Description

The book is a complete recovery plan for all those suffering from agoraphobia.

It deals with every aspect of the condition and provides clear, simple and effective strategies for full recovery. It adopts a holistic approach which ensures improved general health and fitness that form the springboard to recovery.

Written in clear, jargon-free language it explains the condition in layman's terms. It contains guidance on diet, sleep, lifestyle and exercise and explains how these play a vital part in regaining good health. Most important of all are the step-by-step guidelines for overcoming your fears and living a full life. These enable you to progress at the speed that suits you and to tailor your progress to your needs.

It is written by a former agoraphobic who understands the nature of the illness and knows how easy it is to avoid fearful situations and allow the condition to strengthen its grip. The author explains how to confront and overcome these excuses and motivate yourself to full recovery.

About the Author

Joseph O'Neill is a freelance author and broadcaster. He has broadcast and published in both Ireland and Britain. He suffered from agoraphobia for almost thirty years and experienced most forms of therapy during that time. His experience of what works and what doesn't forms the basis of this book.

Author: J O'Neill
Paperback: 312 pages
Company: Chipmunkapublishing (2008-04-04)
ISBN: 1847476562
List Price: $28.00
Amazon Price: $24.14
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Description

"From Agoraphobia to Zen," is the author's true story of her lifelong struggle with panic attacks, agoraphobia and food addiction.

On the dawn of the millennium she makes a decision to break the cycle of mental illness that destroyed her mother and threatens her own life. This authentic, sometimes, brutal journey takes the reader from trauma to comedy, from a Brooklyn housing project to the Hawaiian Islands and from fear to hope.

Armed with her mother's journal and a deep desire to be healed, she uses spiritual guides, imagination and hypnotism to uncover the secrets and lies that both mother and daughter kept. This powerful memoir, filled with fascinating people and compelling photographs is intensified by a genuine sense of time and place, and the author's belief that it's possible to triumph against mental illness.

Author: Marilyn Mendoza
Paperback: 238 pages
Company: Chipmunkapublishing (2011-06-19)
ISBN: 1849915237
List Price: $21.00
Amazon Price: $20.99
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Meg Logan has not been farther than two miles from home in six years. She has agoraphobia, a debilitating anxiety disorder that entraps its sufferers in the fear of leaving safe havens such as home. Paradoxically, while at this safe haven, agoraphobics spend much of their time ruminating over past panic experiences and imagining similar hypothetical situations. In doing so, they create a narrative that both describes their experience and locks them into it.

Constructing Panic offers an unprecedented analysis of one patient's experience of agoraphobia. In this novel interdisciplinary collaboration between a clinical psychologist and a linguist, the authors probe Meg's stories for constructions of emotions, actions, and events. They illustrate how Meg uses grammar and narrative structure to create and recreate emotional experiences that maintain her agoraphobic identity.

In this work Capps and Ochs propose a startling new view of agoraphobia as a communicative disorder. Constructing Panic opens up the largely overlooked potential for linguistic and narrative analysis by revealing the roots of panic and by offering a unique framework for therapeutic intervention. Readers will find in these pages hope for managing panic through careful attention to how we tell the story of our lives.

MASTER YOUR PANIC parallels an actual treatment program in which you are guided, step-by-step, through twelve self-help treatment sessions. Proven, research-based methods are presented in easy-to-follow instructions, accompanied by numerous case examples. Includes guides for identifying triggers of panic attacks, challenging catastrophic thinking and for preventing relapse. Follow Dr. Beckfield's procedures to gain a thorough understanding of the disorder and you can actually resolve the panic in your life.

--Find out why you developed panic attacks in the first place and why they come back. --Learn the tried-and-true "SRB" method to STOP panic the moment it strikes. --Discover your personal triggers for panic and tackle them, one by one -- the thoughts, the physical habits, even the emotional traps. So panic goes away and stays away. --Find out the latest information on the best medications for panic. --Identify the personal stresses and family backgrounds that can lead to panic. --Learn to stop limiting yourself and get your life back -- for GOOD.

Author: Denise F. Beckfield
Paperback: 304 pages
Company: Impact Publishers, Inc. (2003-11-01)
ISBN: 1886230471
List Price: $17.95
Amazon Price: $3.95
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This new edition has been thoroughly updated with the latest anxiety research and medications, and also includes new therapeutic techniques that have been proven effective for the treatment of anxiety and anxiety-related conditions. Each worksheet in this book will help you learn the skills you need to manage your anxiety and start living more freely than you ever thought possible.

