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Psychiatry Research Mar 2021Social avoidance in young patients is a clinically worrisome phenomenon that characterizes impending schizophrenia, but that also constitutes a core phenomenon in... (Review)
Review
Social avoidance in young patients is a clinically worrisome phenomenon that characterizes impending schizophrenia, but that also constitutes a core phenomenon in avoidant personality disorder (AvPD), schizoid personality disorder (ScPD), and in autism spectrum disorder (ASD). Especially in the absence of any other clinically relevant phenomena, understanding the origins of social avoidance may be one the most challenging tasks in assessing whether adolescents and young adults are at risk for developing schizophrenia. Descriptive and psychometric assessments only allow to comment on the absence or the presence of this phenomenon, but do not capture the origins and the meaning of social avoidance. Based on a narrative review, we highlight the importance of a phenomenological approach to unveil the Gestalt of social avoidance in these mental disorders, including and appraisal of the underlying mental structures and attachment styles. The phenomenological approach allows to distinguish the Gestalt of social avoidance between AvPD, ScPD, ASD, and beginning schizophrenia, to ensure correct diagnostic labelling and optimal treatment, and to avoid unwarranted stigmatization.
Topics: Adolescent; Autism Spectrum Disorder; Humans; Personality Disorders; Psychometrics; Schizoid Personality Disorder; Schizophrenia; Social Behavior; Young Adult
PubMed: 33465524
DOI: 10.1016/j.psychres.2021.113718 -
Journal of the American Academy of... May 2024As child psychiatrists, it is our job to ask questions, and many of us would say we are really good at it. We work with our patients to open up about their experiences,...
As child psychiatrists, it is our job to ask questions, and many of us would say we are really good at it. We work with our patients to open up about their experiences, discussing fear, sadness, hope, and joy. By modeling this ability to open up in the office, we help guide children and adolescents through using other skills rather than avoidance. Although avoidance has its place at times, we help show our patients the connection between anxiety and avoidance. This necessity to embrace and challenge fears can be a difficult skill for our patients and also their families. Children bring forward questions that parents may want to avoid, fearing the answer might be more difficult for the child than the rejection of having the question avoided all together. As someone who works with children with chronic illnesses, this avoidance of the question can in fact increase the fear and anxiety of the child or adolescent. When talking to children, often they will express a greater fear than the reality of the situation because they determine that if their parent is avoiding the question, it must be really bad. This same struggle with avoidance can be true for us as child psychiatrists as well. The necessity to take on roles of leadership or run a team often presents itself, but excuses can come up to help us avoid these roles. We might say we are not properly trained, we did not go into medicine to do those responsibilities, or we are too busy. By avoiding these responsibilities, we are setting ourselves up for more frustration. As teams struggle, we have to follow the lead of others without the same clinical knowledge, which may result in additional errors. We must remember to practice what we preach and to identify the cost of avoidance.
Topics: Humans; Child; Adolescent; Child Psychiatry; Fear; Avoidance Learning; Anxiety; Physician-Patient Relations
PubMed: 38387792
DOI: 10.1016/j.jaac.2024.02.004 -
Neurosurgery Clinics of North America Apr 2004Complications are relatively common in the evaluation and treatment of patients with peripheral nerve tumors. The complications are frequently avoidable. Physicians and... (Review)
Review
Complications are relatively common in the evaluation and treatment of patients with peripheral nerve tumors. The complications are frequently avoidable. Physicians and surgeons managing patients with these lesions must possess sufficient knowledge about peripheral nerve tumors and their natural history as well as good diagnostic, decision-making, and technical skills. By avoiding often unnecessary complications, patients and surgeons can be rewarded with better outcomes.
Topics: Humans; Peripheral Nervous System Neoplasms; Postoperative Complications
PubMed: 15177318
DOI: 10.1016/j.nec.2004.01.003 -
Behavioural Pharmacology Apr 2019Individuals with post-traumatic stress disorder avoid trauma-related stimuli and exhibit blunted hypothalamic-pituitary-adrenal axis response at the time of trauma. Our... (Review)
Review
Individuals with post-traumatic stress disorder avoid trauma-related stimuli and exhibit blunted hypothalamic-pituitary-adrenal axis response at the time of trauma. Our laboratory uses predator odor (i.e. bobcat urine) stress to divide adult Wistar rats into groups that exhibit high (avoiders) or low (nonavoiders) avoidance of a predator odor-paired context, modeling the fact that not all humans exposed to traumatic events develop psychiatric conditions. Male avoiders exhibit lower body weight gain after stress, as well as extinction-resistant avoidance that persists after a second stress exposure. These animals also show attenuated hypothalamic-pituitary-adrenal axis response to predator odor that predicts subsequent avoidance of the odor-paired context. Avoiders exhibit unique brain activation profiles relative to nonavoiders and controls (as measured by Fos immunoreactivity), and higher corticotropin-releasing factor levels in multiple brain regions. Furthermore, avoider rats exhibit escalated and compulsive-like alcohol self-administration after traumatic stress. Here, we review the predator odor avoidance model of post-traumatic stress disorder and its utility for tracking behavior and measuring biological outcomes predicted by avoidance. The major strengths of this model are (i) etiological validity with exposure to a single intense stressor, (ii) established approach distinguishing individual differences in stress reactivity, and (iii) robust behavioral and biological phenotypes during and after trauma.
