Panic and bodily alarm

لَا يَحۡزُنُهُمُ ٱلۡفَزَعُ ٱلۡأَكۡبَرُ وَتَتَلَقَّىٰهُمُ ٱلۡمَلَٰٓئِكَةُ هَٰذَا يَوۡمُكُمُ ٱلَّذِي كُنتُمۡ تُوعَدُونَ

They will have no fear of the great Terror: the angels will receive them with the words, ‘This is the Day you were promised!’

إِذۡ يُوحِي رَبُّكَ إِلَى ٱلۡمَلَٰٓئِكَةِ أَنِّي مَعَكُمۡ فَثَبِّتُواْ ٱلَّذِينَ ءَامَنُواْۚ سَأُلۡقِي فِي قُلُوبِ ٱلَّذِينَ كَفَرُواْ ٱلرُّعۡبَ فَٱضۡرِبُواْ فَوۡقَ ٱلۡأَعۡنَاقِ وَٱضۡرِبُواْ مِنۡهُمۡ كُلَّ بَنَانࣲ‏

Your Lord revealed to the angels: ‘I am with you: give the believers firmness; I shall put terror into the hearts of the disbelievers- strike above their necks and strike all their fingertips.’

سَنُلۡقِي فِي قُلُوبِ ٱلَّذِينَ كَفَرُواْ ٱلرُّعۡبَ بِمَآ أَشۡرَكُواْ بِٱللَّهِ مَا لَمۡ يُنَزِّلۡ بِهِۦ سُلۡطَٰنࣰ اۖ وَمَأۡوَىٰهُمُ ٱلنَّارُۖ وَبِئۡسَ مَثۡوَى ٱلظَّٰلِمِينَ

We will strike panic into the disbelievers’ hearts because they attribute partners to God although He has sent no authority for this: their shelter will be the Fire- how miserable is the home of the evildoers

وَأَنزَلَ ٱلَّذِينَ ظَٰهَرُوهُم مِّنۡ أَهۡلِ ٱلۡكِتَٰبِ مِن صَيَاصِيهِمۡ وَقَذَفَ فِي قُلُوبِهِمُ ٱلرُّعۡبَ فَرِيقࣰ ا تَقۡتُلُونَ وَتَأۡسِرُونَ فَرِيقࣰ ا

He brought those People of the Book who supported them down from their strongholds and put panic into their hearts. Some of them you [believers] killed and some you took captive

هُوَ ٱلَّذِيٓ أَخۡرَجَ ٱلَّذِينَ كَفَرُواْ مِنۡ أَهۡلِ ٱلۡكِتَٰبِ مِن دِيَٰرِهِمۡ لِأَوَّلِ ٱلۡحَشۡرِۚ مَا ظَنَنتُمۡ أَن يَخۡرُجُواْۖ وَظَنُّوٓاْ أَنَّهُم مَّانِعَتُهُمۡ حُصُونُهُم مِّنَ ٱللَّهِ فَأَتَىٰهُمُ ٱللَّهُ مِنۡ حَيۡثُ لَمۡ يَحۡتَسِبُواْۖ وَقَذَفَ فِي قُلُوبِهِمُ ٱلرُّعۡبَۚ يُخۡرِبُونَ بُيُوتَهُم بِأَيۡدِيهِمۡ وَأَيۡدِي ٱلۡمُؤۡمِنِينَ فَٱعۡتَبِرُواْ يَٰٓأُوْلِي ٱلۡأَبۡصَٰرِ

It was He who drove those of the People of the Book who broke faith out from their homes at the first gathering of forces––you [believers] never thought they would go, and they themselves thought their fortifications would protect them against God. God came up on them from where they least expected and put panic into their hearts: their homes were destroyed by their own hands, and the hands of the believers. Learn from this, all of you with insight

مَن جَآءَ بِٱلۡحَسَنَةِ فَلَهُۥ خَيۡرࣱ مِّنۡهَا وَهُم مِّن فَزَعࣲ يَوۡمَئِذٍ ءَامِنُونَ

whoever comes with a good deed will be rewarded with something better, and be secure from the terrors of that Day

