Anxiety Disorders

Introduction: This Hungarian cross-sectional study examined patterns and differences in suicide risk factors across various suicidality groups, including individuals with single or multiple suicide attempts, as well as gender-specific variations. Additionally, it explored these risk factors within a biopsychosocial framework to offer a comprehensive understanding of their interconnected effects.

Materials and methods: A total of 300 psychiatric inpatients were recruited from Péterfy Sandor Hospital in Budapest, Hungary, including 146 individuals (48.67%) with a history of suicide attempts and 154 (51.33%) without such a history. Participants ranged in age from 18 to 85 years, with a mean age of 37.98 years (SD = 12.80 for suicide attempters, 13.72 for non-attempters). The overall sample comprised 83 males (27.7%) and 217 females (72.3%). Logistic regression analysis was conducted to assess the influence of demographic characteristics, life history variables, and psychiatric diagnoses on suicide risk, aiming to identify significant predictors of suicide attempts within a biopsychosocial framework.

Results: Depression was the most prevalent psychiatric diagnosis in the sample. Significant predictors of suicide attempts included family history of suicide (OR = 2.283, p = 0.015), prescription drug misuse (OR = 1.900, p = 0.047), and nicotine dependence (OR = 1.869, p = 0.035). In repeated suicide attempts, bipolar disorder (OR = 5.761, p = 0.006), borderline personality disorder (OR = 5.132, p = 0.003), depression (OR = 4.064, p = 0.004), and job loss (OR = 4.348, p = 0.031) emerged as the strongest predictors. Among men, job loss (OR = 4.074, p = 0.014) was a prominent risk factor, while among women, having two or more children (OR = 2.740, p = 0.036) and a family history of suicide (OR = 2.459, p = 0.028) significantly increased suicide risk. Relationship conflict was also associated with higher risk in women (OR = 0.382, p = 0.035).

Conclusions: Our research supports the notion that suicide risk factors interact with one another, and in certain cases, their effects may be synergistic—mutually reinforcing—rather than antagonistic. Similarly, protective factors also appear to amplify each other’s impact, suggesting a cumulative and interactive model of both risk and resilience.

OBJECTIVE: Depressed mood and cognitive impairments are common findings in systemic lupus erythematosus (SLE) and frequently coexist. We assessed the neuropsychological functioning of patients with SLE and investigated its association with psychopathological symptoms. METHODS: A total of 85 patients with SLE (28 with neuropsychiatric syndromes: NPSLE) and 85 healthy control subjects with similar demographic characteristics were asked to perform a series of neuropsychological tests. A self-report questionnaire (the Hospital Anxiety and Depression Scale) was used to screen for psychopathology symptoms. Patients with SLE underwent a neurological examination. RESULTS: Patients with NPSLE were more depressed and were more frequently impaired in cognitive and olfactory functions than controls or non-NPSLE patients. The NPSLE group remained statistically different from the other 2 groups on a series of neuropsychological measures (the Auditory Verbal Learning Test, Trail Making Test - Part...

This prospective study investigated quality of life and caregiver burden of 244 parent caregivers of 113 Spanish patients with Eating Disorders (ED). One hundred eleven mothers and 70 fathers fulfilled the inclusion criteria. ED patients completed the Hospital Anxiety and Depression Scale (HADS) and the Eating Attitudes Test-26. Caregivers completed the HADS, the Short Form-12 (SF-12), the Involvement Evaluation Questionnaire-EU version, and the Anorectic Behaviour Observation Scale. Descriptive statistics, ANOVA, Chi-square and Fisher's exact test were applied. Among mothers, anxiety and depression and patient age contributed to poorer quality of life. Caregiver variables that affected the burden for mothers were marital status, the mental subscale of the SF-12, and the mother's perception of the severity of her child's illness. Caregiver variables that affected the burden for fathers were the caregiver's anxiety and the physical domain of the SF-12. Among mothers but not fathers, being married was a protective factor of caregiver burden. Our findings suggest that mothers and fathers have different perceptions of their quality of life and caregiver burden, and that mothers of patients with ED may be in considerable need for extra psychosocial support.

Domestic violence/intrapersonal violence (DV/IPV), inclusive of physical, sexual, emotional,
psychological, or economic consequences, negatively affects victims and child witnesses. The
impact of DV/IPV on the family system and society is far-reaching. DV/IPV is experienced by
10 million adults and 3.3 million child witnesses in the United States; additionally, 35% of
women worldwide fall victim annually. This systematic review was conducted to examine
empirical literature on DV/IPV victimization, DV/IPV’s influence on women victims’ mental
health, and child witness mental health comorbidities. The primary research question was, how
do barriers to mental healthcare access have detrimental effects on victims’ health and how do
these barriers continue to contribute to the avoidance of help-seeking behaviors? The analysis
guided by PRISMA 2020 revealed three interrelated themes: stigma and mental health access;
cultural differences; psychological control, low self-esteem, and hopelessness. Additionally,
DV/IPV exposure has long-lasting effects on child witnesses, including a risk for future DV/IPV
perpetration. Considering the sociocultural context in which DV/IPV occurs, the costly burden
involves a multiplicity of public services that contribute to individual and family financial strain.
The problem of DV/IPV is compounded by various political, cultural, legal, and economic
factors, requiring a crucial necessity to understand its etiology. Therapists should remain aware
of social and legal sanctions that can inform clinical interventions and prevention strategies and
treat underlying root causes of the DV/IPV perpetration. Future research is needed to improve
behavioral health interventions and develop overall policies to protect affected women and child
witnesses.

Law-abidingness is a construct that may originate from cultural, social, and psychological sources and has various consequences for individuals, many of which are related to mental health. Therefore, understanding the impact of law-abidingness on variables associated with mental health, such as psychological well-being and sexual self-control, is of particular importance. For this reason, a law-abidingness intervention was designed in this study. The purpose of this research was to determine the effectiveness of a law-abidingness intervention on sexual self-control and psychological well-being among female prisoners. The study employed a singlesubject research design. To conduct the research, three prisoners referred to relevant clinics by the Qom Criminal Court and Prosecutor's Office were selected. All three participants underwent six sessions of law-abidingness intervention and, within an ABA design, completed Ryff's Psychological Well-Being Questionnaire (1989) and Esmaeili's Sexual Self-Control Questionnaire (2015) as baseline, in-process, and follow-up assessments (twice with a one-month interval). Data were analyzed descriptively using visual analysis (level, trend, variability). The results indicated that the law-abidingness intervention had a positive effect on the psychological well-being and sexual self-control of female prisoners. Thus, it appears that implementing lawabidingness interventions can help enhance the psychological well-being and sexual self-control of incarcerated women. Therefore, it is recommended that such interventions be incorporated into educational and cultural programs related to prisons.

