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1
Scemes, Silvia, Regina Christina Wielenska, Mariângela Gentil Savoia, and Marcio Bernik. "Choking phobia: full remission following behavior therapy." Revista Brasileira de Psiquiatria 31, no. 3 (August 7, 2009): 257–60. http://dx.doi.org/10.1590/s1516-44462009005000002.
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OBJECTIVE: A phobic behavior pattern is learned by classical and operant conditioning mechanisms. The present article reviews the main determinants of choking phobia etiology and describes the behavior therapy of an adult patient. METHOD: Psychoeducation, functional analysis, and graded exposure to aversive stimuli were used to treat the patient, after extensive psychiatric and psychological assessment. Ingesta and anxiety levels were measured along treatment and at follow-up. RESULTS: A multiple assessment baseline design was used to demonstrate the complete remission of symptoms after seven sessions, each of them exposing the patient to a different group of foods. CONCLUSION: Psychoeducation and exposure were critical components of a successful choking phobia treatment.
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Malik, Samina, Maheen Mirza, Fayyaz Ahmad, and Arif Malik. "Treatment of severe anxiety and social phobia by hypnosis and neurolinguistic programming- A Case Report." Annals of Psychophysiology 8, no. 2 (December 1, 2021): 107–11. http://dx.doi.org/10.29052/2412-3188.v8.i2.2021.107-111.
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Background: Hypnosis is being used in combination with different forms of psychotherapy nowadays, such as neuro-linguistic programming, to work as a complementary treatment. This pairing allows for more targeted and patient-specific approaches to treat psychological disorders, phobias, and pain. An example is our previous study, in which hypnosis was used to treat tobacco-pan addiction. Following a similar model in this case study, we investigate the effectiveness of hypnosis and neuro-linguistic programming as treatments for anxiety and phobias.
Case Presentation: We discuss a case of a 20-year-old boy with severe anxiety and social phobia who was already taking antipsychotic drugs and antidepressants, but they did not aid in treating his condition. He was then treated with hypnotherapy and neuro-linguistic programming to address the rooted triggers for his phobia. A thorough three-hour session revealed the details of each traumatic event. Each incident was isolated and changed in the patient's subconscious mind while he was hypnotized to remove that incident's role as a trigger.
Management & Results: The patient reported approximately seventy percent recovery immediately after the first session in terms of rebuilding his confidence. The recovery was measured on DASS-21 and Rosenberg Self-Esteem Scale (RSES). The severity of his phobia was significantly controlled in a short-span of time, with almost no episode after the first hypnosis and NLP session.
Conclusion: Hypnotherapy and neurolinguistic programming is an effective treatment for anxiety disorder and social phobia. It is also time-efficient and produces better results than other forms of treatment without accompanying side effects.
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Albakri, Ghaida, Rahma Bouaziz, Wallaa Alharthi, Slim Kammoun, Mohammed Al-Sarem, Faisal Saeed, and Mohammed Hadwan. "Phobia Exposure Therapy Using Virtual and Augmented Reality: A Systematic Review." Applied Sciences 12, no. 3 (February 5, 2022): 1672. http://dx.doi.org/10.3390/app12031672.
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A specific phobia is a common anxiety-related disorder that can be treated efficiently using different therapies including exposure therapy or cognitive therapy. One of the most famous methods to treat a specific phobia is exposure therapy. Exposure therapy involves exposing the target patient to the anxiety source or its context without the intention to cause any danger. One promising track of research lies in VR exposure therapy (VRET) and/or AR exposure therapy (ARET), where gradual exposure to a negative stimulus is used to reduce anxiety. In order to review existing works in this field, a systematic search was completed using the following databases: PubMed, ProQuest, Scopus, Web of Science, and Google Scholar. All studies that present VRET and/or ARET solutions were selected. By reviewing the article, each author then applied the inclusion and exclusion criteria, and 18 articles were selected. This systematic review aims to investigate the previous studies that used either VR and/or AR to treat any type of specific phobia in the last five years. The results demonstrated a positive outcome of virtual reality exposure treatment in the treatment of most phobias. In contrast, some of these treatments did not work for a few specific phobias in which the standard procedures were more effective. Besides, the study will also discuss the best of both technologies to treat a specific phobia. Furthermore, this review will present the limitations and future enhancements in this field.
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Baldwin, David, Julio Bobes, Dan J. Stein, Ingebor Scharwächter, and Michel Faure. "Paroxetine in social phobia/social anxiety disorder." British Journal of Psychiatry 175, no. 2 (August 1999): 120–26. http://dx.doi.org/10.1192/bjp.175.2.120.
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BackgroundPreliminary studies have suggested that paroxetine may be effective in social phobia/social anxiety disorder.AimsTo assess the efficacy and tolerability of paroxetine in the acute (12-week) treatment of social phobia.MethodTwo-hundred and ninety patients with social phobia were assigned randomly to paroxetine (20–50 mg/day flexible dose) or placebo for 12 weeks of double-blind treatment. Primary efficacy outcomes were the Liebowitz Social Anxiety Scale (LSAS) total score (patient-rated) and the Clinical Global Impression (GGI) scale global improvement item. The secondary efficacy variables included CGI scale severity of illness score and the patient-rated Social Avoidance and Distress Scale.ResultsParoxetine produced a significantly greater reduction in LSAS total score (mean change from baseline: –29.4 v. –15.6; P 0.001) and a greater proportion of responders (score $2 on CGI global improvement) (65.7% v. 32.4%; P < 0.001) compared with placebo at the end of the 12-week study period. Both primary efficacy variables were statistically significant compared with placebo from week 4 onwards. Paroxetine was generally well tolerated.ConclusionsParoxetine is an effective, well-tolerated treatment for patients with social phobia.
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ENG, W., R. G. HEIMBERG, M. E. COLES, F. R. SCHNEIER, and M. R. LIEBOWITZ. "An empirical approach to subtype identification in individuals with social phobia." Psychological Medicine 30, no. 6 (November 2000): 1345–57. http://dx.doi.org/10.1017/s0033291799002895.
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Background. The present study used cluster analysis procedures to identify empirically subgroups of patients with social phobia in a large clinical sample.Method. The Liebowitz Social Anxiety Scale (LSAS) was administered to 382 patients from several studies of the treatment of social phobia. LSAS fear ratings were summed into four subscale scores (social interaction, public speaking, observation by others, eating and drinking in public) based on a previous factor analytical study of the LSAS. In order to produce a stable and robust solution, these factor scores were submitted to a two-stage clustering procedure consisting of an agglomerative-hierarchical clustering method followed by an iterative non-hierarchical clustering method.Results. Three patient subgroups were identified based on their pattern of feared social situations on the LSAS. These groups were labelled: (1) pervasive social anxiety; (2) moderate social interaction anxiety; and (3) dominant public speaking anxiety. Clusters differed significantly on age and age of social phobia onset, as well as on measures of social anxiety, general anxiety and depressive symptomatology. Clusters also differed in the percentage of assigned patients who met criteria for the generalized subtype of social phobia and avoidant personality disorder.Conclusions. The results provide empirical support for the existence of three subgroups in a clinical sample of individuals with social phobia and contribute to the growing evidence for the heterogeneity of social phobia. Further study of the conceptual, clinical and aetiological significance of these subgroups is needed.
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Ozaki, Atsuta, Hisashi Matsubara, Masahiko Sugimoto, Manami Kuze, Mineo Kondo, and Takashi Shiroyama. "Efficacy of Psychiatric Treatment to Treat a Specific Phobia of Intravitreal Injections in a Patient with Neovascular Age-Related Macular Degeneration." Case Reports in Ophthalmology 12, no. 1 (January 13, 2021): 48–56. http://dx.doi.org/10.1159/000510330.
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Intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) is essential for the treatment of macular diseases such as wet age-related macular degeneration and macular edema. Although continued treatment is needed to maintain good vision, some patients cannot continue such injections for various reasons, including specific phobias. Here, we report a case of a patient with a specific phobia of intravitreal injections who could resume treatment after undergoing combined drug and cognitive-behavioral therapy (CBT). A 74-year-old Japanese man diagnosed with retinal angiomatous proliferation by fluorescein angiography and indocyanine green angiography was treated with intravitreal anti-VEGF injection. However, at 8 months after the first treatment, he became difficult to treat because of a phobia of injections. He was treated with photodynamic therapy, but his macular edema did not improve. After a psychiatric consultation, he was diagnosed with a specific phobia of intravitreal injections. Combined drug and CBT enabled him to resume receiving intravitreal injections. This case demonstrates that a specific phobia of intravitreal injections may benefit from combined drug and CBT. In this regard, some patients with high anxiety and fear of intravitreal injections should be referred to a psychiatrist at an early stage.
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Artigas, Nathalie Ribeiro, Vera Lúcia Widniczck Striebel, Arlete Hilbig, and Carlos Roberto de Mello Rieder. "Evaluation of quality of life and psychological aspects of Parkinson's disease patients who participate in a support group." Dementia & Neuropsychologia 9, no. 3 (September 2015): 295–300. http://dx.doi.org/10.1590/1980-57642015dn93000013.
