Panic Attacks Causes and Cure

Panic Away Program

Psychologists agree that when a person has anxiety of a certain situation, he may suffer from a panic attack. This person then fears that specific location or event. When he find himself in a similar situation, he fears the onset of an attack and essentially cause himself to have an anxiety attack in the process. The One Move method teaches you how to conquer these fears and end this vicious cycle. The One Move technique is capable of breaking any panic attack cycle and it is proved that with this technique you can avoid any panic attack permanently. This is all obtained without any use of medication or relaxation systems. This unique and amazing technique has led to a program designed to assist people take their life back that has reached over 184,000 people in 32 countries. The best thing about this eBook is that its simple and detailed course. Moreover, audio series, video presentations, 60-Day money back Guarantee, members forum and the one on one coaching and counseling with Barry made this program very affordable for me. Read more here...

Panic Away Summary

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Anxiety and depression

(K 42nM, no affinity for a7, minimal interaction with a3p4) which exhibited preclinical activity in the forced swim test, a behavioral model predictive of clinical antidepressant effects 38,39 . The pyridyl ether A-85380 (11) was also active in the forced swim test it was suggested that nicotine and related agonists with antidepressant effects may be achieving their effect at least in part through interaction with the a4p2 receptor 40 . The selective a4p2 agonist A-186253 (12) has also demonstrated activity in the rat and mouse forced swim test models 40 . Evidence for a therapeutic application of nicotinic modulators in treatment of anxiety disorders is limited to a few studies reporting effects of nicotine or mecamylamine administration on measures of anxiety 34,41 .

Peripheral Benzodiazepine Receptor

The isoquinoline carboxamide derivative, (PK11195), is a potent and selective peripheral benzodiazepine receptor (PBR) antagonist with well-characterized pharmacology 45-49 . Racemic N-methyl-11C PK11195 was shown to be rapidly and highly extracted from blood into brain and, in the absence of activated CNS microglial and macrophage pathology, distributed in a uniform manner throughout brain tissue 50,51 . While the PK11195 racemate was first radiolabeled with car-bon-11 as a potential agent for imaging PBR expression in human myocardium, the R-enantiomer (R- N-methyl- 11C PK11195, (18)) has higher affinity for PBR than the racemic mixture and allows improved detection of specific binding 52 . To date, 18 is the most widely used PET PBR imaging agent, largely as the result of the absence of suitable alternative PBR radioligands.

Nonbenzodiazepine hypnotics Zdrugs

'Z-drugs' are the most frequent treatment for insomnia with the compounds zolpidem, zaleplon and zopiclone marketed for transient insomnia and eszopi-clone (S-isomer of zopiclone) for both transient and chronic insomnia. These non-benzodiazepine structures display efficacy equivalent to benzodiazepines for insomnia. The half-lives, ranging from 1.5 to 5 h, are claimed to be enough for sleep maintenance and to avoid daytime sedation. Moreover, 'Z-drugs' have a reduced propensity for inducing tolerance, withdrawal and abuse compared to benzo-diazepines 14 . However, like benzodiazepines, they are classified as schedule IV drugs by the Drug Enforcement Administration (DEA).

Describe the mechanism of action of benzodiazepines

Benzodiazepine receptors, which are found on postsynaptic nerve endings in the central nervous system (CNS), are part of the GABA receptor complex. GABA is the primary inhibitory neurotransmitter of the CNS. The GABA receptor complex is composed of two a-subunits and two p-subunits. The a-subunits are the binding sites for benzodiazepines. The p-subunits are the binding sites for GABA. A chloride ion channel is located in the center of the GABA receptor complex. Benzodiazepines produce their effects by enhancing the binding of GABA to its receptor. GABA activates the chloride ion channel, allowing chloride ions to enter the neuron. The flow of chloride ions into the neuron hyperpolarizes and inhibits the neuron. Benzodiazepines are metabolized in the liver by microsomal oxidation and glucuronidation. They should be used with caution in those with liver disease and the elderly. The potency, onset, and duration of action of benzodiazepines depend on their lipid solubility. Onset of...

Discuss the role of benzodiazepines in premedication

Benzodiazepines are the most popular drugs used for premedication. They act on receptors for the inhibitory neurotransmitter, g-aminobutyric acid, producing anxiolysis, amnesia, and sedation at doses that do not produce significant cardiovascular or ventilatory depression. These drugs are not analgesic and are not associated with nausea and vomiting. Side effects of benzodiazepines include excessive and prolonged sedation in occasional patients, especially with lorazepam. Sometimes paradoxic agitation rather than anxiolysis may follow these drugs. The most commonly used benzodiazepine in current practice is midazolam, administered intravenously in small incremental doses in the immediate preoperative period. Diazepam is associated with pain on intramuscular or intravenous injection and increased risk of phlebitis.

Symptoms of Depression or Anxiety

Some individuals well past childhood have repeatedly sought help for their difficulties from psychologists, psychiatrists, or other mental health professionals who did not recognize their ADHD impairments. In years past, and even today, many professionals in these fields have received no adequate professional training to help them understand and recognize impairments of ADHD. They are, however, usually trained to recognize depression, anxiety, and personality disorders. Consequently, many doctors are quick to identify symptoms of these more familiar disorders in individuals seeking help. They may also assume that conventional psychotherapy or antidepressant medications will alleviate ADD impairments. Unfortunately, these misguided therapies have caused a large number of older adolescents and adults with ADHD to struggle unsuccessfully, and often for many years, to overcome their ADHD symptoms. In 1992 John Ratey and others published a study that described sixty patients with ADHD who...

Impact of Anger and Anxiety on Health

Spielberger et al. (1991) studied the impact of specific emotions such as anxiety and anger on our ability to make decisions and our subsequent development physical illnesses such as cardiovascular disease and cancer. He found that it is not just the intense Type A personality that can cause cardiovascular disease but also the time urgency associated with having to make decisions and get the job done quickly. Cancer patients, on the other hand, may have been living under a stressor for a long time prior to developing cancer, which occurs when the DNA in the cell nucleus is unable to replicate the normal cell and instead

Anxiety disorder 1 phobias

Anxiety and panic disorders were discussed in passing in Chapters 2 and 3 and stress will be considered in the next chapter. This leaves phobias and obsessive-compulsive disorders to mention here. Phobias are persistent irrational fears of something - it can be anything, an object, an event, a setting anything that upsets the individual. All that the word irrational means in this context is that the fear does not make sense to others who do not share it, and that there appears to be no clear basis for it.

Anxiety disorder 2 obsessivecompulsive disorders OCDs

These anxiety-driven disorders take the form of persistent (unwanted) thoughts or impulses to perform certain actions that cannot be resisted, usually in order to be rid of the thoughts. 'If I walk through this doorway 17 times, then I'll stop thinking over and over again that she doesn't love me.' The thoughts and actions involved in OCD are unwanted and not enjoyed at all. The person knows that the behaviour is foolish, nonsensical or pointless, but cannot desist from doing it. He or she might know that they have just checked every window latch in the house and know that they have turned off all electrical appliances, but they just have to go and check again, and again, and again . . . If you think of these types of anxiety disorder or panic attacks and think of those people you know (perhaps yourself) who have suffered from them, what makes them into a disorder We all become a bit obsessional at times, or a bit panicked or certainly a bit stressed. We all have specific fears, of...

Affect and Mathematics Anxiety

The importance of affective factors in education generally, and in the learning of mathematics in particular, is reasserted periodically. In the 1970s and 1980s, the need to enhance females' participation and performance in mathematics generated interest in affect and attitudes towards mathematics, and especially mathematics anxiety (for example, Fennema and Sherman 1976, Tobias 1978). So, too, did the aim of increasing access to higher education, and or 'second chances' with mathematics, for students and adults generally. More recently, the need to account for blocks in mathematical problem-solving episodes has seemed to require a more cognitive, more qualitative approach (e.g McLeod 1992). In this study, from among the range of affective factors discussed in recent years in mathematics education, I emphasise mathematics anxiety. However, competing concepts of anxiety have generated controversy among psychologists and others. There have also been lively discussions of notions of...

Psychological Conceptions and Measures of Anxiety

The study of anxiety within the discipline of psychology certainly came into its own in psychology after the Second World War an estimated 5,000 articles or books on it were published between 1950 and 1970 (Spielberger 1972a). Here I consider the predominant conceptions of anxiety, the measures used, and research into the relationship between anxiety and performance. The concept of anxiety is widely agreed (for example, Spielberger 1972a) to have its basis in the work of Freud. Freud's views on anxiety will only be introduced in this chapter (see also Chapter 7), since some crucial aspects of his theory are not taken up by most postwar work in psychology. Freud proposed a characterisation of anxiety as Because anxiety is 'unpleasant' and often painful, there is a tendency for it, or for the ideas associated with it, to be repressed, to be pushed into the unconscious. However, repression does not destroy these contents rather, they retain their charge, but undergo a transformation. If...

