Panic Disorder
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What We Mean When We Talk About Suffering—And Why Eric Cassell Should Not Have the Last Word
What We Mean When We Talk About Suffering—and Why Eric Cassell Should Not Have the Last Word Tyler Tate, Robert Pearlman Perspectives in Biology and Medicine, Volume 62, Number 1, Winter 2019, pp. 95-110 (Article) Published by Johns Hopkins University Press For additional information about this article https://muse.jhu.edu/article/722412 Access provided at 26 Apr 2019 00:52 GMT from University of Washington @ Seattle What We Mean When We Talk About Suffering—and Why Eric Cassell Should Not Have the Last Word Tyler Tate* and Robert Pearlman† ABSTRACT This paper analyzes the phenomenon of suffering and its relation- ship to medical practice by focusing on the paradigmatic work of Eric Cassell. First, it explains Cassell’s influential model of suffering. Second, it surveys various critiques of Cassell. Next it outlines the authors’ concerns with Cassell’s model: it is aggressive, obscure, and fails to capture important features of the suffering experience. Finally, the authors propose a conceptual framework to help clarify the distinctive nature of sub- jective patient suffering. This framework contains two necessary conditions: (1) a loss of a person’s sense of self, and (2) a negative affective experience. The authors suggest how this framework can be used in the medical encounter to promote clinician-patient communication and the relief of suffering. *Center for Ethics in Health Care and School of Medicine, Oregon Health and Science University, Portland. †National Center for Ethics in Health Care, Washington, DC, and School of Medicine, University of Washington, Seattle. Correspondence: Tyler Tate, Oregon Health and Science University, School of Medicine, Depart- ment of Pediatrics, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098. -
Fast Facts About Social Phobia
PLEASE TEAR OUT AND PHOTOCOPY FOR YOUR PATIENTS!! PATIENTS AS PARTNERS Brought to you by The South African Depression and Anxiety Group Tel: +27 11 783 1474 Fax: +27 11 884 7074 E-mail: [email protected] website: www.anxiety.org.za Fast facts about social phobia • Social Phobia affects an estimated one in ten people. It affects people of all races and social classes. • It is estimated that fewer than 25% of people with Social Phobia receive adequate treatment. • The onset of Social Phobia is typically during adolescence, but it may occur in childhood, prior to the age of ten. Approximately 40% of social phobias appear before the age of ten, and 95% before the age of twenty. • Social Phobia is characterised by an underlying fear of scrutiny by people in social situations. It is also associated with fear of performance situations in which embarrassment may occur. • Social Phobia is not shyness. A person with social phobia who finds it unbearable to sign a cheque in public, might be quite extroverted in other contexts. • People with social phobia will avoid social or occupational situations where their particular anxiety might be provoked for eg urinating in a public restroom, or giving a speech. • Common fears include: being introduced to others, meeting people in authority, using the telephone, eating in restaurants or writing in front of others. • When faced with a feared situation, people may have symptoms of panic, e.g. heart palpitations, trembling, sweating, hot and cold flushes and blushing. • 45% of people with social phobia will develop agoraphobia, where their fear of having a panic attack in a social setting will lead them to avoiding social settings altogether. -
Benzodiazepines: Uses and Risks Charlie Reznikoff, MD Hennepin Healthcare
Benzodiazepines: Uses and Risks Charlie Reznikoff, MD Hennepin healthcare 4/22/2020 Overview benzodiazepines • Examples of benzos and benzo like drugs • Indications for benzos • Pharmacology of benzos • Side effects and contraindications • Benzo withdrawal • Benzo tapers 12/06/2018 Sedative/Hypnotics • Benzodiazepines • Alcohol • Z-drugs (Benzo-like sleeping aids) • Barbiturates • GHB • Propofol • Some inhalants • Gabapentin? Pregabalin? 12/06/2018 Examples of benzodiazepines • Midazolam (Versed) • Triazolam (Halcion) • Alprazolam (Xanax) • Lorazepam (Ativan) • Temazepam (Restoril) • Oxazepam (Serax) • Clonazepam (Klonopin) • Diazepam (Valium) • Chlordiazepoxide (Librium) 4/22/2020 Sedatives: gaba stimulating drugs have incomplete “cross tolerance” 12/06/2018 Effects from sedative (Benzo) use • Euphoria/bliss • Suppresses seizures • Amnesia • Muscle relaxation • Clumsiness, visio-spatial impairment • Sleep inducing • Respiratory suppression • Anxiolysis/disinhibition 12/06/2018 Tolerance to benzo effects? • Effects quickly diminish with repeated use (weeks) • Euphoria/bliss • Suppresses seizures • Effects incompletely diminish with repeated use • Amnesia • Muscle relaxation • Clumsiness, visio-spatial impairment • Seep inducing • Durable effects with repeated use • Respiratory suppression • Anxiolysis/disinhibition 12/06/2018 If you understand this pharmacology you can figure out the rest... • Potency • 1 mg diazepam <<< 1 mg alprazolam • Duration of action • Half life differences • Onset of action • Euphoria, clinical utility in acute -
Managing Anxiety Through Childhood Social-Emotional