Topics: Animals; Avoidance Learning; Brain; Conditioning, Operant; Disease Models, Animal; Humans; Hypothalamo-Hypophyseal System; Male; Odorants; Pituitary-Adrenal System; Rats; Rats, Wistar; Stress Disorders, Post-Traumatic; Stress, Psychological
PubMed: 30640179
DOI: 10.1097/FBP.0000000000000460 -
Developmental Psychology May 2021Infants avoid touching plants. Here we examine for the first time whether infants are also reluctant to touch plant foods. We hypothesized that infants would avoid plant...
Infants avoid touching plants. Here we examine for the first time whether infants are also reluctant to touch plant foods. We hypothesized that infants would avoid plant foods because food neophobia-the avoidance of novel foods-is particularly strong for fruits and vegetables. However, we predicted that infants would avoid processed plant foods to a lesser degree than whole leafy plants because they bear the markers of previous human engagement. In a first assessment, we presented 7- to 15-month-old infants, recruited from a predominantly White population around Berlin, Germany ( = 56; 29 girls), with whole plants, processed whole plant foods, and nonplant food controls. We measured infants' latency to touch each object and their social looks toward adults prior to the first touch. In a follow-up assessment 1 year later, participants' caregivers filled out a questionnaire measuring their child's food neophobia. Infants avoided touching both whole plants and processed plant foods, and engaged in more social looking before touching them, relative to their matched controls. However, infants took longer to touch and engaged in more social looking for whole plants than processed plant foods. The follow-up assessment indicated that avoidance of cut plant foods in older infants was related to their food neophobia measured 1 year later. These results demonstrate that (a) infants avoid plant foods, (b) cues of food processing decrease infants' reluctance to touch plant foods relative to unprocessed plants, suggesting that these cues may signal food safety, and (c) avoiding certain types of plant foods in infancy may be a precursor of later food neophobia. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Topics: Adult; Aged; Child; Emotions; Female; Food Preferences; Fruit; Humans; Infant; Surveys and Questionnaires; Vegetables
PubMed: 34166009
DOI: 10.1037/dev0001146 -
Journal of Behavior Therapy and... Sep 2022In anxiety-related disorders, excessive avoidance often coexists with an impaired sense of control over external threats. In contrast, lab studies have shown that...
BACKGROUND AND OBJECTIVES
In anxiety-related disorders, excessive avoidance often coexists with an impaired sense of control over external threats. In contrast, lab studies have shown that avoidance responding increase with higher objective controllability over threat, accompanied with more confidence in the effectiveness of the avoidance response. One reason for this divergence could be that those lab studies are overly simplistic with a single, avoidable threat.
METHODS
We conducted an experiment that additionally included a completely uncontrollable threat, and we manipulated the reinforcement rate of the avoidance response to the (semi-)controllable threat (75% versus 100%).
RESULTS
The 100% group showed increased avoidance to the controllable threat and decreased avoidance to the unavoidable threat over learning. Interestingly, compared to the 100% group, the 75% group displayed less confidence in their avoidance to the controllable threat and they avoided the uncontrollable threat more often.
LIMITATIONS
Only two reinforcement rates of effective avoidance were included, which may limit the generalizability of the current findings. Perceived control was not directly measured.
CONCLUSIONS
Lower reinforcement rates create ambiguity between effective and ineffective situations of avoidance, which engenders generalization of unpredictability from effective to ineffective situation, thereby driving up ineffective avoidance rates. Partially reinforced effective avoidance responses and elevated ineffective avoidance responses together lead to more exposure to uncontrollable threat, weakening the sense of control over the threat, which could further increase avoidance behaviors. Controllability is often overlooked in avoidance research but can be key to understanding the development of maladaptive avoidance behaviors.
Topics: Avoidance Learning; Humans; Reinforcement, Psychology
PubMed: 35738697
DOI: 10.1016/j.jbtep.2022.101751 -
The International Journal of... Dec 2021Infants express emotional distress through whining, crying, flailing, silence, etc., which can be viewed as communications that also afflict the caregiver(s). One...
Infants express emotional distress through whining, crying, flailing, silence, etc., which can be viewed as communications that also afflict the caregiver(s). One expressive mode, subtle and often unnoticed except by the parents, is . It often elicits parental feelings of rejection, shame and despair, and may be a reason for seeking parent-infant psychotherapy. In therapy, the symptom often discloses a disturbance in the dyad's emotional interaction. Therapy can bring about relief in the symptom and the relational disorder. Sometimes, the therapist discovers that the infant is avoiding the therapist's, rather than the parents', eyes. This challenges the therapist's expertise in establishing contact with the baby and in perceiving and processing emotional reactions to what may be experienced as the baby's dismissal. Gaze avoidance elicits theoretical questions approached in a previous publication: what does the child seem to avoid in the adult's eyes, and how can we conceptualize the psychodynamics behind the symptom? It also evokes technical questions: how can the therapist make contact with an infant who avoids the mother's or the therapist's eyes? How can the clinician exploit their emotional reactions, the countertransference, to understand and further the dyad's emotional communication? Two case vignettes are provided.