Survey and Modelling Results Contexts of Mathematics Anxiety

Research Question 5 concerns the reasonableness of attempting to specify different contexts of mathematics anxiety, and also the adequacy of any results obtained.9 The section on 'Mathematics Anxiety, Measures and Relationships' (this chapter) introduced the idea of representing mathematics anxiety in different contexts as different 'dimensions', and presented results from earlier research specifying two dimensions, maths test and course anxiety (TCA) and numerical anxiety (NA). In this study, these two dimensions are intended to relate to school and practical contexts respectively. Here I present an analysis of responses to the set of mathematics anxiety items in the Polytechnic survey. Initially I consider what the correlation between the two dimensions of mathematics anxiety - and their correlations with measures of general anxiety and confidence in mathematics - might tell us about their dimensionality, and hence the possibility of distinguishing two separate contexts of...

Survey and Modelling Results Social Differences and Mathematics Anxiety

In this section I investigate Research Question 6 gender and social class differences in mathematics anxiety. In particular, I want to scrutinise one of the widely-accepted 'myths' discussed in Chapter 1 - that 'women have more mathematics anxiety than men'. In fact the literature review in 'Mathematics Anxiety, Measures and Relationships' (this chapter) produced conflicting results on gender differences in mathematics anxiety. In this study, as in the others reviewed, the anxiety (and other affective) scales are of course self-report measures, which elicit responses which tend to correspond to social norms. For this reason I was prepared for women to report higher levels of both maths test course anxiety (TCA) and numerical anxiety (NA). Similarly, I expected men might report a higher level of confidence in maths. As for social class differences in mathematics anxiety and other affective variables, the literature gave little guidance. I expected on general grounds that those with...

Survey and Modelling Results Mathematics Anxiety and Performance

Research question 7 concerns the relationship between performance and mathematics anxiety. In general I expected negative correlations between the two dimensions of performance and the two dimensions of mathematics anxiety. More precisely, on the basis of my ideas of context, I expected a higher correlation for school mathematics performance with maths test course anxiety (than with numerical anxiety), and a higher correlation for practical maths performance with numerical anxiety (than with maths test course anxiety). I also expected to find a positive correlation of confidence in school maths with SM performance, and a smaller positive correlation with PM performance. This research question also brings us back to consider regression models for school mathematics and practical maths performance (as in Chapter 3). Here I aim to judge the 'importance' of mathematics anxiety for 'explaining' performance differences - above that provided by the basic social variables - by checking...

Women With Anxiety Disorders

Using data from the 1995 National Survey of Family Growth (NSFG), Cougle et al. (2005) examined survey records of women for risk of generalized anxiety to see if having an abortion or giving birth to a child during their first pregnancies made any difference to their mental states. Approximately two-thirds of them (N 1,813) carried their first pregnancies to term while approximately one-third (N 1,033) had an abortion. They excluded both women who reported a period of anxiety prior to their first pregnancy as well as women with subsequent abortions. Although the entire group who chose to have an abortion demonstrated significantly greater prevalence of anxiety than the entire group of those who had the child, the subsection of women over 20 years old in both groups showed less divergent levels of anxiety, and the entire sample had rates 5 higher than the general population (Cougle et al., 2005). These results indicated that it may be that first pregnancies, and not abortion, are more...

Mathematics Anxiety Measures and Relationships

In the 1950s, the research literature began to refer to 'mathophobia' and 'number anxiety' (for example, Dreger and Aiken 1957). However, it was not until the 1970s that two important new developments occurred, in North America. The notion of 'mathematics anxiety' was crucial in this connection. The idea had strong public and media appeal (see for example Time, 14 March 1977), and Sheila Tobias's work, including Overcoming Math Anxiety (1978), was exceedingly influential in popularising further the notion. matics anxiety was widely used, especially in North America, in mathematics workshops and remedial programmes. Also during this period, questionnaires used to measure maths anxiety - for diagnosis and remediation purposes - were produced. The two mathematics anxiety scales most frequently used in recent years have been the Fennema-Sherman Mathematics Anxiety Scale (MAS) (Fennema and Sherman 1976), produced within the 'gender-inclusive' research programme mentioned earlier the...

Anxiety Disorders

Fear is the driving force behind anxiety disorders. Each of us experiences fear throughout the course of our lives. But instead of feeling the reasonable fear that helps us recognize and respond to immediate danger, such as narrowly avoiding a traffic accident, people with an anxiety disorder experience fear that occurs in response to dangers that are either imagined or not immediately threatening. Such people experience almost constant feelings of worry or dread that interfere with their daily activities, along with symptoms of anxiety such as rapid heartbeat and increased perspiration. Anxiety disorders are the most prevalent mental disorders in adults. About 30 million people in the United States have some type of anxiety disorder, and twice as many women as men are affected. Anxiety disorders appear to arise from a combination of stressful life experiences, psychological traits, and genetic inheritance, although certain disorders such as panic disorder (see page 352) appear to...

Introduction Mathematics the Difficult Subject

I began this study of adults' mathematical thinking and emotions during an exciting period for mathematics education. The findings of an enquiry into mathematics teaching in the UK (Cockcroft Committee 1982) had recently reported, and there was a growing concern with adult 'numeracy'. Many in the research communities were discussing exciting and impressive research on the ways that people's mathematical thinking might be different in different settings for example, when doing school problems, working in street markets, or shopping in supermarkets (e.g. Carraher et al. 1985, Lave et al. 1984). In addition, a few writers on both sides of the Atlantic were discussing mathematics anxiety, and other kinds of feelings about mathematics (e.g. Tobias 1978, Buxton 1981, Nimier 1978).

Conceptual Map and Research Questions

The main outcomes of interest in the study were mathematics performance, and mathematical affect, especially mathematics anxiety. In this chapter, I focus on the performance variables the model is developed further in Chapters 3 and 4, where social and affective variables, respectively, are brought in.

Survey Results for Performance and Context

The fieldwork phase of the survey is described in Appendix 1. In each of the three years of the study, there were samples from the BA Social Science (BASS) and the Diploma in Higher Education (DipHE) the DipHE samples included students taking mathematics and statistics (Quantitative Methods) and, after the first year, another group not doing so. Overall, in the eight subsamples, 935 students completed the questionnaire.16 After inspection of the separate results (Evans 1993), the subsamples were pooled for most of the analyses presented in this chapter. Nevertheless, allowance was made for cohort (year) and course differences when full modelling of the combined effects of all factors such as gender, social class, age and qualification in maths was done for outcomes such as performance and mathematics anxiety (see Chapters 3 and 4).

Social Class Differences

In interviews, however, it would be appropriate to use a broader conception of social class that includes not only economic aspects - such as access to wealth, living standards and orientation to money, but also cultural ones - such as attitudes to work and to education, beliefs about what can be known and how you know it, views on the meaning of 'growing up' and attaining 'independence', and resources for exercising power or manifesting anxiety (cf. Walkerdine et al. 1989). That is, we could include, in our conception of social class, elements relating to identity-formation or subjectivity. This would support my concern with affective and emotional issues.

Reflections on the Study So

My report on the first part of this study is now complete, based on the survey of adult students' experiences with mathematics, their performance, and their feelings, especially anxiety, about mathematics. The analyses, discussed fully in the last three chapters, have provided insights about the relationships considered to hold among the variables in the conceptual map. 5 The possibility of distinguishing 'dimensions' of 'maths test course anxiety' and 'numerical anxiety' broadly parallel to school and 'practical' contexts, within the set of mathematics anxiety items used. 6 Gender differences in reported maths test course anxiety (women greater) and in reported confidence (men greater), when other relevant variables were controlled. 7 Observed relationships1 of maths test course anxiety, and of confidence, with school mathematics performance, and a less powerful one of numerical anxiety with practical mathematics performance. students (21+) - and in practical maths performance. 6 A...

Overview of the Book

In Chapters 2 to 5, I describe the conceptual basis, methodology and findings of the quantitative part of the study. This phase uses a notion of the context of mathematical thinking that is consistent with that used at the time I began the overall study that the context of a mathematical problem is determined basically by its wording and format. In Chapter 2, I consider the different ideas of numeracy or 'practical mathematics' used in several key British studies of adults. I also attempt to compare the levels of numerate performance of the students in my sample with those of a national survey done at about the same time. In Chapter 3, I draw on the literature on gender and social class differences in mathematics performance, to develop my model, and I summarise the results of the survey relating to such performance differences. Statistical modelling is used, so as to control for the effects of other variables that may be 'confounded' with gender and class. Chapter 4 takes up the...

