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Face-to-face and remote Cognitive Behavioral Therapy for adults with panic in Emergency Services: study of three cases. Most patients with panic attacks or panic disorder who seek emergency department care go unnoticed and do not receive appropriate treatment. Although firstline psychological treatments exist for these patients, they may be insensitive and inaccessible to their characteristics. The aim of this study was to describe three different brief protocols based on Cognitive Behavioral Therapy that were adapted for face-to-face or videoconferencing application for patients with panic attacks or panic disorder seeking care in emergency department. Three cases of adult patients, two diagnosed with panic disorder and one with panic attacks, are presented to show the implementation and outcomes of the protocols on diagnostic severity, anxiety sensitivity, quality of life, health services utilization, and patient satisfaction with the protocols. As well as the use of a panic screening diagram designed for the initial evaluation of these patients. After one to seven sessions, a decrease in panic disorder severity or frequency of panic attacks, and anxiety sensitivity was observed. Quality of life improved, patients stopped using emergency department and showed satisfaction with the intervention they received. Brief interventions based on Cognitive Behavioral Therapy, both face-to-face and remote, can be implemented in emergency department to overcome some barriers to mental health access and fit the diverse care possibilities of panic patientsinstrument in the field of acceptance and commitment therapy and other third generation interventions. Key words: cognitive behavioral therapy, panic disorder, panic attack, videoconferencing, emergency services. [ABSTRACT FROM AUTHOR]

Copyright of Revista de Psicoterapia is the property of Revista de Psiquiatria y Psicologia Humanista, S.L. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Acceptance and Commitment Therapy (ACT) highlights the importance of experiential avoidance and cognitive fusion in a wide spectrum of psychological problems. The purpose of this study is to know how the severity of panic disorder and agoraphobia (APT) and the severity of obsessive-compulsive disorder (OCD) influence levels of experiential avoidance and cognitive fusion. It is also intended to examine whether there are differences between the two diagnostic groups. The sample consisted of 67 people diagnosed with APT and OCD. The following assessment instruments were used: Acceptance and Action Questionnaire (AAQ), Cognitive Fusion Questionnaire (CFQ), Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and Beck Anxiety Inventory (BAI). The results showed that patients with APT present higher levels of cognitive fusion compared to patients with OCD, that high levels of anxiety are associated with a higher degree of experiential avoidance, and that greater severity of OCD correlated with high levels of experiential avoidance and fusion cognitive. Early intervention in OCD patients is proposed to prevent the chronicity of the disorder and the importance of the acceptance aspects is emphasized in the course of therapy of these patients. [ABSTRACT FROM AUTHOR]

Copyright of Gaceta Médica de Caracas is the property of Academia Nacional de Medicina and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The assessment of suggestibility and hipnotizability has become a valuable research line in the last decades. However, most studies have focused on general population, and there are limited and insufficient papers dealing with clinical simples. The aim of the present study was to evaluate general suggestibility in a sample of patients (n = 147) compared to a control (non-clinical) group (n = 57), by means of the adminitration of an inventory of suggestibility. Clinical sample participants showed higher levels of suggestibility (overall score) and higher levels of absorption, emotional suggestibility, and influence of others (subscales) than controls. By clinical groups, social anxiety, panic isorder, OCD, and PTSD groups scored higher in suggestibility than controls. These results have relevant implications for clinical practice. [ABSTRACT FROM AUTHOR]

Copyright of Revista Katharsis is the property of Institucion Universitaria de Envigado and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The aim of the study was to examine the factor structure and psychometric properties of the Abbreviated Panic Disorder Questionnaire (CATP) and, in addition, the Panic Disorder Severity Scale-Self Report (PDSS-SR), in a sample of patients with a principal diagnosis of panic disorder (PD). The CATP comprises three separate short scales designed to assess cognitive constructs related to PD, being the Panic Catastrophic Misinterpretations Scale (PCMS), the Panic Self-efficacy Scale (PSES) and the Panic Severity Scale (PSS). Exploratory factor analyses showed a three-factor structure of the PCMS consistent with the three hypothesized dimensions of catastrophic misinterpretations, i.e., physical, mental and social. We also found a strong unidimensional structure for the remaining scales (PSES, PSS and PDSS). Data on reliability (internal consistency) and validity (convergent and discriminant) show that the scales have sound psychometric properties and could be useful instruments to assess positive and negative constructs related to PD. [ABSTRACT FROM AUTHOR]