Law-abidingness is a construct that may originate from cultural, social, and psychological sources and has various consequences for individuals, many of which are related to mental health. Therefore, understanding the impact of law-abidingness on variables associated with mental health, such as psychological well-being and sexual self-control, is of particular importance. For this reason, a law-abidingness intervention was designed in this study. The purpose of this research was to determine the effectiveness of a law-abidingness intervention on sexual self-control and psychological well-being among female prisoners. The study employed a singlesubject research design. To conduct the research, three prisoners referred to relevant clinics by the Qom Criminal Court and Prosecutor's Office were selected. All three participants underwent six sessions of law-abidingness intervention and, within an ABA design, completed Ryff's Psychological Well-Being Questionnaire (1989) and Esmaeili's Sexual Self-Control Questionnaire (2015) as baseline, in-process, and follow-up assessments (twice with a one-month interval). Data were analyzed descriptively using visual analysis (level, trend, variability). The results indicated that the law-abidingness intervention had a positive effect on the psychological well-being and sexual self-control of female prisoners. Thus, it appears that implementing lawabidingness interventions can help enhance the psychological well-being and sexual self-control of incarcerated women. Therefore, it is recommended that such interventions be incorporated into educational and cultural programs related to prisons.

Tachypnea, defined as an abnormally elevated respiratory rate above the expected range for age, is a fundamental yet complex clinical sign encountered across diverse medical settings. Although often overlooked due to its apparent simplicity, tachypnea represents a pivotal diagnostic marker that can signify a broad spectrum of physiological adaptations and pathological conditions. Physiological tachypnea occurs in states of increased metabolic demand, such as exercise, high-altitude exposure, and pregnancy, where accelerated ventilation facilitates adequate oxygen delivery and carbon dioxide clearance. In contrast, pathological tachypnea frequently signals life-threatening conditions, including sepsis, diabetic ketoacidosis, pulmonary embolism, pneumonia, and congestive heart failure. Its recognition is therefore essential in both acute and chronic care.
At the pathophysiological level, tachypnea is driven by intricate neurochemical and mechanical feedback loops involving central and peripheral chemoreceptors, acid-base regulation, and pulmonary stretch receptors. Clinicians must carefully differentiate tachypnea from related entities such as hyperventilation and dyspnea, as misinterpretation can alter management strategies. Diagnostic evaluation integrates bedside assessment, arterial blood gas analysis, advanced imaging, and continuous monitoring technologies. Treatment is fundamentally cause-directed, ranging from supportive oxygen therapy in transient neonatal cases to urgent interventions in respiratory failure or metabolic derangements.
This paper underscores tachypnea as a unifying symptom across medicine, bridging respiratory, cardiovascular, neurologic, metabolic, and psychiatric domains. Recognition, evaluation, and management necessitate an interprofessional approach, highlighting the role of physicians, nurses, respiratory therapists, and allied health professionals in ensuring timely intervention and optimal patient outcomes. By reframing tachypnea as a multifaceted clinical phenomenon rather than a simple numerical observation, healthcare teams can leverage its diagnostic and prognostic potential in guiding patient care.

College entrance is a stressful period with a high prevalence of mental disorders. To assess the role impairment associated with 12-month mental disorders among incoming first-year college students within a large cross-national sample. Web-based self-report surveys assessing the prevalence of DSM-IV mental disorders and health-related role impairment (Sheehan Disability Scale) were obtained and analyzed from 13,984 incoming first-year college students (Response = 45.5%), across 19 universities in eight countries. Impairment was assessed in the following domains: home management, work (e.g., college-related problems), close personal relationships, and social life. Mean age of the sample was 19.3 (SD = 0.59) and 54.4% were female. Findings showed that 20.4% of students reported any severe role impairment (10% of those without a mental disorder vs. 42.9% of those with at least one disorder, P < 0.01). In bivariate analyses, panic disorder, and mania were associated most frequently w...

Understanding the effects of war on mental disorders is important for developing effective post-conflict recovery policies and programs. The current study uses cross-sectional, retrospectively reported data collected as part of the World Mental Health (WMH) Survey Initiative to examine the associations of being a civilian in a war zone/region of terror in World War II with a range of DSM-IV mental disorders. Adults (n = 3370) who lived in countries directly involved in World War II in Europe and Japan were administered structured diagnostic interviews of lifetime DSM-IV mental disorders. The associations of war-related traumas with subsequent disorder onset-persistence were assessed with discrete-time survival analysis (lifetime prevalence) and conditional logistic regression (12-month prevalence). Respondents who were civilians in a war zone/region of terror had higher lifetime risks than other respondents of major depressive disorder (MDD; OR 1.5, 95% CI 1.1, 1.9) and anxiety diso...

Generalized anxiety disorder (GAD) is poorly understood compared with other anxiety disorders, and debates persist about the seriousness of this disorder. Few data exist on GAD outside a small number of affluent, industrialized nations. No population-based data exist on GAD as it is currently defined in DSM-5. To provide the first epidemiologic data on DSM-5 GAD and explore cross-national differences in its prevalence, course, correlates, and impact. Data come from the World Health Organization World Mental Health Survey Initiative. Cross-sectional general population surveys were carried out in 26 countries using a consistent research protocol and assessment instrument. A total of 147 261 adults from representative household samples were interviewed face-to-face in the community. The surveys were conducted between 2001 and 2012. Data analysis was performed from July 22, 2015, to December 12, 2016. The Composite International Diagnostic Interview was used to assess GAD along with com...

Although many studies have indicated that psychosocial factors contribute to hypertension, and that early childhood adversity is associated with long-term adverse mental and physical health sequelae, the association between early adversity and later hypertension is not well studied. Data from 10 countries participating in the World Health Organization (WHO) World Mental Health (WHM) Surveys (N = 18,630) were analyzed to assess the relationship between childhood adversity and adult-onset hypertension, as ascertained by self-report. The potentially mediating effect of early-onset depression-anxiety disorders, as assessed by the WHM Survey version of the International Diagnostic Interview (WMH-CIDI), on the relationship between early adversity and hypertension was also examined. Two or more early childhood adversities, as well as early-onset depression-anxiety, were significantly associated with hypertension. A range of specific childhood adversities, as well as early-onset social phob...

