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OBJECTIVE: High rates of anxiety and depression exist among asthma patient populations. This scoping review will examine the existing interventional therapies that address depression and anxiety symptoms in patients with asthma. DATA SOURCES: Pubmed, Cochrane, Psychinfo, CINAHL, Google Scholar and EMBASE databases were searched using the following search terms: ‘anxiety asthma’, ‘panic disorder asthma’ and ‘depression asthma’ with a randomized clinical trial filter and additional filters to exclude exclusion criteria. STUDY SELECTIONS: Study selections included only randomized control trials with anxiety and/or depression and/or panic disorder outcomes as primary or secondary outcomes. Only full-text articles in the English language were included. RESULTS: This search yielded interventions from pharmacologic (n=3), psychological (n=7), lifestyle medicine (n=10) and complementary and alternative medicine (CAM; n=1) using a range of outcomes from physiologic to psychologic. While the pharmacologic and CAM studies were inconclusive, psychologic and lifestyle interventions showed improvements in asthma (quality of life, symptoms, asthma attacks) and psychological (anxiety, panic fear, depression) outcomes. Variations in selection methods, outcome measures and diagnostic criteria hindered a direct comparison of the studies. Most studies had small sample sizes, high attrition rates and short study durations. CONCLUSION: There is limited evidence on best approaches for managing co-morbid anxiety and/or depression in patients with asthma. Psychological and lifestyle medicine interventions are promising with improvements in both asthma and mental health outcomes. Well-designed randomized controlled studies with larger sample sizes, standardized outcomes and longer durations, are needed to better understand the role of depression and anxiety in adults with asthma.

BackgroundAlthough non-suicidal self-injury (NSSI) is an issue of major concern to colleges worldwide, we lack detailed information about the epidemiology of NSSI among college students. The objectives of this study were to present the first cross-national data on the prevalence of NSSI and NSSI disorder among first-year college students and its association with mental disorders.MethodsData come from a survey of the entering class in 24 colleges across nine countries participating in the World Mental Health International College Student (WMH-ICS) initiative assessed in web-based self-report surveys (20 842 first-year students). Using retrospective age-of-onset reports, we investigated time-ordered associations between NSSI and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-IV) mood (major depressive and bipolar disorder), anxiety (generalized anxiety and panic disorder), and substance use disorders (alcohol and drug use disorder).ResultsNSSI lifetime and 12-month prevalence were 17.7% and 8.4%. A positive screen of 12-month DSM-5 NSSI disorder was 2.3%. Of those with lifetime NSSI, 59.6% met the criteria for at least one mental disorder. Temporally primary lifetime mental disorders predicted subsequent onset of NSSI [median odds ratio (OR) 2.4], but these primary lifetime disorders did not consistently predict 12-month NSSI among respondents with lifetime NSSI. Conversely, even after controlling for pre-existing mental disorders, NSSI consistently predicted later onset of mental disorders (median OR 1.8) as well as 12-month persistence of mental disorders among students with a generalized anxiety disorder (OR 1.6) and bipolar disorder (OR 4.6).ConclusionsNSSI is common among first-year college students and is a behavioral marker of various common mental disorders.

Background The tryptophan-kynurenine pathway is of major interest in psychiatry and is altered in patients with depression, schizophrenia and panic disorder. Stress and immune alterations can impact this system, through cortisol- and cytokine-induced activation. In addition, there is emerging evidence that the kynurenine pathway is associated with suicidality. There have been no studies to date exploring the immune-kynurenine system in social anxiety disorder (SAD), and indeed very limited human studies on the kynurenine pathway in any clinical anxiety disorder. Methods We investigated plasma levels of several kynurenine pathway markers, including kynurenine (KYN), tryptophan (TRYP) and kynurenic acid (KYNA), along with the KYN/TRYP and KYNA/KYN ratios, in a cohort of 32 patients with SAD and 36 healthy controls. We also investigated a broad array of both basal and lipopolysaccharide (LPS)-stimulated blood cytokine levels including IFN-γ, interleukin (IL)-10, IL-1β, IL-2, IL-4, IL-6, IL-8 and tumor necrosis factor (TNF)-α. Results SAD patients had elevated plasma KYNA levels and an increased KYNA/KYN ratio compared to healthy controls. No differences in KYN, TRYP or the KYN/TRYP ratio were seen between the two groups. SAD patients with a history of past suicide attempt showed elevated plasma KYN levels and a higher KYN/TRYP ratio compared to patients without a history of suicide attempt. No differences were seen in basal or LPS-stimulated pro-inflammatory cytokine levels between the patients and controls. However, unstimulated IL-10, an anti-inflammatory cytokine, was significantly lower in the SAD group. A significant sex influence was evident with SAD males having lower levels of IL-10 compared to healthy males but no difference seen between SAD females and healthy females. Conclusions The peripheral kynurenine pathway is altered in SAD and preferentially directed towards KYNA synthesis. Additionally, kynurenine pathway activation, as evidenced by elevated KYN and KYN/TRYP ratio, is evident in SAD patients with a history of past suicide attempt. While no differences in pro-inflammatory cytokines is apparent in SAD patients, lower anti-inflammatory IL-10 levels are seen in SAD males. Further investigation of the role of the immune-kynurenine pathway in SAD and other clinical anxiety disorders is warranted.

Background and objectives Significant psychological morbidity exists in patients with active pemphigus. Pemphigus being a chronic disease, psychological morbidity may exist in pemphigus patients in remission as well. The objectives of the study were to assess the psychological morbidity in pemphigus patients in clinical remission and to correlate it with clinico-demographic parameters. Patients and methods Pemphigus patients in clinical remission were consecutively included and were asked to respond to the Hindi/English version of Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder (GAD-7) and panic disorder module of PHQ. Results Of 107 patients recruited, 41 (38.3 %, 95 % CI: 29.1-48.2 %) patients were found to have either depression (33 [30.8 %, 95 % CI: 22.2-40.5 %]) or anxiety (38 [35.5 %, 95 % CI: 26.5-45.4 %] syndrome based on cut-offs of PHQ-9 score and GAD-7 score, respectively. Number of patients with mild, moderate and moderately severe/severe depression syndrome were 26 (24.3 %, 95 % CI: 17.2-33.2 %), 7 (6.5 %, 95 % CI: 0.3-12.9 %) and 0 respectively and patients with mild, moderate, severe anxiety syndrome were 29 (27.1 %, 95 % CI: 19.6-36.2 %), 9 (8.4 %, 95 % CI: 4.5-15.2 %) and 0 respectively. Patients with anxiety or depression syndrome had significantly higher clinical disease activity in the past, number of days spent in dermatology inpatient and significantly shorter clinical remission at the time of assessment as compared to those without these symptoms. Conclusions Significant burden of mild/moderate depression or anxiety syndrome associated with past severity of disease and shorter duration of clinical remission was found.

BackgroundPanic disorder (PD) is a prevalent and impairing anxiety disorder with previous reports suggesting that the longer the condition remains untreated, the greater the likelihood of nonresponse. However, patients with PD may wait for years before receiving a guideline-recommended pharmacological treatment. The widespread prescription of benzodiazepines (BDZ) for managing anxiety symptoms and disorders might delay the administration of pharmacotherapy according to guidelines (eg, selective serotonin reuptake inhibitors, SSRIs). The present study aimed to determine the mean duration of untreated illness (DUI) in a sample of PD patients, to quantify and compare DUI-SSRI to DUI-BDZ, and to compare findings with those from previous investigations.MethodsThree hundred and fourteen patients with a Diagnostic and Statistical Manual of Mental Disorders, fifth edition diagnosis of PD were recruited from an Italian outpatient psychotherapy unit, and epidemiological and clinical variables were retrieved from medical records. Descriptive statistical analyses were undertaken for sociodemographic and clinical variables, Wilcoxon matched-pair signed rank test was applied to compare the distribution of DUI-SSRI vs DUI-BDZ, and Welch’s t test was performed to compare findings with those from previous studies.ResultsThe mean DUI-SSRI of the total sample was 64.25 ± 112.74 months, while the mean DUI-BDZ was significantly shorter (35.09 ± 78.62 months; P ConclusionsThe present results confirm a substantial delay in implementing adequate pharmacological treatments in patients with PD, and highlight the discrepancy between recommendations from international treatment guidelines and common clinical practice in relation to BDZ prescription.