With this workbook, you'll learn a range of proven methods for overcoming anxiety:

Policies implemented in the mid to late 1990s in Ontario by Mike Harris's Conservative government have had undeniable repercussions for the population of that province. Kate Bezanson's Gender, the State, and Social Reproduction is the first study to consider the implications of those policies for gender relations - that is, how women and men, families, and households coped with these changes, and how division of labour and standards of living were affected. Bezanson also considers implications of neo-liberalism more generally, for the lives of people living under such regimes.

Beginning with an outline of the restructuring experiment which took place under the Conservative government between 1995 and 2000, Bezanson shows how this process dramatically altered the scope of the welfare state, labour market protections and conditions, and the capacity for people to manage and plan their own lives. She combines this detailed investigation of the changes introduced by Harris with data collected in in-depth interviews of selected Ontario households, in order to examine how neo-liberalism affects daily lives, particularly of low income people, and especially of women. Ultimately, Bezanson finds that the neo-liberal restructuring of Ontario in the 1990s consolidated a gender regime that was highly unsustainable for poor households, many of which were lead by women. A controversial and illuminating study, Gender, the State, and Social Reproduction crosses the disciplines of politics, history, gender studies, and sociology.

Aust N Z J Psychiatry. 2012 Feb; 46(2): 118-31
Swinbourne J, Hunt C, Abbott M, Russell J, St Clare T, Touyz S

Objective: To investigate the prevalence of comorbid eating and anxiety disorders in women presenting for inpatient and outpatient treatment of an eating disorder and women presenting for outpatient treatment of an anxiety disorder. Methods: The prevalence of comorbidity was investigated from a sample of 152 women, which included 100 women presenting for treatment of an eating disorder and 52 women presenting for treatment of an anxiety disorder. Results: Of women presenting for treatment of an eating disorder, 65% also met criteria for at least one comorbid anxiety disorder; 69% of these reported the onset of the anxiety disorder to precede the onset of the eating disorder. Of the anxiety disorders diagnosed, social phobia was most frequently diagnosed (42%) followed by post-traumatic stress disorder (26%), generalised anxiety disorder (23%), obsessive-compulsive disorder (5%), panic/agoraphobia (3%) and specific phobia (2%). We also found that 13.5% of women presenting for anxiety treatment also met criteria for a comorbid eating disorder. Furthermore, 71% (n = 5) reported the onset of the anxiety disorder to precede the onset of the eating disorder. Discussion: The results of this study suggest that the prevalence of eating and anxiety disorder comorbidity is high. The present research should improve the clinical understanding of the comorbidity between eating disorders and anxiety disorders. In particular, it is anticipated that this research will have significant aetiological and therapeutic implications especially with regard to improving the clinical effectiveness of psychological treatments for eating disorders and highlighting the importance of screening for eating pathology in the clinical assessment of anxiety disorders.

Patient Prefer Adherence. 2011; 5: 575-80
Mannu P, Rinaldi S, Fontani V, Castagna A, Margotti ML

Agoraphobia is considered to be the most serious complication of panic disorder. It involves progressive development of debilitating anxiety symptoms related to being in situations where one would be extremely embarrassed and could not be rescued in the case of a panic attack. This study aimed to investigate the efficacy of noninvasive brain stimulation using a radioelectric asymmetric conveyor (REAC) for agoraphobia.Twenty-three patients (3 males and 20 females) suffering from agoraphobia and without a history of panic disorder were evaluated by a psychiatrist using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, and the Agoraphobia Scale (AS). The patients were subjected to two 18-session cycles of noninvasive brain stimulation with the REAC, according to an established therapeutic protocol called neuropsycho-physical optimization.Analyzing the anxiety and avoidance parameters of the AS after the first and second cycles of REAC treatment revealed variation in levels of response to treatment, including weak (AS item 7), moderate (AS items 10 and 13), and good responses (AS items 1-6, 8, 9, 11, 12, and 14-20).These results highlight the potential of the REAC to treat complex clinical situations such as agoraphobia, which is typically resistant to pharmacologic treatments. Furthermore, these data show the advantages of REAC treatment, even compared with modern cognitive behavioral therapy, including a relatively rapid and "stable" clinical response (just over 6 months) and economic cost.

