Anna Lucia Spear King

Nomophobia: impact of cell phone use interfering with symptoms and emotions of individuals with panic disorder compared with a control group.

Panic disorder refers to the frequent and recurring acute attacks of anxiety. Objective: This study describes the routine use of mobiles phones (MPs) and investigates the appearance of possible emotional alterations or symptoms related to their use in patients with panic disorder (PD). Background: We compared patients with PD and agoraphobia being treated at the Panic and Respiration Laboratory of The Institute of Psychiatry, Federal University of Rio de Janeiro, Brazil, to a control group of healthy volunteers. Methods: An MP-use questionnaire was administered to a consecutive sample of 50 patients and 70 controls. Results: People with PD showed significant increases in anxiety, tachycardia, respiratory alterations, trembling, perspiration, panic, fear and depression related to the lack of an MP compared to the control group. Conclusions: Both groups exhibited dependence on and were comforted by having an MP; however, people with PD and agoraphobia showed significantly more emotional alterations as well as intense physical and psychological symptoms when they were apart from or unable to use an MP compared to healthy volunteers.

A importância do foco da terapia cognitivo-comportamental direcionado às sensações corporais no transtorno do pânico: relato de caso

CONTEXTO: A conceituacao cognitiva do transtorno de pânico (TP) realca os medos de sensacoes corporais (SC) em consequencia de avaliacoes distorcidas pelo individuo, que interpreta erroneamente as SC de forma catastrofica. OBJETIVO:A importância desse relato de caso e apresentar um trabalho intensivo de inducao dos sintomas de ataque de pânico, com tecnicas da terapia cognitivo-comportamental (TCC) relacionadas as SC. METODO: O caso de E., feminino, 56 anos, foi retirado de uma pesquisa realizada no Laboratorio de Pânico e Respiracao do IPUB (UFRJ), com um grupo de pacientes com diagnostico de TP que se tratou com medicacao e sessoes de TCC (16), com enfoque em exercicios de inducao de sintomas, comparados com grupo controle que usou apenas medicacao. RESULTADOS: Os resultados foram controlados por questionarios e escalas aplicados antes e apos as intervencoes. A paciente apresentava sintomas de hipocondria, queixas de falta de ar, taquicardia e medo de perder o controle, especialmente ao estar em onibus, metros ou tuneis. Ela recebeu prescricao do antidepressivo triciclico, imipramina, 75 mg/dia, e 16 sessoes de TCC. CONCLUSAO: Ao final, a paciente obteve remissao dos ataques de pânico e apresentou melhora significativa do comportamento agorafobico.BACKGROUND: The current cognitive conceptualization for the panic disorder (PD) enhances the fears of body sensations (BS) in consequence of evaluations distorted by the individual who interprets in an erroneous form the BS as catastrophic. OBJECTIVE: The importance of this study is to emphasize the importance of an intensive work of induction of panic symptoms, with cognitive-behavioral therapy (CBT) techniques related to the BS. METHOD: The case of E., woman, 56 year-old, was selected from a research carried through in the Laboratory of Panic and Respiration - IPUB (UFRJ) with a group of patients with PD diagnosis treated with medication and 16 CBT sessions targeted in panic symptoms induction exercises, compared with a control group that used only medication. RESULTS: The results had been controlled through questionnaires and scales applied before and after the interventions. The patient presented hypochondriac symptoms, sensation of shortness of breath, palpitations and fear or loosing control, especially when inside of buses, subways or tunnels. She received a tricycle antidepressant, imipramina, 75 mg/day and 16 CBT sessions. CONCLUSION: At the end of the trial, the patient had panic free status and presented significant improvement of the agoraphobic behavior.

Hiperventilação: A terapia cognitivo-comportamental e a técnica dos exercícios de indução dos sintomas no transtorno de pânico

Resumo O transtorno de pânico (TP) caracteriza-se por ataques agudos de ansiedade frequentes e recorrentes. A actual concepcao para o TP realca o medo das sensacoes corporais a partir do momento em que o individuo associa de forma equivocada as sensacoes fisicas que se apresentam como sendo prenuncio de uma doenca grave e/ou morte iminente, nao conseguindo interpretalas como mecanismos fisiologicos naturais. Relatamos tres casos graves de TP do subtipo respiratorio, com agorafobia, cujos sintomas de hiperventilacao predominavam sobre os demais. O tratamento consistiu na prescricao de antidepressivos triciclicos e no encaminhamento para sessoes de terapia cognitivo-comportamental (TCC). O objectivo do relato dos casos e demonstrar a evolucao satisfatoria do tratamento com a tecnica dos exercicios de inducao de sintomas (EIS) em ambiente de laboratorio para a reducao e/ou extincao dos sintomas hiperventilatorios, entre outros. Esse procedimento foi considerado fundamental na evolucao do tratamento e permitiu preparar os doentes para enfrentarem situacoes agorafobicas subsequentes.

Efficacy of a specific model for cognitive-behavioral therapy among panic disorder patients with agoraphobia: a randomized clinical trial.

CONTEXT AND OBJECTIVE 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. DESIGN AND SETTING Randomized clinical trial at Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro. METHODS 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). RESULTS 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. CONCLUSION 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.

