820 resultados para Fear and anxiety


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Oncological patients are submitted to invasive exams in order to obtain an accurate diagnosis; these procedures may cause maladaptative reactions (fear, anxiety and pain). Particularly in breast cancer, the most common diagnose technique is the incisional biopsy. Most of the patients are unaware about the procedure and for that reason they may focus their thoughts on possible events such as pain, bleeding, the anesthesia, or the later surgical wound care. Anxiety and pain may provoke physiological, behavioral and emotional complications, and because of this reason, the Behavioral Medicine trained psychologist takes an active role before and after the biopsy. The aim of this study was to evaluate the effect of a cognitive-behavioral program to reduce anxiety in women submitted to incisional biopsy for the first time. There were 10 participants from the Hospital Juárez de México, Oncology service; all of them were treated as external patients. The intervention program focused in psycho-education and passive relaxation training using videos, tape-recorded instructions and pamphlets. Anxiety measures were performed using the IDARE-State inventory, and a visual-analogue scale of anxiety (EEF-A), and the measurement of blood pressure and heart rate). Data were analyzed both intrasubject and intersubject using the Wilcoxon test (p≤0.05). The results show a reduction in anxiety (as in punctuation as in ranges) besides, a reduction in the EEF-A.

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L’adversité tôt dans la vie est associée au développement de symptômes anxieux pouvant perdurer jusqu’à l’âge adulte (Casey et el, 2010, Pine 2003). Des études chez l’adulte suggèrent que ces liens pourraient être associés à des altérations du « circuit de la peur » qui inclut l’amygdale, l’hippocampe antérieur, l’insula et le cortex préfrontal (Marek, 2013, Etkin & Wager, 2007). Ceci a cependant peu été étudié chez les jeunes. L’objectif principal de cette thèse était de définir les corrélats comportementaux, physiologiques, biologiques et neuronaux du traitement de la peur chez les jeunes en bonne santé, en lien ou non avec un historique d’adversité -- sous la forme de pratiques parentales coercitives -- et d’anxiété. D’abord, puisque nous nous intéressions aux pratiques parentales coercitives chroniques, nous avons examiné leur évolution et facteurs de risque, en nous concentrant sur la période de 17 à 72 mois. Un total de 2045 dyades mère-enfant ont été incluses dans une analyse de courbe de croissance latente. Nous avons démontré que la coercition maternelle suit une évolution non linéaire durant cette période et atteint un sommet à 42 mois. Les facteurs de risque relatifs à l’enfant et à la mère, mesurés à 17 mois, permettent de prédire les niveaux de coercition à 42 mois. Finalement, les prédicteurs relatifs à l’enfant et l’efficacité maternelle prédisent l’évolution des pratiques parentales coercitives entre 17 et 72 mois. Ensuite, afin de définir une méthodologie solide pour étudier le traitement de la peur chez des jeunes, nous avons adapté une tâche développée par Lau et ses collaborateurs (2008), employant des visages féminins comme stimuli. Le sexe des participants et des visages employés comme stimuli pouvant potentiellement moduler le traitement de la peur (Kret & de Gelder, 2012; McClure, 2000), nous avons étudié leurs influences respectives sur les réponses électrodermales et subjectives de peur durant le conditionnement et l’extinction de la peur chez 117 jeunes. Nous avons démontré que les stimuli féminins suscitent des réponses davantage comparables entre les garçons et les filles que les stimuli masculins. De plus, nous avons observé un effet du « même sexe », caractérisé par un conditionnement différentiel uniquement face aux stimuli du même sexe que le participant. Finalement, nous avons exploré les différences individuelles et conjointes associées aux différents niveaux de pratiques parentales coercitives et d’anxiété en termes de réponses de peur et d’activité cérébrale, durant le conditionnement et l’extinction de la peur chez 84 jeunes. Nous avons démontré que la coercition est spécifiquement associée au fonctionnement du lobe temporal médian et aux interactions entre l’amygdale et l’insula, durant le conditionnement. Durant l’extinction, les niveaux d’anxiété étaient associés à des différences spécifiques d’activation du gyrus cingulaire antérieur (GCA) dorsal. Enfin, les pratiques parentales coercitives et l’anxiété interagissent et viennent moduler la connectivité fonctionnelle amygdale - GCA rostral, l’activation d’une sous-région du GCA dorsal et les réponses subjectives de peur. Ces résultats ajoutent une pièce au casse-tête des neurosciences développementales et fournissent des pistes intéressantes pour le développement d’interventions futures.