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Parkinson's disease (PD) is a neurodegenerative disorder that can dramatically impair patient quality of life (QoL). Objective: To analyze the QoL, motor capacity, depression, anxiety and social phobia of individuals who attended a patient support group (PSG) compared to non-participants. Methods: A cross-sectional study was performed. The sample consisted of 20 individuals with PD who attended a PSG and another 20 PD patients who did not attend a support group for PD patients, serving as the control group (nPSG). All patients answered questionnaires on motor capacity (UPDRS), QoL (Parkinson's Disease Questionnaire- PDQ-39), depression (Beck Depression Inventory), anxiety (Beck Anxiety Inventory) and social phobia (Liebowitz Social Anxiety Scale). To determine data distribution, the Shapiro-Wilk test was performed. For comparison of means, Student's t-test was applied. In cases of asymmetry, the Mann-Whitney test was employed. To assess the association between the scales, Pearson's correlation coefficient (symmetric distribution) and Spearman's coefficient (asymmetric distribution) were applied. For the association between qualitative variables, Pearson's Chi-squared test was performed. A significance level of 5% (p≤0.05) was adopted. Results: Individuals in the PSG had a significantly better QoL (p=0.002), and lower depression (p=0.026), anxiety (p<0.001) and social phobia (p=0.01) scores compared to the nPSG. Conclusion: The participation of PD patients in social activities such as support groups is associated with better QoL and fewer symptoms of depression, anxiety and social phobia.
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HEIMBERG, R. G., K. J. HORNER, H. R. JUSTER, S. A. SAFREN, E. J. BROWN, F. R. SCHNEIER, and M. R. LIEBOWITZ. "Psychometric properties of the Liebowitz Social Anxiety Scale." Psychological Medicine 29, no. 1 (January 1999): 199–212. http://dx.doi.org/10.1017/s0033291798007879.
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Background. The present study provides data on the reliability, validity and treatment sensitivity of the Liebowitz Social Anxiety Scale (LSAS), one of the most commonly used clinician-administered scales for the assessment of social phobia.Method. Three hundred and eighty-two patients from several studies of the treatment of social phobia were evaluated. An independent assessor administered the LSAS to each patient prior to the initiation of treatment. Patients also completed other measures of social anxiety and avoidance, although the specific measures varied across samples.Results. The LSAS and its subscales were normally distributed and demonstrated excellent internal consistency. The convergent validity of the LSAS was demonstrated via significant correlations with other commonly-used measures of social anxiety and avoidance. These correlations also tended to be larger than correlations with measures of depression, especially after treatment. However, the pattern of correlations of LSAS subscales with one another and with the other measures suggest that the fear subscales and the avoidance subscales may not be sufficiently distinct in clinical samples. The LSAS was also demonstrated to be sensitive to the effects of pharmacological treatments of social phobia over time and in comparison to double-blind pill placebo.Conclusion. The LSAS appears to be a reliable, valid and treatment sensitive measure of social phobia. Further study of the LSAS, both in samples with severe social phobia and in community samples, is needed.
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Foulds, Jonathan. "Cerebral Circulation During Treatment of Blood-Injury Phobia: A Case Study." Behavioural Psychotherapy 21, no. 2 (April 1993): 137–46. http://dx.doi.org/10.1017/s0141347300018103.
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A case of blood-injury phobia complicated by fainting is described. Measures of cerebral blood flow velocity (CBFV) and heart rate (HR) indicated that phobic exposure reliably precipitated a marked drop in CBFV, simultaneous with an increase in HR and onset of dizziness. It is suggested that hyperventilation was a factor exacerbating fainting in this case. Muscle tensing produced small increases in cerebral blood flow velocity but these were not of sufficient magnitude to prevent onset of dizziness. The patient improved with treatment involving graded exposure, respiratory control and muscle tensing. At seven months follow-up the patient maintained improvements in anxiety and avoidance but again became faint during exposure.
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Mircea, M. M. "Employing Long Short-Term Memory Networks in Trigger Detection for Emetophobia." Studia Universitatis Babeș-Bolyai Informatica 65, no. 2 (October 27, 2020): 17. http://dx.doi.org/10.24193/subbi.2020.2.02.
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Research focused on mental health-related issues is vital to the modern person’s life. Specific phobias are part of the anxiety disorder umbrella and they are distressing afflictions. Emetophobia is the rarely known, yet fairly common and highly disruptive specific phobia of vomiting. Unlike other phobias, emetophobia is triggered not only by the object of the specific fear, but also by verbal and written mentions of said object. This paper proposes and compares ten neural network-based architectures that discern between triggering and non-triggering groups of written words. An interface is created, where the best models can be used in emetophobia-related applications. This interface is then integrated into an application that can be used by emetophobes to censor online content such that the exposure to triggers is controlled, patient-centered, and patient-paced.
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Terra, Mauro B., Helena M. T. Barros, Airton T. Stein, Ivan Figueira, Luciana D. Athayde, Marcelo de S. Gonçalves, Letícia P. Tergolina, Joana S. Rovani, and Dartiu Xavier da Silveira. "Internal consistency and factor structure of the Portuguese version of the Liebowitz Social Anxiety Scale among alcoholic patients." Revista Brasileira de Psiquiatria 28, no. 4 (October 18, 2006): 265–69. http://dx.doi.org/10.1590/s1516-44462006005000008.
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OBJECTIVE: Liebowitz Social Anxiety Scale is an instrument used to evaluate the severity of social phobia. It has been widely used in different contexts and cultures, presenting variable psychometric properties. The objective of this article is to investigate the internal consistency and the factor structure of this scale. METHOD: In a sample of 300 alcoholic patients hospitalized in 3 mental clinics in Southern Brazil, 74 of them were social phobics (24.6%). The Structured Clinical Interview for DSM-IV-Axis I Disorders - Patient Edition, a semi-structured clinical interview based on DSM-IV, was used to check for the diagnosis of social phobia. The internal consistency was measured by Cronbach's alpha. Data were subjected to a factor analysis with the principal component method of parameter estimation. Questionnaire items loading at 0.35 or above were considered in the final factor solution. RESULTS: The coefficient of internal consistency was 0.95. All items showed corrected item-total correlation coefficient above 0.15, considered the minimum requested index. The factor analysis resulted in 5 dimensions which corresponded to 52.9% of the total variance. The five factors extracted were: factor I - speaking in a group, factor II - activity in public, factor III - social interaction with unknown person, factor IV - attitude of disagreement or disapproval and factor V - social interaction in leisure activity. CONCLUSIONS: The scale proved to be reliable and structurally valid instrument for use in a population of alcoholic patients. The possibility of screening for social phobia through the use of the instrument may be helpful in identifying probable cases of the disorder among alcoholics.
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Good, John. "THE EFFECT OF TREATMENT OF A COMORBID ANXIETY DISORDER ON PSYCHOTIC SYMPTOMS IN A PATIENT WITH A DIAGNOSIS OF SCHIZOPHRENIA: A CASE STUDY." Behavioural and Cognitive Psychotherapy 30, no. 3 (July 2002): 347–50. http://dx.doi.org/10.1017/s1352465802003090.
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This case study deals with the effect of treatment of social phobia on psychotic symptoms in a patient with a diagnosis of schizophrenia. Stress vulnerability models were used to provide a rationale for treatment. The phobia was treated using standard CBT techniques while the therapist avoided any direct treatment of the psychotic symptoms. Scores for social phobia reduced to a sub clinical level over the course of treatment and the psychotic symptoms rapidly abated. Although only a single case study and therefore impossible to generalize to a wider patient group the study would seem to suggest that treatment of comorbid anxiety disorders can effect psychotic symptoms. Some thoughts are presented as to why this might be the case.
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Malbos, Eric, George H. Burgess, and Christophe Lançon. "Virtual Reality and Fear of Shark Attack: A Case Study for the Treatment of Squalophobia." Clinical Case Studies 19, no. 5 (July 13, 2020): 339–54. http://dx.doi.org/10.1177/1534650120940014.
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Research treatment protocols are rare regarding an unusual anxiety disorder, namely the fear of sharks (squalophobia). As a possible solution, the effectiveness of virtual reality (VR) exposure therapy for this phobia was tested. The advantage of using VR becomes clearer when a real life set up is impractical, such as exposing a phobic patient to a feared large marine organism, the shark. The effects were evaluated in a single case study involving multiple context-graded aquatic virtual environments with a virtual shark and using affordable VR apparatus and software. Assessment was based on self-report questionnaires. Scores the psychometric instruments exhibited a discernable reduction in fear toward sharks. Such gains were maintained at a 12-month follow-up. Presence rates indicated immersion when confronted to a three-dimensional (3D) virtual shark. This initial study revealed the potential of VR for the treatment of marine biota phobia and its potential to recreate diverse situations for exposure therapy.
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Tang, Nicole K. Y. "Brief CBT-I for Insomnia Comorbid with Social Phobia: A Case Study." Behavioural and Cognitive Psychotherapy 38, no. 1 (October 26, 2009): 113–22. http://dx.doi.org/10.1017/s1352465809990488.