A volunteer movement has emerged in Ukraine during the Revolution of Dignity and the events that followed it. Experts consider this event as an important component of civil society and the main driving force of the country’s reform. The clinical structure of post-stress disorders among examined volunteers was represented by the following nosologic forms: F 43.2 adjustment disorders (32.7% of men and 28.1% of women), F 43.1 - post-traumatic stress disorder (27.6% of men and 22.9% of women), F 41.0 - panic disorder (22.4% of men and 29.1% of women), F 41.1 - generalized anxiety disorder (17.3% of men and 19.9% of women). According to the Scale of Severity of Traumatic Stress, 62.8% of respondents have complete manifestation and 37.2% clear manifestation of stress disorder. According to the Hamilton Anxiety and Depression Rating Scale, 56.2% of subjects had a severe depressive episode, 62.1% had severe anxiety episode, 42.3% had moderate depressive episode, and 33.4% had a moderate anxiety episode. Severe clinical manifestations of PTSD were characteristic of volunteers who survived the fighting, with a high level of exposure to the traumatic event on all PTSD scales; excessive signs of stress disorder, severe or moderate depressive and anxiety episodes by the Hamilton Anxiety and Depression Rating Scale.

OBJECTIVE Some individuals with panic disorder (PD) display reduced heart rate variability, which may result in an increased risk of cardiovascular mortality. Heart rate variability-biofeedback (HRV-BF) training has been shown to improve the modulation of the autonomic activity. Therefore, this randomized controlled trial was conducted to investigate the effect of a four-week HRV-BF intervention in individuals with PD. Heart rate variability-biofeedback (HRV-BF) training improved the modulation of the autonomic activity. Therefore, with this randomized controlled trial we aimed to investigate the effect of a four-week HRV-BF intervention in people with PD. METHODS Thirty-six women and sixteen men with PD (mean age: 35.85 ± 15.60 years) were randomly allocated either to HRV-BF with 0.1 Hz breathing as intervention group or to HRV-Sham-BF as active control group. HRV-BF was performed over four weeks while HRV was measured both during a short-term resting condition as well as during a paced breathing condition before and after intervention. RESULTS HRV-BF with 0.1 Hz breathing increased HRV and reduced panic symptoms in individuals with PD. HRV-BF with 0.1 Hz breathing demonstrated an increase in the time and frequency domain parameters of HRV during the short-term resting condition (ΔPost-Pre RMSSD: 5.87 ± 14.03 ms; ΔPost-Pre SDNN: 11.63 ± 17.06 ms; ΔPost-Pre Total Power: 464.88 ± 1825.47 ms2; ΔPost-Pre LF: 312.73 ± 592.71 ms2), a decrease in the heart rate during the paced breathing condition (ΔPost-Pre: -5.87 ± 9.14 b/min), and a decrease in the Panic & Agoraphobia Scale (ΔPost-Pre: -3.64 ± 6.30). There was no intervention effect in the HRV-Sham-BF group. CONCLUSIONS HRV-BF as a non-invasive and non-pharmacological treatment seems to be an important intervention option to improve reduced HRV and decrease panic symptoms in individuals with PD. Future studies are needed to establish whether these effects translate to reductions in the risk of cardiovascular disease in PD.

ZusammenfassungEtwa ein Drittel aller Patienten, die sich einem operativen Eingriff unterziehen, nehmen chronisch Psychopharmaka ein. Neben Depressionen und Psychosen stellen chronische Schmerzen sowie Angst- und Panikstörungen die häufigsten Indikationen dar. In den vergangenen 30 Jahren stieg die Häufigkeit der Verordnung von Psychopharmaka um das 7-Fache. Fast alle Psychopharmaka interagieren mit Medikamenten, die perioperativ häufig gegeben werden, beispielsweise mit 5-HT3-Antagonisten, Sympathomimetika oder Opioiden. Einige der Medikamente weisen eine enge therapeutische Breite auf und nicht alle Medikamente können perioperativ pausiert werden. Im Rahmen der präoperativen Risikoevaluation ist daher eine Prüfung im Einzelfall notwendig. Der Anästhesist muss zudem bei Gabe bestimmter Medikamente während der Narkose besondere Vorsicht walten lassen oder ganz auf diese verzichten.Bei der Therapie vieler neurologischer Erkrankungen stellen Medikamente die zentrale Säule dar. Häufig begegnen dem Anästhesisten Patienten mit einer Epilepsie, mit Morbus Parkinson oder mit einer Myasthenia gravis, die eine entsprechende medikamentöse Therapie erhalten. Das perioperative Pausieren der Medikamente lässt zumeist eine Befundverschlechterung der neurologischen Grunderkrankung befürchten. Auf die möglichst rasche postoperative Einnahme der Dauermedikation ist daher besonderer Wert zu legen.

Background:Knowledge about the epidemiology of mental disorders in children and adolescents is essential for research and planning of health services. Surveys can provide prevalence rates, whereas population-based registers are instrumental to obtain precise estimates of incidence rates and risks. Objective:To study the morbidity and the outbreak rate of the psychiatric illnesses among adolescents in Egyptian urban areas. Patients and Methods: This study was conducted during the period from December 2017 to April 2018, this study was conducted on 1014 students: 500 students from Khalil Agha school and 514 from Ismail Al-Kabbany school in Cairo, Egypt. All participants were subjected to Socioeconomic standard application, General health questionnaire (GHQ), Semi-structured clinical interview according to DSM5, Eysenck personality questionnaire for those given positive results by GHQ and Investigations included CT brain and EEG, as per the clinical interview, in order to exclude organic cases. Results: The sample age was 12-19 years and averaged at (14.99), with a standard deviation of (1.53). The number of those who had psychiatric disorders was(154) and (15.2%), while the number of those who didn't have any psychiatric disorders was 860 and (84.8%), Anxiety disorders were the most common in the sample with a percentage of (6.8%), including Generalized Anxiety Disorder (GAD) (2.2%), Social Phobia (2.1%), Obsessive Compulsive Disorder (OCD)(0.8%), Specific Phobia (0.7%), Panic Disorder (0.7%), Single Panic Attack (0.2%), Anxiety Disorder Not Otherwise Specified (0.2%), Depressive Disorders (4.9%), which included Major Depression (2.2%), Minor Depression (1.7%), Dysthymia (1.3%); Adjustment Disorders (2.4%), Conduct Disorder (0.4%), Nightmares Disorder (0.2%) and Teeth-Grinding Disorder (0.2%), The GHQ results average value were 28.68%, with a standard deviation of (12.87). Positive results reached (91.3%), while negative ones reached (8.7%). There was an indicative increase in the GHQ results average value among the ill group, compared to the normal one, The Average value of the socioeconomic standard results was (65.14%), with a standard deviation of (16.88), The results average of Eysenck personality questionnaire hit (46.47), with a standard deviation of (6.26). The average results of the branch scales were: Lie: (14.7), with a standard deviation of (14.4), Neurosis: (13.65), with a standard deviation of (4.5), Extroversion: (12.24), with a standard deviation of (3.12), Psychosis: (5.8), with a standard deviation of (3.21). Conclusion: Rate of psychiatricdisorders increased in Egyptian male adolescents in urban areas.

There is a reciprocal relationship between vestibular and neuropsychological disorders. People with vertigo and dizziness are at higher risk of various psychiatric disorders, particularly anxiety, depression, and panic disorder. On the other hand, people with mood disorders are at higher risk of experiencing vertigo and dizziness. Vestibular information plays a crucial role in cognitive processes, especially visuo-spatial abilities. Consequently, vestibular disorders (both peripheral and central) often result in visuo-spatial deficits. In addition, lesions of the cortical and subcortical components of the vestibular system result in disorders of higher vestibular function, such as hemispatial neglect, pusher syndrome, and topographagnosia.

