PRACTICE GUIDELINE for the Treatment of Patients with Panic Disorder
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Conflict, Arousal, and Logical Gut Feelings
CONFLICT, AROUSAL, AND LOGICAL GUT FEELINGS Wim De Neys1, 2, 3 1 ‐ CNRS, Unité 3521 LaPsyDÉ, France 2 ‐ Université Paris Descartes, Sorbonne Paris Cité, Unité 3521 LaPsyDÉ, France 3 ‐ Université de Caen Basse‐Normandie, Unité 3521 LaPsyDÉ, France Mailing address: Wim De Neys LaPsyDÉ (Unité CNRS 3521, Université Paris Descartes) Sorbonne - Labo A. Binet 46, rue Saint Jacques 75005 Paris France [email protected] ABSTRACT Although human reasoning is often biased by intuitive heuristics, recent studies on conflict detection during thinking suggest that adult reasoners detect the biased nature of their judgments. Despite their illogical response, adults seem to demonstrate a remarkable sensitivity to possible conflict between their heuristic judgment and logical or probabilistic norms. In this chapter I review the core findings and try to clarify why it makes sense to conceive this logical sensitivity as an intuitive gut feeling. CONFLICT, AROUSAL, AND LOGICAL GUT FEELINGS Imagine you’re on a game show. The host shows you two metal boxes that are both filled with $100 and $1 dollar bills. You get to draw one note out of one of the boxes. Whatever note you draw is yours to keep. The host tells you that box A contains a total of 10 bills, one of which is a $100 note. He also informs you that Box B contains 1000 bills and 99 of these are $100 notes. So box A has got one $100 bill in it while there are 99 of them hiding in box B. Which one of the boxes should you draw from to maximize your chances of winning $100? When presented with this problem a lot of people seem to have a strong intuitive preference for Box B. -
Applying ACT to Cases of Complex Depression: New Clinical And
ApplyingApplying ACTACT toto CasesCases ofof ComplexComplex Depression:Depression: NewNew ClinicalClinical andand ResearchResearch PerspectivesPerspectives PartPart I:I: DepressionDepression withwith PsychosisPsychosis andand SuicidalitySuicidality Brandon Gaudiano, Ph.D. Assistant Professor of Psychiatry Grant Support: NIH K23 MH076937 OutlineOutline ¾¾ ClinicalClinical FeaturesFeatures ofof PsychoticPsychotic DepressionDepression ¾¾ ACTACT forfor PsychosisPsychosis ResearchResearch ¾¾ TreatmentTreatment DevelopmentDevelopment ProjectProject ¾¾ ClinicalClinical ConsiderationsConsiderations ¾¾ CaseCase ExampleExample DepressionDepression withwith hallucinationshallucinations and/orand/or delusionsdelusions PsychoticPsychotic DepressionDepression ¾ PrevalencePrevalence ratesrates z 15-19% of individuals with depression have hallucinations or delusions (Ohayon and Schatzberg, 2002) z Up to 25% of depressed hospitalized patients (Coryell et al., 1984) ¾ PsychoticPsychotic depressiondepression cancan bebe difficultdifficult toto diagnosediagnose andand treat:treat: z psychotic features in mood disorders can be more subtle than those found in patients with primary psychotic disorders ¾ PsychoticPsychotic depressiondepression cancan bebe difficultdifficult toto diagnosediagnose andand treat:treat: z psychotic features in mood disorders can be more subtle than those found in patients with primary psychotic disorders z patients often underreport psychotic symptoms due to embarrassment or paranoia ¾ PsychoticPsychotic depressiondepression cancan -
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. -
About Emotions There Are 8 Primary Emotions. You Are Born with These
About Emotions There are 8 primary emotions. You are born with these emotions wired into your brain. That wiring causes your body to react in certain ways and for you to have certain urges when the emotion arises. Here is a list of primary emotions: Eight Primary Emotions Anger: fury, outrage, wrath, irritability, hostility, resentment and violence. Sadness: grief, sorrow, gloom, melancholy, despair, loneliness, and depression. Fear: anxiety, apprehension, nervousness, dread, fright, and panic. Joy: enjoyment, happiness, relief, bliss, delight, pride, thrill, and ecstasy. Interest: acceptance, friendliness, trust, kindness, affection, love, and devotion. Surprise: shock, astonishment, amazement, astound, and wonder. Disgust: contempt, disdain, scorn, aversion, distaste, and revulsion. Shame: guilt, embarrassment, chagrin, remorse, regret, and contrition. All other emotions are made up by combining these basic 8 emotions. Sometimes we have secondary emotions, an emotional reaction to an emotion. We learn these. Some examples of these are: o Feeling shame when you get angry. o Feeling angry when you have a shame response (e.g., hurt feelings). o Feeling fear when you get angry (maybe you’ve been punished for anger). There are many more. These are NOT wired into our bodies and brains, but are learned from our families, our culture, and others. When you have a secondary emotion, the key is to figure out what the primary emotion, the feeling at the root of your reaction is, so that you can take an action that is most helpful. . -
