Latest Cure for Panic Attack

Panic Away Ebook

Psychologists agree that when a person has anxiety of a certain situation, he may suffer from a panic attack. This person then fears that specific location or event. When he find himself in a similar situation, he fears the onset of an attack and essentially cause himself to have an anxiety attack in the process. The One Move method teaches you how to conquer these fears and end this vicious cycle. Panic Away provides a number of specific applications of the 21-7 Technique that relates to everyday life like how to deal with panic attacks while driving, leaving home, anxiety caused by the fear of flying and the fear of public speaking. That first key step to an anxiety free life, revealed in Panic Away, is shared and sinks in your brain in such a powerful way with the videos of Jane dealing with panic, that I give Panic Away my highest recommendation. Read more here...

Panic Away Overview

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My Panic Away Review

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The author presents a well detailed summery of the major headings. As a professional in this field, I must say that the points shared in this manual are precise.

All the testing and user reviews show that Panic Away is definitely legit and highly recommended.

The Epidemiology Of Worry And Generalized Anxiety Disorder

Once considered synonymous with the cognitive components of anxiety (Mathews, 1990 O'Neill, 1985), worry has emerged as a more specific construct that can not only be distinguished from a larger subset of cognitive aspects of anxiety, but also studied in its own right (Davey, 1993 Davey, Hampton, Farrell & Davidson, 1992 Zebb & Beck, 1998). One of the first attempts to define worry was provided by Borkovec, Robinson, Pruzinsky, and DePree (1983, p. 10) Research on the epidemiology of worry has largely evolved over the past 20 years. Much research appears to have been spurred by the adoption of worry as the essential feature of generalized anxiety disorder (GAD) in the revised, third edition of the Diagnostic and Statistical Manual of Mental

The Epidemiology of Generalized Anxiety Disorder

Since their first iteration in DSM-III (APA, 1980) to their current version in DSM-IV (APA, 1994), the diagnostic criteria for GAD have been revised repeatedly, with revisions resulting in a greater focus on the presence of excessive and uncontrollable worry, an increase in the required duration of symptoms, fewer required physical symptoms, and the added requirement that worry and associated symptoms be accompanied by significant distress or impairment. In later editions, GAD was no longer considered a residual category that could only be diagnosed in the absence of other anxiety disorders. These significant changes to the structure of GAD have hampered long-term investigations of the course of the disorder and resulted in considerable heterogeneity in studies examining prevalence rates (Kessler, Walters & Wittchen, 2004 Wittchen, Zhao, Kessler & Eaton, 1994). Nevertheless, several epidemiological surveys provide valuable information regarding the prevalence, course, and...

Generalized Anxiety Disorder

A number of investigations have focused on worry in the context of GAD, often using discriminant function analysis to distinguish older GAD patients from normal controls. In one such study, interference of worry in daily life, worry about minor matters, and worry about the future distinguished GAD from normal aging (Montorio et al., 2003). Similarly, frequency, excessiveness, number of topics of worry, perceived difficulty controlling worry, restlessness, fatigue, irritability, muscle tension, and sleep disturbance distinguished older GAD patients and normals (Wetherell, Le Roux et al., 2003). Older GAD patients reported higher levels of state and trait anxiety, worry, depression, and social fears than normal older adults (Beck et al., 1995). Subsyndromal GAD symptoms, or minor GAD, can be differentiated from both syndromal GAD and normal controls by scores on measures of pathological worry (PSWQ) and trait anxiety in the elderly (Diefenbach et al., 2003). Difficulty controlling worry...

Diagnosis and Classification of Phobias and Other Anxiety Disorders Quite Different Categories or Just One Dimension

Phobias achieved a separate diagnostic status in psychiatric classifications soon after the Second World War, probably because of their frequent occurrence in soldiers at the battlefront. One of the main questions regarding their classification is related to a major issue among nosologists nowadays, at least for some classes of mental disorders such as anxiety disorders are they better represented by diagnostic categories or dimensions Evidence has been accumulated in the last 20 years showing that prototypical mental disorders such as major depressive disorders, anxiety disorders, schizophrenia and bipolar disorders seem to merge imperceptibly into one another and into normality 5 . However, it is somewhat unlikely that the next revision of psychiatric classification systems such as the DSM-V will turn from a categorical to a dimensional approach, since ''it is probably significant that most of the advocates of dimensional representation are not practicing clinicians but are...

Measuring Mood Changes Beck Anxiety Inventory

The Beck Anxiety Inventory (BAI) is designed to measure subjective symptoms of anxiety in adolescents and adults. It is a self-administered inventory and contains 21 descriptive symptoms of anxiety that the patient rates on a 4-point scale 0 not at all 1 mildly, it did not bother me much 2 moderately, it was very unpleasant, but I could stand it and 3 severely, I could barely stand it. Scoring is performed by adding the raw scores for each of the 21 symptoms the maximum score the patient can achieve on this test is 63 points. Minimal anxiety ranges from scores of 0 to 7 points, mild anxiety ranges from scores of 8 to 15 points, moderate anxiety ranges from scores of 16 to 25 points, and greater than 26 points is consistent with severe anxiety.14 This inventory provides only an estimate of overall severity of anxiety. Since the test contains only 21 items, its discriminating power is thus weak as far as psychological tests go. Therefore, it is recommended that this test instrument be...

State Trait Anxiety Inventory

Construction of the State-Trait Anxiety Inventory (STAI) began in 1964 with the goal of developing a single set of items to provide objective measures of state and trait anxiety. The concepts of state and trait anxiety were first introduced by Cattell.26 State anxiety and trait anxiety are analogous in certain respects to kinetic and potential energy. The anxiety state, like kinetic energy, refers to a palpable reaction or process taking place at a given time. On the other hand, anxiety traits, like potential energy, refer to individual differences in reactions.27 samples. One useful function of the STAI is for following patients during treatment. Since it only takes 6 to 7 min to administer this test, it can be used serially to evaluate levels of anxiety throughout the rehabilitation and treatment process.

Anxiety and Depression

As might be expected, within analogue samples the PSWQ correlates significantly with anxiety and depression as measured by the State Trait Anxiety Inventory (STAI Spielberger, 1983) and the Beck Depression Inventory (BDI Beck et al., 1961) respectively. Correlations with the STAI trait are found to be r 0.64-0.79 (Meyer et al., 1990 Davey, 1993 van Rijsoort et al., 1999 Wells & Carter, 1999). A lower correlation is reported with the STAI state, r 0.49 (Meyer et al., 1990), whereas correlations with the BDI are more variable, r 0.36-0.62 (Meyer et al., 1990 Van Rijsoort et al., 1999). Both worry (as measured by the PSWQ) and depressive rumination (as measured by the Response Styles Questionnaire, RSQ Nolen-Hoeksema & Morrow, 1991) are also highly correlated in a non-clinical population (r 0.51 Watkins, 2004). Within clinical populations, few studies have explored these relationships. In one small study (n 14) of individuals meeting the criteria for GAD (via GADQ), PSWQ scores...

Mixed anxiety and depression

Anxiety and depression often coexist, especially in the primary care setting. Patients with combined symptoms are the largest group with psychiatric conditions seen in the primary care office, and a substantial minority (45 ) are not detected by primary care physicians.57 Almost half of the cases of anxiety and depression occur in the same patient at the same time.60 This comorbidity makes accurate diagnosis more difficult, treatment more complicated, and prognosis less favorable.50 Anxiety is often the presenting symptom for depressed patients. The family physician should probe for symptoms for depression so that the depression can be identified and treated. Conversely, anxiety disorders often become comorbid with depression, and both conditions should be identified and managed. Fortunately, there is a great overlap in treatment methods, as the newer antidepressants are often indicated for the management of anxiety. 1 Olfson, M., Shea, S., Feder, A., et al. Prevalence of anxiety,...

Anxiety Symptoms

Although anxiety symptoms are essential for the diagnosis of anxiety disorders, they are so frequently encountered in depression that they should also be considered as an integral part of its clinical picture, particularly at the primary care settings. In ICD-10, the admixture of anxiety and depressive symptoms is listed as a distinct category under the term ''mixed anxiety and depressive disorders''.

Anxiety

The anxiety disorders are characterized by maladaptive, abnormal response to perceived threats or stressors, with resulting mood, cognitive, or physical symptoms (Table 7.6).37 They are the most common psychiatric disorders, with a lifetime prevalence of nearly 25 in the USA.38 Women are twice as likely as men to develop panic disorder, simple phobia, post-traumatic stress disorder, and generalized anxiety disorder, and are at increased risk for obsessive-compulsive disorder and social phobia.39 Over eight million office visits per year document an anxiety-related diagnosis, and the majority of these visits are made by women aged 40-59 years.40 Overall, anxiety accounts for about one-third of direct mental health costs in the USA,41 but this represents only a fraction of the total burden of lost productivity, care-giver time, social services costs, decreased quality of life, and increased mortality imposed by these conditions. Patients with anxiety consult more frequently, generate...

