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PubMed2002

Personality and neuropsychological function in violent, sexual and arson offenders.

We aimed to test the hypothesis that incarcerated offender populations will not differ in neuropsychological test performance if patients are matched on age, intelligence and personality profile, particularly if impulsive aggressive traits and confounds such as substance misuse and performance anxiety are controlled for. 27 violent offenders, 20 sex offenders and 13 arson offenders detained in maximum security hospitals completed dimensional assessments of personality function and were assessed on a battery of frontal and temporal neuropsychological tests. All patients completed a variety of self-report measures of cognitive, affective and behavioural dispositions relevant to offender populations. Trait impulsivity was further assessed and composite impulsivity scores were derived. Assessments of emotional state were administered prior to neuropsychological testing. All patients met the criteria for a DSM-III-R personality disorder diagnosis. There were no significant group differences in age, IQ, or educational attainment. There were no differences in the personality profile of the offender group although sex offenders scored higher on trait anxiety, depression and tension measures. Groups did not significantly differ in their performance on neuropsychological tests apart from poorer perseverative error scores on the Wisconsin Card Sort Test in arsonists, which could not be accounted for by state anxiety or depression scores.

Adult↗
PubMedDate not supplied

Quality of life in social phobia.

The person's perception of his or her quality of life has been neglected in studies of mental health in general and anxiety disorders in particular. However, the judgement of the impact of a mental disorder based on symptomatic distress while ignoring one's overall quality of life is incomplete. In the present study, we examined social phobic patients' judgments of their satisfaction with various domains of life they deem important using the Quality of Life Inventory (QOLI; Frisch, unpublished). Social phobics judged their overall quality of life lower than Frisch's (unpublished) normative sample. Quality of life was inversely associated with various measures of severity of social phobia (especially social interaction anxiety), functional impairment, and depression. It was not, however, related to performance anxiety or trait anxiety. Quality of life also varied across combinations of subtype of social phobia and the presence/absence of avoidant personality disorder, and as a function of marital status. Patients showed significant improvement in quality of life scores after completion of cognitive-behavioral group therapy for social phobia.

Adult↗
PubMed1988

Task difficulty and EEG alpha asymmetry: an amplitude and frequency analysis.

The effects of mathematical, spatial and verbal task difficulty on EEG alpha amplitude and mean frequency asymmetry were investigated. Twenty right-handed subjects with no familial left-handedness (10 female, 10 male) were presented 3 levels of difficulty for each type of task. Difficulty was varied through increasing the rate of auditorily presented numerical stimuli. Also examined were EEG alpha correlates with measures of performance anxiety, subjective difficulty, loss of vigilance, confusion, the tendency to rely on a guessing strategy and performance. While increasing task difficulty led to right-parietal and posttemporal alpha acceleration for all tasks, task-dependent bilateral changes in alpha frequency were also observed. Increased mathematical task difficulty widened parietal amplitude asymmetry differences between high- and low-performance subjects, and produced performance-dependent changes in left-parietal and right-temporal alpha frequency. A curvilinear relationship between spatial-task difficulty and relative right-hemisphere alpha attenuation was found for the high-performance group only. Finally, numerous correlations were found between alpha measures and subjective and performance variables. Most of these correlations were found to be both task- and difficulty-level-specific. Task anxiety appeared to play a significant role in the determination of parietal- and temporal-lobe asymmetry.

Adult↗
PubMed1998

Anxiety and cognitive performance in adolescent women with disruptive behavior disorders.

Comparing 36 disruptive behavior-disordered and 40 normal female adolescents, we found higher levels of anxiety and poorer performance on a measure of verbal fluency in the clinical sample. No group differences were found on a nonverbal measure of reflectivity nor on a measure of interpersonal cognitive problem solving. Nor was evidence found for an hypothesized anxiety-related performance decrement among disruptive behavior-disordered youth. However, anxiety induction facilitated performance across groups on interpersonal cognitive problem solving.

Adolescent↗
PubMed1993

A multifactorial study of test anxiety and coping responses during a challenge examination.

