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The familial prevalence in second-degree relatives of patients with anxiety neurosis (panic disorder).
A family history study of second-degree relatives of 19 patients with anxiety neurosis (panic disorder) and 19 controls showed a morbidity risk of 9.5% among the former compared with 1.4% among the latter. These risks were approximately half those found among first-degree relatives. Female relatives were at higher risk for anxiety neurosis. The risk for other psychiatric illnesses did not differ between the relatives of anxiety neurosis and controls.
Distribution of ancestral secondary cases in anxiety neurosis (panic disorder).
The Slater computational model for use in distinguishing between polygenic inheritance and the effects of a single dominant gene with incomplete penetrance was applied to 15 kindreds of anxiety neurosis (panic disorder). The number of observed unilateral pairs (two ancestral cases from one side of the kindred) was significantly greater than the number expected. Therefore, these results suggest a dominant mode of transmission for anxiety neurosis.
Clinical impact of obsessive-compulsive disorder comorbidity in bipolar disorder: a systematic review and meta-analysis.
BACKGROUND: Bipolar disorder (BD) is commonly comorbid with other psychiatric conditions, such as obsessive-compulsive disorder (OCD). Despite increasing interest in this comorbidity, quantitative data on its clinical characteristics remain limited. This systematic review and meta-analysis aimed to evaluate the clinical impact of OCD comorbidity in BD by comparing individuals with BD and OCD (BD-OCD) to those with BD without OCD. METHODS: We systematically searched the PubMed/MEDLINE, Scopus, PsycINFO, and Web of Science databases up to April 15, 2024. Meta-analyses were conducted to compare BD-OCD and BD without OCD groups across multiple clinical domains. RESULTS: From 11,959 initial records screened, 26 studies were included in the qualitative synthesis, with 22 eligible for meta-analysis. Individuals with BD-OCD showed higher odds of experiencing chronic mood episodes (OR = 9.42; 95%CI = 2.23, 39.9), rapid cycling (OR = 1.92; 95%CI = 1.04, 3.53), comorbid eating disorders (OR = 3.37; 95%CI = 1.99, 5.7), panic disorder (OR = 3.3; 95%CI = 2.11, 5.2), substance use disorders (OR = 1.39; 95%CI = 1.02, 1.89), and lifetime suicide attempts (OR = 1.85; 95%CI = 1.21, 2.84). Additionally, they presented earlier onset of BD (SMD = -0.27; 95%CI = -0.52, -0.01) and reduced functioning (SMD = -0.42; 95%CI = -0.59, -0.24). Most data were derived from adult populations, limiting the evidence available for children and adolescents. CONCLUSIONS: BD-OCD presents a more severe and complex clinical profile, requiring specialized assessment and integrated treatment approaches. Identifying these features may support earlier recognition and inform personalized interventions for this population.
Case 1. Assessment and treatment of phobic anxiety.
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Simple, effective treatment of agoraphobia.
For effective treatment of agoraphobia both patient and therapist must understand the mechanisms of sensitization and self-desensitization. Rather than aiming to adapt to difficult situations, to achieve desensitization by suggestions, or to avoid panic, the agoraphobe must learn to pass through panic and to rid oneself of drug dependency. This method of self-desensitization will, as a rule, achieve results quickly and does not necessarily depend upon finding the cause of the original sensitization.
Mendelian randomization underscores the importance of clinical nursing in mitigating anxiety and panic attack risks among low-educated populations.
Considering the complex and underexplored interplay between educational attainment (EA) and the prevalence of anxiety and panic attacks, which carries significant societal implications, we have designed a two-sample Mendelian randomization (MR) study. The primary objective of this research is to elucidate the causal relationship between education level and the risk of anxiety and panic attacks, thereby providing novel insights for clinical and nursing strategies. Our study adheres to the STROBE-MR guidelines and employs a classical two-sample MR analysis to investigate the causal relationship between EA (exposure) and the occurrence of anxiety/panic attacks (outcome). The data for 8 education-related phenotypes, along with anxiety and panic attack outcomes, were sourced from European population-based Genome-wide association studies databases. To ensure robustness, we applied 5 distinct MR analytical methods, supplemented by comprehensive sensitivity analyses, heterogeneity assessments, and evaluations of reverse causality bias to uphold rigorous quality control standards. Our findings, robust across various MR methods and consistent after inverse variance-weighted and false discovery rate (FDR) corrections, indicate a significant association between lower EA and an increased risk of anxiety or panic attacks. Specifically, individuals with no formal qualifications exhibited a higher risk (P-value = .005, OR = 1.017, 95% CI = 1.005-1.029, FDR = 0.011). In contrast, higher levels of education were associated with a reduced risk: College or University degree (P-value < .01, OR = 0.989, 95% CI = 0.984-0.995, FDR = 0.0007), EA (P-value < .01, OR = 0.999, 95% CI = 0.998-0.9995, FDR = 0.0009), and A levels/AS levels or equivalent (P-value = .011, OR = 0.988, 95% CI = 0.978-0.997, FDR = 0.019). These conclusions were consistently supported by at least 4 MR methods and successfully passed all quality control checks. Our study demonstrates a negative correlation between years of education and the risk of anxiety and panic attacks, suggesting that clinical nursing and patient education efforts should prioritize tailored psychological support and patient communication for individuals with lower EA. This population warrants enhanced attention and more compassionate care to mitigate their elevated risk of anxiety-related disorders.