Topics: Adult; Child; Communication; Countertransference; Humans; Infant; Parents; Psychotherapy
PubMed: 34775917
DOI: 10.1080/00207578.2021.1953384 -
Sensors (Basel, Switzerland) Oct 2021The existing ultrasonic obstacle avoidance robot only uses an ultrasonic sensor in the process of obstacle avoidance, which can only be avoided according to the fixed...
The existing ultrasonic obstacle avoidance robot only uses an ultrasonic sensor in the process of obstacle avoidance, which can only be avoided according to the fixed obstacle avoidance route. Obstacle avoidance cannot follow additional information. At the same time, existing robots rarely involve the obstacle avoidance strategy of avoiding pits. In this study, on the basis of ultrasonic sensor obstacle avoidance, visual information is added so the robot in the process of obstacle avoidance can refer to the direction indicated by road signs to avoid obstacles, at the same time, the study added an infrared ranging sensor, so the robot can avoid potholes. Aiming at this situation, this paper proposes an intelligent obstacle avoidance design of an autonomous mobile robot based on a multi-sensor in a multi-obstruction environment. A CascadeClassifier is used to train positive and negative samples for road signs with similar color and shape. A multi-sensor information fusion is used for path planning and the obstacle avoidance logic of the intelligent robot is designed to realize autonomous obstacle avoidance. The infrared sensor is used to obtain the environmental information of the ground depression on the wheel path, the ultrasonic sensor is used to obtain the distance information of the surrounding obstacles and road signs, and the information of the road signs obtained by the camera is processed by the computer and transmitted to the main controller. The environment information obtained is processed by the microprocessor and the control command is output to the execution unit. The feasibility of the design is verified by analyzing the distance acquired by the ultrasonic sensor, infrared distance measuring sensors, and the model obtained by training the sample of the road sign, as well as by experiments in the complex environment constructed manually.
Topics: Algorithms; Robotics
PubMed: 34695990
DOI: 10.3390/s21206777 -
The European Journal of Neuroscience May 2022Anxiety and stress are adaptive responses to threat that promote harm avoidance. In particular, prior work has shown that anxiety induced in humans using threat of...
Anxiety and stress are adaptive responses to threat that promote harm avoidance. In particular, prior work has shown that anxiety induced in humans using threat of unpredictable shock promotes behavioral inhibition in the face of harm. This is consistent with the idea that anxiety promotes passive avoidance-that is, withholding approach actions that could lead to harm. However, harm can also be avoided through active avoidance, where a (withdrawal) action is taken to avoid harm. Here, we provide the first direct within-study comparison of the effects of threat of shock on active and passive avoidance. We operationalize passive avoidance as withholding a button press response in the face of negative outcomes, and active avoidance as lifting/releasing a button press in the face of negative outcomes. We explore the impact of threat of unpredictable shock on the learning of these behavioral responses (alongside matched responses to rewards) within a single cognitive task. We predicted that threat of shock would promote both active and passive avoidance, and that this would be driven by increased reliance on Pavlovian bias, as parameterized within reinforcement-learning models. Consistent with our predictions, we provide evidence that threat of shock promotes passive avoidance as conceptualized by our task. However, inconsistent with predictions, we found no evidence that threat of shock promoted active avoidance, nor evidence of elevated Pavlovian bias in any condition. One hypothetical framework with which to understand these findings is that anxiety promotes passive over active harm avoidance strategies in order to conserve energy while avoiding harm.
Topics: Anxiety; Avoidance Learning; Humans; Inhibition, Psychological; Reinforcement, Psychology; Reward
PubMed: 33714211
DOI: 10.1111/ejn.15184 -
Clinical, Cosmetic and Investigational... Dec 2013The ever-expanding range of dermal filler products for aesthetic soft tissue augmentation is of benefit for patients and physicians, but as indications and the number of... (Review)
Review
BACKGROUND
The ever-expanding range of dermal filler products for aesthetic soft tissue augmentation is of benefit for patients and physicians, but as indications and the number of procedures performed increase, the number of complications will likely also increase.
OBJECTIVE
To describe potential adverse events associated with dermal fillers and to provide structured and clear guidance on their treatment and avoidance.
METHODS
Reports of dermal filler complications in the medical literature were reviewed and, based on the publications retrieved and the authors' extensive experience, recommendations for avoiding and managing complications are provided.
RESULTS
Different dermal fillers have widely varying properties, associated risks, and injection requirements. All dermal fillers have the potential to cause complications. Most are related to volume and technique, though some are associated with the material itself. The majority of adverse reactions are mild and transient, such as bruising and trauma-related edema. Serious adverse events are rare, and most are avoidable with proper planning and technique.
CONCLUSION
For optimum outcomes, aesthetic physicians should have a detailed understanding of facial anatomy; the individual characteristics of available fillers; their indications, contraindications, benefits, and drawbacks; and ways to prevent and avoid potential complications.
PubMed: 24363560
DOI: 10.2147/CCID.S50546