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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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).

The Nature of Anxiety

This section of the psychological report concerns the nature of anxiety, its quality and intensity in the personality, and how it is experienced, channeled, and manifested. At this point, the logic of considering the nature and role of anxiety follows from previous discussions of cognitive and intellectual functioning and the impairments in such functioning that can occur through the effects of anxiety. These impairments are significant ways in which the presence of anxiety becomes pathologically manifest in the individual's functioning. Exploring these phenomena leads to deeper levels of analysis related to the causes of the patient's anxiety and to the underlying conflicts that generate tension.

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....

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.

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...

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...

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...

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...

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

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.


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...


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...

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...

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...

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.

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...

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

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.

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...

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.

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...

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)....

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...

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...

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...

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...

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.

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.

Detection and Assessment

A physical examination and laboratory screening (e.g., complete blood count, liver function, serum testosterone level, serum vitamin B12, thyroid function) may be performed to exclude potential systemic causes of depressive symptomatology. Testosterone deficiency associated with depressive symptomatology (e.g., anhedo-nia, fatigue, and sexual dysfunction) has been described in males with PD and may possibly be managed with testosterone replacement therapy (120). Likewise, symptoms of hypothyroidism (e.g., anxiety, difficulty with concentration, dysphoria, fatigue, irritability, and motor retardation) resemble depressive symptomatology and are treatable with thyroid replacement. It is also important to ensure that patients are on optimal doses of antiparkinson drugs to minimize motor fluctuations that may contribute to mood fluctuations.

Presentation Of Testicular Cancer

The widespread availability of high-quality scro-tal ultrasonography with Doppler blood flow analysis has nearly eliminated much of the diagnostic difficulty for these patients. Today, patients who are misdiagnosed are mostly those for whom ultrasonography was not ordered. The caveat of the availability of ultrasonography, however, has been an increase in the finding of minor abnormalities such as microcalcifications, which has caused considerable anxiety and debate recently. A number of studies have shown that testicular microcalcifications are commonly found by modern ultrasonography, and their presence does not indicate an increased risk of subsequent testicular cancer.3-5

Assessment of Efficacy

The first step in treating a patient who fails to respond to treatment is to increase the dosage of the antidepressant. If a patient fails to respond to a maximal, tolerated therapeutic dosage, then the antidepressant should be discontinued and replaced by another from a different pharmacologic class. For example, if a patient fails to respond to an SSRI, a switch to a dual action antidepressant (e.g., duloxetine, venlafaxine) should be made. When anxiety is present with depression, there may initially be a slowed response to antidepressant therapy (13,173). Since depression is a potentially recurrent disorder, once depressive symptoms have improved or recovery has been achieved, it is recommended that maintaining treatment at the effective dose should continue for at least six months to reduce the risk for relapse. Persisting symptoms of concurrent anxiety have been found to increase the risk for relapse of depression (174).

Regulation of emotions

The ability to deal with separation, the hallmark of a secure attachment pattern, is an indicator that the anxiety of separation and the sadness of loss can be managed and that other challenges can be dealt with. The experience of repeated success in managing difficulties builds up an internal strength and self-belief, which can be used as an internal reference in the future. In contrast, an insecure attachment handicaps the individual in containing anxiety and regulating the emotional experience of challenging situations. As a result, in keeping with their attachment pattern, the individual either uses a minimising style, dismissing the significance of a situation and any emotions, or perceives it is as a catastrophe, displaying a considerable amount of emotion which is not easily settled. approach and response to genetic counselling are related to individual attachment patterns and the ease or difficulty in managing anxiety and grief. With a secure attachment pattern, an individual...

Treatment Prion Diseases

Care for patients and support for their families. For example, myoclonus and seizures can be controlled with anticonvulsant medications such as valproic acid and benzodiazepines. Severe hyperkinetic movement disorders such as chorea or dyskinesias and psychotic behavioral symptoms can be controlled with neuroleptic medications. Other psychiatric symptoms can be improved with medications that are used for behavioral symptoms in other patients with dementia. Quality nursing care is very important and can limit pain and the complications of being bedridden. Finally, and most importantly, patients and their families need a tremendous amount of emotional and social support to cope with these devastating diseases.