Despite the effectiveness of exposure therapy for treating anxiety disorders, a number of patients fail to benefit or experience a return of fear after treatment. Research suggests that anxious individuals show deficits in the mechanisms believed to underlie exposure therapy, such as inhibitory learning. Targeting these processes may help improve the efficacy of exposure- based procedures. The primary aim of this paper is to provide examples to clinicians for how to apply this model to optimize exposure therapy with anxious clients, in ways that distinguish it from a "fear habituation" approach and "belief disconfirmation" approach within standard cognitive-behavior therapy. Exposure optimization strategies include 1) expectancy violation, 2) deepened extinction, 3) occasional reinforced extinction, 4) removal of safety signals, 5) variability, 6) retrieval cues, 7) multiple contexts, and 8) affect labeling. Case studies illustrate methods of applying these techniques with a variety of anxiety disorders. [ABSTRACT FROM AUTHOR]

Copyright of Revista de Salud Pública is the property of Universidad Nacional de Colombia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Personality and psychopathology differences were explored among a clinical sample of 52 patients with Panic Disorder (PD), with Agoraphobia (PDA) or without Agoraphobia, and two nonclinical samples, one with 45 participants with high anxiety sensitivity (AS) scores, and 55 with low AS scores. The clinical sample was evaluated according to DSM-IV-TR (APA, 2000) criteria. The participants in nonclinical samples were assigned depending on the ''Anxiety sensitivity index'' (ASI; Reiss, Peterson, Gursky, & McNally, 1986) scores. The ''Brief symptom inventory'' (BSI; Derogatis & Melisaratos, 1983) was used to assess general psychopathology and the ''NEO personality inventory- revised'' (NEO-PI-R; Costa & McCrae, 1992) was used to measure personality, both in the three samples. The results show that the only statistically significant differences between the participants with high AS scores and PD/PDA patients were in the psychopathological scales, phobic anxiety and paranoid ideation, and in the personality facet, social anxiety. [ABSTRACT FROM AUTHOR]

In this work we offer a comprehensive review of the scientific contributions that have been made in the last three decades on the influence of personality in the psychopathology of panic disorder (PD) with or without agoraphobia (AG). The findings that are discussed are representative of two different theoretical models in the assessment and the study of personality, the clinical approach to personality and the dimensional approach tit personality. From both perspectives, there is sufficient evidence to associate the personality factors and the pathological personality traits more related to negative emotionality and emotional dysregulation with I'D. with or without AG. Among the vulnerability factors identified in relation to the onset of PD and the maintenance of its symptoms are: specific family and education patterns, behavioral inhibition, anxiety sensitivity, .nu!, more recendy, the perception of anxiety control. From a clinical perspective it is very important to identify these psychopathological vulnerabilities in order to design and implement promotion, prevention and treatment programs that specifically target the disordered psychological processes and reduce, more quickly and effectively, the suffering of people with these conditions. [ABSTRACT FROM AUTHOR]

Panic disorder is a chronic course disorder that causes important distress and impaired social function. The relationship between personality disorders and panic disorder has been studied, and determines its severity, course and treatment, but it has not been studied the relationship between personality traits and outcome of panic disorder. 82 patients with a first episode of panic disorder are selected and followed during 1 year, to analyze the existence and kind of relationship between their personality traits and the outcome of their disorder. [ABSTRACT FROM AUTHOR]