Panic disorder

Panic disorder is characterized by recurrent panic attacks with intense fear of losing control or dying during the attack. There is such marked fear of another panic attack that certain situations or places are avoided (Table 7.7). Approximately half of women with panic disorder also suffer from agoraphobia (fear of the marketplace), an intense irrational fear of being alone in places from which escape is impossible such as crowded public places or elevators.50 The lifetime prevalence of panic disorder is 1.5-3.5 and is twice as high in women than men. The prevalence may be as high as 21 in primary care settings because women with panic disorder are likely to present with physical symptomatology and resultant excess use of medical services.53 Panic disorder rarely begins after age 45, but it may persist or recur throughout the mid-life years. Middle-aged women may also suffer from undiagnosed panic disorder because symptoms often mimic medical conditions or may be masked by...

Age of Onset and Clinical Course

Onset of GAD to occur between the late teens and late 20s, with later onset occurring when GAD develops after another anxiety disorder (Barlow, Blanchard, Vermilyea, Vermilyea & DiNardo, 1986 Brawman-Mintzer et al., 1993 Hoehn-Saric, Hazlett & McLeod 1993 Massion, Warshaw & Keller, 1993 Woodman, Noyes, Black, Schlosser & Yagla, 1999 Yonkers, Massion, Warsaw & Keller, 1996).

Comorbidity and Associated Impairment

Early findings from the ECA study indicated a lifetime diagnosis of DSM-III GAD was associated with at least one additional Axis I disorder in 58 to 65 of respondents, with panic disorder and major depression the most frequent comorbid diagnoses (Blazer et al., 1991). As noted by Kessler and colleagues (2004), high rates of comorbidity for DSM-III GAD observed in early studies resulted in significant modifications to the disorder's diagnostic criteria, particularly the increase in required duration. one study meeting criteria for an additional Axis I disorder (Carter et al., 2001) and 60.6 of respondents in a separate study meeting criteria for an Axis II disorder (Grant et al., 2005). Though GAD appears to be a highly comorbid disorder in general population studies, Wittchen and colleagues (1994) showed that the frequency of individuals with GAD reporting one or more comorbid diagnoses is not much higher than rates observed in other anxiety or mood disorders. In clinical studies of...

Ethnic and Cross Cultural Differences

Though several studies have examined differences in the occurrence of anxiety among various ethnic groups within a specific country, few have reported specifically on differences in the prevalence of GAD (e.g., Jenkins et al., 1997). Overall, findings from three epidemiological surveys conducted in the US have revealed few differences in the prevalence of GAD among representative ethnic groups (Blazer et al., 1991 Wang et al., 2000 Wittchen et al., 1994). In an examination of ethnic differences in worry in a nonclinical population, Scott, Eng, and Heimberg (2002) compared Caucasian, African-American, and Asian Asian-American students on measures of pathological worry, worry domains, and generalized anxiety. No differences were observed among the three groups with respect to pathological worry or generalized anxiety however, African-American participants reported significantly less worry regarding relationship stability, self-confidence, future aims, and work incompetence than the...

Gender and Lifespan Differences

Table 1.2 Twelve-month prevalence of generalized anxiety disorder by age Table 1.2 Twelve-month prevalence of generalized anxiety disorder by age Several studies have found GAD to be the most prevalent anxiety disorder among elderly individuals (e.g., Beekman et al., 1998 Flint, 1994). As shown in Table 1.2, the 12-month prevalence of GAD in people 65 years of age and older appears to fall between 0.8 and 1.6 . However, a recent epidemiological survey of 4,051 individuals between the ages of 65 and 86 yielded higher rates, with 3.2 of participants meeting criteria for current GAD (Schovers, Beekman, Deeg, Jonker & van Tilburg, 2003).

Maladaptive Worry And Rumination

Certainly likely to contribute to psychopathology. Moreover, in the Self-Regulatory Executive Function (S-REF) model of emotional disorders, Wells and Matthews (1994, 1996) suggest that there are at least three factors that contribute to worry and rumination becoming pathological. For purposes of assessment, it may be useful to view these factors as the 3-Ws (l) When worry or rumination is used (e.g., in response to negative mood, before, during and or after threatening situations), (2) What worry or rumination may be used for (e.g., predominant problem-solving and coping strategies), and (3) Whether worry or rumination is negatively appraised (e.g., 'I have no control over my worry rumination'). The contribution of these factors to pathological varieties of worry and rumination is clearly supported by empirical evidence (for reviews, see Papageorgiou & Wells, 2004 Wells, 2000). The following examples will serve to illustrate these factors in maladaptive worry and rumination. An...

Consequences Of Worry And Rumination Consequences of Worry

Worry has been linked to several negative consequences. Experimental inductions of worry have been shown to produce short-term increments in negative intrusive thoughts (e.g., York, Borkovec, Vasey & Stern, 1987). Furthermore, worrying briefly about a self-selected concern leads to increases in both anxiety and depression in non-clinical samples (Andrews & Borkovec, 1988). Wells and Papageorgiou (1995) examined the effects of worry on negative intrusive images following exposure to laboratory-induced stress (i.e., a brief film of an industrial accident). Following this film, participants were assigned randomly to one of five experimental conditions (1) worry about the film and its implications in verbal form, (2) image about the film and its implications, (3) engage in a distraction task consisting of letter cancellation, (4) worry about the things they usually worry about, and (5) settle down. At the end of the experimental manipulation, participants were asked to record the...

Summary And Conclusion

Understanding these factors may facilitate identification, differentiation and treatment of these phenomena in clinical practice. Worry and rumination are associated with a number of negative affective, behavioural and cognitive consequences, which highlights the need to advance our understanding of these core processes and develop effective interventions to target them in therapy. An important way of enhancing our knowledge of these processes is to study the similarities and differences between worry and rumination. Although there is little disagreement regarding the content differences between worry and rumination, there is no conclusive evidence concerning process and metacognitive differences. Moreover, whether the process and metacognitive similarities or differences are key contributors to psychopathology also remains to be addressed in the future. Finally, we have seen that several hypotheses have been proposed to account for the role of worry...

Gerald Matthews and Gregory J Funke Introduction

From concerns about job performance, to anxiety before a test, to apprehension before a presentation, people commonly worry about the outcomes of future events (Tallis, Davey & Capuzzo, 1994). Worry has been previously defined as an anticipatory cognitive process involving thoughts and images that contain fear-producing content related to possible traumatic events and their potentially catastrophic implications, which are rehearsed repeatedly without being resolved (e.g., Borkovec, Ray & Stober, 1978). Of key importance is that worry is primarily anticipatory in nature, relating mainly to future possibilities and the threats they pose. According to Eysenck (1992), worry has three major functions alarm, prompt, and preparation. Within his model, upon detection of an internal or external threat, the alarm function introduces information about the threat into conscious awareness. The prompt function then activates threat-related thoughts and images in long-term memory, and the...

Traits And State Constructs

Worry may be conceptualized as both a stable trait and as a transient mental state. By contrast with research on trait and state anxiety (e.g., Eysenck, 1992), worry research has focused primarily on trait assessments, such as the Penn State Worry Questionnaire (PSWQ Meyer et al., 1990). State worry has been investigated through thought sampling (Smallwood et al., 2004), measures of allied constructs, such as cognitive interference (Sarason et al., 1996), ad hoc indices, and multidimensional state assessment (Matthews, Campbell et al., 2002). We note briefly that there is considerable conceptual and empirical overlap between worry and rumination (e.g., Papageorgiou & Wells, 1999, Watkins, 2004 see Matthews & Wells, 2004, for a review of cognitive process models of rumination). Trait worry represents an outgrowth of the more broadly-defined construct of trait anxiety, which is seen as a facet of the personality superfactor of neuroticism (Matthews et al., 2003). Thus, at least in...

Encoding and Appraisal

The worry process begins with the detection of a potential threat. Threat detection may be triggered by external stimuli (being reminded of an upcoming worrisome event) or generated internally (remembering the date of the event). The early stages of processing threat stimuli are influenced by attentional processes, in that selection and prioritization of threat stimuli is likely to increase worry. It is well-established that general anxiety is associated with a selective attention bias towards detection of threat related information (MacLeod & Rutherford, 2004). The source of bias is often seen as pre-attentive and automatic, although Matthews & Wells (2000) review evidence suggesting a role for voluntary search for threat. Indeed, prioritization of threat processing may be supported by multiple component processes such as voluntary search for threat (Matthews & Harley, 1996), delayed disengagement from threat (Derryberry & Reed, 2002), and automatic threat encoding...

Recent Evidence From Studies of the DSSQ

Laboratory, using the Dundee Stress State Questionnaire (DSSQ Matthews et al., 2002), is exploring how dispositional worry constructs generate state worry. Matthews, Hillyard and Campbell (1999), in a study of test anxiety in students, showed that, at the trait level, there were two distinct cognitive factors that correlated with dispositional evaluation-worry. One factor represented a general dimension of heightened metacognition, defined by perceived uncontrollability of thoughts, positive and negative beliefs about thoughts, and meta-worry. A second factor of adaptive coping was defined most strongly by higher use of task-focused coping and reduced use of avoidance. Interestingly, emotion-focused coping, in the sense of self-criticism and wishful thinking, loaded primarily on metacognition, but also negatively on adaptive coping. A regression analysis showed that both factors independently contributed to the prediction of dispositional worry. Data were also collected on state worry...

