Chapter 4 Panic Disorder
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Differentiating Between Anxiety, Syncope & Anaphylaxis
Differentiating between anxiety, syncope & anaphylaxis Dr. Réka Gustafson Medical Health Officer Vancouver Coastal Health Introduction Anaphylaxis is a rare but much feared side-effect of vaccination. Most vaccine providers will never see a case of true anaphylaxis due to vaccination, but need to be prepared to diagnose and respond to this medical emergency. Since anaphylaxis is so rare, most of us rely on guidelines to assist us in assessment and response. Due to the highly variable presentation, and absence of clinical trials, guidelines are by necessity often vague and very conservative. Guidelines are no substitute for good clinical judgment. Anaphylaxis Guidelines • “Anaphylaxis is a potentially life-threatening IgE mediated allergic reaction” – How many people die or have died from anaphylaxis after immunization? Can we predict who is likely to die from anaphylaxis? • “Anaphylaxis is one of the rarer events reported in the post-marketing surveillance” – How rare? Will I or my colleagues ever see a case? • “Changes develop over several minutes” – What is “several”? 1, 2, 10, 20 minutes? • “Even when there are mild symptoms initially, there is a potential for progression to a severe and even irreversible outcome” – Do I park my clinical judgment at the door? What do I look for in my clinical assessment? • “Fatalities during anaphylaxis usually result from delayed administration of epinephrine and from severe cardiac and respiratory complications. “ – What is delayed? How much time do I have? What is anaphylaxis? •an acute, potentially -
SCHIZOPHRENIA and OTHER PSYCHOTIC DISORDERS of EARLY ONSET Jean Starling & Isabelle Feijo
IACAPAP Textbook of Child and Adolescent Mental Health Chapter OTHER DISORDERS H.5 SCHIZOPHRENIA AND OTHER PSYCHOTIC DISORDERS OF EARLY ONSET Jean Starling & Isabelle Feijo Jean Starling FRANZCP, MPH Child and adolescent psychiatrist, Director, Walker Unit, Concord Centre for Mental Health, Sydney, and senior clinical lecturer, Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, Australia Conflict of interest: none declared Isabelle Feijo FRANZCP Psychiatrist, Walker Unit, Concord Centre for Mental Health, Sydney, Australia and specialist in child and adolescent psychiatry and psychotherapy, Swiss Medical Association Conflict of interest: none declared Jackson Acknowledgement: thanks to Pollock; Polly Kwan who vetted the untitled. Cantonese websites This publication is intended for professionals training or practising in mental health and not for the general public. The opinions expressed are those of the authors and do not necessarily represent the views of the Editor or IACAPAP. This publication seeks to describe the best treatments and practices based on the scientific evidence available at the time of writing as evaluated by the authors and may change as a result of new research. Readers need to apply this knowledge to patients in accordance with the guidelines and laws of their country of practice. Some medications may not be available in some countries and readers should consult the specific drug information since not all dosages and unwanted effects are mentioned. Organizations, publications and websites are cited or linked to illustrate issues or as a source of further information. This does not mean that authors, the Editor or IACAPAP endorse their content or recommendations, which should be critically assessed by the reader. -
Borderline Personality Disorder
Borderline Personality Disorder What is Borderline Personality Disorder? Borderline personality disorder is an illness marked by an ongoing pattern of varying moods, self-image, and behavior. These symptoms often result in impulsive actions and problems in relationships with other people. A person with borderline personality disorder may experience episodes of anger, depression, and anxiety that may last from a few hours to days. Recognizable symptoms typically show up during adolescence (teenage years) or early adulthood, but early symptoms of the illness can occur during childhood. National Institute of Mental Health What are the signs People with borderline personality disorder may and symptoms? experience mood swings and may display uncertainty about how they see themselves and their role in the world. As a result, their interests and values can change quickly. People with borderline personality disorder also tend to view things in extremes, such as all good or all bad. Their opinions of other people can also change quickly. An individual who is seen as a friend one day may be considered an enemy or traitor the next. These shifting feelings can lead to intense and unstable relationships. Other signs or symptoms may include: ♦ Efforts to avoid real or imagined abandonment, such as rapidly initiating intimate (physical or emotional) relationships or cutting off communication with someone in anticipation of being abandoned ♦ A pattern of intense and unstable relationships with family, friends, and loved ones, often swinging from extreme closeness and love (idealization) to extreme dislike or anger (devaluation) ♦ Distorted and unstable self-image or sense of self ♦ Impulsive and often dangerous behaviors, such as spending sprees, unsafe sex, substance abuse, reckless driving, and binge eating. -
Exposure and Cognitive Interventions for Anxiety 1
