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1.
Rev Prat ; 70(6): 667-673, 2020 Jun.
Artigo em Francês | MEDLINE | ID: mdl-33058616

RESUMO

School refusal. School refusal covers a very heterogeneous set of problems ranging from refusal of schooling - in terms of engagement in learning or in situations of evaluation, in relation to knowledge - to school phobia or anxious school refusal. Furthermore, the clinical form of children and adolescents refusing school is determined by a wide range of factors - individual, family, school and cultural - that interact with each other and change over time. In the context of a multidimensional approach, the apprehension of school refusal involves a dialogue between the family, health professionals and the various players in national education. This approach makes it possible to think about the developmental trajectory of the child and lead to the establishment of a personalized care project.


Assuntos
Transtornos Fóbicos , Adolescente , Ansiedade , Criança , Família , Humanos , Transtornos Fóbicos/diagnóstico , Transtornos Fóbicos/terapia , Instituições Acadêmicas
2.
PLoS One ; 15(6): e0231517, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32574167

RESUMO

We present performance results concerning the validation for anxiety level detection based on trained mathematical models using supervised machine learning techniques. The model training is based on biosignals acquired in a randomized controlled trial. Wearable sensors were used to collect electrocardiogram, electrodermal activity, and respiration from spider-fearful individuals. We designed and applied ten approaches for data labeling considering individual biosignals as well as subjective ratings. Performance results revealed a selection of trained models adapted for two-level (low and high) and three-level (low, medium and high) classification of anxiety using a minimal set of six features. We obtained a remarkable accuracy of 89.8% for the two-level classification and of 74.4% for the three-level classification using a short time window length of ten seconds when applying the approach that uses subjective ratings for data labeling. Bagged Trees proved to be the most suitable classifier type among the classification models studied. The trained models will have a practical impact on the feasibility study of an augmented reality exposure therapy based on a therapeutic game for the treatment of arachnophobia.


Assuntos
Aprendizado de Máquina , Transtornos Fóbicos/diagnóstico , Aranhas/fisiologia , Adolescente , Adulto , Animais , Área Sob a Curva , Eletrocardiografia , Humanos , Transtornos Fóbicos/patologia , Curva ROC , Ensaios Clínicos Controlados Aleatórios como Assunto , Telemedicina/métodos , Adulto Jovem
3.
J Fam Pract ; 69(1): 33-36, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32017833

RESUMO

When a patient reports symptoms suggestive of phobia, ask questions designed to clarify thoughts and behaviors. A 4-step exposure therapy plan can also help.


Assuntos
Terapia Implosiva/métodos , Transtornos Fóbicos/diagnóstico , Transtornos Fóbicos/terapia , Gerenciamento Clínico , Humanos , Transtornos Fóbicos/psicologia
4.
Sensors (Basel) ; 20(2)2020 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-31952289

RESUMO

In this paper, we investigate various machine learning classifiers used in our Virtual Reality (VR) system for treating acrophobia. The system automatically estimates fear level based on multimodal sensory data and a self-reported emotion assessment. There are two modalities of expressing fear ratings: the 2-choice scale, where 0 represents relaxation and 1 stands for fear; and the 4-choice scale, with the following correspondence: 0-relaxation, 1-low fear, 2-medium fear and 3-high fear. A set of features was extracted from the sensory signals using various metrics that quantify brain (electroencephalogram-EEG) and physiological linear and non-linear dynamics (Heart Rate-HR and Galvanic Skin Response-GSR). The novelty consists in the automatic adaptation of exposure scenario according to the subject's affective state. We acquired data from acrophobic subjects who had undergone an in vivo pre-therapy exposure session, followed by a Virtual Reality therapy and an in vivo evaluation procedure. Various machine and deep learning classifiers were implemented and tested, with and without feature selection, in both a user-dependent and user-independent fashion. The results showed a very high cross-validation accuracy on the training set and good test accuracies, ranging from 42.5% to 89.5%. The most important features of fear level classification were GSR, HR and the values of the EEG in the beta frequency range. For determining the next exposure scenario, a dominant role was played by the target fear level, a parameter computed by taking into account the patient's estimated fear level.