Nonpeptide Small Molecule Crfr1 Antagonists

Many potent, small molecule CRF-R1 antagonists from a variety of chemical classes have been reported since the disclosure of CRF-R1 antagonist CP-154,526 (1) in 1996 13,14 . Numerous excellent review articles covering progress toward the development of additional novel, small molecule CRF-R1 antagonists with potential use for the treatment of neuropsychiatric disorders, including anxiety and depression, have appeared since then 11,15-22 . This section will focus on advances toward the identification of novel CRF-R1 antagonists.

Monocyclic core CRFR1 antagonists

Two compounds were recently reported from a series of pyridine-based CRF-R1 antagonists for advancement into clinical trials. Compound 2 (CP-316,311) (rat CRF-R1 IC50 6.8 nM) was determined to be a CRF-R1 antagonist with activity in several behavioral models, including reversal of intracerebroventri-cular (i.c.v.) CRF-induced excitation of locus coerulus neurons (60 inhibition at 0.3mg kg, intravenous (i.v.) administration), reversal of startle potentiation induced by i.c.v. CRF (100 at 32 mg kg, oral (p.o.) administration), and activity in the defensive withdrawal model for situational anxiety at 10 mg kg, intraperitoneal (i.p.) administration 23 . No liver toxicity was observed in five-day rat toxicology studies with 2, and it was subsequently selected for advancement into Phase 2 clinical trials in a placebo-controlled study with depressed patients. Due to a significant food effect observed in dogs and humans with compound 2 resulting in variable oral bioavailability, compound 3...

Irritable bowel syndrome

In addition to modulating the HPA axis, CRF is considered to be a key modulator of the gut-brain axis. Thus, CRF may play a role in mediating stress-related alterations of gut motor function associated with functional bowel disorders such as IBS 48,49 . In rats it has been shown that i.p. administration of CRF-R1 antagonist JTC-017 (34) (human CRF-R1 K 5.2 nM) blocked an increase in fecal output induced by exposure to chronic colorectal distention 66 . Additionally, 34 attenuated the anxiety-related behavior seen after exposure to acute colorectal distention. CRF-stimulated colonic motility in rats was also attenuated by central administration of CRF-R1 2 peptide antagonist astressin 67 . In healthy humans, i.v. administration of CRF was shown to affect rectal hypersensitivity and mimic a stress-induced

Drug dependence and withdrawal

Withdrawal from nicotine, cocaine, opiates, and alcohol often leads to a negative emotional state and elevated levels of anxiety. These undesirable effects can sometimes be counteracted by increasing self-administration of the substance, which leads to relapse to the addicted state. External stressors can often lead to a relapse in abuse as well. Antagonists of CRF-R1 are increasingly being examined as potential treatments for addiction and the negative aspects of drug withdrawal 11 . The role of CRF-R2 in drug withdrawal and dependence is less well understood and will not be discussed here.

Womens Responses To Unwanted Pregnancy

The mental health of women who have had abortions reflects their mental health at the time they seek and obtain abortions. Given that abortion most often occurs in the context of unwanted pregnancy, it is not surprising that women who report having an abortion also report higher levels of anxiety and depression, suicidal ideation, and lower life satisfaction. These are risk factors for unwanted pregnancy, and are common outcomes of partner violence, and of childhood physical and sexual abuse, which are more likely to be experienced by women

Modulators of ionotropic GABA receptors

Allosteric modulators of GABA receptors are usually considered to be promising drug leads for two reasons. Firstly, the allosteric sites have greater diversity between receptor subtypes in amino acid sequence than on the GABA recognition sites (orthosteric sites). Secondly, they require the presence of the endogenous ligand to produce an effect and so are thought to be somewhat more 'gentle' drugs compared to ligands acting at the orthosteric site 32 . Benzodiazepines and barbiturates are examples of widely used therapeutic agents that act as positive allosteric modulators at GABAA receptors. Although there is a significant chemical diversity of positive allosteric modulators acting at GABAA receptors 1 , allosteric modulators of GABAc receptors are relatively unknown. A number of early SAR studies of GABAc receptors reported that GABAA receptor modulators including benzodiazepine and steroids were inactive at these receptors 33,34 . However, such compounds were only tested at...

Ionotropic Gaba Receptors And Memory Disorders

GABAa receptor a5-subunits are likely to be involved in aspects of memory. Less than 5 of GABAa receptors in the brain are thought to contain a5-subunits. They are localized mainly to the hippocampus where they may play a key role in cognitive processes by controlling a component of synaptic transmission in the CA1. Mice lacking the a5 gene show improved performance in the Morris water maze model of spatial learning, whereas the performance in non-hippocampal-dependent learning and in anxiety tasks were unaltered in comparison with wild-type controls 62 . Novel selective a5 negative allosteric modulators, e.g. 13, that enhance spatial learning but lack the convulsant or proconvulsant activity associated with non-selective GABAA receptor negative allosteric modulators have been developed 63 .

Neuropeptide Receptor Modulation 51 Neurokinins

The potential for NK1 antagonists as antidepressants has been the subject of a tremendous amount of research effort over the last decade 35 . At least three compounds (aprepitant, L759274, and CP-122721) showed early evidence of anti-depressant effects in clinical studies. The failure of aprepitant to separate from placebo in Phase III studies was a great disappointment 6 . Nonetheless, NK1 antagonists continue to be of interest for depression therapy since they have been shown to potentiate the activity of SSRIs. The NK1 antagonist vestipitant is currently being evaluated in combination with paroxetine for anxiety and depression. Interestingly, both of these activities have been attained in a single compound, 18, which is both a potent SERT inhibitor (pIC50 8.0) and an NK1 antagonist (pIC50 8.5) 36 . This compound reportedly increased rat 5-HT levels up to 250 of baseline (measured by microdialysis), and was orally active in the isolation-induced guinea-pig pup vocalization test of...

Management options

Extreme vigilance is necessary when maternal symptoms are abolished by induction of general anaesthesia. During regional anaesthesia for operative delivery, complaints of faintness, dizziness, restlessness and nausea should alert the anaesthetist to the onset of hypotension. Pallor, particularly of the lips, yawning and non-specific feelings of anxiety are also warning signs of aortocaval compression. Continuous fetal monitoring may indicate signs of fetal distress when the mother adopts the supine or semi-supine position, and occasionally this may be the only indicator of the condition. Turning the mother into the full left lateral

Potential Clinical Applications

Anxiety Disorders - 5-HT2c antagonists have shown anxiolytic activity in several animal models (53-55). Interestingly, 5-HT2c agonists have also shown activity in models of panic and obsessive-compulsive disorder, two types of anxiety disorders in humans (56,57). Clinical support for the 5-HT2C mechanism is provided by a recent report that deramciclane (vide infra) was efficacious and well-tolerated in a controlled Phase 2 trial in GAD patients (58). 5-HT2C agonists antagonists may also be useful for the treatment of depression as suggested by some preclinical animal models, and the known disinhibitory role of 5-HT2c antagonists on mesolimbic DA function (51,57).

Serotonin 5ht1a Receptor

The 5-HT1A receptor has been implicated as a target for the treatment of anxiety and depression. Carbonyl- 11C WAY100635 (8) is a highly selective PET radiotracer for 5-HT1A receptors and has demonstrated utility in drug development applications. The occupancy of 5-HT1A receptors following oral administration of pindolol was determined using 8 in humans 26 . In other studies, 8 has been used to determine occupancy values for varying doses of robalzotan (NAD-299), a selective 5-HT1A receptor antagonist and putative antidepressant drug 21 . Considerable effort has been directed towards the development and validation of an F-18-labeled derivative of WAY100635. One such derivative is 4- 18F fluorocyclohexyl-WAY100635 ( 18F FCWAY (9)). In vivo studies with 9 demonstrated that the compound was rapidly metabolized and that some of the metabolites resulted from defluorination, which led to problematic bone uptake of 18F fluoride 28 . Another radiofluorinated analog of WAY100635, 6- 18F...

Melatonin and depression

Melatonin has been described in the literature as having an antidepressant effect in some animal models of depression. In the mouse tail suspension test (TST), the antidepressant activity of melatonin was proposed to be mediated through an interaction with NMDA receptors and the l-arginine-NO pathway 44 . In a rodent behavioral despair model, administration of melatonin decreased the immobility time that was observed on chronic exposure to forced swimming test 45,46 . Daily treatment of chronically stressed mice with melatonin was shown to reverse various perturbations induced by stress 47 . Recently, published results monitoring the levels of melatonin in trout, also seem to indicate it plays a role in the regulation of stress and anxiety 48 .

