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1.
Adv Exp Med Biol ; 1191: 237-261, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32002933

RESUMO

Anxiety disorders are debilitating psychological disorders characterized by a wide range of cognitive and somatic symptoms. Anxiety sufferers have a higher lifetime prevalence of various medical problems. Chronic medical conditions furthermore increase the likelihood of psychiatric disorders and overall dysfunction. Lifetime rates of cardiovascular, respiratory, gastrointestinal, and other medical problems are disproportionately high in anxiety and panic/fear sufferers. The heightened comorbidity is not surprising as many symptoms of anxiety and panic/fear mimic symptoms of medical conditions. Panic disorder specifically is strongly linked to medical conditions due to its salient somatic symptoms, such as dyspnea, dizziness, numbness, chest pain, and heart palpitations, all of which can signal danger and deterioration for chronic disease sufferers. This chapter identifies shared correlates of medical illness and anxiety disorders and evidence for misinterpretation of symptoms as medically relevant and offers an analysis of implications for treatment of both types of conditions. We will concentrate on medical conditions with high associations for anxiety and panic by aspects of symptomatology, specifically neurological disorders (fibromyalgia, epilepsy, cerebral palsy), diabetes, gastrointestinal illness (irritable bowel syndrome, gastroesophageal reflux disease), and cardiovascular and respiratory illnesses (asthma).


Assuntos
Transtornos de Ansiedade/epidemiologia , Transtornos de Ansiedade/terapia , Transtornos de Ansiedade/complicações , Transtornos de Ansiedade/psicologia , Doença Crônica , Comorbidade , Humanos , Transtorno de Pânico/complicações , Transtorno de Pânico/epidemiologia , Transtorno de Pânico/psicologia , Transtorno de Pânico/terapia
2.
Psychopathology ; 52(3): 184-190, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31401628

RESUMO

BACKGROUND: Different studies have shown that a patient's attachment correlates with the psychotherapy outcome. However, these findings are based on the traditional interview and paper and pencil attachment methods. Latency-based methods like the Implicit Association Test (IAT) have not yet been investigated in clinical attachment research, specifically in therapy outcome research. OBJECTIVES: It can be hypothesized that patients with positive schemas of their mother and their partner may show a better psychotherapeutic outcome than those with less positive schemas of their mother/partner. METHOD: A sample of 103 patients suffering from panic disorder with or without agoraphobia (age 36.73, SD = 10.80), including 56% of patients with affective or other anxiety disorders as comorbidities without a personality disorder, based on the Structured Clinical Interview for DSM-IV (SCID-I/II), were treated with a manualized cognitive-behavioral confrontation therapy. Two IATs (for mother and partner) were implemented before the therapy (t1). The symptom reduction was assessed by the Symptom Checklist-90 (SCL-90) and the Beck Depression Inventory (BDI) with symptoms at t1 and IAT at t1 as predictors of symptoms at t2. RESULTS: The results confirmed a moderate to high therapeutic effect of the confrontation therapy. Furthermore, the mother's IAT at t1 predicted the Global Severity Index (ß = 0.20) as well as the Anxiety subscale (ß = 0.18) at t2 above and beyond the t1 measurement of the criteria. CONCLUSIONS: Implicit attitudes of the mother predicted the symptom reduction and a better therapeutic outcome. Relationship aspects with less impact awareness predicted the therapeutic outcome, even though mostly cognitive-behavioral techniques were used.


Assuntos
Manual Diagnóstico e Estatístico de Transtornos Mentais , Transtorno de Pânico/psicologia , Psicoterapia/métodos , Adulto , Feminino , Humanos , Masculino , Resultado do Tratamento
3.
Nord J Psychiatry ; 73(7): 417-424, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31373520