Traits And Implicit Processing Tendencies

Variations in self-reported traits play a relatively small role in selective attention. In the emotional Stroop task, a person is asked to name the color of words. Of interest is whether the semantic nature of the ignored word interferes with attention to the primary color-naming task. For example, one might expect trait anxious participants to exhibit slower color-naming latencies for words like criticism because such words capture attention among anxious individuals. However, a substantial literature review (Williams, Mathews, & MacLeod, 1996) has concluded that subclinical variations in anxiety do not seem to be robust predictors of performance. That is, subclinically anxious participants do not, by and large, exhibit selective attention for threatening words. This conclusion is reinforced by work with the spatial probe paradigm. In this paradigm, several words are simultaneously presented, and attention toward a threatening word is inferred from fast latencies to respond to...

Pharmacologic characteristics see table

Drug interactions drugs that potentiate nondepolarizing relaxants include volatile agents, local anesthetics, calcium channel blockers, aminoglycosides, polymyxins, lincosamines, h e x a m e t h o n i u m , t r i m e t h a p h a n , immunosuppressants, high-dose benzodiazepines, dantrolene, and magnesium.

Adaptive Function of the

However, testing referrals that are made to determine acceptance into special progress classes or to assist in determining job promotions all require estimates of the degree to which this function is operating. The adaptive function of the ego involves flexible cognitive organization with the capacity to utilize inner resources and energy creatively. Integration of thinking, feeling, fantasy, and behavior predominates with only limited interfering anxiety. In reporting on this ego function, the focus is on evaluating the extent to which one's coping experience is successful. Behavior in school, on the job, and in relationships is the criterion to be considered. In terms of diagnostic implications, the successful operation of this ego function reflects a well-integrated personality. In such an adaptive personality, ego functioning involves a cognitive organization that is integrated, consistent, and cohesive with respect to the manner in which thinking,...

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...

Caffeinerelated disorders

In the clinician's handbook for diagnosing mental disorders (the Diagnostic and Statistical Manual of Mental Disorders, known as the DSM-IV-TR), caffeine-related disorders are classified under the rubric of substance-related disorders. DSM-IV-TR specifies four caffeine-related disorders caffeine intoxication, caffeine-induced anxiety disorder, caffeine-induced sleep disorder, and caffeine-related disorder not otherwise specified. A fifth, caffeine withdrawal, is listed under the heading of Criteria Sets and Axes Provided for Further Study. The symptoms of caffeine intoxication are easy to confuse with those of an anxiety disorder.

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.

The importance of early attachment pattern and the effect of an early disruption being exposed in genetic counselling

A woman requested predictive testing as her father had Huntington's disease. She was accompanied by her husband and they explained that they were worried that their son who, as a late teenager, might need to know whether there was a possibility of him carrying the Huntington's gene mutation. To date, he knew nothing of his mother's family history and they believed that he would only need to know if his mother tested positive. The woman went through the stages of the Huntington's disease protocol openly and thoughtfully and she seemed well prepared to take the test. There were no worries about how she would cope with the result. Unfortunately, she was found to have the Huntington's disease mutation and, after receiving the test result, she became extremely disturbed. She was unable to go to work, cried incessantly and was frightened to be left alone. The situation did not improve with the supportive help of a genetic counsellor and a psychiatric assessment was requested. Examination of...

The role of the counsellor

These elements have been explained in earlier chapters and the importance of processing emotions and containing anxiety has been emphasised. The theories of stress and attachment have been used to explain the psychological processes and the importance of the counselling relationship in determining the outcome. However there are additional ideas, taken from the general theory of psychotherapy, which can further inform the counsellor and help to expand the skills repertoire.

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).

The structure of the interview

Time, with an attitude appropriate to an understanding relationship, creates somewhere different where the conversation is different, and people can talk about extremely painful issues. With this approach patients can bring what is relevant of their lives into the genetic counselling consultation. The interview may offer a freedom to talk meaningfully but, paradoxically, the freedom can only exist within the containment and boundary of a time limit. The function of maintaining a time frame is not simply a rigid framework which makes sure others are not kept waiting, as it is a way of containing anxiety.

Regulatory Status

The German E Commission has approved St. John's wort for internal consumption for psychogenic disturbances, depressive states, sleep disorders, and anxiety and nervous excitement, particularly that associated with menopause. Oily Hypericum preparations are approved for stomach and gastrointestinal complaints, including diarrhea. Oily Hypericum preparations are also approved by the Commission E for external use for the treatment of incised and contused wounds, muscle aches, and first degree burns (96).