Background and objectives-Associations between asthma and anxiety and mood disorders are well established, but little is known about their temporal sequence. We examined associations between a wide range of DSM-IV mental disorders with adult onset of asthma and whether observed associations remain after mental comorbidity adjustments. Methods-During face-to-face household surveys in community-dwelling adults (n = 52,095) of 19 countries, the WHO Composite International Diagnostic Interview retrospectively assessed lifetime prevalence and age at onset of 16 DSM-IV mental disorders. Asthma was assessed by self-report of physician's diagnosis together with age of onset. Survival analyses estimated associations between first onset of mental disorders and subsequent adult onset asthma, without and with comorbidity adjustment. Results-1,860 adult onset (21 years+) asthma cases were identified, representing a total of 2,096,486 person-years of follow up. After adjustment for comorbid mental disorders several mental disorders were associated with subsequent adult asthma onset: bipolar (OR=1.8; 95%CI 1.3-2.4), panic (OR=1.4; 95%CI 1.0-2.0), generalized anxiety (OR=1.3; 95%CI 1.1-1.7), specific phobia (OR=1.4; 95%CI 1.2-1.6); post-traumatic stress (OR=1.5; 95%CI 1.1-2.0); binge eating (OR=1.9; 95%CI 1.2-2.9) and alcohol abuse (OR=1.5; 95%CI 1.2-2.0). Mental comorbidity linearly increased the association with adult asthma. The association with subsequent asthma was stronger for mental disorders with an early onset (before age 21). Conclusions-A wide range of temporally prior mental disorders are significantly associated with subsequent onset of asthma in adulthood. The extent to which asthma can be avoided or improved among those with early mental disorders deserves study.

Background-Suicidality risk-factors between countries with similar economic and religious background have been rarely compared, especially within genders. Methods-Lifetime prevalence of suicide ideation, plans, and attempts in the ESEMeD surveys were stratified on four separate groups: French women, Spanish women, French men, Spanish men. Outcome odds-ratios (OR) were modelled within each group using logistic regression including demographic characteristics, lifetime mood/anxiety disorders, parental bonding, marital status, and health service-use. Results-Lifetime prevalence of suicide attempts was 3.4% in France (1.1% men, 5.4% women) and 1.5% in Spain (1.2% men, 1.7% women), with a significantly greater gender difference in France (p=0.001). Regarding risk-factors, French women reported suicide attempt more commonly with authoritarian mothers (OR=1.51; 95%CI=1.04-2.18), unlike Spanish women (OR=0.77; 95%CI=0.51-1.15) (p<0.001). Spanish men showed more than eight-times higher odds of suicide attempt with overprotecting mothers than French men (p=0.03). General practitioner-(GP)-use was significantly protective of suicide attempt among Spanish women (OR=0.08; 95%CI=0.02-0.35) with no effect in French women (OR=1.03; 95%CI=0.54-2.00) (p=0.01). No significant differences in the effect of marital status, any lifetime antidepressant use, mental disorders, or religiosity on suicide attempt were observed between France and Spain within gender-stratum. Limitations-Parental bonding is retrospective and potentially influenced by mental state. Response rate was considerably lower in France than in Spain. Spain. Parental bonding dimensions may be interpreted differently according to country, underlining cultural importance. As recommended by WHO, mental health decisions must involve GPs in conjunction with psychiatrists or psychologists.

Background: Precise knowledge of the epidemiology of suicidality provides necessary information for designing prevention programs. The aims of the present study were to investigate the prevalence and correlates of suicidal ideas and attempts in the general population of Europe. Methods: The European Study on the Epidemiology of Mental Disorders (ESEMED) is a cross-sectional household survey carried out in a probability representative sample of non-institutionalised adults (aged 18 years or older) of six European countries (Belgium, France, Germany, Italy, the Netherlands and Spain). The Composite International Diagnostic Interview (CIDI 3.0) was administered to 21,425 individuals. Results: Lifetime prevalence of suicidal ideation was 7.8% and of suicidal attempts 1.3%. Being women, younger and divorced or widowed were associated with a higher prevalence of suicide ideation and attempts. Psychiatric diagnoses were strongly related to suicidality. Among them, major depressive episode (Rate ratio 2.9 for lifetime ideas and 4.8 for lifetime attempts), dysthymia (RR 2.0 and 1.6), GAD (RR 1.8 and 2.3 for lifetime), PTSD (RR 1.9 and 2.0) and alcohol dependence (RR 1.7 and 2.5) were the most important. Population attributable risks for lifetime suicidal attempt was 28% for major depression.

Purpose of the review-To review recent epidemiological research on age-of-onset (AOO) of mental disorders, focusing on the WHO World Mental Health (WMH) surveys. Recent findings-Median and inter-quartile range (IQR; 25 th -75 th percentiles) of AOO is much earlier for phobias (7-14, IQR: 4-20) and impulse-control disorders (7-15, IQR: 4-35) than other anxiety disorders (25-53, IQR: 15-75), mood disorders (25-45, IQR: 17-65), and substance disorders (18-29, IQR: 16-43). Although less data exist for non-affective psychosis, available evidence suggests that median AOO is in the range late teens through early 20s. Roughly half of all lifetime mental disorders in most studies start by the mid-teens and three-fourths by the mid-20s. Later onsets are mostly secondary conditions. Severe disorders are typically preceded by less severe disorders that seldom are brought to clinical attention. Summary-First onset of mental disorders usually occurs in childhood or adolescence, although treatment typically does not occur until a number of years later. Although interventions with early incipient disorders might help reduce severity-persistence of primary disorders and prevent secondary disorders, additional research is needed on appropriate treatments for early incipient cases and on long-term evaluation of the effects of early intervention on secondary prevention.

SummaryThe aims of this study areto describe the adequacy of treatment for anxiety and depressive disorders in Europe and how it differs between providers, using data from the ESEMeD study The overall proportion of adequate treatment was 45.8% (57.4% in the specialised sector and 23.3% in the general medical care sector). Between-country differences were found in treatment adequacy in the specialised setting. Organisational and political aspects may explain these findings.

Background: The prevalence of obsessive-compulsive symptom dimensions and their sociodemographic and psychopathological correlates at the population level are unknown. Method: Obsessive-compulsive symptom dimensions and mental disorders were assessed with the Composite International Diagnostic Interview 3.0 in a random subsample (n=2804) of individuals participating in a cross-sectional survey of the adult general population of six European countries. Results: The lifetime prevalence of any obsessive-compulsive symptom dimension was 13%. Harm/ Checking was the most prevalent dimension (8%) followed by Somatic obsessions (5%) and Symmetry/Ordering (3%). Females were more likely to have symptoms in Contamination/Cleaning (OR = 3, 95%CI = 1.06-8.51) and Somatic obsessions (OR= 1.88, 95%CI = 1.05-3.37). All symptom dimensions were associated with an increased risk of most mental (but not physical) disorders. There were some differences in prevalence between countries. Limitations: The interference associated with each symptom dimension could not be assessed. Few direct data are available on the validity of the CIDI to assess obsessive-compulsive symptom dimensions. Conclusions: Obsessive-compulsive symptom dimensions are relatively frequent in the general population. Their sociodemographic and psychopathological correlates may be slightly different in clinical and community samples. They are associated with an increased risk of most mental disorders.