RESUMO

Aims: The current study explore the relationship between the trajectories of primary panic disorder symptoms and secondary depressive symptoms during guided internet-delivered cognitive behaviour therapy for panic disorder. Materials and methods: The patients (N=143) were recruited from an ongoing effectiveness study in secondary mental health outpatient services in Norway. Weekly self-reported primary panic disorder symptoms and secondary depressive symptoms were analysed. Results: primary panic disorder symptoms and secondary depressive symptoms improved significantly during the course of treatment, and at six months follow-up. Parallel process latent growth curve modelling showed that the trajectory of depressive symptoms and trajectory of panic disorder symptoms were significantly related. A supplementary analysis with cross-lagged panel modelling showed that (1) pre-treatment depressive symptoms predicted a positive effect of panic disorder symptoms early in treatment; (2) high early treatment panic disorder symptoms predicted low depressive symptoms at post-treatment. Conclusions: Guided ICBT for panic disorder is effective for both primary panic disorder symptoms and secondary depressive symptoms. Patients with high pre-treatment secondary depressive symptoms may constitute a vulnerable subgroup. A high level of panic disorder symptoms early in treatment seems beneficiary for depressive symptoms outcome. A time-dependent model may be necessary to describe the relationship between PAD symptoms and depressive symptoms during the course of treatment.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Depressão/terapia , Internet , Transtorno de Pânico/terapia , Autorrelato , Terapia Assistida por Computador/métodos , Adolescente , Adulto , Idoso , Serviços Comunitários de Saúde Mental/métodos , Depressão/epidemiologia , Depressão/psicologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Noruega/epidemiologia , Transtorno de Pânico/epidemiologia , Transtorno de Pânico/psicologia , Resultado do Tratamento , Adulto Jovem
4.
Nord J Psychiatry ; 73(6): 380-386, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31322453

RESUMO

Objective: In the present study, we compared social anxiety disorder (SAD) patients with (n = 31) and without childhood and adulthood separation anxiety disorder (SeAD) (n = 50) with respect to suicidal behavior, avoidant personality disorder (AvPD), other anxiety disorders (ADs), and major depression as well as some sociodemographic variables. Methods: In assessment of patients, we used Structured Clinical Interview for Separation Anxiety Symptoms, childhood and adulthood Separation Anxiety Symptom Inventories, Liebowitz Social Anxiety Scale, The SCID-II Avoidant Personality Disorder Module, Beck Depression Inventory, and Beck Scale for Suicidal Ideation. Results: SAD patients with SeAD had higher comorbidity rates of AvPD, other lifetime ADs and panic disorder, and current major depression than those without SeAD. The current scores of SAD, depression, and suicide ideation and the mean number of AvPD symptoms were significantly higher in comorbid group compared to pure SAD subjects. The SAD and SeAD scores had significant associations with current depression, suicide ideations, and AvPD. The mean number of AvPD criteria and the current severity of depression were significantly associated with the comorbidity between SAD and SeAD. Conclusion: Our findings might indicate that the comorbidity of SeAD with SAD may increase the risk of the severity of AvPD and current depression.


Assuntos
Ansiedade de Separação/complicações , Ansiedade de Separação/psicologia , Fobia Social/complicações , Fobia Social/psicologia , Adulto , Ansiedade de Separação/diagnóstico , Comorbidade , Depressão/diagnóstico , Depressão/psicologia , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/psicologia , Feminino , Humanos , Masculino , Transtorno de Pânico/diagnóstico , Transtorno de Pânico/psicologia , Transtornos da Personalidade/diagnóstico , Transtornos da Personalidade/psicologia , Fobia Social/diagnóstico , Escalas de Graduação Psiquiátrica , Ideação Suicida
5.
Nord J Psychiatry ; 73(4-5): 293-301, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31157577

RESUMO

Background: The impairments in metacognitive functions and emotion recognition are considered as liable factors in anxiety disorders. Aims: The better understanding of these cognitive abilities might lead to develop more accurate treatment methods for patients who suffer from anxiety. Methods: Forty-four patients with panic disorder (PD), 37 individuals with generalized anxiety disorder (GAD) and 44 healthy control (HC) were participated in our study. Metacognition questionnaire-30 (MCQ-30), Reading The Mind From The Eyes Test and symptom severity tests were administered. Results: Statistical analyses estimated the dysfunctional metacognitive beliefs and disrupted emotion recognition in patients relative to HC. The 'need to control thoughts' aspect of metacognitive beliefs was accounted for symptom severity in GAD. Improper metacognitive beliefs were significantly predicted the PD and GAD. In addition, impoverished emotion recognition predicted the GAD. Conclusions: Our study revealed the role of inconvenient metacognitive beliefs and distorted emotion recognition in PD and GAD. These findings might facilitate the treatment management in cognitive therapies of anxiety disorders via pointing out more reasonable targets across improper cognitive fields.