MANAGING ANXIETY THROUGH CHILDHOOD SOCIAL-EMOTIONAL DEVELOPMENT by Adriane Hannah Dohl B.A., The University of British Columbia, 2008 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS in THE FACULTY OF GRADUATE AND POSTDOCTORAL STUDIES (School Psychology) THE UNIVERSITY OF BRITISH COLUMBIA (Vancouver) October 2013 © Adriane Hannah Dohl, 2013 Abstract School professionals are implementing a universal social-emotional learning program for children in Kindergarten and Grade 1 (aged 4-6 years) in many schools across the province with training and funding provided by the government. The Fun FRIENDS (Barrett, 2007) program focuses on increasing social-emotional learning and promotes coping techniques and resiliency in order to prevent the onset of behavioural and emotional disorders (Pahl & Barrett, 2007). Preliminary results (Pahl & Barrett, 2007, 2010) have highlighted the effectiveness of the Fun FRIENDS program in reducing anxiety in children. The present study utilized a quasi-experimental design to evaluate the effectiveness of the Fun FRIENDS program in reducing anxiety and promoting social-emotional competence among a sample of Kindergarten and Grade 1 students (N = 33) in a British Columbia school district. Results revealed a significant decrease in program participants’ anxiety symptoms as rated by teachers when compared with those in the control group. Teachers also reported that children who participated in the program had significant increases in social-emotional skills, while those in the control group’s skills remained the same. However, overall, children in the control group had significantly higher social-emotional skills, as rated by teachers. No significant results were found for parent rated levels of anxiety or social-emotional skills of children enrolled in either condition. -
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. . -
QUESTION 20 Despair We Next Have to Consider the Vices Opposed to Hope
QUESTION 20 Despair We next have to consider the vices opposed to hope: first, despair (desperatio) (question 20) and, second, presumption (praesumptio) (question 21). On the first topic there are four questions: (1) Is despair a sin? (2) Can despair exist without unbelief? (3) Is despair the greatest of sins? (4) Does despair arise from listlessness (acedia)? Article 1 Is despair a sin? It seems that despair is not a sin (desperatio not sit peccatum): Objection 1: As is clear from Augustine in De Libero Arbitrio, every sin involves turning toward some changeable good, combined with turning away from the unchangeable good. But despair does not involve turning toward any changeable good. Therefore, it is not a sin. Objection 2: What arises from a good root does not seem to be a sin, since, as Matthew 7:18 says, “A good tree cannot bring produce bad fruits.” But despair seems to proceed from a good root, viz., fear of God, or horror at the magnitude of one’s sins. Therefore, despair is not a sin. Objection 3: If despair were a sin, then, in the case of the damned, their despairing would be a sin. But this is not imputed to them as a sin (non imputatur eis ad culpam); instead, it is imputed to their being damned. Therefore, it is not imputed as a sin to those who are in this life, either (neque viatoribus imputatur ad culpam). And so despair is not a sin. But contrary to this: That through which men are induced to sin seems to be not only a sin, but a principle of sins. -
University Basic Needs Insecurity: a National #Realcollege Survey Report
APRIL 2019 College and University Basic Needs Insecurity: A National #RealCollege Survey Report AUTHORS: Sara Goldrick-Rab, Christine Baker-Smith, Vanessa Coca, Elizabeth Looker and Tiffani Williams Executive Summary NEARLY 86,000 STUDENTS PARTICIPATED. THE RESULTS The #RealCollege survey is the nation’s largest annual INDICATE: assessment of basic needs security among college students. The survey, created by the Hope Center • 45% of respondents were food for College, Community, and Justice (Hope Center), insecure in the prior 30 days specifically evaluates access to affordable food and housing. This report describes the results of the • 56% of respondents were #RealCollege survey administered in the fall of 2018 at housing insecure in the previous year 123 two- and four-year institutions across the United States. • 17% of respondents were homeless in the previous year Rates of basic needs insecurity are higher for students attending two-year colleges compared to those attending four-year colleges. Rates of basic needs insecurity are higher for marginalized students, including African Americans, students identifying as LGBTQ, and students who are independent from The Hope Center thanks the their parents or guardians for financial aid purposes. Lumina Foundation, the Jewish Students who have served in the military, former foster Foundation for Education of youth, and students who were formerly convicted of a crime are all at greater risk of basic needs insecurity. Women, the City University Working during college is not associated with a lower of New York, the Chicago risk of basic needs insecurity, and neither is receiving City Colleges, the Institute for the federal Pell Grant; the latter is in fact associated with higher rates of basic needs insecurity. -
Depression and Anxiety: a Review