Exposure and Cognitive Interventions for Anxiety 1 Running head: EXPOSURE AND COGNITIVE INTERVENTIONS FOR ANXIETY Exposure Therapy and Cognitive Interventions for the Anxiety Disorders: Overview and Newer Third Generation Perspectives John P. Forsyth, Velma Barrios, and Dean T. Acheson University at Albany, State University of New York Forsyth, J. P., Barrios, V., & Acheson, D. (2007). Exposure therapy and cognitive interventions for the anxiety disorders: Overview and newer third-generation perspectives. In D. C. S. Richard & D. Lauterbach (Eds.), Handbook of the exposure therapies (pp. 61-108). New York: Academic Press. Exposure and Cognitive Interventions for Anxiety 2 Author Biosketches John P. Forsyth, Ph.D. John P. Forsyth, Ph.D. earned his Ph.D. degree in clinical psychology from West Virginia University in 1997, after serving as Chief Resident in the Department of Psychiatry and Human Behavior at the University of Mississippi Medical Center. He is an Associate Professor and Director of the Anxiety Disorders Research Program in the Department of Psychology at the University at Albany, SUNY. His basic and applied research focuses on variables and processes that contribute to the etiology, maintenance, and treatment of anxiety-related disorders. He has written widely on acceptance and experiential avoidance, and the role of emotion regulatory processes in the etiology and treatment of anxiety disorders. Dr. Forsyth was the recipient of the 2000 B. F. Skinner New Research Award by Division 25 of the American Psychological Association and the 1999 Outstanding Dissertation Award by the Society for a Science of Clinical Psychology. He has authored over 50 scientific journal articles, numerous book chapters, and several teaching supplements for courses in abnormal psychology. -
“What About Bob?” an Analysis of Gendered Mental Illness in a Mainstream Film Comedy
“What About Bob?” An Analysis of Gendered Mental Illness in a Mainstream Film Comedy A Thesis Presented in partial fulfillment of the requirements for the degree of Master of Arts in the College of Graduate Studies of Northeast Ohio Medical University. Anna Plummer M.D. Medical Ethics and Humanities 2020 Thesis Committee: Dr. Julie Aultman (Advisor) Dr. Rachel Bracken Brian Harrell Copyright Anna Plummer 2020 ABSTRACT Mental illness has been a subject of fictional film since the early 20th century and continues to be a popular trope in mainstream movies. Portrayals of affected individuals in movies tend to be inaccurate and largely stigmatizing, negatively influencing public perception of mental illness. Recent research suggests that gender stereotypes and mental illness intersect, such that some mental illnesses are perceived as “masculine” and others as “feminine.” This notion may further stigmatize such disorders in individuals, as well as falsely inflate observed gender disparities in certain mental illnesses. Since gendered mental illness is a newly identified concept, little research has been performed exploring the way stereotypical gendered mental illness is depicted in mainstream film. This paper analyzes the movie What About Bob? to show that comedic film perpetuates stigma surrounding feminine mental illness in men and identifies the need for further study of gendered mental illness in movies to ascertain the effect such depictions have on the observed gender disparities in prevalence of certain mental disorders, as well as offers a proposal for coursework for film and medical students. i ACKNOWLEDGMENTS This paper would not have been possible without Dr. Aultman, whose teaching inspired me to pursue further education in Medical Ethics and Humanities, and whose guidance has been invaluable not only for this project, but also for addressing ethical issues in the clinic. -
No Limits Freediving
1 No Limits Freediving "The challenges to the respiratory function of the breath-hold diver' are formidable. One has to marvel at the ability of the human body to cope with stresses that far exceed what normal terrestrial life requires." Claes Lundgren, Director, Center for Research and Education in Special Environments A woman in a deeply relaxed state floats in the water next to a diving buoy. She is clad in a figure-hugging wetsuit, a dive computer strapped to her right wrist, and another to her calf. She wears strange form-hugging silicone goggles that distort her eyes, giving her a strange bug-eyed appearance. A couple of meters away, five support divers tread water near a diving platform, watching her perform an elaborate breathing ritual while she hangs onto a metal tube fitted with two crossbars. A few meters below the buoy, we see that the metal tube is in fact a weighted sled attached to a cable descending into the dark-blue water. Her eyes are still closed as she begins performing a series of final inhalations, breathing faster and faster. Photographers on the media boats snap pictures as she performs her final few deep and long hyperventilations, eliminating carbon dioxide from her body. Then, a thumbs-up to her surface crew, a pinch of the nose clip, one final lungful of air, and the woman closes her eyes, wraps her knees around the bottom bar of the sled, releases a brake device, and disappears gracefully beneath the waves. The harsh sounds of the wind and waves suddenly cease and are replaced by the effervescent bubbling of air being released from the regulators of scuba-divers. -