OBJECTIVE: Panic disorder is a debilitating psychiatric disorder that often co-occurs with substance use disorders. Given the current opioid epidemic, the high reported rates of comorbid panic disorder and opioid use disorder are particularly concerning. In this narrative review, we describe the literature on panic disorder and opioid use disorder co-occurrence. METHODS: 86 studies, 26 reviews, 2 commentaries, and 5 guidelines pertaining to opioid use disorder, panic disorder, and their comorbidity were identified using all EBSCO databases, PubMed, and Google Scholar. RESULTS: First, we review epidemiological literature on the prevalence of the comorbid condition above and beyond each disorder on its own. Additionally, we discuss the challenges that complicate the differential diagnosis of panic disorder and opioid use disorder and contribute to difficulties establishing rates of comorbidity. Second, we review three theoretical models that have been proposed to explain high rates of co-occurring panic disorder and opioid use disorder: the precipitation hypothesis, the self-medication hypothesis, and the shared vulnerability hypothesis. Third, we outline how co-occurring panic and opioid use disorder may impact treatment for each condition. CONCLUSION: Based on findings in the field, we provide recommendations for future research as well as treatment considerations for co-occurring panic and opioid use disorders.

Objective Several predictors of unfavorable pharmacological treatment response (PTR) in panic disorder (PD) patients have been suggested, such as the duration of the illness, presence of agoraphobia, depression, being a woman, and early trauma. This study aimed to examine whether pathological worry is associated with PTR in PD patients.Methods This study included 335 PD patients and 418 healthy controls (HCs). The Penn State Worry Questionnaire (PSWQ), the Early Trauma Inventory Self Report-Short Form (ETISR-SF), Beck Depression Inventory (BDI), Panic Disorder Severity Scale (PDSS), and Anxiety Sensitivity Inventory-Revised (ASI-R) were administered. We measured the PTR at 8 weeks and 6 months. Student t-test, chisquare tests, Pearson’s correlation analyses, and binary logistic regression model were used.Results Our results showed that the total scores of the PSWQ correlated with the ETISR-SF, BDI, and ASI-R were significantly higher in patients with PD compared with HCs. The PSWQ and BDI could predict unfavorable PTR at 6 months in PD patients.Conclusion This is the first study to demonstrate that pathological worry may contribute to poor long-term PTR in PD patients. Therefore, our research suggests that clinicians must be aware of worry to optimize PTR for PD patients.

Termination in psychodynamic therapy (PDT) is a potentially conflictual and turbulent phase for patients, with a risk for increases in symptoms. However, few studies of PDT have assessed symptoms frequently enough during the treatment to determine whether such setbacks are in fact common in PDT.In a doubly randomized clinical preference trial, 217 adults, female = 163; M age = 34.8 (12.6), with panic disorder with or without agoraphobia were treated with panic-focused psychodynamic psychotherapy (PFPP) or panic control treatment (PCT), a form of cognitive behavioral therapy. Participants completed the Panic Disorder Severity Scale Self-Report (PDSS-SR) weekly during treatment (Weeks 1-12), and 6, 12, and 24 months after treatment. Using piecewise latent growth curve modeling, we tested the trajectories of change focusing on the termination phase in PFPP.Week-to-week improvement on the PDSS-SR stopped (a termination setback [TS]) in PFPP during Weeks 10-12, whereas PCT participants continued to improve. Larger symptom reductions up to Week 10 in PFPP predicted a more severe TS. Less avoidant attachment and less severe interpersonal problems also predicted more severe TS. The TSs tended to last, as evidenced by inferior outcomes, up to the 12-month follow-up.This study provides evidence of a TS in PDT. Resurgence of symptoms as termination approached was more common in PFPP than in PCT. Studies involving weekly assessment of primary and comorbid symptoms, as well as qualitative analyses of the patient experiences of the therapeutic process during termination, in different forms of PDT, are warranted. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Introduction According to the official Russian source, in 2017 only 0.27% of the population of Russia was diagnosed with International Classification of Diseases, tenth revision (ICD-10) F4 category disorders (neurotic, stress-related and somatoform disorders), despite these disorders being among the most prevalent mental disorders worldwide. Here we report the results of a large-scale survey among Russian psychiatrists with the primary objective to assess the proportion of psychiatrists who use the diagnoses of interest (mixed anxiety and depression disorder [MADD], adjustment disorder [AdD], panic disorder [PD], agoraphobia, generalized anxiety disorder [GAD], social phobia, simple phobia, acute stress disorder and posttraumatic stress disorder) and compare results with those of a recent World Psychiatric Association (WPA) and World Health Organization (WHO) survey. We also compared the incidence of these diagnoses between state and non-state psychiatric services in Russia. Methods Mean proportions and distribution of proportions of participants who made diagnoses of interest at different rates were calculated and compared with the results of the recent WPA and WHO survey. Risk ratios (RR) of the incidence of these diagnoses made at a frequency of at least once a week were calculated to compare state and non-state psychiatric services. The 95% confidence intervals of the RRs were calculated using the Koopman asymptotic score method. Results Responses of 960 Russian psychiatrists were included in the analysis. Of these 95, 89 and 87% reported making diagnoses of MADD, AdD and PD, respectively, during the preceding 12 months, a far larger proportion compared to other disorders of interest. In general, a significantly smaller proportion of participants in our survey made diagnoses of anxiety disorders compared to respondents in the international WPA–WHO survey. Based on RRs, diagnoses of MADD, AdD, PD, GAD and acute stress disorder were less frequently made in the state-operated psychiatric service. Conclusion Our survey revealed a serious underdiagnosis of anxiety disorders in Russia that may be associated with complex factors that include, but are not limited to the current stigma associated with the state-operated psychiatric service, which is still the exclusive source of official statistical data in Russia.

A pandemic, as defined by the World Health Organization [1], is an epidemic occurring worldwide, or over a very wide area, crossing international boundaries and usually affecting a large number of people. Presently, the COVID-19 pandemic is raging through the USA, and as time is progressing, the larger undercurrent of neuropsychiatric ailments and disorders is making its presence felt. At the time of writing this paper, in the last week of November 2020, 1 year after the detection of the first case of COVID-19 in Wuhan, China, there have been over 57.8 million cases and 1.3 million deaths worldwide [2]. Most patients with COVID-19 present initially with fever (83%–99%), cough (59%–82%), fatigue (44%–70%), anorexia (40%–84%), and shortness of breath (31%–40%) [3]. However, the signs and symptoms present at the illness onset may vary widely and involve various organ systems. Recent literature is beginning to shed light on the impact of COVID-19 on the nervous system and its neuropsychiatric sequelae. Studies describing the association between COVID-19 and neuropsychiatric symptoms are limited. Large-scale cohort studies are currently not available in the extant literature. A recent study assessing the potential relationship between COVID-19 and psychiatric disorders found a reciprocal relationship between the two [4]. This study included 62,354 patients diagnosed with COVID-19 with the primary outcomes being the incidence and hazard ratios for psychiatric disorders, dementia, and insomnia during the first 14 to 90 days after a diagnosis of COVID-19 was established. The authors observed that the patients recovering from COVID-19 had a significantly higher rate of psychiatric disorders. There was a 5.8% probability of being newly diagnosed with a psychiatric illness within 90 days post COVID-19 diagnosis. The most frequently acquired psychiatric diagnosis was anxiety disorder, with a probability of outcome within 90 days of 4.7%. Among anxiety disorders, adjustment disorder, generalized anxiety disorder (GAD), posttraumatic stress disorder (PTSD), and panic disorder were the most frequent. The probability of a new diagnosis of mood disorder within 14 to 90 days after COVID-19 diagnosis was 2%. Interestingly, previous psychiatric illness was found to be independently associated with an increased risk of being diagnosed with COVID-19. A diagnosis of a psychiatric disorder 1 year prior to the onset of the COVID-19 pandemic was associated with a 65% increased risk of COVID-19 compared with a cohort matched for established physical risk factors for COVID-19, but without a psychiatric diagnosis. This finding held ground in sensitivity analyses. In this article, we will review and discuss the existing evidence regarding various neuropsychiatric manifestations of COVID-19, including delirium, cognitive impairment, psychosis, depression, suicide, mania, and anxiety in patients with COVID-19 and COVID-19 survivors. We will also discuss the neurobiological mechanisms that are hypothesized to be involved in developing neuropsychiatric symptoms. Furthermore, we will discuss the potential role of medications used for treatment of COVID-19 in causing/worsening neuropsychiatric symptoms. Lastly, we will review the psychosocial factors contributing to the psychiatric presentations of infected individuals considering how important psychosocial factors are in the occurrence of primary psychiatric disorders.

