person would consider it as being negative. Tension may be perceived only dimly or not at all nevertheless, the presence of such tension provides a strong and reliable signal that elicits defenses in an automatic manner. The automatic evoking of defenses in response to signal anxiety has far-reaching consequences for the individual. These consequences regarding the operation of defenses in response to signal anxiety results from the repeated utilization of characteristic behavior patterns when a threat to the individual's well-being, integrity, or security is experienced or even anticipated. This threat to well-being can stem from...

The genetic disorder and parental overprotection

When there is a genetic problem, the parents can understandably become overprotective and, in so doing, interrupt the developmental processes in a child. Families react differently to a child's disorder and some, because of anxiety, do not allow enough space for the child to be as normal as possible.

Venous Leg Ulceration

Chronic venous leg ulceration (VLU) is a common recurrent problem in the elderly population and may result in immobility, with 45 of patients being housebound (Baker & Stacey 1994). As a result, individuals with VLU frequently experience depression, anxiety, social isolation, sleeplessness and reduced working capacity (Leach 2004). CVI, which is characterised by an increase in capillary permeability, inflammatory reactions, decreased lymphatic reabsorption, oedema and malnutrition of tissues, is a precursor to VLU. As HCSE increases venous tone while reducing venous fragility and capillary permeability and possesses anti-oedematous and antiinflammatory properties, it has been speculated that by improving microcirculation, ulceration may be delayed or prevented (Blaschek 2004).

Emotion Controlled Types Obsessive Compulsive Personality

Pleasure is frequently only associated with the completion of projects or with a sense of effort directed toward organizing in an elaborate manner. Such persons are consumed with needs for controlling tension and anxiety, and consequently only minimal energies are then available to devote to sharing and giving in interpersonal relations. Instead, dispassionate intellectually oriented approaches are generated. Obsessive-compulsive individuals are also overly concerned with rules and regulations, and their behavior is characterized by a focus on form rather than content. For example, the student who underlines in textbooks in multicolored inks, always careful to use a rule so that each page becomes a colorful, well-organized object of perfection, frequently has the greatest difficulty absorbing the content of the material. The issue that assumes importance is the orderly completion of a task designed to control anxiety rather than learning the work. In addition, projects often are not...

Factors Unique To Older Minorities

Depression, and anxiety (Griffin, 1983 Henderson, 1996 Masten, Penland, & Nayani, 1994). The process of acculturation is recognized as stressful, a primary factor in the adjustment of immigrants to their new society (Moyerman & Forman, 1992). Furthermore, the acculturating individual can become caught between the two cultures, attempting to maintain the behaviors of the traditional culture while adapting to the new culture (Paniagua, 1998).

Cardiac LType Calcium Channel

The most abundant HVA Ca2+ channel of the heart and vascular smooth muscle is the L-type a1C calcium channel, which provides an essential part of the Ca2+ necessary for contraction. In addition, the L-type Ca2+ current contributes to the plateau of the cardiac action potential. Under physiological conditions, the threshold membrane potential for the activation of macroscopic L-type Ca2+ current is above - 40 mV with the maximum current around 10 mV. Its unitary conductance is 25 pS in the presence of 100 mM Ba2+ (for review, see McDonald et al., 1994). The relative high unitary conductance, together with the long duration of the current, increases the subsarcolemmal Ca2+ from submicromolar to above micromolar concentrations, which are necessary to trigger Ca2+ release from the sarcoplasmic reticulum. To prevent Ca2+ overload, these channels are inactivated by the inflowing Ca2+ and by the depolarized membrane potential (Fig. 2). Pharmacologically, the L-type Ca2+ current is blocked by...

Preoperative Education

Preoperative education for the patient with a high-grade CNS malignancy is a unique challenge to nurses. Management of this patient population involves multiple treatment modalities and requires ongoing vigilance of a multidisciplinary team to detect and treat newly diagnosed and recurrent tumors. Multiple studies have indicated that preoperative education significantly reduces pre- and postoperative anxiety. Certainly, with the addition of a potential malignant diagnosis, and the often rapid succession of events from diagnosis to surgery, patient and family education is a cornerstone in this population.

The Methodological and Conceptual Fulcrum Identity and Reputation

From our perspective, the self-reports used to assess identity and the observer ratings used to assess reputation both afford unique, yet flawed, information about a person. Certain psychological phenomena, such as feelings of anxiety, may best be accessed through self-reports of identity. On the other hand, determining a person's true levels of agreeableness might be better assessed through the opinion of their friends and relatives who may be less defensive about another person's behavior than their own. Each perspective is potentially defective, in that neither the persons reporting on themselves nor the persons reporting on a friend or relative are

Intersubject Coregistration

Assessing significance of abnormalities in SPECT and PET images is the most common reported clinical application of intersubject coregistration. Richardson and Koepp et al. 22, 23 used intersubject coregistration to investigate abnormalities of central benzodiazepine binding with 11C flumazenil PET in two partial epilepsy patient groups (epilepsy of mesial temporal lobe origin and neocortical origin, the latter specifically from focal cortical dysgenesis). They took advantage of control subject normative data mapped into the same stereotactic space as the patient image volumes. Then they used statistical parametric mapping 24 to objectively measure the distribution of normal and abnormal benzodiazepine binding in each patient. The coregistered MRI allowed important correction for partial volume effects with the use of convolving gray matter from segmented MRI.