Associated Factors Genetics And Consequences

Worry in the elderly is associated with anxiety, distress, and negative affect (Skarborn & Nicki, 1996 Wisocki, 1994 Wisocki et al., 1986) poor self-perceived health, presence of medical conditions, or functional limitations (Hadjistavropoulos, Snider & Hadjistavropoulos, 2001 Skarborn & Nicki, 1996 Wisocki, 1988) approaching retirement (Skarborn & Nicki, 2000) and lower levels of knowledge about aging (Neikrug, 1998). In one recent study, older GAD patients reported impairment in quality of life comparable to that associated with major depression and more than that associated with Type II diabetes or recent acute myocardial infarct (Wetherell et al., 2004). A study of older adults reporting sleep difficulties indicated that they reported higher levels of worry than either self-reported good sleepers or normal controls (Pallesen et al., 2002), suggesting that insomnia may be one consequence of worry in later life. This is consistent with data from Wetherell, Le Roux et al....

What Do Children And Adolescents Worry About

Reported more by older children compared to younger ones in a study of clinically referred anxious children (Weems, Silverman & La Greca, 2000). Similarly, Last, Strauss and Francis (1987) reported that children with a diagnosis of Overanxious Disorder Generalised Anxiety Disorder, were more likely to have a comorbid diagnosis of Social Phobia than any other anxiety disorder, indicating that in excessive worriers, worries about one's social functioning are paramount. Both academic and popular speculation surrounds the changing nature of worry in children as societies alter over time. Clearly it is difficult to study worry over historical time periods, but in one study that attempted this, the worries of North American children in the 5th and 6th grade in 1977, were compared to those reported by a similar cohort in 1939. It was found that boys in the 1930s worried more about economic issues, and girls in the 1970s worried more about all areas except for personal health. In general,...

Should We Be Worried About Worry In Childhood

It is now widely recognised that generic child anxiety, when severe, is deleterious to functioning, and can have long-term negative outcomes. For example, anxious children often subsequently develop depression (Kovacs, Gatsonis, Paulauskas & Richards, 1989), and may be at increased risk of substance misuse. (Kushner, Sher & Beitman, 1990). Even less serious levels of anxiety have been shown to have an impact on children's academic and social functioning (Pine, 1997). However, to the author's knowledge, no research has yet examined the impact of worrying (as distinct from generic anxiety symptoms) on children's functioning. However, if, as seems likely, excessive worry has the same impact on young sufferers as it does on adults, and if it has the same impact that we now know high levels of generic anxiety to have on children, then this is an area that should be of serious concern.

Normal And Clinical Worry

It is clear that children and adolescents do experience worry, but to what extent do they experience levels that would qualify them for a diagnosis of Generalised Anxiety Disorder (GAD) Epidemiological studies vary substantially in the degree to which they report prevalences of GAD (or its earlier counterpart overanxious disorder). In a large epidemiological study of British children (Ford, Goodman & Meltzer, 1999) GAD (using DSM-IV criteria) was found to be present in less than 1 of 5-10 olds. However, in a study employing slightly less conservative DSM-III-R criteria for 'overanxious disorder' Boyle, Offord, Racine, et al. (1993) reported overanxious disorder in over 11 of their US sample of 6-11 year olds. However, these rates must be interpreted in the context of the sample under investigation, and in light of the particular instruments, criteria and other methodology employed. Similarly, Perrin and Last (1997) examined worry in pre-adolescents, diagnosed with anxiety...

Worry and Cognitive Attentional Biases

There is now substantial evidence in the adult literature to suggest that anxious adults have cognitive biases towards threat information, and overestimate the likelihood of such threat. Evidence is now beginning to suggest that these biases are apparent early on in the development of anxiety disorders i.e. in childhood and adolescence, (see Ehrenreick and Gross (2002) for a review).

Parents And Families Parentchild Relationships and Worry

It has now been demonstrated on a number of occasions, that childhood anxiety in general is associated with a pattern of parenting characterised by over-protection (see Wood, McLeod, Sigman et al. (2003) for a review). This finding has now been extended specifically to childhood worry, in a study by Muris (2002), which demonstrated that over-protective parenting (as reported by children) was associated with worry, in a large questionnaire study of 13-16 year olds. Similarly, we know that impaired parent-child attachment is associated with increased anxiety in the child (e.g. Warren, Huston, Egeland & Sroufe, 1997), and it has now been demonstrated that impaired attachment is Additional aspects of parenting that have been associated with anxiety in general, are 'rejection', 'emotional warmth', 'anxious parenting' and 'controlling' parenting, (which is similar to the concept of 'over-protection' described above). These constructs too, have now been associated specifically with worry....

Interventions For Childhood Worry

Unfortunately, there are (to this author's knowledge) no interventions that have been directed specifically at childhood worry. There are now a number of Cognitive Behaviour Therapy (CBT) based treatments that appear to have efficacy in treating childhood and adolescent anxiety in general (e.g. see Cartwright-Hatton, Roberts, Chitasabesan et al. (2004) for a review). However, these interventions have largely been targeted at the emotional (e.g. fear) and physiological aspects of anxiety. Very few treatment protocols have modules specifically for dealing with worry. Indeed, because of the developmental limitations on children's ability to use the more cognitive elements of CBT, most interventions focus heavily on behavioural elements, such as exposure and relaxation. If evidence from the adult literature is indicative, it seems unlikely that these elements will have a substantial impact on worry. Where cognitive elements are incorporated into treatment, these are usually limited to...

Reliability Of The Pswqinternal Consistency And Stability

The 16-item PSWQ has routinely demonstrated high internal consistency in the case of both clinical and non-clinical criterion groups (Molina & Borkovec, 1994). Cronbach's alpha coefficients have been shown to range between 0.88 and 0.95 for clinical samples (GAD patients and mixed anxiety disorder samples, as diagnosed by the Anxiety Disorders Interview Schedule-Revised ADIS-R, Di Nardo & Barlow, 1988) and non-clinical college student and community derived samples (assessed by questionnaire Borkovec, 1994 Brown et al., 1992 Davey, 1993 Molina & Stober, 1998 van Rijsoort et al., 1999). The PSWQ also demonstrates good test-retest reliability amongst samples of college students (r 0.74-0.92 over intervals of 2 to 10 weeks Molina & Borkovec, 1994 Meyer et al., 1990 Stober, 1998), as well as substantial inter-rater reliability amongst college students (when comparisons are made with peer ratings, intraclass correlation coefficient 0.42 Stober, 1998) and between peer and...

NonGAD Symptomatic Samples

Nevertheless, high PSWQ scores are often present in non-GAD analogue clinical samples, including those with symptoms of post-traumatic stress disorder (PTSD) and obsessive compulsive disorder (OCD both in Molina & Borkovec, 1994), as well as panic disorder and social phobia (both from Erickson, 2002). Similarly, individuals diagnosed by questionnaire with analogue irritable bowel syndrome exhibit high levels of worry (Hazlett-Stevens, Craske, Mayer, Chang & Naliboff, 2003). Despite substantial worry elevation in these analogue non-GAD groups, analogue GAD groups manifest slightly higher average scores, as indicated in Table 7.2. However, because analogue studies have infrequently screened out other comorbid analogue conditions, such groups may well be symptomatically heterogeneous. In samples with clinically diagnosed patients, a parallel picture has emerged GAD patients tend to show higher PSWQ scores than other patients, though not in every case....

Worry and Ruminative Thought

Rumination is considered the cognitive component of depression and has been defined as behaviors and thoughts that focus one's attention on one's depressive symptoms and the implications and consequences of these symptoms (Nolen-Hoeksema & Morrow, 1993, pp. 561-562) (see Chapter 2). Within a non-clinical population, worry (as measured by the PSWQ), depressive rumination (as measured by the Response Style Questionnaire, RSQ Nolen-Hoeksema & Morrow, 1991), anxiety and depression (as measured by the Hospital Anxiety and Depression Scale, HADS Zigmond & Snaith, 1983) are all significantly positively correlated (smallest r 0.43) (Watkins, 2004).

Helen M Startup and Thane M Erickson

The need for a psychometrically sound measure of worry was reinforced by the introduction of DSM-III-R (American Psychiatric Association, 1987). With its introduction, Generalized Anxiety Disorder ceased being a residual diagnostic category. Although exclusion criteria still existed, the key variable of unrealistic or excessive anxiety and worry (apprehensive expectation) assumed paramount definitional significance for the disorder (APA, 1987, p. 252). The fundamental significance of this feature was further buttressed in the fourth edition of DSM (DSM-IV, APA, 1994), which added the requirement that worry be perceived as uncontrollable (Brown, Barlow & Liebowitz, 1994). With this in mind and by drawing together the available research of the time, Silvia Molina and Tom Borkovec (1994) noted that in order to adequately tap this phenomenon, it followed that a trait measure of worry would need to evaluate the following a) the typical tendency of the individual to worry, b) the...

The Sref Model Of Worry

Stable biases of these various kinds cause individual differences in dispositional worry, overlapping somewhat with general trait anxiety and neuroticism (Matthews et al., 2000). Importantly, traits relate to packages of biases that may be located in multiple, independent components of the architecture, given unity by their common functional orientation towards, in the case of dispositional worry, anticipation and preparation for threat (Matthews et al., 2003 Matthews & Zeidner, 2004). Traits such as neuroticism and dispositional metacognitive beliefs influence state worry in interaction with situational factors that may facilitate or inhibit the various process factors just listed. The role of worry processes in clinical anxiety pathology is largely beyond the scope of this chapter (see Matthews & Wells, 2000 Wells, 2000 for more detailed accounts), but we will indicate two differences between normal and pathological states of elevated worry. First, recent work using the DSSQ...