Of all anxiety disorders, panic disorder with agoraphobia is the most disabling one, and it has been associated with difficulties in emotional processing. Emotional Intelligence (EI), which covers a set of abilities to perceive, use, understand and manage emotions, can be useful for studying these difficulties. The aim of this descriptive study was to investigate the relationship between EI and clinical symptoms of agoraphobia in a sample of 99 outpatients diagnosed with panic disorder with agoraphobia and 101 healthy controls who were assessed with the TMMS-24, SCL-R-90 and Agoraphobia Inventory. Scores in Emotional Attention and Regulation showed a difference between both groups. In addition, correlations between Emotional Repair, on one hand, and anxiety symptoms (r=-.414, p=.000) and agoraphobia (r=-.363, p=.006) on the other, suggest that a perceived low emotional self-efficacy could constitute a vulnerability factor in the development or maintenance of panic disorder with agoraphobia. [ABSTRACT FROM AUTHOR]

Numerous studies have shown, on the one hand, the existing relationship between high levels of stress and the onset of or increase in tobacco use and, on the other hand, a direct causal relationship between long term nicotine use and the future onset of panic disorder. The aim of this systematic review was to analyse the scientific literature published on the relationship between stress and anxiety and the onset and maintenance of tobacco use in adolescent and adult populations, as well as the negative effects that prolonged smoking can have on the onset of panic disorder. There is evidence of a positive relationship between high levels of stress and the onset of or increase in tobacco use, which in turn multiplies (there is more evidence in this sense) the risk of developing panic disorder in the long term. As a conclusion, tobacco use constitutes a serious risk for mental health, especially in the case of panic disorder. Special importance is given to the development of new and better tobacco prevention and cessation treatments especially designed for those people suffering from high levels of stress and anxiety. [ABSTRACT FROM AUTHOR]

