Biomedical subjects

R G Jacob

Publications and source records attributed to R G Jacob.

61 records · Page 4Linked to original sources

PubMedDate not supplied

Vestibular rehabilitation for patients with agoraphobia and vestibular dysfunction: a pilot study.

This study examined whether physical therapy with vestibular rehabilitation exercises would benefit patients with agoraphobia and vestibular dysfunction. Nine patients went through a 2-week no-treatment baseline phase, a 4-week behavioral treatment phase focusing on self-directed exposure, and an 8-12-week vestibular rehabilitation phase (weekly sessions). On the main outcome measure, clinical global impressions (CGI) ratings of severity, behavioral treatment was accompanied by a reduction in severity (effect size d=0.8; P<.10). On the supplementary measures, the Hamilton Anxiety Scale (Hamilton-A) and the Chambless Mobility Inventory (MI), no significant improvements were noted. After vestibular rehabilitation therapy, further improvement occurred in CGI severity (d=0.65; two-tailed P<.10), and significant improvements occurred in the supplementary measures. The physical therapist identified motion-induced dizziness and disturbances in balance in most patients. These improved with rehabilitation. Although the results can be attributed to other explanations, they are not inconsistent with the hypothesis that vestibular dysfunction maintains agoraphobic symptoms in some patients.

Adult↗

PubMedDate not supplied

Space and motion discomfort in Brazilian versus American patients with anxiety disorders.

Space and motion discomfort (SMD) was studied in 38 Brazilian and 50 U.S. patients belonging to one of three diagnostic groups: (a) panic disorder with agoraphobia, (b) panic disorder without agoraphobia, and (3) other nonpanic anxiety disorders. A group of 30 U.S. normal controls was also included. SMD was assessed by the Situational Characteristics Questionnaire (SitQ), which includes two scales for SMD--the Smd1 and the Smd2, and one scale for non-space-related agoraphobic discomfort, the Ag1. The score in the Smd2 is based on the sum of Likert style items, while the scores of the Smd1 and Ag1 are based on differences between contrasting subitems. A significant diagnosis effect was observed in all scales, with the highest scores in the agoraphobia group. A country effect was found only in the Smd2. A country effect was also observed when all subitems of the Smd1 and Ag1 were added rather than subtracted, suggesting that this country bias is related to a tendency of Brazilian patients to endorse symptoms. Implications of these findings to the trans-cultural validation of rating scales are discussed.

Adult↗

PubMedDate not supplied

Déjà vu all over again: critical misunderstandings concerning anxiety sensitivity and constructive suggestions for future research.

The debate concerning the relation between anxiety sensitivity (AS) and trait anxiety has been constructive for the field and has suggested a number of important directions for future research. Reiss' (1997) commentary on AS and trait anxiety in this journal, however, contains several serious factual mis-statements and logical errors that confuse, rather than clarify, many of the central issues in this debate. These misunderstandings are corrected and the implications of the issues raised by Reiss are addressed here. The authors suggest that future research on AS (a) embed this construct within the context of broader temperamental and personality variables and (b) explicitly recognize the biodirectionality of emotional and cognitive influences.

Anxiety Disorders↗

PubMedDate not supplied

Relaxation therapy for hypertension: setting-specific effects.

We determined the effect of relaxation therapy for hypertension in patients whose blood pressure remained elevated despite the use of antihypertensive medication. The effect was assessed in multiple settings, including the relaxation therapist's office, the Hypertension Clinic, and the patient's natural environment, the latter using 24-hour automated ambulatory blood pressure measures. Nineteen patients were randomized either to temperature biofeedback-assisted relaxation or to an attention control, "stress education." Antihypertensive medication was kept constant. In the behavioral therapist's office, blood pressure decreased in equivalent amounts with both treatments. Hypertension Clinic nurse blood pressure remained stable or increased with both treatments, but again there was no difference between treatments. Ambulatory blood pressure increased with relaxation therapy and decreased with stress education, the effect being significant for diastolic pressure. The effects on ambulatory blood pressure were limited to the waking hours. The only variable that showed superior effects for relaxation therapy was physician-determined blood pressure. These results call into question the generalizability of the effects of relaxation therapy from one setting to another.

Adult↗

PubMedDate not supplied

Surface dependence: a balance control strategy in panic disorder with agoraphobia.