As part of the worldwide pandemic of SARS-CoV-2 infection, Bangladesh was infected. The firstthree cases were confirmed by the Institute of Epidemiology Disease Control and Research (IEDCR) in the first week of March 2020. The Bangladeshi government immediately required its citizens to comply with the national lockdown to curb the spread of a virus where everyone keeps themselves safe and protected at home except for medical professionals, who risk treating patients in a hospital. This article explores the situation medical professionals go through during the pandemic. This study used a quantitative method with a cross-sectional survey based on frequently asked questions (FAQ). Primary data were obtained from 200 respondents (doctors, nurses, medical professionals). According to the study, the lack of access and availability of PPE such as Particulate Respirator Masks, face shields, protective clothing, protective gloves, and hand sanitizer/disinfectant as facilities in hospitals causes Generalized Anxiety Disorder, Panic Disorder, Social Phobia, and Post-Stress Disorder Trauma from before. However, a positive correlation was found between lack of supply of protective equipment and increased anxiety, panic disorder, social phobia, etc., among healthcare professionals.

Studies have reported a strong link between asthma and panic disorder. We conducted a 17-year community-based large cohort study to examine the relationship between asthma, early smoking initiation, and panic disorder during adolescence and early adulthood. A total of 162,766 participants aged 11–16 years were categorized into asthma and nonasthma groups at baseline and compared within the observation period. Covariates during late childhood or adolescence included parental education, cigarette smoking by family members of participants, and participant’s gender, age, alcohol consumption, smoking, and exercise habits. Data for urbanicity, prednisone use, allergic comorbidity, and Charlson comorbidity index were acquired from the National Health Insurance Research Database. The Cox proportional-hazards model was used to evaluate the association between asthma and panic disorder. Our findings revealed that asthma increased the risk of panic disorder after adjustment for key confounders in the Cox proportional hazard regression model (adjusted HR: 1.70, 95% CI 1.28–2.26). Hospitalizations or visits to the emergency department for asthma exhibited a dose–response effect on the panic disorder (adjusted HR: 2.07, 95% CI 1.30–3.29). Patients with asthma with onset before 20 years of age who smoked during late childhood or adolescence had the greatest risk for panic disorder (adjusted HR: 4.95, 95% CI 1.23–19.90). Patients newly diagnosed with asthma had a 1.7-times higher risk of developing panic disorder. Smoking during late childhood or adolescence increased the risk for developing the panic disorder in patients with asthma.

Treatment resistance affects 20–60% of patients with psychiatric disorders; and is associated with increased healthcare burden and costs up to ten-fold higher relative to patients in general. Whilst there has been a recent increase in the proportion of psychiatric research focussing on treatment resistance (R2 = 0.71, p

Mindfulness-based cognitive therapy (MBCT) as an adjunctive to pharmacotherapy (PT) has been suggested as a good treatment option for panic disorder (PD). However, its long-term effectiveness in generating positive treatment outcomes remains to be established. We assessed the long lasting effectiveness of adjunctive MBCT up to 5 years and the influence of genetic variations on treatment outcomes in patients with PD. A total of 109 participants who received adjunctive MBCT to PT (MBCT + PT) and 109 age- and sex-matched patient controls (PT-alone) were followed up for relapse or aggravation of PD up to 5 years. The serotonin transporter gene-linked polymorphic region (5-HTTLPR), catechol-O-methyltransferase, and brain-derived neurotrophic factor polymorphisms were analyzed at baseline. Adjunctive MBCT significantly reduced the risk for relapse or aggravation of PD for up to 5 years. 5-HTTLPR polymorphism also had a significant positive effect on the long term outcome of PD; however, there was no therapygenetic effect on the benefits of adjunctive MBCT. This 5-year follow-up study demonstrated the enduring therapeutic effects of MBCT adjunctive to PD for improving long-term treatment outcome in patients with PD. Furthermore, 5-HTTLPR polymorphism may be a moderator of treatment experiences that further boost treatment success. Future investigations are warranted to establish the clinical application of MBCT and the need for personalized treatment strategies to maintain positive outcomes in patients with PD.

Background We aimed to identify the distribution and effective factors of agoraphobic situations and how they relate to panic disorder. We included confirmed 61 patients with agoraphobia in Bozorgmehr Psychiatric Clinic of Tabriz. Multiple logistic regression was used to measure panic disorder, agoraphobia, and effective factors. Results The average age of participants was 37.26 (SD 10.9), including 68.85% female and 31.15% male. Out of those, around three-fourths, 45 (73.7%), had panic disorder or comorbidity at least by one psychiatric disorder. Among various types of agoraphobia situations, leaving 34.63% and being 32.63% home alone had the most occurrences. A trend was observed between the rising of agoraphobia situations and panic risk. The final analysis was found a significant relationship between being bathroom alone (OR = 1.3; CI 1.12–1.56), having more than one psychiatric disorder (AOR = 8.25; CI 1.12–27.17), and panic risk. Conclusions We found leaving home alone, being home alone, being in a crowd, and standing in line as the most common agoraphobic situations. There appears agoraphobia and panic disorders are poorly understood in primary mental health care systems. The screening and treating programs are needed for increasing the quality of life and early identification of these disorders.

Background Panic disorder (PD) is thought to be related with deficits in emotion regulation, especially in cognitive reappraisal. According to the cognitive model, PD patients’ intrinsic and unconscious misappraisal strategies are the cause of panic attacks. However, no studies have yet been performed to explore the underlying neuromechanism of cognitive reappraisal that occur on an unconscious level in PD patients. Methods Twenty-six patients with PD and 25 healthy controls (HC) performed a fully-verified event-block design emotional regulation task aimed at investigating responses of implicit cognitive reappraisal during an fMRI scan. Participants passively viewed negatively valanced pictures that were beforehand neutrally, positively, or adversely portrayed in the task. Results Whole-brain analysis of fMRI data showed that PD patients exhibited less activation in the right dorsolateral prefrontal cortex (dlPFC) and right dorsomedial prefrontal cortex (dmPFC) compared to HC, but presented greater activation in parietal cortex when negative pictures were preceded by positive/neutral vs negative descriptions. Simultaneously, interactive effects of Group × Condition were observed in the right amygdala across both groups. Furthermore, activation in dlPFC and dmPFC was is negatively correlated to severity of anxiety and panic in PD when negative images were preceded by non-negative vs negative descriptions. Conclusions Emotional dysregulation in PD is likely the result of deficient activation in dlPFC and dmPFC during implicit cognitive reappraisal, in line with impaired automatic top-down regulation. Correlations between severity of anxiety and panic attack and activation of right dlPFC and dmPFC suggest that the failure to engage prefrontal region during implicit cognitive reappraisal might be associated wtih the severity of anxiety and panic; such functional patterns might be the target of possible treatments.

Purpose We aimed at investigating the lifetime prevalence of mood, eating and panic disorders in a large sample of obese patients referred to bariatric surgery. We also explored the patterns of psychiatric comorbidity and their relationship with Body Mass Index (BMI). Methods The sample was composed of patients consecutively referred for pre-surgical evaluation to the Obesity Center of Pisa University Hospital between January 2004 and November 2016. Clinical charts were retrieved and examined to obtain sociodemographic information, anthropometric variables and lifetime psychiatric diagnoses according to DSM-IV criteria. Results A total of 871 patients were included in the study; 72% were females, and most patients had BMI ≥ 40 kg/m2 (81%). Overall, 55% of the patients were diagnosed with at least one lifetime psychiatric disorder. Binge eating disorder (27.6%), major depressive disorder (16%), bipolar disorder type 2 (15.5%), and panic disorder (16%) were the most common psychiatric diagnoses. Mood disorders showed associations with panic disorder (OR = 2.75, 95% CI = 1.90–3.99, χ2 = 41.85, p = 0.000) and eating disorders (OR = 2.17, 95% CI 1.64–2.88, χ2 = 55.54, p = 0.000). BMI was lower in patients with major depressive disorder (44.9 ± 7.89) than in subjects without mood disorders (46.75 ± 7.99, padj = 0.017). Conclusion Bariatric patients show high rates of psychiatric disorders, especially binge eating and mood disorders. Longitudinal studies are needed to explore the possible influence of such comorbidities on the long-term outcome after bariatric surgery. Level of evidence V, cross sectional descriptive study.