The greatest terror shall not make them sorrow, and the angels will receive them: “This is the day that you were promised.” On the Day of Resurrection in the greatest gathering place and most tremendous courtyard, they will not hear from the angels the call “no good news” [25:22], nor the address, “Stand apart today, O offenders!” [36:59], nor the harsh call, “Slink into it, and do not talk to Me!” [23:108]. They will not hear the call of separation's pain, nor will they despair of mercy. Rather the angels will keep on coming, company after company, and they will give the good news: “This is the day that you were promised,” that is, “This is the day in which you have the promised reward.” Among them are those who will be received by the angels, and among them are those who will be addressed and made known by the King. God will say, “My servants, have you been yearning for Me?” He will sa

The Supreme Terror — which is that a servant be ordered off to the Fire shall not grieve them and the angels shall receive them upon their exiting from their graves saying to them ‘This is your day the one which you were promised’ during the life of the world.

When your Lord inspired the angels with whom He reinforced the Muslims saying ‘I am with you with assistance and victorious help so make the believers stand firm by helping them and giving them good tidings. I shall cast terror fear into the hearts of the disbelievers; so smite above the necks that is the heads and smite of them every finger!’ that is smite the extremities of their hands and feet thus when one of them went to strike an disbeliever’s head it would roll off before his sword reached it. The Prophet s threw a handful of pebbles against them and every single idolater was struck in his eye and thus they were defeated.

(Remember) when He covered you with a slumber as a security from Him, and He caused water (rain) to descend on you from the sky, to clean you thereby and to remove from you the Rijz (whispering or dirt) of Shaytan, and to strengthen your hearts, and make your feet firm thereby (11)(Remember) when your Lord revealed to the angels, "Verily, I am with you, so keep firm those who have believed. I will cast terror into the hearts of those who have disbelieved, so strike them over the necks, and smite over all their fingers and toes. (12)This is because they defied and disobeyed Allah and His Messenger. And whoever defies and disobeys Allah and His Messenger, then verily, Allah is severe in punishment (13)This is (the torment), so taste it; and surely, for the disbelievers is the torment of the Fire (14) Slumber overcomes Muslims Allah reminds the believers of the slumber that He sent down o

(We shall cast terror into the hearts of those who disbelieve) [3:151]. Said al-Suddi: �After Uhud, Abu Sufyan and the idolaters headed toward Mecca. But after they traversed a certain distance, they felt regret, saying: �Evil is that which we have done! We massacred them such that none of them remained except those who fled from the battlefield and then we left them alone. Go back and exterminate them�. But when they decided to do so, Allah, exalted is He, cast terror in their hearts which made them decide against what they had resolved to do. Allah, exalted is He, then revealed this verse�.

(All that is in the heavens and all that is in the earth glorifieth Allah� Allah is Able to do all things) [59:1-6]. The commentators of the Qur'an said: �This verse was revealed about Banu'l-Nadir. When the Prophet, Allah bless him and give him peace, moved to Medina, they signed a treaty with him in which they agreed not fight against him or with him and the Messenger of Allah, Allah bless him and give him peace, consented. Then when the Messenger of Allah, Allah bless him and give him peace, defeated the idolaters at Badr, Banu'l-Nadir said: 'By Allah, he is the Prophet whose description we find in the Torah; he will not be defeated'. However, when the Muslims were defeated at Uhud, they broke their pledge and showed enmity toward the Messenger of Allah, Allah bless him and give him peace, and Muslims. The Messenger of Allah, Allah bless him and give him peace, surrounded them and the

