Latest Cure for Anxiety Attacks

The 60 Second Panic Solution

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

The 60 Second Panic Solution Summary


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Highly Recommended

This is one of the best books I have read on this field. The writing style was simple and engaging. Content included was worth reading spending my precious time.

As a whole, this manual contains everything you need to know about this subject. I would recommend it as a guide for beginners as well as experts and everyone in between.

The Effects of Anxiolytic Drugs

In a massive review of the literature, Gray (1977) attempted to identify the behavioral effects of anxiolytic drugs or minor tranquilizers, the underlying psychological processes altered by these drugs, and the brain structures involved in these effects of minor tranquilizers. Although numerous other papers addressed the second and third questions, this publication provided the definitive answer to the first question. In order to conceptually organize this literature, Gray provided a brief summary of a theoretical context derived from animal learning, taken from his earlier book-length presentation (Gray, 1975). In this view, organisms are seen as maximizing exposure to rewarding ( appetitive ) events and minimizing exposure to punishing ( aversive ) events. Rewarding or appetitive events consist of presentation of a reward (Rew), termination of punishment (Pun ), or omission of an expected punishment (nonPun), while punishing or aversive events consist of presentation of punishment...

Fear anxiety and stress

Fear, anxiety and stress are related but slightly different phenomena. Fear is obviously an anticipation of an event, but often with an unknown outcome. Information from the periphery, including the eyes and ears, as well as our memory and thinking processes can stimulate a feeling of fear. The feeling becomes anxiety when focused on a particular event or situation, such as an examination or a visit to the dentist, or an operation. However, some people do experience what is known as 'free floating' anxiety, which does not seem to have a focus. Stress is a word that refers to the stimulus and to the response. The use of the word stressor as the threat or stimulus helps to clarify things, with the word stress as the response (Lazarus and Folkman 1984). Cannon and Baird (1929 and 1934 respectively) first identified the psychological and physical links embodying anxiety. They argued that this response created three alternative reactions fright, flight or fight. There are both physical and...

General Comments On Drug Treatment Foranxiety Disorders

The effective dose of antidepressant for anxiety is generally higher than that for antidepressant effect and takes longer for improvements to be seen (at least 4-8 weeks compared to 2-3 weeks for depression). The patient should be maintained on as high a dose as can be tolerated for at least 8 weeks before changing a medication. Educating the patient is crucial to obtaining cooperation. The duration of treatment is often a controversial issue. Anxiety disorders (apart from the self-limiting acute stress reaction) are chronic conditions and may require treatment for as long as that used in depression. In a first episode, patients may need medication for at least 6 months, withdrawing over a further 4-8 weeks if they are well. Those with recurrent illness may need treatment for 1-2 years to enable them to learn and put into place psychological approaches to their problems. In many cases the illnesses are lifelong and chronic maintenance

Genetic Epidemiology of Anxiety Disorders

Evidence for a genetic contribution to anxiety disorders is equally compelling and also comes from a variety of study designs (Chantarujikapong et al., 2001 Hettema, Prescott, & Kendler, 2001 Hudson et al., 2003 Kendler, Neale, Kessler, Heath, & Eaves, 1992b, 1992c Kendler, Walters, et al., 1995 Koenen et al., 2002 Mendlewicz, Papadimitriou, & Wilmotte, 1993 Noyes, Clarkson, Crowe, Yates, & McChesney, 1987 Scherrer et al., 2000 Skre, Onstad, Torgersen, Lygren, & Kringlen, 1993 Sullivan, Kovalenko, York, Prescott, & Kendler, 2003 Torgersen, 1983). Hettema, Neale, and Kendler (2001) meta-analyzed data from family and twin studies of panic disorder, GAD, phobias, and OCD. Their results based on the twin studies are summarized in Table 11.5. Three twin studies TABLE 11.5. Summary of Population-Based Twin Studies that Have Investigated the Genetic (A) and Environmental (C E) Etiology of Anxiety Disorders TABLE 11.5. Summary of Population-Based Twin Studies that Have Investigated the...

Sources of Covariance among Neuroticism Mood Disorders and Anxiety Disorders

Based on data from the Australian Twin Registry, Jardine and colleagues (1984) examined the covariance between the symptoms of anxiety and depression, using a shortened version of the Delusion Symptoms States Inventory (Bedford & Deary, 1997 Foulds & Bedford, 1975) as well as the Neuroticism scale from the EPQ (Eysenck & Eysenck, 1975). Their results revealed that the phenotypic covariation between the two measures could be best explained by a single genetic factor common to both measures. There was no evidence for genetic factors specific to one measure and having no influence on the other. In a longitudinal design based on 1733 same-sex female twin pairs, Kendler and colleagues (1993b) have estimated that the proportion in the observed correlation between neuroticism and the liability to major depression that could be explained by a shared genetic risk was approximately 70 . In the same study, extraversion was unrelated to lifetime or 1-year prevalence of major depression. Using the...

Test or Performance Anxiety

Many children report a greater frequency of pain symptoms prior to a stressful event or competitive activity at school, including athletic events and examinations (4). Such circumscribed anxiety may benefit from the use of positive self-coaching statements, such as, I know I can do it if I just do my best. Negative self-statements, such as What if I fail , should be eliminated. The use of adaptive self-statements is important to enhance coping strategies and diminish distorted negative thoughts when approaching stressful tasks.

Anxiety Sensitivity and Anxiety

Within the field of cognitive risk factors for anxiety, one that has been attracting increasing attention is anxiety sensitivity. This is defined as the fear of anxiety sensations which arises from beliefs that these sensations have harmful somatic, social or psychological consequences (Taylor, 1999). Originally, anxiety sensitivity was proposed as a unitary construct that increases risk for anxiety in general and panic in particular. However, subsequent analyses of relevant data indicated the presence of subfactors within the construct. These two approaches were brought together by the proposal of a hierarchical factor structure, with one first-order factor and several (usually three) second-order factors (Zinbarg & Barlow, 1997). These second-order factors reflect concerns about physical phenomena (e.g., worry about fast heart rate), concerns about mental illness (e.g., worry about loss of cognitive control), and social concerns that apply to visible symptoms of anxiety (e.g., worry...

Effects on Anxiety and Insomnia

Cannabis smoking produces a relaxant effect which most users value and it has been suggested that the beneficial effects of cannabis and THC observed in neurological disorders such as motor tics, dystonias and Huntingdon's chorea are due to sedative and anxiolytic actions. In addition, sedation is by far the most common side effect of cannabis, and in particular THC, observed in clinical trials against a range of disorders. This has lead to the suggestion that cannabis and some cannabinoids may be useful in disorders accompanied by anxiety and or insomnia. Sethi et al. (1986) noted a reduction of anxiety in 50 chronic cannabis users compared to controls, in terms of scores on the Taylor Manifest Anxiety Scale. Oral preparations of cannabis have a sedative or tranquillising effect in man, accompanied by diminished anxiety at doses much lower than those producing psychoactivity (Graham and Li, 1976). However, anxiety and panic, possibly due to depersonalisation, intoxication and loss of...

Grays Later Theory Of Anxiety

In the interest of saving space, we can now skip forward to the last comprehensive summary of this work on anxiety (Gray & McNaughton, 2000), entitled The Neuropsychology of Anxiety An Enquiry into the Functions of the Septo-Hippocampal System (2nd ed.). This work was published with Gray's one-time student Neil McNaughton, who was for many years his colleague collaborator and now is the heir apparent to this approach to anxiety and anxiety disorders. Although McNaughton was a major contributor to this 2000 revision of the earlier book (Gray, 1982), their collective effort constitutes an excellent statement of the evolution of Gray's contributions. A more recent review of the theory with revisions by McNaughton and Corr (2004) is highly recommended, but it is not included here because Gray was not involved. The first part of the present summary describes the continuity and change with respect to the core theory already described, while the second part describes the expansion of the...

Behavioral Genetic Studies Of Anxiety And Depression

Behavioral genetic studies seek to understand the causes of variation in behavioral outcomes (for an introduction to the study of behavioral genetics, the reader is referred to Plomin, DeFries, McClearn, & McGuffin, 2001). These causes can be divided into those that are genetic and those that can be attributed to the environment. Indexing and quantifying these different sources of influence form the basis of most behavioral genetic designs (see Table 16.1). Through such twin and family studies, the importance of genetic factors in the etiology of anxiety and depression in childhood and adolescence has now been well accepted. Estimates of heritability typically account for about a third of the variance in anxiety symptoms, with the remainder of the risk being attributable to moderate shared environmental influences and substantial nonshared environmental influences (Eley & Gregory, 2004). For depression, a similar profile of effects is obtained, but with a somewhat lesser contribution...