The basics of emotion cognition

Clearly, this is an example of anxiety and one that is shared by many people, and it seems equally clear to understand. However, consider the elements that go to make up the reaction. It is your beliefs or knowledge about the nature of root canal operations that lead to the anxiety. You have considered what is to come and judged how it is likely to affect you. The result is anxiety. The emotional reaction has followed on the heels of cognitions in the form of beliefs and knowledge. If you had already experienced a root canal procedure and found that it was easy and painless, then your beliefs would be different and you would not be anxious. Schachter and others conducted many studies to test this theory. Although many of the studies were ingenious, they did not prove that emotion necessarily depends on arousal and cognition. For example, it is possible to induce arousal through cognition, say, by reflecting on what your reactionary father said to you last time you spoke to him. Or it...

Premedication and Preparation

The modalities of preoperative treatment intended to reduce anxiety and achieve an adequate level of sedation will depend on the neurologic condition and clinical grade of the patient immediately prior to surgery and, therefore, must be individualized. The benefits of preventing anxiety-related arterial hypertension, which could lead to aneurysmal rebleeding, must be balanced against the risk of oversedation, which prevents appropriate preoperative neurologic assessment and depresses ventilation. The latter could also result in hypercarbia and subsequent increase in CBF and intracranial pressure (ICP). Patients who present with Hunt and Hess (H& H) (6) or World Federation of Neurological Surgeons (WFNS) (7) Grades I and II benefit from a reassuring preoperative visit by the anesthesiologist. A patient who appears anxious might benefit from a small intravenous (IV) dose of a benzodiazepine and or opioids (midazolam 1-2 mg fentanyl 50-100 mcg) administered. In contrast, patients with...

The specific emotions

In everyday life, the specific emotions are very important to us. We don't just feel 'emotional', we experience anger or sadness or joy or guilt, or whatever it might be. Emotions exist in quite discrete ways although they can also appear in very complex mixtures. So, for example, we might well experience sadness in a very pure form if our dog has just died or we might experience a complex mixture of sadness, anger, anxiety, jealousy and even guilt and shame if our relationship has just ended. Are some emotions more important than others When we are in the all-encompassing throes of a particular emotion, it seems as significant at the time as any other. We might be as wracked with envy over a rival's promotion as we are consumed by anger over a social slight or trembling with anxiety at the thought of an impending speech. However, there is one sense in which some emotions do seem to be more important than others, in that they are more basic to survival. For example, fear is probably...

How is awake intubation performed

In preparing the patient, administration of glycopyrrolate, 0.2 to 0.4 mg 30 minutes before the procedure, is useful to reduce secretions. Many clinicians also administer nebulized lidocaine to provide topical anesthesia of the entire airway, although many techniques are available to provide airway anesthesia. Once the patient arrives in the operating suite, standard anesthetic monitors are applied, and supplemental oxygen is administered. The patient is sedated with appropriate agents (e.g., opioid, benzodiazepine, propofol). The level of sedation is titrated so the patient is not rendered obtunded, apneic, or unable to protect the airway (Table 8-1).

Recent Advances in the Treatment of Insomnia

2.1 Non-benzodiazepine hypnotics 'Z-drugs' 65 Current drug therapy for insomnia includes g-aminobutyric acid A (GABAa) receptor agonists, melatonin receptor agonists, over-the-counter (OTC) products, antidepressants and antihistamines. Among these, only GABAa receptor agonists (benzodiazepines and non-benzodiazepine 'Z-drugs') and melatonin receptor agonists are approved for insomnia therapy. Moreover, despite the fact that insomnia is often a chronic condition, only two medications, eszopiclone (non-benzodiazepine structure) and ramelteon (melatonin receptor agonist), have been approved with no time limitation by the U.S. Food and Drug Administration (FDA). All other medications are limited to less than 35 days but are commonly used off-label for chronic conditions. Marketed compounds display well-known efficacy in inducing sleep onset, but many fail in the maintenance of sleep throughout the night due to short half-lives. On the other hand, longer acting compounds, such as the...

GABAa receptor modulators

GABAa receptor agonists used for insomnia fall into two classes 'Z-drugs' and benzodiazepines. Zolpidem, a 'Z-drug', is the market leading compound in this therapeutic group and will enter the generic market in 2007. This fact has triggered the search for alternatives with improved properties, e.g. increased duration of action or elimination of day-after and rebound effects. The search strategies fall into three main categories innovative formulations and devices for older compounds, enantiomerically pure molecules and alternative structures. We have attempted here to review the strategies to improve 'Z-drugs' together with the recent medicinal chemistry advances in this area and the pharmacological and clinical outcome, taking into consideration that the pharmacology of GABA receptors and their therapeutic relevance has been recently reviewed by M. Chebib et al. in this series 13 .

Potential Therapeutic Applications

Anxiety and Depression - A large body of evidence has implicated a role for NPY and its receptors in psychiatric illnesses such as anxiety and depression, and this has been extensively reviewed (4,29). NPY is consistently reported to produce anxiolytic effects in a variety of anxiety depression models, including punished responding tests, exploratory behavior models, social interaction and fear potentiated startle. The data support a strong role for the NPY Yi receptor in anxiety however, involvement of other NPY receptors has not been ruled out.

Fetal heart rate and CTG

Low risk (low-risk pregnancy and normallabour) intermittent monitoring with a Pinard's stethoscope is said to be as effective as CTG monitoring. Structured intermittent monitoring involves listening immediately after a contraction for a minimum of 60 seconds and repeating this every 15 minutes in the first stage of labour (every 5 minutes in the second stage). It has been suggested that CTG monitoring in the low-risk group may lead to unnecessary intervention and increased anxiety.

Recent advances in Zdrugs research

Imidazo 1,2-a pyridine, the central scaffold in Zolpidem (1), has been extensively explored in the search for insomnia drugs. Fang et al. 17 have described compounds bearing such heterocycles but lacking the side chain amide group. 2 inhibits 3H -flunitrazepam binding to central receptors with an IC50 value of 36 nM and to peripheral receptors with an IC50 of 180 nM. In vivo, this compound was active at 10mg kg in the maze test for anxiety 17 . In addition, Falco et al. have described compounds bearing an inverse amide group side chain (3) that display sedative-hypnotic action (94 inhibition of motor activity) following i.p. administration in mice 18 . Azaisosteres of zolpidem, pyrazolo 1,5-a pyrimidines, have been identified as selective ligands for Bz GABAA receptor subtypes. Compound 4 has been described to have affinity only for a1 p2y2 subtype (Kj 31 nM) and revealed sedative and anxiolytic-like properties without any amnesic and myorelaxant effects in rodents 19 . Pyrazolo 1,5-a...

The Cultural Perspective

As mentioned earlier, cultural factors influence the risk taking behavior of patients and physicians and their attitude toward a watchful waiting approach for febrile illness. One of the earliest reports that compared risk taking in medical decision making evaluated British, Dutch, and Belgian general practitioners.21 Doctors in Belgium had the highest levels of no risk-taking attitudes with 60 preferring not to take risks Dutch doctors had the lowest levels with only 24 preferring not to take risks. Not only physicians, but also patients of different origin may express variability in uncertainty avoidance, leading to different expectations of receiving antibiotics. In a survey from the United States, parents of Latino or Asian origin had the highest anxiety level compared to white parents when visiting a pediatrician for their sick child.22

Pharmacological Studies

Anxiety and Depression - Central administration of CRF produces anxiety-like behavior in animals and antagonists of the CRF receptors have reversed these effects (6,7). Astressin reversed the CRF induced anxiety-like behavioral effects as measured in the plus maze paradigm and reversed the anxiogenic effects of social Selective small molecule CRFi antagonists have also reversed the anxiogenic effects of CRF, implicating CRFi as the key receptor mediating these effects. Analogous to the peptide antagonists, 19 blocked ultrasonic vocalizations of rats exposed to stress and neonatal separation and blocked interferon-a (IFN-a) depression-like behavior as measured by the tail suspension test in mice (57 - 59). Depression is a common side effect observed in IFN-a treated hepatitis C patients which is reversed with antidepressent therapy. Chronic administration of 19 (3.2 mg kg day) for 10 days in rodents resulted in a decrease of anxiety-associated behavior in the defensive withdrawal model...

Initial Stabilization

Generalized sympathetic activation with high catecholamine levels, as well as pain and anxiety, generally cause elevated blood pressure after SAH. Because hypertension is associated with aneurysmal rerupture, it requires prompt treatment however, headache should be addressed first. Nimodipine, used routinely for prevention of vasospasm, and analgesics may be sufficient for blood pressure control in some patients, whereas others may require the administration of additional antihypertensive medications. The most widely employed agents are combined a-1 and P-blocker labetalol or other general P-blockers, none of which raises ICP.

Behavioral Pharmacology Models Of Addiction

This model measures the ability of stress (e.g., foot-shock) to induce an animal to resume drug-seeking behavior following extinction. Negative affective states such as stress, anger, anxiety, and depression have been identified in humans as common mechanisms that can lead to relapse.