Assuntos
Transtornos de Ansiedade/psicologia , Emoções/fisiologia , Metacognição/fisiologia , Transtorno de Pânico/psicologia , Inquéritos e Questionários , Adulto , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/terapia , Terapia Cognitivo-Comportamental/métodos , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtorno de Pânico/diagnóstico , Transtorno de Pânico/terapia
6.
J Abnorm Psychol ; 128(4): 295-304, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31045412

RESUMO

Major depressive disorder (MDD), generalized anxiety disorder (GAD), and panic disorder (PD), constitute common mental disorders that may have chronic and disabling courses. Cognitive and behavioral theories posit that lack of engagement in certain strategies (goal persistence, self-mastery, positive reappraisal) increases vulnerability toward these disorders. Further, scar effect theories assert that experiencing more of these disorders may diminish engagement in such strategies within individuals across time. However, dynamic longitudinal associations between cognitive-behavioral strategies (CBS) and disorder counts across adulthood are not well understood. Using bivariate latent difference score models, this study aimed to test the dynamic trajectories between disorder counts and each CBS across 18 years. Participants were 3,294 community-dwelling adults ages 45.62 years (SD = 11.41, range = 20-74; 54.61% female) who took part in 3 waves of measurement spaced 9 years apart. Self-mastery, disorder counts, and their change were not significantly related. However, higher within-subject increase in goal persistence (but not self-mastery or positive reappraisal) led to greater future decline in disorder counts, but not vice versa. Last, within individuals, greater prior levels of goal persistence and positive reappraisal predicted larger subsequent reduction in disorder counts, and vice versa. The reciprocal, bidirectional associations between specific CBS (goal persistence, positive reappraisal) and disorder counts support both vulnerability and scar models of depression and anxiety. Treatments for MDD, GAD, and PD should attempt to enhance perseverance and optimism. Theoretical and clinical implications are further discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Transtornos de Ansiedade/diagnóstico , Transtorno Depressivo Maior/diagnóstico , Transtorno de Pânico/diagnóstico , Adolescente , Adulto , Idoso , Ansiedade , Transtornos de Ansiedade/psicologia , Transtorno Depressivo Maior/psicologia , Feminino , Metas , Humanos , Masculino , Pessoa de Meia-Idade , Otimismo , Transtorno de Pânico/psicologia , Autoimagem , Autogestão , Adulto Jovem
7.
Behav Cogn Psychother ; 47(5): 611-615, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30935431

RESUMO

BACKGROUND: Cognitive behavioural therapy (CBT) for panic disorder encourages patients to learn about and make changes to thoughts and behaviour patterns that maintain symptoms of the disorder. Instruments to assess whether or not patients understand therapy content do not currently exist. AIMS: The aim of this study was to examine if increases within specific knowledge domains of panic disorder were related to improvement in panic symptoms following an intensive 2-day panic treatment. METHOD: Thirty-nine Veterans enrolled in an intensive weekend panic disorder treatment completed knowledge measures immediately before the first session of therapy and at the end of the last day of therapy. Four panic disorder experts evaluated items and reached consensus on subscales. Subscales were reduced further to create psychometrically sound subscales of catastrophic misinterpretation (CM), behaviours (BE), and self-efficacy (SE). A simple regression analysis was conducted to determine whether increased knowledge predicted symptom change at a 3-month follow-up assessment. RESULTS: The overall knowledge scale was reduced to three subscales BE (n = 7), CM (n = 13) and SE (n = 8) with good internal consistency. Veterans' knowledge of panic disorder improved from pre- to post-treatment. Greater increase in scores on the knowledge assessment predicted lower panic severity scores at a 3-month follow-up. A follow-up analysis using the three subscales as predictors showed that only changes in CM significantly contributed to the prediction. CONCLUSIONS: In an intensive therapy format, reduction in panic severity was related to improved knowledge overall, but particularly as a result of fewer catastrophic misinterpretations.


Assuntos
Terapia Cognitivo-Comportamental , Transtorno de Pânico/psicologia , Transtorno de Pânico/terapia , Adulto , Feminino , Humanos , Masculino , Psicometria , Estudos Retrospectivos , Autoeficácia , Resultado do Tratamento , Veteranos/psicologia
8.
Behav Ther ; 50(3): 659-671, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31030881