In this review, the author examines the evidence for psychopharmacologic treatments among adults for generalized anxiety disorder, panic disorder, and social anxiety disorder derived from clinical trials. For each disorder, major categories of drugs are reviewed, and then the evidence-based medications in each category are discussed. The author reviews key safety and tolerability considerations for each of the medications or classes. Evidence-based dosing for most specific agents is displayed in a comprehensive reference table. Subsequently, the author synthesizes the available information to suggest a pragmatic stepwise approach to treatment that accounts for patient-specific factors. To inform the guidance, the author incorporates and refines perspectives from treatment guidelines already written by clinical professional organizations. The author also briefly reviews the relatively new quantitative systematic review methodology of network meta-analysis (NMA) and discusses how NMA may help guide pharmacologic treatment sequencing decisions in the future by way of ranking treatments according to effect size and the relative amount of study to which treatments have been subject. Caveats of NMA studies are briefly discussed, as are results of recent NMAs regarding the pharmacologic treatment of anxiety disorders.

Repetitive transcranial magnetic stimulation (rTMS) and intermittent theta-burst stimulation (iTBS) are evidenced-based treatments for patients with major depressive disorder (MDD) who fail to respond to standard first-line therapies. However, although various TMS protocols have been proven to be clinically effective, the response rate varies across clinical applications due to the heterogeneity of real-world psychiatric comorbidities, such as generalized anxiety disorder, posttraumatic stress disorder, panic disorder, or substance use disorder, which are often observed in patients with MDD. Therefore, individualized treatment approaches are important to increase treatment response by assigning a given patient to the most optimal TMS treatment protocol based on his or her individual profile. This literature review summarizes different rTMS or TBS protocols that have been applied in researches investigating MDD patients with certain psychiatric comorbidities and discusses biomarkers that may be used to predict rTMS treatment response. Furthermore, we highlight the need for the validation of neuroimaging and electrophysiological biomarkers associated with rTMS treatment responses. Finally, we discuss on which directions future efforts should focus for developing the personalization of the treatment of depression with rTMS or iTBS.

Purpose The female jail population is steadily growing in rural jails across the country. Detainees have high rates of mental health and substance use disorders, some of which are linked to violent offenses. These conditions include post-traumatic stress disorder (PTSD), panic disorder (PD) and alcohol use disorder (AUD). This study aims to examine the associations between these disorders among females charged with violent offenses. Design/methodology/approach The sample consists of 167 female detainees from local rural jails in the USA. To assess participants’ behavioral health, the Comprehensive Addictions and Psychological Evaluation – 5 (CAAPE-5) was administered. The associations between PTSD, PD, AUD and violent offenses were investigated using bivariate statistics and multivariate logistic regression. Findings Over half of the female detainees in the sample met criteria individually for PTSD, PD or AUD, substantiating previous work on prevalence rate. Of the sample, only 10% were charged with violent offenses, from which the predominant condition reported was PTSD. Among detainees arrested for violent offenses, 69% also met criteria for PTSD, 56% for AUD and 44% for PD. Multivariate results indicate AUD was the only significant predictor for violent offenses. Research limitations/implications Female detainees experience trauma and mental health conditions at high rates. Research-informed mental health care may result in increased treatment efficacy. Provided the links between PTSD, PD and AUD, special considerations for this population should address interpersonal factors in treatment that may relate to violent offenses. Originality/value Little research exists examining female jail detainees and the implications of AUD, PTSD and PD on violent offending. To the authors' knowledge, this is the first study to examine the relationship between AUD, PTSD and PD in female jail detainees with violent offenses.

Background Early trauma (ET) is a risk factor for adult psychiatric disorders. ET exposure is known to cause structural brain alterations, particularly in the fronto-temporo-limbic circuitry. ET-related effects on brain development may differ based on individual characteristics and cause different psychiatric outcomes. We investigated the interaction effect of ET exposure and panic disorder (PD) on cortical thickness. Methods Sixty-six participants with PD and 66 healthy controls were enrolled. High-resolution T1-weighted images were acquired, and a whole-brain vertex-based analysis was performed to estimate cortical thickness. The Early Trauma Inventory Self Report-Short Form, Anxiety Sensitivity Inventory-Revised, Panic Disorder Severity Scale, Beck Depression Inventory-II, and Beck Anxiety Inventory were administered. Results There was a significant interaction between ET exposure and PD on the mean cortical thickness in the bilateral insula and right pars triangularis. An exploratory correlational analysis revealed a positive correlation between the mean cortical thickness in the left insula and severity of anxiety sensitivity to cardiovascular symptoms in participants with PD. Limitations Our findings may be affected by recall bias because this study is limited by its retrospective cross-sectional design. Conclusions Our findings suggest that ET exposure may affect brain structures differently based on a diagnosis of PD. Furthermore, individual variations in brain alterations after ET may confer trait vulnerability that triggers the development of PD. Future longitudinal studies are warranted to elucidate the neurobiological mechanisms underlying ET and psychiatric outcomes.

Na nadciśnienie tętnicze choruje około 1/4 światowej populacji dorosłych. Ze względu na szerokie rozpowszechnienie, wpływ na śmiertelność i powodowane koszty socjoekonomiczne, ważne jest poszukiwanie modyfikowalnych przyczyn rozwoju tej choroby. W pracy tej został przeprowadzony przegląd piśmiennictwa w poszukiwaniu odpowiedzi na pytanie, czy w populacji dorosłych pacjentów (≥18r.ż) chorujących na nadciśnienie tętnicze częściej występuje zaburzenie lękowe z napadami lęku, niż w populacji ogólnej? W przeglądzie literatury znaleziono 10 badań przekrojowych opisujących związek pomiędzy nadciśnieniem tętniczym, a zespołem lęku panicznego. Iloraz szans współchorobowości tych dwóch jednostek chorobowych wynosił między OR = 3,31 (2,99-3,67), a AOR 1,19 (0,87–1,62). Natomiast częstość współwystępowania wahała się od 4,2%, do 18,75%. W badaniach prospektywnych wykazano zależność między zaburzeniem lękowym z napadami lęku, a następczym rozwinięciem się nadciśnienia tętniczego w ciągu życia jako OR= 1,7 (1,4–2,0). Z drugiej strony ryzyko rozwinięcia się zaburzenia lękowego z napadami lęku u badanych z nadciśnieniem tętniczym w czasie 12-miesięcznej obserwacji wynosiło OR= 3,23 (1,51–6,93), a z 3-letnim okresem obserwacji było nieistotne statystycznie OR= 1,12 (0,80–1,57). Na podstawie przeglądu literatury, ze względu na różnice w metodologii oraz małą ilość badań prospektywnych można jedynie sugerować klinicystom, by w niektórych przypadkach poszukiwali zaburzeń lękowych z napadami lęku u pacjentów z nadciśnieniem tętniczym, szczególnie przy obserwacji niekontrolowanych i krótkotrwałych wzrostów ciśnienia tętniczego.

Several effective pharmacological therapies for panic disorder (PD) are available, but they have some drawbacks, and unsatisfactory outcomes can occur. Expanding the variety of anti-panic medications may allow for improving PD treatment. The authors performed an updated systematic review of preclinical and clinical (Phase I–III) pharmacological studies to look for advances made in the last six years concerning novel-mechanism-based anti-panic compounds or using medications approved for nonpsychiatric medical conditions to treat PD. The study included seven published articles presenting a series of preclinical studies, two Phase I clinical studies with orexin receptor (OXR) antagonists, and two clinical studies investigating the effects of D-cycloserine (DCS) and xenon gas in individuals with PD. The latest preclinical findings confirmed and expanded previous promising indications of OXR1 antagonists as novel-mechanism-based anti-panic compounds. Translating preclinical research into clinical applications remains in the early stages. However, limited clinical findings suggested the selective OXR1 antagonist JNJ-61393115 may exert anti-panic effects in humans. Overall, OXR1 antagonists displayed a favorable profile of short-term safety and tolerability. Very preliminary suggestions of possible anti-panic effects of xenon gas emerged but need confirmation with more rigorous methodology. DCS did not seem promising as an enhancer of cognitive-behavioral therapy in PD. Future studies, including objective panic-related physiological parameters, such as respiratory measures, and expanding the use of panic vulnerability biomarkers, such as hypersensitivity to CO2 panic provocation, may allow for more reliable conclusions about the anti-panic properties of new compounds.