Ce poster résume le contenu de l'article long présenté à ERGO-IA 2023 intitulé « Humain connecté pour l'étude de l'attention à partir d'interfaces coeur-ordinateur ». Il se base sur des études antérieures sur les relations entre les ressources attentionnelles et la synchronie d'événements dynamiques avec la fréquence cardiaque. Il présente deux interfaces coeur-ordinateur et exploite en temps réel une mesure de la fréquence cardiaque des utilisateurs. Le premier environnement numérique est une simulation de conduite de train pour l'étude de l'attention distribuée et le second est un exercice de comptage pour analyser l'attention focalisée. Les résultats d'expérimentations avec ces outils montrent l'impact de la synchronisation d'événements avec la fréquence cardiaque. Les temps de réponse augmentent lorsque la fréquence d'occurrence de clignotement ou de bip d'alarmes est synchronisée avec la fréquence cardiaque. La perception de stimuli imprévus comme l'affichage d'images est moindre lorsque la fréquence d'occurrence d'événements à comptabiliser est synchronisée avec la fréquence cardiaque. Des voies de recherche sur cette synchronie peuvent alors être envisagées pour la conception et l'évaluation de futurs systèmes sociotechniques basées sur la connexion de l'humain avec les systèmes réels ou virtuels. This poster summarizes the content of the article presented at ERGO-IA 2023 entitled "Connected human for the study of attention from heart-computer interfaces". It is based on previous studies about impact on the attentional resources of the synchrony between dynamic events and heart rate. It presents two heart-computer interfaces that consider in real time a measurement of the heart rate of their users. The first numerical environment is a train driving simulation for the study of distributed attention and the second is a counting exercise to analyze focused attention. The results of experimental campaigns carried out with these tools have demonstrated the impact of synchronizing events with heart rate. Response times increase when the frequency of occurrence of flashing or beeping alarms is synchronized with heart rate. The perception ability of unexpected stimuli such as the display of images is reduced when the frequency of

Background: During Flotation-REST a person is floating inside a quiet and dark tank, filled with heated salt saturated water. Deep relaxation and beneficial effects on e.g. stress, sleep difficulties, anxiety and depression have been documented in earlier research. Despite that treatments for generalized anxiety disorder (GAD) are effective; it is till the least successfully treated anxiety disorder, indicating that treatment protocols can be enhanced. The use of Flotation-REST as a treatment of GAD has not been researched. The aim of the present study was to conduct an initial evaluation of the effects in a self-diagnosed GAD sample. Methods: This study was a randomized, parallel group, non-blinded trial with 1:1 allocation ratio to waiting list control group (n = 25) or to a twelve session treatment with flotation-REST (n = 25). Inclusion criteria's were: 18-65 years and GAD (as defined by self-report measures). The primary outcome was GAD-symptomatology, and secondary outcomes were depression, sleep difficulties, emotion regulation difficulties and mindfulness. Assessments were made at three time points (baseline, four weeks in treatment, post-treatment), and at six-month follow-up. The main data analyses were conducted with a two-way MANOVA and additional t-tests. Forty-six participants (treatment, n = 24; control, n = 22) were included in the analyses. Results: A significant Time x Group interaction effect for GAD-symptomatology [F (2,88) = 2.93, p < .001, η p 2 = .062] was found. Further analyses showed that the GAD-symptomatology was significantly reduced for the treatment group (t (23) = 4.47, p < .001), but not for the waiting list control group (t (21) = 0.98, p > .05), when comparing baseline to post-treatment scoring. Regarding clinical significant change, 37 % in the treatment group reached full remission at post-treatment. Significant beneficial effects were also found for sleep difficulties, difficulties in emotional regulation, and depression, while the treatment had ambiguous or non-existent effects on pathological worry and mindfulness. All improved outcome variables at post-treatment, except for depression, were maintained at 6-months follow. No negative effects were found. The findings suggest that the method has potential as a complementary treatment alongside existing treatment for GAD. More studies are warranted to further evaluate the treatments efficacy.

Exposure to a predator elicits an innate fear response and mimics several behavioral disorders related to post-traumatic stress disorder (PTSD). The protective role of an enriched condition (EC) against psychogenic stressors in various animal models has been well documented. However, this condition has not been tested in field mice in the context of PTSD. In this study, we show that field mice (Mus booduga) housed under EC exhibit predominantly proactive and less reactive behavior compared with mice housed under standard conditions (SC) during exposure to their natural predator (field rat Rattus rattus). Furthermore, we observed that EC mice displayed less anxiety-like behavior in an elevated plus maze (EPM) and light/dark-box after exposure to the predator (7 hrs/7 days). In EC mice, predator exposure elevated the level of serotonin (5-Hydroxytrypamine, [5-HT]) in the amygdala as part of the coping response. Subsequently, the serotonin transporter (SERT) and 5-HT 1A receptor were up-regulated significantly, but the same did not occur in the 5-HT 2C receptor, which is associated with the activation of calmodulin-dependent protein kinase-II (CaMKII) and a transcription factor cAMP response element binding protein (CREB). Our results show that predator exposure induced the activation of CaMKII/CREB, which is accompanied with increased levels of histone acetylation (H3, H4) and decreased histone deacetylases (HDAC1, 2). Subsequently, in the amygdala, the transcription of brain-derived neurotrophic factor (BDNF), neuropeptide Y (NPY) and its Y1 receptor were up-regulated, whereas the Y2 receptor was down-regulated. Therefore, EC facilitated a coping response against a fear associated cue in a PTSD animal model and reduced anxiety by differentially activating serotonergic and NPY-ergic systems.

In reconsolidation studies, memories are typically retrieved by an exposure to a single conditioned stimulus (CS). We have previously demonstrated that reconsolidation processes are CS-selective, suggesting that memories retrieved by the CS exposure are discrete and reconsolidate separately. Here, using a compound stimulus in which two distinct CSs are concomitantly paired with the same aversive unconditioned stimulus (US), we show in rats that reexposure to one of the components of the compound CS triggers extinction or reconsolidation of the other component. This suggests that the original training conditions play a critical role in memory retrieval and reconsolidation.

Keyora MoodFlow 8 in 1 is a comprehensive nutritional formulation designed to address stress-related emotional, cognitive, and sleep disturbances through a multi-axis regulatory strategy.