أَخْبَرَنَا أَبُو عَبْدِ الرَّحْمَنِ، أَحْمَدُ بْنُ شُعَيْبٍ قَالَ أَنْبَأَنَا عَمْرُو بْنُ عَلِيٍّ، قَالَ حَدَّثَنَا أَبُو عَاصِمٍ، قَالَ حَدَّثَنَا ابْنُ أَبِي ذِئْبٍ، قَالَ حَدَّثَنِي أَسِيدُ بْنُ أَبِي أَسِيدٍ، عَنْ مُعَاذِ بْنِ عَبْدِ اللَّهِ، عَنْ أَبِيهِ، قَالَ أَصَابَنَا طَشٌّ وَظُلْمَةٌ فَانْتَظَرْنَا رَسُولَ اللَّهِ صلى الله عليه وسلم لِيُصَلِّيَ بِنَا ثُمَّ ذَكَرَ كَلاَمًا مَعْنَاهُ فَخَرَجَ رَسُولُ اللَّهِ صلى الله عليه وسلم لِيُصَلِّيَ بِنَا فَقَالَ ‏"‏ قُلْ ‏"‏ ‏.‏ فَقُلْتُ مَا أَقُولُ قَالَ ‏"‏ ‏{‏ قُلْ هُوَ اللَّهُ أَحَدٌ ‏}‏ وَالْمُعَوِّذَتَيْنِ حِينَ تُمْسِي وَحِينَ تُصْبِحُ ثَلاَثًا يَكْفِيكَ كُلَّ شَىْءٍ ‏"‏ ‏.‏

It was narrated from Mu'adh bin 'Abdullah that his father said:"It was raining and dark, and we were waiting for the Messenger of Allah [SAW] to lead us in prayer. Then the Messenger of Allah [SAW] came out to lead us in prayer and he said: 'Say.' I said: 'What should I say?' He said: 'Say: He is Allah, (the) One and Al-Mu'awwadhatain in the evening and in the morning, three times, and that will suffice you against everything

أَخْبَرَنَا مُحَمَّدُ بْنُ عَلِيٍّ، قَالَ حَدَّثَنِي الْقَعْنَبِيُّ، عَنْ عَبْدِ الْعَزِيزِ، عَنْ عَبْدِ اللَّهِ بْنِ سُلَيْمَانَ، عَنْ مُعَاذِ بْنِ عَبْدِ اللَّهِ بْنِ خُبَيْبٍ، عَنْ أَبِيهِ، عَنْ عُقْبَةَ بْنِ عَامِرٍ الْجُهَنِيِّ، قَالَ بَيْنَا أَنَا أَقُودُ، بِرَسُولِ اللَّهِ صلى الله عليه وسلم رَاحِلَتَهُ فِي غَزْوَةٍ إِذْ قَالَ ‏"‏ يَا عُقْبَةُ قُلْ ‏"‏ ‏.‏ فَاسْتَمَعْتُ ثُمَّ قَالَ ‏"‏ يَا عُقْبَةُ قُلْ ‏"‏ ‏.‏ فَاسْتَمَعْتُ فَقَالَهَا الثَّالِثَةَ فَقُلْتُ مَا أَقُولُ فَقَالَ ‏"‏ ‏{‏ قُلْ هُوَ اللَّهُ أَحَدٌ ‏}‏ ‏"‏ ‏.‏ فَقَرَأَ السُّورَةَ حَتَّى خَتَمَهَا ثُمَّ قَرَأَ ‏{‏ قُلْ أَعُوذُ بِرَبِّ الْفَلَقِ ‏}‏ وَقَرَأْتُ مَعَهُ حَتَّى خَتَمَهَا ثُمَّ قَرَأَ ‏{‏ قُلْ أَعُوذُ بِرَبِّ النَّاسِ ‏}‏ فَقَرَأْتُ مَعَهُ حَتَّى خَتَمَهَا ثُمَّ قَالَ ‏"‏ مَا تَعَوَّذَ بِمِثْلِهِنَّ أَحَدٌ ‏"‏ ‏.‏

It was narrated that 'Uqbah bin 'Amir Al-Juhani said:"While I was leading the Messenger of Allah [SAW] on his mount on a military campaign, he said: 'O 'Uqbah, say!' I listened, then he said: 'O 'Uqbah, say!' I listened, then he said it a third time. I said: 'What should I say?' He said: 'Say: He is Allah, (the) One...' and he recited the Surah to the end. Then he recited: 'Say: I seek refuge with (Allah) the Lord of the daybreak...' and I recited it with him until the end. Then he recited: 'Say: I seek refuge with (Allah) the Lord of mankind...' and I recited it with him until the end. Then he said: 'No one ever sought refuge (with Allah) by means of anything like them

