-
Epilepsy & Behavior Reports 2024A 51-year-old woman showed structural epilepsy following an atypical, nontraumatic intracranial hemorrhage in the right frontal area. Despite successful seizure control...
A 51-year-old woman showed structural epilepsy following an atypical, nontraumatic intracranial hemorrhage in the right frontal area. Despite successful seizure control with lamotrigine, she developed severe morning anxiety and panic attacks, leading to agoraphobia, social withdrawal, and psychogenic nonepileptic seizures. Neuropsychiatric and psychological assessments confirmed an anxiety disorder with no significant symptoms of depression. The patient received various psychopharmacological treatments with limited success. This case report illustrates that managing panic disorder in patients with structural epilepsy requires a comprehensive treatment approach that includes pharmacotherapy and psychotherapy. Differential diagnosis and accurate treatment are crucial because of the symptom overlap between panic attacks and -ictal fear. Screenings instruments such as the Panic and Agoraphobia Scale (PAS) can aid in assessing anxiety-related symptoms. First-line pharmacotherapy with selective serotonin reuptake inhibitors, especially sertraline, or venlafaxine can effectively reduce panic attacks and can be recommended in patients with epilepsy. Psychotherapy, particularly cognitive-behavioral therapy, is the treatment of choice. Referral to a psychiatrist is indicated when symptoms are severe or refractory to treatment.
PubMed: 38299123
DOI: 10.1016/j.ebr.2024.100646 -
Advances in Experimental Medicine and... 2020In almost all treatments for prevalent psychiatric conditions, particular attention has been devoted to stress and its consequences; this has led to an involuntary and... (Review)
Review
In almost all treatments for prevalent psychiatric conditions, particular attention has been devoted to stress and its consequences; this has led to an involuntary and unavoidable reinforcement of negative aspects of life. Because of the important influence of individual and cultural influences on positive health, well-being is a challenge from a clinical and scientific perspective and interventions aimed at enhancing it represent an area of growing interest for the future of clinical practice and research. Well-being therapy (WBT) is a short-term psychotherapeutic strategy aimed at enhancing well-being based on the model originally developed in 1958 by Marie Jahoda. It emphasizes self-observation, with the use of a structured diary, interaction between patients and therapists, and homework. WBT may be used as the only therapeutic strategy or in sequential combination with other psychotherapeutic strategies, mainly cognitive behavioral therapy. WBT can be differentiated from positive interventions based on several features which are described in detail in the present chapter. We also report the clinical use of WBT in the treatment of anxiety disorders, mainly generalized anxiety disorder, panic disorder, and agoraphobia. Potential further clinical application of WBT is withdrawal after antidepressants discontinuation and side effects during long-term antidepressant treatment.
Topics: Agoraphobia; Antidepressive Agents; Anxiety Disorders; Cognitive Behavioral Therapy; Humans; Panic Disorder; Psychotherapy
PubMed: 32002942
DOI: 10.1007/978-981-32-9705-0_24 -
Journal of Affective Disorders Dec 2021Anxiety disorders are amongst the most commonly diagnosed mental illnesses amongst men; however male-specific anxiety research is lacking. This review explores men's... (Review)
Review
AIM
Anxiety disorders are amongst the most commonly diagnosed mental illnesses amongst men; however male-specific anxiety research is lacking. This review explores men's anxiety symptoms and disorders including help-seeking, coping and the role of masculinity.
METHOD
Four electronic database searches identified 8,333 citations, with 25 studies meeting inclusion criteria. Nineteen studies employed quantitative methods, five studies reported qualitative research, and one utilised mixed methods.
RESULTS
Unique profiles of anxiety, including psychosomatic symptoms, were identified and persisted over extended periods of time. Men commonly reported self-reliance over formal help-seeking, and typically managed anxiety symptoms through problem-based coping. Masculinity was related to anxiety in complex ways; adherence to norms of toughness could be protective against anxiety onset, while adherence to emotional restrictiveness and heterosexual presentation norms were positively associated with anxiety. The experience of, and help-seeking for anxiety transgressed many men's adherence to masculinity norms resulting in significant social and self-stigmas.