The formulation integrates eight clinically supported bio-actives-including 5hydroxytryptophan (5-HTP), L-Theanine, magnesium glycinate, vitamin B complex, and Ashwagandha-each contributing distinct yet complementary neurobiological mechanisms. Mechanistically, the formula enhances serotonergic and GABAergic transmission, supports melatonin synthesis, regulates the hypothalamic-pituitary-adrenal (HPA) stress axis, and promotes neuroplasticity in prefrontal-limbic circuits.

Clinical evidence indicates its efficacy in alleviating depressive and anxiety symptoms, improving sleep quality, and sustaining cognitive flexibility in high-stress populations.

Positioned within the framework of nutritional psychiatry, MoodFlow offers a synergistic, non-pharmacological intervention tailored for students, professionals, entrepreneurs, and menopausal women - populations characterized by heightened stress vulnerability. Its safety profile aligns with validated clinical doses of individual components, supporting long-term applicability.

Conclusion:
Keyora MoodFlow 8 in 1 represents a scientifically grounded, multi-component intervention addressing the interconnected triad of mood, sleep, and cognition, with clear applicability across stress-prone populations.

Vitamin B complex, particularly thiamine (B₁), pyridoxine (B₆), and cobalamin (B₁₂), play essential roles in neuro-metabolic regulation and mood stability. Acting as coenzymes in neurotransmitter synthesis, mitochondrial energy production, one-carbon metabolism, and myelin maintenance, these vitamins support both cognitive

5-Hydroxytryptophan (5-HTP) is an intermediate metabolite derived from tryptophan and the direct precursor of serotonin (5-HT). It crosses the blood-brain barrier more efficiently than tryptophan and avoids intestinal competition, making it a clinically relevant precursor supplementation strategy. In addition to mood regulation, 5-HTP plays essential roles in sleep initiation, appetite, pain perception, and cognitive flexibility, positioning it as a critical upstream nutrient in emotional and neurophysiological stability. Mechanistically, 5-HTP supports serotonergic biosynthesis, promotes melatonin production for circadian alignment, attenuates hypothalamic-pituitary-adrenal (HPA) axis overactivation, and enhances prefrontal-limbic connectivity. These pathways provide multi-dimensional benefits for individuals with depression, anxiety, insomnia, and stressrelated disorders. Clinical evidence, including randomized controlled trials and metaanalyses, demonstrates that 5-HTP significantly improves mild-to-moderate depressive symptoms, reduces anxiety sensitivity, and enhances deep sleep quality. Its onset of action is faster than conventional antidepressants, while maintaining a favorable safety and tolerability profile.

Multiple psychiatric patients are prescribed long-term drug treatment of
Psychotropic agents, and the anesthesiologist must be aware of the potential interactions
with anesthetic drugs. Psychotropic drugs often given in combination with each other or
with other non-psychiatric drugs. Hence, prior intake of these drugs is very important in
the management of the patient about to undergo anesthesia and operations. This article
highlights the effects of anesthetics on patients taking antipsychotics, antidepressants,
lithium carbonate. And tramadol the risk should be considered in the perioperative period
and the extent of surgery, the patient's physical state, anesthesia, the effects of
psychotropic drugs, risk of withdrawal effects and risk of psychiatric relapse and the risk of
psychiatric emergency cases like Serotonin syndrome and Neuroleptic Malignant 
Syndrome must be consider
Keyword:- Anesthetic Management, antidepressants, Bipolar Disorders, Schizophrenia,
Serotonin syndrome, Neuroleptic Malignant Syndrome
Copyright : © 2023 The Authors. Published by Publisher. This is an open
access article under the CC BY-NC-ND license
(https://creativecommons.org/licenses/by-nc-nd/4.0/).
Supplementary information The online version of this article
(https://doi.org/xx.xxx/xxx.xx) contains supplementary material,which is
available to autho-rized users.
Corresponding Author: Hesham Maged abdelfatah, Neuropsychiatry
Doctor, the Egyptian Ministry of Health, Al Abbassia psychiatric Hospital,
Cairo, Egypt, Email: hesham.maged2011@ yahoo.com

Traumatic brain injury (TBI) is called the silent epidemic as many of the symptoms are not readily detectable despite TBI being a worldwide public health issue. Epidemiological studies in the US shоw that annually up to 2 millions people experience a traumatic brain injury (TBI). Of these, almost 300,000 are hospitalised, and over 50,000 will die from their injuries. [1] Trauma registries shоw that approximately 5.3 millions American are living with TBIrelated disabilities. [2] The 2010 Global Burden of Disease survey shоw that in most countries, motor vehicle accident are the most prevalent cause of TBIs. [3] In regions of the world that are currently experiencing gating and hostilities (Central America, the Middle East and Central Africa), military combat is the most prevalent cause of TBI. [4] Traumatic brain injury (TBI) is significantly linked to a wide range of psychiatric conditions, including depression, anxiety, post-traumatic stress disorder (PTSD), and personality changes. These mental health issues can be acute or chronic, are common after both mild and severe TBIs, and are associated with worse health outcomes, decreased quality of life, and challenges with rehabilitation and independence.

With the increased survival of patients with large burns comes a new focus on the psychological challenges and recovery that such patients must face. Most burn centres employ social workers, vocational counsellors, and psychologists as part of the multidisciplinary burn team. Physiological recovery of burn patients is seen as a continual process divided into three stages resuscitative or critical, acute, and long term rehabilitation. The psychological needs of burn patients differ at each stage. Depression and anxiety Symptoms of depression and anxiety are common and start to appear in the acute phase of recovery. The antidepressants Mirtazapine and vilazodone hydrochloride are the most save antidepressants regarding to Hyponatremia Side effect of other antidepressants. Lorazepam has been found to lessen burn pain, largely by treating acute anxiety.

Basic Understanding of Sleep. This paper informs of how sleep works in humans and how it is controlled by different parts of our brain.It involves the working of different chemicals which induce sleep.The most interesting about this is how we pass through different stages of sleep every night. THE SCIENCE of SLEEP:Biological Rhythms and Brain Functioning------>

Patient-focused research systems have been developed to monitor and inform therapists of patients' treatment progress in psychotherapy as a method to enhance patient outcome. The current study examined the effects of providing treatment progress information and problemsolving tools to both patients and therapists during the course of psychotherapy. Three hundred seventy patients at a hospital-based outpatient psychotherapy clinic were randomly assigned to one of two treatment groups: treatment-as-usual, or an experimental condition based on the use of patient/therapist feedback and clinical decision-support tools. Patients in the feedback condition were significantly more improved at termination than the patients in the treatment as usual condition. These findings are consistent with past research on these approaches although the effect size was smaller in this study. Treatment effects were not a consequence of different amounts of psychotherapy received by experimental and control clients. Not all therapists were aided by the feedback intervention.