HT1A receptor knockout and anxiety

The converging lines of evidence that 5-HT1A receptor deficiency or dysfunction is involved in depression and anxiety disorders led to the genetic inactiva-tion of this receptor in mice (for reviews, see Lesch, 2005 Lesch et al., 2003). Htrla knockout (KO) mice show a complete lack of ligand binding to brain 5-HT1A receptors in null-mutant Htrla- - mice, with intermediate binding in the heterozygote Htr1a+ - mice. Importantly, a similar behavioral phenotype characterized by increased anxiety-related behavior and stress reactivity in several avoidance and behavioral despair paradigms was observed in three different KO mouse strains (Lesch & Mossner, 1999). Htr1a KO mice consistently display a spontaneous phenotype that is associated with a gender-modulated and gene- dose-dependent increase of anxiety-related behaviors (Heisler et al., 1998 Parks, Robinson, Sibille, Shenk, & Toth, 1998 Ramboz et al., 1998). With the exception of an enhanced sensitivity of terminal 5-HT1B receptors, no...

TABLE 163 Anxiety Disorders

Anxiety disorders cause great distress and impair function, but those affected are not psychotic. The disorders are distinguished by the symptoms, the entities feared, or the stressors. Panic Disorder Generalized Anxiety Disorder A panic disorder is defined by recurrent, unexpected panic attacks, at least one of which has been followed by a month or more of persistent concern about further attacks, worry over their implications or consequences, or a significant change in behavior in relation to the attacks. A panic attack is a discrete period of intense fear or discomfort that develops abruptly and peaks within 10 minutes. It involves at least four of the following symptoms (1) palpitations, pounding heart, or accelerated heart rate, (2) sweating, (3) trembling or shaking, (4) shortness of breath or a sense of smothering, (5) a feeling of choking, (6) chest pain or discomfort, (7) nausea or abdominal distress, (8) feeling dizzy, unsteady, lightheaded, or faint, (9) feelings of...

The BIS and the Neural Substrate for an Anxiety System circa 1976

During the 1970s, Gray published several papers proposing that the BIS is the anxiety system that is, with titles such as The Neuropsychology of Anxiety or A Neuropsychological Theory of Anxiety (Gray, 1976b, 1978, 1979) and The Behavioural Inhibition System A Possible Substrate for Anxiety (Gray, 1976a). The compelling logic of calling the BIS the anxiety system was that (1) he had demonstrated that a behavioral system largely conceptualized on the basis of the animal learning literature was antagonized by the anxiolytic drugs and (2) the function of the BIS is to process CSs for aversive outcomes (punishment, frustrative nonreward), as would be expected for an anxiety system. Gray had then proceeded to map the BIS and the effects of anxiolytic drugs onto structures in the central nervous system (CNS). On the basis of a similarity between the behavioral effects of lesions and the behavioral effects of anxiolytic drugs, the septal area and the hippocampus had emerged as key structures...

Psychopathology as Related to Systems Underlying Personality Anxiety Disorders

The obvious application of Gray's work to psychopathology is to anxiety disorders. As already discussed, Gray and McNaughton (2000) related the BIS to GAD and the fight-flight system to panic attacks and responses to phobic stimuli. This conceptualization plays a central role in Barlow's (e.g., 2000, 2002) comprehensive theory of the anxiety disorders, and Barlow cites Gray's work as a basis for some of his theorizing. In addition, Gray and McNaughton (pp. 34-35, 289-290) proposed that the well-established strong cognitive attentional components (an excessively strong focus on potential threats) of GAD can be understood as manifestations of excessive activity in the BIS. As noted above, Gray and McNaughton (2000) viewed the BIS as activated only when danger stimuli must be approached and when stimulus input produces conflict between incompatible goals. In their theoretical approach, by definition, only BIS activation constitutes anxiety. In consequence, they suggested that neuroticism...

Mood And Anxiety Disorders

Almost one in five people will experience a significant mood or anxiety disorder at some stage in life. The lifetime prevalence rates of Diagnostic and Statistical Manual of Mental Disorders, third edition, revised (DSM-III-R) mood and anxiety disorders are shown in Table 11.1. As can be seen, the lifetime prevalence of major depression is almost twice as high for females as for males, and this is a robust finding in the literature (Blazer, Kessler, McGonagle, & Swartz, 1994 Breslau, Schultz, & Peterson, 1995 Kendler & Prescott, 1999 Newman, Bland, & Orn, 1988 Parker & Hadzi-Pavlovic, 2001). Anxiety disorders represent the most common comorbid diagnoses (Sanderson, Beck, & Beck, 1990). Like that of mood disorders, the prevalence of anxiety disorders is higher among females (Kessler et al., 1994). When based on the DSM-III-R, the lifetime prevalence for generalized anxiety disorder (GAD) in the United States is 3.6 for males and 6.6 for females. In reality, the prevalence rates for...

The experience of anxiety and fear

Some people get a sense of thrill from putting themselves in a fear-provoking situation, but one in which there are safeguards against anything actually happening. Thus frightening and horrifying films can be 'enjoyed' from the safety of a cinema seat, or one's own sitting room. Similarly some sport and other recreational activities can offer the thrill of fear as part of their attraction. However, real fear, of an event over which one has little or no control, is a rather different thing. Here there is a physiological reaction and a mental response that is far more acute than anything offered in the cinema or sport. In many ways one would expect feelings of fear and anxiety to be experienced prior to surgery for example or before a visit to the dentist. Most people will have experienced the latter, and

Mediating Mechanisms Motivation versus Anxiety

The developmental predictions regarding how susceptible children are to CL and AL might be further explained by differences in the mechanisms that are triggered by these labels. Mainly, there are two main explanations that have been used to interpret the significant effects in the gender labeling studies. Initially, the results were explained in terms of motivational factors (e.g., Bradbard et al., 1986 Davies, 1986, 1989 Helper & Quinlivan, 1973 Montemayor, 1974). For example, cognitive theories suggest that children do not explore, choose, or perform well in opposite-sex tasks because they are motivated to define themselves according to the gender norms set forth by society. In this view, children make value judgements according to their self-categorization as either a boy or a girl and seek to behave in ways consistent with these values. Similarly, the proposed mechanism by social learning or social cognitive theory is also motivation. Children's motivation to avoid doing well or...

State and Trait Anxiety

It has been recognized for some time that anxiety is not a unitary construct, but instead may be composed of various dimensions underlying different aspects of vulnerability to the phenotype (Smoller & Tsuang, 1998). One common distinction that has been made is between state anxiety and trait anxiety (Spielberger, 1966). State anxiety is the transitory pattern of emotions elicited by environmental stressors, including physiological arousal and symptoms of apprehension, worry, and tension. It therefore represents the environmentally reactive component of anxiety. Trait anxiety, however, refers to individual differences in the predisposition to respond to threatening situations, and is often characterized as a personality disposition toward anxiety. Although both of these independently define anxiety, it is the association between the two the expression of trait anxiety as state anxiety that may be suggestive of how vulnerability to anxiety symptoms is expressed. Specifically,...

The Behavioral Inhibition System and the Effects of Anxiolytic Drugs

The effects of the anxiolytic drugs map nicely onto the stimuli that activate the BIS and the response-inhibitory effects of the BIS, allowing the elegantly simple proposal that anxiolytic drugs antagonize the BIS. Two experimental paradigms were important in showing that this effect was not just one of disinhibiting behavior, but rather included the emotional arousing aspects of the BIS. The first had to do with the partial reinforcement acquisition effect (PRAE). In the alley runway, it is often found that at the end of training, animals receiving reward only 50 of the time (on a random schedule) run faster than animals receiving 100 reinforcement. This PRAE is abolished by anxiolytic drugs, which is noteworthy, because this reduced behavioral vigor is the opposite of the disinhibition seen in most of the paradigms affected by anxiolytic drugs. The PRAE can be understood, however, by attributing the increased running speed to the BIS-produced arousal associated with its processing...