LIMITATIONS
The anxiety measurement scales utilised were inconsistent across included studies and there was limited scope of research into panic disorders, phobias and agoraphobia.
CONCLUSION
Findings demonstrate the enduring nature of anxiety for men and a potential under-reporting of symptoms, especially amongst younger men. To better tailor clinical care and public health resources to the needs of men with anxiety disorders, targeted research examining men's lived experiences of (and coping strategies for) anxiety is essential.
Topics: Anxiety; Anxiety Disorders; Humans; Male; Masculinity; Men; Men's Health; Social Stigma
PubMed: 34517242
DOI: 10.1016/j.jad.2021.08.136 -
Psychological Medicine Mar 2023Agoraphobic avoidance of everyday situations is a common feature in many mental health disorders. Avoidance can be due to a variety of fears, including concerns about...
BACKGROUND
Agoraphobic avoidance of everyday situations is a common feature in many mental health disorders. Avoidance can be due to a variety of fears, including concerns about negative social evaluation, panicking, and harm from others. The result is inactivity and isolation. Behavioural avoidance tasks (BATs) provide an objective assessment of avoidance and anxiety but are challenging to administer and lack standardisation. Our aim was to draw on the principles of BATs to develop a self-report measure of agoraphobia symptoms.
METHOD
The scale was developed with 194 patients with agoraphobia in the context of psychosis, 427 individuals in the general population with high levels of agoraphobia, and 1094 individuals with low levels of agoraphobia. Factor analysis, item response theory, and receiver operating characteristic analyses were used. Validity was assessed against a BAT, actigraphy data, and an existing agoraphobia measure. Test-retest reliability was assessed with 264 participants.
RESULTS
An eight-item questionnaire with avoidance and distress response scales was developed. The avoidance and distress scales each had an excellent model fit and reliably assessed agoraphobic symptoms across the severity spectrum. All items were highly discriminative (avoidance: = 1.24-5.43; distress: = 1.60-5.48), indicating that small increases in agoraphobic symptoms led to a high probability of item endorsement. The scale demonstrated good internal reliability, test-retest reliability, and validity.
CONCLUSIONS
The Oxford Agoraphobic Avoidance Scale has excellent psychometric properties. Clinical cut-offs and score ranges are provided. This precise assessment tool may help focus attention on the clinically important problem of agoraphobic avoidance.
Topics: Humans; Reproducibility of Results; Agoraphobia; Anxiety; Anxiety Disorders; Fear; Panic Disorder
PubMed: 37010211
DOI: 10.1017/S0033291721002713 -
The International Journal of... Feb 2024This paper describes the anxiety evoked in a patient threatened by invasion or engulfment by his object on the one hand, and the fears of isolation and abandonment on...
This paper describes the anxiety evoked in a patient threatened by invasion or engulfment by his object on the one hand, and the fears of isolation and abandonment on the other. The author illustrates the patient's strugles to find a distance between himself and his object he can tolerate. The analyst has also to cope with the anxieties evoked by the patient's projections, and find a distance between himself and his patient that enables him to think and work.
Topics: Male; Humans; Anxiety; Fear; Projection
PubMed: 38470288
DOI: 10.1080/00207578.2023.2286753 -
Ochsner Journal 2023Anxiety disorders are commonly diagnosed and cause substantial functional impairment. A mixture of pharmacologic and psychosocial treatments currently exists, but these... (Review)
Review
Anxiety disorders are commonly diagnosed and cause substantial functional impairment. A mixture of pharmacologic and psychosocial treatments currently exists, but these treatments are not always tolerable and effective. For patients with anxiety resistant to standard therapy, psychedelics may be a promising alternative. This review assesses the therapeutic benefits and safety of psychedelics in treating anxiety disorders. We searched PubMed, Embase, PsycInfo, and CINAHL for clinical trials investigating psychedelics in patients with clinician-diagnosed generalized anxiety disorder, social anxiety disorder, specific phobia, separation anxiety disorder, selective mutism, panic disorder, agoraphobia, and anxiety attributable to another medical condition. We analyzed data from 9 independent psychedelic-assisted trials testing ayahuasca (1 study), ketamine (4 studies), lysergic acid diethylamide (LSD) (2 studies), 3,4-methylenedioxymethamphetamine (MDMA) (1 study), and psilocybin (1 study). Efficacy was assessed by measuring the change in outcome measures and the quality of life from baseline. The reviewed studies demonstrated encouraging efficacy in reducing anxiety symptoms, increasing self-perception, and increasing social function in patients with generalized anxiety disorder, social anxiety disorder, or anxiety attributable to another medical condition while establishing feasibility and evidence of safety. For many patients, the therapeutic effects of the psychedelic treatment lasted weeks, and no severe adverse events were reported. Based on the evidence of symptom reduction and safety, the current literature (2011 to 2021) shows that psychedelics could be considered for treating clinician-diagnosed anxiety disorders. Psychedelics may provide an alternative therapeutic option for patients resistant to current standard treatments.