Assuntos
Aprendizado Profundo , Medo/classificação , Transtornos Fóbicos , Processamento de Sinais Assistido por Computador , Adulto , Ansiedade , Diagnóstico por Computador , Eletroencefalografia , Resposta Galvânica da Pele/fisiologia , Frequência Cardíaca/fisiologia , Humanos , Transtornos Fóbicos/diagnóstico , Transtornos Fóbicos/fisiopatologia , Transtornos Fóbicos/terapia , Adulto Jovem
5.
Turk J Med Sci ; 49(5): 1324-1331, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31648437

RESUMO

Background/aim: This study was designed to investigate the relationship between kinesiophobia and the level of physical activity, depression, disease activity, fatigue, pain, and quality of life in female patients with systemic lupus erythematosus (SLE). Materials and methods: Seventy volunteer female patients were included in the study. Kinesiophobia, physical activity level, disease activity, fatigue, depression, pain, and quality of life were assessed using the Tampa Scale for Kinesiophobia (TSK), International Physical Activity Questionnaire- Short Form (IPAQ), Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), Fatigue Severity Scale (FSS), Beck Depression Inventory (BDI), McGill Pain Questionnaire- Short Form (MPQ-SF) and Nottingham Health Profile (NHP), respectively. Results: Two-thirds of the patients in the study had a high degree of kinesiophobia. Although there was a significant correlation between kinesiophobia and depression and some subscales of quality of life (sleep, social isolation, emotional reactions) (P < 0.05), no significant correlation with other parameters was found. Conclusion: As a result of this study, the majority of SLE patients included in the study were identified as having high levels of kinesiophobia. Patients' fear and avoidance reaction from movement can be influenced by psychosocial factors. Treatments focusing on kinesiophobia of SLE patients could be beneficial in increasing the success of rehabilitation.


Assuntos
Exercício Físico/psicologia , Lúpus Eritematoso Sistêmico/psicologia , Transtornos Fóbicos/etiologia , Adulto , Depressão/etiologia , Feminino , Humanos , Lúpus Eritematoso Sistêmico/complicações , Transtornos Fóbicos/diagnóstico , Escalas de Graduação Psiquiátrica , Qualidade de Vida/psicologia , Inquéritos e Questionários
6.
Span J Psychol ; 22: E44, 2019 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-31640832

RESUMO

A new computerized instrument (the Multimedia Behavioral Avoidance Test, or MBAT) for blood-injury-injection phobia (BII) assessment is presented. Analogous stimuli such as images and videos can also elicit anxiety responses; thus, they can be used for the assessment of phobia. The MBAT was applied to participants via computer, and subjective anxiety responses and time latency were recorded. The MBAT was composed of 30 original images and 30 videos related to blood, injury and injections. The MBAT was compared with other pencil-and-paper questionnaires for BII phobia, and heart rate was also measured with a pulsioximeter. The participants included 160 students and professionals (34.5% males, 65.6% females; mean 28.6 years old). The results showed a high reliability for internal consistency in images and videos (α = .98 both), with a single factor that groups all the items. In addition, the MBAT had high concurrent validity (r = .78 to .85) with the different anxiety scales compared. The MBAT diagnosed 12 participants with possible BII phobia. It is a useful instrument in the assessment of this kind of phobia because it is easier and quicker than pencil-and-paper questionnaires, it uses more objective measurements, and it is useful in planning subsequent exposure with images and videos.


Assuntos
Aprendizagem da Esquiva , Diagnóstico por Computador/normas , Testes Neuropsicológicos/normas , Transtornos Fóbicos/diagnóstico , Adulto , Aprendizagem da Esquiva/fisiologia , Sangue , Feminino , Humanos , Injeções/psicologia , Masculino , Multimídia , Transtornos Fóbicos/fisiopatologia , Reprodutibilidade dos Testes , Ferimentos e Lesões/psicologia , Adulto Jovem
8.
BMC Med ; 17(1): 101, 2019 05 24.
Artigo em Inglês | MEDLINE | ID: mdl-31122269