Calcium Dependent Inactivation

FIGURE 6 Calcium channel blocker binding sites. Amino acids interacting with dihydro-pyridines (DHP black circles or rods), phenylalkylamines (PAA, open squares), dihydro-pyridines and phenylalkylamines (DHP+PAA, gray circles or rods), phenylalkylamines and benzodiazepines (PAA+BTZ, dashed squares), and all three blocker types (DHP+PAA+BTZ, dashed circle or rod) are shown. Amino acids conserved between DHP-sensitive, L-type calcium channels and DHP-insensitive, non-L-type calcium channels are marked by an arrowhead. The IS6 segment contributes significantly to the high-affinity binding of dihydropyridines to the smooth muscle L-type calcium channel. FIGURE 6 Calcium channel blocker binding sites. Amino acids interacting with dihydro-pyridines (DHP black circles or rods), phenylalkylamines (PAA, open squares), dihydro-pyridines and phenylalkylamines (DHP+PAA, gray circles or rods), phenylalkylamines and benzodiazepines (PAA+BTZ, dashed squares), and all three blocker types...

Range Of Psychopathology And Personality Disorders Within Scope Of Treatment

IRT is most appropriate for treatment-resistant cases of personality disorder and for Axis I disorders that are comorbid with personality disorder, such as depression, anxiety, or certain forms of thought disorder such as delusions, dissociations, and transient hallucinations. Detail on how to link Axis I and Axis II problems appears in Benjamin, 2003, chapter 2. Because IRT fundamentally is a learning process, it is not appropriate for individuals whose capacity to learn is compromised. It is, therefore, not appropriate for individuals with severely limited cognitive skills whether the limitations are due to trauma or inherited factors that compromise learning ability. Uncontrolled use of drugs or alcohol also interferes with IRT, so users are required to participate successfully in concurrent programs designed specifically for management of substance abuse.

The Washington Needs Assessment Household Survey

The Washington Needs Assessment Household Survey (WANAHS) was conducted in the State of Washington by Washington State University for The Washington State Department of Social and Health Services. Although primarily a substance abuse survey, it included assessments for major depression, mania, anxiety, panic attacks, and psychosis using a CIDI-based screener developed by Kessler from the NCS. The WANAHS differs from the ECA and NCS in several significant ways first, it was a telephone survey second, it covered only one state and third, it provided significant oversamples of five major ethnic groups, including White, Black, Asian, Native, and Hispanic.

Trauma team and organization of the initial resuscitation

The resuscitation of severely injured patients usually involves many personnel, and too often takes place in an environment of anxiety and confusion. A well-planned and organized approach to such patients is fundamental to optimal management. Resuscitation implies a coordinated group of actions performed to secure the airway, support breathing and restore circulation. Survival after severe injury depends on promptly re-establishing adequate tissue oxygenation. Hence, critical time limitations apply to the successful performance of the elements of resuscitation. There is thus a need to assure that the personnel and equipment needed for resuscitation are present and utilized in an optimal fashion. Achieving this goal is assisted by appropriate pre-planning and coordination among personnel caring for the injured patient in the field, in the emergency department and elsewhere in the hospital. Such pre-planning and coordination involve equipment and supplies in the emergency area. However,...

Clinical manifestation

HIVE is considered to be a subcortical dementia, typically emerging over the course of weeks and months. Acutely developing symptoms point to another etiology. Fever, exhaustion, the effects of tranquilizers and reduced physical condition, e.g. with opportunistic infection, may all mimic dementia. In these cases, diagnosis of HIVE can only be made after repeated examinations when the condition mimicking dementia has improved.

Function of Protein Kinase C

Closer analysis of the phenotypes of knockout animals of various PKC isozymes does suggest a common theme animals deficient in PKC are deficient in adaptive responses. For example, PKCe - - mice have reduced anxiety and reduced tolerance to alcohol 53 , PKCy- - mice have reduced pain perception 54 , and PKC0II- - mice have reduced learning abilities 55 . This theme carries over to the molecular level, where many of the substrates of PKC are receptors that become desensitized following PKC phosphorylation.