DEPRESSION AND ANXIETY: A REVIEW Clifton Titcomb, MD OTR Medical Consultant Medical Director Hannover Life Reassurance Company of America Denver, CO [email protected] epression and anxiety are common problems Executive Summary This article reviews the in the population and are frequently encoun- overall spectrum of depressive and anxiety disor- tered in the underwriting environment. What D ders including major depressive disorder, chronic makes these conditions diffi cult to evaluate is the wide depression, minor depression, dysthymia and the range of fi ndings associated with the conditions and variety of anxiety disorders, with some special at- the signifi cant number of comorbid factors that come tention to post-traumatic stress disorder (PTSD). into play in assessing the mortality risk associated It includes a review of the epidemiology and risk with them. Thus, more than with many other medical factors for each condition. Some of the rating conditions, there is a true “art” to evaluating the risk scales that can be used to assess the severity of associated with anxiety and depression. Underwriters depression are discussed. The various forms of really need to understand and synthesize all of the therapy for depression are reviewed, including key elements contributing to outcomes and develop the overall therapeutic philosophy, rationale a composite picture for each individual to adequately for the choice of different medications, the usual assess the mortality risk. duration of treatment, causes for resistance to therapy, and the alternative approaches that The Spectrum of Depression may be employed in those situations where re- Depression represents a spectrum from dysthymia to sistance occurs. -
Examining Affective Forecasting and Its Practical and Ethical Implications
Examining Affective Forecasting and its Practical and Ethical Implications Emily Susan Brindley BSc Psychology 2009 Supervisor: Prof. David Clarke Contents Page Introduction 1 1. Affective Forecasting – What do we know? 1 2. Biases – Why people cannot predict their emotions accurately 3 2.1 Impact Bias 3 2.2 ‘Focalism’ 4 2.3 Immune Neglect 4 2.4 Dissimilar Context 4 3. The Self-Regulating Emotional System 5 4. Affective Forecasting Applied 6 4.1 Healthcare 6 4.2 Law 7 5. Can AFing be improved? 8 6. Ethics: Should people be taught to forecast more accurately? 10 Conclusions 12 References 13 Examining Affective Forecasting and its Practical and Ethical Implications Introduction Emotions are important in guiding thoughts and behaviour to the extent that they are used as heuristics (Slovic, Finucane, Peters & MacGregor, 2007), and are crucial in decision-making (Anderson, 2003). Affective forecasting (AFing) concerns an individual’s judgemental prediction of their or another’s future emotional reactions to events. It is suggested that “affective forecasts are among the guiding stars by which people chart their life courses and steer themselves into the future” (Gilbert, Pinel, Wilson, Blumberg & Wheatley, 1998; p.617), as our expected reactions to emotional events can assist in avoiding or approaching certain possibilities. We can say with certainty that we will prefer good experiences over bad (ibid); however AFing research demonstrates that humans are poor predictors of their emotional states, regularly overestimating their reactions. Further investigation of these findings shows that they may have critical implications outside of psychology. If emotions are so influential on behaviour, why are people poor at AFing? Furthermore, can and should individuals be assisted in forecasting their emotions? These issues, along with the function of AFing in practical applications, are to be considered and evaluated. -
Abnormal Noradrenergic Function in Posttraumatic Stress Disorder
Original Article Abnormal Noradrenergic Function in Posttraumatic Stress Disorder Steven M. Southwick, MD; John H. Krystal, MD; C. Andrew Morgan, MD; David Johnson, PhD; Linda M. Nagy, MD; Andreas Nicolaou, PhD; George R. Heninger, MD; Dennis S. Charney, MD • To evaluate possible abnormal noradrenergic neuronal of stress. The effects of stress on brain noradrenergic func regulation in patients with posttraumatic stress disorder tion have been particularly well studied. For example, (PTSD), the behavioral, biochemical, and cardiovascular stress, especially uncontrollable stress, produces an ele effects of intravenous yohimbine hydrochloride (0.4 mg/kg) vated sense of fear and anxiety and causes regional were determined in 18 healthy male subjects and 20 male increases in norepinephrine turnover in the locus ceruleus patients with PTSD. A subgroup of patients with PTSD were (LC), limbic regions (hypothalamus, hippocampus, and observed to experience yohimbine-induced panic attacks amygdala), and cerebral cortex.3,4 In addition, a series of (70% [14/20]) and flashbacks (40% [8/20]), and they had investigations have shown that uncontrollable stress re larger yohimbine-induced increases in plasma 3-methoxy sults in an increased responsiveness of LC neurons to ex 4-hydroxyphenylglycol levels, sitting systolic blood pres citatory stimulation that is associated with a reduction in 5,6 sure, and heart rate than those in healthy subjects. In addi a2-adrenergic autoreceptor sensitivity. tion, in the patients with PTSD, yohimbine induced Recent clinical investigations suggest that a subgroup of significant increases in core PTSD symptoms, such as intru patients with chronic PTSD may exhibit abnormalities in sive traumatic thoughts, emotional numbing, and grief.