RESUMO

BACKGROUND: Specific phobia (SP) is a relatively common disorder associated with high levels of psychiatric comorbidity. Because of its early onset, SP may be a useful early marker of internalizing psychopathology, especially if generalized to multiple situations. This study aimed to evaluate the association of childhood generalized SP with comorbid internalizing disorders. METHODS: We conducted retrospective analyses of the cross-sectional population-based World Mental Health Surveys using the Composite International Diagnostic Interview. Outcomes were lifetime prevalence, age of onset, and persistence of internalizing disorders; past-month disability; lifetime suicidality; and 12-month serious mental illness. Logistic and linear regressions were used to assess the association of these outcomes with the number of subtypes of childhood-onset (< 13 years) SP. RESULTS: Among 123,628 respondents from 25 countries, retrospectively reported prevalence of childhood SP was 5.9%, 56% of whom reported one, 25% two, 10% three, and 8% four or more subtypes. Lifetime prevalence of internalizing disorders increased from 18.2% among those without childhood SP to 46.3% among those with one and 75.6% those with 4+ subtypes (OR = 2.4, 95% CI 2.3-2.5, p < 0.001). Twelve-month persistence of lifetime internalizing comorbidity at interview increased from 47.9% among those without childhood SP to 59.0% and 79.1% among those with 1 and 4+ subtypes (OR = 1.4, 95% CI 1.4-1.5, p < 0.001). Respondents with 4+ subtypes also reported significantly more disability (3.5 days out of role in the past month) than those without childhood SP (1.1 days) or with only 1 subtype (1.8 days) (B = 0.56, SE 0.06, p < 0.001) and a much higher rate of lifetime suicide attempts (16.8%) than those without childhood SP (2.0%) or with only 1 subtype (6.5%) (OR = 1.7, 95% CI 1.7-1.8, p < 0.001). CONCLUSIONS: This large international study shows that childhood-onset generalized SP is related to adverse outcomes in the internalizing domain throughout the life course. Comorbidity, persistence, and severity of internalizing disorders all increased with the number of childhood SP subtypes. Although our study cannot establish whether SP is causally associated with these poor outcomes or whether other factors, such as a shared underlying vulnerability, explain the association, our findings clearly show that childhood generalized SP identifies an important target group for early intervention.


Assuntos
Transtornos Mentais/epidemiologia , Transtornos Fóbicos/diagnóstico , Transtornos Fóbicos/epidemiologia , Adolescente , Adulto , Idade de Início , Idoso , Envelhecimento/psicologia , Biomarcadores/análise , Criança , Estudos Transversais , Diagnóstico Precoce , Feminino , Saúde Global/estatística & dados numéricos , Inquéritos Epidemiológicos , Humanos , Longevidade , Masculino , Transtornos Mentais/diagnóstico , Saúde Mental , Pessoa de Meia-Idade , Prevalência , Psicopatologia , Estudos Retrospectivos , Adulto Jovem
9.
J Neurol ; 266(Suppl 1): 80-87, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31102019

RESUMO

Recent epidemiological studies indicate that about one-third of the general population suffers from a more or less disabling height intolerance, with a relevant impact on quality of life in many of them. Acrophobia, the most severe form of visual height intolerance, has a life-time prevalence of around 5%. Although it is commonly believed that fear of heights should continuously aggravate with increasing elevation, this issue has not been systematically investigated yet. Here, we examined this topic using immersive virtual reality, an established tool in therapy for fear of heights, that allows to flexibly manipulate height stimuli. In a comprehensive cohort (including insusceptible subjects as well as subjects with height intolerance up to acrophobia) height intolerance severity was graded by an established metric scale (vHISS). Participants were randomly exposed to different virtual elevations using a head-mounted display. Behavioral responses to virtual height exposure were analogous to exposure in vivo. Participants exhibited increased anxiety and musculoskeletal stiffening with enhanced high-frequency body sway, to an extend that corresponded to the individual subjective height intolerance rating. For all behavioral responses, we observed a saturation above a certain altitude. Body sway and musculoskeletal stiffening became maximal at 20 m above ground, whereas anxiety saturated above 40 m. These results suggest that fear of heights is characterized by a nonlinear stimulus-response relationship and a dissociation between visual-height-induced bodily and emotional reactions.