The elements of a therapeutic professional relationship

All these terms are used to describe the same qualities and as they are all used it is important for the counsellor to be familiar with their meaning. Winnicott's explorations of the mother and infant identified the 'good-enough' mother as having particular qualities - an attitude of being emotionally available, supportive, aware and understanding of the infant's vulnerability. Winnicott (1988) used the term 'holding' to refer to the actual physical holding of the infant by the mother and also the emotional holding of attunement in the mother's mind. That relationship could then become 'facilitating' for emotional growth and development. These ideas can be transferred to a professional consultation and the empathic understanding of a patient's anxiety. Winnicott emphasised that constructive relaxation could take place in the confidence of a living relationship. Further a well-timed interpretation of correct understanding 'gives a sense of being held, that...

Subdividing Groups of Verbal and Performance Subtests

The four-way division outlined here is particularly useful in view of the analysis of ego and reality functions developed in chapters 4 and 5 on cognitive functioning. Understanding the utilization of ego functions in the service of cognitive organization includes an evaluation of memory, planning ability, judgment, frustration tolerance, ability to abstract, control over anxiety, and so forth. Thus, this four-part analysis of verbal and performance subtests allows a parsimonious approach to cognitive analysis. For example, obtaining the average of the scaled scores on the attention and concentration tasks of Digit Span and Arithmetic can reveal the extent to which the subject tolerates frustration and is able to control anxiety. A detailed analysis of the subtest scores of the intelligence scale can go well beyond isolated numbers. Components of the

Difficulties In Distinguishing Psychopathology From Culturerelated Conditions

Chopathology associated with a given cultural context. For example, many Asian clients believe that emotional problems bring shame and guilt to the Asian family, preventing these clients from reporting such problems to others outside the family during the first session (Paniagua, 1998 Sue & Sue, 1990). Under this condition, it would be extremely difficult to conclude that the intense anxiety an Asian client is experiencing during the first session is an example of the culture-bound syndrome horo (Castillo, 1997 Chowdhury, 1996 see Table I).

The Big Five Model And The Fivefactor Model

The facet scales measuring different aspects of Neuroticism make it clear that two individuals with similar domain-level scores might manifest this trait differently. The facets include Anxiety, Angry Hostility, Depression, Self-Consciousness, Impulsiveness, and Vulnerability. High scorers on Anxiety tend to experience both specific fears and free-floating worries, leaving them tense and nervous. Angry Hostility is associated with greater likelihood of experiencing anger, which may be expressed in a variety of ways depending on other NEO-PI-R components such as Agreeableness. Individuals who are high on the Depression facet scale manifest as dejected, hopeless, and guilty. The Self-Consciousness facet taps the experience of interpersonal shame or embarrassment. individuals who are high on impulsiveness find it difficult to exercise control over cravings, and their frustration tolerance is low. The Vulnerability facet scale describes individuals who have real difficulty handling...

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...

Estimating Potential Levels of Intellectual Functioning

An analysis and discussion of the patient's potential intellectual capacity necessarily focuses on the factors that interfere with the expression of this potential. An estimate of intellectual potential can be derived from analyzing the experiences that interfere with intellectual functioning. These impeding experiences may have several sources for example, the effect of such variables as emotional conflict, disruptive anxiety, organic impairment, cultural conditioning, lack of conventional intellectual stimulation, and decreased opportunities for interplay with the environment that are ordinarily encouraged in economically advantaged settings. Any of these variables can affect the I.Q. score significantly. Whenever

Current theories about the origin of mental disorders

Dementias are also noted to run in families, but most of these disorders cannot be predicted with any certainty for the following generation. Only one disorder, Huntington's chorea, which is really a movement disorder with a psychiatric component, appears to be determined by a single gene. Dementia of the Alzheimer's type does seem to have familial pattern, but again, the expression of the disease in any specific individual is not predictable at this time. Scientists believe that similar statements can be made for many mental disorders that run in families, such as obsessive-compulsive disorder (OCD), depression, anxiety, and panic disorder. The roles of the environment and learning behavior in the ultimate expression of genetically predisposed individuals are, however, undisputed. Major neurotransmitters identified thus far include acetylcholine, dopamine, epinephrine, norepinephrine, histamine, and serotonin. Serotonin and norepinephrine are most highly implicated in depression,...