Micronutrients Anxiety

May decrease anxiety and nervous tension.4 Medications, illness, and stress can deplete magnesium stores and produce agitation and irritability possible sensitivities and eliminate the offending foods (see pp. 205). Although small amounts of caffeine can have mood-elevating properties, chronic high intake of coffee and black teas may aggravate anxiety and de-pression.2

Social Anxiety Disorder

The essential feature of social phobia is a marked and persistent fear of performance situations when patients feel they will be the centre of attention and will do something humiliating or embarrassing. The situations that provoke this fear can be quite specific, for example public speaking, or be of a much more generalised nature involving fear of most social interactions, for example initiating or maintaining conversations, participating in small groups, dating, speaking to anyone in authority. Exposure to the feared situation almost invariably provokes anxiety with similar symptoms to those experienced by patients with panic attacks but some seem to be particularly prominent and difficult i.e. blushing, tremor, sweating and a feeling of 'drying up' when speaking. TABLE I9.S Relative effectiveness of pharmacological treatments for anxiety disorders

Anxiety Animal studies

Musty et al. (1985) found CBD increased licking for water in the lick suppression test in a dose related fashion (mg kg). Equivalent effects were found with the classic anxiolytic drug diazepam. In an effort to find more potent effects, they tested two analogs, 2-pinyl-5-dimethylheptyl resorcinol (PR-DMH) and Mono-methyl canna-bidiol (ME-CBD-2). ME-CBD-2 had anxiolytic activity, but was less potent than CBD, while PR-DMH had no anxiolytic properities. Of the two active compounds, both were less potent than diazepam. a measure of anxiety or fear. Both CBD and diazepam decreased the amount of time spent in the enclosed arms. Since these studies were conducted, Petitet et al. (1998) reported CBD is an antagonist of the CBX receptor in the micromolar range suggesting that CBD may have pharmacological effects as an antagonist of the CBj receptor. Since the discovery of the synthetic, highly potent CBX receptor antagonist, SR 141716, by Rinaldi-Carmona, Barth, Heaulme et al., several other...

Diet Anxiety

In people susceptible to reactive hypoglycemia (see pp. 185), consumption of refined carbohydrates or sugar may trigger increased anxiety and, in rare cases, panic attacks.1 In individuals prone to nervousness and anxiety, consumption of caffeine can worsen their symptoms.2

Test Anxiety

In one of the first longitudinal studies of performance anxiety, Hill and Sarason (1966) found that anxiety both increases across the elementary and junior high school years and becomes more negatively related to subsequent grades and test scores. They also found that highly anxious children's achievement test scores were up to 2 years behind the scores of their low anxious peers and that girls' anxiety scores were higher than boys'. Subsequent research has provided estimates of just how many children in the United States suffer from extreme forms of test anxiety For example, Hill and Wig-field (1984) estimated that as many as 10 million U.S. children and adolescents experience significant evaluation anxiety. What explains individual differences in test anxiety Researchers point to both biological and social factors. For example, some research suggests that having parents who have overly high expectations and put too much pressure on their children contributes to high levels of test...

Separation Anxiety

Separation anxiety refers to developmentally inappropriate and excessive anxiety concerning separation from home or from those to whom the child is attached (15). One symptom criterion for the diagnosis of separation anxiety disorder includes repeated complaints of physical symptoms (such as headaches or stomachaches, nausea or vomiting) when separation from major attachment figures occurs or is anticipated (p. 113). Typically, such symptoms occur on the morning of schooldays and are less pervasive on weekends when the child will not be separated from caregivers (4). Symptoms may reoccur on Sunday evening in anticipation of separation from caregivers to attend school on Monday. Other symptoms of separation anxiety include recurrent or excessive distress when separation from home or major attachment figures occurs or is anticipated persistent and excessive worry about losing, or possible harm befalling, major attachment figures persistent and excessive worry that an untoward event will...

How anxiety works

There is evidence of direct links between the reception of the information and the motor behavioural responses, bypassing the cognitive processes. This allows an immediate, perhaps survival reaction to occur if the stimulus is very intense or suggests danger (Le Doux 1986). This response seems however to be influenced by the 'mental set' of the individual which relates to the level of trait anxiety (a personality characteristic). State anxiety is the level or kind of anxiety that results from a particular situation or stimulus, as opposed to trait anxiety which is an ongoing level of awareness or sensitivity to anxiety-provoking stimuli.

Anxiety Disorders

Comorbid anxiety and anxiety disorders appear to be associated with increased suicidal behavior in bipolar disorder. Simon et al. (2004) found that a history of an anxiety disorder was an independent risk factor for a more severe and debilitative course of bipolar illness, and brought on higher risk of attempting suicide (odds ratio 2.45, 95 CI 1.4-4.2). Anxiety disorders were highly prevalent in this study, with a lifetime history of an anxiety disorder in 51.2 of the sample. A current anxiety disorder was present in 30.5 of subjects. Henry et al. (2003) did not find such an association in a smaller sample of 318 subjects with bipolar disorder. Only 24 of this sample had a lifetime anxiety disorder, and there was no increase in suicide attempts in the subjects with a history of an anxiety disorder. This sample may not have had enough statistical power to find such a difference, and their negative finding may represent a type II error (i.e., failing to find a difference when one...

Components of Cardiac Rehabilitation

The physiologic parameters targeted by cardiac rehabilitation interventions include an improvement in exercise tolerance and in exercise habits optimization of coronary risk factors, including improvement in lipid and lipoprotein profiles, body weight, blood glucose levels and blood pressure levels, and cessation of smoking. There should be attention to the emotional responses to living with heart disease, specifically reduction of stress and anxiety and lessening of depression. An essential goal, particularly for elderly patients, is functional independence. Return to appropriate and satisfactory occupation is thought to benefit both patients and society.

Conclusion On Preclinical Testing

As drugs are developed and promoted for long-term use in more and relatively trivial conditions, e.g. minor anxiety, and affluent societies become less and less willing to tolerate small physical or mental discomforts, the demand for and the supply of new safer medicines will continue to increase. Only profound knowledge of molecular mechanisms will reduce risk in the introduction of new drugs. Occasional failures of prediction are inevitable, with consequent public outcry.

The Behavioral Inhibition System

Gray and McNaughton (2000) reaffirmed the earlier conclusions regarding the pattern of behavioral effects of anxiolytic drugs (pp. 72-82), including the novel anxiolytics however, the conclusions were based on far fewer studies for the latter drugs, and the effects were clearer when chronic administration or other means of preventing short-term interaction with the pituitary-adrenal system was used (McNaughton, Panickar, & Logan, 1996 Zhu & McNaughton, 1995). These effects included the familiar passive avoidance and extinction paradigms, as well as the conceptually similar tasks involving successive discrimination, fixed-interval reward schedules, and differential reinforcement of low rates of response. In addition, the authors included approach-approach conflict tasks, in which correct performance requires inhibiting a response that was previously correct but currently is incorrect. As in earlier writings, these effects can be understood as inhibiting prepotent or at least competing...

Pharmacological Concerns 71 Drug Distribution

The intravenous route is the most direct and avoids the barriers of hepatic first-pass metabolism and tissue absorption. However, some drugs cause pain on intravascular injection. The discomfort can be lessened by slowing the rate of injection or by dilution of the drug in volume or with simultaneous infusion of maintenance fluids. Analgesics known to cause discomfort on injection, especially when minimally diluted, include morphine and ketorolac. Sedatives that cause discomfort on injection include diazepam and propofol. Intramuscular injections are discouraged in children because of the anxiety and pain caused by hypodermic injection.

Hair Head and Pubic 51 Forensic Evidence

Hair is most commonly sampled to detect body fluids or retrieve foreign hairs or particles. It has been known for many decades that numerous ingested, prescribed, and illicit drugs (e.g., barbiturates, amphetamines, opiates, cocaine, benzodiazepines, y-hydroxy butyrate, and cannabis) are deposited in the hair (44). Although toxicology of hair was originally used to detect drugs that had been repeatedly ingested, recent advances in analytical techniques have meant that toxicology may be useful after single-dose ingestion as would occur in a substance-facilitated sexual assault (45,46). This is particularly pertinent because complainants of possible drug-facilitated sexual assaults frequently do not report the incident expeditiously because of amnesia and or doubt about what might have happened, and drugs may be accessible to analysis for longer periods in hair compared to blood or urine (47). In addition, it may be used as a reference sample for DNA analysis.

Depressive Phenomenology

Outside of psychomotor agitated depression, there is also the question of whether anxious depression is related to bipolar disorder. The presence of anxiety along with the major depressive episode is a com mon occurrence. It is not generally considered diagnostically informative, though often such patients will have manic symptoms that can represent a depressive mixed state. The interesting clinical question is whether anxious depression, in the absence of other manic-like symptoms, is more common in bipolar than unipolar depression. Anxiety symptoms are extremely common in bipolar disorder, so that when the diagnostic criteria for anxiety are applied, lifetime comorbidity ranges from 55 to 90 (Boylan et al. 2004) consequently, comorbidity with anxiety has been reported to be more frequent than with unipolar depression. On the basis of extensive clinical experience, Koukopoulos and Koukopoulos (1999) suggest a link between anxiety and bipolar disorder, as does Perugi (Perugi and...

Physiologically Active Substances A

Ethylene is effective when given 5-30 days before irradiation (202). Other inhibitors of mitosis, however, can enhance survival these include demecolcine (Colcemid), sodium ar-senite, epinephrine, cortisone, and typhoid paratyphoid vaccine (203). Tranquilizers and other psychotropic drugs possess only moderate radioprotective activities. These compounds probably are active by depression of whole-body metabolism through diminished oxygen uptake (35).