Psychiatr Pol. 2011 Jul-Aug; 45(4): 469-80
Potoczek A

The author examined psychiatrically a group of 106 patients with difficult asthma and 100 patients with aspirin-induced asthma.106 consecutive adults with confirmed, physician-diagnosed difficult asthma and 100 patients with aspirin-induced asthma underwent a psychiatric interview and assessment using M.I.N.I 5.0, Beck Depression Inventory (BDI) and Panic And Agoraphobia Scale (PAS). Psychiatric assessment was performed by an experienced liaison psychiatrist according to ICD-10 and DSM-IV diagnosis. In the difficult asthma group there were 78 women (74%) and 28 men (26%). The average age was 51.3 (SD = 14.5) for women and 47.5 (SD = 12.7) for men. In aspirin induced asthma group there were 66 women (66%) and 34 men (34%). The average age was 52.7 (SD = 12.3) for women and 48.8 (SD = 13.0) for men.In difficult asthma both panic and depressive symptoms were statistically much more severe than in aspirin-induced asthma. Comorbidity between panic and depressive symptoms was almost equal in women and men with difficult asthma, but in aspirin-induced asthma, comorbidity was more common among women than men. Panic-depression comorbidity is regarded as a predictor of especially severe course and outcome of psychiatric disorder.It is possible that especially severe panic and depressive symptoms both with panic-depression comorbidity in women and men with difficult asthma have an impact on aethiology of this near-fatal and treatment resistant subtype of asthma.

Neurol Sci. 2011 Dec 23;
Mancuso M, Orsucci D, Ienco EC, Pini E, Choub A, Siciliano G

Mitochondrial disorders are caused by impairment of the respiratory chain. Psychiatric features often represent part of their clinical spectrum. However, the real incidence of psychiatric disorders in these diseases is unknown. The aim of this study was to evaluate psychiatric involvement in a group of patients with mitochondrial disorders and without already diagnosed mental illness. Twenty-four patients with mitochondrial disorder and without already diagnosed mental diseases have been studied by means of the mini-international neuropsychiatric interview (MINI) and the newcastle mitochondrial diseases adult scale (NMDAS). In patients with mitochondrial disease, psychiatric conditions were far more common than in general Italian population (about 60 vs. 20-25%), and included major depression, agoraphobia and/or panic disorder, generalized anxiety disorder, social anxiety disorder, psychotic syndromes. Psychiatric involvement did not seem to depend on disease progression. Large, multicenter studies are strongly needed to better characterize the natural history of mitochondrial disorders and of their psychiatric involvement. Moreover, the possibility of mitochondrial diseases should be considered in patients with psychiatric diseases. Finally, we encourage psychiatric evaluation as a routinary approach to mitochondrial patients.

Ann Clin Psychiatry. 2012 Feb; 24(1): 6-22
Schaffer A, McIntosh D, Goldstein BI, Rector NA, McIntyre RS, Beaulieu S, Swinson R, Yatham LN

Comorbid mood and anxiety disorders are commonly seen in clinical practice. The goal of this article is to review the available literature on the epidemiologic, etiologic, clinical, and management aspects of this comorbidity and formulate a set of evidence- and consensus-based recommendations. This article is part of a set of Canadian Network for Mood and Anxiety Treatments (CANMAT) Comorbidity Task Force papers.We conducted a PubMed search of all English-language articles published between January 1966 and November 2010. The search terms were bipolar disorder and major depressive disorder, cross-referenced with anxiety disorders/symptoms, panic disorder, agoraphobia, generalized anxiety disorder, social phobia, obsessive-compulsive disorder, and posttraumatic stress disorder. Levels of evidence for specific interventions were assigned based on a priori determined criteria, and recommendations were developed by integrating the level of evidence and clinical opinion of the authors.Comorbid anxiety symptoms and disorders have a significant impact on the clinical presentation and treatment approach for patients with mood disorders. A set of recommendations are provided for the management of bipolar disorder (BD) with comorbid anxiety and major depressive disorder (MDD) with comorbid anxiety with a focus on comorbid posttraumatic stress disorder, use of cognitive-behavioral therapy across mood and anxiety disorders, and youth with mood and anxiety disorders.Careful attention should be given to correctly identifying anxiety comorbidities in patients with BD or MDD. Consideration of evidence- or consensus-based treatment recommendations for the management of both mood and anxiety symptoms is warranted.