Clinical Opportunities For

From SAR studies in the pyrazolo 1,5-a pyrimidine series emerged NBI-30775 (R121919) as a potent (CRF1 K 2.8 nM), selective (CRF2 K, > 2000 nM) CRF, receptor antagonist which inhibits CRF-induced cAMP accumulation (IC50 26 nM) and CRF-stimulated ACTH release from cultured rat anterior pituitary cells (EC50 28 nM) and displayed an excellent pharmacokinetic profile in rat following oral administration (35,76). The effect of R121919 was also studied in the elevated plus maze in two complementary rat breeds that exhibit high- and low-anxiety related behavior (77). The compound reduced anxiety-related behavior in the former group in a dose dependent manner but was without effect in the low anxiety group suggesting that CRF antagonists should be measurably active in clinical situations where there is an exaggerated stress response. Based on this and other data, the compound was selected for clinical development and, in an open label study with 20 depressed patients, a significant...

Modification of labour pain Psychological factors

There is considerable evidence that preparation for childbirth can significantly modify the degree of pain experienced. This was the basis of the 'childbirth without fear' movement, which was popular in the 1960s. Although there can be little doubt that fear, fatigue and anxiety enhance pain perception, for the majority of mothers it is misleading to suggest that good antenatal education will lead to painless childbirth. Such expectations may in fact have the reverse effect, since the mother may develop complete loss of self-confidence when she begins to experience significant labour pain.

MLT agonists in clinical development for insomnia

Agomelatine (13) represents an outsider within this group, because it is not in development for insomnia but for depression and anxiety. Although it is a MT1 MT2 receptor agonist in the picomolar range, it also displayed potent affinity for the 5HT2c receptor (IC50 270 nM). This compound was extensively reviewed in 2004 29,42 , and, since then, new phase III trials for major depressive disorder were completed. However, the European Medicines Agency (EMEA) refused authorization in July 2006 due to concerns about its effectiveness 43 .

The educational preparation for advanced practice

Historically, much of the debate about educational preparation for advanced practice was really about whether nurse practitioners were advanced practice nurses. When you take nurse practitioners out of the equation, in the UK there is little doubt that advanced practitioners should be educated to Master's level (Elcock 1996 Wright, 1997 Manley, 1997), a view which is now supported by the NMC (2005). There is a consensus that the key components of the role would be expert practitioner, educator, researcher and consultant (Elcock, 1996). This is because advanced practitioners are involved in the breaking down of existing professional barriers and redefining practice parameters and contributing to health policy. This level of critical thinking and decision-making, and analytical skills, can only be achieved through a Master's level educational preparation (Davies & Hughes, 2002). This is similar to the educational preparation in the USA (Mick & Ackerman, 2000), and in the Nordic...

Persistent viral infections

Reactivation requires active participation of the host. Immunity, which normally shields the body against reinfection, must temporarily decline. Such a decline can be triggered by the host's reaction to physical or psychological stress. HSV reactivation often correlates with a host stressed by fatigue or anxiety. VZV reactivation leads to shingles, a very painful recrudescence throughout the sensory nerve net serving the site of the latent virus. Unlike HSV reactivation, VZV reactivation results in destruction of the nerve ganglion and is associated with a generalized decline in immunity associated with aging.

Glatiramer Acetate Copaxone

Lymphadenopathy (up to 30 of patients in clinical trials) is usually limited to inguinal nodes but may be generalized. Injection site rotation and or discontinuation of injections may be beneficial. Benign systemic reaction (chest tightness, anxiety, palpitations, or dyspnea) occur in less than 15 of patients within a few minutes after injection and last 30 s to 30 min. Long-term treatment with GA does not result in hematologic or liver enzyme abnormalities. Binding antibodies to GA may develop within 3-4 months after initiation of therapy but do not interfere with efficacy.

How does ketamine differ from other induction agents

Ketamine is an N-methyl-D-aspartate receptor antagonist with profound analgesic properties. Chemically related to phencyclidine, it causes a dose-dependent dissociative state and unconsciousness and may cause hallucinations or disturbing dreams in the emotionally susceptible. Its amnestic ability is weak. Concurrent administration of a benzodiazepine may decrease the incidence of adverse sensory effects.

Bronchial Hyperresponsiveness

One of the absolute features of asthma is exaggerated nonspecific airway reactivity to a variety of irritating stimuli. Thus, asthmatics develop airway obstruction in response to natural exposures (cold air, exercise, irritating chemicals, laughing, and coughing) or to provocations in the laboratory (histamine, methacholine, cold air hyperventilation) (Table 9). Airway hyperresponsiveness is found universally in asthmatics, in a portion of subjects with chronic bronchitis, in some subjects with allergic rhinitis, and in 3-8 of otherwise normal subjects. There is a close correlation between the degree of increased responsiveness and disease severity patients with the most reactive airways often require oral CCSs for control, whereas milder degrees of abnormality predict the requirement for fewer medications. Hyperresponsiveness increases after allergen exposure, late-phase allergic reactions, viral infections (especially influenza-type infections), and ozone exposure. Conversely,...

Emotion in the arts and in sport

Although sport is about performance, it is obvious that what makes the performance is the emotional reactions to it on the part of both participants and observers. Almost any emotion can impede sporting performance. Go to play any sport while in the grip of some or other emotion (anxiety, anger, jealousy, guilt, even an overabundance of joy or elation) and your performance is likely to suffer. On the other hand, a moderate level of anxiety and perhaps a general background state of happiness are likely to enhance sporting performance.

The Characteristics of Individuals Suffering from BDD

The body sites reported most frequently of concern include hair, nose, skin, eyes, thighs, abdomen, breast size and shape, lips, chin, scars, height and teeth. It is difficult to delineate between obsessive-compulsive disorder and the treatment of both is similar. Besides depression, the occurrence of sexual dysfunction makes diagnosis difficult 19 .

How to Get a Good Nights Sleep

Healthy may find that they simply don't need as much sleep as they did when they were younger. Overweight men may have problems getting a good night's sleep. Snoring also may contribute to a loss of sleep. Sleep apnea (a condition characterized by brief episodes of interrupted breathing during sleep) is another common reason for losing sleep. Many people who have sleep apnea find it difficult to stay awake during the day. However, the most common reason for an occasional night of lost sleep is worry or anxiety.

Dual function for sex differences in the brain

Inspired by these findings we proposed that sex differences can cause or prevent sex differences in specific behaviours or centrally regulated functions (De Vries and Boyle, 1998). This hypothesis is perfectly testable. One would predict that, in the former case, blocking AVP neurotransmission would blunt or eliminate sex differences and that, in the latter case, blocking would cause a sex difference that was not there before. In fact, such tests have already been done. For example, AVP antagonist injections block social recognition memory in male but not in female rats, thereby causing a sex difference that was previously absent (Bluthe and Dantzer, 1990). Similarly, a knockout in the V1a receptor gene reduces anxiety in male but not in female mice (Bielsky et al., 2005), exactly what one would predict if a system is more important for a function in one sex than in the other.

Clinical Implications of Benign MS

The default position regarding the use of DMA in the USA currently seems to be to treat. This, however, remains controversial 21, 54 . The decision to treat a patient with a DMA should be based upon a shared patient physician therapeutic decision-making model. This model incorporates knowledge of the natural history of the disease, evidence-based medicine, and the patient's personal preference. Evidence-based medicine statistics inform us of the magnitude of benefit of the currently available DMA. As has been discussed above, DMA reduces relapse rate and MRI lesion accrual and has modest benefits in terms of short-term disability. However, the long-term benefits remain unproven 47 . The benefit of treating secondary progressive MS is unclear, and no benefit has been found in primary progressive MS. Patients may be overwhelmed by the data and unwilling to initiate an injectable treatment. They may have significant anxiety regarding the use of subcutaneous or intramuscular injections,...

Interacting Circuits Are Needed for Executive Functions

These various brain circuits that support executive functions do not work in isolation. For most tasks, their operations are closely linked and interdependent. For example, Jan de Fockert and others (2001) used imaging studies to demonstrate linkage of working memory with tasks of selective attention. Imaging by the labs of Helen Mayberg (1999) and Jean-Baptiste Pochon (2002) have demonstrated circuits in the brain that gate emotions. Florence Levy (2004) has explained the crucial role of dopamine in this gating process that allows most people to attenuate emotional reactions, such as anxiety or discouragement, when they are trying to deal with important concerns. Posner (1994) and Raichle did a series of imaging studies that showed linkages within the prefrontal cortex and with other brain regions they found four different areas of the brain consistently lighting up when adults were asked to do simple verbal tasks.