Treatment Of Dependence

Young illicit users by i.v. injection (heroin, benzodiazepines, amphetamine) have a high mortality. Either death follows overdose, or septicaemia, endocarditis, hepatitis, AIDS, gas gangrene, tetanus and pulmonary embolism ensue from the contaminated materials used without aseptic precautions (schemes to provide clean equipment mitigate this). Smugglers of illicit cocaine or heroin sometimes carry the drug in plastic bags concealed by swallowing or in the rectum ('body packing'). Leakage of the packages, not surprisingly, may have a fatal result.7

Withdrawal Of Alcohol

Abrupt withdrawal of alcohol from a person who has developed physical dependence, such as may occur when an ill or injured alcoholic is admitted to hospital, can precipitate withdrawal syndrome (agitation, anxiety and excess sympathetic autonomic activity) in 6 h and an acute psychotic attack (delirium tremens) and seizures (at 72 h).

Xanthinecontaining Drinks

Excessive prolonged consumption of caffeine causes anxiety, restlessness, tremors, insomnia headache, cardiac extrasystoles and confusion diarrhoea may occur with coffee and constipation with tea. The cause can easily be overlooked if specific enquiry into habits is not made including children regarding cola drinks. Of coffee drinkers, up to 25 who complain of anxiety may benefit from reduction of caffeine intake. An adult heavy user may be defined as one who takes more than 300 mg caffeine day, i.e. 4 cups of 150 ml of brewed coffee, each containing 80 20 mg caffeine per cup or 5 cups (60 20) of instant coffee. The equivalent for tea would be 10 cups at approximately 30 mg caffeine per cup and of cola drinks about 2.01. Plainly, caffeine drinks brewed to personal taste of consumer or vendor must have an extremely variable concentration according to source of coffee or tea, amount used, method and duration of brewing. There is also great individual variation in the...

Waters Unique Role in the Fitness of the Environment

Hyperventilation, defined as a breathing rate more rapid than necessary for normal CO2 elimination from the body, can result in an inappropriately low CO2(g) in the blood. Central nervous system disorders such as meningitis, encephalitis, or cerebral hemorrhage, as well as a number of drug- or hormone-induced physiological changes, can lead to hyperventilation. As CO2(g) drops due to excessive exhalation, H2CO3 in the blood plasma falls, followed by decline in H + and HCO3 in the blood plasma. Blood pH rises within 20 sec of the onset of hyperventilation, becoming maximal within 15 min. H + can change from Hypoventilation is the opposite of hyperventilation and is characterized by an inability to excrete CO2 rapidly enough to meet physiological needs. Hypoventilation can be caused by narcotics, sedatives, anesthetics, and depressant drugs diseases of the lung also lead to hypoventilation. Hypoventilation results in respiratory acidosis, as CO2(g) accumulates, giving rise to H2CO3,...

Sexually Transmitted Infections

Some centers prescribe antibiotic prophylaxis for all complainants of penile penetrative sexual assaults at the time they present (6,207,208). The use of antibiotic prophylaxis reduces the need for repeated examinations, avoids the anxiety incurred in waiting for the results, and is acceptable to the majority of women to whom it is offered (209). Antibiotic prophylaxis should cover the prevalent, treatable organisms in the local population, and advice should be sought from the local center for disease control regarding an appropriate regimen.

Psychosomatic Disorders

Nail Biting Adults Photos

Foreign objects (e.g., pencils or pipes) nail biting or excessive use of tobacco, which are all potentially injurious to the periodontium.Self-inflicted gingival injuries such as gingival recession have been described in both children and adults. Correlation between psychiatric and anxiety states and the occurrence of periodontal disease have been reported, but these reports have been questioned by some investigators.''1,1 Psychologic factors in the cause of necrotizing ulcerative gingivitis are discussed in Chapter 19.

Mapping coproduction sites methods and partial perspectives

It has long been acknowledged in anthropology that the positioning and identity of the researcher is always something of a negotiation that influences and to an extent informs ethnographic research. This process is heightened in research that spans numerous different persons, groups and intersecting contexts and where the anthropologist and their research are in Riles's terms, both 'inside' and instrumental to such networks (2001). Moreover, given the way that the developments of interest in this book are inseparable from, as well as having consequences for, the politics of women's health many questions are raised about the (critical) perspective of the author. As a feminist academic anthropologist I have discovered that there are no comfortable positions. Anxiety about 'medicalising' health care interventions co-exists with the recognition of long denied rights to equality of access and care in medicine or scientific research. Moreover despite the dangers of co-option, I continue to...

The ABCG White Subfamily

The human white or ABCG subfamily consists of five fully cloned genes (ABCG1, ABCG2, ABCG4, ABCG5, and ABCG8) and one gene so far only found in rodents (ABCG3) 22 . The ABCGs are thought to dimerize to form active membrane transporters. Among the half-size molecules ABCG proteins have a peculiar domain organization characterized by a nucleotide binding domain (ATP binding cassette) at the N-terminus followed by six transmembrane-spanning domains (Tab. 3.1 and Fig. 3.1). The founding member of this group, ABCG1, was independently described by Chen et al. and Croop et al. as the human homolog of the Dro-sophila white gene 112, 113 and its genomic organization, including the promoter region, has been described recently 114, 115 . Earlier indications linked ABCG1 with the congenital recessive deafness (DFNB10) syndrome, based on its chromosomal localization on chromosome 21q22.3 116 . However, a recent report 117 has excluded ABCG1 along with five other known genes as candidates for...

Ten Aspects To Consider for Future Research into Brain Mechanisms Involved in Wasting and Cachexia

Links and feedbacks exist among neurological, psychological and psychiatric manifestations of diseases accompanied by wasting and cachexia. Symptoms or signs such as anxiety, depression, cognitive impairment, fatigue and asthenia, and anorexia can exacerbate wasting and cachexia due to deleterious positive feedback cycles. This increases the frequency of complications, decreases the quality of life and activities of daily living and performance, and has an impact on overall morbidity and mortality. What are the main mechanistic interactions and magnitude of the individual contributions responsible for symptomatology interface

The latest diagnostic test

As discussed earlier, the Johns Hopkins study of neurally mediated hypotension was an uncontrolled trial conducted on a small sample of CFS patients. Similar responses have been made to the earlier claims, and at different points in time patients may have been eagerly awaiting results from viral antibody titres, hyperventilation tests, or maybe NK cell counts. Clearly, the need to have a legitimate marker for the illness is paramount for CFS patients.

Psychiatric illness and the social context of chronic fatigue syndrome

Many of the organic hypotheses arose from the observation that CFS shares a number of symptoms with certain medical conditions. However, it could be argued that there is even greater symptom overlap with primary psychiatric disorder. Debilitating fatigue and sleep disturbances are consistently associated with psychiatric disorder in studies of the community, primary care and tertiary care (David et al. 1990 Pawlikowska et al. 1994). Up to 85 per cent of CFS patients report depression as a key symptom, while between 50 and 70 per cent report anxiety (Komaroff and Buchwald 1991). Further, the current definitions of CFS are based on descriptive phenomenology, the traditional domain of psychiatric, rather than medical, diagnoses.

Psychiatric Comorbidity

Smokers more often suffer from psychiatric diseases, namely depression, anxiety disorder and schizophrenia, than do non-smokers. At least 70-90 of all schizophrenia patients smoke.15 There is a clear connection between smoking and depression and anxiety disorders. On the one hand, depression makes smoking lead to nicotine addiction more easily and, on the other hand, smoking promotes the development of depression. The same holds for anxiety and panic disorders. Smoking cessation can cause a temporary aggravation of the depression or anxiety.15

Neuromuscular Blocking Drugs

Thetic techniques and monitoring, awareness while paralysed for a surgical procedure is extremely rare. In the UK, general anaesthesia using volatile agents should always be monitored with agent analysers, which measure and display the end-tidal concentration of volatile agent. In the past, misguided concerns about the effect of volatile anaesthetics on the newborn led many anaesthetists to use little, if any, volatile agent when giving general anaesthesia for caesarean section. Under these conditions some mothers were conscious and experienced pain while paralysed and therefore unable to move. Despite its extreme rarity nowadays, fear of awareness under anaesthesia is still a leading cause of anxiety in patients awaiting surgery.

Myocardial Infarction

Heart-disease-specific instruments.8'9'12'13 A widely used MI-specific HRQoL instrument is the Quality of Life after Myocardial Infarction (QLMI) questionnaire.8 Since development, it has been further modified to a version called the MacNew QLMI.9 This consists of 26 items in three dimensions -Limitations, Emotions, and Social - with an overall HRQoL score as the sum of the MacNew QLMI dimensions (see Hoefer et al.45 for a review). A number of studies with the MacNew QLMI have shown it predicts later adverse health events.46'47 Predictors of quality of life have also been examined for MI patients. In a large British study, 288 MI patients were followed over the subsequent year. Levels of depression and anxiety during hospitalization did not predict mortality but did predict HRQoL, measured with a generic instrument, at one year.48

Suggestibility and Compliance

Appearing to have special knowledge about the alleged offense. This special knowledge may seriously mislead the police and the courts to assume the suspect's guilt erroneously. Suggestibility correlates with anxiety, lack of assertiveness, poor self-esteem, and low intelligence (56).