The reasons for the positive association between anxiety disorders and asthma are unknown. We investigated the possible role of shared exposures in early life.We conducted a case–control study among adolescents (age 12–17 years) with and without asthma in urban Uganda, as part of a larger asthma case–control study. Anxiety disorders were diagnosed by psychiatric clinical officers. We focused on generalised anxiety disorder (GAD), panic disorder and social anxiety disorder. Asthma was doctor-diagnosed by study clinicians. We used questionnaires to collect data on early-life exposures. The data were analysed using multiple logistic regression.We enrolled 162 adolescents; 73 of them had asthma. Adolescents with asthma were more likely to have any of the three anxiety disorders studied (46.6%) than adolescents without asthma (21.4%) (adjusted OR (aOR) 2.68, 95% CI 1.30–5.53). The association was strong for GAD (aOR 4.49, 95% CI 1.48–13.56) and panic disorder (aOR 5.43, 95% CI 2.11–14.02), but not for social anxiety disorder. The early-life risk factors associated with anxiety disorders among adolescents were similar to asthma risk factors previously published, including urban residence at birth (aOR 3.42, 95% CI 1.29–9.09) and during most of the first 5 years of life (aOR 2.87, 95% CI 1.07–7.66), father's tertiary education (aOR 2.09, 95% CI 1.00–4.37), and adolescent's history of other allergy-related diseases (aOR 4.64, 95% CI 1.66–13.00).We confirm a positive association between anxiety disorders and asthma among adolescents in urban Uganda. The early-life risk factors associated with anxiety disorders among adolescents were similar to those for asthma in the same age group, suggesting shared underlying environmental exposures.

During flight, passengers may experience aviation-related symptoms such as headache, nausea, respiratory failure, and panic disorders. To treat patients with these symptoms, emergency drugs are prepared in the cabin and crews treat patients according taking into account usage and dose guidelines described on the drug containers. However, certain types of drugs are limited and not adequately prepared in the cabin. The aim of this study was to examine (1) emergency drugs used during flight and frequency of symptoms experienced in passengers and (2) cognizance of drug usage among crews was also determined in low-cost carriers. Most frequent symptoms recorded were headache (74.1%), abdominal pain (72.3%), nausea (70.5%), and ear pain (60.7%). Panic disorder (50.9%) is the fifth frequent syndrome in passengers, but emergency drugs are not available for this condition in the cabin. The cognizance survey showed that 21% of crews out of 112 who responded were not interested in usage guidelines of emergency drugs or simply ignored. Thirty-seven percent of crews failed to pay attention to drug expiration dates. Our findings suggest that crews need to be better trained for preparation and usage of emergency drugs in the cabin for passengers suffering from various symptoms. Further, it is recommended that airline companies need to consider to improve the emergency drug management system by requesting training from pharmacists and doctors for safe drug usage.

Objective: Life expectancy in patients suffering from affective disorders is considerably diminished. We investigated whether skin autofluorescence (SAF), indicating concentration of advanced glycation end products in the skin and oxidative stress, mediates the association between affective disorders and excess mortality. Methods: Included were 81,041 participants of the Lifelines cohort study. Presence of major depressive disorder, dysthymia, generalised anxiety disorder, panic disorder or social phobia was assessed with the Mini-International Neuropsychiatric Interview. SAF was assessed as mediator in Cox proportional hazards models for all-cause or natural-cause mortality. Results: Mortality was increased in cases with major depression compared to controls (36.4 vs. 22.5 per 100,000 person years). Partial mediation by SAF of the association between affective disorders and mortality was shown (9.0-10.5%, P

In the practice of neurologists and therapists, patients with complaints of headache, increased fatigue, and irritability are common. The most frequent causes of headaches in ambulatory patients are primary headaches (migraine and tension headaches). Lack of sleep, stress, symptoms of anxiety and depression, and abuse of analgesic drugs are the most common factors that contribute to the frequency of headaches. Magnesium deficiency is another factor, the role of which has been discussed in the frequency of primary headaches, in the development of neurotic disorders and depression. Clinical manifestations of magnesium deficiency itself usually include such nonspecific symptoms as fatigue, anxiety, irritability, numbness in the extremities, leg cramps, sleep disorders, etc.Magnesium deficiency is widespread among the population of developed countries, especially among women of reproductive age, often occurs during pregnancy, while taking oral contraceptives. Magnesium is involved in the regulation of the nervous system, neuromuscular transmission, cardiac activity, regulation of vascular tone, blood clotting and bone tissue metabolism. Magnesium deficiency is associated with diseases such as coronary heart disease, hypertension, type 2 diabetes, Alzheimer’s disease, migraine, osteoporosis, depression, neurotic disorders (panic disorder, generalized anxiety, various phobias), and fibromyalgia syndrome. Stress can lead to a decrease in magnesium levels in the body, and magnesium deficiency, in turn, reduces tolerance to stressful situations. Timely diagnosis and adequate treatment of magnesium deficiency and associated conditions represent important clinical challenges.The clinical case of a patient with neurotic disorder, headache and magnesium deficiency is presented, and the effectiveness of an interdisciplinary approach including an educational talk, adequate therapy for headache management, magnesium drug therapy and psychological methods is demonstrated. The role of magnesium deficiency in the development of various neurologic diseases is reviewed. The most effective magnesium compounds for therapy are discussed. Principles of diagnosis and treatment of patients with magnesium deficiency are presented.

Context Excess glucocorticoids impact fetal health. Maternal glucocorticoids peak in early morning. Fetoplacental 11β-hydroxysteroid dehydrogenase type 2 (11β-HSD2) inactivates cortisol to cortisone, protecting the fetus from high glucocorticoids. However, time-specific alterations of human fetoplacental 11β-HSD2 have not been studied. Objective We hypothesized that fetoplacental 11β-HSD2 activity shows time-specific alteration and acute affective or anxiety disorders impact fetoplacental 11β-HSD2 activity. Methods In this observational study we investigated 78 pregnant European women undergoing amniocentesis (15.9 ± 0.9 weeks of gestation). Amniotic fluid was collected (8:00 to 16:30 hours) for analysis of fetoplacental 11β-HSD2 activity, using cortisol (F):cortisone (E) ratio in amniotic fluid, E/(E + F). Fetoplacental 11β-HSD2 rhythm and association with “acute affective or anxiety disorder” (patients with at least one of: a major depressive episode, specific phobia, panic disorder, generalized anxiety disorder, mixed anxiety and depressive disorder) and “acute anxiety disorder” (one of: panic disorder, generalized anxiety disorder, mixed anxiety, depressive disorder), assessed using Mini International Neuropsychiatric Interview, were investigated. Results Activity of 11β-HSD2 correlated with time of amniocentesis, peaking in the morning (r = −0.398; P Conclusion Our study indicates a time-specific alteration of fetoplacental 11β-HSD2 activity with peaking levels in the morning, demonstrating a mechanism of fetal protection from the morning maternal glucocorticoid surge.

Men with anxiety disorders have been identified as high risk of developing erectile dysfunction (ED). The aim of this review is to define the prevalence and severity of ED in the male anxiety disorder population. A literature search of three electronic databases (PubMed, Embase and PsychINFO) and a grey literature registry was conducted. Inclusion criteria were studies that investigated adult males, documented diagnosis of anxiety disorders made by a qualified psychiatrist and use of a validated tool to diagnose ED such as International Index of Erectile Function or ICD-10/DSM-IV. The search yielded 1220 articles and 12 studies were selected. The anxiety disorders investigated were post-traumatic stress disorder, obsessive–compulsive disorder, social phobia/social anxiety disorder and panic disorder. We found that the median [IQR] prevalence of ED was 20.0 [5.1–41.2]% and the median [IQR] International Index of Erectile Function-5 scores were 17.62 [13.88–20.88], indicating a mild to moderate severity. Our review suggests a high prevalence of ED in the anxiety disorder population and ED may be more severe in this cohort, therefore advocating this is an important clinical topic. However, the evidence is limited due to the high heterogeneity between the studies and more research is required in this field.