Etiology Of Worry States A Cognitive Perspective

There are multiple sources of cognitive bias that may elevate state worry in persons high in trait worry. Some biases are associated with neuroticism and trait anxiety, including negative self-beliefs, evidenced by their correlations with measures of self-concept, self-efficacy, self-esteem, and allied constructs (Matthews, et al., 2000,2003). Following Beck and Clark (1997), these biases have been conceptualized in terms of individual differences in the self-schema, the structured set of propositions held in LTM, although implicit, procedural self-knowledge may be equally important (Wells & Matthews, 1994).

PSWQ Scores in Relation to Demographic Variables

The PSWQ can also be used to assess worry in children (see Chapter 6), but may perform better in a revised format. Chorpita et al. (1997) adapted the PSWQ for youth by rewording nine items to second grade level and changing the Likert response scale from five to four points (0-3). Examination of psychometric properties in a community school sample of youth in grades 1-12 led to the elimination of two items. The remaining 14 items had a range of 0-42, yielding the PSWQ for Children (PSWQ-C). This measure demonstrated a single-factor structure, as well as satisfactory psychometric properties in student and clinical samples (see Table 7.3 for descriptives). In the unselected community sample, adolescents (age 12-18) scored higher than younger (age 6-11) children. In a separate sub-study, youths with GAD scored significantly higher than those with other anxiety disorders, who in turn scored significantly higher than non-anxious youths. Muris et al. (2001) examined PSWQ-C scores in a...

PSWQ Cut Points For Differentiating Various Groups

Recent studies have enhanced the utility of the PSWQ by testing for optimal cut-scores to screen for GAD caseness. Several studies have applied receiver operating characteristic analysis to determine PSWQ scores that optimize sensitivity (likelihood of identifying true positives from all persons with positive diagnosis according to the questionnaire) and specificity (likelihood of identifying true negatives from all persons without diagnosis on the measure) vis-a-vis clinician diagnosis or questionnaire-selected analogue GAD. Behar, Alcaine, Zuellig and Borkovec (2003) found that a PSWQ score of 45 optimized sensitivity and specificity in discriminating treatment-seeking GAD clients from non-anxious controls in contrast, in a large student sample, a score of 62 performed best. This latter, higher, score was required to differentiate analogue GAD individuals (categorized via GAD-Q-IV) from those with self-reported diagnoses of social anxiety disorder, moderate depression, and or PTSD....

Theories of Chronic and Pathological Worry

And Generalised Anxiety Disorder ____ 179 Chapter 12 A Cognitive Model of Generalized Anxiety Disorder The Role of and Generalised Anxiety Disorder ____ 259 and Generalized Anxiety Disorder ____ 273 Chapter 18 Pharmacological Treatments for Worry Focus on Generalised Anxiety Disorder 305 Anxiety Disorder 359

Why Do People Worry And Ruminate

In an earlier section of this chapter, the numerous negative consequences associated with worry and rumination were reviewed. Despite these consequences, it is puzzling to understand why people choose to engage in worry and rumination when stressors are encountered. Knowledge of the factors implicated in proneness to worry and rumination may contribute to our understanding of the mechanisms underlying the frequency and severity of worry and anxiety symptoms as well as rumination and depressive symptoms. Moreover, the modification of these factors may assist in reducing vulnerability to worry and rumination and maximising the efficacy of psychological interventions for anxiety and depression. A number of hypotheses have been advanced to account for the role of worry in anxiety and rumination in depression. Worry has been viewed as a form of avoidance (Borkovec & Inz, 1991 see Chapter 14), problem solving (Davey, 1994), coping strategy (Wells, 1994,1997), and intolerance of...

The Content of Worry The Worry Domains Questionnaire Tallis Davey Bond 1992

The Worry Domains Questionnaire was developed as an instrument to measure non-pathological worry. By means of a cluster analytic method, six domains of worry were highlighted (1) Relationships, (2) Lack of Confidence, (3) Aimless Future, (4) Work Incompetence, (5) Financial and (6) Socio-Political (for a full description of scale development, see Tallis et al., 1994). The scale is comprised of 30 items. The prefix I worry is followed by a list of 30 worries (e.g., that I will lose close friends) that cover the six worry domains, however, the sixth cluster (socio-political) may be dropped. For each item, participants indicate how much they worry on a five-point scale from not at all (0) to extremely (4). The WDQ can distinguish between high and low worriers drawn from a non-clinical population. The total WDQ score gives an indication of worry frequency, and the subscales provide information with respect to worry content. The resultant scale has shown internal consistency (Cronbach's...

Definitions and Characteristics of Rumination

Although there is little debate as to the concept of worry, it appears that different theorists define rumination somewhat differently despite the obvious similarities between the various definitions proposed. It has been noted that this problem is particularly reflected in the existing measures of rumination (Siegle, Moore & Thase, 2004). In a factor analytic study of different measures of rumination, Siegle et al. (2004) showed that there were several separate constructs represented in the measures. Thus, there appears to be a range of constructs of rumination, and it is conceivable that their contribution to dysphoria depression may differ. Moreover, psychometric tools assessing worry and rumination have been found to be highly correlated with each other, and with other measures of perseverative thinking, anxiety and depression (Fresco, Frankel, Mennin, Turk & Heimberg, 2002, Harrington & Blankenship 2002, Segerstrom, Tsao, Alden & Craske, 2000). Future research may...

Julie Loebach Wetherell Prevalence

Furthermore, epidemiological research suggests that the prevalence of generalized anxiety disorder (GAD) is lower in those over 65 than in younger age groups (Blazer, George & Hughes, 1991). As is the case with most cross-sectional comparisons, it is impossible to determine the reason for these differences. It is possibly due to survival biases, in that people who have higher levels of worry are less likely to live to old age, or to cohort differences, given that people who are currently elderly survived World War II and the Great Depression and were typically raised with the values of self-reliance and minimizing or not discussing negative emotions. Older adults may not remember past episodes of worry. It is also possible that over the course of a lifetime, older adults develop wisdom (e.g. develop

Christine Purdon and Jennifer Harrington Worry In Psychopathology

Historically, worry has been viewed as simply a symptom, or side-effect of anxiety and not an especially interesting topic for study on its own. For example, O'Neill (1985) argued that worry will extinguish through the same mechanisms as anxiety (e.g., flooding), and so does not need to be identified or treated as a separate construct. Borkovec (1985) disagreed, arguing that worry is the cognitive component of anxiety and its relationship to the physiological and behavioral components of anxiety needs to be understood. Furthermore, early research suggested that worry may serve to actually elicit and maintain anxiety. Thus, worry might be a causal factor in anxiety, as opposed to solely being part of its phenomenology. This latter view now prevails (e.g., Barlow, 2002 Craske, 1999), and since those early debates, worry has been accepted as a topic of legitimate study. With respect to content, worry typically concerns negative future events and is an attempt to avoid negative outcomes...

Comparisons Between Worry And Rumination

The nature of worry and rumination suggests that these processes should overlap with and differ from each other. It is evident that worry and rumination can exist dynamically within the same individual. However, the study of similarities and differences between worry and rumination may offer a number of important opportunities. First, it may allow us to construct systematically a profile of the constituents of persistent negative thinking processes that contribute to specific and or general manifestations of psychological disturbance. In this way, an examination of the similarities and differences between worry and rumination may also assist in refining the proposed concepts. Whether the similarities or differences are key contributors to psychopathology is not yet clear. Second, this research may also facilitate the development and validation of idiosyncratic models for understanding perseverative negative thinking in anxiety and depression. Third, knowledge of similarities and...

The Phenomenology of Normal and Pathological Worry

Few empirical studies have actually examined the occurrence and phenomenology of worry independent of GAD (Tallis, Davey & Capuzzo, 1994). As a result, much of our empirical understanding regarding what actually occurs when people worry, what they most often worry about, and how frequently they worry has been derived from examinations of nonanxious control groups. As noted by Ruscio (2002), these studies may not provide an accurate representation of the frequency and manifestation of normal worry because participants in these groups have been selected based on low worry scores and an absence of anxiety. In much of the empirical literature, normal worry has been regarded as mild, transient, generally limited in scope, and experienced by the majority of individuals (Ruscio, 2002, p. 378). However, without adequate studies of worry in normal individuals (i.e., not simply low-anxiety individuals), it is difficult to determine how much the above perception is based on specific...

Worry And Task Performance

Wells and Matthews (1994) point out that anxiety may have both direct and indirect effects on information-processing, attention, and performance. Direct effects are those that reflect the person's motivated attempts to cope with perceived threats and pressures. The prime example is the bias in selective attention towards threat associated with general anxiety. Worry may generate a feedback process in which bias in selective attention elevates awareness of threat and worry, which in turn maintains the focus of attention on sources of threat (Matthews & Wells, 2000). However, Yovel and Mineka (2005) found that general anxiety predicted selective attention bias for subliminally presented emotional Stroop stimuli, but the PSWQ did not. Worry may tend to affect later processing stages such as stimulus interpretation, metacognition, and volitional appraisal and coping processes more strongly than these early encoding processes. A recent study (Reidy, 2004) also suggests that trait...