Is There a Synergistic Interaction Between Peripheral Impulse Input and Central Facilitation

These phenomena may be integrally related to hypervigi-lance, level of somatic focus, or other factors related to emotional regulation. The relationship of negative affect to pain conditions is well documented in the literature (66). In nearly all published reports, the presence of negative mood is associated with higher levels of pain. Induction of negative mood has also been shown to be related to pain report and pain behavior, with some specificity to the type of emotion induced (67-70). Interventions or instructional sets that reduce negative emotion also reduce pain report (62,71). Our work in IBS patients indicates that the magnitude of placebo analgesia is related to changes in expectations of pain (and anxiety), desire for pain relief, and somatic focus (72). That hyperalgesia can be completely normalized by either reducing a peripheral source of tonic impulse input or removing CNS facilitation is puzzling. It may be the case that there exists...

Implications for Patient Management

The research on depression following MI has clear implications for patient management. As soon as MI patients are medically stable, as determined by a cardiologist, they should undergo routine screening to identify those that are severely distressed. There are many self-report questionnaires available53 to assess depression, with the Beck Depression Inventory,54 and the Hospital Anxiety and Depression Scale55 being among those most commonly employed. Symptoms of depression should be assessed using a self-report instrument during hospitalization (3 to 7 days post-MI), and 6 weeks or so after discharge (usually when formal cardiac rehabilitation classes begin), to identify those patients who are experiencing significant emotional distress. Appropriate referral to a mental health professional should be considered for those patients demonstrating persistent elevated symptoms of depression, to allow for assessment of clinical depression and appropriate treatment. For those patients who are...

HBGAM and Nsyndecan in Synaptic Plasticity

Another molecule that binds to heparin is the heparin-binding growth-associated molecule (HB-GAM). It has been implicated in the regulation of neurite outgrowth, axon guidance and synaptogenesis in vitro (for a review see Rauvala and Peng 1997). HB-GAM is expressed in an activity-dependent manner (Lauri et al. 1996). In the adult hippocampus, application of HB-GAM inhibited NMDA receptor-dependent LTP, but did not affect L-type VDCC-dependent LTP, that was induced by application of the K+ channel blocker tetraethylammonium. This indicates that the action of HB-GAM is limited to NMDA receptor-dependent LTP (Lauri et al. 1998). In HB-GAM-deficient mice, a lower threshold for induction of LTP was observed, which was restored to the wild-type level by application of HB-GAM (Amet et al. 2001). The observation that LTP is attenuated in transgenic mice that overexpress HB-GAM is consistent with these findings. These changes in LTP are accompanied by behavioral alterations. Paradoxically,...

The Meaning of Social Support

Two conclusions can be drawn from the above. First, positive social support is important for the prognosis of CHD patients. This entails emotional (understanding and acceptance of feelings), appraisal (good advice and opportunity to discuss how to manage the new life situation), informational (knowledge about CHD, risk factors, and lifestyle), and instrumental (help with practical problems). All of these aspects should be included in comprehensive cardiac rehabilitation and secondary prevention. Second, in order for spouses and family members to be able to provide adequate social support, they themselves need social support. There is evidence that when spouses exhibit higher levels of anxiety and depression and lower sense of control than the patient, the patient's psychosocial adjustment to illness is adversely affected.6 It is a good investment to offer some structured support to spouses and family members of CHD patients. There are at least three reasons for this. First, family...

Muscle cardiovascular and respiratory abnormalities

Hyperventilation or over-breathing is yet another posited cause for CFS. Based on patients' perceptions of their feelings of shortness of breath following voluntary hyperventilation, Rosen and colleagues (Rosen et al. 1990) concluded that CFS was nothing more than chronic hyperventilation. Subsequent studies using more rigorous methods to measure hyperventilation, such as measuring decreased levels of carbon dioxide in the system, have shown that carbon dioxide levels cannot account for either the degree of symptoms nor functional impairment reported by CFS patients (Lavietes et al. 1996 Saisch et al. 1994). CFS patients with and without hyperventilation report the same severity of fatigue-related symptoms (Bazelmans et al. 1997). Saisch et al. (1994) also found that CFS patients with unequivocal hyperventilation had either panic disorder or asthma which would account for the decreased levels of carbon dioxide in their system. Consequently, while hyperventilation may contribute to the...

Guide To Further Reading

Anderson IM, Nutt D J et al 2000 Evidence-based guidelines for treating depressive disorders with antidepressants a revision of the 1993 British Association for Psychopharmacology guidelines. Journal of Psychopharmacology 14 3-20 Ballenger J C et al 1998 Consensus statement on panic disorder from the International Consensus Group on Depression and Anxiety. Journal of Clinical Psychiatry 59 47-54 Ballenger J C et al 1998 Consensus statement on social anxiety disorder from the International Consensus Group on Depression and Anxiety. Journal of Clinical Psychiatry 59 54-60 Ballenger J C et al 2000 Consensus statement on posttraumatic stress disorder from the International Consensus Group on Depression and Anxiety. Journal of Clinical Psychiatry 61 60-66 Ballenger J C et al 2001 Consensus statement on generalized anxiety disorder. Journal of Clinical Psychiatry 62 53-58 Davies S J C et al 1999 Association of panic disorder and panic attacks with hypertension. American Journal of Medicine...

CCK2Gastrin Receptor Antagonists

A number of chemically diverse CCK3 gas- trin-receptor antagonists have been examined in clinical trials as antisecretory agents or inhibitors of panic anxiety attacks. To date, however, none has been marketed (Table 3.7). CCK2 gastin-receptor antagonists, including ose compounds in preclinical development well as those that have progressed to hu-ans, were the subject of a recent review (176).

Variability In The Development Of Sensitized States

It has however been noted that around 20 of subjects fail to sensitize to esophageal acid infusion. Furthermore, there is a variation in the magnitude of response (reduction in pain threshold to acid infusion) between subjects to the order of 24 . Also, while most subjects will demonstrate reproducible sensitization to acid in repeated studies, around 14 will habituate to acid with diminishing sensitization to repeated acid infusions (95). Recent work in healthy subjects has shown that visceral pain thresholds inversely correlate with baseline anxiety scores (96). Whether the effect of anxiety in these subjects is to amplify pain responses through the effect of attention toward the visceral stimulation is unknown.

Formulation of Guidelines

This information can help to allay unnecessary anxiety from the outset and ensures that the victim is referred, if appropriate, to the designated hospital at the earliest opportunity. Knowledge of precise treatment protocols is not required, but it is helpful to be able to explain to the victim what to expect. For example, he or she will be asked to provide a voluntary baseline blood sample for storage and numerous follow-up samples for testing depending on the nature of the exposure. This is especially relevant for hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). Occasionally, it may be necessary for samples to be obtained as long as 6 mo after the incident.

Cognitive behavioural models of chronic fatigue syndrome

They suggested that an organic insult such as a virus precipitates a cycle of psychological responses, which mediate between the acute organic illness and the chronic syndrome. In other words, while organic factors might precipitate the illness, cognitive behavioural factors perpetuate the condition. Wessely and colleagues explain that when resuming normal activity levels following a bad viral infection, it is common to experience symptoms of physical deconditioning. If people attribute these symptoms to signs of ongoing disease rather than deconditioning, they will tend to resort to rest and inactivity in an attempt to 'cure' the symptoms. A cycle of avoidance and symptom experience develops which can lead to loss of control, demoralisation and possibly depression and anxiety. These psychological states can further perpetuate the illness through generating more physical symptoms and possibly through compromising the immune system.

Evidence for Altered Psychological State

Certain stressful life events have been associated with both the onset and exacerbation of a number of disorders of the GI tract including FGD (109), PI-IBS (110), and inflammatory bowel disease (111). Anxiety, somatization, neuroticism, hypochondriasis, and preceding adverse life events have all been reported to increase the risk of developing IBS after gastroenteritis (110,112). Both early-life stress in the form of abuse and an acute episode of extreme stress in adult life such as rape have been suggested as important risk factors for the development of FGD (113,114). A number of physiological and psychological theories have been proposed that might modulate the effects of anxiety and stress on pain sensitivity. Of the psychological theories, the attributional theory proposes that anxiety that has painful sensation as its focus (pain-relevant anxiety) will lead to heightened pain responses, whereas pain-irrelevant anxiety will reduce pain responses. The attentional theory proposes...