Current theory and future directions

Integrate some of the electromagnetic aspects of nature into the mind-brain puzzle. In addition, the National Institute of Mental Health (NIMH) is researching alternative healing modalities. Prominent among them is acupuncture, which has been used to treat depression, anxiety and panic disorder. Other alternative treatments being studied include the effects of prayer, meditation, creative writing, and yoga.

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...

Glucocorticoids and Behavioral States Reciprocal Determinism

Their functional outputs represent a close interplay across levels of organization. Consequently, manipulations at one point may have diverse effects throughout these circuits. The central CRH system, in addition to its regulation of pituitary ACTH release, is considered to be a general orchestrator of the cognitive, affective, behavioral, autonomic, and neuroendocrine aspects of stress. Local intracerebro-ventricular infusions of CRH in primates results in an activation of stress-related brain circuits, induces anxiety- and depressive-like reactions, and decreases social interactions (Strome et al., 2002). Because glucocorticoid administration alters central CRH activity, it is not immediately apparent whether the effects of this manipulation reveal the direct actions of glucocorticoids or indirect effects on CRH systems. Dissecting reciprocally interacting systems requires multiple experimental approaches and converging data that can provide a more comprehensive perspective than a...

Chloral Hydrate Noctec

Actions central nervous system depressant effects are due to its active metabolite trichloroethanol, mechanism unknown. Indications sedative hypnotic. Dose (adult) sedative 250 mg PO 3 times daily hypnotic 500-1000 mg PO PR at bedtime or 30 minutes prior to procedure (max 2 gm 24 hr). Dose (ped) sedation anxiety 5-15 mg kg dose PO PR q8 hr (max 500 mg) sedation (non-painful procedure) 50-75 mg kg dose 30-60 minutes prior to procedure, may repeat 30 minutes after initial dose if needed hypnotic 20-40 mg kg dose PO up to a max of 50 mg kg 24.

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...

Performance Subtests Wechsler Scales

This subtest requires the capacity for abstraction and concept formation along with planning, judgment, visual analysis, and visual-motor coordination skills. Patients with diagnoses of schizophrenia, organic impairment, or intense anxiety may have particular difficulty with this subtest because of the attenuation of the abstract attitude that is necessary for success on it. Patients with depression may also have difficulty succeeding on this subtest because of the complex analysis and synthesis required in a timed context. Thus, the performance subtests of the Wechsler intelligence scales sample a variety of cognitive and personality variables, including both short-term and practical, working memory, planning, abstraction, conceptualization, the need for structure, the ability to learn new material, perception of details, perceptual analysis, visual-motor coordination, identifying patterns, and sensitivity to social interactions. Because most of the performance subtests...

General Treatment Considerations

The literature on treatment of sexual aversion emphasizes the usefulness of cognitive behavioral treatment approaches (9,12) and there is support for the practical and relatively brief use of systematic desensitization (13). In this case, treatment consisted first of the creation of a hierarchy of aversion- and anxiety-provoking images, ranging from masturbation, which evoked the least anxiety, to intercourse, which evoked the greatest anxiety. In addition, Joyce was taught diaphragmatic deep breathing and an autogenic relaxation technique. The least anxiety-provoking stimuli were addressed first, with Joyce imagining each situation and reporting being able to remain relaxed and anxiety-free before each stimulus was subsequently approached in vivo. Importantly, sexual situations were designed to remain fully in her control Bill had agreed to allow Joyce to determine the rate at which each of the items on the hierarchy was engaged. Fifteen sessions conducted over a period of 5 months...

Needs Of Dying Persons

An ethic of care for terminally ill persons must be responsive to needs. Generally, the needs of dying persons will span the needs of life itself, from physical and medical care issues to psychological and social needs and often to spiritual concerns. To focus the point, consider persons dying from cancer. Sometimes these people will have to experience the deterioration of their bodies over a period of weeks or months. Anxiety, fear, loneliness, and depression are common. Most people can expect to experience symptoms from the primary disease. When a curative therapy is no longer possible, sometimes quite complicated medical care issues arise not only from the primary disease but from secondary sources, issuing in pain and discomfort. These may include appetite disturbance, fever, dysphagia (swallowing problems), persistent constipation, infections, dyspnea (difficulty in breathing), bladder dysfunction and incontinence, 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.

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