Diagnostic and Management Guidelines for Mental Disorders in Primary Care
Diagnostic and Management Guidelines for Mental Disorders in Primary Care ICD-10 Chapter V ~rimary Care Version Published on behalf of the World Health Organization by Hogrefe & Huber Publishers World Health Organization Hogrefe & Huber Publishers Seattle . Toronto· Bern· Gottingen Library of Congress Cataloging-in-Publication Data is available via the Library of Congress Marc Database under the LC Catalog Card Number 96-77394 Canadian Cataloguing in Publication Data Main entry under title: Diagnostic and management guidelines for mental disorders in primary care: ICD-lO chapter V, primary care version ISBN 0-88937-148-2 1. Mental illness - Classification. 2. Mental illness - Diagnosis. 3. Mental illness - Treatment. I. World Health Organization. 11. Title: ICD-ten chapter V, primary care version. RC454.128 1996 616.89 C96-931353-5 The correct citation for this book should be as follows: Diagnostic and Management Guidelines for Mental Disorders in Primary Care: ICD-lO Chapter V Primary Care Version. WHO/Hogrefe & Huber Publishers, Gottingen, Germany, 1996. © Copyright 1996 by World Health Organization All rights reserved. Hogrefe & Huber Publishers USA: P.O. Box 2487, Kirkland, WA 98083-2487 Phone (206) 820-1500, Fax (206) 823-8324 CANADA: 12 Bruce Park Avenue, Toronto, Ontario M4P 2S3 Phone (416) 482-6339 SWITZERLAND: Langgass-Strasse 76, CH-3000 Bern 9 Phone (031) 300-4500, Fax (031) 300-4590 GERMANY: Rohnsweg 25,0-37085 Gottingen Phone (0551) 49609-0, Fax (0551) 49609-88 No part of this book may be translated, reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, microfilming, recording or otherwise, without the written permission from the copyright holder. -
Drug Class Review on Second Generation Antidepressants
Drug Class Review on Second Generation Antidepressants FINAL REPORT November 2004 The Agency for Healthcare Research and Quality has not yet seen or approved this report Gerald Gartlehner, M.D., M.P.H. Richard A. Hansen, Ph.D. Leila Kahwati, M.D., M.P.H. Kathleen N. Lohr, Ph.D. Bradley Gaynes, M.D., M.P.H Tim Carey, M.D., M.P.H. Produced by RTI-UNC Evidence-based Practice Center Cecil G. Sheps Center for Health Services Research University of North Carolina at Chapel Hill 725 Airport Road, CB# 7590 Chapel Hill, NC 27599-7590 Tim Carey, M.D., M.P.H., Director Final Report Drug Effectiveness Review Project Table of Contents Introduction........................................................................................................................ 4 Overview................................................................................................................. 4 Scope and Key Questions ....................................................................................... 7 Methods............................................................................................................................. 10 Literature Search................................................................................................... 10 Study Selection ..................................................................................................... 10 Data Abstraction ................................................................................................... 12 Quality Assessment.............................................................................................. -
Alprazolam-Induced Dose-Dependent Anorgasmia: Case Analysis Kenneth R