Anticipating the test

It's clearly difficult, in some cases, to disaggregate the effect of patients expectations and desires for testing, from the actions of GPs and other health professionals and or a even particular agenda in the media about genetic testing for breast cancer (see Henderson and Kitzinger 1999). At the same time the possibility cannot be discounted that anticipating a genetic test was perceived as simply part of or necessary to being a patient who would be seen, screened and generally looked after on a routine basis. Whatever the source of such anticipated interventions, genetic testing clearly provides a powerful symbol of the precision and expertise that many of those I met associated with this medical speciality, holding out the hope of providing concrete answers in the midst of widespread fear and anxiety about the risk of breast cancer.

Patient Related Factors

Sociodemographic factors such as age, gender, ethnicity, socioeconomic status, and education have not been consistently related to adherence.1,2 A number of psychological factors have been investigated, including traits, states, knowledge, and beliefs. There is little evidence of personality traits influencing adherence and the search for the non-adherent personality type has provided limited insight. Negative psychological states such as stress, depression, anxiety, and low levels of perceived social support increase the risk of non-adherence.2

Endtidal PO2 and PCO2

Consequently, the profile of PET,co2 with increasing WR is normally such that it increases progressively up to 9l, then stabilises in the region of isocapnic buffering, and subsequently decreases as frank compensatory hyperventilation is manifest 2, 5, 86 . In contrast, end-tidal Po2 (Pet,o2) progressively decreases up to 9l, after which it increases systematically (fig. 7), accelerating further with the onset of compensatory hyperventilation.

Sexual Counseling of the Cardiac Patient

Cardiovascular disease is a common cause of sexual dysfunction. Patients and their partners may experience sexual problems as a result of anxiety, symptoms or sexual dysfunction. They worry about the effect of the condition on sexual activity, the effect of sex on the heart, symptoms that may occur during sexual activity and possible effects of medication.

Review of Studies up to 2002

It should be emphasized that the great majority of the studies published up to 2002 (as summarized above) were descriptive, not hypothesis driven, and did not control for various important factors such as expectation, response requirements, previous exposure to the stimulus, affective comorbidity, symptom-related anxiety, or sex of the subjects. Thus, one may speculate that the most consistently reported regions in these studies (such as insula and dACC), which also are consistently activated in somatic pain studies and across patient and healthy populations, may be those that are less dependent on non-stimulus-related variables. This may be particularly true about the anterior insula which has been referred to as the interoceptive cortex, and activation of which has been found to covary with stimulus intensity (18). Other areas that are found to be significantly activated in some studies, but not others (in particular, limbic and prefrontal regions, as well as thalamus), may be more...

Neurobehavioral and in vitro actions of cannabinoids

The CBj antagonist, induced anxiolysis that was dependent on the mouse strain used in the anxiety model and blocked the anxiogenic effects of anandamide or methanandamide whereas, SR141716A had no effect on the anandamide inhibition of kainite activated currents in vitro. We tested another hypothesis that there might exist in the central nervous system a multiplicity of Cnrs. The basis for the hypothesis has been the myriad neuro-behavioral effects produced after smoking marijuana or the administration of cannabinoids to humans and animals. We therefore studied the neurobehavioral specificity of CB1 Cnr gene expression and whether A9-THC induced neurobehavioral changes are attributable to genetic differences (Onaivi et al., 1996). We also examined whether some of these neurobehavioral changes were mediated by specific brain regions in the mouse model. We found that the differential sensitivity following the administration A9-THC to three mouse strains, C57BL 6, DBA 2 and ICR mice...

Studies of Neurotransmitter Function

Other transmitter-related findings in bipolar depression include increased sensitivity to acetylcholine (Sitaram et al. 1982) and reduced Y-aminobutyric acid (GABA) in body fluids (Brambilla et al. 2003 Petty et al. 1993). Cerebrospinal fluid (CSF) GABA levels in euthymic subjects with bipolar disorder were the same as those in control subjects (Berret-tini et al. 1982, 1986) therefore, low GABA levels may be a characteristic of depressive episodes in general. There is also a complex array of endocrine findings, most involving the hypothalamic-pituitary-adreno-cortical axis (HPA). Reported HPA abnormalities include increased cortisol excretion with reduced sensitivity to negative feedback regulation, resulting in an increased incidence of dexamethasone nonsup-pression in both bipolar and nonbipolar depressions (Stokes et al. 1984). Despite original suggestions that HPA dysfunction was related to a specific type of treatment-responsive depressive episode, there are no reliable or...

Evidence for Sensitization of Visceral Afferent Pathways

Sensitization at supraspinal levels, as well as cognitive and emotional modulation of the chronic visceral pain experience related to coping mechanisms and symptom-related anxiety (28). Brain imaging in human subjects is one modality, which may allow us to differentiate between these different pain modulation mechanisms.

Psychological Aspects

When coordinating the program,the cardiac rehabilitation nurse must ensure that psychological support is provided as part of the mainstream service. The psychological aspect should consist of group sessions or individual counseling, where appropriate. The most common evaluation is screening for levels of anxiety and depression and the most common assessment tools are the Hospital Anxiety and Depression Scale (HADS) and the Short Form 36 questionnaire (SF-36). Ideally a psychologist should provide this service and the nurse as coordinator will liaise with them to integrate the sessions into the program. In the absence of a psychologist, with appropriate training, the nurse would be able to provide the basic requirements of the service, but screening for patients who need further intervention must be carried out and patients referred on to specialists as required.

Evidence for Central Pain Amplification

The brain has multiple ways to modulate the perception of afferent information, and this modulation is influenced by cognitive factors (e.g., attention), the emotional state of the individual (e.g., fear, anxiety, or anger), or memories of previous sensory events. Considerable progress has been made on both preclinical and, more recently, clinical levels to identify brain regions, circuits, and mechanisms that play a role in the facilitation and inhibition of the subjective pain experience (53,55). Phillips et al. used a study paradigm involving viewing of emotional faces and non-painful esophageal distension to evaluate the neural mechanisms underlying the effect of emotional context on visceral perception (56). In a first paradigm, they studied brain responses of eight healthy subjects (seven males) to nonpainful esophageal distension using a 1.5T fMRI. Brain responses to the esophageal stimulation during either neutral or negative emotional context were evaluated. Activation within...

Evidence for Alterations in Descending Pain Modulation

Demonstrate the activation of brain stem regions in the context of central sensitization in healthy human volunteers (68). Using 3T fMRI, they compared whole brain responses, including the brain stem, to punctuate mechanical stimulation in an area of secondary hyperalgesia (induced by heat capsaicin sensitization model) or in a control area. They found greater activation during stimulation of the hyperalgesic region in several cortical regions, including posterior insula and anterior and posterior cingulate cortex, as well as the thalamus and pons. The brain stem activation was localized to the NCF and the PAG, two regions that receive inputs from corticolimbic networks (including the rostral ACC), send projections to the rostro-ventral medulla, and are part of a corticolimbic pontine pain modulation circuit (69,70). These intriguing findings correlate nicely with recent findings in rodents demonstrating the upregu-lation of spino bulbo spinal loops, which play a role in the...

Mental Status Examination Reports

Helen Jackson, a 67-year-old African American female, was evaluated during routine rounds at the Cedar Springs Nursing Home. Her grooming was adequate and she was cooperative with the examination. She reported her mood as desperate because she had recently misplaced her glasses. Her affect was characterized by intermittent anxiety, generally associated with having misplaced items or with difficulty answering the examiner's questions. Her speech was slow, halting, and soft. She repeatedly became concerned with her personal items, clothing, and general appearance, wondering where her scarf ran off to and occasionally inquiring as to whether her appearance was acceptable (e.g., Do I look okay You know, I have lots of visitors coming by later. ). Ms. Jackson was oriented to person and place, but indicated the date as January 9, 1981 (today is July 8, 2002). She was unable to calculate serial sevens and after recalling zero of three items, became briefly anxious and concerned, stating...

Define the Content of the Program

Should be assessed and additional education provided. Patients should learn to manage symptom monitoring and flexible intake of diuretics when signs and symptoms of fluid retention occur. After a period of deterioration, patients and families may experience insecurity and anxiety and need support. Consultations in nurse-based programs are often longer (30-60 minutes) than visits to the physician and enables a caring assessment, in-depth education and psychosocial support. In order to prevent readmission the cause of the previous admission should be determined and addressed in order to lower the risk for readmissions.