Psychiatr Pol. 2011 Jul-Aug; 45(4): 481-93
Potoczek A

The author examined psychiatrically a group of 106 patients with difficult asthma and 100 patients with aspirin-induced asthma. The special interest of the study were differences in the intensity of catastrophic interpretation of body sensations and it's specific links with severity of symptoms of panic disorder and depression in women and men from both groups.106 consecutive adults with confirmed, physician-diagnosed difficult asthma and 100 patients with aspirin-induced asthma underwent a psychiatric interview and assessment using M.I.N.I 5.0, Beck Depression Inventory (BDI), Panic And Agoraphobia Scale (PAS) and Body Sensations Interpretation Questionnaire (BSIQ). Psychiatric assessment was performed by an experienced liaison psychiatrist according to ICD-10 and DSM-IV diagnosis. In the difficult asthma group there were 78 women (74%) and 28 men (26%). The average age was 51.3 (SD = 14.5) for women and 47.5 (SD = 12.7) for men. In aspirin induced asthma group, there were 66 women (66%) and 34 men (34%). The average age was 52.7 (SD = 12.3) for women and 48.8 (SD = 13.0) for men.General intensity of catastrophic interpretation ofbody sensations was much higher in the difficult asthma group. In both groups of asthmatic patients women were the majority, with more frequent severe panic and depressive symptoms than men. Nevertheless there was a very similar and strong tendency to increased intensity of catastrophic interpretation due to severity of both panic and depressive symptoms in subgroups of women and men with difficult and aspirin-induced asthma.It is possible that differences in the intensity of catastrophic interpretation of body sensations used by women and men with difficult asthma affect the development, course and severity of their panic and depressive symptoms. This may play a special role in development of difficult asthma phenomenon.

Behav Ther. 2012 Mar; 43(1): 153-9
Gallo KP, Chan PT, Buzzella BA, Whitton SW, Pincus DB

Previous research findings have shown positive effects of cognitive-behavioral therapy for primary anxiety disorders as well as for nonprimary, co-occurring anxiety disorders. In this study, we analyzed data from an existing randomized controlled trial of intensive treatment for panic disorder with or without agoraphobia (PDA) to examine the effects of the treatment on comorbid psychiatric diagnoses. The overall frequency and severity of aggregated comorbid diagnoses decreased in a group of adolescents who received an 8-day treatment for PDA. Results suggest that an 8-day treatment for PDA can alleviate the symptoms of some specific comorbid clinical diagnoses; in particular specific phobias, generalized anxiety disorder, and social phobia. These findings suggest that an intensive treatment for PDA is associated with reductions in comorbid symptoms even though disorders other than PDA are not specific treatment targets.

Depress Anxiety. 2011 Nov; 28(11): 999-1007
Deckersbach T, Moshier SJ, Tuschen-Caffier B, Otto MW

Studies of the neurocognitive effects of long-term benzodiazepine use have been confounded by the presence of neurocognitive deficits characterizing the clinical conditions for which these medications are taken. Similarly, studies of the neurocognitive effects of anxiety disorders have been confounded by the inclusion of chronically benzodiazepine-medicated patients. This study was designed to tease apart the potentially confounding effects of long-term benzodiazepine use and panic disorder (PD) on memory and visuoconstructive abilities.Twenty chronically benzodiazepine-medicated and 20 benzodiazepine-free patients with PD with agoraphobia were compared with a group of 20 normal control participants, group-matched for age, education, and gender on a battery of neuropsychological tests assessing short-term, episodic long-term, and semantic memory, as well as visuoconstructive abilities.Results indicated that benzodiazepine-free panic patients were relatively impaired in nonverbal short-term and nonverbal episodic long-term memory and visuoconstructive abilities, whereas verbal short-term and verbal episodic memory and semantic memory were preserved. Only limited evidence was found for more pronounced impairments in chronically benzodiazepine-medicated PD patients.This study provides evidence that patients with PD are characterized by relative impairments in nonverbal memory and visuoconstructive abilities, independent of benzodiazepine use. Nonetheless, we found evidence that chronic treatment with benzodiazepines is associated with intensification of select relative impairments in this realm. Documentation of these deficits raises questions about the broader etiology of neurocognitive impairment in PD as well as its impact on daily functioning.

J Clin Psychopharmacol. 2012 Feb; 32(1): 120-6
Nardi AE, Freire RC, Mochcovitch MD, Amrein R, Levitan MN, King AL, Valença AM, Veras AB, Paes F, Sardinha A, Nascimento I, de-Melo-Neto VL, Dias GP, E Silva AC, Soares-Filho GL, da Costa RT, Mezzasalma MA, de Carvalho MR, de Cerqueira AC, Hallak JE, Crippa JA, Versiani M