Challenge examinations offer registered nurse students enrolled in our baccalaureate nursing programme the opportunity to demonstrate mastery of course content through a testing process. Successful students receive credit for the course while those who are unsuccessful must take the course to proceed in the programme. Faculty observations of registered nurse students during the challenge process suggested this testing was stressful. Therefore, a study was conducted to determine anxiety levels and coping strategies of on-campus and distance education registered nurse students at three different times during the challenge examination process. Differences between the two groups of nursing students on selected demographic variables, past academic performance, anxiety levels and coping strategies were assessed from the perspective of Folkman & Lazarus's (1984) theory of stress and coping. Significant differences were found in anxiety levels, coping strategies and past academic performance by age, marital status, employment and work setting. Several different coping strategies were used. However, problem solving was used extensively by both groups while social support was used more by the on-campus students. The results are discussed in terms of Folkman & Lazarus's theory of stress and coping, and implications for nurse educators are presented.

Adaptation, Psychological↗
PubMedDate not supplied

[Beta-blocking drugs and anxiety. A proven therapeutic value].

The therapeutic value of propranolol and other beta-adrenergic receptor blockers in anxiety disorders is reviewed. The potential side-effects of benzodiazepines, eg psychomotor impairment and dependance, suggest that the main indicators of these compounds are the acute anxiety states and the short term treatment of anxiety disorders requiring sedation. Thus, other psychotropic drugs may be of potential value in the treatment of these disorders. The results of the placebo-controlled studies reviewed here strongly suggest that propranolol is useful in the treatment of anxiety disorders, especially those: 1) characterized by the presence of somatic symptoms related to increased adrenergic tone; 2) of moderate intensity and/or seen in general practice; 3) of recent onset and not fulfilling DSM III criteria for specific chronic anxiety disorders. Propranolol and other beta-blockers may also be useful in the prevention of performance anxiety such as the fear of speaking in public or specific social phobias when limited in number in the same patients. Average therapeutic doses range from 20 to 40 mg, once to three times a day; the clinical efficacy of beta-blockers administered for periods longer than 4 weeks remains to be demonstrated. The potential impairment of cognitive functions by propranolol is still a matter of controversy as well as its ability to induce depressive states in predisposed patients. Furthermore, the efficacy of beta-blockers that do not cross the blood-brain barrier in the treatment of anxiety raises unresolved questions concerning the mode of action (central vs peripheric) of these medications. In short, beta-blocking agents, and especially propranolol, should be considered as potential therapeutic agents in the pharmacological treatment of anxiety disorders besides benzodiazepines, antidepressant compounds and the newer azapirones, eg buspirone.

Adrenergic beta-Antagonists↗
PubMed2005

Integrating neurobiology and psychopathology into evidence-based treatment of social anxiety disorder.

Social anxiety disorder (SAD) is a common, chronic psychiatric disorder characterized by a persistent fear of social or performance situations in which embarrassment can occur. This disorder typically appears during the mid-adolescent years and is unremitting throughout life if not properly treated. SAD presents as two subtypes: the more common and debilitating generalized form, and the nongeneralized form, which consists predominantly of performance anxiety. The majority of patients with SAD have comorbid mental disorders, including mood, anxiety, and substance abuse. No single development theory has been proposed to account for the origins of SAD, although current understanding of the etiology of SAD posits an interaction between psychological and biological factors. Risk factors include environmental and parenting influences and dysfunctional cognitive and conditioning events in early childhood. The neurobiology of SAD appears to involve neurochemical dysfunction, as evidenced by studies of neuroreceptor imaging, neuroendocrine function, and profiles of response to specific medications. Clinical trials have demonstrated that benzodiazepines and antidepressants are effective in the treatment of SAD. The selective serotonin reuptake inhibitors are emerging as the first-line treatment for SAD, based on their proven safety, tolerability, and efficacy. Goals for ongoing future research include development of approaches to achieve remission, to convert nonresponders and partial responders to full responders, and to prevent relapse and maintain long-term efficacy. This monograph explores the epidemiology, clinical presentation, and differential diagnosis of SAD, with a focus on neural circuitry of social relationships and neurochemical dysfunction. The prevalence, rates of recognition and treatment, patterns of comorbidity, quality-of-life issues, and natural history of SAD are discussed as well as pharmacologic and psychosocial treatment strategies for SAD.

Adult↗
PubMed1994

Motivational effects of anxiety on psychomotor performance.