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Background: Despite an obvious link between social anxiety and acute state of insomnia, chronic types of sleep disturbances in people with social phobia have so far received limited research/clinical attention. This case report aims to illustrate the possibility of rectifying sleep disturbances comorbid with social phobia, using a brief cognitive behaviour therapy for insomnia (CBT-I). Method: Treatment involved five sessions of CBT-I provided individually on a weekly basis. Major treatment components included psychoeducation, sleep restriction therapy, stimulus control and cognitive restructuring. Results: Treatment effects were assessed using sleep diary and questionnaires over the course of the treatment and at ~9 month follow-up. The results were encouraging with all targeted sleep parameters demonstrating improvements that met dual criteria for clinical significance. The gains were well maintained even at ~9 months after treatment. These improvements in sleep were accompanied by a reduction in sleep-related anxiety and dysfunctional beliefs and attitudes about sleep. Whilst the patient also reported a corresponding improvement in daytime functioning and general anxiety, no gains were observed in depression and social anxiety. Conclusions: These findings highlight the potential benefits of incorporating brief CBT-I into existing treatments for social phobia and encourage further research on the intricate relationship between sleep, mood and social anxiety.
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McManus, Freda, David M. Clark, and Ann Hackmann. "SPECIFICITY OF COGNITIVE BIASES IN SOCIAL PHOBIA AND THEIR ROLE IN RECOVERY." Behavioural and Cognitive Psychotherapy 28, no. 3 (July 2000): 201–9. http://dx.doi.org/10.1017/s1352465800003015.
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Cognitive theorists propose that each anxiety disorder is associated with a specific tendency to overestimate the danger inherent in particular situations or internal states. Studies comparing anxious patients with non-patient controls have shown that several anxiety disorders are associated with elevated subjective estimates of the likelihood (probability) and cost of negative events. The present study focuses on social phobia and extends previous findings by: a) including a control group of equally anxious patients with another anxiety disorder and b) investigating the effects of successful cognitive and drug treatments on patients' probability and cost estimates. In line with cognitive theory, the results indicate that social phobia is associated with a specific elevation in subjective estimates of both the probability and cost of potentially negative social events. Reductions in overestimation occurred in successful cognitive and drug treatment and were closely related to the degree of symptomatic improvement in both treatments. Contrary to previous findings, there was no evidence that reductions in cost were more important than reductions in probability.
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Smeltere, Ligita, Vladimirs Kuzņecovs, and Roberts Smelters. "Research on Social Anxiety in Patients with Essential Tremor and Parkinson’s Disease in a Sample of the Latvian Population / Sociālās Trauksmes Izpēte Pacientiem ar Esenciālu Tremoru un Parkinsona Slimību Latvijas Populācijā." Proceedings of the Latvian Academy of Sciences. Section B. Natural, Exact, and Applied Sciences. 69, no. 5 (September 5, 2015): 250–58. http://dx.doi.org/10.1515/prolas-2015-0038.
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Abstract Essential tremor is considered to be one of the most common movement disorders in the world, but its non-motor symptoms have been studied relatively little in clinical practice. The objective of this study was to identify the symptoms of social anxiety and their association with motor symptoms in 40 patients with essential tremor (ET), in comparison with 35 patients with Parkinson’s disease (PD) and 39 patients of the control group from the Latvian population. This was conducted by neurological investigation, five patient self-assessment questionnaires (DASS, BDI, SIAS, SPS, STAI), and clinical interviews. The findings are as follows: using SIAS (Social Interaction Anxiety Scale), in ET patients there was no significant correlation between the severity of tremor and anxiety during social contacts (p > 0.05), but there was a moderate positive significant correlation with the social phobia scale (SPS) score (rs=0.35; p < 0.05). In the ET group, social anxiety (phobia) disorder was found in 50% of the patients according to ICD-10, but in 35% according to DSM-5. In the PD group, the diagnostic criteria of social anxiety disorder were met by 42.86% according to ICD-10 and 25.71% according to DSM-5. In the control group mild social anxiety was found and the criteria met by 20.51% according to ICD-10 and 7.69% according to DSM-5.
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Demirbilek, Huseyin, Ergun Parmaksiz, Gokcen Gokcan, Fatih Turhan, Ozlem Cigerli, Seval Yesim Kokturk, Rabia Papila, and Fatma Nurhan Ozdemir Acar. "A psycho-social viewpoint to anxiety and social phobia in dialysis patient." Medical Journal of Goztepe Training and Research Hospital 26, no. 3 (March 5, 2013): 112–16. http://dx.doi.org/10.5222/j.goztepetrh.2011.112.
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Mallet, J., V. Guillard, O. Huillard, C. Dubertret, and F. Limosin. "Effectiveness of Cognitive Behavioral Therapy in the Treatment of a Phobic Disorder in a Patient with Down Syndrome and Early Alzheimer's Disease." European Psychiatry 33, S1 (March 2016): S476. http://dx.doi.org/10.1016/j.eurpsy.2016.01.1739.
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IntroductionDown syndrome was clinically described the first time in France by Esquirol (1838) followed by Down (England, 1866), to the identification of a chromosomal abnormality in 1959 (trisomy 21), which is the most common abnormality in neurodevelopmental disorders. Life expectancy increased from 9 years in 1929 to 55 currently. This is a common cause of mental retardation, and few tools are suitable for the care of these patients, including patients with Alzheimer's disease (prevalence of 55% between 50 and 59) or depression (prevalence 30%). No study evaluates the effectiveness of cognitive and behavioral therapy (CBT) in patients with Down syndrome but it is known to be effective in Alzheimer's patients. Some cases have been reported on the efficacy of CBT on phobias in patients with intellectual disability.Objectives and aimsTo evaluate the efficacy of CBT in the treatment of a specific phobia in a patient with Down syndrome and early Alzheimer's disease.MethodLiterature review and clinical case of a 51-year-old patient, hospitalized under constraints for behavioral disorders (agitation, body treatments refusals).ResultsBy adapting CBT techniques to the problem of intellectual disability, treatment against the phobia was effective with clinical improvement, which allowed a return home.ConclusionThe tools provided by CBT are suitable for the treatment of anxiety disorders in patients with intellectual disability, especially in patients with Down syndrome. Psychiatric disorders are under-diagnosed in these patients and under-treated. CBT is an aid to the treatment. It may allow the dismantling of symptoms and reduce behavioral problems.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Pollack, Mark H. "Pharmacologic Treatments for Anxiety." CNS Spectrums 9, no. 4 (2004): 4–8. http://dx.doi.org/10.1017/s1092852900027103.
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While the public health perspective prioritizes large populations of affected individuals, our job as clinicians is to help one patient at a time. Over the last 10–20 years, there has been marked improvement in pharmacologic and psychosocial interventions available for patients with anxiety disorders (Slide 8).The use of antidepressants, particularly the serotonergic and serotonergic noradrenergic agents, have received increased attention as first-line treatment for most of the anxiety disorders, including panic disorder, social phobia, posttraumatic stress disorder (PTSD), and generalized anxiety disorder (GAD). Antidepressants are often used as first-line therapy for anxiety disorders because of their broad spectrum of efficacy against common comorbidities, especially depression, and because of concern about benzodiazepine-associated dependence, abuse liability, and lack of efficacy for depression and other comorbidities (Slide 9).These newer antidepressants have advantages over the older antidepressants, particularly the tricyclics and the monoamine oxidase inhibitors, in that they are generally better tolerated and more appropriate for use in potentially suicidal patients because they are less lethal in overdose. However, there are some side effects that may limit their use in some patients. In the case of the serotonergic antidepressants, many patients are hesitant to initiate or maintain treatment due to concerns about sexual dysfunction.
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Pallanti, Stefano, Leonardo Quercioli, and Adolfo Pazzagli. "Social Anxiety and Premorbid Personality Disorders in Paranoid Schizophrenic Patients Treated With Clozapine." CNS Spectrums 5, no. 9 (September 2000): 29–43. http://dx.doi.org/10.1017/s1092852900021635.