The Development of Executive Functions in the Brain

In a similar manner, individuals differ in their inborn baseline levels of sensitivity to change and stress. Studies by Jerome Kagan and colleagues (1994, 2004) showed that in a sample of infants about 20 percent are born with a very low threshold for anxiety they tend from the earliest months of life to respond with obvious distress and excessive behavioral inhibition when confronted with novel or stressful situations. These individuals are likely to be seen by others as exceptionally sensitive or overly fearful well into childhood and beyond. Work by Louis Schmidt and others (1999) indicates that these more socially reticent and anxious children tend to be less successful than age-mates at tasks requiring use of working memory and are more often off task. This may be due to these children being flooded with anxious emotions in ways that interfere with their attending to other stimuli and tasks.

Etiology Possible Causes And Modifiers

There are a number of other studies pointing to the importance of heredity. Familial risk for ADD ADHD and antisocial behaviors is higher among the relatives of children who have a conjoint diagnosis of both ADD ADHD and CD than among the relatives of children who are only ADD ADHD (219-225). Faraone et al. (222) found that the family members of probands with ADHD and ODD had a higher risk for ADHD and CD than the family members of probands with ADHD alone. However, the risk was lower for familial spread than in a group who were comorbid for both ADD ADHD and CD. Biederman et al. (226) report significant prevalence of mood, anxiety, and antisocial disorders in the first-degree relatives of ADHD children. Elsewhere, Biederman et al. (227) report an association between anxiety disorders and ADD ADHD, with the risk of anxiety disorders among the relatives of ADD ADHD children higher than that for the relatives of normal children (220,227).

How does the age of pediatric patients influence premedication

Children up to 6 months of age do not appear to suffer anxiety when separated from parents. However, preschool children older than 6 months are at greatest risk of separation anxiety and may suffer long-term psychologic trauma from a negative hospital experience. It is difficult to reassure and explain the expected events to this group. It is easier to communicate with patients older than 5 years, who can be reassured. Parental behavior is also important in the psychologic preparation of pediatric patients. The needs of each patient must be assessed individually. Most children older than 1 year benefit from some sedative premedication. Oral midazolam (0.5 mg kg dissolved in flavored syrup, to a maximum dosage of 20 mg) is commonly used. Atropine may be given intravenously once venous access has been obtained, just before airway manipulation, which can provoke vagal reflexes.

Describe the preoperative management of a morbidly obese patient with a difficult airway Assume that the patient is

A morbidly obese patient is considered at increased risk of pulmonary aspiration during induction of anesthesia because of delayed gastric emptying and the possibility of difficult airway management. Therefore H2 blockers given the evening before (if possible) and the morning of surgery, preoperative metoclopramide, and oral nonparticulate antacids are in order. Glycopyrrolate is useful for planned fiberoptic intubation. It improves visualization by drying secretions, increases the effectiveness of the topical anesthesia, and decreases airway responsiveness. Opioids and benzodiazepines should be judiciously titrated, using supplemental oxygen and close observation to ensure an awake, appropriately responding patient who can protect his or her own airway.

Small molecule MCH1R antagonists

Oral efficacy in rodent models on a high-fat diet was also achieved by ATC-0175 9, which provided a 10 weight reduction during a 4-day feeding cycle (45 mpk) relative to a sibutramine control 66,67 . Anxiolytic activity was also demonstrated in a number of rodent anxiety models. In this and related structural series, the aminoquinazoline and aryl amide can be linked by a variety of structures including piperidyl and cyclohexyl moieties of differing chain lengths. The czs-1,4-cyclohexyl derivatives confer improved selectivity over Y5 and a2a receptors.

Biological Studies And Theories Of Addadhd 91 Quay and Gray

Quay (92) speculates that ADHD, CD, and anxiety withdrawal (AW) disorder can be differentiated in terms of Gray's (124) theory of two important control systems a behavioral inhibition system (BIS) and a behavioral reward system (REW). In Gray's theory, increases in responding brought about by positive reinforcement (hope) and by both active avoidance and escape paradigms (reward is escape from punishment, or relief) are under the control of REW. Reductions in responding that occur in extinction procedures and passive avoidance are under the control of BIS. Anxiety is activity in the BIS that is cued by conditioned stimuli that signal fear or frustration. Predatory aggression, on the other hand, is under the control of REW. Gray has postulated anatomic loci for these two systems the reward system corresponds to the catecholaminergic structures mediating the rewarding effects of self-stimulation of the brain (228). The BIS, a supposed noradrenergic system, is localized in the lateral...

What benefits and risks are associated with preoperative cigarette cessation

All health care providers should take advantage of any opportunity to encourage patients to quit smoking. In years past various arguments were made to suggest that smoking cessation immediately before surgery increased certain perioperative risks such as increased airway irritability, diminished wound healing with nicotine replacement therapy, and increased patient anxiety associated with nicotine withdrawal. Most of these arguments have since been disproven and nonetheless pale in comparison to the overall health benefit of smoking cessation.

How is the patient who is fighting the ventilator approached

Initially the potential causes are separated into ventilator (machine, circuit, and airway) problems and patient-related problems. Patient-related causes include hypoxemia, secretions or mucous plugging, pneumothorax, bronchospasm, infection (pneumonia or sepsis), pulmonary embolus, myocardial ischemia, gastrointestinal bleeding, worsening PEEPi, and anxiety. The ventilator-related issues include system leak or disconnection inadequate ventilator support or delivered FiO2 airway-related problems such as extubation, obstructed endotracheal tube, cuff herniation, or rupture and improper triggering sensitivity or flows. Until the problem is sorted out, the patient should be ventilated manually with 100 oxygen. Breath sounds and vital signs should be checked immediately. Arterial blood gas analysis and a portable chest radiograph are valuable, but, if a tension pneumothorax is suspected, immediate decompression precedes the chest radiograph.

Success friendship and dominance

It has also been established that there is a link between anxiety and affiliation. We tend to seek the company of others when we feel isolated and fearful. Interestingly, if we are fearful of the situation that we are in and are sharing this situation with strangers, the strangers rapidly become friends, at least for the time being. Think of the rapidity with which conversations are struck up when the lift becomes stuck between floors or the train between stations. Also, it is likely that people who share some extreme physical dimension would also more rapidly establish social contact than those who do not the very tall or the very short, for example.

Definition And Identification Of Key Neuropsychiatry Symptoms

Anxiety is characterized by excessive and unjustified apprehension, feelings of foreboding, and thoughts of impending doom. Patients are tense and irritable, and frequently exhibit autonomic disturbances including sweating, palpitations, gastrointestinal distress, and shortness of breath. Both low-grade, free-floating anxiety and acute and intense panic attacks may occur. Although less frequently reported, a number of other neuropsychiatric symptoms need to be mentioned. Agitation, such as aggression, restlessness, and shouting, can usually be observed, and thus the identification of these symptoms is less problematic. However, key symptoms of agitation are often secondary to other psychiatric syndromes. For example, anxiety may lead to restlessness, shouting, or trailing carers, or aggression may be secondary to delusional beliefs. Disinhibition is characterized by inappropriate social and interpersonal interactions. Elation euphoria refers to an elevated mood with excessive...

Measuring Psychiatric Symptoms

A number of different instruments have been used to measure neuropsychiatry symptoms in patients with parkinsonian disorders. These can be divided into clinical interviews that focus upon a broad range of symptoms or more focused scales. Examples of the first group include the Present Behavioural Examination (PBE) (6), Neuropsychiatric Inventory (NPI) (7), and Brief Psychiatric Rating Scale (BPRS) (8). The PBE is a lengthy interview with a detailed assessment of behavior in patients with dementia, and requires a trained observer. The NPI is a highly structured, caregiver-based interview, which can be completed in a relatively short time depending on the amount of disturbances (see below). The BPRS was constructed essentially for schizophrenic states, and requires a trained rater. Examples of scales that assess specific syndromes in more detail are the Hamilton Depression Rating Scale (HAM-D) (9) and self-rating scales completed by the patients themselves (i.e., Beck Depression...

The Neuropsychiatry Of The Basal Ganglia

On the other hand, imaging studies have revealed that the basal ganglia are involved in functional psychiatric disorders. Magnetic resonance imaging (MRI) studies report reductions in caudate and putamen volume in unipolar and bipolar depression in addition to the prefrontal cortex, and positron emission tomography (PET) studies reveal hypermetabolism of globus pallidus in patients with unipolar and bipolar depression (19). Similarly, in obsessive compulsive disorder (20) changes in caudate activity have been reported. Thus, it is not surprising that diseases of the basal ganglia are associated with a wide range of neuropsychiatry disturbances. Furthermore, since the three frontosubcortical circuits mediating cognitive and emotional control transverse different regions of the basal ganglia, it is likely that the differential involvement of the basal ganglia in different diseases results in different patterns of neuropsychiatric symptoms.