Mitral valve prolapse syndrome and anxiety neurosis/panic disorder.
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Propranolol abuse or performer's maturation?
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Rapid opiate detoxification: clinical evidence of antidepressant and antipanic effects of opiates.
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A rationale for opiate withdrawal symptomatology.
The discovery of opioid peptide transmitters and the delineation of their interactions with the noradrenergic locus ceruleus (LC) has led to our proposing that opiate effects on mood and physiological responses result from the opiate-induced inhibition of the LC. Withdrawal of opiates removes this "tonic" inhibition of the LC and could readily result in a piperoxane-like release from inhibition. The hypothesis that noradrenergic hyperactivity underlies the physiologic and affective changes seen in opiate withdrawal and spontaneous panic seen in man can be readily tested in man by evaluating the efficacy of drugs which inhibit the LC and block piperoxane- and LC-elicited increases in specific behaviors for the treatment of opiate withdrawal and naturally occurring panic-anxiety states in man.
The influence of propranolol on the exposure in vivo of agoraphobics.
This study examines the influence of 40 mg of propranolol on agoraphobics throughout 5-hour periods of exposure in vivo on 3 alternate days. Twenty-three patients were studied using a double-blind parallel design and 19 followed up for 3 months. The propranolol group spent significantly less time than the placebo group travelling alone in the month after treatment, and had improved significantly less on a measure of general symptoms at 3 months. The adverse influence of propranolol on treatment outcome appeared mainly due to a waning effect in the last hour of exposure. Attempts to measure coping with panics as an independent variable were largely unsuccessful.
Mental health and dental education.
The relationship between mental health and the educational process in dental school has rarely been explored. In the author's experience as the mental health consultant at the USC School of Dentistry, several focal points of conflict do influence academic effectiveness. These problem areas are often marked by a variety of physical or psychological symptoms such as anxiety--sometimes of panic proportions--gastrointestinal disturbances, and the like. These are frequently related to fear of failure, being exposed as being intellectually inept and fraudulent, neurotic competitive needs, real and unreal paranoid attitudes toward instructors, the student's expectations as to what his or her "silent partners" require to him or her, and the effect dental education has on marriage.
[Extreme psychogenic shock states in childhood].
An attempt is made in this paper to describe a syndrome consequent upon extreme psychogenic shock situations, which has been observed in a number of children. This syndrome is characterized by panic, flight, and anxiety during the actual event, which are followed by a relatively prolonged period of exclusion from consciousness of painful memories. Besides, there may be observed neurotic symptoms manifesting themselves in a decrease in proficiency level, refusal to establish contacts with other people, and mental digestion of the events. Assimilation of the events by intensive psychotherapy seems to be possible within about six months. Also discussed in this paper is the problem of actual neurosis and the origin of preconscious repression.
Exposure in vivo of agoraphobics: contributions of diazepam, group exposure, and anxiety evocation.
Fifty-seven chronic agoraphobic outpatients were treated by 12 hours of exposure in vivo on four days over two weeks to check the effects of oral diazepam versus placebo during group exposure, group versus individual exposure, and high versus medium anxiety arousal during individual exposure. The controlled parallel design allowed comparative evaluation of each treatment condition to six months follow-up. Assessment was blind with respect to drug and psychological treatment. Patients in all treatment conditions improved significantly in phobias and in related life areas. Outcome to group exposure on phobias and other measures was similar in all three drug conditions (placebo, waning diazepam, peak diazepam) with no significant differences between them. Diazepam patients had significantly less discomfort than placebo patients during group exposure treatment. Group exposure patients improved slightly but significantly more than individual exposure patients on non-phobic measures, though group exposure was accompanied by more panics during treatment yet was easier to run by the therapist. Individual exposure under high anxiety arousal was no more therapeutic than with lower anxiety. Diazepam is a mild palliative during group exposure but does not facilitate outcome to treatment. Group exposure in vivo is mildly facilitatory for outcome compared with individual exposure. Anxiety evocation during treatment was not therapeutically helpful.
Behavior therapy, supportive psychotherapy, imipramine, and phobias.
In a controlled outcome study of phobias, 111 adult patients (69% women, 31% men) received a course of 26 weekly treatment sessions consisting of (1) behavior therapy and imipramine hydrochloride (2) behavior therapy and placebo, or (3) supportive psychotherapy and imipramine. Patients were classified as agoraphobic, mixed phobic, or simple phobic. The great majority of patients in all groups showed moderate to marked global improvement (70% to 86%, depending on rater). In agoraphobics and mixed phobics (both groups experiencing spontaneous panic attacks), imipramine was significantly superior to placebo. There was no difference between behavior therapy and supportive therapy, both resulting in high improvement rates (76% to 100%, depending on rater). In simple phobic patients, there was a high rate of improvement with all treatment regimens (72% to 93%, depending on rater), with no significant difference between imipramine and placebo or between behavior therapy and supportive therapy. Of 88 moderately to markedly improved patients followed up for one year after completing treatment, 83% maintained their gains and 17% relapsed. No patients showed symptom substitution. Eighteen percent of the patients receiving imipramine hydrochloride showed marked stimulant side effects on from 5 to 75 mg/day.