This long-term extension of an 8-week randomized, naturalistic study in patients with panic disorder with or without agoraphobia compared the efficacy and safety of clonazepam (n = 47) and paroxetine (n = 37) over a 3-year total treatment duration. Target doses for all patients were 2 mg/d clonazepam and 40 mg/d paroxetine (both taken at bedtime). This study reports data from the long-term period (34 months), following the initial 8-week treatment phase. Thus, total treatment duration was 36 months. Patients with a good primary outcome during acute treatment continued monotherapy with clonazepam or paroxetine, but patients with partial primary treatment success were switched to the combination therapy. At initiation of the long-term study, the mean doses of clonazepam and paroxetine were 1.9 (SD, 0.30) and 38.4 (SD, 3.74) mg/d, respectively. These doses were maintained until month 36 (clonazepam 1.9 [SD, 0.29] mg/d and paroxetine 38.2 [SD, 3.87] mg/d). Long-term treatment with clonazepam led to a small but significantly better Clinical Global Impression (CGI)-Improvement rating than treatment with paroxetine (mean difference: CGI-Severity scale -3.48 vs -3.24, respectively, P = 0.02; CGI-Improvement scale 1.06 vs 1.11, respectively, P = 0.04). Both treatments similarly reduced the number of panic attacks and severity of anxiety. Patients treated with clonazepam had significantly fewer adverse events than those treated with paroxetine (28.9% vs 70.6%, P < 0.001). The efficacy of clonazepam and paroxetine for the treatment of panic disorder was maintained over the long-term course. There was a significant advantage with clonazepam over paroxetine with respect to the frequency and nature of adverse events.

Assessment. 2011 Dec 20;
Kemper CJ, Lutz J, Bähr T, Rddel H, Hock M

Using two clinical samples of patients, the presented studies examined the construct validity of the recently revised Anxiety Sensitivity Index-3 (ASI-3). Confirmatory factor analyses established a clear three-factor structure that corresponds to the postulated subdivision of the construct into correlated somatic, social, and cognitive components. Participants with different primary clinical diagnoses differed from each other on the ASI-3 subscales in theoretically meaningful ways. Specifically, the ASI-3 successfully discriminated patients with anxiety disorders from patients with nonanxiety disorders. Moreover, patients with panic disorder or agoraphobia manifested more somatic concerns than patients with other anxiety disorders and patients with nonanxiety disorders. Finally, correlations of the ASI-3 scales with other measures of clinical symptoms and negative affect substantiated convergent and discriminant validity. Substantial positive correlations were found between the ASI-3 Somatic Concerns and body vigilance, between Social Concerns and fear of negative evaluation and socially inhibited behavior, and between Cognitive Concerns and depression symptoms, anxiety, fear of negative evaluation, and subjective complaints. Moreover, Social Concerns correlated negatively with dominant and intrusive behavior. Results are discussed with respect to the contribution of the ASI-3 to the assessment of anxiety-related disorders.

Neuropsychiatr Dis Treat. 2011; 7: 621-37
Perna G, Daccò S, Menotti R, Caldirola D

Although there are controversial issues (the "American view" and the "European view") regarding the construct and definition of agoraphobia (AG), this syndrome is well recognized and it is a burden in the lives of millions of people worldwide. To better clarify the role of drug therapy in AG, the authors summarized and discussed recent evidence on pharmacological treatments, based on clinical trials available from 2000, with the aim of highlighting pharmacotherapies that may improve this complex syndrome.A systematic review of the literature regarding the pharmacological treatment of AG was carried out using MEDLINE, EBSCO, and Cochrane databases, with keywords individuated by MeSH research. Only randomized, placebo-controlled studies or comparative clinical trials were included.After selection, 25 studies were included. All the selected studies included patients with AG associated with panic disorder. Effective compounds included selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, selective noradrenergic reuptake inhibitors, and benzodiazepines. Paroxetine, sertraline, citalopram, escitalopram, and clomipramine showed the most consistent results, while fluvoxamine, fluoxetine, and imipramine showed limited efficacy. Preliminary results suggested the potential efficacy of inositol; D-cycloserine showed mixed results for its ability to improve the outcome of exposure-based cognitive behavioral therapy. More studies with the latter compounds are needed before drawing definitive conclusions.No studies have been specifically oriented toward evaluating the effect of drugs on AG; in the available studies, the improvement of AG might have been the consequence of the reduction of panic attacks. Before developing a "true" psychopharmacology of AG it is crucial to clarify its definition. There may be several potential mechanisms involved, including fear-learning processes, balance system dysfunction, high light sensitivity, and impaired visuospatial abilities, but further studies are warranted.