The Role Of Neuropsychiatric Assessment In Diagnosis Of Parkinsonian Disorders

The NPI profile of a community-based sample of 139 patients with PD was characterized by relatively high levels of depression (38 ), hallucinations (27 ), and anxiety (20 ), whereas euphoria and disinhibition were uncommon (12) (Table 1). A positive score on at least one NPI item was

Psychiatric Aspects Of Dementia With Lewy Bodies

Ized by loss of normal skeletal muscle atonia during REM sleep with prominent motor activity and dreaming. RBD is particularly common in DLB (64). When associated with dementia or parkin-sonism, RBD usually predicts an underlying synucleinopathy, and it has been proposed that RBD should be included in the clinical diagnostic criteria for DLB (64). In PD, an association between RBD and visual hallucinations has been reported (65). Interestingly, during clonazepam treatment, which may improve RBD, the frequency of visual hallucinations decreased, suggesting a causal link between RBD and halucinations (65). In a direct comparison with PD and dementia, DLB and PD patients showed very similar profiles of neuropsychiatric symptoms, although the frequency of most symptoms was higher in DLB than in PD patients (59). The majority of DLB patients were diagnosed by autopsy, but the methods of assessing neuropsychiatry symptoms differed slightly in the two groups. In 93 DLB patients recruited to...

Sexual Feelings and Relationships

There is little evidence that there has been any reduction in the anxiety associated with masturbatory practices by the young who are beginning their sexual lives it is the existence of this anxiety about masturbation that supports our experiential belief that the sexual drive is one of extreme potency. We presume that we are experiencing a biologically powerful experience when in fact it is the guilt and the anxiety associated with arousal identified as sexual which is provoking our sense of intensity. (p. 56)

Findings From Genetic Studies In Adhd

The efficiency of serotonergic signaling is controlled by the serotonin transporter 5-hydroxytryptamine transporter (5-HTT), which removes serotonin from the synaptic cleft. A polymorphism (44-bp insertion deletion) located upstream of the transcriptional site of the transporter was found to influence the expression of the gene, consequently altering the levels of reuptake of dopamine. The homozygous insertion (L L) yields a higher level of 5-HTT expression than the heterozygous (L S) or the homozygous deletion (S S). An association between the L L 5-HTTLPR (5-HTT promoter region) genotype and ADHD has been reported (99-101). Zoroglu et al. (102) observed that the 5-HTTLPR S S genotype was significantly lower in ADHD patients than in the controls. Pharmacological studies using the 5-hydroxytryptamine 1B receptor (5-HT1B) agonist RU24969 suggest that the activation of the 5-HT1B receptor in mice leads to increased anxiety and locomotion in these animals. In addition,

Pharmacological Treatment Of

A number of case reports and case series indicate that cholinesterase inhibitors may improve not only the cognitive impairment, but also the psychiatric symptoms in approx 170 of DLB cases with good tolerability (with no exacerbation of parkinsonism in most reports). The first double-blind, placebo-controlled trial of cholinesterase inhibitor therapy for the treatment of DLB confirms these encouraging results (113). The total NPI score improved in 61 of patients on rivastigmine compared with 28 in the placebo group. Hallucinations and delusions, apathy, anxiety, and motor overactivity were the symptoms that improved most markedly. Rivastigmine was well tolerated with no increase in adverse events requiring withdrawal in comparison with the placebo group. Furthermore, there was no deterioration in parkinsonism in the treatment group. Given the potential hazards of neuroleptic treatment, most specialists would now recommend cholinesterase inhibitor therapy as a first-line treatment for...

Is memory affected with MS

Confusion can accompany attacks and can be associated with memory difficulty, but this is not defined as true memory impairment. It is associated with generally impaired Cognition cognition. Anxiety and or depression also can rob a anxiety or depression abates, memory is again normal. However, memory complaints tend to increase with the duration of illness and disability. The recent Avonex CHAMPS trial documented that early treatment in the course of the illness can prevent cognitive impairment.

Pharmacological Targeting of Mitochondrial Dysfunction in SLE

Production and intracellular alkalinization in lupus PBLs (37). Therefore, IL-10 antagonists may partially correct signaling dysfunction in lupus. A proapoptotic 1,4-benzodiazepine (Bz-423) has been found to promote ROI-mediated apoptosis of germinal center B cells and ameliorate glomerulonephritis in lupus-prone NZB W mice (66). The mechanism of mitochondrial hyperpo-larization and ATP depletion require further studies, which in turn could identify novel targets for pharmacological intervention in patients with SLE.

Janet A Amico1A Julie A Miedlar1 Hou Ming Cai1 and Regis R Vollmer1

Abstract Oxytocin (OXT) that is released centrally is believed to be anxiolytic and have stress-attenuating effects. Oxytocin knockout (OXTKO) mice, a genetic model of OXT deficiency, have heightened corticosterone release after acute stress and greater anxiety-related behaviour in an elevated plus maze compared to wild-type (WT) mice. In the present set of experiments, we recorded the rise in body temperature, referred to as stress-induced hyperthermia (SIH), following transfer to a metabolic cage, which triggers both anxiety and corticosterone release in mice. SIH is a marker of activation of the hypothalamic-pituitary-adrenal (HPA) axis and sympathetic nervous system. Because corticosterone release after acute stress is typically greater in OXTKO than in WT mice, we measured SIH as a surrogate marker of corticosterone release. Following transfer to a metabolic cage, both OXTKO and WT mice increased body temperature, but to the same degree. Pregnant mice, which are known to have...

Multimodal neurosurgical strategies for the management of dystonias

Although it is evident that the optimal target for dys-tonia lies in the GPi, it is not known whether the traditional GPi target used for control of Parkinson's disease (PD) is best for dystonia. Also many of the patients with dystonia tend to be obsessive or in an excessive anxiety state, which indicates that the background pathophysiol-ogy of dystonia also involves limbic pallidum that is It is well known that patients with dystonia tend to have a particular psychological or mental character. Patients with CD are often depressive, aggressive, but occasionally obedient. Focal hand dystonia patients are often obsessive, and perfect and impeccable pursuit. Those with DYT-1 dystonia are almost always bright, clever, intelligent. Patients with dystonias may develop psychiatric problems even after treatment of the physical symptoms, and it is also well known that psychiatric disorders are sometimes followed by movement disorders called tardive dyskinesia and dystonia. Thus movement...

Disorders That Obstruct Air Flow245

Asthma affects the lining of the bronchi and the bronchioles. These airways become inflamed and produce extra mucus. Smooth muscle tissue in the airways contracts, narrowing the passageways even further. Common symptoms of asthma include wheezing (a faint whistling noise that occurs with each breath), shortness of breath, chest tightness (feeling as if someone is squeezing your chest), and coughing. Signs of an asthma emergency include extreme difficulty breathing, bluish tinge (cyanosis) to the lips and face, severe anxiety, rapid pulse, and sweating. anxiety

Problemsspecial considerations

Pre-eclampsia and obesity are controversial relative contraindications. The mother should be nil-by-mouth in case a complication occurs. The fetus is monitored continuously, and with the mother in the tilted supine position, talcum powder is applied to the abdominal wall and rotationary pressure applied to the fetus whilst attempting to lift the presenting part out of the pelvis. Tocolytic drugs, e.g. b2-agonists, may be given. There may be considerable discomfort, particularly if the mother is especially tense, which reduces the chance of success. Various maneouvres have been used in an attempt to improve the success and tolerability of ECV, including sedation (e.g. with benzodiazepines) and epidural analgesia, although many obstetricians consider the degree of discomfort a useful indicator of when to stop the attempted procedure and prefer to avoid the use of adjuncts. In the UK, anaesthetists are rarely involved. A maximum of 10 minutes is usually allowed before considering the...

Failure or Success Is Not a Good Measure

When I inquired in detail about specific ADHD symptoms, the attorney identified very few of them as applying to his experience. He had not been significantly impaired by ADHD symptoms during his years in school, and he was not currently experiencing more difficulties from these symptoms than most other adults. His lack of success in his goal of becoming a partner in his law firm was not due to his having ADHD. It appeared to be due more to his chronic anxiety and some personality problems. Not all lack of success is due to ADHD countless other variables may be involved, including luck.

Summary and implications of findings and future directions

OXTKO mice have been used for studying the proposed central effects of OXT. There is abundant literature implicating OXT in the responses to stress, anxiety and ingestive behaviour, including studies using this mouse model. Our results indicate that the combined effect of measuring rectal temperature, handling and transfer to a novel environment induces SIH in male and female WT and OXTKO mice. These data are consistent with previous research on SIH in mice, whether group or single housed. SIH was ineffective as a means to consistently identify the stress hyperre-sponsiveness of OXTKO mice and the reasons for this are discussed below. However, a novel finding from our study is that SIH can be used to identify the stress-hyporesponsive period of late pregnancy. Late-pregnant mice confronted with the same stress as cycling mice had comparable basal body temperatures but markedly blunted rises in core body temperature.