RESUMO

Emotion regulation (ER) has been incorporated into many models of psychopathology, but it has not been examined directly in cognitive behavioral therapy (CBT) for panic disorder with agoraphobia (PD/A). In this study, a preliminary model of ER in CBT for PD/A is proposed based on existing theories, and several propositions of the model are tested. We hypothesized that increases in cognitive reappraisal would precede decreases in biased cognitions, decreases in expressive suppression would follow decreases in biased cognitions, and a reduction in symptom severity would follow decreases in expressive suppression. Twenty-nine patients who received CBT for PD/A completed weekly self-report measures of symptom severity, anxiety sensitivity, reappraisal and expressive suppression. In addition, patients were compared to a matched normal sample. Cross-lagged analyses partially supported the hypotheses. Reappraisal did not change until late stages of therapy and was generally not associated with treatment outcome. Suppression decreased significantly and exhibited a reciprocal relationship with biased cognitions. Symptom reduction followed decreases in suppression as hypothesized. However, patients did not differ in ER from matched controls at either pre- or posttreatment. Results suggest the important distinction between reappraisal and appraisal, and stress the role of session-by-session decreases in suppression as a predictor of symptom reduction.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Emoções/fisiologia , Transtorno de Pânico/psicologia , Transtorno de Pânico/terapia , Adulto , Agorafobia/diagnóstico , Agorafobia/psicologia , Agorafobia/terapia , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/psicologia , Transtornos de Ansiedade/terapia , Cognição/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtorno de Pânico/diagnóstico , Autorrelato , Resultado do Tratamento
9.
Neuropsychobiology ; 78(1): 7-13, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30970364

RESUMO

BACKGROUND: Recent investigations have highlighted significant differences in verbal recall between patients with panic disorder (PD) and controls. These studies have highlighted that verbal memory and working memory could be impaired in PD. OBJECTIVES: The objective of the present meta-analysis is to confirm this hypothesis, reviewing the studies that have investigated neurocognitive testing in PD. METHODS: We performed a systematic literature search for studies published between 1980 and 2015 that reported cognitive measurements in PD patients and controls. Effect size estimates were computed using the restricted maximum likelihood model. Only case-control studies were selected for this meta-analysis. We included studies that made a direct comparison between PD subjects and healthy controls. The diagnostic group consisted of adult patients aged over 18 years diagnosed with PD. We excluded the studies that did not employ a case-control design. All statistical analyses were carried out on R using the "metafor" package version 1.9-8. The effect size for each study neuropsychological test was calculated using the mean and SD of performance results, and p values < 0.05 were considered significant. RESULTS: We identified few studies that tested verbal memory and executive functions in PD patients and controls, and this difference was not significant. On the other hand, there are several studies that have used the emotional Stroop task to assess cognitive functions in PD. There is no robust evidence of impairment of memory function in PD; however, when considering the emotional Stroop task, it was found that PD patients performed slower (p < 0.01) than healthy controls for all three types of stimuli (neutral, negative, positive). CONCLUSION: This meta-analysis included a small number of studies, which may have introduced bias into the analysis. However, there is some evidence of impairment of neurocognitive functions in PD when performing the emotional Stroop task. Furthermore, the paucity of studies evaluating neurocognition in PD suggests the need for further research in this field in order to draw meaningful conclusions.


Assuntos
Atenção , Emoções , Transtorno de Pânico/psicologia , Humanos , Teste de Stroop
10.
Neuropsychobiology ; 78(1): 31-37, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30947222

RESUMO

Panic disorder (PD) is associated with increased body vigilance and reduced cognitive resources directed at non-fear-related stimuli, particularly in the absence of stimulus-rich environments. To date, only few studies have investigated whether this deficit in PD is reflected in reduced mismatch negativity (MMN), an event-related potential indexing preattentive sensitivity to unexpected stimulus changes. We tested 35 patients affected by PD and 42 matched healthy controls in an oddball paradigm, using frequency and duration deviant stimuli to measure auditory MMN. PD patients displayed reduced duration MMN amplitudes in comparison to healthy controls. No group differences were detected for duration MMN latency, as well as frequency MMN indices. Results support the notion of reduced processing of non-fear-related stimuli in PD patients, particularly with regard to the preattentive processing of sound duration deviants. Additionally, our findings are in line with clinical studies reporting divergent deficits in preattentive processing of frequency and duration deviants.