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This study aimed to identify clusters of symptoms, to determine the patient characteristics associated with identified, and determine their strength of association with survival in patients with advanced cancer (ACPs). Consecutively eligible ACPs not receiving cancer-specific treatment, and referred to a Tertiary Palliative Care Clinic, were enrolled in a prospective cohort study. At first consultation, patients rated 9 symptoms through the Edmonton Symptom Assessment System (0-10 scale) and 10 others using a Likert scale (1-5). Principal component analysis was used in an exploratory factor analysis to identify. Of 318 ACPs, 301 met eligibility criteria with a median (range) age of 69 (37-94) years. Three SCs were identified: neuro-psycho-metabolic (NPM) (tiredness, lack of appetite, lack of well-being, dyspnea, depression, and anxiety); gastrointestinal (nausea, vomiting, constipation, hiccups, and dry mouth) and sleep impairment (insomnia and sleep disturbance). Exploratory factor analysis accounted for 40% of variance of observed variables in all SCs. Shorter survival was observed for patients with the NPM cluster (58 vs. 23, P < 0.001), as well as for patients with two or more SCs (45 vs. 21, P = 0.005). In a multivariable model for survival at 30-days, age (HR: 0.98; 95% CI: 0.97-0.99; P = 0.008), hospitalization at inclusion (HR: 2.27; 95% CI: 1.47-3.51; P < 0.001), poorer performance status (HR: 1.90, 95% CI: 1.24-2.89; P = 0.003), and NPM (HR: 1.64; 95% CI: 1.17-2.31; P = 0.005), were associated with worse survival. Three clinically meaningful SC in patients with advanced cancer were identifiable. The NPM cluster and the presence of two or more SCs, had prognostic value in relation to survival.

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Background Dyslexia is the most common form of specific learning difficulty affecting approximately 6% of the general UK population and believed to affect approximately 2% of UK medical students. The impact of dyslexia on early practice has not been studied. Objectives To develop an understanding of the challenges faced by doctors with dyslexia in the first year of practice and their support requirements. Methods Semistructured telephone interviews were conducted with seven foundation year 1 doctors with dyslexia from Scottish hospitals between March 2013 and August 2013. Results Foundation doctors indicated that due to their dyslexia, they experience difficulty with all forms of communication, time management and anxiety. There were concerns about disclosure of their dyslexia to colleagues and supervisors. Coping strategies used frequently were safety-netting and planning; technology solutions did offer some assistance. Conclusions Although technological interventions have the potential to offer benefits to foundation doctors with dyslexia, increased openness about a diagnosis of dyslexia with discussion between doctor and supervisors about the challenges and anxieties is likely to provide the most benefit

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Several studies have found that fatigue is one of the most commonly reported symptoms after stroke and the most difficult to cope with. The present study aimed to investigate the presence and severity of self-reported fatigue six years after stroke onset and associated factors. The cohort "Life After Stroke Phase I" (n = 349 persons) was invited at six years to report fatigue (Fatigue Severity Scale 7-item version), perceived impact of stroke and global recovery after stroke (Stroke Impact Scale), anxiety and depression (Hospital Anxiety and Depression Scale), life satisfaction (Life Satisfaction Checklist) and participation in everyday social activities (Frenchay Activities Index). At six years 37% of the 102 participants in this cross-sectional study reported fatigue. The results showed that in nearly all SIS domains the odds for post-stroke fatigue were higher in persons with a higher perceived impact. Furthermore, the odds for post-stroke fatigue were higher in those who had experienced a moderate/severe stroke and had signs of depression and anxiety. Fatigue is still present in one-third of persons as long as six years after stroke onset and is perceived to hinder many aspects of functioning in everyday life. There is an urgent need to develop and evaluate interventions to reduce fatigue.