فتوهم نفسك وقد وثبت متغيرا وجهك مغبرا بدنك من فرقك إلى قدمك من تراب قبرك مبهوتا من شدة الصعقة شاخص العين نحو النداء وقد ثار الخلق ثورة واحدة من القبور التى طال فيها بلاؤهم وقد أزعجهم الفزع والرعب مضافا إلى ما كان عندهم من الهموم والغموم وشدة الانتظار لعاقبة الأمر كما قال تعالى ونفخ فى الصور فصعق من فى السموات ومن فى الأرض إلا من شاء الله ثم نفخ فيه أخرى فإذا هم قيام ينظرون وقال تعالى @QB@ فإذا نقر في الناقور فذلك يومئذ يوم عسير على الكافرين غير يسير @QE@ وقال تعالى @QB@ ويقولون متى هذا الوعد إن كنتم صادقين ما ينظرون إلا صيحة واحدة تأخذهم وهم يخصمون فلا يستطيعون توصية ولا إلى أهلهم يرجعون ونفخ في الصور فإذا هم من الأجداث إلى ربهم ينسلون قالوا يا ويلنا من بعثنا من مرقدنا هذا ما وعد الرحمن وصدق المرسلون @QE@ فلو لم يكن بين يدي الموتى إلا هول تلك النفخة لكان ذلك جديرا بأن يتقى فإنها نفخة وصيحة يصعق بها من فى السموات والأرض يعنى يموتون بها إلا من شاء الله وهو بعض الملائكة

واما المنافق فانه عمي قلبه لم يجاوز بصره الظلمة ولم ير الا برقا يكاد يخطف البصر و رعدا عظيما وظلمة فاستوحش من ذلك وخاف منه فوضع اصابعه في اذنيه لئلا يسمع صوت الرعد وهاله ذلك البرق وشدة لمعانه وعظم نوره فهو خائف ان يختطف معه بصره لان بصره اضعف من ان يثبت معه فهو في ظلمة يسمع اصوات الرعد القاصف ويرى ذلك البرق الخاطف فان اضاء له ما بين يديه مشى في ضوئه وان فقد الضوء قام متحير ا لا يدري اين يذهب ولجهله لا يعلم ان ذلك من لوازم الصيب الذي به حياة الأرض والنبات وحياته هو نفسه بل لا يدرك الا رعدا وبرقا وظلمة ولا شعور له بما وراء ذلك فالوحشة لازمة له والرعب والفزع لا يفارقه واما من انس بالصيب وعلم انه لا بد فيه من رعد وبرق وظلمة بسبب الغيم استانس بذلك ولم يستوحش منه ولم يقطعه ذلك عن اخذه بنصيبه من الصيب فهذا مثل مطابق للصيب الذي نزل به جبريل صلى الله عليه وسلم من عند رب العالمين تبارك وتعالى على قلب رسول الله صلى الله عليه وسلم ليحيي به القلوب والوجود اجمع اقتضت حكمته ان يقارنه من الغيم والرعد وا

وجملة أدب المريض حسن الصبر وقلة الشكوى والضجر والفزع إلى الدعاء والتوكل بعد الدواء على خالق الدواء

وجملة آداب المريض: حسن الصبر، وقلة الشكوى والتضجر، والفزع إلى #

أي لذلك الماء الذي غمر الأرض ومن عليها فصل وأما الوهل فهو بتحريك الهاء وأصله الفزع والروع يقال وهل يوهل وهو وهل ومستوهل قال القطامي يصف إبلا

وأما اللوعة فقال في الصحاح لوعة الحب حرقته وقد لاعه الحب يلوعه والتاع فؤاده أي احترق من الشوق ومنه قولهم أتان لاعة الفؤاد إلى جحشها قال الأصمعي أي لائعة الفؤاد وهي التي كأنها ولهى من الفزع فصل

A Lifetime Prevalence of Comorbidity Between Bipolar Affective Disorder and Anxiety Disorders: A Meta-analysis of 52 Interview-based Studies of Psychiatric Population.: Background: Bipolar affective disorder has a high rate of comorbidity with a multitude of psychiatric disorders and medical conditions. Among all the potential comorbidities, co-existing anxiety disorders stand out due to their high prevalence. Aims: To determine the lifetime prevalence of comorbid anxiety disorders in bipolar affective disorder under the care of psychiatric services through systematic review and meta-analysis. Method: Random effects meta-analyses were used to calculate the life