ObjectiveDepressed patients rate social support as important for prognosis, but evidence for a prognostic effect is lacking. We aimed to test the association between social support and prognosis independent of treatment type, and the severity of depression, and other clinical features indicating a more severe illness.MethodsIndividual patient data were collated from all six eligible RCTs (n = 2858) of adults seeking treatment for depression in primary care. Participants were randomized to any treatment and completed the same baseline assessment of social support and clinical severity factors. Two‐stage random effects meta‐analyses were conducted.ResultsSocial support was associated with prognosis independent of randomized treatment but effects were smaller when adjusting for depressive symptoms and durations of depression and anxiety, history of antidepressant treatment, and comorbid panic disorder: percentage decrease in depressive symptoms at 3–4 months per z‐score increase in social support = −4.14(95%CI: −6.91 to −1.29). Those with a severe lack of social support had considerably worse prognoses than those with no lack of social support: increase in depressive symptoms at 3–4 months = 14.64%(4.25% to 26.06%).ConclusionsOverall, large differences in social support pre‐treatment were associated with differences in prognostic outcomes. Adding the Social Support scale to clinical assessments may be informative, but after adjusting for routinely assessed clinical prognostic factors the differences in prognosis are unlikely to be of a clinically important magnitude. Future studies might investigate more intensive treatments and more regular clinical reviews to mitigate risks of poor prognosis for those reporting a severe lack of social support.

Crack cocaine is the crystal form of cocaine, produced by adding sodium bicarbonate to cocaine base paste. Brazil is the largest consumer of crack cocaine in the world. Users of crack cocaine show important physiological and behavioral alterations, including neuropsychiatric symptoms, such as anxiety-related symptoms. Nevertheless, few pre-clinical studies have been previously performed to understand the neurobiological effects of crack cocaine. The purpose of the present study was to investigate effects of the subchronic treatment (5 days, IP) of rats with crack cocaine in an animal model of anxiety/panic, the elevated T-maze (ETM). The ETM model allows the measurement of two behavioral defensive responses, avoidance and escape, in clinical terms, respectively, associated to generalized anxiety and panic disorder, the two main psychiatric conditions that accompany substance use disorders. Immediately after the ETM model, animals were tested in an open field for locomotor activity assessment. Analysis of delta FosB protein immunoreactivity was used to map areas activated by crack cocaine exposure. Results showed that crack treatment selectively altered escape displayed by rats in the ETM test, inducing either a panicolytic (18 mg/kg IP) or a panicogenic-like effect (25 and 36 mg/kg IP). These effects were followed by the altered functioning of panic-modulating brain regions, i.e., the periaqueductal gray and the dorsal region and lateral wings of the dorsal raphe nucleus. Treatment with 36 mg/kg of crack cocaine also increased locomotor activity. These are the first observations performed with crack cocaine in a rodent model of anxiety/panic and contribute to a better understanding of the behavioral and neurobiological effects of crack cocaine.

Background The paradox of similar diagnostic criteria but potentially different neuropathologies in panic disorder (PD) and social anxiety disorder (SAD) needs to be clarified. Methods We performed a qualitative systematic review and a quantitative whole-brain voxel-based morphometry (VBM) meta-analysis with an anisotropic effect-size version of seed-based D mapping (AES-SDM) to explore whether the alterations of grey matter volume (GMV) in PD are similar to or different from those in SAD, together with potential confounding factors. Results A total of thirty-one studies were eligible for inclusion, eighteen of which were included in the meta-analysis. Compared to the respective healthy controls (HC), qualitative and quantitative analyses revealed smaller cortical-subcortical GMVs in PD patients in brain areas including the prefrontal and temporal-parietal cortices, striatum, thalamus and brainstem, predominantly right-lateralized regions, and larger GMVs in the prefrontal and temporal-parietal-occipital cortices, and smaller striatum and thalamus in SAD patients. Quantitatively, the right inferior frontal gyrus (IFG) deficit was specifically implicated in PD patients, whereas left striatum-thalamus deficits were specific to SAD patients, without shared GMV alterations in both disorders. Sex, the severity of clinical symptoms, psychiatric comorbidity, and concomitant medication use were negatively correlated with smaller regional GMV alterations in PD patients. Conclusion PD and SAD may represent different anxiety sub-entities at the neuroanatomical phenotypes level, with different specific neurostructural deficits in the right IFG of PD patients, and the left striatum and thalamus of SAD patients. This combination of differences and specificities can potentially be used to guide the development of diagnostic biomarkers for these disorders.

Some patients with psychiatric disorders respond poorly to treatment. Case reports are presented to show the value of ideomotor hypnoanalysis as an augmentation assessment technique in psychiatric disorders like Depressive Disorders, Panic Disorders, Illness Anxiety Disorders, Post Traumatic Stress Disorders and Somatic Symptom Disorders. The use of ideomotor hypnoanalysis may be of great clinical value in uncovering subconscious imprints, past traumas, sensitizing, and precipitating memories.

Background: Panic disorder (PD) is a kind of anxiety disorder that impacts the life quality and functional perspectives in patients. However, the pathophysiological study of PD seems still inadequate and many unresolved issues need to be clarified. Objectives: In this review article of biomarkers in PD, the investigator will focus on the findings of magnetic resonance imaging (MRI) of the brain in the pathophysiology study. The MRI biomarkers would be divided into several categories, on the basis of structural and functional perspectives. Methods: The structural category would include the gray matter and white matter tract studies. The functional category would consist of functional MRI (fMRI), resting-state fMRI (Rs-fMRI), and magnetic resonance spectroscopy (MRS). The PD biomarkers revealed by the above methodologies would be discussed in this article. Results: For the gray matter perspectives, the PD patients would have alterations in the volumes of fear network structures, such as the amygdala, parahippocampal gyrus, thalamus, anterior cingulate cortex, insula, and frontal regions. For the white matter tract studies, the PD patients seemed to have alterations in the fasciculus linking the fear network regions, such as the anterior thalamic radiation, uncinate fasciculus, fronto-occipital fasciculus, and superior longitudinal fasciculus. For the fMRI studies in PD, the significant results also focused on the fear network regions, such as the amygdala, hippocampus, thalamus, insula, and frontal regions. For the Rs-fMRI studies, PD patients seemed to have alterations in the regions of the default mode network and fear network model. At last, the MRS results showed alterations in neuron metabolites of the hippocampus, amygdala, occipital cortex, and frontal regions. Conclusion: The MRI biomarkers in PD might be compatible with the extended fear network model hypothesis in PD, which included the amygdala, hippocampus, thalamus, insula, frontal regions, and sensory-related cortex.

Objective: Previous studies have focused on the relationship between childhood separation anxiety disorder (SAD) and adult panic disorder (PD)-agoraphobia. It is not clear enough whether SAD, which...

BackgroundAnxiety is associated with poorer prognosis in patients with coronary artery disease (CAD). Due to their severity and chronic course, anxiety disorders, particularly generalized anxiety disorder (GAD) and panic disorder (PD), are of considerable interest and clinical importance in this population. This study has two main objectives: (1) to estimate the prevalence and incidence of GAD and PD in patients with CAD over a 2-year period and (2) to prospectively assess the association between PD or GAD and adverse cardiac events, treatment adherence, CAD-related health behaviors, quality of life and psychological distress.Design/MethodThis is a longitudinal cohort study in which 3610 participants will be recruited following a CAD-related revascularization procedure. They will complete an interview and questionnaires at 5 time points over a 2-year period (baseline and follow-ups after 3, 6, 12 and 24 months). The presence of PD or GAD, adherence to recommended treatments, health behaviors, quality of life and psychological distress will be assessed at each time point. Data regarding mortality and adverse cardiac events will be collected with a combination of interviews and review of medical files.DiscussionThis study will provide essential information on the prevalence and incidence of anxiety disorders in patients with CAD and on the consequences of these comorbidities. Such data is necessary in order to develop clear clinical recommendations for the management of PD and GAD in patients with CAD. This will help improve the prognosis of patients suffering from both conditions.