Ethnicity And Adolescent Depression A Prevalence

Cole and his colleagues (1998) obtained yearly self-report, peer nomination, and teacher-rating assessments of depression symptoms, anxiety symptoms, and social acceptance on two cohorts of African American (N 139 and 184, respectively) and European American school children (N 328 and 339, respectively), yielding a total of six waves of data between 3rd and 8th grade. Analyses demonstrated that the measures were equally valid across ethnic groups. Peer-nomination measures of depression and anxiety symptoms appeared to be biased, however, leading to the underestimation of psychopathology in African American children. Adjusting for this, African American youths evinced more signs of depression and anxiety in grades three, four, and five than did European American children. Such differences were not significant in grades six, seven, and eight.

Environmental adversity and reproductive development

The relation between interuterine growth retardation, resulting in diminished birth weight, and an early onset of sexual maturation may seem somewhat counterintuitive. Note, however, that this relation is only apparent under conditions of adequate postnatal nutrition, and indeed is best reflected in those children that reveal postnatal catch-up growth. Interuterine growth retardation is a reliable consequence of materno-fetal function under conditions of environmental adversity. Indeed, increased activity of the maternal and or fetal hypothalamic-pituitary-adrenal (HPA) axis is considered the proximal cause of interuterine growth retardation (Goland et al., 1993, 1995 Matthews and Meaney, 2005 Meaney et al., in press Seckl, 1998). Thus, poverty is associated with a significantly increased risk for inter-uterine growth retardation (IUGR) and the major predictors of low birth weight, maternal protein deprivation, tobacco and alcohol consumption, and maternal stress anxiety are related to

Integrating Diagnostic Levels

If the findings additionally indicate the presence of neurotic or symptom phenomena, these can be considered to be components of the diagnostic formulation at a separate level. Such neurotic or symptom features can be specified in the diagnostic assessment that summarizes the totality of the patient's pathological functioning. In keeping with the previous illustration of the obsessive-compulsive personality disorder, if phobic disturbances also are reflected in test results, this anxiety-related level of diagnosis can become a diagnostic qualifier the diagnosis becomes obsessive-compulsive personality disorder with phobic features. If, in addition, the test findings reported indicate the presence of a psychotic process or organic impairment, these levels of personality disturbance would also be encapsulated in the diagnostic assessment to elaborate further the summary of pathological functioning.

Behavioral Management Techniques

A number of behavioral symptoms are amenable to psychotherapy. For the AD patient, therapy early in the course of the disease may be more beneficial than later because of increased memory problems in later stages and problems with insight. Psychotherapy for the early stage patient can help alleviate symptoms of depression, anger, denial, and anxiety. Early stage patients may also benefit from the increased support offered in group therapy (Bonder, 1994 Goldsilver & Gruneir, 2001 Haggerty, 1990). Approaches to psychotherapy vary, and traditional outcomes for nondemented patients attempt to enhance daily functioning by providing insight, leading to an expression of emotion. Data on individual and group therapy for AD patients suggest both alleviate behavioral symptoms of demented patients in the early stages however, developing insight is not thought to be successful or a helpful goal with these patients (Haggerty, 1990 Miller, 1989).

Learning To Interview

There are many ways to teach interviewing skills. In the interviewing class taught by the first author (Handler), students first practice using role playing and psychodrama techniques. Then they conduct videotaped interviews with student volunteers, and their interviews are watched and discussed by the class. Students learn to identify latent emotions produced in the interview, to handle their anxiety in productive ways, to manage the interviewee's anxiety, to go beyond mere chitchat with the interviewee, and to facilitate meaningful conversation. Students also learn to examine relevant life issues of the people they interview to conceptualize these issues and describe them in a report to ask open-ended questions rather than closed-ended questions, which can be answered with a brief yes or no to reflect the person's feelings and to encourage more open discussion.

Multimethod Assessment And Construct Validation

After this discussion of CFA, we then review the studies that have used CFA to determine the construct validity of clinical psychology measures. The review of these studies provides information on how well certain constructs in clinical psychology are currently measured (e.g., the convergent and discriminant validity of measures of anxiety and depression in children).

Complexities Of Multitrait By Multimethod By Multisource Analyses

Table 27.1 summarizes the results from these studies. Two of the studies focused on the amount of trait, source, and error variance in parent and teacher ADHD rating scales (Burns et al., 2003 Gomez et al., 2003). Here the source effects were strong, being consistently larger or equal to the trait effects. The one exception was that the teacher ratings of the ADHD-HI symptoms consistently showed slightly more trait and source variance (see also Gomez, Burns, Walsh, & Hafetz, 2005). For measures of depression and anxiety in children (e.g., the Child Depression Inventory and the Revised Manifest Anxiety Scale Cole, 1990 Cole, Truglio, & Peeke, 1997), the source effects were consistently stronger than the trait effects with there often being little trait variance in the measures of depression and anxiety.

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