PubMed: 38143548
DOI: 10.31486/toj.23.0076 -
Journal of Affective Disorders Dec 2023Brain functional abnormalities have been commonly reported in anxiety disorders, including generalized anxiety disorder, social anxiety disorder, panic disorder,... (Review)
Review
BACKGROUND
Brain functional abnormalities have been commonly reported in anxiety disorders, including generalized anxiety disorder, social anxiety disorder, panic disorder, agoraphobia, and specific phobias. The role of functional abnormalities in the discrimination of these disorders can be tested with machine learning (ML) techniques. Here, we aim to provide a comprehensive overview of ML studies exploring the potential discriminating role of functional brain alterations identified by functional magnetic resonance imaging (fMRI) in anxiety disorders.
METHODS
We conducted a search on PubMed, Web of Science, and Scopus of ML investigations using fMRI as features in patients with anxiety disorders. A total of 12 studies (resting-state fMRI n = 5, task-based fMRI n = 6, resting-state and task-based fMRI n=1) met our inclusion criteria.
RESULTS
Overall, the studies showed that, regardless of the classifiers, alterations in functional connectivity and aberrant neural activation involving the amygdala, anterior cingulate cortex, hippocampus, insula, orbitofrontal cortex, temporal pole, cerebellum, default mode network, dorsal attention network, sensory network, and affective network were able to discriminate patients with anxiety from controls, with accuracies spanning from 36 % to 94 %.
LIMITATIONS
The small sample size, different ML approaches and heterogeneity in the selection of regions included in the multivariate pattern analyses limit the conclusions of the present review.
CONCLUSIONS
ML methods using fMRI as features can distinguish patients with anxiety disorders from healthy controls, indicating that these techniques could be used as a helpful tool for the diagnosis and the development of more targeted treatments for these disorders.
Topics: Humans; Anxiety Disorders; Phobic Disorders; Panic Disorder; Anxiety; Brain; Magnetic Resonance Imaging; Brain Mapping
PubMed: 37683943
DOI: 10.1016/j.jad.2023.09.006 -
The Journal of Nervous and Mental... Oct 2022This study examined the relationship between eight measures of religious involvement and five anxiety disorders among a nationally representative sample of...
This study examined the relationship between eight measures of religious involvement and five anxiety disorders among a nationally representative sample of African-Americans ( N = 3403). The Diagnostic and Statistical Manual of Mental Disorders, 4th Edition , World Mental Health Composite International Diagnostic Interview was used to assess 12-month and lifetime prevalence for each disorder. Logistic regression indicated weekly service attendance was inversely associated with 12-month and lifetime panic disorder, lifetime agoraphobia, and 12-month and lifetime posttraumatic stress disorder (PTSD). Prayer was inversely associated with 12-month agoraphobia, 12-month social phobia, and lifetime PTSD. Listening to religious radio and looking to God for strength were also inversely related to, respectively, 12-month and lifetime panic disorder. Conversely, reading religious materials was positively associated with 12-month panic disorder, 12-month agoraphobia, lifetime PTSD, and lifetime generalized anxiety disorder. The results are discussed in light of conceptual models that specify multiple and sometimes divergent pathways through which religion impacts health, and suggestions for clinicians addressing anxiety disorders are delineated.
