Treatment of Adolescent Panic Disorder: A Nonrandomized Comparison of Intensive Versus Weekly CBT

This study compared the relative efficacy of intensive versus weekly panic control treatment (PCT) for adolescent panic disorder with agoraphobia (PDA). Twenty-six adolescents participated in weekly sessions and 25 received intensive treatment involving daily sessions. Both groups demonstrated significant and comparable reductions in panic disorder severity and general anxiety symptoms, which maintained over time. Participants receiving weekly treatment showed significant decreases in depressive symptoms, whereas those in the intensive program reported no change. Findings support the efficacy of the intensive approach for adolescent PDA, but suggest that adolescents receiving intensive treatment may benefit from a brief course of additional weekly sessions.     

双血供胸大肌皮瓣修补咽颈部缺损

探讨双血供胸大肌皮瓣修补咽颈部缺损的可行性。介绍应用双血供胸大肌皮瓣修补咽颈部缺损36例,窄蒂胸大肌皮瓣修补咽颈部缺损7例。结果前者愈合23例,出血3例,感染5例,咽瘘5例,皮瓣坏死无;后者愈合2例,出血1例,感染1例,咽瘘2例,皮瓣坏死1例。双血供胸大肌皮瓣修补咽颈部缺损更利于术后愈合、预防咽瘘。     

Mass Perturbation of a Body Segment: I. Effects on Segment Dynamics

Investigators often use mass perturbation of body segments as an experimental paradigm to study movement coordination. To analyze the effect of mass perturbation on small-amplitude oscillations, the authors linearize the equation of motion of a single segment moving in a vertical plane and derive the effect of added mass on the undamped eigenfrequency, the relative damping, and the low-frequency control gain of the segment. Mass addition results in a decrease in both the relative damping and the low-frequency control gain; the undamped eigenfrequency increases for mass addition between the pivot point and R₀ (where R₀ is the length of a point mass pendulum whose undamped eigenfrequency is identical to that of the unperturbed segment), decreases for mass addition beyond R₀, and remains unaffected for mass addition at R₀. For a typical lower leg + foot segment, R₀ is just proximal to the ankle joint. That location may explain the absence of an effect on oscillation frequency in studies in which mass has been added to the ankle. The authors' analysis provides a basis for a more effective application of mass perturbations in future experiments.     

Childhood anxiety associated with low BMI in women with Anorexia Nervosa

Objective

Extremely low body mass index (BMI) values are associated with increased risk for death and poor long-term prognosis in individuals with anorexia nervosa (AN). The present study explores childhood personality characteristics that could be associated with the ability to attain an extremely low BMI.

Methods

Participants were 326 women from the Genetics of Anorexia Nervosa (GAN) Study who completed the Structured Interview for Anorexia Nervosa and Bulimic Syndromes and whose mother completed the Child Behavioral Checklist and/or Revised Dimensions of Temperament Survey.

Results

Children who were described as having greater fear or anxiety by their mothers attained lower BMIs during AN (p < 0.02). Path analysis in the GAN and a validation sample, Price Foundation Anorexia Nervosa Trios Study, confirmed the relation between early childhood anxiety, caloric restriction, qualitative food item restriction, excessive exercise, and low BMI. Path analysis also confirmed a relation between childhood anxiety and caloric restriction, which mediated the relation between childhood anxiety and low BMI in the GAN sample only.

Conclusion

Fearful or anxious behavior as a child was associated with the attainment of low BMI in AN and childhood anxiety was associated with caloric restriction. Measures of anxiety and factors associated with anxiety-proneness in childhood may index children at risk for restrictive behaviors and extremely low BMIs in AN.     

The anxiety disorder spectrum: Fear imagery,physiological reactivity,and differential diagnosis∗

Abstract

This review considers recent research assessing psychophysiological reactivity to fear imagery in anxiety disorder patients. As in animal subjects, fear cues prompt in humans a state of defensive motivation in which autonomic and somatic survival reflexes are markedly enhanced. Thus, a startle stimulus presented in a fear context yields a stronger (potentiated) reflex, providing a quantitative measure of fearful arousal. This fear potentiation is further exaggerated in specific or social phobia individuals when viewing pictures or imagining the phobic object. Paradoxically, fear imagery studies with more severe anxiety disorder patients – panic disorder with agoraphobia, generalized anxiety disorder, or anxious patients with comorbid depression – show a blunted, less robust fear potentiated response. Furthermore, this reflex blunting appears to systematically be more pronounced over the anxiety disorder spectrum, coincident with lengthier chronicity, worsening clinician-based judgments of severity and prognosis, and increased questionnaire-based indices of negative affectivity, suggesting that normal defensive reactivity may be compromised by an experience of long-term stress.     