Assuntos
Atenção , Percepção Auditiva , Transtorno de Pânico/psicologia , Adulto , Atenção/fisiologia , Percepção Auditiva/fisiologia , Encéfalo/fisiopatologia , Eletroencefalografia , Feminino , Humanos , Masculino , Transtorno de Pânico/fisiopatologia , Transtorno de Pânico/terapia
11.
J Affect Disord ; 251: 130-135, 2019 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-30921596

RESUMO

BACKGROUND: Symptoms of depressed mood and anxiety have been associated with immune dysregulation and atopic disorders, however it is unclear whether this relationship spans other forms of psychopathology. The objective of this study was to use a large, population-based sample to examine the association between several common psychiatric conditions and two atopic disorders: seasonal allergies and asthma. This study also examined whether comorbidity between psychiatric disorders confounded the relationship between atopy and each psychiatric disorder. METHODS: Data come from the Comprehensive Psychiatric Epidemiology Surveys, a nationally-representative sample of US adults (N = 10,309). Lifetime history of major depressive disorder (MDD), generalized anxiety disorder (GAD), panic disorder (PD), and post-traumatic stress disorder (PTSD) was assessed using the Composite International Diagnostic Inventory. History of seasonal allergies and asthma were assessed by self-report. Weighted logistic regression was used to evaluate the association between allergies and asthma and psychopathology. Psychiatric comorbidities were also examined as potential confounders. RESULTS: Approximately 36.6% had a history of allergies and 11.5% a history of asthma. Seasonal allergies were positively associated with odds of MDD (Odds ratio (OR): 1.24, 95% Confidence Interval (CI): 1.06-1.46), GAD (OR: 1.54 (1.28-1.84)), PD (OR: 1.54 (1.24-1.91)), and PTSD (OR: 1.32 (1.09-1.59)). Asthma was not significantly associated with any psychiatric disorder. All significant associations persisted after adjustment for psychiatric comorbidities. LIMITATIONS: Limitations include self-reporting of atopic disorder status and of all disorder ages of onset. CONCLUSIONS: This study confirms the association between MDD and PD and seasonal allergies, and extends this relationship to GAD and PTSD.


Assuntos
Transtornos de Ansiedade/epidemiologia , Asma/epidemiologia , Transtorno Depressivo Maior/epidemiologia , Transtorno de Pânico/epidemiologia , Rinite Alérgica Sazonal/epidemiologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Adolescente , Adulto , Idoso , Transtornos de Ansiedade/psicologia , Transtorno Depressivo Maior/psicologia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Transtorno de Pânico/psicologia , Psicopatologia , Autorrelato , Transtornos de Estresse Pós-Traumáticos/psicologia , Estados Unidos/epidemiologia , Adulto Jovem
12.
Depress Anxiety ; 36(6): 522-532, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30838764

RESUMO

BACKGROUND: It is unknown whether social anxiety disorder (SAD) has a unique association with alcohol use disorder (AUD) over and beyond that of other anxiety disorders, how the associations develop over time, and whether the associations are likely to be causal. METHODS: Diagnoses of AUD, SAD, generalized anxiety disorder, panic disorder, agoraphobia, and specific phobias were assessed twice using the Composite International Diagnostic Interview among 2,801 adult Norwegian twins. The data were analyzed using logistic regression analyses and multivariate biometric structural equation modeling. RESULTS: SAD had the strongest association with AUD, and SAD predicted AUD over and above the effect of other anxiety disorders. In addition, SAD was prospectively associated with AUD, whereas other anxiety disorders were not. AUD was associated with a slightly elevated risk of later anxiety disorders other than SAD. Biometric modeling favored a model where SAD influenced AUD compared to models where the relationship was reversed or due to correlated risk factors. Positive associations between AUD and other anxiety disorders were fully explained by shared genetic risk factors. CONCLUSIONS: Unlike other anxiety disorders, SAD plausibly has a direct effect on AUD. Interventions aimed at prevention or treatment of SAD may have an additional beneficial effect of preventing AUD, whereas interventions aimed at other anxiety disorders are unlikely to have a similar sequential effect on AUD.


Assuntos
Alcoolismo/complicações , Alcoolismo/psicologia , Transtornos de Ansiedade/complicações , Transtornos de Ansiedade/psicologia , Fobia Social/complicações , Fobia Social/psicologia , Adulto , Agorafobia/complicações , Agorafobia/psicologia , Feminino , Humanos , Masculino , Noruega , Transtorno de Pânico/complicações , Transtorno de Pânico/psicologia , Transtornos Fóbicos/complicações , Transtornos Fóbicos/psicologia , Fatores de Risco , Gêmeos/psicologia , Adulto Jovem
13.
J Affect Disord ; 250: 204-209, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-30870769

