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The Psychiatric Quarterly Sep 2020Generalized Anxiety Disorder (GAD) from an official recognition as a residual category in DSM-III has come a long way to be appreciated as a common underlying anxiety...
Generalized Anxiety Disorder (GAD) from an official recognition as a residual category in DSM-III has come a long way to be appreciated as a common underlying anxiety pathway in the literature. Despite still being defined as extreme anxiety and worry upon performance and about one's health, GAD seems to be a general umbrella of anxiety, covering even social anxiety and panic disorder (PD) and even when not treated and chronic, leading to major depressive disorder (MDD). Along the line of some other similar studies and contentions, in the present study we sought to validate the hypothesis of GAD encompassing social anxiety as well as performance anxiety and its extension to PD and MDD. We also examined the onset of each diagnostic category of GAD, PD and MDD and their developmental course in our clinical sample. 113 patients with Generalized Anxiety Disorder (GAD) out of 295 referrals to our mood and anxiety clinic during the three months of May-July 2019, were identified and included in this research. We expanded the definition of GAD as per our clinical observation to include any situations triggering the anxiety including any performance and social situations and did not exclude if the anxiety led to panic attacks. The results of our study showed that an encompassing GAD (including performance and social anxiety) has an early onset, recognized partially in childhood, but mostly during adolescence. An untreated GAD was complicated with panic disorder and episodes of major depression, each with an onset later in life. GAD in our study was also found to be familial and genetic, while its post-morbid depression seemed to be more a reaction to a long-standing untreated anxiety. The findings of our study if replicated has research implication of better understanding the developmental course of mood disorders and hold the promise of more targeted treatments of anxiety, panic and depression in clinical practice.
Topics: Adult; Age of Onset; Anxiety Disorders; Comorbidity; Depressive Disorder, Major; Humans; Panic Disorder; Phobia, Social
PubMed: 32383134
DOI: 10.1007/s11126-020-09747-0 -
General Hospital Psychiatry 2022Caffeine has been purported to have anxiogenic and panicogenic properties, specifically salient in patients with panic disorder (PD). However, compilations of the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Caffeine has been purported to have anxiogenic and panicogenic properties, specifically salient in patients with panic disorder (PD). However, compilations of the magnitude of the effect of caffeine on anxiety and panic attacks are lacking and potential dose-response relationships have not been examined.
OBJECTIVES
In the present systematic review and meta-analysis, we aimed to examine the acute effects of placebo-controlled caffeine challenge on occurrence of panic attacks and subjective anxiety in patients with PD and healthy controls (HC), including dose-response relationships.
METHODS
Systematic searches were performed in six databases. We included blinded placebo-controlled studies of acute caffeine challenge on panic attacks and/or subjective anxiety in adult patients with PD.
RESULTS
Of the 1893 identified articles, ten met our inclusion criteria. The 9 studies investigating panic attacks included 237 patients, of which 51.1% had a panic attack following caffeine, but none after placebo. Six of these studies compared 128 patients with 115 healthy controls (HC), finding that patients (53.9%) were more vulnerable than HC (1.7%) for panic attacks following caffeine (log RR: 3.47; 95% CI 2.06-4.87). Six studies investigated subjective anxiety in 121 patients and 111 HC following caffeine, with an overall effect indicating increased sensitivity to the anxiogenic effects of caffeine in the patient group (Hedges' g = 1.02 [95% CI: 0.09-1.96]). The restricted range of caffeine employed [400-750 mg] and few studies (3) not using 480 mg prevented any meaningful analysis of a dose-response relationship.
LIMITATIONS
Of the ten studies included, only 2 reported anxiety data for the placebo condition, precluding a proper meta-analysis comparing anxiogenic effects of caffeine and placebo. The restricted dose range used prevented assessment of dose-response relationships.
CONCLUSIONS
The results confirm that caffeine at doses roughly equivalent to 5 cups of coffee induces panic attacks in a large proportion of PD patients and highly discriminates this population from healthy adults. Caffeine also increases anxiety in PD patients as well as among healthy adults at these doses although the exact relationship between caffeine-induced anxiety and panic attacks remains uncertain. The results suggest that caffeine targets important mechanisms related to the pathophysiology of PD.