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Thesis (Ph.D.)--University of Washington, 2016-08

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This essay examines the themes of paranoia and claustrophobia as elements of horror in John Campbell’s novella “Who Goes There?” (1938) and John Carpenter’s film-adaptation of said novella, called The Thing (1982). The novella and the film utilize the lack of trust and reliability in between the characters as elements of fear as well as supernatural elements in the form of a monster. This essay focuses on the different parts of the story running through both versions, mainly the setting, the characters and the monster, to show how the themes of paranoia and claustrophobia are used throughout these as elements of fear and horror. With the help of Sigmund Freud’s concept of the uncanny, as well as other sources, this essay argues that while the monster plays an important role throughout the story, the threats created by the paranoia and claustrophobia are equal to the monster itself.

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The present paper provides a review of the current knowledge relating to the health benefits of probiotics, specially focused on the effects they may have together with physical exercise on mood disorders and related chronic medical conditions. With both these conditions being a substantial contributor to the global disease burden any alternative therapy must be considered. Probiotics influence the gut microbiota through a complex network of events which can influence mechanisms leading to development of mood disorders such as depression and anxiety. Similarly, through a complex interaction between psychological and neurobiological mechanisms, exercise has been found to play a key role in mood enhancement.

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Introduction: Every individual has a necessity to establish affective relationships throughout life in order to feel comfort and support. This need is called attachment and allows the human being to explore the world, acquiring knowledge about himself and everyone else(1) There are several changes that occur on students’ lives when enrolling and attending university, a period that is known to include a set of situational and academic transitions which might lead to mental health problems, and thus making students more vulnerable and more prone to develop suicidal behaviours. Objectives: To determine the prevalence of suicidal ideation on higher education students and to assess its relationship with attachment patterns. Methods: Quantitative, descriptive and correlational study, applied on a sample of 1074 students from a Portuguese higher education institution. Data collection was possible through an online platform that included a survey with questions regarding sociodemographical and academic profiling, the Portuguese version of the Adult Attachment Scale (EVA)(2) and the Suicidal Ideation Questionnaire(3) Results: Students’ age varies between the 17 and 49 ( = 23,9 years old ± 6,107 Sd), the vast majority (64.7%) are females. Results show that the presence/severity of suicidal thoughts is low ( = 13.84; ± 20.29 Sd) on a scale from 0 to 180 and cut-off point > 41 for values that suggest potential suicidal risk, and based on that, 84 students were identified (7,8%). We verified significant relationships between suicidal ideation and anxiety and attachment (r=0.314 p=0.000). Conclusions: Although there is not a high prevalence of suicidal ideation on students, we found 84 students in our sample (7,8%) that reveal a potential risk for suicide. The results also show that young students with safe attachment patterns display less suicidal ideation. Safe attachment patterns are essential on interpersonal and social relationships and play an important role during the academic period. We cannot be indifferent towards this issue due to its individual, familiar and social repercussions. Every higher education institution should then establish student support offices and develop mental health promotion programs as well as suicide prevention campaigns.