RESUMO

BACKGROUND: Hypervigilance to panic-related stimuli is believed to play a critical role in the pathogenesis of panic disorder. The current event-related potential study explored whether this hyperresponsivity occurred in the absence of focused attention. METHODS: Mismatch negativity (MMN) responses to panic-related vs. neutral deviants were assessed in 15 medication-free panic patients without agoraphobia and 16 healthy controls using a reverse-standard-deviant paradigm. RESULTS: Panic patients relative to healthy controls exhibited an enhanced MMN in response to panic-related sounds but a reduced MMN in response to neutral sounds. Furthermore, MMN responses were delayed in panic patients compared to healthy controls, irrespective of stimulus type. LIMITATION: The sample size is relatively small. CONCLUSIONS: Our data provide evidence that panic disorder was associated with an increased sensitivity to panic-related changes, accompanied by a reduced sensitivity to other acoustic changes as well as a general slow-down of cognitive processing during the preattentive processing stage.


Assuntos
Atenção/fisiologia , Potenciais Evocados Auditivos/fisiologia , Transtorno de Pânico/fisiopatologia , Estimulação Acústica , Adulto , Eletroencefalografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtorno de Pânico/psicologia
14.
Psychiatry Res ; 273: 82-88, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30640055

RESUMO

Nocturnal panic involves waking suddenly from sleep in a state of panic, with no apparent cause, and affects more than half of patients with panic disorder. The Fear of Loss of Vigilance theory is the only proposed model for nocturnal panic, suggesting nocturnal panickers fear states in which they are unable to react to danger or protect themselves from threats. Prior work using a self-report questionnaire designed to test the theory (i.e., Fear of Loss of Vigilance Questionnaire; FLOVQ) was unsuccessful at differentiating nocturnal from daytime panickers. This study tested the theory using alternative measures to the FLOVQ. We predicted nocturnal panickers would show elevated responses to measures assessing fears of being unable to respond to or protect themselves from threats. A diverse community sample (N = 218) completed self-report measures related to panic attacks, intolerance of uncertainty, responsibility for harm, and anxiety sensitivity dimensions. Nocturnal panickers endorsed greater inhibitory intolerance of uncertainty and responsibility for harm, but not prospective intolerance of uncertainty, or anxiety sensitivity physical or cognitive concerns. This study provides support for the fear of loss of vigilance theory and suggests intolerance of uncertainty and responsibility for harm reduction be targeted in treatment for nocturnal panic attacks.


Assuntos
Medo/psicologia , Transtorno de Pânico/diagnóstico , Transtorno de Pânico/psicologia , Inquéritos e Questionários , Incerteza , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Transtornos do Sono-Vigília/diagnóstico , Transtornos do Sono-Vigília/psicologia
16.
Psychiatry Res ; 272: 349-358, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30599438

RESUMO

Checking behavior (CB) occurs in a variety of disorders such as obsessive-compulsive (OCD), body dysmorphic (BDD), illness anxiety (IA), and panic disorder (PD), as well as anorexia (AN) and bulimia nervosa (BN). Etiological models of these disorders - with the exception of those for PD - postulate that CB mainly occurs in situations characterized by negative affect and serves to regulate it. We aimed to test these assumptions: N = 386 individuals with a self-reported diagnosis of one of the disorders rated their affect at baseline, directly before a remembered CB episode, during, immediately afterwards, and 15 and 60 minutes afterwards, and rated their endorsement of different functions of CB. The results show that transdiagnostically negative affect is significantly higher before CB compared to baseline, and is significantly reduced from before CB to all post-CB assessments. Reduction of negative affect and Attainment of certainty were the sole functions predicting the affective course during CB, and most prominently reported transdiagnostically. Assumptions of the etiological models were confirmed, suggesting that exposure and ritual prevention should be examined across disorders. As attainment of certainty seems to be predictive for the course of CB, this might be targeted in cognitive interventions.