The Hull-Spence theory of anxiety drive (A) was tested in a psychomotor learning situation in which both correct responses (R+) and competing responses (R-) were evoked by the task. Measures of A-Trait and A-State were obtained from 151 women and 52 men, all of whom were then exposed to a sequence of 16 trials on a mirror-tracking task presented either continuously or with 2-min. intertrial intervals. Analyses of the effects of A were then performed on samples of 68 women and 16 men drawn from the tails of the A distributions. Theoretical predictions about the effects of A on initial scores and performance trends of both R+ and R- were strongly supported, somewhat more so within the A-State classification than within the A-Trait classification owing to the larger amount of variance accounted for. Analyses involving intermediate levels of A showed that R+ was a monotonic and essentially linear function of A.

Adolescent↗
PubMed1989

Self-injection of papaverine and phentolamine in the treatment of psychogenic impotence.

This study prospectively assessed the use, effectiveness, and sexual and psychosocial impact of self-injection treatment in 15 men with psychogenic impotence. Sixty percent dropped out of self-injection treatment by 6 months. Those who remained used self-injections about four times monthly with a 94% success rate. Frequency of intercourse and sexual satisfaction increased. Anxiety decreased, and trends toward improvement in depression and self-esteem were evident. Qualitative data indicated that performance anxiety was not alleviated, dependence upon injections for intercourse remained, symptom substitution did not occur, and capacity for intimacy was not improved.

Erectile Dysfunction↗
PubMed2000

School and neuropsychological performance of evacuated children in Kyiv 11 years after the Chornobyl disaster.

This paper examines the cognitive and neuropsychological functioning of children who were in utero to age 15 months at the time of the Chornobyl disaster and were evacuated to Kyiv from the 30-kilometer zone surrounding the plant. Specifically, we compared 300 evacuee children at ages 10-12 with 300 non-evacuee Kyiv classmates on objective and subjective measures of attention, memory, and school performance. The evacuee children were not significantly different from their classmates on the objective measures (grades; Symbolic Relations subtest of the Detroit Test; forms 1 and 2 of the Visual Search and Attention Test; Benton Form A; Trails A; Underline the Words Test) or on most of the subjective measures (the attention subscale of the Child Behavior Checklist completed by mothers; the attention items of the Iowa Conners Teacher's Rating Scale; mother and child perceptions of school performance). The one exception was that 31.3% of evacuee mothers compared to 7.4% of classmate mothers indicated that their child had a memory problem. However, this subjective measure of memory problems was not significantly related to neuropsychological or school performance. No significant differences were found in comparisons of evacuees and classmates who were in utero at the time of the explosion, children from Pripyat vs. other villages in the 30-kilometer zone, and children manifesting greater generalized anxiety. For both groups, children with greater Chornobyl-focused anxiety performed significantly worse than children with less Chornobyl-focused anxiety on measures of attention. The results thus fail to confirm two previous reports that relatively more children from areas contaminated by radiation had cognitive deficits compared to controls. Possible reasons for the differences in findings among the studies are discussed.

Achievement↗
PubMed1983

Effects of lorazepam and its withdrawal on sleep, performance, and subjective state.

The effects of 3 mg lorazepam on polysomnographic recordings, performance, anxiety, and perceived sleep were examined. Six insomniac subjects slept in the sleep laboratory for 18 consecutive nights after having taken placebo or lorazepam. Polysomnographic data and subjective reports indicated hypnotic efficacy in terms of sleep initiation and maintenance. There was some evidence of rebound insomnia after drug withdrawal, although it was not evident from all measures. Clear performance decrements occurred during lorazepam use.

Adult↗
PubMed2005

Virtual reality therapy versus cognitive behavior therapy for social phobia: a preliminary controlled study.

Social phobia is one of the most frequent mental disorders and is accessible to two forms of scientifically validated treatments: anti-depressant drugs and cognitive behavior therapies (CBT). In this last case, graded exposure to feared social situations is one of the fundamental therapeutic ingredients. Virtual reality technologies are an interesting alternative to the standard exposure in social phobia, especially since studies have shown its usefulness for the fear of public speaking. This paper reports a preliminary study in which a virtual reality therapy (VRT), based on exposure to virtual environments, was used to treat social phobia. The sample consisted of 36 participants diagnosed with social phobia assigned to either VRT or a group-CBT (control condition). The virtual environments used in the treatment recreate four situations dealing with social anxiety: performance, intimacy, scrutiny, and assertiveness. With the help of the therapist, the patient learns adapted cognitions and behaviors in order to reduce anxiety in the corresponding real situations. Both treatments lasted 12 weeks, and sessions were delivered according to a treatment manual. Results showed statistically and clinically significant improvement in both conditions. The effect-sizes comparing the efficacy of VRT to the control traditional group-CBT revealed that the differences between the two treatments are trivial.