About The Editors

Graham Davey is Professor of Psychology at the University of Sussex in Brighton, UK. He has been an active researcher in areas associated with anxiety and its disorders, especially pathological worrying, phobias, and perseverative psychopathologies generally. He has published his research in many high-impact international journals including Journal of Abnormal Psychology, Behavioral & Brain Sciences, Journal of Experimental Psychology, and Behaviour Research & Therapy. He has authored or edited a total of 11 books, including Davey, G.C.L. (1997) (Ed) Phobias A handbook of theory, research and treatment, Chichester Wiley, and Davey, G.C.L. & Tallis, F. (1994) (Eds) Worrying Perspectives on theory, assessment and treatment, Chichester Wiley. He was elected President of the British Psychological Society from 2002-2003. Adrian Wells is Professor of Clinical & Experimental Psychopathology at the University of Manchester, and Professor II in Clinical Psychology at the Norwegian...

List Of Contributors

Adult Anxiety Clinic, Department of Psychology, Temple University, 1701 North 13th Street, Philadelphia, PA 19122-6085, USA Adult Anxiety Clinic, Department of Psychology, Temple University, 1701 North 13th Street, Philadelphia, PA 19122-6085, USA Thomas L. Rodebaugh Adult Anxiety Clinic, Department of Psychology,

Prevalence

Table 1.1 Prevalence of generalized anxiety disorder in the community Table 1.1 Prevalence of generalized anxiety disorder in the community The prevalence of GAD has also been assessed in primary care settings. Findings from large scale investigations in several countries indicate that GAD is one of the most frequently diagnosed mental disorders in primary care, with a current prevalence rate between 3.7 and 8 (Maier et al., 2000 Olfson et al., 1997 Ormel et al., 1994 Ustun & Sartorius, 1995) and a 12-month prevalence rate of 10.3 (Ansseau et al., 2004). Among high utilizers of medical care, 21.8 of those who reported significant emotional distress met criteria for a current diagnosis of GAD, whereas 40.3 met criteria for GAD at some point in their lives (Katon et al., 1990). As noted by Wittchen (2002), the higher prevalence of GAD in primary care settings compared to the general population differs from patterns observed in most other anxiety disorders, suggesting that individuals...

Conclusion

Normal worry appears to be a fairly common phenomenon, and recent research suggests that pathological worry independent of GAD may be more prevalent that previously thought. Though some similarities have emerged between normal worry and worry associated with GAD, most investigations have found that individuals with GAD worry more frequently, worry more about miscellaneous topics, and find their worry more difficult to control than their nonanxious counterparts. However, as noted by Ruscio (2002), most comparisons of normal and pathological worry to date have involved individuals with GAD and those not meeting criteria for an anxiety disorder. Thus, given that most individuals who report pathological worry do not actually meet criteria for GAD, observed differences between GAD and nonanxious control samples may not be representative of true differences between normal and pathological worry. Future research would greatly benefit from more focused examinations of what actually...

Costas Papageorgiou

Although the tendency to engage in recurrent negative thinking about past stressful events, current difficulties, and anticipated future problems is a common psychological feature of a range of disorders, worry and rumination are considered to be core cognitive processes in generalised anxiety disorder and major depressive disorder, respectively. This chapter begins by examining definitions and characteristics of worry and rumination. The second section discusses processes implicated in maladaptive worry and rumination. The affective, behavioural and cognitive consequences of worry and rumination are considered in the third section of this chapter. In the fourth section, both conceptual and empirical comparisons are made between worry and rumination. The final section considers factors that may predispose certain individuals to engage in worry and rumination.

Metacognition

An important clinical feature of worry is that its content often refers to worry itself experiencing intrusive thoughts may itself be a focus for worry (Wells, 2000). Such metacognitions may be negative (worrying could make me go crazy) or positive (if I worry I'll be prepared). Wells and colleagues have developed several scales for metacognitive traits, including metaworry (worry about worry Wells, 1994), positive and negative beliefs about worry (Wells & Cartwright-Hatton, 2004), and typical strategies used for thought control (Wells & Davies, 2004). Evidence reviewed by Wells (2000) links each type of trait to dispositional worry. For example, in a study of thought control the PSWQ related to thought control strategies of deliberate worrying and punishment (for thinking unacceptable thoughts) (Wells & Davies, 1994). Metaworry has been found to predict trait worry, even with trait anxiety and level of worry about external threats controlled (Nuevo, Montorio & Borkovec,...

Worry Content

In a comparison of normal older adults, those with subsyndromal anxiety, and GAD patients, worries about family and personal health were the most common topics of concern in all groups, but GAD patients worried more about all topics than the other groups (Montorio et al., 2003). All older adults tended to worry more about present concerns rather than past or future concerns. Worry correlated with anxiety. Interference of worry with daily life and worry about minor matters were the best predictors of GAD in this sample.

Theories Of Worry

Relatively few studies have attempted to apply theories about worry to older adults. Because older adults appear to experience lower levels of arousal due to physiological changes in the autonomic nervous system associated with aging, worry may form a more important component of anxiety in the elderly than in younger adults. One recent investigation tested Wells' cognitive model of pathological worry in a sample of older Spanish adults and found that metaworry (positive and negative beliefs about worry) was a significant predictor of severity of worry and interference of worry in daily life even after controlling for trait anxiety, worry content, and uncontrollability of worry (Nuevo, Montorio & Borkovec, 2004).

Treatment

GAD has typically included the elements of psychoeducation and recognition of anxiety symptoms, relaxation training, cognitive restructuring, and imaginal and in vivo exposure to worrisome thoughts and situations with prevention of overly cautious behaviors. Effect sizes (Cohen's d) immediately following treatment have typically been in the large range for those studies comparing CBT to wait list or usual care (Mohlman et al., 2003, .65 Stanley et al., 2003, .75 Stanley et al., 2003, 1.01 Wetherell, Gatz, & Craske, 2003, .85) and in the small to medium range for those studies comparing CBT to an alternative treatment or attention placebo (Gorenstein et al., 2005, .36 Stanley et al., 1996, .28 Wetherell, Gatz et al., 2003, .29). These results are generally less favorable than in comparable studies with younger adults. In a pooled analysis of CBT trials for late-life GAD, amount of at-home practice was the most consistent predictor of improvement, both immediately after treatment and...

Assessment

As will have become clear, there are very few instruments that are designed to measure worry in children and adolescents. Most of the studies described above have employed idiosyncratic checklists or interviews designed for the study in question, with varying levels of attention to the psychometric properties of these. In large part, this lack of high-quality measures is due to the difficulties in measuring a concept that is as slippery as worry. This difficulty is compounded by the developmental issues that children bring. For instance, it is far from clear that young children have access to a reliable definition of worry, and their ability to report on this, therefore, with any degree of reliability and validity is constrained. A number of instruments are now available for assessing fears and anxiety in general, and a number of these have scales, or at least a few items, that attempt to measure worry. For instance, the widely used 'Revised Manifest Anxiety Scale for Children'...

Scale Development

For a comprehensive description of the initial development of the PSWQ, the reader is referred to Meyer et al. (1990) and Molina and Borkovec (1994). To summarize Molina and Borkovec (1994), the PSWQ was derived from the factor analysis of 161 items thought to be related to worry. These items were drawn from clinical and research experience with GAD patients and worriers, daily diaries from GAD patients, a prior cognitive-somatic anxiety inventory, and theoretical views on worry. The resulting questionnaire, which asked participants to rate each item on a 5-point scale (not at all typical to very typical), was administered to 337 college students and submitted to factor analysis with oblique rotation. Seven factors emerged. However, because the goal was to create a trait measure of the general tendency to worry without regard to content-specific topics, subsequent attention was focused on the first factor, which reflected the frequency and intensity of worry in general (accounting for...

General Samples

Panic disorder by questionnaire Panic disorder with agoraphobia Panic disorder non-anxious according to diagnostic screen self-report questionnaires such as the original Generalized Anxiety Disorder Questionnaire (GADQ Roemer, Borkovec, Posa & Borkovec, 1995) or a version revised to match DSM-IV criteria (GAD-Q-IV Newman et al., 2000), they show average PSWQ scores near or below the scale's midpoint (Erickson, 2002 Molina & Borkovec, 1994). Persons not meeting GAD criteria during structured diagnostic interviews (in this case, the Anxiety Disorders Interview Schedule-Revised, ADIS-R DiNardo & Barlow, 1988) yield low scores as well (Molina & Borkovec, 1994). Unselected groups, whether in predominantly student samples (Erickson, 2004 Molina & Borkovec, 1994 Sibrava, 2005) or community samples (Gillis, Haaga & Ford, 1995 van Rijsoort et al., 1999) tend to exhibit slightly higher average scores, presumably reflecting the natural inclusion of a subset of high worriers in...