IMPLICATIONS
Future studies should employ a wider range of caffeine doses and investigate contributions of biological and psychological mechanisms underlying the anxiogenic and panicogenic effects of caffeine. In the clinic, patients with PD should be informed about the panicogenic and anxiogenic effects of caffeine, with the caveat that little is known regarding smaller doses than 480 mg. Registration. PROSPERO (www.crd.york.ac.uk/prospero) registration number CRD42019120220.
Topics: Adult; Anxiety; Anxiety Disorders; Caffeine; Humans; Panic Disorder
PubMed: 34871964
DOI: 10.1016/j.genhosppsych.2021.11.005 -
Advances in Experimental Medicine and... 2020Anxiety disorders are debilitating psychological disorders characterized by a wide range of cognitive and somatic symptoms. Anxiety sufferers have a higher lifetime... (Review)
Review
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).
Topics: Anxiety Disorders; Chronic Disease; Comorbidity; Humans; Panic Disorder
PubMed: 32002933
DOI: 10.1007/978-981-32-9705-0_15 -
Social Science & Medicine (1982) Jan 2019Medical emergencies are staple features of today's 24/7 culture of breaking news. As politics becomes increasingly stylised, audiences fragmented, and established...
Medical emergencies are staple features of today's 24/7 culture of breaking news. As politics becomes increasingly stylised, audiences fragmented, and established knowledge claims contested, health crises have become even more vulnerable to politicisation. We offer the vocabulary of medical populism to make sense of this phenomenon. We define medical populism as a political style based on performances of public health crises that pit 'the people' against 'the establishment.' While some health emergencies lead to technocratic responses that soothe anxieties of a panicked public, medical populism thrives by politicising, simplifying, and spectacularising complex public health issues. To demonstrate the concept's analytical value, we offer four illustrative examples. Thabo Mbeki's HIV denialism and the Philippines' vaccination scandal are examples of the populist logic of forging vertical divisions between the people and the establishment (e.g. the West, big pharma, medical experts). Meanwhile, the Ebola scare and Southeast Asia's drug wars are examples of horizontal divisions that divide the 'virtuous people' against 'dangerous outsiders' (e.g. racial minorities, drug addicts) whose 'threats' have long been overlooked by out-of-touch members of the political and medical establishment. The article concludes by examining the implications of medical populism to health communication and democratic politics.
Topics: Democracy; Epidemics; Global Health; HIV Infections; Health Communication; Health Policy; Hemorrhagic Fever, Ebola; Humans; Politics; Public Health
PubMed: 30553118
DOI: 10.1016/j.socscimed.2018.12.006 -
Clinical Infectious Diseases : An... Sep 2015This article addresses whether Ebola may have been present in an urban setting in Athens in 430 bce and explores the historical importance of the ancient outbreak. New... (Review)
Review
This article addresses whether Ebola may have been present in an urban setting in Athens in 430 bce and explores the historical importance of the ancient outbreak. New knowledge from today's West African epidemic allows a more accurate assessment of whether Ebola may have caused the Athenian outbreak than was once possible. The Athenian disease, whose etiology remains unknown, developed abruptly with fevers, abdominal pain, vomiting, diarrhea, dehydration, and hemorrhage. It originated in sub-Saharan Africa and was especially contagious to doctors and caregivers. No remedies were effective. But the few survivors who were reexposed to diseased patients were not attacked a second time, suggesting protective immunity. What lessons can we learn from the ancient outbreak that bears a clinical and epidemiologic resemblance to Ebola? The historian Thucydides, an eyewitness and disease sufferer, described how the unsuspecting city panicked as it struggled to handle the rapidly spreading, devastating disease. Moreover, he stressed a theme that has relevance today-namely, that fear and panic intensified the disruption of society and damage to the individual that was directly caused by the disease. Moreover, fear amplified the spread of disease. The destructive nature of fear has remained a signature feature of pestilences that have subsequently caught ill-prepared societies off-guard-Bubonic plague in medieval times, AIDS in the 1980s, and Ebola today. The ancient Athenian epidemic is relevant for today's West African Ebola outbreak because it shows how fear and panic can endanger the individual, our society, and our efforts to handle the disease.