Assuntos
Altitude , Medo/psicologia , Transtornos Fóbicos/psicologia , Transtornos Fóbicos/terapia , Terapia de Exposição à Realidade Virtual/métodos , Adulto , Idoso , Medo/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Fóbicos/diagnóstico , Equilíbrio Postural/fisiologia
10.
Behav Ther ; 50(3): 621-629, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31030878

RESUMO

Disgust propensity (DP) has been conceptualized as a stable personality trait that confers risk for contamination-related OCD (C-OCD). However, the extent to which DP leads to the subsequent development of C-OCD is unclear. In fact, the presence of C-OCD might lead to an increase in DP rather than the inverse. The present study was aimed to test this hypothesis in a large clinical sample of OCD patients (≥ 21 years of age) with (C-OCD; n = 56) and without (NC-OCD; n = 103) contamination-related symptoms that completed measures of OCD symptoms, depression, anxiety, and DP. DP was assessed twice, in reference to the present situation (T1) and to when the participant was 18 years old (T0). The two groups did not significantly differ in DP at T0. However, C-OCD participants reported higher DP scores than NC-OCD at T1. Furthermore, the T1 vs T0 difference in DP was significant only in the C-OCD group. Subsequent analyses also showed that T1 DP levels, but not T0 levels, significantly predicted contamination-related symptoms. Despite study limitations, these findings question the role of DP as a risk factor for C-OCD.


Assuntos
Asco , Transtorno Obsessivo-Compulsivo/diagnóstico , Transtorno Obsessivo-Compulsivo/psicologia , Transtornos Fóbicos/diagnóstico , Transtornos Fóbicos/psicologia , Autorrelato , Adolescente , Adulto , Ansiedade/diagnóstico , Ansiedade/psicologia , Depressão/diagnóstico , Depressão/psicologia , Emoções/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
11.
Med Hypotheses ; 126: 95-108, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31010507

RESUMO

How a social episode is perceived by a person and how the experience affects her/his subsequent behaviors will inevitably and sometimes accidentally vary in each case on the developmental trajectory from the birth of consciousness to death. Both the preceding developmental conditions and the social impact of the episode become a starting point for the following states of human complex conditions, creating the extraordinary diversity that characterizes our complex society. In this evolutionarily carved landscape, genetic factors including stochastic epistasis, environmental modification, and gene-environment interactions are all active. In these processes, interactions between developmental social vulnerability and environmental influences can lead to the emergence and persistence of some derivative states with social maladaptation. In our model, every psychiatric condition including aberrant paranoid-hallucinatory states is classified as a derivative state. The probability distribution curve for these derivative states has a non-linear relationship with the liability in the population, and there is none with probability 1.0 or zero. Individuals with trivial social vulnerability or high resilience may develop the derivative states in tremendously stressful circumstances, and individuals with huge social vulnerability may not necessarily develop the derivative states in the presence of adequate social supports. Social skillfulness/unskillfulness and behavioral flexibility/inflexibility form the core of the vulnerability-related dimensions. The clinical picture of a derivative manifestation is profiled depending on the individual trait levels in the derivative-related dimensions. Each derivative state has a requisite lineup of dimensions and each dimension can contribute to multiple psychiatric conditions. For example, aberrant paranoid-hallucinatory states and bipolar condition may share some developmental conditions as the derivative-related dimensions. Therefore, multiple derivative states can co-occur or be sequentially comorbid. Although the 'learned strategies' can ostensibly mask the clinical manifestation of developmental deviations, the change of the true dimensional position to the socially skillful direction is efficiently obtained through social experiences in a supportive environment. The liability-probability model makes it impossible to discriminate individuals with psychiatric diagnosis from individuals without the diagnosis and allows all of us to reside in the same human complex diversity.


Assuntos
Transtorno Autístico/fisiopatologia , Deficiências do Desenvolvimento/fisiopatologia , Transtornos Mentais/fisiopatologia , Psiquiatria/normas , Psicologia/normas , Transtornos Psicóticos/fisiopatologia , Esquizofrenia/fisiopatologia , Comportamento Social , Adulto , Transtorno Autístico/diagnóstico , Comportamento , Criança , Depressão/diagnóstico , Depressão/fisiopatologia , Deficiências do Desenvolvimento/diagnóstico , Epistasia Genética , Transtornos da Alimentação e da Ingestão de Alimentos/diagnóstico , Transtornos da Alimentação e da Ingestão de Alimentos/fisiopatologia , Interação Gene-Ambiente , Humanos , Transtornos Mentais/diagnóstico , Transtornos Paranoides/diagnóstico , Transtornos Paranoides/fisiopatologia , Fenótipo , Transtornos Fóbicos/diagnóstico , Transtornos Fóbicos/fisiopatologia , Probabilidade , Psiquiatria/métodos , Psicologia/métodos , Psicopatologia , Transtornos Psicóticos/diagnóstico , Esquizofrenia/diagnóstico , Mudança Social , Processos Estocásticos , Estresse Psicológico , Tentativa de Suicídio
12.
Curr Psychiatry Rep ; 21(4): 27, 2019 03 12.
Artigo em Inglês | MEDLINE | ID: mdl-30868272