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AbstractThe concept of anxiety as a distinct comorbid disorder in schizophrenia has recently been rediscovered after having been neglected for a long period of time due to both theoretical and clinical approaches adopted from the appearance of the first edition of the Diagnostic and Statistical Manual of Mental Disorders in 1950. This rediscovery was accentuated by the fact that the concept of comorbidity in various psychiatric disorders has recently won widespread favor within the scientific community, and that the use of atypical neuroleptic medication to treat patients with schizophrenia has been reported to lead to the emergence of anxiety symptoms. Of the atypical neuroleptic medications used to treat schizophrenia, clozapine has most frequently been reported to induce anxiety symptoms. In this paper, 12 cases of patients with paranoid schizophrenia who developed social phobia during clozapine treatment are reported, and their response to fluoxetine augmentation is assessed. Premorbid personality disorders were also investigated; patients were assessed using the Structured Clinical Interview for DSM-III-R—Patient Version and the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (DSM-III-R=Diagnostic and Statistical Manual of Mental Disorders, Third Edition Revised; DSM-IV=Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition). In addition, the Scale for the Assessment of Negative Symptoms, the Scale for the Assessment of Positive Symptoms, the Liebowitz Social Anxiety Scale (LSAS), the Frankfurt Beschwerde Fragebogen (Frankfurt Questionnaire of Complaints), and the Brief Psychiatric Rating Scale were used to rate clinical symptomatology. All patients were reevaluated after 12 weeks of cotreatment with clozapine and fluoxetine. In 8 (66.6%) of the 12 cases, symptoms responded (≥35% LSAS score reduction) to an adjunctive regimen of fluoxetine. Furthermore, in 7 (58.3%) of the 12 cases, an anxious personality disorder (avoidant=33.3%; dependent=25%) was identified, but no significant differences in the prevalence of comorbid personality disorders emerged in comparison with a group of 16 patients with paranoid schizophrenia treated with clozapine who did not show symptoms of social phobia. The clinical relevance of the assessment and treatment of anxiety disorders is discussed in light of a clinical therapeutic approach that overcomes the implicit hierarchy of classification. Considering that the onset of anxiety-spectrum disorders (such as social phobia) can occur during the remission of psychotic symptoms in clozapine-treated patients with schizophrenia, a comprehensive approach to pharmacological therapy for patients with schizophrenia (or, at least for those treated with clozapine) should be adopted.
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Newell, Robert, and Isaac Marks. "Phobic nature of social difficulty in facially disfigured people." British Journal of Psychiatry 176, no. 2 (February 2000): 177–81. http://dx.doi.org/10.1192/bjp.176.2.177.
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BackgroundOver 390 000 people in the UK are disfigured. Facial disfigurement distresses sufferers markedly but has been studied little.AimsTo compare fearful avoidance of people with a facial disfigurement with that of a group of patients with phobia.MethodComparison of Fear Questionnaire agoraphobia, social phobia and anxiety depression sub-scale scores of 112 facially disfigured people (who scored high on Fear Questionnaire problem severity in three survey studies) with those of 66 out-patients with agoraphobia and 68 out-patients with social phobia.ResultsFacially disfigured people and patients with social phobia had similar Fear Questionnaire scores. In contrast, facially disfigured people scored lower on the agoraphobia sub-score but higher on the social phobia sub-score than did patients with agoraphobia.ConclusionsFacially disfigured people with psychological difficulties resembled people with social phobia on Fear Questionnaire social phobia, agoraphobia and anxiety/depression sub-scores but were less agoraphobic and more socially phobic than were people with agoraphobia. Facially disfigured people thus appeared to be socially phobic and to deserve the cognitive – behavioural therapy that is effective for such phobias.
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Mazhar, Mir, Tariq Hassan, and Tariq Munshi. "Treatment of Anxiety Disorders and Comorbid Alcohol Abuse with Buspirone in a Patient with Antidepressant-Induced Platelet Dysfunction: A Case Report." Case Reports in Psychiatry 2013 (2013): 1–3. http://dx.doi.org/10.1155/2013/572630.
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The risk of abnormal bleeding with serotonin reuptake inhibitors has been known, but there is insufficient evidence base to guide pharmacological treatment of anxiety in patients with underlying haematological conditions. The following case report is about a 50-year-old female with generalized anxiety disorder, social phobia, obsessive compulsive disorder, and alcohol abuse where pharmacological treatment of anxiety symptoms has been difficult as it would lead to bruising due to the patient’s underlying qualitative platelet dysfunction. Treatment with venlafaxine, citalopram, escitalopram, and clomipramine resulted in improvement and anxiety symptoms, as well as reduction in alcohol use, but pharmacological treatment has to be discontinued because of bruising and hematomas. In view of an active substance use disorder, benzodiazepines were avoided as a treatment option. The patient’s anxiety symptoms and comorbid alcohol abuse responded well to pharmacological treatment with buspirone which gradually titrated up to a dose of 30 mg BID. Patient was followed for around a six-month period while she was on buspirone before being discharged to family doctor’s care. Buspirone is unlikely to have a significant effect on platelet serotonin transponder and could be an effective alternative for pharmacological treatment of anxiety in patients with a bleeding diathesis.
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Cardoso, Ana Carolina de Lima, Ana Karlla Rocha, Bruna Rafaella Ramos Melo, Lyzandra Cardoso Calixto, Marilia Mattar de Amoêdo Campos Velo, and Dayse Andrade Romão. "Manifestation of Anxiety during Dental Treatment: Integrative Literature Review." Journal of Health Sciences 21, no. 5 (December 20, 2019): 445–53. http://dx.doi.org/10.17921/2447-8938.2019v21n5p445-453.
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Abstract Even with the technical-scientific advance in Dentistry, it is still seen as a profession that causes anxiety in children and adults. Therefore, in addition to the technical knowledge, the dental surgeon must have different strategies in the management and conduct of this situation once anxiety if aggravated can become pathological and interfere in the patient's oral health and his or her quality of life. Thus, the present study was conducted in order to realize the main aspects of dental anxiety, aiming to improve patient-dentist relationship, avoiding the onset of phobic disorders. This is an integrative review of the literature, using the Lilacs and SciELO databases with the descriptors anxiety, phobia and dentist verified individually and later they were crossed with AND operator with search period from 2000 to 2019, articles in Portuguese and in fulltext. The exclusion criteria were: thesis, books, final paper and dissertations. 20 articles were identified which showed that anxiety directly interferes with the effectiveness of treatment in different age groups. Priority should be given to communication between the dental surgeon and his or her patient, to recognize possible causes of discomfort. In addition, it is necessary to carry out more studies because there are differences in the literature concerning the interference of social and economic factors and schooling levels in the anxiety development. Keywords: Anxiety. Dentist. Phobia. ResumoMesmo com o avanço técnico-científico na Odontologia, esta ainda é vista como uma profissão que provoca ansiedade em crianças e adultos. Dessa forma, além do conhecimento técnico, o cirurgião-dentista deve possuir estratégias diferenciadas no manejo e na conduta perante esta situação, uma vez que, se agravada, a ansiedade pode torna-se patológica e interferir na saúde bucal do paciente, afetando diretamente sua qualidade de vida. Assim, o presente estudo foi conduzido com intuito de perceber os principais aspectos da ansiedade odontológica, visando aperfeiçoar as relações paciente-dentista, evitando o desencadeamento de transtornos fóbicos. Trata-se de uma revisão integrativa da literatura, utilizando as bases de dados Lilacs e Scielo com os descritores: medo, fobia e dentista, verificados individualamente e posteriormente feito cruzamenento com AND, com período de busca de 2000 a 2019, artigos em portugues e na íntegra. Os critérios de exclusão foram: teses, livros, trabalhos de conclusão de cursos e dissertações. Foram identificados 20 artigos que evidenciaram que a ansiedade interfere diretamente na efetividade do tratamento em diferentes faixas etárias, devendo-se priorizar a comunicação entre o cirurgião-dentista e seu paciente, para reconhecer possíveis causas de desconforto. Porém, é necessário realizar mais estudos devido as divergências na literatura referente a interferência de fatores sociais, econômicos e níveis de escolaridade, no desenvolvimento da ansiedade. Palavras-chave: Ansiedade. Dentista. Fobia.
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Bowen, Rudradeo C., Donald G. Fischer, Peter Barrett, and Carl D'Arcy. "The Relationship between Agoraphobia, Social Phobia and Blood-Injury Phobia in Phobic and Anxious-Depressed Patients." Canadian Journal of Psychiatry 32, no. 4 (May 1987): 275–81. http://dx.doi.org/10.1177/070674378703200405.
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This paper reports the results of principal components and stepwise discriminant analyses of anxiety, depression and fear scores for 74 phobic and anxious-depressed psychiatric patients. Factor analysis indicated a coherent agoraphobia factor, with less coherent blood-injury and social phobia factors. Discriminant analysis showed a high degree of correct classification of diagnosed agoraphobic, blood-injury and social phobic patients particularly for agoraphobia. A frequency distribution of the phobia scores indicated an all or nothing quality to agoraphobic fears. The results indicate that agoraphobia is a fairly coherent syndrome, but that more work is needed on the concepts and measurement of blood-injury and social phobias.
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Trzesniak, Clarissa, David Araújo, and José Alexandre S. Crippa. "Magnetic resonance spectroscopy in anxiety disorders." Acta Neuropsychiatrica 20, no. 2 (April 2008): 56–71. http://dx.doi.org/10.1111/j.1601-5215.2008.00270.x.
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Objective:Magnetic resonance spectroscopy (MRS) is a non-invasive in vivo method used to quantify metabolites that are relevant to a wide range of brain processes. This paper briefly describes neuroimaging using MRS and provides a systematic review of its application to anxiety disorders.Method:A literature review was performed in the PubMed, Lilacs and Scielo databases using the keywords spectroscopy and anxiety disorder. References of selected articles were also hand-searched for additional citations.Results:Recent studies have shown that there are significant metabolic differences between patients with anxiety disorders and healthy controls in various regions of the brain. Changes were mainly found in N-acetylaspartate, which is associated with neuronal viability, but some of them were also seen in creatine, a substance that is thought to be relatively constant among individuals with different pathological conditions.Conclusions:MRS is a sophisticated neuroimaging technique that has provided useful insights into the biochemical and neurobiological basis of many anxiety disorders. Nevertheless, its utilization in some anxiety disorders is still modest, particularly social phobia and generalised anxiety. Although it is an extremely useful advance in neuroimaging, further research in other brain areas and patient populations is highly advisable.