Curr Top Med Chem. 2012 Feb 1;
Marazziti D, Carlini M, Dell'osso L

Anxiety disorders represent the most prevalent psychiatric disorders. In addition, a considerable burden is associated with them, not only for individual sufferers, but also for the health care system. However, many patients who might benefit from treatment are not diagnosed or treated. This may partly be due to lack of awareness of the anxiety disorders by primary care practitioners and by the sufferers themselves. In addition, the stigma still associated with psychiatric disorders and lack of confidence in psychiatric treatments are factors leading to no/under recognition and treatment, or the use of unnecessary or inappropriate treatments. This paper aims to provide a comprehensive review of recommendations for the pharmacological treatment of the two common anxiety disorders, in particular obsessive-compulsive disorder (OCD) and panic disorder (PD). The first-line treatments of OCD include medium-high doses of include selective serotonin reuptake inhibitors (SSRIs) and clomipramine, a tricyclic (TCA) antidepressant with prevalent serotonergic activity. The recommended drugs for PD include SSRIs, TCAs and serotonin-norepinephrine reuptake inhibitors (SNRIs); in treatment-resistant cases, benzodiazepines like alprazolam may be used in patients with no history of dependency and tolerance. Other treatment options include irreversible and reversible monoamine-oxidase inhibitors, hydroxyzine, and others. Besides pharmacological treatments, some psychological strategies have been shown to be effective, in particular, cognitive behavior therapy (CBT) and other variants of behavior therapy have been sufficiently investigated in controlled studies, and, therefore, will be reviewed herein.

Psychiatrike. 2011 Oct-Dec; 22(4): 307-13
Lykouras L, Michopoulos J

Anxiety disorders are the most prevalent mental disorders in developed countries. On the other hand, obesity is recognized to be one of the greatest public health problems worldwide.The connection between body weight and mental disorders remains an open issue.Low body weight has been studied enough (anorexia nervosa is a typical example) but high body weight has not been addressed sufficiently. It is known that obesity has been related with depression. Although moderate level of evidence exists for a positive association between obesity and anxiety disorders, the exact association between these two conditions is not clear yet.The studies about this subject are quite few and they follow different methodology. Furthermore,anxiety disorders share some common elements such as anxiety, avoidance and chronicity, butthey also present a great deal of differences in phenomenology, neurobiology, treatment response and prognosis. This factor makes general conclusions difficult to be drawn. Obesity has been associatedwith anxiety disorders as following: most of the studies show a positive relationship with panic disorder, mainly in women, with specific phobia and social phobia. Some authors have founda relationship with generalised anxiety disorder but a negative relationship has been also reported.Only few studies have found association between obesity and agoraphobia, panic attacks and posttraumatic stress disorder. There has not been reported a relationship between obesity and obsessivecompulsive disorder. The causal relationship from obesity to anxiety disorders and vice versais still under investigation. Pharmacological factors used for obesity treatment, such as rimonabant,were associated with depression and anxiety. Questions still remain regarding the role of obesityseverity and subtypes of anxiety disorders. Besides, it is well known that in the morbidly obese patientsbefore undergoing surgical treatment, unusual prevalence of psychopathology, namely depressionand anxiety disorders, is observed. Anxiety is also a common trait in personality disorders.There is no single personality type characteristic of the morbidly obese, they differ from the generalpopulation as their self-esteem and impulse control is lower. Obese patients present with passivedependent and passive aggressive personality traits, as well as a trend for somatization and problemdenial. Their thinking is usually dichotomous and catastrophic. Obese patients also show lowcooperativeness and fail to see the self as autonomous and integrated. When trying to participate insociety roles they are subject to prejudice and discrimination and should be treated with concern tohelp alleviate their feelings of rejection and guilt.

J Anxiety Disord. 2012 Mar; 26(2): 377-83
Fontenelle LF, Cocchi L, Harrison BJ, Shavitt RG, do Rosário MC, Ferrão YA, de Mathis MA, Cordioli AV, Yücel M, Pantelis C, Mari Jde J, Miguel EC, Torres AR

We evaluated whether traumatic events are associated with a distinctive pattern of socio-demographic and clinical features of obsessive-compulsive disorder (OCD). We compared socio-demographic and clinical features of 106 patients developing OCD after post-traumatic stress disorder (PTSD; termed post-traumatic OCD), 41 patients developing OCD before PTSD (pre-traumatic OCD), and 810 OCD patients without any history of PTSD (non-traumatic OCD) using multinomial logistic regression analysis. A later age at onset of OCD, self-mutilation disorder, history of suicide plans, panic disorder with agoraphobia, and compulsive buying disorder were independently related to post-traumatic OCD. In contrast, earlier age at OCD onset, alcohol-related disorders, contamination-washing symptoms, and self-mutilation disorder were all independently associated with pre-traumatic OCD. In addition, patients with post-traumatic OCD without a previous history of obsessive-compulsive symptoms (OCS) showed lower educational levels, greater rates of contamination-washing symptoms, and more severe miscellaneous symptoms as compared to post-traumatic OCD patients with a history of OCS.