This study examined the influence of group climate on empathy in a Dutch youth correctional facility in a sample of 59 incarcerated delinquent boys. Higher levels of empathy have been shown to be associated with less delinquent and more prosocial behaviour and may therefore be vital for successful rehabilitation and recidivism reduction. Although empathy was originally considered to be a trait, recent neurobiological research has shown that empathy has state-like properties in that levels of empathy change in response to the social environment. This study showed that differences in group climate were associated with cognitive empathy in juvenile delinquents but not with affective empathy. It is speculated that inmates&#39; state-depressive feelings and anxiety could diminish the effects of prison group climate on affective empathy. The discussion focuses on group dynamics in youth correctional facilities. A positive prison group climate in a youth correctional facility could turn ou...

health nursing, inonu university nursing faculty, malatya, Turkey SummAry -The aim of this study was to determine the effect of home care provided for stroke patients and education of caregivers on the caregiver burden and quality of life. The study was conducted by using a true experimental method with pre-test and post-test control group. The study included 43 experimental and 43 control patients and their caregivers. The Patient and Caregiver description form, Patient Problem identifying form, Caregiving Burden Scale and Sf-36 Quality of life Scale were used to collect data in the study. nursing care was provided to the experimental group patients according to the model of daily living activities, while their caregivers received training and consultancy. in the control group, there was no such intervention. Percentage distribution, χ 2 , independent sample t-test, paired t-test, mann-Whitney u test, and Wilcoxon signed-rank tests were used on statistical analyses. There was no significant difference in pre-test score means between experimental and control group caregivers. however, a statistically significant difference was found in all sub-dimensions of the quality of life scale between pre-test and post-test score means in the experimental group caregivers. This study results indicated that home care provided for stroke patients and education of caregivers decreased the caregiver burden and increased their quality of life.

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Given the limited availability and accessibility of onsite cognitive behavioral therapy for insomnia (CBT-I), other CBT-I settings, such as internet-delivered CBT-I (iCBT-I), have been proposed. The primary aim of the study was to compare the efficacy of available CBT-I settings on insomnia severity. A systematic review and frequentist network meta-analysis of available CBT-I settings was performed. PsycINFO, PsycARTICLES, MEDLINE, PubMed, and CINAHL were searched for randomized controlled trials (RCTs) investigating any CBT-I settings in adults with insomnia disorder. The systematic literature search (3851 references) resulted in 52 RCTs. For the primary outcome insomnia severity, all examined CBT-I settings except smartphone-delivered CBT-I yielded significant effects when compared to WL. Large standardized mean differences were found for individual onsite CBT-I (− 1.27;95%CI − 1.70, − 0.84), group-delivered CBT-I (− 1.00;95%CI − 1.42. − 0.59), telehealth (− 1.28;95%CI − 2.06, − 0...

Adolescence is a critical developmental period marked by significant changes and mental health challenges. This study investigated the extent of anxiety experienced by adolescents aged 11-19 years in Vadodara city, Gujarat, India and suggested effective coping strategies to adolescents for managing their anxiety. A sample of 120 adolescents were selected through purposive sampling technique. The data related to their background information and anxiety levels (physical, emotional, and social aspects) were collected through questionnaire. The findings revealed that a more than half (74.32%) of the respondents reported a high extent of anxiety. Based on these findings and existing literature, the study proposed coping strategies categorized as mindfulness and relaxation techniques, cognitive strategies, behavioral strategies, social and emotional support and lifestyle adjustments. These strategies offer a comprehensive framework for adolescents to manage their anxiety. The study highlights the high prevalence of anxiety among adolescents in the urban Indian setting and emphasizes the need for increased awareness and early intervention. The suggested coping strategies provide a valuable resource for adolescents, parents, educators and mental health professionals to promote adolescent well-being.

Background: The purpose of this study is to examine the prevalence of affective temperaments between clinically unaffected relatives of bipolar patients and secondarily to investigate the impact of these "subaffective" forms on their quality of life (QoL). Methods: The study was performed in seven sites across Argentina. We administered the scales TEMPS-A and Quality of Life Index to a sample of 114 non-ill first degree relatives of bipolar disorder patients ("cases") and 115 comparison subjects without family history of affective illness ("controls"). We used The Mood Disorder Questionnaire to rule out clinical bipolarity. Results: Mean scores on all TEMPS-A subscales were significantly higher in cases, except for hyperthymia. The prevalence of affective temperaments, according to Argentinean cut-off points, was also higher, with statistical significance for cyclothymic and anxious temperaments. Regarding QoL, we found no significant differences between both groups, except for interpersonal functioning, which was better in controls. A detailed subanalysis showed significant effects of QoL domains for all temperaments, except for the hyperthymic. Limitations: We used self-report measures. A larger sample size would have provided us greater statistical power for certain analyses.

Recent studies suggest that migraine may be associated with gastrointestinal (GI) disorders, including irritable bowel syndrome (IBS), inflammatory bowel syndrome, and celiac disease. Here, an overview of the associations between migraine and GI disorders is presented, as well as possible mechanistic links and clinical implications. People who regularly experience GI symptoms have a higher prevalence of headaches, with a stronger association with increasing headache frequency. Children with a mother with a history of migraine are more likely to have infantile colic. Children with migraine are more likely to have experienced infantile colic compared to controls. Several studies demonstrated significant associations between migraine and celiac disease, inflammatory bowel disease, and IBS. Possible underlying mechanisms of migraine and GI diseases could be increased gut permeability and inflammation. Therefore, it would be worthwhile to investigate these mechanisms further in migraine ...

Background: Psychiatric disorders are more prevalent among women than men worldwide. The lifetime risk of depres­sion and dysthymia are twice as common in women as men. Rural women usually undergoes more stressful situations and also scores more on stress scale than that of urban and slum population. Objectives: The research objectives of this study are: 1) To find out the prevalence of psychiatric disorders among the study population. 2) To compare the disorders among the rural and slum female population. 3) To find out the influence of existing socio-demographic factors on psychiatric disorders. Method: This is a community-based study, which is also cross sectional and descriptive in nature. The sample for the main study constituted 366 randomly selected respondents. A two-staged screening procedure was carried in the study. First, the total population was studied by screening test-Self Reporting Questionnaire (SRQ) to divide the sample into &#39;screen positive&#39; and &#39;scre...