BJPsych Open (2018) 4, 274–277. doi: 10.1192/bjo.2018.35 Alprazolam-induced dose-dependent anorgasmia: case analysis Kenneth R. Kaufman, Melissa Coluccio, Michelle Linke, Elizabeth Noonan, Ronke Babalola and Rehan Aziz Background increasing alprazolam to 2.5 mg total daily dose, the patient Sexual dysfunctions are associated with multiple medical and reported anorgasmia. Anorgasmia was alprazolam dose- psychiatric disorders, as well as pharmacotherapies used to dependent, as anorgasmia resolved with reduced weekend treat these disorders. Although sexual dysfunctions negatively dosing (1 mg b.i.d. Saturday/1.5 mg total daily dose Sunday). affect both quality of life and treatment adherence, patients infrequently volunteer these symptoms and clinicians do not Conclusions pose directed questions to determine their presence or severity. Sexual dysfunction is an important adverse effect negatively This issue is especially important in psychiatric patients, for influencing therapeutic outcome. This case reports alprazolam- whom most common psychotropics may cause sexual dys- induced dose-dependent anorgasmia. Clinicians/patients should functions (antidepressants, antipsychotics, anxiolytics and be aware of this adverse effect. Routine sexual histories are mood-stabilising agents). There is limited literature addressing indicated. benzodiazepines, and alprazolam in particular. Declaration of interest Aims None. To report dose-dependent alprazolam anorgasmia. Method Keywords Case analysis with PubMed literature review. Alprazolam; benzodiazepine; sexual dysfunction; anorgasmia; adverse effect; nonadherence; anxiety disorder, major depres- Results sive disorder; obsessive–compulsive disorder, attention-deficit A 30-year-old male psychiatric patient presented with new-onset hyperactivity disorder; clinical care; education. anorgasmia in the context of asymptomatic generalised anxiety disorder, social anxiety, panic disorder with agoraphobia, Copyright and usage obsessive–compulsive disorder, major depression in remission, © The Royal College of Psychiatrists 2018. -
In This Issue
July 2020 NEWS Post-Traumatic Stress Disorder (PTSD) Assessment and Treatment In this Issue: Guidelines for Pediatric Primary Upcoming Clinical Care Conversations 5 Clinical Conversation: May 26, 2020 Presented by Sylvia Krinsky, MD, Tufts Medical Center For some children, childhood is far from a carefree time; they Leadership: experience trauma which can disrupt development and lead John Straus, MD to post-traumatic stress disorder (PTSD). At the May Clinical Founding Director Conversation, Sylvia Krinsky, MD, MCPAP site director at Tufts Barry Sarvet, MD Medical Center, discussed how to address PTSD in the primary Medical Director care setting. Beth McGinn Types of trauma Program Manager There are three major types of trauma: Elaine Gottlieb • Discrete Trauma – examples include a car accident, injury, Contributing Writer medical procedure, or a single episode of physical or sexual assault, when life is filled with otherwise helpful and supportive people • Complex Trauma – series of repeated traumas usually in close interpersonal contexts, such as childhood abuse or neglect, witnessing domestic or community violence, or racism and chronic social adversities • Adverse Childhood Event – a term from the Adverse Childhood Experiences (ACE) study, referring to potentially traumatic events that can have an impact on physical and psychological health Discrete trauma is most recognized in the DSM-5, while ACE is more familiar to the medical community, says Dr. Krinsky. 1000 Washington St., Suite 310 One study reported in the Journal of the American Medical Boston, MA 02118 Association (JAMA) found that more than 90 percent of pediatric Email: [email protected] patients seen in a primary care pediatric clinic had experienced a traumatic exposure, and 25 percent met full or partial criteria for www.mcpap.org PTSD. -
Emerging Drug List CANADIAN COORDINATING OFFICE for HEALTH ESCITALOPRAM TECHNOLOGY ASSESSMENT
Emerging Drug List CANADIAN COORDINATING OFFICE FOR HEALTH ESCITALOPRAM TECHNOLOGY ASSESSMENT NO. 35 JANUARY 2003 Generic (Trade Name): Escitalopram (LexaproTM) Manufacturer: Forest Laboratories, Inc. Indication: For the treatment of major depressive disorders in adults.1 Current Regulatory Escitalopram was approved by the US FDA for the above indication in August 2002.2 It Status: was just recently launched in the US, according to the company's web site.3 It was launched in June 2002 in the UK under the trade name Cipralex by Lundbeck for both the treatment of depression and panic disorder.4 In Canada, escitalopram has been sub- mitted for review; no planned marketing date is available (Drug Information, Lundbeck Canada, Montreal: personal communication, 2002 Sep 30). Description: Escitalopram is the S(+) enantiomer of the chiral compound citalopram. It is a