How prevalent are anxiety disorders in schizophrenia? A meta-analysis and critical review on a significant association.: Objective: The presence of anxiety disorders (AD) in schizophrenia (SZ) is attracting increasing interest. However, published studies have yielded very broad variations in prevalence rates across studies. The current meta-analysis sought to (1) investigate the prevalence of co-occurring AD in SZ by reporting pooled prevalence rates and (2) identify potential sources of variations in reported rates that could guide our efforts to identify and treat these co-occurring disorders in patients with SZ

Experience sampling and ecological momentary assessment for studying the daily lives of patients with anxiety disorders: a systematic review.: Anxiety disorders are highly prevalent. Symptoms may occur unpredictably (e.g., panic attacks) or predictably in specific situations (e.g., social phobia). Consequently, it may be difficult to assess anxiety and related constructs realistically in the laboratory or by traditional retrospective questionnaires. Experience sampling methods (ESM) and ecological momentary assessment (EMA) can deepen the understanding of the course of anxiety disorders by frequently assessing symptoms and other variab

The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders Compared With Diagnosis-Specific Protocols for Anxiety Disorders: A Randomized Clinical Trial.: Importance: Transdiagnostic interventions have been developed to address barriers to the dissemination of evidence-based psychological treatments, but only a few preliminary studies have compared these approaches with existing evidence-based psychological treatments. Objective: To determine whether the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) is at least as efficacious as single-disorder protocols (SDPs) in the treatment of anxiety disorders. Design, setting, an

Virtual reality exposure therapy for anxiety and related disorders: A meta-analysis of randomized controlled trials.: Trials of virtual reality exposure therapy (VRET) for anxiety-related disorders have proliferated in number and diversity since our previous meta-analysis that examined 13 total trials, most of which were for specific phobias (Powers & Emmelkamp, 2008). Since then, new trials have compared VRET to more diverse anxiety and related disorders including social anxiety disorder (SAD), posttraumatic stress disorder (PTSD), and panic disorder (PD) with and without agoraphobia. With the availability of

Comorbidity of personality disorders in anxiety disorders: a meta-analysis of 30 years of research.: Background: A comprehensive meta-analysis to identify the proportions of comorbid personality disorders (PD) across the major subtypes of anxiety disorders (AD) has not previously been published. Methods: A literature search identified 125 empirical papers from the period 1980-2010 on patients with panic disorders, social phobia, generalised anxiety, obsessive-compulsive (OCD) and post-traumatic stress disorder (PTSD). Several moderators were coded. Results: The rate of any comorbid PD was high

Affective disorder in the parents of a clinic sample of children with anxiety disorders.

Background: Family history studies in adults reveal strong familiality for the anxiety disorders with some specificity. The aim of the current study was to establish whether there was an elevated rate of anxiety disorders in the parents of children with anxiety disorders, and whether there was intergenerational specificity in the form of disorder. Methods: The mental state of a clinic sample of 85 children with anxiety disorder and their parents was systematically assessed, together with a comparison sample of 45 children with no current disorder and their parents. Results: Compared to the rate of anxiety disorder amongst parents of comparison children, the rate of current anxiety disorder in mothers of anxious children was significantly raised, as was the lifetime rate of anxiety disorder for both mothers and fathers. The mothers of children with generalised anxiety disorder, social pho…

matched on Panic Disorder (mesh), Agoraphobia (mesh), Obsessive-Compulsive Disorder (mesh), Phobic Disorders (mesh)

Grief following miscarriage: a comprehensive review of the literature.

Objective: The literature exploring the relationship between miscarriage and grief is sparse. This paper summarizes the literature on grief subsequent to an early miscarriage to elucidate the nature, incidence, intensity, and duration of grief at this time and to identify potential moderators. Methods: An electronic search of the Medline and Psych Info databases was conducted. Studies were selected for inclusion if they related to early miscarriage, used a standardized measure to assess perinatal grief, and specified the assessment intervals employed. Qualitative studies were included when helpful to develop hypotheses. Results: Descriptions of grief following miscarriage are highly variable but tend to match descriptions of grief used to characterize other types of significant losses. A sizable percentage of women seem to experience a grief reaction, with the actual incidence of grief u…

matched on Panic Disorder (mesh)

The psychiatric sequelae of traumatic injury.