PLoS One. 2011; 6(11): e28079
Johnston L, Titov N, Andrews G, Spence J, Dear BF

Anxiety disorders share common vulnerabilities and symptoms. Disorder-specific treatment is efficacious, but few access evidence-based care. Administering transdiagnostic cognitive-behavioral therapy via the internet (iCBT) may increase access to evidence-based treatment, with a recent randomized controlled trial (RCT) providing preliminary support for this approach. This study extends those findings and aims to answer three questions: Is a transdiagnostic iCBT program for anxiety disorders efficacious and acceptable? Does it result in change for specific disorders? Can good clinical outcomes be obtained when guidance is provided via a Coach rather than a Clinician?RCT (N = 131) comparing three groups: Clinician-supported (CL) vs. Coach-supported (CO) vs. waitlist control (Control). Individuals met DSM-IV criteria for a principal diagnosis of generalized anxiety disorder (GAD), social phobia (SP) or panic disorder with or without agoraphobia (Pan/Ag). Treatment consisted of an 8-lesson/10 week iCBT program with weekly contact from a Clinician or Coach, and follow-up at 3-months post-treatment.Outcomes for the pooled treatment groups (CL+CO) were superior to the Control group on measures of anxiety, depression and disability, were associated with medium to large effect sizes (Cohen's d = .76-1.44) (response rate = 89-100%), and were maintained at follow-up. Significant reductions were found on disorder-specific outcomes for each of the target diagnoses, and were associated with large effect sizes. CO participants achieved similar outcomes to CL participants at post-treatment, yet had significantly lower symptom severity scores on general anxiety, panic-disorder, depression and disability at follow-up (d = .45-.46). Seventy-four percent of CO and 76% of CL participants completed the program. Less than 70 minutes of Clinician or Coach time was required per participant during the program.This transdiagnostic iCBT course for anxiety appears to be efficacious, associated with significant change for three target disorders, and is efficacious when guided by either a Clinician or Coach.Australian New Zealand Clinical Trials Registry ACTRN12610000242022.

Sao Paulo Med J. 2011; 129(5): 325-34
King AL, Valença AM, de Melo-Neto VL, Freire RC, Mezzasalma MA, Silva AC, Nardi AE

Cognitive-behavioral therapy is frequently indicated for panic disorder. The aim here was to evaluate the efficacy of a model for cognitive-behavioral therapy for treating panic disorder with agoraphobia.Randomized clinical trial at Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro.A group of 50 patients with a diagnosis of panic disorder with agoraphobia was randomized into two groups to receive: a) cognitive-behavioral therapy with medication; or b) medication (tricyclic antidepressants or selective serotonin reuptake inhibitors).Although there was no difference between the groups after the treatment in relation to almost all variables with the exception of some items of the Sheehan disability scale and the psychosocial and environmental problems scale, the patients who received the specific therapy presented significant reductions in panic attacks, anticipatory anxiety, agoraphobia avoidance and fear of body sensations at the end of the study, in relation to the group without the therapy. On the overall functioning assessment scale, overall wellbeing increased from 60.8% to 72.5% among the patients in the group with therapy, thus differing from the group without therapy.Although both groups responded to the treatment and improved, we only observed significant differences between the interventions on some scales. The association between specific cognitive-behavioral therapy focusing on somatic complaints and pharmacological treatment was effective among this sample of patients with panic disorder and the response was similar in the group with pharmacological treatment alone.

J Anxiety Disord. 2012 Jan; 26(1): 173-81
Brandt CP, Johnson KA, Schmidt NB, Zvolensky MJ

The current study investigated the main and interactive effects of emotion dysregulation and distress tolerance in relation to panic-relevant variables among daily smokers. The sample consisted of 172 adults (61.2% male; M(age)=31.58, SD=11.51), who reported smoking an average of 15.99 cigarettes per day (SD=10.00). Results indicated that both emotion dysregulation and distress tolerance were significantly related to interoceptive fear and agoraphobia. Additionally, emotion dysregulation, but not distress tolerance, was significantly related to anxiety sensitivity. All effects were evident above and beyond the variance accounted for by average cigarettes per day, tobacco-related physical illness, and panic attack history. The interaction between emotion dysregulation and distress tolerance significantly predicted interoceptive and agoraphobic fears as well as the cognitive component of anxiety sensitivity. Such findings underscore the importance of emotion dysregulation and distress tolerance in regard to panic-specific fear and expectancies about anxiety-related sensations among daily smokers.