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Van Zuuren, Florence J. "The Fear Questionnaire." British Journal of Psychiatry 153, no. 5 (November 1988): 659–62. http://dx.doi.org/10.1192/bjp.153.5.659.
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In order to assess some psychometric properties of Marks & Mathews' (1979) short Fear Questionnaire, a Dutch translation of this form was administered to 143 phobic outpatients: 100 women and 43 men. There was a special interest in assessing validity by comparing the scores of agoraphobics, social phobics and simple phobics. The findings were that all scales have sufficient internal consistency, although the Total Phobia scale does not seem to add meaningful information to its subscales. Most scales are significantly related to neuroticism, and the Social Phobia subscale is strongly related to social anxiety. The Agoraphobia and Social Phobia subscales discriminate between categories of phobics in the expected way. For the Blood/Injury subscale the relevant comparisons could not be made. The data presented in this study can be used to develop FQ norms for phobic patients.
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Wulandari, Patricia. "Panic Disorder with Choking Phobia : a Case Report." Scientia Psychiatrica 1, no. 2 (April 13, 2020): 25–30. http://dx.doi.org/10.37275/scipsy.v1i2.11.
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Abstract
Panic disorder is a form of anxiety disorder characterized by repeated panic attacks and preoccupied with worrying that a panic attack will occur. Panic attacks are characterized by fears of a disaster or loss of self-control even though there is really nothing to worry about. Other symptoms experienced during a panic attack are heart palpitations (similar to a heart attack), shortness of breath, feelings of suffocation, and the body feels weak. If this disorder is not detected early, it will affect the daily life of the patient. This case report presents the case of a 34-year-old woman who experiences symptoms of panic disorder with choking phobia that is managed with antidepressants and cognitive behavior therapy. In addition, there is discussion of differential diagnosis and the role of cognitive behavior therapy in handling this case.
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Roy, D. "Emetophobia (a specific phobia of vomiting): A case study." European Psychiatry 41, S1 (April 2017): S416—S417. http://dx.doi.org/10.1016/j.eurpsy.2017.01.367.
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IntroductionCase presentation of a young woman Ms. A.M., referred by her GP with an eating disorder, who was thereafter diagnosed with an uncommon type of phobia (emetophobia – a specific phobia of vomiting) and treated accordingly.ObjectivesTo highlight the diagnostic dilemma with such uncommon cases, who are often misdiagnosed as having anorexia nervosa or bulimia nervosa or suffering from other anxiety disorders (like OCD or GAD).MethodsA comprehensive mental state examination was conducted including a diagnostic clarification interview. She was followed up by the mental health team on a regular basis with support and also providing appropriate psychotherapy.DiscussionMs. A.M. refused medications and only agreed to non-pharmacological treatment. She was therefore commenced on once weekly psychotherapy (CBT), which she undertook for a period of 4 months. She showed good response to the psychotherapy with significant attenuation of her core symptoms, although she still continued to exhibit some avoidance behaviors.ConclusionsThis particular patient showcases a relatively uncommon and often misdiagnosed specific phobia (emetophobia) and highlights the positive response seen in this case with psychotherapy.Disclosure of interestThe author has not supplied his declaration of competing interest.
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Olagunju, Andrew Toyin, Olasimbo Adenike Ogundipe, Victor Olufolahan Lasebikan, Ayodele Olurotimi Coker, and Chinyere Nkiruka Asoegwu. "Pattern of anxiety psychopathology experienced among postgraduate medical trainees." Bangladesh Journal of Medical Science 15, no. 1 (April 11, 2016): 25–32. http://dx.doi.org/10.3329/bjms.v15i1.20497.
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Objectives: Postgraduate medical training is characteristically intensive and stressful. Given that anxiety disorders are often linked with stress-related scenarios; awareness of the burden of anxiety disorders among postgraduate medical trainees and their determinants is essential for informed intervention. This study was set to investigate the pattern of anxiety psychopathology, and to determine its correlates among doctors in a Nigerian postgraduate medical training facility.Methods: The participants, made up of 204 resident doctors were administered questionnaire to elicit their socio-demographic and work related variables. Subsequently, 12- item General Health Questionnaire (GHQ-12) was used to ascertain the presence of emotional distress, and the Structured Clinical Interview for Diagnostic & Statistical Manual for Mental Disorders- fourth edition [DSM-IV] Axis-1 Disorders, Non-patient edition (SCID-1/NP) was administered to characterize anxiety related psychopathology in the participants.Results: The mean age of participants was 33.44 (±4.50). In all, 120 (58.8%) respondents reported various difficulties with their examinations, 14(8.3%) reported having physical disorder and 59(28.9%) respondents were emotionally distressed. The prevalence of anxiety psychopathology based on DSM-IV criteria was 13.2% and the pattern elicited based on recognised categories include generalized anxiety disorder (4.9%), obsessive-compulsive disorder (3.4%), specific phobia (2.4%), social phobia (1.5%) and substance induced anxiety disorders (1.0%). Having additional qualification to the medical degree seems protective against anxiety psychopathology (?2= 3.91; df=1; p<0.05), while those with emotional distress (?2=17.54; df=1; p<0.001) were more likely to experience anxiety.Conclusion: Comprehensive and need-based mental health services with psychosocial support for trainee doctors are implied. Future research focusing on modifiable predictors of mental health challenges among resident doctors and their linkage with specific aspects of training is indicated.Bangladesh Journal of Medical Science Vol.15(1) 2016 p.25-32
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Stangier, Ulrich, Thomas Heidenreich, and Karin Schermelleh-Engel. "Safety Behaviors and Social Performance in Patients With Generalized Social Phobia." Journal of Cognitive Psychotherapy 20, no. 1 (March 2006): 17–31. http://dx.doi.org/10.1891/jcop.20.1.17.
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The cognitive model of social phobia (Clark & Wells, 1995) suggests that safety behaviors, besides preventing disconfirmation of dysfunctional beliefs, cause significant impairment in social performance. To test this hypothesis, the current study investigated the relationship between observer-rated social performance, self-rated safety behaviors, and anxiety in 20 generalized social phobics, 14 controls with anxiety, and 17 controls without anxiety in two experimental tasks: a conversation with a stooge and a brief speech. Compared to the control groups, socially phobic patients displayed higher anxiety levels, reported more safety behaviors, and did not perform as well as the control groups in both tasks. There was a nonsignificant tendency of socially phobic patients to display more negative thoughts than both control groups. Differences in heart rate responses were not significant. A path analysis revealed that safety behaviors partially mediated the relation between diagnostic group and social performance deficit in both tasks. The results highlight the importance of safety behaviors for social performance deficit in social phobia.
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van Vliet, I. M. "Biological aspects of social phobia." Acta Neuropsychiatrica 8, no. 4 (December 1996): 87–89. http://dx.doi.org/10.1017/s0924270800036978.
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SummaryIn contrast to the research in panic disorder, not much neurobiological studies have been conducted in social phobia. In challenge-tests using lactate or pentagastrin general anxiety and anxiety symptoms were induced in social phobies, although not as frequent is in panic disorder patients, but no specific social phobic anxiety was induced. The role of neurotransmitters such as serotonin, dopamine and noradrenalin is, as yet, unclear. There are no indications for abnormal hypothalamic-pituitary-adrenal-axis activity or abnormal hypothalamic-pituitary-thyroid-axis activity in social phobia. To the present, preliminary findings in neuroimaging studies show no differences between patients and controls, except a possibly diminished and reversible metabolic activity.
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Marks, Isaac M., David Mataix-Cols, Mark Kenwright, Rachel Cameron, Steven Hirsch, and Lina Gega. "Pragmatic evaluation of computer-aided self-help for anxiety and depression." British Journal of Psychiatry 183, no. 1 (July 2003): 57–65. http://dx.doi.org/10.1192/bjp.183.1.57.
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BackgroundMost anxiety/depression is not effectively treated.AimsOpen evaluation of a free clinic giving immediate computer-aided cognitive – behavioural therapy (CBT) self-help plus brief advice from a therapist.MethodTest of outcome of self-referrals who used one of four computer-aided CBT systems for depression, phobia/panic, general anxiety or obsessive-compulsive disorder.ResultsThe equivalent of one full-time clinician managed 355 referrals over a year. Of the 266 who had a screening interview 79% were suitable. Completers and non-completers of computer-aided CBT had similar pre-treatment features, with very chronic, moderately severe problems. Completers of the computer-aided self-help had a mean total of an hour's live therapist support over 12 weeks. They improved significantly and clinically meaningfully with three of the four systems and felt ‘fairly satisfied’. Improvement resembled that in controlled and other trials of computer-aided CBT.ConclusionsComputer-aided self-help is a‘clinician extender’ that greatly cuts per-patient therapist time without impairing improvement. It could reduce the per-patient cost of CBT.