Generic For Chloralodol

Interactions because benzodiazepines do not induce hepatic microsomal enzyme production. The advantages of benzodiazepines over older hypnotic drugs and especially over barbiturates are as follows safer in overdose, less tendency to tolerance and dependency, less adverse potential, greater sedation-to-anxioly-sis ratio, and fewer drug interactions. and dependence and their danger in overdose. Chloral hydrate (3) (see Table 5.5) seems the least problematic with relatively low abuse potential it is still used as an alternative to benzodiazepines. The adverse effects include gastric irritation, light headedness, ataxia, nightmares, excitement, confusion, allergic reactions, and skin rash. It also causes drowsiness and motor incoordination therefore, chloral hydrate should not be used concomi-tantly with other CNS depressant drugs such as alcohol. The adverse effects of ethchlorvynol (4) (see Table 5.5) are similar to those of

Diseases with Akinetic Rigidity Idiopathic Parkinsons Disease

Lewy Body Pathology

Combinations of extrapyramidal disorders and auto-nomic dysfunctions, frequently accompanied by neuro-psychiatric symptoms, define the disease. The cardinal motor symptoms are cogwheel rigidity of muscle tone, bradykinesia akinesia, postural instability, and pill-rolling tremor at rest. A stooped posture, shuffling and festinating gait, lack of facial expression, micrographia, weak monotonous speech, and dysphagia are additional characteristic features. In some patients, akinetic-rigidity predominates in others, resting tremor. Characteristic autonomic dysfunctions include orthostatic hypotension, seborrhea, sialorrhea, hyperhydrosis, constipation, bladder disorder, sleep disorder, and, rarely, sexual dysfunction. Anxiety, depression, psychosis, hallucination, and cognitive decline may emerge at any time during the course of the disease, which ranges from 10 to 20 years. No specific diagnostic tests are available. PET and SPECT show diminished striatal dopamine uptake.

Pharmacological Targeting of Mitochondrial Dysfunction in SLE

Production and intracellular alkalinization in lupus PBLs (37). Therefore, IL-10 antagonists may partially correct signaling dysfunction in lupus. A proapoptotic 1,4-benzodiazepine (Bz-423) has been found to promote ROI-mediated apoptosis of germinal center B cells and ameliorate glomerulonephritis in lupus-prone NZB W mice (66). The mechanism of mitochondrial hyperpo-larization and ATP depletion require further studies, which in turn could identify novel targets for pharmacological intervention in patients with SLE.

The Role of Cardiac Rehabilitation Psychological Support and Stress Management

Psychosocial factors play an important role in the prevalence and in the progression of coronary artery disease. This has consequences for the provision of psychosocial support within the framework of a CR service. The psychological expertise within the CR team should advise the employer on means of limiting a stressful work environment in patients where mental stress or strain at the workplace has been reported. Patients may be helped by participating in stress management classes or in special cases through individual counseling by a psychologist. Overprotection by family and friends and the attitude of work colleagues and supervisors may extend sickness absence. Here clear and timely information from the CR team is invaluable Anxiety and depression should be diagnosed early post-MI and treated if indicated with pharmacotherapy. Repeated mental reinforcement within the CR program may help the patient to regain self-confidence and trust in the ability to face work demands.

Physical Dependence And Tolerance

Tolerance may result from a compensatory biochemical cell response to continued exposure to opioid. In short, both physical dependence and tolerance may follow the operation of homeostatic adaptation to continued high occupancy of opioid receptors. Changes of similar type may occur with GABA transmission, involving benzodiazepines. There is commonly cross-tolerance between drugs of similar, and sometimes even of dissimilar, chemical groups, e.g. alcohol and benzodiazepines.

The Team Approach

As described earlier, chronic CO2 retention occurs when the kidneys are unable retain sufficient bicarbonate to balance with the primary elevation of carbon dioxide, and restore the pH. In other words, the pH remains acidotic. Causes for acute-on-chronic CO2 retention can be worsening V Q mismatch with demand for increased effort, shutting off the hypoxic drive, or respiratory depressants such as sleeping pills or antianxiety medications. Congestive heart failure, acute bronchitis, pneumonia, and pneumothorax, as discussed earlier, all worsen the V Q mismatch with demand for increased respiratory effort.5 Acute-on-chronic carbon dioxide retention is associated with the general condition of acute respiratory distress syndrome (ARDS). Sleeping pills or antianxiety medications, taken chronically as abused drugs, depress the respiratory center when taken in large amounts and cause acute-on-chronic CO2 retention. These drugs include barbiturates, such as phenobarbital or secobarbital opium...

Feelings as Byproducts

There is no question that you feel anxious, but this feeling is not why you decide to go home. Both the anxious feeling and your decision to leave are easily traced to the negative experience in the elevator that occurred 6 months ago. It is this prior conditioning that behavior analysts emphasize. Notice that the behavioral position does not deny your feelings. These are real events. However, it is your previous interaction with the broken elevator that changed both how you feel and how you act.

Adherence to Health Recommendations

However, sociodemographic factors such as age, gender, ethnicity, socioeconomic status, and education have not been consistently related to adherence. Patient beliefs about treatments and health conditions appear to make a difference while negative psychological states such as depression and anxiety increase non-adherence. Non-adherence has also been associated with poorly developed health services, lack of training in chronic disease management for health, and short consultation times. Interventions to improve adherence have had weak to moderate effects. However, even modest improvements in adherence may result in substantial mortality and economic savings. Adherence has been identified as a core outcome goal for cardiac rehabilitation services. Future research thus needs to identify those patients at highest risk for non-adherence and strategies that facilitate long-term adherence to recommendations since long-term behavior change is intrinsic to much...

Appetite Loss and Anorexia

Patients receiving THC for nausea and vomiting associated with cancer chemotherapy have often shown improved appetite after receiving THC, but the effect is unpredictable (Regelson et al., 1976). In a small study comparing THC with diazepam in patients with anorexia nervosa, THC did not improve caloric intake and three of the eleven patients who took the drug developed paranoia (Gross et al., 1980). The Food and Drug Administration approved the use of synthetic THC (dronabinol) for anorexia associated with weight loss in patients with AIDS, based on clinical studies in which the effect of THC was sustained for up to 5 months a placebo-controlled trial involving 139 patients with AIDS in the US and Puerto Rico was carried out for an initial period of 6 weeks. The patients in the active arm of the trial received 2.5 mg THC twice daily before meals. THC produced a significant increase in appetite compared to the placebo but no corresponding increase in weight gain. Side effects...

The influence of distress on symptoms

An important factor that is closely related to the reporting of physical symptoms is psychological distress. Psychological distress incorporates the concepts of depression, anxiety or negative affect. We have already seen in Chapter 4 that premorbid distress is a predicator of CFS and that CFS patients have higher levels of distress than a number of other chronic illness groups. Distress in CFS is strongly associated with the experience of somatic symptoms (Wessely et al. 1996a). This relationship is true both for symptoms included in the current CDC definition of CFS and non-CDC somatic symptoms. Therefore the association between distress and symptoms has particular relevance for CFS. Anxiety can also make us more alert to other physical problems. If a new symptom is detected, it is more likely to be interpreted as a sign of an illness than if it was thought to be a normal response to a stressful situation (Moss-Morris and Petrie 1999). Distress and bad moods also influence...

Differences in Brain Responses to Visceral and Somatic Pain Stimuli

Extensive visceral (esophageal balloon distension) and somatic (contact heat on the midline chest) animal and human experimental studies have demonstrated that the perceptual, auto-nomic, and behavioral responses to noxious stimulation of somatic structures differ from those of the viscera (28,29). These differences have been explained based on the functional neuro-anatomic differences between visceral and somatic pain processing. Experimentally induced aversive visceral sensations in humans are generally described as more unpleasant than somatic sensations (30,31). A series of studies from Bushnell's laboratory evaluated perceptual and central nervous system responses to visceral and cutaneous painful stimuli to the chest. In these studies, the authors used controlled balloon distension of the esophagus as a visceral stimulus and contact heat exposure of the chest as a corresponding somatic stimulus, matched in terms of perceived intensity within the same dermatome (30,32,33). In an...

The Large Intestine Rectum and Anus

These effects may be the result of increased anxiety, another stimulus that can reproduce some IBS symptoms in adult rats following partial restraint (48) and other experimental stressors (49). Genetic models have been used with some success to examine visceral pain. For example, the Wistar Kyoto rat (a high-anxiety strain) exhibits significantly more colonic hypersensitivity than other strains, including the commonly used Sprague Dawley rat strain (50). Specific transgenic models have been produced with intestinal inflammation, results that have been used to propose the pathophysiology of inflammatory bowel disease (IBD). Such genetic models include the knockout of genes such as that for the anti-inflammatory cytokine interleu-kin-10, which results in increased cytokine production by TH1 lymphocytes and chronic enterocolitis with some IBD-like symptoms (51).

The Relationship Between the Lesion and Disability

CB programs started because it was obvious that the amount of disability shown by a patient often had little or no relationship to the amount of damage to their back. There was little or no connection between the impairment (the lesion) and the disability (pain, functional capacity, anxiety, etc.). This is also true in cardiac illness.4,5 For example, the degree to which angina interferes with a patient's daily life is not related to the extent of atheroma in their arteries. From a CB perspective this lack of association is to be expected because having a lot of mistaken beliefs, known as cardiac misconceptions, is associated with increased disability but not with impairment. If the patient does not believe the angina misconception that every further attack of angina is damaging them, they are much more likely to stay active even if this sometimes causes angina. This repeated ischemic challenge can lead to an increase in the blood flow through capillaries to the ischemic area,...