Metaworry

The Consequences of Worrying Scale (Davey, Tallis, & Capuzzo, 1996) assesses the perceived positive and negative consequences of worrying and can be used with non-clinical samples. The scale assesses three dimensions representing the negative consequences of worrying (1) worrying disrupts effective performance, (2) worrying exaggerates the problem, and (3) worrying causes emotional discomfort. There are two factors representing the positive consequences of worrying (1) worry motivates and (2) worry helps analytic thinking. From the limited data available, the scale demonstrates good psychometric properties (Davey et al. 1996). The sub-scales correlate with other measures of worry, such as the PSWQ and WDQ and with relevant measures of psychopathology such as trait anxiety (BAI) and depression (BDI) (Davey et al. 1996). Interestingly, one study found that participants who held both negative and positive beliefs about the consequences of worrying scored significantly higher on...

Alternative therapies

Empirical scientific evidence has demonstrated the positive benefits of exercise, such as improved strength, reduced anxiety, improved blood lipid profile, and decreased risk of cardiovascular disease. The modality required to obtain these benefits can vary from a structured exercise program (resistance training and walking running) and alternative therapies (yoga and t'ai chi) to daily physical activity (mowing the lawn and climbing stairs).

Prodromal Symptoms And Onset

According to Yung and McGorry, the prodromal features most commonly described in the most methodologically sound first-episode studies include, in descending order of frequency reduced concentration and attention, reduced drive and motivation, anergia, depressed mood, sleep disturbance, anxiety, social withdrawal, suspiciousness, deterioration in role functioning and irritability. In Loebel et al's 58 sample, the first psychotic symptoms appeared on average one year, and prodromal signs almost 3 years before first admission. In the Age, Beginning and Course of Schizophrenia (ABC) study 62, 63 , the period from the first sign of a mental disturbance and the first hospital-ization averaged 4.2 years for men and 4.9 years for women. The first signs were non-specific indicators such as loss of energy and motivation, difficulty concentrating, anxiety, suspiciousness and social withdrawal. Even the first psychotic symptoms appeared on average 2 years prior to the first hospital-ization. In...

Comparison of ICD10 with DSMIV

As shown in Table 1.1, ICD-10 and DSM-IV are basically similar in their orientation, and despite their differences, mainly in terminology, may be used interchangeably in clinical practice. They converge on the following major features (a) the previously dispersed depressive disorders are grouped together under a common name signifying a unified syndromal entity (b) the term ''affective disorders'' is replaced by the term ''mood disorders'', thus narrowing the depression's boundaries by not subsuming anxiety disorders under the same roof (c) while the clear intraclass distinction between bipolar and depressive disorders is retained, the term ''unipolar'' is abandoned (d) the diagnostic criteria are symptom-based, descriptive and not explanatory (e) symptom severity and recurrence are used as subtyping and specifying criteria (f) diagnostic threshold is determined by a constellation of core and supplementary symptoms, which have to fulfill the number and duration criteria in order to...

Treatment of Early Localized Prostate Cancer

The optimum management of patients with localized prostate cancer remains controversial. Three major treatment options are available radical prostatectomy, radical radiotherapy (external beam radiotherapy EBRT or brachy therapy), and active surveillance (also known as active monitoring and watchful waiting). Each treatment involves its own risk. Radical treatments can cause harmful side effects including incontinence, erectile dysfunction, and even death, whereas watchful waiting causes anxiety relating to the presence of cancer and carries a risk of disease progression. However, outcomes in terms of overall survival appear similar with each of the three modalities.

Quantification Process

Scientific fields and disciplines constantly evolve, usually starting at a qualitative stage (by being mostly descriptive, as the early anatomical or zoological knowledge), to enter later into more quantitative stages (like counting the number of lobes of an organ, weighing it and or searching for a known geometrical shape to approximate it). It is obvious that some disciplines are more quantifiable and quantified than others. The cardiovascular and respiratory systems, for example, are easier in this respect because their variables have precise mathematical definitions. Psycho-physiology, instead, does not have yet clear-cut variables to work with and, as a consequence, its quantification process is slower. Variables like anxiety, fear or anguish are rather elusive.

Psychomotor Disturbances

Psychomotor disturbances have the advantage of being readily observed and even objectively measured. They include, on the one hand, agitation (hyperactivity) and on the other, retardation (hypoactivity). Although agitation, usually accompanied by anxiety, irritability and restlessness, is a common symptom of depression, it lacks specificity. In contrast, retardation, manifested as slowing of bodily movements, mask-like facial expression, lengthening of reaction time to stimuli, increased speech paucity and, at its extreme, as an inability to move or to be mentally and emotionally activated (stupor), is considered a core symptom of depression. Their presence is currently being used as a diagnostic symptom of the melancholic type of depression in DSM-IV and the severe depression with somatic symptoms in ICD-10.

Subsyndromal Depressive Symptoms SSD

Epidemiological studies yield prevalence rates of 80 for mild to moderate and 3-8 for severe premenstrual symptoms 72 . Among the many symptoms, the most frequent are depressed mood, anxiety, irritability, mood lability, tiredness, sleep and eating disturbances, and difficulty in concentrating.

Postnatal Depressive Disorders

These disorders present in three forms. The first is a transient anxiety-depressive state known as postpartum blues that occurs a few days after delivery, peaks within 10 days and subsides usually within 3 weeks after delivery. About half of the mothers experience the blues in various degrees 4,10, 79 . The symptoms are mild, not necessitating medical attention. Characteristic symptoms include mild depressive mood, crying, fatigue. The second form occurs in almost 10-15 of mothers 80 , as a rule within the first month after delivery. The symptoms do not essentially differ from the moderate and severe non-psychotic DE MD. They have a disrupting and long-term effect on the personal and family life of the mother. The third, known as post-partum depression with psychotic features, occurs in about one out of 1000 mothers. In this form of postnatal depression, the first month after delivery is characterized, in addition to DE MD symptomatology, by psychotic features among which are...

Purposes Of Diagnostic And Other Classifications

Diagnostic classifications may stem from political as well as scientific processes. DSM's demotion of agoraphobia into an aspect of ''panic disorder'' reflects two political processes in the late 20th century. One was US psychiatry's bid for more mainstream medical status. This strengthened its view of panic and other problems as signs of brain dysfunction needing drug therapy. The second political process was the pharmaceutical industry's successful bid for US Food and Drug Administration (FDA) approval to market ''antipanic'' drugs for ''panic disorder'' (the FDA approves drugs for particular diagnoses 12 ). The industry sponsored professional meetings to boost that diagnostic entity and funded research worldwide into ''antipanic'' drugs for ''panic disorder''. In addition, cognitive therapists jumped onto the panic disorder bandwagon by claiming that panic stemmed from ''catastrophic cognitions'' which required cognitive restructuring.

Posttraumatic Stress Disorder PTSD

The differentiating features of this condition are the intense and or protracted response to a stressful event or situation of an exceptionally threatening or catastrophic nature. A qualifying criterion is that the onset of the symptoms should occur within the 6-month time frame following the stressful event. Typical symptoms include hyperarousal, episodes of reliving the traumatic experience, detachment, numbness, maladaptive coping responses and excessive use of alcohol and drugs 93 . A recent study, in which the ability of experienced clinicians to differentiate PTSD from MD and generalized anxiety disorder (GAD) was applied as a validating criterion, has shown that the clinicians readily distinguished PTSD from the other two disorders 94 .

Phobias May be Cued Triggered Evoked by Almost Anything

A classification based entirely on the triggers of terror leads to an endless terminology telling us little beyond the label. Such a classification was prominent in the past. Numerous Greek and Latin prefixes were attached to -phobia according to the object or situation that was feared (for a long table of such phobias, see 13 ). Today's enquirers from the media often ask ''What do you call a phobia of spiders (or heights or blushing or whatever) '' and rest content with the label ''arachnophobia'' or ''acrophobia'' or ''erythrophobia''. Such dry scholasticism has little merit, though below we will see value in the terms ''agoraphobia'' (fear of public places) and ''social phobia'', because clinicians commonly see phobias of particular clusters of public or social situations, each cluster having its own correlates (e.g. a fear of crowds often associates with certain other agoraphobic and non-phobic features, and a fear of blushing with other social fears). Particular clusters of...

Drug abusedependence and Depression

Symptoms of anxiety and depression frequently appear during the intoxication and withdrawal phases of drug dependence and in that case they are considered as part of the ''substance abuse induced disorder'' (with predominant anxiety or depression symptoms). Symptoms meeting the full criteria of depressive disorder, however, are encountered in drug dependants while they are free from both the direct drug effect and withdrawal symptoms. According to a number of recent studies in which structured interviews were used and operational diagnostic criteria were applied, cooccurrence of depression and drug abuse is much higher than expected in the general population. The rates vary somewhat across studies in different sites, but the overall figures of lifetime and recent prevalence of the two conditions confirm their close association 117-120 . The subthreshold depressive symptomatology was shown to have an equal or even higher impact than

Primacy and Recency Effects Getting the Right Cognitive

For example, if a question begins by describing a patient as having a generalized anxiety disorder, all of the information that follows will tend to be seen in that context, even though the anxiety disorder diagnosis may not be directly pertinent to the correct answer for the question.

Specific Instruments for Measuring the Severity of Depression

The HAM-D (Hamilton Rating Scale for Depression) is the most widely used observer-reporting scale all over the world, particularly in clinical trials. It requires special observation skills. It is biologically oriented, and somatic symptoms weigh preferentially on the total score. Nonetheless, it rates highly for anxiety symptoms 81,133 .