Phobic postural vertigo (PPV) is a frequent diagnosis which can be challenging to treat. Objective: To investigate the presence of psychiatric disturbances in patients with PPV; to assess the psychological status of patients using adaptive diagnosis; to verify possible correlations between severity of psychiatric disturbance and adaptive efficacy. Method: A total of nineteen subjects were assessed and two instruments applied: the Primary Care Evaluation of Mental Disorders Questionnaire (PRIME-MD) and the Adaptive Operationalized Diagnostic Scale (AODS), and results from both tests were compared. results: Fourteen patients presented with mood disorder and thirteen with anxiety. All patients presented compromised adaptive efficacy. Correlation was found between overall outcome on the PRIME and the AODS (tau= -0.42, p=0.027), Separate analysis revealed correlation between results of the AODS and anxiety disorders (tau= -0.45, p=0.018) but not with mood disorders (tau= -0.36, p=0.054). conclusion: Adaptive compromise was observed in individuals with PPV which was shown to be associated to psychiatric disorders.

Background Vaccination against SARS-CoV-2 is the most effective way to stop the pandemic and to avoid its related deaths. COVID-19 vaccine hesitancy, represent now a major hurdle to achieve herd immunity. Cancer patients constitute a prioritized group for COVID-19 vaccination as they are particularly vulnerable to severe infection and death. The aim of this study was to assess vaccine hesitancy among cancer patients of the Salah Azaiez Institute (SAI) of cancer and to identify its knowledge and attitudes associated factors. Methods A cross sectional study was conducted among all inpatients aged above 18 years old during the month of February 2021. Participants were asked according to a well-structured questionnaire about knowledge (vaccine literacy) and attitudes towards COVID-19 vaccine. Vaccine literacy was assed using two scales (functional and interactive-critical scales) for which a global score was calculated ranging from 1 to 4. A lower score corresponding to lower vaccine li...

Finally, I would like to thank my friends and fellow students for being a constant source of support and encouragement. I am especially grateful for my labmate and friend, Ian Villalta, whose help and friendship have been invaluable throughout graduate school.

Pharmacological evidence indicates that the basolateral nucleus of the amygdala (BLA) is involved in the mediation of inhibitory avoidance but not of escape behavior in the elevated T-maze test. These defensive responses have been associated with generalized anxiety disorder (GAD) and panic disorder, respectively. In the present study, we determined whether the BLA plays a differential role in the control of inhibitory avoidance and escape responses in the elevated T-maze. Male Wistar rats (250-280 g, N = 9-10 in each treatment group) were pre-exposed to one of the open arms of the maze for 30 min and 24 h later tested in the model after inactivation of the BLA by a local injection of the GABA A receptor agonist muscimol (8 nmol in 0.2 µL). It has been shown that a prior forced exposure to one of the open arms of the maze, by shortening latencies to withdrawal from the open arm during the test, improves the escape task as a behavioral index of panic. The effects of muscimol in the elevated T-maze were compared to those caused by this GABA agonist in the avoidance reaction generated in the light/dark transition test. This defensive behavior has also been associated with GAD. In the elevated T-maze, intra-BLA injection of muscimol impaired inhibitory avoidance (control: 187.70 ± 14.90 s, muscimol: 37.10 ± 2.63 s), indicating an anxiolytic effect, without interfering with escape performance. The drug also showed an anxiolytic effect in the light/dark transition test as indicated by the increase in the time spent in the lighted compartment (control: 23.50 ± 2.45 s, muscimol: 47.30 ± 4.48 s). The present findings point to involvement of the BLA in the modulation of defensive responses that have been associated with GAD.

Penelitian ini bertujuan untuk melihat faktor-faktor yang mempengaruhi kecemasan mahasiswa dalam menghadapi tugas akhirnya. Metode penelitian ini merupakan penelitian kuantitatif dengan desain cross sectional study. Hasil penelitian didapatkan rata-rata umur responden adalah 21 tahun, dengan umur termuda 20 tahun dan umur tertua 22 tahun. Sebagian besar (76,3%) responden penelitian adalah perempuan yaitu sebanyak 45 responden dan dari keseluruhan responden, mayoritas (64,9%) sebanyak 24 responden mengalami kecemasan tingkat sedang. Serta 31 responden (83,8%) memiliki dukungan keluarga yang tinggi kemudian pengaruh teman sebaya yang tinggi sebanyak 31 responden (83,8%), pengaruh dosen pembimbing yang tinggi yaitu sebanyak 33 responden (89,2%) dan pengaruh dari lingkungan yang baik sebanyak 30 responden (81,1%). Hasil analisis bivariat menunjukkan bahwa p-value untuk semua variabel < 0,05. Simpulan, terdapat hubungan yang signifikan antara dukungan keluarga, teman sebaya, dosen pembimbing, dan lingkungan dengan kecemasan mahasiswa dalam menghadapi tugas akhir.

The purpose of this study was to compare muscle tension between individuals with and without generalized anxiety disorder (GAD) during a resting state and a stressful mental arithmetic task. Methods: A total of 95 undergraduate students (68 females and 27 males; mean age=19.6, SD=3.5) completed an online survey on GAD symptoms and pathological worry, a diagnostic interview, and two laboratory tasks (resting and mental arithmetic tasks) while electromyography (EMG) signals were being recorded. Results: We found a significant main effect of condition, F(1,93) = 24.13, p<.001, and group, F(1,93) = 4.55, p=.036. Furthermore, there was a significant interaction effect between condition and group, F(1,93) = 5.85, p=.017. A post-hoc analysis revealed that the increase in EMG activity from the resting period, 95% CI [.002398 .003474], to the mental arithmetic task, 95% CI [.003850 .005086], was significant for the GAD group, but not for the non-GAD group. Conclusions: Individuals with and without GAD did not show significant differences in physiologically measured muscle tension at baseline. However, the GAD group showed higher levels of muscle tension during stressful situations when compared to the non-GAD group.

Naloxone remains a cornerstone in the emergency response to opioid overdoses, with over five decades of use substantiating its life-saving impact. Yet, its full potential is realized only when incorporated into a broader, multidisciplinary public health strategy that addresses the complex social, educational, and clinical dimensions of the opioid epidemic. The current urban-centric model of overdose education and naloxone distribution must evolve to embrace rural communities, where overdose prevalence and barriers to emergency care are most acute. Empowering laypersons through simplified, accessible training, coupled with the destigmatization of naloxone use, can substantially improve timely intervention rates.
Moreover, interprofessional collaboration—particularly the proactive involvement of nurses and pharmacists—is critical in bridging gaps between opioid prescribing, patient education, and harm reduction. These healthcare providers are uniquely positioned to advocate for safer pain management alternatives, facilitate naloxone accessibility, and support patients’ transitions from overdose reversal to addiction treatment.
Legislative advances such as Good Samaritan laws have begun to dismantle legal obstacles to naloxone administration, fostering community confidence and enabling broader distribution. However, naloxone should not be viewed as a standalone solution; rather, it must be integrated with addiction medicine services that address the underlying substance use disorder. The immediate post-overdose period represents a pivotal opportunity to engage patients in comprehensive care, which is essential for sustained recovery and prevention of subsequent overdose events.