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Aim: To investigate how diversity within the African migrant population in Scotland affects their understandings of HIV and uptake of HIV testing and treatment, in order to improve HIV-related outcomes. Background: In the UK, Africans have the worst outcomes for HIV infection, primarily due to late diagnosis. Improvement requires better understanding of the barriers to healthcare engagement. This PhD study investigates how diversity among first generation African migrants in Scotland could affect engagement with general healthcare and HIV related interventions and services. Methods: I conducted qualitative research, involving participant observation at two sites (an African religious group and an asylum seeker/refugee drop-in centre) and interviews with African migrants attending these and three additional sites (two advocacy charities and a student association). Data were collected in two cities (Glasgow and Edinburgh) and two smaller towns (Paisley and Kirkcaldy). I interviewed 27 Africans, including economic migrants (n=8), students (n=9) and asylum seeker/refugees (n=10) and 14 representatives from organisations with high levels of African attendees (e.g., country associations, community organisations, advocacy groups, commercial establishments and religious based organisations). Thematic data analysis was carried out. Results: Diversity of the population and related issues of identity: Participants were highly diverse and reported considerable heterogeneity in the African diaspora in Scotland. The identity of “African” was bound with various negative stereotypes and appeals to this identity did not necessarily have relevance for participants. Nature of African affiliated organisations in Scotland: There were a wide range of organisations that advertised their remit as catering for the African diaspora. They varied in consistency and sustainability and contributed towards healthcare engagement to different degrees. Engagement with healthcare: There were multiple experiences and understandings of the healthcare system within the sample as a whole, and to an extent by migrant type. Whilst the majority reported successful and satisfactory service use, distinct barriers emerged. These included: understandings of rights and access to care based on African models of healthcare; the interplay of religious based understandings with ideas about access to healthcare; and assumptions and anxiety about the connections between visa status and health status. Knowledge of HIV and engagement with HIV related services: Participants had good knowledge about HIV, with some notable exceptions, but there was no patterning by migrant type. They had diverse views about risk of HIV infection, most of which did not align with the HIV epidemiology that identifies African migrants as an at risk group. Most of the sample did not think targeting African migrants for HIV interventions would be successful and were hostile to the proposal for various reasons, especially because they believed it would perpetuate stigma and prejudice towards the African diaspora. There were mixed experiences of HIV related services, and prompts to test for HIV had elicited a range of reactions, the majority negative. Conclusion: Diversity within the African diaspora in Scotland should be taken into account to improve the salience and relevance of future HIV interventions. Attitudes towards current HIV testing promotion suggest that a more cooperative approach could be taken with African communities to build on existing relationships of trust and understandings of HIV.

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L’adversité tôt dans la vie est associée au développement de symptômes anxieux pouvant perdurer jusqu’à l’âge adulte (Casey et el, 2010, Pine 2003). Des études chez l’adulte suggèrent que ces liens pourraient être associés à des altérations du « circuit de la peur » qui inclut l’amygdale, l’hippocampe antérieur, l’insula et le cortex préfrontal (Marek, 2013, Etkin & Wager, 2007). Ceci a cependant peu été étudié chez les jeunes. L’objectif principal de cette thèse était de définir les corrélats comportementaux, physiologiques, biologiques et neuronaux du traitement de la peur chez les jeunes en bonne santé, en lien ou non avec un historique d’adversité -- sous la forme de pratiques parentales coercitives -- et d’anxiété. D’abord, puisque nous nous intéressions aux pratiques parentales coercitives chroniques, nous avons examiné leur évolution et facteurs de risque, en nous concentrant sur la période de 17 à 72 mois. Un total de 2045 dyades mère-enfant ont été incluses dans une analyse de courbe de croissance latente. Nous avons démontré que la coercition maternelle suit une évolution non linéaire durant cette période et atteint un sommet à 42 mois. Les facteurs de risque relatifs à l’enfant et à la mère, mesurés à 17 mois, permettent de prédire les niveaux de coercition à 42 mois. Finalement, les prédicteurs relatifs à l’enfant et l’efficacité maternelle prédisent l’évolution des pratiques parentales coercitives entre 17 et 72 mois. Ensuite, afin de définir une méthodologie solide pour étudier le traitement de la peur chez des jeunes, nous avons adapté une tâche développée par Lau et ses collaborateurs (2008), employant des visages féminins comme stimuli. Le sexe des participants et des visages employés comme stimuli pouvant potentiellement moduler le traitement de la peur (Kret & de Gelder, 2012; McClure, 2000), nous avons étudié leurs influences respectives sur les réponses électrodermales et subjectives de peur durant le conditionnement et l’extinction de la peur chez 117 jeunes. Nous avons démontré que les stimuli féminins suscitent des réponses davantage comparables entre les garçons et les filles que les stimuli masculins. De plus, nous avons observé un effet du « même sexe », caractérisé par un conditionnement différentiel uniquement face aux stimuli du même sexe que le participant. Finalement, nous avons exploré les différences individuelles et conjointes associées aux différents niveaux de pratiques parentales coercitives et d’anxiété en termes de réponses de peur et d’activité cérébrale, durant le conditionnement et l’extinction de la peur chez 84 jeunes. Nous avons démontré que la coercition est spécifiquement associée au fonctionnement du lobe temporal médian et aux interactions entre l’amygdale et l’insula, durant le conditionnement. Durant l’extinction, les niveaux d’anxiété étaient associés à des différences spécifiques d’activation du gyrus cingulaire antérieur (GCA) dorsal. Enfin, les pratiques parentales coercitives et l’anxiété interagissent et viennent moduler la connectivité fonctionnelle amygdale - GCA rostral, l’activation d’une sous-région du GCA dorsal et les réponses subjectives de peur. Ces résultats ajoutent une pièce au casse-tête des neurosciences développementales et fournissent des pistes intéressantes pour le développement d’interventions futures.