Evidence for the CB Approach

(Seattle Angina Questionnaire), and a lower level of anxiety and depression. They were also more likely to report having changed their diet and increased their daily walking.9 This replicated the success of an earlier CB program for post-MI patients, the Heart Manual,10 a rehabilitation method also now widely used in CR in the United Kingdom.

Mutable mobiles contingency triage and codeswitching

Nevertheless this analysis of clinical power and authority is, only part of the story in understanding the use of paper tools and techniques. The practices elicited by and through the predictive techniques of the clinic must also be understood in relation to a broader nexus of co-production. This not only includes patients' desires to engage in practices of awareness or surveillance, but also takes account of the regulatory governance of cancer genetics and the inherent contingencies of predictive interventions themselves. The collective negotiation and management of these tensions during clinical encounters ensures these tools and technologies, rather than being 'immutable mobiles' (Latour 1987), can in fact become and are sometimes deliberately positioned by practitioners as mutable and somewhat unstable. When these tools are just as essential to the work of re-assuring inappropriately referred and unnecessarily anxious patients or in discharging those not at greatly increased...

Evidence for Autonomic Nervous System Dysfunction

Diminished variability in heart rate and skin conductance has been demonstrated in anxiety, and these are likely to be due to the interaction of both the sympathetic and parasym-pathetic nervous systems. Piccirillo et al. demonstrated that healthy adults with higher anxiety scores have lower LF and HF power values, and demonstrate a higher LF HF ratio compared to those that report lower anxiety scores on questionnaires (124). The significantly higher LF power suggested cardiac sympathetic hyperactivity. Other work has suggested that the variations in power spectral components in anxiety are associated with reduced vagal modulation of cardiac control (125). The mechanisms whereby anxiety can modulate the ANS, HPA axis, and eventually pain perception are incompletely understood, but this area of research is likely to gain interest due to their prevalence in FGD and the advancement of monitoring technologies.

Specific Diagnostic Criteria

In contrast to establishing a satisfactory definition for mental disorders, identifying a DSM diagnosis for a particular client may seem, on the surface, rather simple and straightforward. After all, accurate diagnosis is based on determining the presence or absence of various symptom clusters or patterns (i.e., syndromes). In most cases, DSM-IV-TR provides specific, somewhat measurable criteria for its diagnoses. Typically, DSM diagnoses are characterized by a list of symptoms for defining the condition accompanied by a few factors that, if present, would rule out the condition in question. For example, to qualify for the DSM's generalized anxiety disorder, individuals must meet the criteria in Table 10.1. The diagnostic criteria for generalized anxiety disorder illustrate tasks associated with accurate diagnosis. First, based on criterion A, diagnostic interviewers must establish whether a given client is experiencing excessive anxiety and worry, how frequently the anxiety is...

Drug Interactions With Cannabinoids

Most clinical trials have administered cannabinoids alone to treat a particular disorder rather than in combination with other drugs. There appear have been no adverse interactions of any consequence between a wide range of cancer chemotherapies, when cannabinoids have been given to counteract the nausea and vomiting associated with the latter or indeed during specific studies in man (Riggs et al., 1981). The beneficial effects of administering THC with another antiemetic, prochlorperazine, have been referred to above. Considering the central nervous system depressant action of these agents, it would be wise to be cautious when administering them with other, CNS depressants, such as benzodiazepines, barbiturates, antidepressants and alcohol. The interaction between marijuana smoking and the enhanced metabolism of

Assessment and Diagnosis Problems

To competently determine that a client meets the diagnostic criteria for generalized anxiety disorder, an interviewer must determine, by collecting assessment data, whether the client has three of six symptoms from criterion C. Given this fact, it may be sufficient (and justifiable) to directly ask the client a series of specific DSM-IV-TR-generated questions pertaining to generalized anxiety disorder. For example, the following questions could be directed to the client

Nurse Led Self Care Management Programs

Many chronic diseases lend themselves to self-management as long as patients have the requisite cognitive skills, mental health, and health literacy, and a number of programs have been developed and evaluated. A recent review suggests that the effectiveness of self-management educational programs varies but that patients with diabetes and hypertension gain small to moderate benefit as measured by improved glycosylated hemoglobin levels and systolic blood pressure.5 It is clear that effective self-care management programs differ from traditional patient education. Michael Von Korff has recently described the common features of effective chronic disease management programs, which include a personalized written care plan education in self-management tailored to the individual's age and circumstances the monitoring of outcome and adherence to treatment the targeted use of specialist consultation or referral. He also notes that to be effective staff facilitating the program must recognize...

Lay Advice and Support

There is a good deal of evidence to support the use of peer mentors (also called lay advisors or buddies) with at-risk patients13 and cardiac patients. For example, peer advisors can provide social support to decrease heart disease-related depression, encourage healthy recovery, and decrease hospital readmission rate.14 Peer support for cardiac surgery patients reduced anxiety and led to increased activity post surgery.15 Peer support groups for people 12 months after a cardiac event led to an increase in physical activity and smoking cessation.16 Home visits to post-Mi patients by trained lay volunteers, who had attended CR themselves, significantly increased the likelihood of attendance at CR. Peer support was also shown to be useful in promoting exercise in seniors,17 and using peers as an extension to care by nurses to post-Mi patients had positive outcomes for both patient and the peer advisor.18

Central Vestibular Nystagmus

Central vestibular nystagmus is caused by damage to the vestibular nuclei or to their connections with the ocular motor nuclei. Since the vestibular, optokinetic, and pursuit systems all converge on a common final pathway through the vestibular nuclei, they are all impaired. Due to the loss of the optokinetic and pursuit systems, the sufferer is unable to stop the nystagmus-driven movement of images across the retina. Consequently, central vestibular nystagmus (in contradistinction to peripheral vestibular nystagmus) cannot be suppressed by the fixation maintenance system. The result is intractable oscillopsia. Treatment is largely unsatisfactory. Drugs like baclofen and clonazepam when given in sufficiently high doses can dampen the nystagmus, but often produce an unacceptable level of somnolence.

History Of Lead Discovery And Screening

Scientists such as Paul Ehrlich, searching for an antisyphilitic, have exemplified the idea of serial screening of compounds in an attempt to find a magic bullet. This approach, although tedious and time consuming, did generate a remarkable number of drugs, such as the benzodiazepines, chlorpromazine, and others (14).

Triage and the necessity of limits

I am very aware that as a service we are oversubscribed, so I try to stick fairly rigidly to the criteria. That means not starting mammography screening or follow up appointments until people are 35 and if someone's got a mother who was 41 when she got breast cancer, then they don't fit the criteria. I do try and stick to that but there are obviously some very anxious people who find it difficult to cope with not fitting the criteria. So it depends on the person, say you have a person and you say you don't fit the criteria, well you might have to explain how it's not a perfect system.

Adapted Programs for Special Groups

As control of salt and water intake, support to overcome anxiety and depression, and instructions to adapt physical activity to the reduced cardiac performance are of crucial importance. The need for specific psychological support in these patients is now recognized. Although rehabilitation of cardiac transplantation may be a rare challenge in regular programs due to the low number of patients, specific physiological aspects of the cardiovascular system have a major impact on exercise testing and training modalities. Furthermore, adjustment of the patient, his family and partner have to be supported.

Reviewing Client Problems

Similarly, the lay public overuses the terms compulsive and panic. In diagnostic circles, compulsive behavior generally alerts the clinician to symptoms associated with either obsessive-compulsive disorder or obsessive-compulsive personality disorder. In contrast, many individuals with eating disorders and substance abuse disorders refer to their behaviors as compulsive. Once again, further questioning is needed before assuming that the client is suffering from a compulsive disorder. Finally, panic disorder is a very specific syndrome in DSM-IV-TR. However, many individuals with social phobias, agoraphobia, or public speaking anxiety talk about being frozen with panic. Therefore, although client use of the word panic should alert the interviewer to the possibility of an anxiety disorder, the appropriate diagnosis may not be panic disorder.

Disorders Of Adrenal Medullary Hormones

Pheochromocytomas are tumors that produce excess catecholamines. The majority of pheochromocytomas arise from the adrenal medulla. The classic symptoms of pheochomocytomas are those attributable to excess hormone production, which include recurring episodes of sweating, headache, and a feeling of heightened anxiety. Although the disease is rare, any patient with hypertension that is difficult to control should be assessed for pheochromocytoma. The peak incidence for the disorder is in the third to fifth decades of life.

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