Avoidant coping in panic disorder: a yohimbine biological challenge study

Abstract

Few studies have addressed whether the use of avoidance-oriented coping strategies is related to the development of panic in patients with panic disorder(PD). Self-report, clinician-rated, and physiological data were collected from 42 individuals who participated in a yohimbine biological challenge study, performed under double-blind, placebo-controlled conditions. Participants included 20 healthy controls and 22 currently symptomatic patients who met DSM-IV-TR diagnostic criteria for PD. Consistent with prediction, patients with PD who had higher perceived efficacy of avoidance-oriented strategies in reducing anxiety-related thoughts reported increased severity in panic symptoms during the yohimbine challenge condition as compared to the placebo. Further, patients with PD who had more fear of cognitive dyscontrol, cardiovascular symptoms, and publicly observable anxiety also reported increased severity in panic symptoms during the challenge. Healthy controls who had more fear of cardiovascular symptoms similarly reported increased severity in panic symptoms during the challenge. No effects were found for heart rate response to the challenge agent. These results provide support for the role of avoidance-oriented coping strategies and fear of anxiety-related symptoms as risk and maintenance factors in the development of panic symptoms, particularly within a biological challenge model.     

Intuitive understanding of the relation between velocities and masses in simulated collisions

The participants in our experiments were asked to judge whether simulated horizontal collisions appeared to be “natural” or “unnatural”. We manipulated the implied masses and the velocity ratio of two colliding objects. Implied masses were varied through manipulations of the objects' simulated materials (Experiment 1) and sizes (Experiments 2 and 3). For each participant, we determined the interval of velocity ratios that produced “natural” responses most of the time and evaluated how this interval varied as a function of implied masses. The results revealed a fair degree of consistency between predictions of Newtonian mechanics and the participants' responses; this consistency was greater when the implied masses of the colliding objects were varied through manipulations of the simulated materials. Overall, the results support the hypothesis that the cognitive system can integrate multiple sources of stimulus information, enabling individuals to understand multidimensional mechanical events.     

Health Perceptions and Anxiety Sensitivity in Patients with Panic Disorder

Separate lines of research indicate that patients with panic disorder display negative perceptions of physical health and elevated fear of autonomic arousal. Because health perceptions and anxiety sensitivity may be related, the present study evaluated the degree to which these constructs can be distinguished in patients meeting DSM-IV criteria for panic disorder (N = 44). Perceived health, anxiety sensitivity, and the clinical features of panic disorder were assessed at pretreatment and following 12 sessions of cognitive–behavioral treatment. Findings consistently indicated that perceived health and anxiety sensitivity can be meaningfully differentiated. Perceived physical health was only moderately associated with anxiety sensitivity, and each was uniquely associated with pretreatment symptomatology and posttreatment end-state functioning. Perceived physical health appears to be a clinically useful index in the overall evaluation of panic disorder and is readily distinguishable from anxiety sensitivity.     

Whole Body Coordination and Knee Movement Control During Five Rehabilitation Exercises

Knee rehabilitation exercises to improve motor control, target movement fluency, and displacement variability. Although knee movement in the frontal plane during exercise is routinely assessed in clinical practice, optimal knee control remains poorly understood. In this study, 29 healthy participants (height: 1.73 ± 0.11 m, mass: 73.5 ± 16.4 kg, age: 28.0 ± 6.9 years) performed 4 repetitions of 5 rehabilitation exercises while motion data were collected using the VICON PlugInGait full-body marker set. Fluency and displacement variability were calculated for multiple landmarks, including center of mass (CoM) and knee joint centers. Fluency was calculated as the inverse of the average number of times a landmark velocity in the frontal plane crossed zero. Variability was defined as the standard deviation of the frontal plane movement trajectories. CoM fluency and displacement variability were significantly different between tasks (p < .001). CoM displacement variability was consistently smallest compared to the constituent landmarks (p < .005). This was interpreted as a whole body strategy of compensatory variability constraining CoM frontal plane movement. Ipsilateral knee fluency (p < .01) and displacement variability (p < .001) differed substantially between tasks. The role of the weight-bearing knee seemed dependent on task constraints of the overall movement and balance, as well as constraints specific for knee joint stability.     

A MODEL FOR INTEGRATING ACTUAL NEUROTIC OR UNREPRESENTED STATES AND SYMBOLIZED ASPECTS OF INTRAPSYCHIC CONFLICT

In psychoanalytic theory, the importance of actual neuroses—considered to be devoid of psychic content—diminished as Freud and subsequent analysts focused on unconscious intrapsychic conflict. This paper explores the relationship between actual neurotic and unrepresented states, which are believed to be best addressed through attention to countertransference, intersubjectivity, and enactments rather than interpretation of intrapsychic conflict. Models suggesting how actual neurotic states and symbolized intrapsychic conflict may interact with each other and environmental stressors are described. Symbolizing actual neurotic states and establishing meaningful linkages between somatic/affective experiences and intrapsychic conflict are viewed as necessary for effective treatment of many disorders.