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A good night sleep enables to achieve physical and mental wellbeing (Paiva, 2015). The preservation of sleep quality is paramount as who sleeps well has a high adaptation capacity to adverse circumstances such as stress and anxiety, amongst others. There is an impacting relationship between reduced sleeping hours and high levels of anxiety, depression and stress (Pinto et al., 2012). Measure the sleep quality and stress levels amongst higher education students.Quantitative study with a descriptive-correlational and transversal design. A socio-demographic record, the Pittsburgh Sleep Quality Index (PSQI) from Ramalho (2008) and the Anxiety, Depression and Stress Scale (EADS-21) from Ribeiro, Honrado and Leal (2004) were applied. The sample included 358 students. 54% of the students present a bad sleep quality, go to bed on average at 1am, take about 19 minutes to fall asleep and sleep on average 7 hours effectively. Female students have a 48% higher probability of having bad sleep quality. Stress, anxiety and depression levels were considered disperse with stress presenting the higher average. The majority of the students that refer having a bad sleep quality present an average score of 6.57 on the stress scale being approximately double of the students that refer having a good sleep quality (3.35). Stress, anxiety and depression are positively and with statistic signiicance correlated to the sleep quality index where a higher score means worse sleep quality.

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Exercise and physical activity are lifestyle behaviors associated with enriched mental health. Understanding the mechanisms by which exercise and physical activity improve mental health may provide insight for novel therapeutic approaches for numerous mental health disorders. This dissertation reports the findings from three studies investigating the influence of acute and chronic exercise on behavioral and mechanistic markers of hippocampal plasticity and delves into the potential role of noradrenergic signaling in the hippocampal adaptations with exercise. The first study assessed the effects of long-term voluntary wheel running on hippocampal expression of plasticity-associated genes and proteins in adult male and female C57BL/6J mice, highlighting sex differences in the adaptations to long-term voluntary wheel running. The second study examined the influence of acute exercise intensity on AMPA receptor phosphorylation, a mechanism essential for hippocampal plasticity, plasticity- associated gene expression, spatial learning and memory, and anxiety-like behavior. The unexpected finding that acute exercise increased anxiety-like behavior encouraged investigation into the role of central noradrenergic signaling in acute exercise-induced anxiety. The third study determined how previous exposure to voluntary wheel running modulates the response to an acute bout of exercise, focusing primarily on transcription of the important plasticity-promoting gene, brain-derived neurotrophic factor. Using a pharmacological approach to compromise the locus coeruleus noradrenergic system, a system that is implicated in age-related mental health disorders such as Alzheimer’s Disease, the third study also investigated the influence and interaction of the noradrenergic system and acute exercise on expression of multiple brain-derived neurotrophic factor transcripts. Together, this dissertation reports the findings from a series of experiments that explored similarities, differences, and interactions between the effects of acute and chronic exercise on markers of hippocampal plasticity and behavior. Further, this work provides insight into the role of the noradrenergic system in exercise-induced hippocampal plasticity.