Subtipos respiratório e não respiratório do transtorno de pânico: Comparações clínicas e de qualidade de vida

Resumo Objectivo: comparar os scores dos diversos dominios de qualidade de vida e quadro clinico entre os doentes com subtipos respiratorio e nao respiratorio de transtorno de pânico (TP) em tratamento no Laboratorio de Pânico e Respiracao da UFRJ. Metodo: estudo transversal com 32 doentes com TP com ou sem comorbidades em tratamento ambulatorial, selecionados consecutivamente e diagnostica-dos atraves do MINI v.4.4. Destes, 12 (37,5%) apresentam o subtipo respiratorio (SR) e 20 (62,5%) o subtipo nao respiratorio (SN), de acordo com Briggs et al. Resultados: Em relacao aos indices de qualidade de vida, houve apenas diferenca no dominio psicologico, sendo que os doentes do subgrupo SN apresentaram piores scores. Os diferentes subtipos de TP (SR e SN) nao apresentaram diferencas significativas quanto a distribuicao por genero, idade, escolaridade, ocupa-cao, estado civil, tabagismo e comorbidades. Clinica-mente tambem nao foram encontradas diferencas significativas nos scores de ansiedade, nem de gravidade do TP (BAI, STAI-T, STAI-S, PAS), bem como nao se observaram diferencas quanto a idade de inicio do transtorno ou tempo de evolucao da doenca. Conclusao: Doentes do subtipo nao respiratorio, que apresentam indices semelhantes de ansiedade e gravidade do TP, quando em tratamento, apresentam piores scores de qualidade de vida psicologica do que os do subtipo respiratorio. Rev Port Pneumol 2009; XV (5): 859-874

Treatment of Internet Addiction in Patient with Panic Disorder and Obsessive Compulsive Disorder: A Case Report

Problematic Internet use is a worldwide social issue and it can be found in any age, social, educational, or economic range. In some countries like China and South Korea internet addiction (IA) is considered a public health condition and this governments support research, education and treatment. Internet addiction has been associated with others psychiatric disorders. Panic disorder (PD) and Obsessive Compulsive Disorder (OCD) are anxiety disorders that involve a lot of damages in patients life. We report a treatment of a patient with Panic Disorder and Obsessive Compulsive Disorder and internet addition involving pharmacotherapy and Cognitive Behavioral Therapy (CBT). The Cognitive Behavioral Therapy was conducted 1 time per week during 10 weeks and results suggest that the treatment was an effective treatment for the anxiety and for the internet addiction.

Respiratory and non-respiratory panic disorder subtypes: Clinical and quality of life comparisons

AIM to compare the scores of the WHOQOL quality of life domains with the clinical features of patients with respiratory and non-respiratory panic disorders (PD) treated at the UFRJ Panic and Respiration Laboratory. METHOD cross sectional study. Thirty-two PD outpatients under treatment were consecutively selected and evaluated by the MINI v.4.4. They were divided into two different groups according to Briggs et al. classification of respiratory and non-respiratory PD subtypes. Twelve (37.5%) patients had the respiratory subtype (SR) and 20 (62.5%) the non-respiratory subtype (SN). RESULTS the SN patients presented worse scores in the psychological domain of the WHOQOL. There were no differences between groups in gender, age, level of schooling, occupational status, marital status, smoking and comorbidities. There were no differences in the anxiety questionnaires and PD questionnaire (BAI, STAI-T, STAI-S, PAS) scores and in the age at the beginning of the disorder and the disorders duration. CONCLUSION non-respiratory subtype patients presented worse scores in the psychological domain of WHOQOL than the respiratory subtype group, when they had similar anxiety and PD scores.

Risco de suicídio em paciente alcoolista com depressão

Alcohol addiction is the uncontrolled use of alcohol despite its harmful consequences. Depression consists of a long and continuous period of depressed mood with specific symptoms. Treatment for depression comorbidity in alcohol-dependent patients is essential to prevent complications as the suicide risk. Among adolescents and adults with major depression disorder alcohol abuse enhances the risk of suicide. Among alcohol abusers, risk attempts are usually preceded by depression. This is a case report of a patient with alcohol dependence and severe depression with risk of suicide assisted as an outpatient in the drug abuse research and assistance program of Instituto de Psiquiatria of Universidade Federal do Rio de Janeiro. The treatment consisted in the use of antidepressants and cognitive-behavior psychotherapy. The treatment of depression was associated with the achievement of treatment retention, alcohol relapse prevention and suicide risk reduction. The early diagnosis of the comorbidity of depressive disorder in alcohol abusers accomplished by trained professionals is indispensable for adequate treatment and to reduce suicide risk.

Stimulation by Light and Sound: Therapeutics Effects in Humans. Systematic Review.

Introduction : The objective of the study was to make a systematic review of published studies that used the brain stimulation by light and sound as means to optimize brain function and increase the different treatments. Methods : The methods followed the Prisma model for eligibility of studies. Results : Four studies on the systematic review were included 3 experimental studies and 1 case report. Two of these studies were focused in learning and sportive performance, and 2 focused on increasing physical and mental health. Conclusion : It was concluded that the investigation of brain stimulation technique can be applied to induce favorable mental states to enlarge treatments of several disorders that affect humans in a safe and noninvasive way. It is suggested that positive results can also be found through the association of brain stimulation by light and sound with therapies that combat depression and anxiety states.

Subtipo respiratório versus não respiratório no transtorno de pânico com agorafobia: avaliação com terapia cognitivo-comportamental

The objective of the present study was to verify the response of patients with panic disorder (agoraphobia) to existing cognitive-behavior therapy models (CBT) of two respiratory subtypes of panic disorder (PD): respiratory subtype (RS) and non respiratory subtype (NRS). We randomly selected a sample of 50 patients diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders. The medication used was tricycle or selective serotonin reuptake inhibitor antidepressants. Seventy-seven point six percent of the patients from both groups showed RS and 22.4% the NRS. The RS patients responded satisfactorily to the treatment with techniques of CBT decreasing anxiety, breathing symptoms and panic attacks. According to the global functioning assessment scale, RS patients improved from 55.8 to 70.9 in comparison with NRS ones.