Topics: Black or African American; Agoraphobia; Anxiety Disorders; Diagnostic and Statistical Manual of Mental Disorders; Health Surveys; Humans; Prevalence
PubMed: 35605210
DOI: 10.1097/NMD.0000000000001538 -
Neuro Endocrinology Letters Oct 2020Panic disorder and agoraphobia not only affect the patients themselves but also may have a detrimental effect on their intimate relationships. A problem arising in the... (Review)
Review
BACKGROUND
Panic disorder and agoraphobia not only affect the patients themselves but also may have a detrimental effect on their intimate relationships. A problem arising in the intimate sphere could be a trigger, a modulator, a maintenance factor, or the result of the panic disorder and agoraphobia. The consequences of panic disorder include increased demands on the non-affected partner to adapt, which may prove to be too challenging for some to manage. Panic disorder and agoraphobia can also change earlier relationship patterns which may result in partnership dysfunction. This review explores the effect of panic disorder and agoraphobia upon partnership problems and satisfaction.
METHOD
Relevant studies were identified via PubMed and Web of Science, published between January 1970 and April 2020. The search terms included "panic disorder", "agoraphobia", "marital problems", "marital conflicts" and "marital adjustment". Further references were found in reviews, books, and book chapters of the relevant papers. A total of 1154 articles were nominated by primary assortment using the keywords in different combinations. After selecting according to the inclusion and exclusion criteria, evaluating the complete texts and searching for secondary documents, 173 papers were finally chosen.
RESULTS
Problems in a relationship can act as a trigger for the development of the panic disorder and agoraphobia and could also function as modulating and maintenance factors. Panic disorder and agoraphobia often have a negative influence on the relationship and the non-affected partner. Partnership problems can be both a precursor and a consequence of panic disorder and agoraphobia.
Topics: Agoraphobia; Family Conflict; Humans; Marriage; Panic Disorder; Personal Satisfaction
PubMed: 33307653
DOI: No ID Found -
Journal of the American Academy of... Feb 2022Depression and anxiety disorders together account for the majority of mental health disorders in childhood and adolescence, and are often comorbid. The frequent...
Depression and anxiety disorders together account for the majority of mental health disorders in childhood and adolescence, and are often comorbid. The frequent co-occurrence of these disorders has motivated clinicians and researchers to consider dimensional taxonomy models that focus on neurobiological substrates that explain transdiagnostic constructs of functioning (eg, reward processing abnormalities). Such an approach would redefine not only depression and anxiety disorders but could also revolutionize clinical care, as such biobehavioral targets, rather than a traditional primary diagnosis, could serve as the basis for treatment planning. In this issue of the Journal, Auerbach et al. examined whether and how a key structure involved in reward processing, the nucleus accumbens (NAcc), is altered in adolescents aged 14 to 17 years with depression and/or anxiety (including generalized anxiety, separation anxiety, social anxiety, specific phobia, agoraphobia, and panic) disorders, and whether NAcc morphometry and function would improve prediction of 6-month symptomatology. As part of the Boston Adolescent Neuroimaging of Depression and Anxiety (BANDA) initiative, the researchers compared 129 adolescents with primary diagnoses of depression and/or anxiety and 64 psychiatrically healthy controls on gray matter volumes of the NAcc and on functional activation of the NAcc during a monetary incentive delay task using magnetic resonance imaging (MRI) protocols harmonized with the Human Connectome project (http://www.humanconnectomeproject.com/). Compared to healthy adolescents, depressed/anxious adolescents exhibited significantly smaller volumes of the NAcc and blunted NAcc responses to reward receipt. Among the 88 depressed/anxious adolescents and 57 healthy controls who provided symptom data 6 months later, the researchers also found that inclusion of NAcc volumes, but not reward-related responses of the NAcc on the task, significantly improved statistical prediction of subsequent depression symptoms.
Topics: Adolescent; Anxiety; Anxiety Disorders; Connectome; Depression; Humans; Magnetic Resonance Imaging; Nucleus Accumbens; Reward
PubMed: 34216777
DOI: 10.1016/j.jaac.2021.06.013