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Increasing research suggests that elevations in the cortisol awakening response (CAR), the natural increase of cortisol 30 to 40 minutes after waking, may serve as a vulnerability marker for depression. However, existing studies have focused on adolescence and adulthood; very little is known about the CAR in early childhood and the factors that are associated with it. The current study aimed to examine the validity of the CAR as a potential early-emerging vulnerability marker for depression in a sample of preschool-age children. We examined associations between the CAR and two well-established risk factors for depression: maternal psychopathology and early child temperament (high negative emotionality (NE) and/or low positive emotionality (PE)). The sample consisted of 146 preschool-age children, of whom 71 (49.3%) had a biological mother with a history of depression and 65 (45.5%) had a biological mother with a history of anxiety. To assess the CAR, salivary cortisol samples were collected from the child upon waking, 30 and 45 minutes post-waking on two weekdays. Children’s CAR was examined as the total volume of cortisol secreted (AUCg) and the total increase in cortisol (AUCi) across waking. Evening cortisol was collected 30 minutes before bedtime. Child temperament was assessed using observational laboratory measures. Maternal depression and anxiety were assessed with clinical interviews. Associations with children’s CAR, as indicated by AUCg or AUCi, appeared to be specific to maternal current psychopathology and symptoms of anhedonia. Additionally, we observed significant interactions for both maternal lifetime and current depression and anxiety, in combination with child NE and PE, on elevated evening cortisol levels and flattened diurnal cortisol rhythms, indicating altered patterns of basal cortisol activity in offspring. Our study contributes to the limited but growing knowledge on the development of the CAR in preschool age children and as a marker of early risk. Findings suggest that there is a complex interplay between familial risk, affective vulnerability, and their joint effects on neuroendocrine dysfunction in young children, and highlight the need for future research to examine which aspects of the early diurnal rhythm predict the emergence of later depressive illness.

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Cigarette smoking remains the leading preventable cause of death and disability in the United States and most often is initiated during adolescence. An emerging body of research suggests that a negative reinforcement model may explain factors that contribute to tobacco use during adolescence and that negative reinforcement processes may contribute to tobacco use to a greater extent among female adolescents than among male adolescents. However, the extant literature both on the relationship between negative reinforcement processes and adolescent tobacco use as well as on the relationship between gender, negative reinforcement processes, and adolescent tobacco use is limited by the sole reliance on self-report measures of negative reinforcement processes that may contribute to cigarette smoking. The current study aimed to further disentangle the relationships between negative reinforcement based risk taking, gender and tobacco use during older adolescence by utilizing a behavioral analogue measure of negative reinforcement based risk taking, the Maryland Resource for the Behavioral Utilization of the Reinforcement of Negative Stimuli (MRBURNS). Specifically, we examined the relationship between pumps on the MRBURNS, an indicator of risk taking, and smoking status as well as the interaction between MRBURNS pumps and gender for predicting smoking status. Participants included 103 older adolescents (n=51 smokers, 50.5% female, Age (M(SD) = 19.41(1.06)) who all attended one experimental session during which they completed the MRBURNS as well as self-report measures of tobacco use, nicotine dependence, alcohol use, depression, and anxiety. We utilized binary logistic regressions to examine the relationship between MRBURNS pumps and smoking status as well as the interactive effect of MRBURNS pumps and gender for predicting smoking status. Controlling for relevant covariates, pumps on the MRBURNS did not significantly predict smoking status and the interaction between pumps on the MRBURNS and gender also did not significantly predict smoking status. These findings highlight the importance of future research examining various task modifications to the MRBURNS as well as the need for replications of this study with larger, more diverse samples.