Neuropsychiatric syndromes

Neuropsychiatrie syndromes following traumatic brain injury are not well delineated from the classical psychiatric syndromes such as depression, psychosis, or anxiety. As a term of art, they refer to complex brain-behavior relationships that affect cognition or that may result in neurobe-havioral syndromes such as posttraumatic epilepsy, central nervous system hypersomnolence, posttraumatic headache syndrome, or normal-pressure hydrocephalus. Thus, these disorders present with both features of altered behavior and a brain-based neurological disorder.

Screening for Prostate Cancer

In screen-detected cases for any of the major treatments (radical prostatectomy, radical radiotherapy including brachytherapy, and watchful waiting, otherwise known as active monitoring or surveillance) and each can result in damaging iatrogenic complications and outcomes, including various levels of incontinence and impotence for radical interventions and anxiety relating to the presence of cancer in watchful waiting. The problem is compounded because many of the published studies contain flawed analyses and unsubstantiated conclusions. The same evidence has resulted in different approaches to screening on either side of the Atlantic, and even among states in the United States.

Categorical and Dimensional Perspectives of Depression

A first example is ''adjustment disorders in response to psychosocial stressors'' with depressed mood and with mixed anxiety and depressed mood under the diagnostic threshold of an Axis I mood disorder. In a multiaxial perspective, a psychosocial stressor would clearly belong to Axis IV, and depressive symptoms as subdiagnostic depression to Axis I. A second example is bereavement (again following a psychosocial stressor), where a 2-month criterion is totally arbitrary for the distinction between ''normal'' and ''pathological''. The point I would like to make is that both categories are undesirable survivals even if they are built on plausible hypotheses of causation. A much more complicated and difficult problem is psychiatric comorbidity, defined as the association of two or more psychiatric disorders. The association rarely represents a truly separate disorder, as is the case with the association of mania with depression in bipolar illness. But even in this case we...

Flaws of Current Diagnosis of Depression

That this statement is not a pure chimera, is demonstrated by the concept of stressor-precipitated, cortisol-induced, serotonin-related, anxiety aggression-driven depression (SeCA depression), a diagnostic concept representing a ''verticalized'' symptom structure 2 . Disorders in anxiety and aggression regulation are considered to be the primary symptoms, and related to certain disturbances in the serotonin system. They are both the precursor symptoms and the key symptoms that might trigger disturbances in mood regulation, which then would lead to the development of a depressive syndrome. case in point is the serotonergic dysfunctions ascertained in depression. They appear not to be correlated with a particular syndromal or noso-logical depression type, but with disorders in aggression and anxiety regulation, across diagnoses. A typical case in point is the group of mood disorders. In clinical practice and in research the main DSM-certified categories, major depression and dysthymia,...

Depression the Complexity of its Interface with Soft Bipolarity

Of all the classificatory schemas for affective disorders, the unipolarbipolar distinction is the one that has the broadest consensus among both researchers and clinicians. Stefanis and Stefanis wisely avoid the term ''unipolar.'' This caution is justified in as much as an increasing body of research data has indicated the existence of a prevalent group of soft bipolar disorders that occupy an intermediary position between the two poles. Bipolar II, which is the prototype of soft bipolarity, has affinity to classic manic depressive illness from a familial standpoint, but in some respects resembles unipolar patients, especially from the point of view of anxiety comorbidity. Unlike unipolars, these patients tend to cycle with antide-pressants, hence the need for mood stabilizers. Their treatment is often a nightmare, because treatments for anxiety disorders tend to destabilize the course of these patients, and mood stabilizers may not always bring about the necessary stabilization....

Duration of Acute Treatment

As there generally is a lot of inter-individual variation in the response to the acute treatment of schizophrenia, the question of when to expect first signs of this response or, alternatively, at which time the response may be judged to be insufficient and a treatment change should be initiated, is commonly asked. Respective recommendations range between 1 and 2 weeks up to half a year. Some answers may be found in reports such as that by Levinson et al 49 , which documents that patients who ultimately respond to antipsychotic treatment have shown an amelioration of various non-specific symptoms, such as sleep disturbance or anxiety and agitation, but also of positive symptoms within the first two treatment weeks. One may cautiously conclude from such studies that ongoing treatment needs to be re-evaluated if patients show no response whatsoever within the first treatment weeks.

Management of Acute Symptoms

Morphine sulfate remains an extremely effective treatment for pulmonary edema and administration should be titrated in small aliquots (2 to 5 mg IV) to reduce preload and improve cardiac performance by reducing afterload. Morphine also alleviates the sensation of air hunger, thereby indirectly reducing the level of circulating catecholamines released due to anxiety. Overadministration of morphine is unusual in patients with pulmonary edema if respiratory depression does occur, it can be easily reversed with IV nalox-one hydrochloride (Narcan).

Age Loss and the Diagnostic Boundaries of Depression

Furthermore, bereavement stands alone as a life event capable of negating the diagnosis of major depression. Thus, for example, depression following divorce, financial ruin, or the destruction of one's home is depression. Why should depression following this one life event, loss of a loved one, be any different Finally, depression is the only disorder negated by loss. If a bereaved individual develops recurrent panic attacks and associated worries after a death, the diagnosis of panic disorder is made (like depression, anxiety disorders also may be precipitated by loss) or if severe, crushing, left-sided chest pain occurs, no cardiologist would call it bereavement rather than what it really is. Thus, it might be argued that bereavement, a throwback to the outworn notion of reactive depression, should be eliminated from DSM-V. That bereavement and depression have symptoms in common, such as sadness and poor sleep, cannot be contested. But the same can be said for depression and...

Selfrating Depression Scales Some Methodological Issues

An important but much neglected issue of self-rating scales is their reduced validity after repeated use. Self-rating scales are often used to measure the temporal change of the condition. Kitamura et al 1 administered Zung's Self-Rating Depression Scale (SDS) 2 to the same women twice during pregnancy and twice after childbirth. The SDS validity was measured in terms of sensitivity and specificity using operationalized diagnoses made by psychiatrists. The SDS sufficiently identified cases of depressive disorders on the first occasion (the first trimester) but subsequently lost its validity. In the same sample, the scores of the General Health Questionnaire (GHQ) 3 lost significant differences between those women with and those without minor psychiatric morbidity 4 . This was due to the fact that the GHQ score decreased among the suffering women while the score of the non-suffering women did not change. In the literature, we have found ample reports of ''improvement'' of questionnaire...

Management of sexual concerns Decreased sexual desire

Consider discontinuing, substituting, or reducing the dosage of medications that could be contributing. Selective serotonin reuptake inhibitors (SSRIs) are very successful for treating depression and anxiety, but unfortunately they can negatively affect the sexual response cycle. Drug holidays from SSRIs can be effective, but more so for paroxetine than fluoxetine or sertraline, which have longer half-lives. Small studies show benefits to rescue agents,30,32 such as amfebutanone(buproprion), methylphenidate, amantadine, and dextroamphetamine. Sildenafil33 and yohimbine can enhance sexual desire by enhancing arousal (Table 5.5).

Limited Options on Diagnosing Depression

The presence of somatic symptoms further complicates diagnosing depressive disorders in patients with medical illnesses such as cancer or those who are elderly 1,2 . It maybe difficult to discern whether the somatic symptoms are due to depression or to the underlying medical or physical disease 3 . Some methods have been used effectively to overcome this difficulty, such as revising the number of criteria to be fulfilled 4 , or substituting some of the somatic symptoms with non-somatic ones 2 . The Hospital Anxiety and Depression Scale (HADS) has proved to be an effective scale to detect depression and assess its severity in patients with medical or physical illnesses, since it contains mainly cognitive and affective symptoms of depression and anxiety 5 .

Scorpion Venom Poisoning

Scorpion venoms have received much research attention in recent years as efforts to isolate the various components proceed. The venoms of scorpions posing a serious threat to human life possess toxins with significant neurologic and cardiovascular effects. These venoms stimulate massive release of neurotransmitters from autonomic nerve terminals, neuromuscular junctions, and the adrenal medulla, resulting in sympathetic, parasympathetic, and paralytic signs and symptoms.105,120 Pain is a common immediate symptom and may be enhanced by the presence of serotonin in many venoms.120 Paresthesias may occur as well. Systemic findings are related to venom-induced release of acetylcholine and catecholamines. Such findings may include restlessness, anxiety, roving eye movements, hypersalivation, diaphoresis, nausea, vomiting, hypertension, bradycardia, tachycardia, dysrhythmias, hyperthermia, muscle fasciculations, alternating opisthotonos and emprosthotonos, weakness, paralysis, difficulty...

Whether Non Phobic Uncued As Well as Phobic Cued Symptoms are Present

The absence of non-phobic (uncued, unexpected, unpredictable) anxiety or depression is per se insufficient to classify a phobia, but its presence strengthens the chance that one is seeing agoraphobia or social phobia. Whereas specific phobics rarely have other mental health problems, many agoraphobics also have non-phobic panics and anxiety without any particular trigger, often during depressive episodes 4,5,16,21 . The more diffuse forms of social phobia too are liable to low mood. Calling such associated non-phobic symptoms comorbidities seems premature, as that would imply their being separate from the phobia. Until this issue has been better explored, we prefer to call them associations rather than comorbidities. The association of phobias with non-phobic anxiety and depression was noted yet again in recent multivariate analyses. A higher order ''internalizing'' factor comprising several phobic and other anxiety disorders and mood disorders emerged in analyses of a US national...