Background: Persistent Depressive Disorder (PDD) has higher comorbidity rates and negative impact on different aspects of patient’s life than episodic, non-chronic, Major Depressive Disorder. To our knowledge, no recent studies about PDD held in Egypt. Objective: To estimate the prevalence and comorbidities of PDD and its subtypes among a sample of psychiatric outpatients. Patients and methods: This was an observational, cross-sectional, non-randomized study. It was conducted in Al-Azhar University hospitals over the period from October 2109 till July 2020. Sample of 111 adult patients, aging (18 - 65) years old from both genders, who are visiting the psychiatric outpatient for whatever complaint are collected consecutively. Prior to applying the tests, patients with the diagnosis of bipolar I and II disorders, psychotic disorders, acute suicidality, intellectual disabilities, organic mental disorders, or history of brain surgery were excluded from the study. Those patients underwent detailed clinical examination, patient health questionnaire and persistent depression screener. Results: Prevalence of PDD among our sample was 36.9% (n=41) with late onset in 55% (n=22). The subtype “intermittent major depressive episodes with current episode” was the most prevalent subtype in 61% (n=25). post-traumatic stress disorder and specific phobia were significantly more common in PDD cases (P= 0.001, P=0.41 respectively), while panic disorder was significantly less common (P=0.013). All other comorbidities were equally distributed among PDD and non-PDD cases. Conclusion: PDD was a highly prevalent psychiatric disorder and may be masked by comorbid psychiatric disorders even MDD. These findings might promote psychiatrists to give more attention to PDD because of its impact on prognosis of other disorders and patient’s quality of life.

INTRODUCTION[|]Ischemia modified albumin (IMA) is an altered type of albumin produced due to exposure to hypoxia, acidosis, inflammation, or oxidative stress. In this study, we aimed to evaluate the serum IMA levels in newly diagnosed and medication-naive generalized anxiety disorder (GAD) and panic disorder (PD) patients.[¤]METHODS[|]This cross-sectional study included medication-naive 23 GAD, 25 PD patients, and 28 healthy controls. The participants were evaluated with a sociodemographic form, the Beck Depression Inventory (BDI), and the Beck Anxiety Inventory (BAI). Venous blood samples were collected from all participants, and IMA levels and routine biochemical parameters were measured.[¤]RESULTS[|]There was no statistically significant difference between three groups in terms of age, gender, body mass index (BMI) and routine biochemical markers of the participants (p>0.05). The GAD and PD groups had significantly higher serum IMA levels than healthy controls (p

Previous studies have investigated the role of inflammatory markers in suicidality of patients with major depressive disorder (MDD) or panic disorder (PD). However, few studies have investigated associations between serum inflammatory cytokine levels and suicidality. We hypothesized that MDD and PD status might be significantly associated with serum inflammatory cytokines and that we could predict levels of improvement in suicide ideation intensity using serum inflammatory biomarkers in patients with MDD and PD. For this study, 41 patients with MDD, 52 patients with PD, and 59 healthy control (HC) subjects were enrolled. Psychological measurements and serum inflammatory markers such as interleukin (IL) -6, -10, interferon (IFN)-γ, tumor necrosis factor (TNF)-α, and C reactive protein (CRP) were examined. A total of five visits were completed during 12 weeks. After controlling for confounding factors, log-transformed IL-6 (ln_IL-6) at baseline (MDD: 0.297 ± 0.626; PD: 0.342 ± 0.723; HC: -0.121 ± 0.858; p = 0.007,0.0017, 0.05/30) and mean ln_IL-6 (MDD: 0.395 ± 0.550, PD: 0.249 ± 0.544, HC: -0.139 ± 0.622, p = 0.002,0.0017, 0.05/30) levels were trends towards significantly higher in patients with MDD and PD than in HC. In MDD patients, a higher level of basal ln_TNF-α was a significant predictor of ΔSSI (changes in SSI scores between baseline and week 12) even after controlling for changes of depression symptoms and baseline SSI scores (standardized β = 0.541, p = 0.002 0.0028, 0.05/18). In conclusion, we could predict ΔSSI using baseline inflammatory biomarkers for patients with MDD.

INTRODUCTION[|]Limited number of studies is available investigating the influences of COVID-19 pandemic on mental health. Most of the studies were focused on general population and risky health personnel. No studies are available in literature investigating the mental status of the recovering patients from COVID-19. The aim of the present study is to evaluate the psychiatric diagnosis of the patients who recovered from COVID-19 and to determine the prevalence of mental disorders in these individuals.[¤]METHODS[|]Fifty individuals who were proven to catch COVID-19 through clinical tests and at least one month passed from recovery were included in the study. [¤]RESULTS[|]As the result of clinical evaluations, other specified anxiety disorders (meets diagnostic criteria of generalized anxiety disorder but not duration criteria) was detected in 5 (10%), panic disorder was detected in 3 (6%), other specified somatic symptom and related disorder (short somatic symptom disorder) was detected in 2 (4%), major depression was detected in 1 (2%), post-traumatic stress disorder in 1 (2%), obsessive-compulsive disorder in 1 (2%) and another specified insomnia disorder (short-term insomnia) was detected in 1 (2%). 6 (12%) participants had anxiety symptoms that do not meet diagnostic criteria, 2 (4%) had depressive symptoms that do not meet diagnostic criteria. No mental disorder was detected in remaining 28 (56%) participants.[¤]DISCUSSION AND CONCLUSION[|]The present study reveals that anxiety symptoms are quite frequent following recovery period of COVID-19 although it has some limitations.[¤]

Research with probability samples of civilians has found that marital distress is associated with incidence of several psychiatric disorders. However, there is little longitudinal research on marital distress and incidence of psychiatric disorders in military personnel. This study examined the prospective association between marital distress and incidence of major depressive episode (MDE), generalized anxiety disorder (GAD), panic disorder, posttraumatic stress disorder (PTSD), and substance use disorder in a probability sample of active-duty soldiers from the U.S. Army (N = 934). Results indicated that among individuals who did not meet diagnostic criteria for the associated disorder at baseline, marital distress at baseline was associated with 30-day incidence of MDE, GAD, and PTSD assessed 5 years later. These results support continued research on the role of marital distress and the onset and course of psychopathology in active-duty military personnel and suggest that couple-based interventions designed to prevent or reduce marital distress may be effective in the prevention and treatment of psychopathology in military personnel. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Increasing evidence shows that the alternations under escitalopram treatment for Panic disorder (PD) patients are related to the cAMP response element-binding protein (CREB) and brain-derived neurotrophic factor (BDNF). We aimed to explore the single nucleotide polymorphisms (SNPs) of genes BDNF and CREB1 in the treatment response to escitalopram on PD.There were 80 PD patients with DSM-5 diagnosis and 78 healthy controls. All PD patients have received escitalopram treatment for consecutive 8 weeks. The Chinese version of Panic Disorder Severity Scale (PDSS-CV) and the Hamilton Anxiety Scale (HAMA-14) were used to evaluate the severity of panic and anxious symptoms for PD patients at baseline, week-2, week-4, and week-8, respectively. Four SNPs (rs11904814, rs6740584, rs2253206, and rs2551941) in CREB1 gene and rs6265 in BDNF gene were genotyped using matrix-assisted laser desorption time-of-flight mass spectrometry (MALDI-TOF MS). Quantitative and binary genetic associations between SNPs and escitalopram treatment response were performed.The comparisons of three genotypes in CREB1 SNPs rs11904814 and rs2551941 among the PDSS-CV responders showed significant differences at the end of week-2 (both p0.05). The results remained significant after Bonferroni corrections. For candidate genes in our present study, the gene CREB1 SNP rs11904814 (p=0.007) was significantly associated with changes of PDSS-CV scores under escitalopram treatment for 12 weeks in PD patients. And the result was still significant after adjusting age and gender.The findings provide preliminary evidence supporting the potential role of BDNF and CREB1 on a rapid response after escitalopram intervention in PD patients.