selective serotonin reuptake inhibitor that exerts activity in both depressive and anxiety disorders. After oral administration of a single dose, maximal concentrations are reached within three to four hours. It is extensively metabolized via the liver, with eight percent excreted unchanged by the kidneys. After a 20 mg dose, the elimination half-life (of the parent compound) ranges from 22 to 27 hours.5 Current Treatment: Options for the treatment of depressive disorders are vast and include selective serotonin norepinephrine reuptake inhibitors (SNRI), norepinephrine dopamine reuptake inhibitors (NDRI), serotonin-2 antagonists/reuptake inhibitors (SARI), noradrenergic/specific -
Understanding Children's Mental Health Disorders and the Impact On
Understanding Children’s Mental Health Disorders and the Impact on Learning and Functioning 1 2 Introduction to Children’s Mental Health An Overview of Depression 3 Depression is Common Estimates of Incidence 1 % Preschoolers 2 % School age 5 % Adolescents 20 % Lifetime prevalence during adolescence (parallels adult life time prevalence) Birmaher et al., 2002 4 Risk and Reoccurrence Childhood Adolescent Later Onset Depression Adolescent Depression Depression Adult Depression 5 Depression is… a mood disorder a sleep and energy disorder a thinking disorder 6 Depression: Signs and Symptoms Mood Changes Behaviors MEANING Interpersonal Relationships Physical Changes Cognitive Changes School Performance 7 Mood Symptoms Sad Sadness Irritable “mood swings” Anhedonia loss of interest social withdrawal or Anhedonia Irritability isolation boredom 8 Physical Symptoms Sleep Difficulty either with too much or too little sleep Fatigue Appetite Change loss of appetite increased carbohydrate craving 9 Cognitive Symptoms Difficulty concentrating Increased distractibility and “spaciness” Decreased attention and focus 10 Cognitive Symptoms Worried, ruminating thoughts Worthlessness, low self-esteem, guilt Distortions, misperceptions, misinterpretations 11 Symptoms in Infants and Toddlers Mood – Excessive whining – Too little or too much crying – Withdrawn from cuddling, being held – Lack of interest in surroundings 12 Symptoms in Infants and Toddlers Physical – Sleep disturbance – Sad or flat facial expression – Little motor activity – Failure to grow and -
NEW RESEARCH BOOK I a I 2011 H AW Photo By: Hawaii Tourism Authority Tourism By:Photo Hawaii
NEW RESEARCH BOOK I I A AW 2011 H Photo By: Hawaii Tourism Authority Tourism By:Photo Hawaii American Psychiatric Association Transforming Mental Health Through Leadership, Discovery and Collaboration WWW.PSYCH.ORG NEW RESEARCH BOOK NEW RESEARCH RESIDENT POSTER SESSION 01 Chp.: Michel Burger M.D., Centre Hospitalier Erstein, May 14, 2011 13 route de Krafft BP 30063, Erstein, 67152 France, 10 – 11:30 AM Co-Author(s): Christelle Nithart, Ph.D., Luisa Weiner, Hawaii Convention Center, Exhibit Hall, Level 1 M.Sc., Jean-Philippe Lang, M.D. NR01‑01 PROMOTING HEALTH THROUGH THE SUMMARY: BEAUTIFUL GAME: ENGAGING WITH Introduction We present the psychiatric AND ADVOCATING FOR RESIDENTS OF rehabilitation program we are developing in VANCOUVER’S DOWNTOWN EASTSIDE Erstein, France, since September 2008. This THROUGH STREET SOCCER program is based on a residential facility located in the community, which is conceived as an Chp.:Alan Bates M.D., Psychiatry Dept., 11th Floor, interface between inpatient care and psychosocial Gordon & Leslie Diamond Health Care Centre, 2775 rehabilitation. Objective To evaluate the viability Laurel St., Vancouver, V5L 2V8 Canada, Co-Author(s): of the Courlis residential facility in facilitating Fidel Vila-Rodriguez, M.D., Siavash Jafari, M.D., patients’ psychiatric rehabilitation. Method Lurdes Tse, B.Sc., Rachel Ilg, R.N., William Honer, M.D. A comprehensive psychosocial and medical evaluation is undertaken at admission. Criteria for SUMMARY: admission are the following: functional disability Vancouver’s Downtown Eastside is one of the due to chronic psychiatric illness in symptomatic poorest neighbourhoods in North America. remission, and very low socioeconomic status. A Mental illness and addictions are prevalent and socio‑educative and a psychiatric team act together contribute significantly to marginalization and to improve independent social functioning, social disadvantage.Street Soccer for people affected symptomatic remission, and quality of life, according by homelessness re‑engages marginalized people to individual profiles and aims.