Psychotic Symptoms in Adolescents with Borderline Personality Disorder Features
European Child & Adolescent Psychiatry https://doi.org/10.1007/s00787-018-1257-2 ORIGINAL CONTRIBUTION Psychotic symptoms in adolescents with borderline personality disorder features Katherine N. Thompson1,2 · Marialuisa Cavelti1,2,4 · Andrew M. Chanen1,2,3 Received: 23 April 2018 / Accepted: 14 November 2018 © Springer-Verlag GmbH Germany, part of Springer Nature 2018 Abstract Psychotic symptoms have been found to be relatively common among adults with borderline personality disorder (BPD), and to be a marker of BPD severity, but are not recognised in daily clinical practice in these patients. This study is the frst to examine the prevalence of psychotic symptoms in 15–18-year olds with BPD features. It was hypothesised that adoles- cents with full-threshold BPD would have signifcantly more psychotic symptoms than adolescents with sub-threshold BPD features, and that both these groups would have signifcantly more psychotic symptoms than adolescents with no BPD features. A total of 171 psychiatric outpatients, aged 15–18 years, were assessed using a structured interview for DSM-IV personality disorder and categorised into three groups: no BPD features (n = 48), sub-threshold BPD features (n = 80), and full-threshold BPD (n = 43). The groups were compared on measures of psychopathology and functioning (e.g. Youth Self Report, Symptom Check List-90-R, SOFAS). Adolescents with full-threshold BPD reported more psychotic symptoms than the sub-threshold BPD group (p < .001), and both these groups reported more psychotic symptoms than those with no BPD features (p < .001). Adolescents with full-threshold BPD reported more confusion (p < .01), paranoia (p < .001), visual hallucinations (p < .001) and strange thoughts (p < .01), than the other two groups. -
Understanding the Connection Between Posttraumatic Stress Symptoms and Respiratory Problems: Contributions of Anxiety Sensitivity
Journal of Traumatic Stress February 2017, 30, 71–79 Understanding the Connection Between Posttraumatic Stress Symptoms and Respiratory Problems: Contributions of Anxiety Sensitivity Brittain L. Mahaffey,1 Adam Gonzalez,1 Samantha G. Farris,2,3 Michael J. Zvolensky,2,4 Evelyn J. Bromet,1 Benjamin J. Luft,5 and Roman Kotov1 1Department of Psychiatry, Stony Brook University, Stony Brook, New York, USA 2Department of Psychology, University of Houston, Houston, Texas, USA 3Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, USA 4Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, Texas, USA 5Department of Medicine, Stony Brook University, Stony Brook, New York, USA Respiratory problems and posttraumatic stress disorder (PTSD) are the signature health consequences associated with the September 11, 2001 (9/11), World Trade Center disaster and frequently co-occur. The reasons for this comorbidity, however, remain unknown. Anxiety sensitivity is a transdiagnostic trait that is associated with both PTSD and respiratory symptoms. The present study explored whether anxiety sensitivity could explain the experience of respiratory symptoms in trauma-exposed smokers with PTSD symptoms. Participants (N = 135; Mage = 49.18 years, SD = 10.01) were 9/11-exposed daily smokers. Cross-sectional self-report measures were used to assess PTSD symp- toms, anxiety sensitivity, and respiratory symptoms. After controlling for covariates and PTSD symptoms, anxiety sensitivity accounted for significant additional variance in respiratory symptoms (R2 = .04 to .08). This effect was specific to the somatic concerns dimension (β = .29, p = .020); somatic concerns contributed significantly to accounting for the overlap between PTSD and respiratory symptoms, b = 0.03, 95% CI [0.01, 0.07]. -
Balance and Aging by Charlotte Shupert, Phd, with Contributions by Fay Horak, Phd, PT Oregon Health & Science University, Portland, Oregon
TH 5018 NE 15 AVE · PORTLAND, OR 97211 · FAX: (503) 229-8064 · (800) 837-8428 · [email protected] · VESTIBULAR.ORG Balance and Aging By Charlotte Shupert, PhD, with contributions by Fay Horak, PhD, PT Oregon Health & Science University, Portland, Oregon One of the leading health concerns for in the feet and legs; and degeneration of people over the age of 60 is falling, which the vestibular system. is often related to balance problems. The percent of people falling increases from Balance is also dependent on muscle 40% to 65% to 82% with each decade strength, joint mobility, and healthy feet. after age 65 years. A sedentary lifestyle, painful arthritis or diseases of bones and muscles can The consequences of falls can be compromise strength, mobility, and the disastrous; between 12% and 67% of base of foot support. elderly adults who fracture a hip die Balance control also depends on healthy within one year. Even if a bone is not brain function across many brain areas. fractured during a fall, falls cause pain The brain needs to process and interpret and injury while reducing future mobility sensory information, select appropriate and quality of life. As a result, major balance strategies, and adapt and learn scientific efforts are devoted to deter- new strategies with practice. As we age, mining the causes of falling in older adults brain processing can slow down, which in an attempt to reduce this significant results in slower balance responses. health hazard. People with cognitive problems also have balance problems, showing the Causes of imbalance in older people importance of higher level brain Balance in walking and standing is processing in balance control. -