Assuntos
Anorexia Nervosa/psicologia , Transtornos Dismórficos Corporais/psicologia , Bulimia Nervosa/psicologia , Hipocondríase/psicologia , Transtorno Obsessivo-Compulsivo/psicologia , Transtorno de Pânico/psicologia , Adulto , Afeto/fisiologia , Anorexia Nervosa/diagnóstico , Anorexia Nervosa/epidemiologia , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/epidemiologia , Transtornos de Ansiedade/psicologia , Transtornos Dismórficos Corporais/diagnóstico , Transtornos Dismórficos Corporais/epidemiologia , Bulimia Nervosa/diagnóstico , Bulimia Nervosa/epidemiologia , Comorbidade , Feminino , Humanos , Hipocondríase/diagnóstico , Hipocondríase/epidemiologia , Masculino , Transtorno Obsessivo-Compulsivo/diagnóstico , Transtorno Obsessivo-Compulsivo/epidemiologia , Transtorno de Pânico/diagnóstico , Transtorno de Pânico/epidemiologia , Autorrelato/normas
17.
Artigo em Inglês | MEDLINE | ID: mdl-29705713

RESUMO

Depression and panic disorder (PD) share the common pathophysiology from the perspectives of neurotransmitters. The relatively high comorbidity between depression and PD contributes to the substantial obstacles to differentiate from depression and PD, especially for the brain pathophysiology. There are significant differences in the diagnostic criteria between depression and PD. However, the paradox of similar pathophysiology and different diagnostic criteria in these two disorders were still the issues needing to be addressed. Therefore the clarification of potential difference in the field of neuroscience and pathophysiology between depression and PD can help the clinicians and scientists to understand more comprehensively about significant differences between depression and PD. The researchers should be curious about the underlying difference of pathophysiology beneath the significant distinction of clinical symptoms. In this review article, I tried to find some evidences for the differences between depression and PD, especially for neural markers revealed by magnetic resonance imaging (MRI). The distinctions of structural and functional alterations in depression and PD are reviewed. From the structural perspectives, PD seems to have less severe gray matter alterations in frontal and temporal lobes than depression. The study of white matter microintegrity reveals more widespread alterations in fronto-limbic circuit of depression patients than PD patients, such as the uncinate fasciculus and anterior thalamic radiation. PD might have a more restrictive pattern of structural alterations when compared to depression. For the functional perspectives, the core site of depression pathophysiology is the anterior subnetwork of resting-state network, such as anterior cingulate cortex, which is not significantly altered in PD. A possibly emerging pattern of fronto-limbic distinction between depression and PD has been revealed by these explorative reports. The future trend for machine learning and pattern recognition might confirm the differentiation pattern between depression and PD based on the explorative results.


Assuntos
Encéfalo/diagnóstico por imagem , Transtorno Depressivo Maior/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Rede Nervosa/diagnóstico por imagem , Transtorno de Pânico/diagnóstico por imagem , Transtorno Depressivo Maior/psicologia , Diagnóstico Diferencial , Humanos , Imagem por Ressonância Magnética/normas , Transtorno de Pânico/psicologia
18.
Soc Psychiatry Psychiatr Epidemiol ; 54(5): 639-647, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30003310

RESUMO

PURPOSE: Posttraumatic stress disorder (PTSD) often co-occurs with panic disorder (PD), with some etiological models positing a causal role of panic reactivity in PTSD onset; however, data addressing the temporal ordering of these conditions are lacking. The aim of this study was to examine the bi-directional associations between PD and PTSD in a nationally representative, epidemiologic sample of trauma-exposed adults. METHODS: Participants were community-dwelling adults (62.6% women; Mage = 48.9, SD 16.3) with lifetime DSM-IV PTSD criterion A trauma exposure drawn from the 2001/2 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) and re-interviewed in 2004/5 (N = 12,467). Cox discrete-time proportional hazards models with time-varying covariates were used to investigate the bi-directional associations between lifetime PD and PTSD, accounting for demographic characteristics, trauma load, and lifetime history of major depression, generalized anxiety disorder, and social anxiety disorder. RESULTS: PD was significantly associated with subsequent onset of PTSD (HR 1.210, 95%CI = 1.207-1.214, p < .001), and PTSD was significantly associated with onset of PD (HR 1.601, 95% CI 1.597-1.604, p < .001). The association between PTSD and subsequent PD was stronger in magnitude than that between PD and subsequent PTSD (Z = - 275.21, p < .01). Men evidenced stronger associations between PD and PTSD compared to women. CONCLUSIONS: Results were consistent with a bidirectional pathway of risk, whereby PD significantly increased risk for the development of PTSD, and PTSD significantly increased risk for PD. Given the association between PTSD and subsequent PD, particularly among men, clinicians may consider supplementing PTSD treatment with panic-specific interventions, such as interoceptive exposure, to prevent or treat this disabling comorbidity.