OBJECTIVE: Previous studies have reported vestibular dysfunction and impaired balance in patients with agoraphobia. Vestibular dysfunction may lead to an information processing strategy focusing on spatial stimuli from two nonvestibular sensory channels, vision and proprioception. This nonvestibular balance control strategy may in turn lead to discomfort in situations involving inadequate visual or proprioceptive spatial cues (space and motion discomfort). The objective of this study was to examine sensory integration of spatial information in agoraphobia. Because of previous findings that space and motion discomfort and vestibular dysfunction are common in agoraphobia, we hypothesized that agoraphobics would use a nonvestibular balance control strategy. METHOD: Using computerized dynamic posturography, we examined balance performance in patients with panic disorder with agoraphobia, uncomplicated panic disorder, nonpanic anxiety disorders, and depression without anxiety, as well as healthy subjects for comparison. The posturography procedure included six sensory conditions in which visual and proprioceptive balance information was manipulated experimentally by permutations of sway-referencing the support surface or the visual surround or by having patients close their eyes. RESULTS: The agoraphobics had impaired balance when proprioceptive balance information was minimized by sway-referencing the support surface (p < 0.02). This pattern, called surface dependence, tended to be more pronounced in agoraphobics who reported space and motion discomfort, including fear of heights or boats. CONCLUSION: Agoraphobics rely on proprioceptive cues for maintenance of upright balance. This strategy may lead to intolerance of situations characterized by unstable support.

Adult↗

PubMedDate not supplied

Ambulatory blood pressure responses and the circumplex model of mood: a 4-day study.

BACKGROUND: The relation between mood or emotions and concurrent ambulatory blood pressure responses holds both fundamental and clinical interest. METHODS: The primary sample consisted of 69 normotensive or borderline hypertensive but otherwise healthy adult males. The validation sample consisted of 85 healthy male undergraduate college students. Both samples underwent half-hourly 24-hour ambulatory blood pressure measurements on four separate workdays, 1 week apart. At each ambulatory measurement, subjects recorded their behavior, environment, and mood. The circular mood scale, a circular visual analogue scale based on the circumplex model of mood, was used to reflect the totality of a participant's affective state space. Longitudinal random effects regression models were applied in the data analysis. RESULTS: The results for both samples were quite similar. Sleep and posture had the greatest influence on ambulatory blood pressure and heart rate. The effects of the environmental setting, social setting, and consumption were modest but statistically significant. Independent of these covariates, mood exerted a significant effect on blood pressure and heart rate. Relative to the "mellow" default category, blood pressure increased both for "anxious/annoyed" and "elated/happy" and decreased during "disengaged/sleepy" mood. The range of mood-related blood pressure estimates was 6.0/3.7 mm Hg. CONCLUSIONS: The pattern of blood pressure responses suggests that they were related to the degree of engagement of a mood rather than the degree of unpleasantness. The hypothesis that posits that negative affect-related cardiovascular reactivity mediates the observed correlation between negative affect and disease risk should be reconsidered.

Adolescent↗

PubMedDate not supplied

Clinical evidence that the vestibular system participates in autonomic control.

The vestibular system, including both the peripheral vestibular system, that is, the labyrinth, and the central vestibular system, is known to influence autonomic function in several ways that have clinical implications. This paper discusses evidence for vestibular influences on autonomic control from normal human subjects, evidence for vestibular influences on autonomic control from patients, clinical implications of vestibulo-autonomic regulation, and speculations regarding possible clinical implications of vestibulo-autonomic control. Situations that provoke vestibular-induced autonomic responses in normal subjects include vestibular laboratory testing, vehicular motion, simulators, and, possibly, exposure to microgravity. Patients with peripheral and central vestibular abnormalities manifest both symptoms and signs of autonomic dysfunction presumably via vestibulo-autonomic connections. Vestibulo-autonomic regulation impacts vestibular diagnostic testing, clinical diagnosis of balance disorders, and treatment of balance disorders. In addition to well-recognized peripheral and central vestibular disorders, anxiety disorders have recently been linked to vestibular dysfunction in a subset of patients. In particular, vestibular dysfunction has been linked to panic disorder and agoraphobia. Vestibular-autonomic connections may form a basis for an association between vestibular dysfunction and panic attacks. The importance of vestibulo-autonomic regulation in the clinical arena is not fully known. Two speculative areas discussed in this paper include vestibular-induced orthostatic intolerance and the role of vestibular-respiratory pathways on sleep apnea.

Autonomic Nervous System↗