RESUMO

PURPOSE OF REVIEW: This paper seeks to identify the risk factors of fear of childbirth (FOC) and posttraumatic stress disorder (PTSD) related to birth and reviews the efficacy of their respective screening tools and therapeutic interventions. RECENT FINDINGS: Biofeedback, hypnosis, internet-based cognitive behavioral therapy, and antenatal education are promising treatments for FOC. Training midwives to address traumatic birth experiences could help in preventing PTSD. A shorter more pragmatic screening tool for FOC than the Wijma Delivery Expectancy/Experience Questionnaire (WDEQ) is needed. Women with PTSD attributed a mismatch between the expected mode of delivery (MOD) and the actual MOD as the cause of their trauma. A history of mental health disorders, lack of social support, previous negative birth experiences, and MOD are correlated to FOC and postpartum PTSD. Psycho-education and CBT-based treatments have been found to reduce levels of FOC and PTSD.


Assuntos
Transtornos de Ansiedade/epidemiologia , Transtornos de Ansiedade/terapia , Medo/psicologia , Parto/psicologia , Transtornos Fóbicos/epidemiologia , Transtornos Fóbicos/terapia , Período Pós-Parto/psicologia , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/psicologia , Terapia Cognitivo-Comportamental , Feminino , Humanos , Transtornos Fóbicos/diagnóstico , Transtornos Fóbicos/psicologia , Gravidez , Apoio Social , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/etiologia , Transtornos de Estresse Pós-Traumáticos/terapia , Inquéritos e Questionários
13.
J Arthroplasty ; 34(6): 1116-1121, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30853160

RESUMO

BACKGROUND: The shortened version of the Tampa Scale for Kinesiophobia (TSK-11) has been well characterized in the literature. However, to the best of our knowledge, no previous studies have evaluated the reliability and validity of the TSK-11 for Chinese-speaking patients who have undergone total knee arthroplasty (TKA). Thus, the objectives of this study were to translate and adapt the TSK-11 cross-culturally into Chinese and to evaluate its reliability and validity in a sample of Chinese TKA patients. METHODS: The TSK-11 was translated and cross-culturally adapted into Chinese according to the international guidelines for the cross-cultural adaptation of self-report measures. The Chinese version of TSK-11 was administered to 254 patients following their TKA, along with the Fear-Avoidance Beliefs Questionnaire, Pain Catastrophizing Scale, Numerical Rating Scale, and 12-Item Short Form Health Survey. Psychometric testing included internal consistency, test-retest reliability, floor and ceiling effects, construct validity, and convergent validity. RESULTS: A high completion rate of 95.8% with no floor or ceiling effects was noted in the Chinese version of the TSK-11. The questionnaire also showed good internal consistency (Cronbach's α = 0.883) and test-retest reliability (intraclass correlation coefficient = 0.798). Construct validity was assessed by exploratory factor analysis, and 3 factors were extracted that accounted for 65.2% of the variance. Convergent validity was confirmed by significant Pearson correlations between the Chinese version of the TSK-11 and the Pain Catastrophizing Scale (r = 0.751), Fear-Avoidance Beliefs Questionnaire (r = 0.719) and VAS (r = 0.450), as well as the 12-Item Short Form Health Survey subdomains Bodily Pain (r = -0.391), Mental Health (r = -0.356), Physical Functioning (r = -0.339), Role-Emotional (r = -0.317), and Role-Physical (r = -0.277). CONCLUSION: The Chinese version of the TSK-11 demonstrated satisfactory acceptability, reliability, and validity; therefore, it can be used in clinical practice and research for assessing kinesiophobia in Chinese patients after TKA.