Adaptation, Psychological↗
PubMedDate not supplied

Effect of beta blockade on singing performance.

The symptoms associated with performance anxiety, or the so-called stage fright syndrome, are similar to those of alpha and beta adrenergic stimulation. Suppression of symptoms and improvement in instrumentalist's performance after beta blockade suggest that this modality would be of benefit for singers as well. To evaluate the dose-effect relationship of beta blockade upon singing performance and the possible effect of these agents upon performance maturation, we studied 34 singing students during end of semester juries, using a double-blind crossover paradigm. Students performed once with either placebo, 20, 40, or 80 mg of nadolol, and again 48 hours later, with placebo. There was a significant dose-related, limiting effect upon intraperformance cardiac rate. A small, but statistically significant, dichotomous effect upon performance rating was noted: low-dose nadolol tended to enhance performance, whereas larger doses impaired performance. We conclude that the effects of low dose beta blockade upon singing are minimally helpful and high doses may detract from performance ability.

Adolescent↗
PubMed2003

Motivational climate and perceived competence in anxiety and tennis performance.

This study was done to verify a prediction in achievement goal-orientation theory in a Korean physical education setting. It was hypothesized that the interactions of situationally induced motivational climates (Task and Ego) and perceived competence would differentially influence anxiety and performance in tennis classes. 60 undergraduate men were assigned to a Task-involving and an Ego-involving program in tennis classes for 6 wk. Their perceptions of motivation climates and tennis competence were measured after the first 3 wk., and anxiety responses (cognitive and somatic) and tennis skill performance were evaluated every week over the second 3 wk. of the class. Analysis showed in Task-involving condition students decreased anxiety responses and increased tennis performance, whereas Ego-involving students who had low perception of their tennis competence maintained their anxiety responses and decreased their tennis performance. These results support the hypotheses and the predictions of goal-orientation theory and suggested practical application of the goal-orientation theory in Korea could be explored.

Adult↗
PubMedDate not supplied

Sexual dysfunction, Part I: Classification, etiology, and pathogenesis.

BACKGROUND: The sexual dysfunctions are extremely common but are rarely recognized by primary care physicians. They represent inhibitions in the appetitive or psychophysiologic changes that characterize the complete adult sexual response and are classified into four major categories: (1) sexual desire disorders (hypoactive sexual desire, sexual aversion disorder), (2) sexual arousal disorders (female sexual arousal disorder, male erectile dysfunction), (3) orgasmic disorders (inhibited male or female orgasm, premature ejaculation), and (4) sexual pain disorders (dyspareunia, vaginismus). METHODS: Articles about the sexual dysfunctions were obtained from a search of MEDLINE files from 1966 to the present using the categories as key words, along with the general key word "sexual dysfunction." Additional articles came from the reference lists of dysfunction-specific reviews. RESULTS AND CONCLUSIONS: Cause and pathogenesis span a continuum from organic to psychogenic and most often include a mosaic of factors. Organic factors include chronic illness, pregnancy, pharmacologic agents, endocrine alterations, and a host of other medical, surgical, and traumatic factors. Psychogenic factors include an array of individual factors (e.g., depression, anxiety, fear, frustration, guilt hypochondria, intrapsychic conflict), interpersonal and relationship factors (e.g., poor communication, relationship conflict, diminished trust, fear of intimacy, poor relationship models, family system conflict), psychosexual factors (e.g., negative learning and attitudes, performance anxiety, prior sexual trauma, restrictive religiosity, intellectual defenses), and sexual enactment factors (e.g., skill and knowledge deficits, unrealistic performance expectations). Understanding the cause and pathophysiology of sexual disorders will help primary care physicians diagnose these problems accurately and manage them effectively.

Humans↗