Antifungal resistance conclusion

The most considered response that can be given to questions about the danger of emergence of antifungal-resistant fungi is that the phenomenon definitely occurs and that it has been seen to occur rapidly in oral Candida isolates in HIV-infected patients. However, in other clinical settings, the emergence of resistant fungi seems not to be an inevitable corollary of antifungal usage, and recorded changes in incidence and or prevalence of causative fungal species have been associated with alterations in the type of patient at risk of mycosis and the methods of their management (Husain et al., 2003 Kovacicova et al., 2001 Krcmery and Barnes, 2002 Nucci and Colombo, 2002 Singh et al., 2002 Torres et al., 2003), and by no means exclusively with alterations in antifungal treatments. Prudence to avoid unnecessary use of antifungal agents is reasonable anxiety about the large-scale emergence of resistant strains is not.

Posttraumatic Stress Disorder

There are several identifying symptoms of PTSD, including intrusive recollections of the traumatic event even when it is not occurring, hyper-vigilance, fear and anxiety about one's safety, and a numbing of emotions and avoidance of people or places that remind the person of the original trauma. These emotions are being moderated by cortisol-releasing factors and the neurotransmitters released by the ANS to try to reregulate and stabilize our emotions. It is not known exactly how these emotional

Blood Pressure And Stroke

Vascular tone, and thus CBF, are also regulated by the arterial content of carbon dioxide (PaCO2) and oxygen (PaO2). Reduction in PaCO2 leads to vasoconstriction and decreased CBF, whereas reduction in PaO2 leads to vasodilatation and increased CBF (Fig. 2). The response to PaCO2 is much more robust than that to PaO2 CBF increases 1 to 2 mL 100 g min for 1 mmHg increase in PaCOi and decreases 1 to 2 mL 100 g min for 1 mmHg decrease in PaCO2 (25). In ischemic brain, the ability to autoregulate blood flow in response to changes in perfusion pressure is clearly impaired whether an appropriate response to CO2 occurs in ischemic brain is less clear. Within the ischemic core, CBF does not change normally in response to changes in COii the response to CO2 within the penumbra, however, may be preserved (26,27). If the CBF response to changes in PaCO2 is impaired in ischemic tissue, but maintained in normal brain, the vasodilatory response to hypercapnia in the nonischemic tissue could lead to...

The Clinical Interview The Most Sensitive Assessment Tool

Usually such an interview requires at least two hours, during which time the interviewer and patient will discuss the patient's (1) adaptive strengths and weaknesses, how the person does their work, what they do for fun, and what they struggle with daily (2) strengths and stressors in the family background as well as any blood relatives with related problems (3) health history, focusing on any medical or developmental problems that may be relevant (4) history of school achievement and struggles with particular types of academic work (5) relationships with peers, family, teachers, employers, and friends (6) eating and sleeping habits (7) current mood patterns and any significant difficulties with anxiety, temper, or behavior and (8) history of previous evaluations or treatment.

Intracranial Pressure And Malignant Cerebral Edema

Despite the presence of cerebral edema and the risk of herniation in malignant MCA ICA infarcts, no clear role for ICP monitoring has been established for the treatment of stroke (138). Transtentorial herniation is the major risk associated with hemispheric infarction, and it is possible for the temporal lobe to slip over the tentorium without a documented increase in ICP. Thus, close and frequent neurologic examination is imperative (139). For patients who progress to herniation or are at risk of imminent herniation, emergent intubation for control of the airway and ventilation is necessary. Prolonged hyperventilation can worsen cerebral ischemia by causing arterial vasoconstriction, and prolonged hyperventilation was associated with worse clinical outcome in patients with traumatic brain injury therefore, indefinite hyperventilation cannot be recommended in patients with stroke (140). Transient hyperventilation in the setting of acute herniation, however, might be a lifesaving...

Incest and Child Sexual Abuse

Linehan's dialetical behavior therapy helps people who have not adequately been able to develop their emotional domain by giving them another chance to do so. One of her most important techniques is called mindfulness, which teaches people to learn to focus and attend to the matter at hand, even when it stimulates excessive amounts of anxiety (Hayes, Follette, & Linehan, 2004 Spradlin, 2003). Sometimes meditation also helps train someone's mind to attend and focus at appropriate times rather than to dissociate, fantasize, or simply daydream rather than deal with reality.

Nprotein Interacting Compounds

A series of 1,4-benzodiazepine derivatives have recently been described 27 which inhibit viral replication and have been shown to give rise to mutations in the N-protein. Initial library screening in a full virus assay led to the identification of the acetamide 14 with an IC50 of 8 p.M. This activity was confirmed in both ELISA and plaque-reduction assays. Structural modifications to 14 showed that the unsubstituted benzodiazepine template was optimal for antiviral activity but that potency could be markedly improved by modification of the amide moiety. Ortho substituted aromatic groups were particularly good, (e.g. 15 IC50 2 p.M). Urea derivatives were also potent. Resolution of the pendant amide bond into the (S)-configuration demonstrated enhanced activity with this enantiomer 28 . The ortho-fluorophenyl urea 16 was identified as a development candidate (RSV-604, IC50 600 nM). This compound was equipo-tent versus both A- and B-strains of RSV and active against a large range of

Other Factors Affecting PAS

There have also been studies that attempt to assess for other moderating factors (i.e., factors that affect the magnitude and direction) in post-abortion sequelae. In addition to age, socioeconomic status, social support, and interpersonal relationships, Coleman et al. (2005) also cited the woman's emotional attachment to the fetus, as well as her perceiving the fetus as already human, could also negatively affect self-esteem and increase levels of guilt, anxiety, and depression. Some of the scripts that therapists and counselors are required to read to women could well cause the emotional impact rather than the abortion procedure itself.

Disorders That May Accompany ADD Syndrome

MYTH Someone can't have ADD and also have depression, anxiety, or other psychiatric problems. ADHD has extraordinarily high rates of comorbidity with virtually every other psychiatric disorder listed in the DSM-IV, both in the cross-sectional and lifetime analyses. For example, studies have found that about 5 to 10 percent of children in the general population suffer from anxiety disorders (Tannock 2000). Among children with ADHD, the rate of anxiety disorders is three to six times greater.

Posttest discussion points when giving an HIVpositive result

Most patients who test positive for HIV are likely to have a high degree of anxiety, even before getting their results. The reasons for this may be varied, but generally they may involve knowing people who have already died from AIDS-related illnesses, misconceptions about the facts of HIV infection, and anxieties about informing close family and partners. While giving a result, you should be aware that the anxiety and emotion that accompany a positive result are likely to have a significant effect on the patient, and they normally need some time to absorb the initial result before you give them any further information. With most patients, it is generally advised not to give small amounts of information about specific areas (e.g. viral loads and CD4 counts), and to focus more on how the patient is, who they are going to inform about the result and who will be able to give them some emotional support if needed. At a follow-up appointment in a week's time, normally when they return for...

What do I need to know now that I have been diagnosed with MS

When faced with stress, it is difficult for us to understand and accept difficult issues such as a new diagnosis. Psychological counseling may help some patients with anxiety resulting from the stress related to their diagnosis. The inability to predict the course of MS, apart from a few generalities regarding the illness, sometimes detracts from any confidence the patients might have in the treating neurologist. No neurologist can foretell the course for an individual patient, but MS takes on certain predictabilities in relationship to the course of illness, as outlined briefly in the previous paragraph. The reality of predictably effective, safe, and convenient therapy promises to take out much of the sting associated with accepting the diagnosis of MS. However, some will require the help of social workers, psychologists, or even psychiatrists to help them cope with anxiety precipitated by the new diagnosis.

What pulmonary changes occur in a patient with cirrhosis

Arterial hypoxemia with compensatory hyperventilation may be secondary to atelectasis from ascites hydrothorax or hepatopulmonary syndrome (HPS). HPS is caused by intrapulmonary arteriovenous (AV) shunting. Portal hypertension and neovascularization are responsible for these AV shunts. The clinical features of HPS include platypnea (shortness of breath while standing) and orthodeoxia (decreased saturation when upright). They are indicative of the ventilation perfusion mismatching.

Disorders of Arousal and Motivation

Pennington (2002) proposed a category called disorders of motivation, which includes (1) depression and dysthymia, (2) anxiety disorders, (3) posttraumatic stress disorder, and (4) bipolar illness. Each of these involves disruptions in the arousal motivation system of the brain. To this category I have added obsessive-compulsive disorder as well as substance abuse and dependence. These two additional disorders are also essentially disruptions in the brain's normal regulation of arousal and motivation. Each of the six disorders in this expanded list occurs more frequently among persons with ADHD. According to Thomas Spencer and others (2000) depression and or dysthymia occurs in 15 to 75 percent of children or adolescents with ADHD. Since both ADHD and depression can be severely debilitating, any individual, like Charles, who suffers from both of these disorders should receive effective treatment for both. And some suffer not only from ADHD and depression, but also from anxiety...

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