Assuntos
Artroplastia do Joelho , Medição da Dor , Transtornos Fóbicos/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/psicologia , Adulto , Idoso , Aprendizagem da Esquiva , China , Comparação Transcultural , Características Culturais , Medo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ortopedia/métodos , Dor , Psicometria/métodos , Reprodutibilidade dos Testes , Autorrelato , Inquéritos e Questionários , Resultado do Tratamento
14.
Psychosom Med ; 81(5): 398-407, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30920464

RESUMO

Illness anxiety disorder is a primary disorder of anxiety about having or developing a serious illness. The core feature is the cycle of worry and reassurance seeking regarding health, as opposed to a focus on relief of distress caused by somatic symptoms (as in Somatic Symptom Disorder). Clinically significant health anxiety is common, with estimates ranging up to 13% in the general adult population. There are evidence-based treatments, including psychopharmacology and cognitive behavioral therapy, that can significantly alleviate symptoms. An understanding of the core psychopathology and clinical features of illness anxiety disorder is essential to fostering a working alliance with patients with health anxiety, as is the maintenance of an empathic, curious, and nonjudgmental stance toward their anxiety. Collaboration between medical providers is essential to avoid the pitfalls of excess testing and medical treatment.


Assuntos
Atitude Frente a Saúde , Terapia Cognitivo-Comportamental , Transtornos Fóbicos/fisiopatologia , Transtornos Fóbicos/terapia , Inibidores de Captação de Serotonina/uso terapêutico , Adulto , Feminino , Humanos , Transtorno de Pânico/diagnóstico , Transtorno de Pânico/fisiopatologia , Transtorno de Pânico/terapia , Transtornos Fóbicos/diagnóstico , Transtornos Fóbicos/epidemiologia
15.
Artigo em Inglês | MEDLINE | ID: mdl-30763673

RESUMO

BACKGROUND: Exposure is the gold standard treatment for phobic anxiety and is thought to represent the clinical application of extinction learning. Reward sensitivity might however also represent a predictive factor for exposure therapy outcome, as this therapy promotes positive experiences and involves positive comments by the therapist. We hypothesized that high reward sensitivity, as expressed by elevated reward expectancy and reward value, can be associated with better outcome to exposure therapy specifically. METHODS: Forty-four participants with a specific phobia for spiders were included in the current study. Participants were randomly assigned to exposure therapy (n = 25) or progressive muscle relaxation (PMR) (n = 19). Treatment outcome was defined as pre- versus post-therapy phobia symptoms. Before treatment, functional brain responses and behavioral responses (i.e. reaction time and accuracy) during reward anticipation and consumption were assessed with the Monetary Incentive Delay task (MID). Behavioral and neural responses in regions of interest (i.e. nucleus accumbens, ventromedial prefrontal cortex and the ventral tegmental area) as well as across the whole-brain were subsequently regressed on treatment outcomes. RESULTS: Exposure therapy was more effective in reducing phobia symptoms than PMR. Longer reaction times to reward cues and lower activation in the left posterior cingulate cortex during reward consumption were selectively associated with symptoms reductions following exposure therapy but not following PMR. Only within the exposure therapy group, greater symptom reduction was related to increased activation in the ventrolateral prefrontal cortex during reward anticipation, and decreased activation in the medial prefrontal cortex during reward consumption. CONCLUSION: Results indicate that individual differences in reward sensitivity can specifically predict exposure therapy outcome. Although activation in regions of interest were not related to therapy outcome, regions involved in attentional processing of reward cues were predictive of phobic symptom change following exposure therapy but not PMR.


Assuntos
Encéfalo/fisiologia , Terapia Implosiva , Transtornos Fóbicos/fisiopatologia , Transtornos Fóbicos/terapia , Valor Preditivo dos Testes , Córtex Pré-Frontal/fisiologia , Recompensa , Adolescente , Adulto , Método Duplo-Cego , Feminino , Neuroimagem Funcional , Humanos , Imagem por Ressonância Magnética , Masculino , Transtornos Fóbicos/diagnóstico , Tempo de Reação , Terapia de Relaxamento , Resultado do Tratamento , Adulto Jovem
16.
Child Psychiatry Hum Dev ; 50(1): 13-26, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-29860615