Evidence from recent studies about the epidemiology of panic disorder (PD) indicates that it is present in 4.7% of general population. In Mexico City, 2.9% of females and 1.9% of males are affected by this disease. Due to the incidence cited above, It is considered an important mental health problem that has impacted social, labor and familiar areas. On the other hand, PD is frequently present in comorbidity with other disorders like major depression, social phobia and generalized anxiety disorder. Moreover, in some cases, it may lead to a suicide risk. PD is characterized by recurrent, unexpected panic attacks, and is commonly associated with agoraphobia. A panic attack Is defined as a discrete period of fear or discomfort that includes physical, cognitive and behavioral symptoms. Physical symptoms comprise short breath, palpitations, sweating, dizziness, gastrointestinal discomfort, and chest pain. Cognitive symptoms are associated with catastrophic interpretation of bodily sensations; behavioral symptoms are mainly avoidant of different places, situations and actions that patient had associated with fear of loss of control. In the past few years there has been a growing interest in the neuropsychology of anxiety disorders. Neuropsychological evaluation Is relevant because it implies an objective assessment of the cognitive and behavioral abilities and weaknesses that make possible the prediction of the course of the disorder and the effects of treatment modalities. One of the most important contributions of neuropsychological evaluation is the identification of stable patterns of cognitive profiles of a specific disorder considered as neurocognitive endophenotypes. Some recent studies have demonstrated the relationship between neuropsychological alterations and anxiety; nevertheless, most of them were observed in obsessive-compulsive disorder patients. On the other hand, studies examining neuropsychological functioning in PD patients are scarce and report conflicting results. The main objective of the present study was to evaluate whether PD patients with and without agoraphobia, who attended the National Institute of Psychiatry «Ramón de la Fuente» in Mexico City, showed neuropsychological impairments relative to healthy controls in attention, memory and executive functions. We studied a total sample of 48 subjects (24 patients with PD, the patients sample was selected according toa psychiatric evaluation, based on DSM-IV-TR criteria. Inclusion criteria were age between 19 and 56, men or women, without previous pharmacological or psychotherapeutically treatment; and 24 gender, age and education matched healthy control subjects). A neuropsychological test battery (Neuropsi Attention and Memory) in Spanish with norms by age and educational level was administered. The Neuropsi assesses orientation, attention and concentration, executive functions, working memory and immediate and delayed verbal and visual memory. Likewise, all patients were assessed with the Anxiety Sensitivity Index, Beck's Anxiety Inventory and Panic Disorder Severity Scale. According to this psychometric evaluation, the PD patients showed severe anxiety, high anxiety sensitivity, as well as a severe degree of panic symptoms. The differences between PD patients and control subjects in neuropsychological performance were determined through one way analysis of variance (p<0.05) with the assistance of the SPSS 12. The results of the present study indicate that the neuropsychological test performance of patients with PD is diminished relative to that of the health control. According to obtained results, there were significant differences in the total score of executive functions and attention, memory and global attention and memory between patients and healthy controls. In the analysis of different subscales, it was found that patients had reduced performance in visual search, digit backward span, world list free recall, Rey-Ostereith Complex Figure Test encoding and retrieval, word list cued recall, faces retrieval and in diverse executive functions like category formation test, semantic and phonological verbal fluency, as well as design fluency. This suggests that PD is associated with alterations in tasks that require flexibility in the mental processes, short-term memory, working memory, and in the generation of strategies to solve problems. However, it is possible that these alterations were present before the onset of panic disorder and predispose the ulterior development of this disorder. In the visual detection subscale, that evaluates selective attention, there were also differences in latency of response because patients were slower than healthy controls trying to find the correct figure. This deficiency is associated with the difficulty of PD patients to perceive important details of the environment due to the extreme attention In the corporal sensations. Besides, no group differences were found in orientation, attention and concentration. These findings are consistent with previous studies with PD patients, where impairments in verbal memory, executive functions and visuospatial memory were found. Nevertheless, these findings differ from the reported by others studies, where neuropsychological alterations in PD patients were found. These discrepancies could be due to methodological procedures in the sample selection, pharmacological treatment, intensity of anxiety, and the use of different neuropsychological instruments. In the present study, the clinical sample was characterized by absence of pharmacological and psychotherapeutic treatments before neuropsychological evaluation was done with the Neuropsi. A notable finding was that, in the face recognition subscale, patients had better scores than controls. This can be related to a previous reported finding, which suggested that PD patients pay more attention to the details of a face to evaluate if these are safe or unsafe before the possibility of having a panic attack. Also, it is possible to consider it like an special ability developed by these patients as a compensatory behavior before the disability caused by this disorder and the vulnerability they experience when not having control of their symptoms. in conclusion, we have demonstrated deficits in the visuospatial and verbal memory, and executive functions in PD patients. This finding supported a disturbance in the amygdaline fronto-temporal neural network in the disorder, related in the conditioned fear network involved in the etiology of panic disorder. Future neuropsychological studies will benefit from use of neuroimaging studies to examine pattern of brain activation and elucidate the pathophysiology features of the disorder. As well as determine whether cognitive performance varies as a function of severity of panic symptoms. [ABSTRACT FROM AUTHOR]

Objective: To test the relationship between anxiety, joint hypermobility syndrome (JHS) and other associated variables, and identify physical and psychological variables that distinguish individuals with and without JHS. Method: One hundred undergraduate students were assessed using the following instruments: Brighton's criteria for JHS, State-Trait Anxiety Inventory (STAI), Liebowitz Social Anxiety Scale (LSAS), Hospital Anxiety and Depression Scale (HADS), a questionnaire of neuropsychosomatic affections (ALPIN) and a questionnaire of anxiety disorders. Results: Anxiety scores measured by the HADS and STAI (state scale) were significantly higher among participants with JHS. A set of physical and psychological variables turned out to be statistically significant when distinguishing students with or without JHS. Conclusions: Participants with JHS reported relatively higher levels of anxiety than those without JHS in this study. We suggest it is possible to detect the presence of JHS by assessing physical and psychopathological symptoms. [ABSTRACT FROM AUTHOR]