The opioid epidemic remains a critical public health challenge in the United States and globally, with opioid-related overdoses causing significant morbidity and mortality. Naloxone, an opioid antagonist, is a proven, life-saving intervention for reversing opioid overdose, yet its potential is underutilized due to geographic disparities, barriers to public education, and variable healthcare team engagement. This review explores the multifaceted role of community education programs, emphasizing the importance of extending outreach beyond urban centers to underserved rural populations where overdose rates are disproportionately high. We examine barriers to naloxone self-administration, including health literacy and withdrawal management, and highlight the crucial educational roles nurses and pharmacists play in mitigating opioid harm. Despite long-standing evidence supporting naloxone’s efficacy and safety, societal stigma and policy inconsistencies hinder widespread acceptance. Interprofessional collaboration, coupled with legislative support such as Good Samaritan laws, can optimize naloxone accessibility and integrate overdose reversal with comprehensive addiction treatment pathways. Finally, we emphasize that naloxone administration, while lifesaving, must be embedded within a continuum of care that includes addiction medicine consultation to improve long-term patient outcomes. This article provides a detailed analysis of strategies to enhance healthcare team outcomes in opioid overdose prevention and recovery.

Objective: To examine the effectiveness of an "Enhancing Positive Emotions Procedure" (EPEP) based on positive psychology and cognitive behavioral therapy in relieving distress at the time of adjuvant chemotherapy treatment in colorectal cancer patients (CRC). It is expected that EPEP will increase quality of life and positive affect in CRC patients during chemotherapy treatment intervention and at 1 month follow-up. Method: A group of 24 CRC patients received the EPEP procedure (intervention group), whereas another group of 20 CRC patients did not receive the EPEP (control group). Quality of life (EORTC-QLQC30), and mood (PANAS) were assessed in three moments: prior to enter the study (T1), at the end of the time required to apply the EPEP (T2, 6 weeks after T1), and, at follow-up (T3, one-month after T2). Patient's assessments of the EPEP (improving in mood states, and significance of the attention received) were assessed with Lickert scales. Results: Insomnia was reduced in the intervention group. Treatment group had better scores on positive affect although there were no significantly differences between groups and over time. There was a trend to better scores at T2 and T3 for the intervention group on global health status, physical, role, and social functioning scales. Patients stated that positive mood was enhanced and that EPEP was an important resource. Objetivo: Examinar la eficacia de un programa basado en la Psicología Positiva y en la terapia cognitivo-conductual (EPEP) para incrementar emociones positivas y reducir malestar en pacientes de cáncer colorrectal (CRC) que reciben quimioterapia adyuvante. Se espera que el EPEP mejore calidad de vida y estados de ánimo durante la quimioterapia y en el seguimiento un mes después. Método: Un grupo de 24 CRC recibió el EPEP (grupo de intervención: GI), y otro grupo de 20 CRC no recibió el EPEP (grupo control: GC). Se evaluaron la calidad de vida (EORTC-QLQC30) y los estados de ánimo (PANAS) en tres momentos: al entrar en el estudio (T1); 6 semanas después, tiempo de aplicación del EPEP (T2), y un mes después del T2 (seguimiento:T3). Las opiniones de los pacientes sobre el EPEP (mejoría del estado de ánimo e importancia de la atención recibida) fueron evaluadas con escalas Lickert. Resultados: El GI mostró mejores puntuaciones en estado de ánimo positivo, aunque sin diferencias significativas con el GC. Las puntuaciones en T2 y T3 tendían a ser mejores en el GI en nivel global de salud, y en las escalas física, social y de rol, El GI redujo el nivel de insomnio. Los pacientes indicaron que el EPEP era importante y mejoraba el estado de ánimo. Conclusiones: Los datos sugieren que el EPEP mejora el estado de ánimo positivo y la calidad de vida, y los pacientes lo consideraron

We conducted a MEDLINE search to locate all published randomized controlled trials of psychotherapies identifi ed by their authors as being "psychodynamic" or "psychoanalytic." We also used meta-analyses and review articles to identify trials , examined the reference lists of recovered articles, and consulted experts in the fi eld to ensure that we obtained a comprehensive list. All studies that randomized participants to two or more treatments, one of which was identifi ed as "psychodynamic" or "psychoanalytic" treatment, were included. Studies that identifi ed themselves as precursors to larger and more complete studies were excluded even if randomization was performed. To capture the full range of study quality, we did not use a sample size cutoff in selecting trials. Only studies with published articles in English were included. A total of 94 trials were identifi ed that met inclusion and exclusion criteria.

Chapter 6 consists of six subsections, describing the anxiety disorders treated with child and adolescent anxiety psychodynamic psychotherapy (CAPP). These include generalized anxiety disorder, social anxiety disorder, separation anxiety disorder, panic disorder, agoraphobia and phobic avoidance, and (comorbid) posttraumatic stress disorder. Each section is organized as follows: the authors describe the phenomenology and diagnostic criteria, followed by the salient psychodynamic factors and conflicts. Each section concludes with treatment considerations, addressing transdiagnostic techniques, which apply to all anxiety disorders, and diagnosis-specific adaptations. Clinical vignettes are given for each anxiety disorder. A detailed table summarizes psychodynamic theory, target symptoms, and treatment strategies, followed by specific clinical approaches, rounding out variations of core fantasies and changes in techniques expected for each variant of the anxiety disorders.

An open, pilot clinical trial of Child and Adolescent Anxiety Psychodynamic Psychotherapy (CAPP), a 24-session, 12-week, manualized psychodynamic psychotherapy, was conducted in 10 patients, ages 8 to 16 years with primary generalized anxiety disorder (GAD), social phobia, and/or Separation Anxiety Disorder. Study benchmarks, including inclusion/exclusion criteria, outcome measures, and definitions of response were designed to match those of the Child/Adolescent Anxiety Multimodal Study (CAMS). The goal was to determine whether or not dynamic therapy has a clinical impact on CAMS subjects. Eligible patients were treated in 12-week, twice-weekly psychodynamic psychotherapy sessions. There was one dropout. Subjects improved across all measured outcome domains at treatment termination, and results were sustained at six-month no-treatment follow up. Child and Adolescent Anxiety Psychodynamic Psychotherapy merits further testing, and may be a promising alternative treatment for youth anxiety disorders.