RESUMO

School and social anxiety are common problems and have a significant impact on youths' development. Nevertheless, the questionnaires to assess these anxious symptoms in French adolescents have limitations. The aim of this study is to provide a French version of the Social Anxiety Scale for Adolescents (SAS-A) and the School Anxiety Inventory (SAI), analysing their psychometric properties by the factor structure, internal consistency, and convergent validity. The SAS-A and the SAI were collectively administered in a sample of 1011 French adolescents (48.5% boys) ranging in age from 11 to 18 years. Confirmatory factor analyses replicated the previously identified correlated three-factor structure of the SAS-A and the correlated four-factor structure of the SAI. Acceptable internal consistency indexes were found for SAS-A and SAI scores. Correlations supported the convergent validity of the questionnaires' subscales. Overall, results supported the internal consistency and validity of the French versions of the SAS-A and SAI.


Assuntos
Transtornos de Ansiedade , Fobia Social , Transtornos Fóbicos , Psicometria/métodos , Adolescente , Ansiedade/etiologia , Ansiedade/psicologia , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/psicologia , Criança , Análise Fatorial , Feminino , França , Humanos , Masculino , Fobia Social/diagnóstico , Fobia Social/psicologia , Transtornos Fóbicos/diagnóstico , Transtornos Fóbicos/psicologia , Reprodutibilidade dos Testes , Escala de Ansiedade Frente a Teste , Traduções
17.
Span. j. psychol ; 22: e44.1-e44.9, 2019. ilus, tab, graf
Artigo em Inglês | IBECS | ID: ibc-190195

RESUMO

A new computerized instrument (the Multimedia Behavioral Avoidance Test, or MBAT) for blood-injury-injection phobia (BII) assessment is presented. Analogous stimuli such as images and videos can also elicit anxiety responses; thus, they can be used for the assessment of phobia. The MBAT was applied to participants via computer, and subjective anxiety responses and time latency were recorded. The MBAT was composed of 30 original images and 30 videos related to blood, injury and injections. The MBAT was compared with other pencil-and-paper questionnaires for BII phobia, and heart rate was also measured with a pulsioximeter. The participants included 160 students and professionals (34.5% males, 65.6% females; mean 28.6 years old). The results showed a high reliability for internal consistency in images and videos (α = .98 both), with a single factor that groups all the items. In addition, the MBAT had high concurrent validity (r = .78 to .85) with the different anxiety scales compared. The MBAT diagnosed 12 participants with possible BII phobia. It is a useful instrument in the assessment of this kind of phobia because it is easier and quicker than pencil-and-paper questionnaires, it uses more objective measurements, and it is useful in planning subsequent exposure with images and videos


No disponible


Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Aprendizagem da Esquiva , Diagnóstico por Computador/normas , Testes Neuropsicológicos/normas , Transtornos Fóbicos/diagnóstico , Aprendizagem da Esquiva/fisiologia , Sangue , Injeções/psicologia , Multimídia , Transtornos Fóbicos/fisiopatologia , Reprodutibilidade dos Testes , Ferimentos e Lesões/psicologia
18.
Arch Med Res ; 50(8): 490-501, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-32018071

RESUMO

BACKGROUND: This article reports the results of one of a series of global field studies implemented by the World Health Organization (WHO) to evaluate the accuracy, clinical utility, and global applicability of the new diagnostic guidelines for Mental, Behavioural and Neurological Disorders included in the next version of WHO's International Classification of Diseases (ICD-11). AIMS OF THE STUDY: The purpose of this study was to compare the diagnostic accuracy and clinical utility ratings of global clinicians implementing the ICD-11 diagnostic guidelines for Anxiety and Fear-Related Disorders, relative to those applying ICD-10 guidelines. The study also aimed to identify elements of the guidelines that required further refinement or clarification. METHODS: 1840 global mental health professionals registered with WHO's Global Clinical Practice Network completed the study in one of six study languages. Participants were randomly assigned to apply either the ICD-11 or ICD-10 guidelines to diagnose standardized case vignettes, and to rate the clinical utility of their assigned guidelines. RESULTS: ICD-11's diagnostic accuracy and clinical utility were equivalent or superior to that of ICD-10. Global clinicians were significantly more accurate in diagnosing Generalized Anxiety Disorder, Specific Phobia and adult cases of Separation Anxiety Disorder when using ICD-11 and provided high clinical utility ratings for these disorders. Clinicians also found the ICD-11 guidelines easy to use, clear, and a good fit to patients they see in their clinical practice. However, clinicians had difficulty with distinguishing the boundary between disorder and normality for subthreshold cases of anxiety, and also with applying the new ICD-11 guidelines on panic attacks. CONCLUSIONS: The new diagnostic guidelines for Anxiety Disorders in ICD-11 can be applied in an acceptably consistent manner by global clinicians and perform as well or better than the previous guidelines for ICD-10. Study findings also helped identify aspects of the ICD-11 guidelines that required refinement prior to their publication and areas that should be emphasized in training programs.