The efficacy of cognitive-behavior therapy (CBT) in the treatment of panic disorder (TP) with or without agoraphobia is well documented, but less is known about group CBT effectiveness. The purpose of this study is to investigate the effectiveness of a combination of the main techniques used in a specific version of CBT for the treatment of this disorder: the Control Panic Program. The treatment consisted of 12 weekly group sessions, following the guidelines proposed by Martin (2007) to implement the Barlow program in a group format (Barlow 1988). All patients showed significant gains in all dimensions assessed, with a high degree of remission in panic attacks' physiological symptoms and significant improvement in associated symptoms. Results warrant recommending this model for the treatment of panic disorder in public mental health consultancies. [ABSTRACT FROM AUTHOR]

Aimed at inducing high levels of physiological activity, the use of voluntary hyperventilation (VH) as a therapeutic tool in the treatment of panic disorder has spread among clinical psychologists over the last few years, in spite of its limitations. However, VH does not generate anxiety in all patients. Noteworthy individual differences associated to different factors, have accounted for this. Literature has focused on the predictive validity of a number of psychological constructs, i.e., sensitivity to anxiety, trait anxiety, and anxiety level within the three response systems - cognitive, physiological and behavioral/motor. These factors may explain differences in the anxiety experience during VH tests both in clinical and non-clinical population. Results show that VH interoceptive exposure treatment for patients with panic should be revised and probably replaced by a more cognitive oriented intervention. [ABSTRACT FROM AUTHOR]

The articles on anxiety disorders published by Spanish authors, since 1994 up until 2005, in the PSYCINFO database are reviewed in this study. Different parameters are examined, such us the number of articles (compared to that of the rest of authors in the same field of study), the most relevant journals and the different assessment instruments used. After comparing the data with what has been published by other authors, the results are analyzed and discussed. This review offers a clear vision of the increasing amount of research being undertaken on anxiety disorders. During the aforementioned range of years, Spanish authors have carried out 3.9% of all the research in this field. [ABSTRACT FROM AUTHOR]

The authors examined (a) the incidence and perception of life events during the year prior to the onset of panic disorder (PD), (b) whether psychosocial stress are related to clinical severity and course of PD, and (c) whether domains of life events are differentially associated with panic and agoraphobia. The Cuestionario de Sucesos Vitales [Life Events Questionnaire] (Sandín and Chorot, 1999) and the Panic Disorder Severity Scale (Shear et al., 1997) were completed by subjects with diagnosis of PD with/without agoraphobia and nonclinical subjects (controls). There were significant differences between clinical and nonclinical subjects on general perceived life stress and on health, social, work, and family domains. Although antecedent life stress was not associated with subsequent panic severity or course of the disorder after 8 weeks of cognitive-behavior therapy, the social life stress domain predicted agoraphobia. The findings are discussed in light to the relationship between life stress and PD. [ABSTRACT FROM AUTHOR]

The study of the coping strategies along with their relationship with the health-illness process has been broadly reviewed. However, the role of these strategies in the panic disorder is a newly research issue. This work looks into the existing empirical literature on the study of the patients' coping strategies with panic disorder. The methodology consists of the 1990-to-2005-period-of-time review of the empirical literature from the Medline and PsycINFO database. The search words have been 'coping' and 'panic disorder'. Theoretical concepts of both words are introduced. A description of the different research guidelines on the issue is also done. Finally, the conclusions emphasizing on the application of the different studies outcomes in the clinical area are presented. [ABSTRACT FROM AUTHOR]