Psychiatrike. 2011 Oct-Dec; 22(4): 320-9
Ferentinos P, Kontaxakis VP, Havaki-Kontaxaki BJ, Dikeos D, Papadimitriou GN, Lykouras L

Several studies have investigated fatigue in the general population, in primary care facilitiesas well as in patients with fatigue-related physical diseases, but only marginally in patientswith Major Depressive Disorder (MDD). Therefore, the investigation of correlates of depression-related fatigue is highly warranted and expected to facilitate the implementation of effectivefatigue-specific treatment strategies. Depressed patients often suffer from comorbid anxietydisorders (CADs) or subthreshold anxiety symptoms. This study aimed to investigate the independentcorrelation of the severity of fatigue in female patients with MDD with the presence, numberand type of CADs. We studied 70 consecutive female MDD patients (48.6% inpatients), aged 23-65years (mean 48.2±10.6 years), currently in a Major Depressive Episode [17-item Hamilton DepressionRating Scale (HDRS) score≥17] and free of other fatigue-associated conditions. Diagnostic assessmentswere made with the short structured DSM-IV-based MINI version 5.0.0. Reported fatigue wasassessed with the 14-item Chalder Fatigue Questionnaire (FQ). Correlations between the FQ scoreand age, inpatient status, HDRS score, presence and number of CADs were calculated. Then, stepwisemultiple regression analyses were performed, with the FQ score as the dependent variable,so as to isolate independent predictors of the severity of fatigue. 92.9% of patients had clinicallysignificant fatigue. 62.9% were suffering from at least one CAD (38.6% met criteria for one CAD,21.4% for two and 2.9% for three). 51.4% were diagnosed with generalized anxiety disorder (GAD),25.7% with panic disorder and/or agoraphobia (PD/AP), 17.1% with social anxiety disorder and 7.1%with obsessive-compulsive disorder. The FQ score was significantly correlated with the HDRS score(r=0.406, p

J Psychiatr Res. 2012 Feb; 46(2): 168-73
Bryant RA, Creamer M, O'Donnell M, Silove D, McFarlane AC

One rationale for establishing the acute stress disorder diagnosis was to identify recently trauma-exposed people who may develop later posttraumatic stress disorder (PTSD). This study conducted a multi-site assessment of the extent to which ASD predicts subsequent PTSD, and also major depressive disorder, panic disorder, agoraphobia, social phobia, specific phobia, generalized anxiety disorder, and substance use disorder, 12 months after trauma.Consecutive admissions to 5 major trauma hospitals across Australia (N = 1084) were assessed during hospital admission and within one month of trauma exposure and subsequently re-assessed for psychiatric disorder 12 months after the initial assessment (N = 859).Whereas 120 (10%) patients met criteria for ASD in the initial month after trauma, 83 (10%) met criteria for PTSD, and 268 (31%) had any psychiatric disorder at 12 months. In terms of those diagnosed with ASD, 28 (36%) subsequently met criteria for PTSD and 50 (65%) subsequently developed any psychiatric disorder.Whereas the majority of people with ASD subsequently develop a psychiatric disorder, most people with a disorder at 12 months do not initially display ASD.

Am J Med Genet B Neuropsychiatr Genet. 2012 Jan 17;
Logue MW, Bauver SR, Knowles JA, Gameroff MJ, Weissman MM, Crowe RR, Fyer AJ, Hamilton SP

Replication has been difficult to achieve in linkage studies of psychiatric disease. Linkage studies of panic disorder have indicated regions of interest on chromosomes 1q, 2p, 2q, 3, 7, 9, 11, 12q13, 12q23, and 15. Few regions have been implicated in more than one study. We examine two samples, the Iowa (IA) and the Columba panic disorder families. We use the fuzzy-clustering method presented by Kaabi et al. [Kaabi et al. (2006); Am J Hum Genet 78: 543-553] to summarize liability to panic disorder, agoraphobia, simple phobia, and social phobia. Kaabi et al. applied this method to the Yale panic disorder linkage families and found evidence of linkage to chromosomes 4q21, 4q32, 7p, and 8. When we apply the same method to the IA families, we obtain overlapping evidence of linkage to chromosomes 4q21 and 7p. Additionally, we find evidence of linkage on chromosomes 1, 5, 6, 16, and 22. The Columbia (CO) data does not indicate linkage to any of the Kaabi et al. peaks, instead implicating chromosomes 2 and 22q11 (2 Mb from COMT). There is some evidence of overlapping linkage between the IA and CO datasets on chromosomes 1 and 14. While use of fuzzy clustering has not produced complete concordance across datasets, it has produced more than previously seen in analyses of panic disorder proper. We conclude that chromosomes 4q21 and 7p should be considered strong candidate regions for panic and fear-associated anxiety disorder loci. More generally, this suggests that analyses including multiple aspects of psychopathology may lead to greater consistency across datasets. © 2012 Wiley Periodicals, Inc.