Assuntos
Transtorno de Pânico/epidemiologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Fatores de Tempo , Adulto , Comorbidade , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtorno de Pânico/diagnóstico , Transtorno de Pânico/psicologia , Modelos de Riscos Proporcionais , Fatores de Risco , Fatores Sexuais , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/psicologia , Estados Unidos/epidemiologia
19.
Soc Psychiatry Psychiatr Epidemiol ; 54(2): 145-156, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30027449

RESUMO

PURPOSE: Mental health problems are prevalent after combat; they are also common in its absence. Estimates of deployment-attributability vary. This paper quantifies the contribution of different subtypes of occupational trauma to post-deployment mental health problems. METHODS: Participants were a cohort of 16,193 Canadian personnel undergoing post-deployment mental health screening after return from the mission in Afghanistan. The screening questionnaire assessed post-traumatic stress disorder, depression, panic disorder, generalized anxiety disorder, and exposure to 30 potentially traumatic deployment experiences. Logistic regression estimated adjusted population attributable fractions (PAFs) for deployment-related trauma, which was treated as count variables divided into several subtypes of experiences based on earlier factor analytic work. RESULTS: The overall PAF for overall deployment-related trauma exposure was 57.5% (95% confidence interval 44.1, 67.7) for the aggregate outcome of any of the four assessed problems. Substantial PAFs were seen even at lower levels of exposure. Among subtypes of trauma, exposure to a dangerous environment (e.g., receiving small arms fire) and to the dead and injured (e.g., handling or uncovering human remains) had the largest PAFs. Active combat (e.g., calling in fire on the enemy) did not have a significant PAF. CONCLUSIONS: Military deployments involving exposure to a dangerous environment or to the dead or injured will have substantial impacts on mental health in military personnel and others exposed to similar occupational trauma. Potential explanations for divergent findings in the literature on the extent to which deployment-related trauma contributes to the burden of mental disorders are discussed.


Assuntos
Militares/psicologia , Doenças Profissionais/epidemiologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Adulto , Campanha Afegã de 2001- , Transtornos de Ansiedade/epidemiologia , Transtornos de Ansiedade/psicologia , Canadá/epidemiologia , Estudos de Coortes , Transtorno Depressivo/epidemiologia , Transtorno Depressivo/psicologia , Feminino , Humanos , Modelos Logísticos , Masculino , Doenças Profissionais/psicologia , Transtorno de Pânico/epidemiologia , Transtorno de Pânico/psicologia , Prevalência , Transtornos de Estresse Pós-Traumáticos/psicologia , Adulto Jovem
20.
Behav Cogn Psychother ; 47(2): 164-180, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29897024

RESUMO

BACKGROUND: Exposure is an effective intervention in the treatment of pathological anxiety, but it is insufficiently disseminated. Therapists' negative attitudes towards exposure might be of relevance when considering factors contributing to the non-application of this intervention. AIMS: In order to be able to measure concerns in German-speaking therapist populations, the study aimed at validating a German version of the Therapist Beliefs about Exposure Scale. METHOD: The scale was translated into the German language and validated in a sample of 330 German licensed cognitive behavioural therapists. RESULTS: In the present sample, the mean total score was significantly lower than in the original study including US-American therapists. Confirmatory factor analysis did not confirm the proposed one-factor model, while the exploratory factor analysis indicated that more than one factor is necessary to explain the structure of negative attitudes towards exposure. The internal consistency was high. Higher scores (more negative beliefs) were significantly correlated with older age, holding a master's degree (vs PhD), not being specialized in the treatment of anxiety disorders and with less experience with performance of exposure gained during clinical training. Negative beliefs about exposure were further associated with the self-reported average number of sessions spent on exposure in current treatment of post-traumatic stress disorder and panic disorder, and with negative attitudes towards application of exposure sessions presented in case vignettes. CONCLUSIONS: The German adaptation provides the opportunity of measuring concerns regarding application of exposure in German-speaking therapist populations. However, the presented data reveal suggestions for further scale development.


Assuntos
Pessoal Técnico de Saúde/psicologia , Ansiedade/terapia , Atitude do Pessoal de Saúde , Terapia Cognitivo-Comportamental/normas , Transtorno de Pânico/terapia , Transtornos de Estresse Pós-Traumáticos/terapia , Adulto , Idoso , Ansiedade/psicologia , Análise Fatorial , Feminino , Alemanha , Humanos , Linguagem , Masculino , Pessoa de Meia-Idade , Transtorno de Pânico/psicologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Traduções
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