Panic Disorder
Panic Disorder The Anxiety Disorders Association of America (ADAA) is a national 501 (c)3 nonprofit organization whose My heart’s pounding, mission is to promote the prevention, treatment and cure of anxiety disorders and to improve the lives of all it’s hard to breathe. people who suffer from them. Help ADAA help others. Donate now at www.adaa.org. “I feel like I’m going to go crazy or die. For information visit www.adaa.org or contact I have to get out Anxiety Disorders Association of America 8730 Georgia Ave., Ste. 600 of here NOW. Silver Spring, MD 20910 Phone: 240-485-1001 ” Anxiety Disorders Association of America What is Panic Disorder? About Anxiety Disorders We’ve all experienced that gut-wrenching fear when suddenly faced with a threatening or dangerous situation. Crossing the street as a car shoots out of nowhere, losing a child in Anxiety is a normal part of living. It’s the body’s way of telling the playground or hearing someone scream fire in a crowded us something isn’t right. It keeps us from harm’s way and theater. The momentary panic sends chills down our spines, prepares us to act quickly in the face of danger. However, for causes our hearts to beat wildly, our stomachs to knot and some people, anxiety is persistent, irrational and overwhelming. our minds to fill with terror. When the danger passes, so do It may get in the way of day-to-day activities and even make the symptoms. We’re relieved that the dreaded terror didn’t them impossible. -
Panic Disorder Issue Brief
Panic Disorder OCTOBER | 2018 Introduction Briefings such as this one are prepared in response to petitions to add new conditions to the list of qualifying conditions for the Minnesota medical cannabis program. The intention of these briefings is to present to the Commissioner of Health, to members of the Medical Cannabis Review Panel, and to interested members of the public scientific studies of cannabis products as therapy for the petitioned condition. Brief information on the condition and its current treatment is provided to help give context to the studies. The primary focus is on clinical trials and observational studies, but for many conditions there are few of these. A selection of articles on pre-clinical studies (typically laboratory and animal model studies) will be included, especially if there are few clinical trials or observational studies. Though interpretation of surveys is usually difficult because it is unclear whether responders represent the population of interest and because of unknown validity of responses, when published in peer-reviewed journals surveys will be included for completeness. When found, published recommendations or opinions of national organizations medical organizations will be included. Searches for published clinical trials and observational studies are performed using the National Library of Medicine’s MEDLINE database using key words appropriate for the petitioned condition. Articles that appeared to be results of clinical trials, observational studies, or review articles of such studies, were accessed for examination. References in the articles were studied to identify additional articles that were not found on the initial search. This continued in an iterative fashion until no additional relevant articles were found. -
Vulnerable Narcissism Is (Mostly) a Disorder of Neuroticism
Journal of Personality 86:2, April 2018 VC 2017 Wiley Periodicals, Inc. Vulnerable Narcissism Is (Mostly) a DOI: 10.1111/jopy.12303 Disorder of Neuroticism Joshua D. Miller,1 Donald R. Lynam,2 Colin Vize,2 Michael Crowe,1 Chelsea Sleep,1 Jessica L. Maples-Keller,1 Lauren R. Few,1 and W. Keith Campbell1 1University of Georgia 2Purdue University Abstract Objective: Increasing attention has been paid to the distinction between the dimensions of narcissistic grandiosity and vulnerability. We examine the degree to which basic traits underlie vulnerable narcissism, with a particular emphasis on the importance of Neuroticism and Agreeableness. Method: Across four samples (undergraduate, online community, clinical-community), we conduct dominance analyses to partition the variance predicted in vulnerable narcissism by the Five-Factor Model personality domains, as well as compare the empirical profiles generated by vulnerable narcissism and Neuroticism. Results: These analyses demonstrate that the lion’s share of variance is explained by Neuroticism (65%) and Agreeableness (19%). Similarity analyses were also conducted in which the extent to which vulnerable narcissism and Neuroticism share similar empirical networks was tested using an array of criteria, including self-, informant, and thin slice ratings of personality; interview-based ratings of personality disorder and pathological traits; and self-ratings of adverse events and functional out- comes. The empirical correlates of vulnerable narcissism and Neuroticism were nearly identical (MrICC 5 .94). Partial analyses demonstrated that the variance in vulnerable narcissism not shared with Neuroticism is largely specific to disagreeableness- related traits such as distrustfulness and grandiosity. Conclusions: These findings demonstrate the parsimony of using basic personality to study personality pathology and have implications for how vulnerable narcissism might be approached clinically.