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Marinova, Anna, Iveta Mihailova, and Nikolay Yordanov. "WORKING WITH PEOPLE WITH ANXIETY DISORDERS – THE NEED OF TRAINING FOR NURSES." Knowledge International Journal 34, no. 4 (October 4, 2019): 1051–57. http://dx.doi.org/10.35120/kij34041051m.
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Anxiety disorders are a common problem in modern society, as the number of people suffering from this type of psychological problems, has grown drastically in recent years. People with anxiety disorders often seek medical specialists for examinations or running tests, due to the physical and psychological discomfort that accompanies the condition. One of the most serious problems that we face is the wrong approach and communication of medical staff to them.Nurses are the type of health care professionals, who most often have to communicate with people with anxiety. The lack of sufficient knowledge and skills to work with people with anxiety disorders complicates all prophylactic and therapeutic activities aimed at this type of patients, whether they are related to their mental or physical health.Practice shows that in Bulgaria this process of developing the communication between the nurse and the patient is troubled and is accomplished incorrectly or ineffective. Many nurses often lack the necessary skills to maintain proper psychological and medical perspective towards patients with anxiety disorders. Misunderstanding and lack of proper approach makes the patient with anxiety to avoid medical assistance and to turn to self-medication, whether it is physiological or psychological problem. That puts him at risk and impedes the healing process in general. Simultaneously, patients with anxiety disorders endure the implementation of various manipulations much more dramatic, as they experience their interventions way more painful and at increased rates of anxiety. As a result, the stress level increases and so does the danger of unlocking an extra mental disorder such as depression, specific phobia, addiction, suicidal action.This study aims to establish awareness among the students specialty "nurse" concerning the characteristics of anxiety disorders, their knowledge and their skills to work with this type of patients. It shows the need to introduce additional classes or independent training for working with people with anxiety disorders in a wider aspect.Specific recommendations have been prepared to correct deficiencies in the education system. They are about the teachers in classes of Medical Psychology, Educational institutions and the subject "Medical psychology" in the Universities.
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Bowden, Charles L. "Comorbidities with Bipolar Disorders: Significance, Recognition, and Management." CNS Spectrums 15, S3 (February 2010): 8–9. http://dx.doi.org/10.1017/s1092852900027760.
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Bipolar disorder, particularly bipolar type I disorder, is at least as highly comorbid with other psychiatric and behavioral disorders as any Axis I medical disorder (Slide 1). Two iterations of the National Comorbidity Survey study, which is epidemio-logic-based and not anecdotal evidence from clinical offices and hospital emergency rooms, have shown that these data are reflective of the overall population in the United States and potentially for all other countries across the world.In particular, if the prevalence rates of all anxiety disorders are grouped together, they are almost as prevalent as bipolar disorder itself, and clinicians rarely see a patient with bipolar disorder who does not have an anxiety disorder. This finding raises the question that anxiety may not be a separate entity, but an additional fundamental component of bipolar symptomatology, at least for a substantial number of patients. Regardless, the role of anxiety in bipolar disorder is unique. Perugi and colleagues studied the time sequence of different anxiety disorders in relation to first presence and clinical recognition of bipolar disorder (Slide 2). In contrast to panic disorder/agoraphobia and obsessive-compulsive disorder (OCD), social anxiety or social phobia was shown to be prevalent in 94.7% of patients prior to onset of hypomania and the clinically recognizable problematic school and home situations before the diagnosis of the bipolar disorder. This finding suggests that there may be some fundamental aspect of social anxiety and other anxiety disorders that is a ties. These patients tend to be more unstable symptomatically and have multiple comorbidities.
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Feldker, K., C. Y. Heitmann, P. Neumeister, S. V. Tupak, E. Schrammen, R. Moeck, P. Zwitserlood, M. Bruchmann, and T. Straube. "Transdiagnostic brain responses to disorder-related threat across four psychiatric disorders." Psychological Medicine 47, no. 4 (November 21, 2016): 730–43. http://dx.doi.org/10.1017/s0033291716002634.
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BackgroundThere is an ongoing debate whether transdiagnostic neural mechanisms are shared by different anxiety-related disorders or whether different disorders show distinct neural correlates. To investigate this issue, studies controlling for design and stimuli across multiple anxiety-related disorders are needed.MethodThe present functional magnetic resonance imaging study investigated neural correlates of visual disorder-related threat processing across unmedicated patients suffering from panic disorder (n = 20), social anxiety disorder (n = 20), dental phobia (n = 16) and post-traumatic stress disorder (n = 11) relative to healthy controls (HC; n = 67). Each patient group and the corresponding HC group saw a tailor-made picture set with 50 disorder-related and 50 neutral scenes.ResultsAcross all patients, increased activation to disorder-related v. neutral scenes was found in subregions of the bilateral amygdala. In addition, activation of the lateral amygdala to disorder-related v. neutral scenes correlated positively with subjective anxiety ratings of scenes across patients. Furthermore, whole-brain analysis revealed increased responses to disorder-related threat across the four disorders in middle, medial and superior frontal regions, (para-)limbic regions, such as the insula and thalamus, as well as in the brainstem and occipital lobe. We found no disorder-specific brain responses.ConclusionsThe results suggest that pathologically heightened lateral amygdala activation is linked to experienced anxiety across anxiety disorders and trauma- and stressor-related disorders. Furthermore, the transdiagnostically shared activation network points to a common neural basis of abnormal responses to disorder-related threat stimuli across the four investigated disorders.
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Prasko, J., A. Grambal, Z. Sigmundova, P. Kasalova, D. Kamaradova, K. Vrbova, M. Ociskova, et al. "Dissociation and Therapy of Depressive and Anxiety Disorders with or Without Personality Disorders." European Psychiatry 41, S1 (April 2017): S111. http://dx.doi.org/10.1016/j.eurpsy.2017.01.1885.
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ObjectiveGoal of the study was to analyze the impact of dissociation on the treatment of the patients with anxiety/neurotic spectrum and depressive disorders, and with or without personality disorders.MethodsThe sample consisted of inpatients who met the ICD-10 criteria for the Depressive disorder, Panic disorder, GAD, Mixed anxiety-depressive disorder, Agoraphobia, Social phobia, OCD, PTSD, Adjustment disorders, dissociative/conversion disorders, Somatoform disorder or other anxiety/neurotic spectrum disorder. The participants completed Beck Depression Inventory, Beck Anxiety Inventory, subjective version of clinical global impression-severity, Sheehan Patient-Related Anxiety Scale, and Dissociative Experience Scale, at the start and the end of the therapeutic program.ResultsThe total of 840 patients with anxiety or depressive spectrum disorders, who were resistant to pharmacological treatment in outpatients basis and were referred for hospitalization for the six-week complex therapeutic program, were enrolled in this study. Six hundred and six of them were statistically analyzed. The patients’ mean ratings on all measurements were significantly reduced during the treatment. The patients without comorbid personality disorder improved significantly more than patients with comorbid personality disorder in the reduction of depressive symptoms. However, there were no significant differences in change of anxiety levels and severity of the disorder between the patients with and without personality disorders. The higher degree of dissociation at the beginning of the treatment predicted minor improvement. The higher therapeutic change was connected to the greater reduction of the dissociation level.ConclusionsDissociation presents an important factor influencing treatment effectiveness in the treatment-resistant patients with anxiety/depression with or without personality disorders.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Kaluza, Antonia J., Anna Lisa Aydin, Berrit L. Cordes, Gianna Ebers, Albert Fuchs, Christiane Konietzny, Rolf van Dick, and Ulrich Baumann. "A Sorrow Shared Is a Sorrow Halved? Patient and Parental Anxiety Associated with Venipuncture in Children before and after Liver Transplantation." Children 8, no. 8 (August 11, 2021): 691. http://dx.doi.org/10.3390/children8080691.
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Taking blood via venipuncture is part of the necessary surveillance before and after liver transplantation. The spectrum of response from children and their parents is variable, ranging from a short and limited aversion to paralyzing phobia. The aim of this retrospective, cross-sectional study was to determine the level of anxiety amongst children during venipuncture, to compare the anxiety reported by children and parents, and to identify the factors affecting the children’s and parents’ anxiety in order to develop therapeutic strategies. In total, 147 children (aged 0–17 years, 78 female) and their parents completed questionnaires. Statistical analysis was performed using qualitative and quantitative methods. Results showed that the majority of children reported anxiety and pain during venipuncture. Younger children had more anxiety (self-reported or assessed by parents). Children and parental reports of anxiety were highly correlated. However, the child’s anxiety was often reported as higher by parents than by the children themselves. The child’s general anxiety as well as the parents’ perceived stress from surgical interventions (but not the number of surgical interventions) prompted parental report of child anxiety. For children, the main stressors that correlated with anxiety and pain were factors during the blood collection itself (e.g., feeling the puncture, seeing the syringe). Parental anxiety was mainly related to circumstances before the blood collection (e.g., approaching the clinic, sitting in the waiting room). The main stressors mentioned by parents were the child’s discomfort and their inability to calm the child. Results indicate that the children’s fear of factors during the blood collection, along with the parents’ perceived stress and helplessness as well as their anticipatory anxiety are important starting points for facilitating the drawing of blood from children before and after liver transplantation, thereby supporting a better disease course in the future.