Topics: Disease Outbreaks; Fear; Greece, Ancient; Hemorrhagic Fever, Ebola; History, Ancient; Humans; Panic
PubMed: 26033924
DOI: 10.1093/cid/civ418 -
Frontiers in Public Health 2021
Topics: Consumer Behavior; Humans; Panic
PubMed: 34095081
DOI: 10.3389/fpubh.2021.694734 -
Forensic Science, Medicine, and... Dec 2023The fear of being buried alive or taphophobia remains a significant concern for a number of individuals. In previous centuries however, reports of live burials were...
The fear of being buried alive or taphophobia remains a significant concern for a number of individuals. In previous centuries however, reports of live burials were frequently promulgated in the media fostering an industry focused around the manufacturing and selling of security coffins which either facilitated egress or enabled the recently buried to alert those on the surface to their plight. Holding mortuaries with resuscitation facilities were also established mainly in Continental Europe to permit close observation of the recently deceased until definitive signs of putrefaction had developed. Underpinning much of this panic was the inability of medical practitioners to definitely diagnose death. Although still a rare possibility, mainly in situations where qualified medical personnel are not available, the likelihood of alive burial is nowadays fortunately rare.
Topics: Humans; Fear; Burial; Panic; Records
PubMed: 37195590
DOI: 10.1007/s12024-023-00644-z -
Translational Psychiatry Jul 2020The aim of this review is to summarize evidence regarding rat emotional experiences during carbon dioxide (CO) exposure. The studies reviewed show that CO exposure is... (Review)
Review
The aim of this review is to summarize evidence regarding rat emotional experiences during carbon dioxide (CO) exposure. The studies reviewed show that CO exposure is aversive to rats, and that rats respond to CO exposure with active and passive defense behaviors. Plasma corticosterone and bradycardia increased in rats exposed to CO. As with anxiogenic drugs, responses to CO are counteracted by the administration of anxiolytics, SRIs, and SSRI's. Human studies reviewed indicate that, when inhaling CO, humans experience feelings of anxiety fear and panic, and that administration of benzodiazepines, serotonin precursors, and SSRIs ameliorate these feelings. In vivo and in vitro rat studies reviewed show that brain regions, ion channels, and neurotransmitters involved in negative emotional responses are activated by hypercapnia and acidosis associated with CO exposure. On the basis of the behavioral, physiological, and neurobiological evidence reviewed, we conclude that CO elicits negative emotions in rats.
Topics: Animals; Anti-Anxiety Agents; Brain; Carbon Dioxide; Emotions; Panic; Rats
PubMed: 32709846
DOI: 10.1038/s41398-020-00936-w -
Frontiers in Psychiatry 2022Panic disorder (PD) is unique among anxiety disorders in that the emotional symptoms (e.g., fear and anxiety) associated with panic are strongly linked to body... (Review)
Review
Panic disorder (PD) is unique among anxiety disorders in that the emotional symptoms (e.g., fear and anxiety) associated with panic are strongly linked to body sensations indicative of threats to physiological homeostasis. For example, panic attacks often present with feelings of suffocation that evoke hyperventilation, breathlessness, or air hunger. Due to the somatic underpinnings of PD, a major focus has been placed on interoceptive signaling and it is recognized that dysfunctional body-to-brain communication pathways promote the initiation and maintenance of PD symptomatology. While body-to-brain signaling can occur several pathways, immune and humoral pathways play an important role in communicating bodily physiological state to the brain. Accumulating evidence suggests that neuroimmune mediators play a role in fear and panic-associated disorders, although this has not been systematically investigated. Currently, our understanding of the role of immune mechanisms in the etiology and maintenance of PD remains limited. In the current review, we attempt to summarize findings that support a role of immune dysregulation in PD symptomology. We compile evidence from human studies and panic-relevant rodent paradigms that indicate a role of systemic and brain immune signaling in the regulation of fear and panic-relevant behavior and physiology. Specifically, we discuss how immune signaling can contribute to maladaptive body-to-brain communication and conditioned fear that are relevant to spontaneous and conditioned symptoms of PD and identify putative avenues warranting future investigation.
PubMed: 36523875
DOI: 10.3389/fpsyt.2022.1015349