INTRODUCTION: The objective is to investigate the possible association between four serotonin gene polymorphisms (T102C, A-1438G, 5-HTTLPR and VNTR-5HTT) and panic disorder (PD). PATIENTS AND METHOD: 92 PD outpatients (DSM-IV criteria) and 174 healthy volunteers from Asturias (control group) were included. Polymorphisms were determined after polymerase chain reaction amplification followed by digestion with restriction enzymes and electrophoresis on an agarose gel. RESULTS: Both 5-HT2A polymorphisms are in complete linkage disequilibrium in our population. No statistically significant differences in genotype frequencies of serotonin gene polymorphisms (T102C, A-1438G, 5HTTLPR and VNTR-5HTT) were found between patients and control subjects. Allele frequencies did not differ between both groups. No differences were found according to gender. CONCLUSIONS: The polymorphisms studied were not associated with PD in our population. However, larger patient samples are necessary to confirm or reject these findings. [ABSTRACT FROM AUTHOR]

INTRODUCTION: The objectives of this study were to evaluate the prevalence of drug use in out-patients with panic disorder and their influence in evolution and therapeutic response of panic disorder. MATERIAL AND METHODS: The sample was made up of 79 out-patients diagnosed of panic disorder or agoraphobia with panic disorder according to the ICD-10 criteria and 83 controls from the same center with other psychiatric disorders. Subjects were followed-up for six months. RESULTS: Prevalence of regular lifetime drug use was: 13 % for alcohol, 52 % for nicotine and 47 % for caffeine. No other drug use was observed. Patients with panic disorder used less caffeine than controls, there being no differences in other drug use. Caffeine use was associated with higher antidepressant dosages. CONCLUSIONS: Thus, prevalence of regular drug use in panic disorder during the lifetime of out-patients with panic disorder was: 13 % for alcohol, 47 % for caffeine use and 52 % for nicotine use. Those with panic disorder use less caffeine than other psychiatric patients, but there were no differences in other drug use. Presence of agoraphobia has no repercussion on consumption. There were no differences in clinical manifestations and treatment responses between users and non-users, but drug use may modify antidepressant dosages. [ABSTRACT FROM AUTHOR]

La estimulación magnética transcraneal (EMT) ha sido probada en el algunos trastornos de ansiedad (trastornos obsesivo compulsivo y trastorno por estrés postraumático) con resultados dispares. En este trabajo presentamos un estudio piloto en el que participaron tres pacientes con diagnóstico DSM-IV de trastorno de angustia. Todos llevaban más de un año de evolución, y no habían respondido satisfactoriamente al abordaje psicofarmacológico y psicoterapéutico. Recibieron a lo largo de dos semanas 10 sesiones de 30 trenes de 60 segundos de duración a 1 Hz en el córtex prefrontal dorsolateral derecho, al 110% del umbral motor. Los tres refirieron una muy discreta y parcial mejoría sintomática, que no parecía clínicamente relevante. Dos pacientes aceptaron continuar con una segunda fase de EMT en la que se alternó la misma pauta de estimulación previa con 30 trenes de 2 seg a 20 Hz en córtex prefrontal izquierdo. Esta forma de administración alternativa en cada sesión de EMT de alta y baja frecuencia fue igualmente bien tolerada, pero no supuso mejoría clínica adicional. Además de exponer estos tres casos clínicos y su pobre respuesta global, destacamos la relación entre algunos hallazgos neurobiológicos descritos en los trastornos de ansiedad con las acciones neurofisiológicas inducidos por la EMT que creemos merece seguir siendo estudiada. [ABSTRACT FROM AUTHOR]

Se describe el caso de una mujer de 34 años, con antecedentes de ansiedad social, fobias específicas y síntomas de ansiedad generalizada, cuya enfermedad se inició con ataques de pánico y depresión. La paciente recibió paroxetina, con lo que presentó exacerbación del cuadro afectivo y aparición de síntomas psicóticos que persistieron luego de suspender el antidepresivo y que respondieron a sulpiride y posteriormente a tioridazina. Se discute la pertinencia del diagnóstico de esquizofrenia pseudoneurótica y la comorbilidad entre psicosis y ansiedad. [ABSTRACT FROM AUTHOR]