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Yao, Sai-Nan, Jean Cottraux, Evelyne Mollard, Pascale Robbe-Grillet, Eliane Albuisson, Martine Dechassey, Ivan Note, et al. "THE FRENCH VERSION OF THE SOCIAL INTERACTION SELF-STATEMENT TEST (SISST): A VALIDATION AND SENSITIVITY STUDY IN SOCIAL PHOBICS." Behavioural and Cognitive Psychotherapy 26, no. 3 (July 1998): 247–59. http://dx.doi.org/10.1017/s1352465898000265.
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The French version of the Social Interaction Self-Statement Test (SISST) was studied in 95 social phobia and 87 non-clinical subjects. Total scores on both positive and negative scales significantly discriminated social phobics from non-clinical control subjects. Social phobics had higher scores than controls on negative statements and lower scores on positive statements. The positive and negative subscales of the SISST for social phobic patients were correlated with anxiety, depression and avoidant behaviours. The negative subscale was significantly sensitive to change in patients with social phobia receiving cognitive behavioural therapy. Our findings showed good convergent and discriminant validity of the SISST and the sensitivity of the negative sub-scale to improvement after cognitive behavioural therapy.
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Williams, Chris, and Anne Garland. "A cognitive–behavioural therapy assessment model for use in everyday clinical practice." Advances in Psychiatric Treatment 8, no. 3 (May 2002): 172–79. http://dx.doi.org/10.1192/apt.8.3.172.
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Cognitive–behavioural therapy (CBT) is a shortterm, problem-focused psychosocial intervention. Evidence from randomised controlled trials and metaanalyses shows that it is an effective intervention for depression, panic disorder, generalised anxiety and obsessive–compulsive disorder (Department of Health, 2001). Increasing evidence indicates its usefulness in a growing range of other psychiatric disorders such as health anxiety/hypochondriasis, social phobia, schizophrenia and bipolar disorders. CBT is also of proven benefit to patients who attend psychiatric clinics (Paykel et al, 1999). The model is fully compatible with the use of medication, and studies examining depression have tended to confirm that CBT used together with antidepressant medication is more effective than either treatment alone (Blackburn et al, 1981) and that CBT treatment may lead to a reduction in future relapse (Evans et al, 1992). Generic CBT skills provide a readily accessible model for patient assessment and management and can usefully inform general clinical skills in everyday practice.
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Volpe, Erin G., and Michael R. Nash. "The Use of Hypnosis for Airplane Phobia With an Obsessive Character." Clinical Case Studies 11, no. 2 (March 29, 2012): 89–103. http://dx.doi.org/10.1177/1534650112440167.
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This is a single-case study of a middle-aged woman with specific phobia and panic symptoms associated with airplanes. Treatment was brief and supportive in nature, using hypnosis for both exposure purposes and as a self-regulatory tool for anxiety management. The patient’s identified target symptom (readiness to fly) was tracked using daily subjective, self-report measures over the 12-session treatment. Simulation modeling analysis for time-series was used to evaluate the level change across baseline, treatment, and follow-up phases. The patient’s self-assessed readiness to fly increased significantly over the course of treatment, and she successfully engaged in a “practice flight” toward the end of her treatment. However, this patient required a drastic shift in treatment modality, after which progress was made. Theoretical rationale for this shift and ultimate success is discussed.
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Weisel, Kiona K., Anna-Carlotta Zarski, Thomas Berger, Tobias Krieger, Christian T. Moser, Michael P. Schaub, Dennis Görlich, Matthias Berking, and David D. Ebert. "User Experience and Effects of an Individually Tailored Transdiagnostic Internet-Based and Mobile-Supported Intervention for Anxiety Disorders: Mixed-Methods Study." Journal of Medical Internet Research 22, no. 9 (September 16, 2020): e16450. http://dx.doi.org/10.2196/16450.
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Background Internet interventions have been shown to be effective in treating anxiety disorders. Most interventions to date focus on single disorders and disregard potential comorbidities. Objective The aim of this mixed-methods study was to investigate feasibility, user experience, and effects of a newly developed individually tailored transdiagnostic guided internet intervention for anxiety disorders. Methods This study is an uncontrolled, within-group, baseline, postintervention pilot trial with an embedded qualitative and quantitative process and effect evaluation. In total, 49 adults with anxiety disorders (generalized anxiety disorder n=20, social phobia n=19, agoraphobia without panic n=12, panic with agoraphobia n=6, panic without agoraphobia n=4, subclinical depression n=41) received access to the 7-session intervention. We examined motivation and expectations, intervention use, user experience, impact, and modification requests. Qualitative data were assessed using semistructured interviews and analyzed by qualitative content analysis. Quantitative outcomes included symptom severity of anxiety and depression (Hamilton Anxiety Rating Scale [HAM-A], Quick Item Inventory of Depressive Symptomatology clinician rating [QIDS-C]), diagnostic status in clinical interviews (Mini International Neuropsychiatric Interview [MINI]), and web-based self-reports (Generalized Anxiety Disorder–7 [GAD-7], Center for Epidemiological Studies Depression Scale [CES-D], Beck Anxiety Inventory [BAI], Panic and Agoraphobia Scale [PAS], Social Phobia Scale [SPS], Patient Health Questionnaire–9 [PHQ-9]) at baseline and postassessment. Quantitative data was analyzed by comparing within-group means expressed as Cohen d. Results Anxiety symptom severity (HAM-A d=1.19) and depressive symptoms (QIDS-C d=0.42) improved significantly, and 54% (21/39) no longer were diagnosed as having any anxiety disorder. The main positive effects were the general improvement of disease burden and attentiveness to feelings and risk situations while the main negative effects experienced were lack of change in disease burden and symptom deterioration. The most prevalent reasons for participation were the advantages of online treatment, symptom burden, and openness toward online treatment. Helpful factors included support, psychoeducation and practicing strategies in daily life; the main hindering factors were too little individualization and being overwhelmed by the content and pace. Conclusions The intervention was found to be feasible and results show preliminary data indicating potential efficacy for improving anxiety and depression. The next step should be the evaluation within a randomized controlled trial. Concerning intervention development, it was found that future interventions should emphasize individualization even more in order to further improve the fit to individual characteristics, preferences, and needs.
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Khezretkulov, H. "A case of rabies in humans." Kazan medical journal 70, no. 3 (June 15, 1989): 217. http://dx.doi.org/10.17816/kazmj99896.
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For 3 years we monitored 4 people with rabies who did not receive anti-rabies vaccinations after being bitten by an unknown dog. Two adult patients and one adolescent patient developed the disease 35-41 days after the bite. However, in another adolescent the incubation period was 15 months. The patients were bitten by an animal in the leg (2), arm (1), and facial area (1).The victims went to a doctor on days 2-4 of the disease. All patients had typical symptoms of the neurological phase of rabies. They felt headache, anxiety, restlessness, insomnia, dry mouth, water phobia. Against the background of therapy, the condition continued to worsen progressively, and the death of the patients occurred on days 7, 9 and 12 of the disease with the phenomena of suffocation. No autopsy was performed.
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Attridge, Mark. "Internet-Based Cognitive-Behavioral Therapy for Employees With Anxiety, Depression, Social Phobia, or Insomnia: Clinical and Work Outcomes." SAGE Open 10, no. 1 (January 2020): 215824402091439. http://dx.doi.org/10.1177/2158244020914398.
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This applied study profiled four self-directed behavioral health support tools from Learn to Live, Inc., when offered as an employee benefit. Each of these automated online programs featured eight structured lessons that emphasized cognitive-behavioral therapy techniques. Archival operational information collected across multiple employers in the United States was analyzed for 1,297 unique participants with longitudinal program use data. Significant reductions were found on validated measures of clinical symptoms specific to each program: Depression ( d = 0.93, n = 268; Patient Health Questionnaire–nine-item scale [PHQ-9]), Insomnia ( d = 0.69, n = 295; Medical Outcomes Study [MOS] Sleep), Social Anxiety ( d = 0.53, n = 170; Social Phobia Inventory [SPIN]), and Stress, Anxiety, & Worry ( d = 0.50, n = 633; Generalized Anxiety Disorders–seven-item scale [GAD-7]). Moderators of improvement included greater initial clinical severity and greater engagement in the programs (more lessons used and use of optional live support from a coach or friend/family). Follow-up survey results ( n = 290) revealed high satisfaction and improved work absenteeism and job performance. Financial return to the employer from improved work productivity was estimated at US$2,431 per employee user.
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Ramsawh, H. J., S. D. Raffa, M. Orlando Edelen, R. Rende, and M. B. Keller. "Anxiety in middle adulthood: effects of age and time on the 14-year course of panic disorder, social phobia and generalized anxiety disorder." Psychological Medicine 39, no. 4 (July 30, 2008): 615–24. http://dx.doi.org/10.1017/s0033291708003954.