Assuntos
Transtornos de Ansiedade/diagnóstico , Ansiedade/diagnóstico , Medo/psicologia , Classificação Internacional de Doenças , Transtorno de Pânico/diagnóstico , Transtornos Fóbicos/diagnóstico , Adulto , Ansiedade/psicologia , Transtornos de Ansiedade/psicologia , Estudos de Casos e Controles , Feminino , Pessoal de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Transtorno de Pânico/psicologia , Transtornos Fóbicos/psicologia , Organização Mundial da Saúde
19.
Rev Prat ; 69(9): 970-973, 2019 Nov.
Artigo em Francês | MEDLINE | ID: mdl-32237612

RESUMO

CURRENT NOSOGRAPHIC CLASSIFICATIONS TOF ANXIETY DISORDERS. Anxiety disorders are psychiatric pathologies covering a wide range of clinical entities that are characterized by a pathological anxiety leading to severe emotional distress and marked impairment in daily functioning. They primarily differentiate from each other according to the general content of concerns, and originally included the panic disorder with or without agoraphobia, specific phobias, social anxiety disorder, generalized anxiety disorder, obsessive-compulsive disorder and post-traumatic stress disorder. However, the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders introduced the classification of anxiety disorders into three separate subcategories in 2013, mainly comprising the anxiety disorders themselves (panic disorder with or without agoraphobia, specific phobia, social anxiety disorder and generalized anxiety disorder), obsessive- compulsive disorder and post-traumatic stress disorder on the basis of their respective clinical, psychological and pathophysiological determinants.


Assuntos
Transtorno Obsessivo-Compulsivo , Transtorno de Pânico , Transtornos Fóbicos , Transtornos de Estresse Pós-Traumáticos , Agorafobia/diagnóstico , Transtornos de Ansiedade/diagnóstico , Humanos , Transtorno Obsessivo-Compulsivo/diagnóstico , Transtorno de Pânico/diagnóstico , Transtornos Fóbicos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/diagnóstico
20.
Rev Prat ; 69(9): 979-980, 2019 Nov.
Artigo em Francês | MEDLINE | ID: mdl-32237615

RESUMO

EPIDEMIOLOGY OF ANXIETY DISORDERS - The prevalence of anxiety disorders is higher in high-income countries than in middle- and low-income countries. In France, their lifetime prevalence ranges from 2.1% for panic disorder to 10.7% for specific phobias. They are more frequent among young, female subjects, with low levels of education, unemployed, with low income and not living with a partner. Phobic disorders, separation anxiety and social anxiety have an early onset, most often in childhood; other anxiety disorders have a later and more variable onset age. Apart from separation anxiety, anxiety disorders have a chronic course in more than half of cases and are frequently associated with a substantial functional impairment. The most common comorbid psychiatric disorders are other anxiety disorders, followed by mood disorders, particularly depression, substance use disorders and impulse control disorders. In France, less than a third of people with anxiety disorders receive treatment and less than 15% receive potentially adequate treatment. Of those who perceive a need for care, less than half receive adequate treatment.


Assuntos
Transtornos de Ansiedade , Transtorno de Pânico , Transtornos Fóbicos , Transtornos Relacionados ao Uso de Substâncias , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/terapia , Criança , Comorbidade , Feminino , França , Humanos , Transtorno de Pânico/diagnóstico , Transtorno de Pânico/terapia , Transtornos Fóbicos/diagnóstico , Transtornos Fóbicos/terapia , Prevalência , Prognóstico
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