Preoperative Planning

The information should be clear and understandable, in order for the patient to give his or her informed consent to the procedure. In addition to the patient's right to information, good preoperative information reduces preoperative anxiety, thereby decreasing stimulation of the sympathetic nerve system. Preoperative anxiety, cigarette smoking and other stimulation of the sympathetic nervous system, in addition to the surgical trauma, lead to an increase in peri-operative coronary thrombosis and vasospasms.

Effects of Anaesthesia

Some procedures, most often carotid thromboendar-terectomy (TEA) and acute peripheral embolectomy, may be performed under local anaesthesia. Due to the known cardiac risk of the vascular patient, it is important to treat the anxiety of a patient who is awake during surgery. However, some surgeons prefer to have the patient awake to be able to assess their level of consciousness, especially during carotid surgery, and to avoid unnecessary use of a shunt during the procedure.

Sexual pain syndromes

Discuss the woman's options to determine which she is most comfortable with. Use of fingers can readily transfer to partner's fingers and, for male partners, the penis. Many couples describe this process as anxiety provoking but also very erotic. Initially, the woman starts her homework solo. With lots of sexual lubrication, have her practice touching her genitalia and inserting one finger into her vagina. Once she is comfortable with this step, have her progress to inserting two fingers. She moves on to the next step once she is comfortable.

Mary Anne Enoch Md Mrcgp

Case Mrs A., a middle-aged, smartly dressed woman who prided herself on her homemaker skills, came to see her family practitioner, Dr B., complaining of tiredness, depressed mood, anxiety, disturbed sleep, and weight gain. Dr B. knew that her husband, a well-known local politician, had recently left her for a younger woman, so he tactfully avoided that subject, asking instead after her grown children who lived out of state. After questioning Mrs A. about her symptoms, Dr B. concluded that she might be hypothyroid, depressed, anemic, or all three, and ran the appropriate tests. Several visits later, after normal test results and a failed trial of antidepressants, Dr B. was feeling baffled until Mrs A. finally broke down in tears and revealed the cause of her symptoms. She had been a heavy drinker in her youth but had managed to stop when she had decided to have children. However, the recent stress and humiliation of her husband's desertion and subsequent loss of self-esteem, social...

Comorbidity with other psychiatric disorders

Alcoholism is complicated by the fact that, particularly in women, it is often accompanied by other psychiatric disorders therefore, a holistic approach is required for treatment. Comorbid conditions include tobacco use, drug abuse, major depression, anxiety disorders, bulimia nervosa, and antisocial personality disorder (ASPD).4 Alcohol problems predict the subsequent use of tran-quilizing drugs in older women.5 Severe alcoholism, impulsivity, and suicidal tendencies also tend to coexist but are more likely to group in men.6 ASPD and antisocial symptoms are more prominent in male alcoholics, whereas in women alcoholism is often associated with anxiety (particularly social phobia) and affective disorders.4 Major depression is much more common in women than in men, and many studies have shown that antecedent depression is a risk factor for problem drinking. In women, there is a strong relationship between depression and smoking depressed individuals are more likely to smoke and are...

Anesthesia for Endovascular Interventions

Cedure and to augment sedation at the onset of the intervention. Premedication with 25 to 50 mg of diphenhydramine and 5mg of diazepam given orally 1 hour prior to the procedure relieves many patients of the anxiety and anticipation of the intervention. Once the patient is on the catheterization table, sedation with 1 to 2mg of lorazepam in addition to 50 mg of fentanyl provides further sedation and excellent pain control. The skin at the puncture site is infiltrated with the chosen local anesthetic and the potential track of the puncture needle is also infiltrated. If during the arterial puncture the patient complains of pain, additional local anesthetic can be infiltrated in the area directly through the Seldinger needle prior to arterial puncture.

Severity and Duration of Major Depressive Episode MDE

Decreased social ability Anxiety Anxiety, psychic* Anxiety, somatic Psychomotor agitation Depressed mood* Guilt feelings* mixed anxiety-depression Factor-analytic studies with the HAM-D 25 have shown that the first factor is a severity one whereas the second factor is a bipolar one, measuring anxiety vs. retardation. As discussed elsewhere 21 , the Kielholz classification system for antidepressants includes a sedative-anxiolytic vs. an activating profile. The SRMs, especially mianserin and mirtazapine whose action is also anti-histaminergic, are sedative-anxiolytic drugs. This is reflected in the use of reference drugs when evaluating the antidepressive effects of new drugs in patients with major depression. Thus, mirtazapine has typically been compared to amitriptyline, whereas the SSRIs and moclobemide typically have been compared to imipramine, and reboxetine to imipramine or desipramine.

Environmental factors

When stressed, partly because cigarette smoking is anxiolytic. Stress frequently provokes smoking relapse. Analyses of large national surveys of women's drinking habits found that the prevalence of childhood sexual abuse in the community was 15-26 ,25 and was associated with a fourfold increase in the lifetime prevalence of alcoholism and other drug abuse, depression, anxiety, and sexual dysfunction.26,27 Among women drug users, 70 report childhood sexual abuse and more than 80 had at least one parent addicted to alcohol or drugs.28

Facts about skin disease causes and prevalence

Conditions that fall under this category have a known course. Conditions such as skin cancer (melanomas) come under this heading. If left untreated, melanomas will get progressively worse and in some cases cause death. The course that progressive conditions follow can have both positive and negative aspects in terms of patient's psychological adjustment to the condition. On the one hand, because the condition will progress in a predictable fashion, patients should know what to expect and be able to prepare for it. On the other hand, however, the course that the condition will be expected to take is usually based on general estimates and may vary from patient to patient. It may therefore cause anxiety if the condition does not progress as the patient expects.

Proven Routine For Handling Each Question

You have three chances to get each question right. If you cannot get a clear answer using these three attempts, you do not know the answer. Mark your favorite letter and move on to the next question. The key to this strategy is that you always know what you are going to do next This helps you feel in control and reduces anxiety. Step 1 Read the Question. This may seem trivial, but studies have shown that most students look at the answers first. Questions cause anxiety and answers provide the solution, so many people go right for the solution. However, you cannot pick the correct answer until you know what you are being asked.

Psychiatric syndromes

We have seen in Chapter 1 that traumatic brain injury of the closed-head type preferentially causes lesions in the frontal and temporal brain structures. Within these structures lie the primary neural systems for regulation of affect and mood. Thus, it is not surprising that the more classical psychiatric syndromes might be seen following brain injury.218 Neuropsychiatry syndromes following traumatic brain injury described earlier were distinguished by complex brain-behavior relationships that affect cognition or that might result in neurobehavioral syndromes. On the other hand, the more pure forms of psychiatric disturbance also occur following brain injury and do not necessarily carry the accompanying cognitive impairment of the neuropsychiatric disorders. McAllister and Green and others have reminded us that many psychiatric disorders, including mood disorders, psychotic disorders, anxiety disorders, and obsessive-compulsive disorders, occur with significantly increased frequency...

Terms And Definitions

Fear is the emotional response that is aroused by anxiety, panic, fright, terror, horror, an or apprehension to real danger. d. Anxiety. Anxiety is the distress or uneasiness caused by danger or situational stress that involves the feeling of apprehension, uncertainty, and insecurity.

Sustained treatment prevention of relapse

There is considerable evidence that long-lasting neurobiological changes in the brains of alcoholics contribute to the persistence of craving. At any stage during recovery, relapse can be triggered by internal factors (craving for alcohol, depression, and anxiety) or external factors (environmental triggers, social pressures, life events, taking drugs, and narcotics). Depression is associated with relapse in women but not in men. For both sexes the severity of alcoholism is a predictor of relapse, but for women a measure of psychological functioning and social networks are predictive of outcome. Married men are less likely to relapse after treatment. For women, being married contributes to relapse in the short term.45 Alcoholic women appear to receive less support from family and friends than do non-alcoholic women, both in childhood and adulthood.42 The development of new, fulfilling social roles and an effective social support network (such as through Alcoholics Anonymous or Women...

Current Classifications Of Phobic Disorders And Their Similarities And Differences

ICD-10 lists, under the heading ''Neurotic, stress-related and somatoform disorders'', F40 Phobic anxiety disorders, the diagnoses F40.0 Agoraphobia, 40.1 Social phobias and 40.2 Specific (isolated) phobias, which closely resemble those that DSM-IV-TR lists under the heading ''Anxiety disorders'' (300.21, 300.22, 300.23 and 300.29). ICD-10 lists, under F40 Phobic anxiety disorders, two diagnoses (F40.8 Other phobic anxiety disorders and F40.9 Phobic anxiety disorder unspecified) that have no counterpart in DSM-IV-TR. ICD-10 lists a diagnosis F41.0 Panic disorder (episodic paroxysmal anxiety) under F41 Anxiety disorders rather than F40 Phobic anxiety disorders (and excludes from it F40.0 Panic disorder with agoraphobia). DSM-IV-TR lists its counterpart 300.01 Panic disorder without agoraphobia under ''Anxiety disorders''.

Anxiety Away

Anxiety Away

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