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BackgroundMuch about the long-term course of anxiety disorders is unknown. The present study utilizes a naturalistic, longitudinal, short-interval follow-up design to elucidate the course of anxiety disorders over 14 years in a largely middle-aged adult sample recruited from out-patient psychiatry and primary care facilities.MethodThe sample consisted of 453 participants with a diagnosis of panic disorder (PD), social phobia (SP) and/or generalized anxiety disorder (GAD). Anxiety symptom ratings were tracked using weekly psychiatric status ratings (PSRs). Controlling for demographic and clinical variables, the course of PD, GAD and SP were examined using longitudinal growth models, with the most severe PSR at each follow-up point as the main outcome variable.ResultsPSRs significantly decreased in severity over time in each of the three disorders. In the interaction effects models, age×time had a significant effect on course for PD and GAD, but not for SP, in that older age was associated with lower PSRs over time.ConclusionsThe present findings suggest that the severity of anxiety disorders declines over time, although this decline is modest and depends on the specific disorder being assessed. Older individuals with PD and GAD have a better prognosis than their younger counterparts, as their course is characterized by a steeper decline in severity. The present findings provide important information about the course of anxiety disorders in mid-life.
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Paul, Mousumi. "Effectiveness of Play Therapy during Hospitalization in reducing Anxiety among 6-12 Years Children in the Selected Tertiary Hospital at Bhubaneswar." Journal of Advanced Research in Psychology & Psychotherapy 03, no. 3&4 (January 16, 2021): 8–14. http://dx.doi.org/10.24321/2581.5822.202008.
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Background: Hospitalization can be a threatening and stressful experience for children. Because of unfamiliar with the environment and medical procedures and unaware of the reasons for hospitalization, it can result in children’s anger, anxiety. Objectives: The objectives of the study are to do the baseline assessment of anxiety score of hospitalized children of experimental and control group, to assess the effectiveness of play therapy and to assess the pre and post intervention score of anxiety across different sub group of anxiety disorder like Separation anxiety, Social phobia, OCD, Panic/agoraphobia, Physical injury fears, Generalized anxiety. Methods: Randomized clinical control trial design with control group was used and the formal consent was obtained from Pradyumna Bal Memorial Hospital and the investigator selected 60 samples using consecutive sampling technique (taking every patient who met the selection criteria over the specified time period) and then randomized into experimental and control groups. Measurement of anxiety experienced by the school going children was assessed with the help of Spence Children Anxiety Scale. Descriptive and inferential statistics were used to analyze the data. Result: The mean anxiety score of children in control group was 39.4 and the experimental group was 34.433. The p value in comparing the anxiety score of children in control and experimental group was 0.004, which was statistically significant at p<0.01 level indicating that there was significant difference in the post test level of anxiety between the control and experimental group. Conclusions: The study was concluded that play therapy was effective in reducing the anxiety among school going children.
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Piercy, Marlena A., John J. Sramek, Neil M. Kurtz, and Neal R. Cutler. "Placebo Response in Anxiety Disorders." Annals of Pharmacotherapy 30, no. 9 (September 1996): 1013–19. http://dx.doi.org/10.1177/106002809603000917.
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OBJECTIVE: To review literature on placebo response in anxiety, to discuss sources and levels of placebo response in various anxiety disorders, and to suggest methods to prevent high placebo response rates in clinical research trials. DATA SOURCE: Data from scientific literature were identified using a MEDLINE search, and were extracted and summarized for this review. STUDY SELECTION: Representative findings were selected from clinical and epidemiologic studies, review articles, letters to the editor, book chapters, and proceedings. DATA EXTRACTION: Data from English-language reports of studies on humans were included. Only the most representative conclusions drawn from review articles were used. DATA SYNTHESIS: Anxiety disorders in general are thought to be extremely susceptible to a variety of influences, including patient characteristics and environmental variables. Reported placebo response levels in clinical studies of anxiolytics for generalized anxiety disorder and panic disorder vary widely, with a tendency to be rather high, although studies in social phobia and obsessive-compulsive disorder appear to have consistently low placebo response rates. Comparisons of anxiety studies with studies of other indications, such as depression, show similar overall placebo response rates. To determine efficacy, drug response rates and placebo response rates must be clearly differentiated. CONCLUSIONS: Examination of the literature suggests that placebo response rates in studies of anxiolytics are influenced by a number of factors, including both endogenous and exogenous variables. High placebo response rates may mask true drug response rates and may result from poor study design or lack of procedural standardization. The use of certain design methods may help to prevent high placebo response rates in anxiolytic clinical trials.
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Reinecke, Katharina C. H., Daniela Dvoretska, Peter Joraschky, and Hedda Lausberg. "Fidgeting Behavior During Psychotherapy: Hand Movement Structure Contains Information About Depressive Symptoms." Journal of Contemporary Psychotherapy 50, no. 4 (July 7, 2020): 323–29. http://dx.doi.org/10.1007/s10879-020-09465-5.
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Abstract Fidgeting may be a motor sign reflecting self-regulation processes in patients with social anxiety disorder (SAD) and depressive patients. Since SAD co-occurs with comorbid depression, the question arises whether fidgeting is a disorder-unspecific phenomenon or a specific and therefore diagnostically relevant sign of depression. 33 SAD patients with (n = 12) and without (n = 21) depression from the Social Phobia Psychotherapy Research Network project were compared regarding their nonverbal behavior. Four video sequences of a psychotherapy session with each patient were analyzed using a standardized system for the analysis of nonverbal behavior by two independent, certified, blind raters. SAD patients with comorbid depression exhibited significantly more (number/minute) irregular movements, but fewer (number/minute) repetitive movements than SAD patients without depression. Irregular movements, which reflect less structured motor behavior, are associated with comorbid depression in SAD. In contrast, in SAD without depression, more structured repetitive movements were prominent. Thus, irregular movements represent a diagnostically relevant behavior for comorbid depression among SAD patients.
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Uruha, Akinori, Katsuo Kimura, and Ryoichi Okiyama. "An Asian Patient with Myoclonus-Dystonia (DYT11) Responsive to Deep Brain Stimulation of the Globus Pallidus Internus." Case Reports in Neurological Medicine 2014 (2014): 1–3. http://dx.doi.org/10.1155/2014/937095.
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We describe the case of a 42-year-old Japanese woman with childhood-onset myoclonus, dystonia, and psychiatric symptoms, including anxiety, phobia, and exaggerated startle response. The diagnosis was confirmed as myoclonus-dystonia (DYT11) by identifying a mutation in the gene encodingε-sarcoglycan. Interestingly, while motor-related symptoms in DYT11 generally improve with alcohol ingestion, the patient’s symptoms were exacerbated by alcohol intake. Her severe and medically intractable symptoms were alleviated by bilateral deep brain stimulation of the globus pallidus internus, with myoclonus and dystonia scores showing 70% improvement after the surgery compared to presurgical scores. This is the first report of a genetically confirmed case of DYT11 in Japan. This paper together with other recent reports collectively demonstrates that DYT11 patients are distributed worldwide, including Asia. Thus, a diagnosis of DYT11 should be considered when clinicians encounter a patient with childhood-onset myoclonus and/or dystonia with psychiatric symptoms, regardless of ethnic background.
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Karakhonova, Sarvinoz. "Psychocorrection and optimal pharmacotherapy in anxiety-phobic syndrome." Psychosomatic Medicine and General Practice 4, no. 1 (April 18, 2019): e0401175. http://dx.doi.org/10.26766/pmgp.v4i1.175.
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The article presents methods of detection and ways of correction of psychosomatic disorders among patients suffering from anxiety and phobic syndrome. These studies have shown that among patients with anxiety-phobic syndrome of psychosomatic disorders are most pronounced anxiety, phobia, fear, panic. Therefore, in addition to the basic therapy in patients with anxiety-phobic syndrome, psychotherapy was used, which leaded to early recovery, effective treatment, as well as lengthening the period of remission.
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Eddy Hartono, Ary Rizqi Rachman, Nuraini Abidin, and Ajardiana Idrus. "Holistic approach in covid-19 phobia causing near missing ectopic pregnancy treatment." International Journal of Science and Research Archive 2, no. 2 (May 30, 2021): 057–65. http://dx.doi.org/10.30574/ijsra.2021.2.2.0052.
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Ectopic pregnancy is one of the major cause of death in the first trimester of pregnancy. Complications may result from misdiagnosis, diagnosis delay, or mistreatment. COVID-19 is currently became pandemic. There is still no specific recommendations for manage pregnant women with COVID – 19. Mrs. EF, 34 y.o., G2P1011 admitted to Wahidin Sudirohusodo Hospital Makassar referred from Hermina Hospital dianosed with missed abortion and suspected of COVID-19 infection. She was first refused to undergo COVID – 19 screening and diagnostic test, though finally agree to proceed with examination. She was definitively diagnosed with ectopic pregnancy following 4 days of undetermined COVID – 19 status. Emergency explorative laparotomy was then performed. This is a maternal near miss case. Delay in performing COVID – 19 examination may compromise management of true emergency obstetrics situation. COVID-19 phobia is one factor that describe excessive fear and anxiety about the transmission of corona virus among health workers. Health workers may be reluctant in treating patient because of undetermined status of COVID-19 causing diagnosis delay.