Objective: Traumatic injury affects millions of people each year. There is little understanding of the extent of psychiatric illness that develops after traumatic injury or of the impact of mild traumatic brain injury (TBI) on psychiatric illness. The authors sought to determine the range of new psychiatric disorders occurring after traumatic injury and the influence of mild TBI on psychiatric status. Method: In this prospective cohort study, patients were drawn from recent admissions to four major trauma hospitals across Australia. A total of 1,084 traumatically injured patients were initially assessed during hospital admission and followed up 3 months (N=932, 86%) and 12 months (N=817, 75%) after injury. Lifetime psychiatric diagnoses were assessed in hospital. The prevalence of psychiatric disorders, levels of quality of life, and mental health service use were assessed at the follow-…

matched on Panic Disorder (mesh), Agoraphobia (mesh), Phobic Disorders (mesh), panic disorder (text)

An analysis on the panic during COVID-19 pandemic through an online form.

With the rapid spread of global pandemic coronavirus disease 2019 (COVID-19), people around the world express panic in various behaviors. This affects the economy of the county, social values, and psychological stress of the people involved regardless of the directness of contact with the infected. This study aims to analyze the panic responses of the people as well as the perception on the global issue through an online survey. The researchers used Health Anxiety Inventory and open ended questions regarding the feelings, thoughts and actions of people during the enhanced community quarantine. Quantitative and qualitative data were both analyzed and interpreted interactively. Results also show that there is a significant difference (p = 0.028) in the Avoidance behavior between locations. Furthermore, a significant difference (p = 0.000) also shows on the Symptoms of Hypochondriasis betwe…

matched on Panic (mesh), Panic Disorder (mesh)

PDI-4A: an augmented provisional screening instrument assessing 5 additional common anxiety-related diagnoses in adult primary care patients.

Patients with nonpsychotic mental health and emotional problems are commonly seen by primary care physicians. The objective of this study was to expand the Provisional Diagnostic Instrument-4 (PDI-4) to include a short self-report screen for 5 common anxiety-related diagnoses: panic attack (PA), social phobia (SP), obsessive-compulsive disorder (OCD), hypochondriasis, and post-traumatic stress disorder (PTSD). Primary care patients (N = 343) were originally evaluated with a self-report screen comprised of 85 Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition symptom-based candidate questions, then interviewed by a trained rater for Structured Clinical Interview Research Version (SCID)/Adult ADHD Clinician Diagnostic Scale version 1.2 (ACDS) assessment and diagnosis. Responses to screening questions were used to calculate sensitivity and specificity for an SCID diagnosi…

matched on Panic Disorder (mesh), Obsessive-Compulsive Disorder (mesh), Phobic Disorders (mesh), panic attack (text)

Barriers to treatment seeking for anxiety disorders: initial data on the role of mental health literacy.

Background: Anxiety disorders represent the single largest mental health problem in the United States [Greenberg et al., 1999. J Clin Psychiatry 60:427-435; Rice and Miller, 1998. Br J Psychiatry 173:4-9]. However most individuals with anxiety disorders never seek treatment [Henderson et al., 2002. Can J Psychiatry 47:819-824; Mojtabai et al., 2002. Arch Gen Psychiatry 59:77-84; Roness et al., 2005. Acta Psychiatr Scand 111:51-58]. Deficits in the ability to recognize anxiety disorders and beliefs about them, (i.e., "mental health literacy") may contribute to low levels of help seeking. Methods: Survey data assessing mental health literacy for multiple anxiety disorders and for depression were collected from 284 undergraduate students enrolled in psychology courses at a public university in the United States. Specifically, respondents were presented with vignettes portraying individuals …

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Neuroinflammatory pathways in anxiety, posttraumatic stress, and obsessive compulsive disorders.

As prevalence of anxiety, posttraumatic stress, and obsessive compulsive disorders continue to rise worldwide, increasing focus has been placed on immune mediated theories in understanding the underlying mechanisms of these disorders. Associations between the dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis and these disorders have been recognized in the scientific literature, specifically in regard to cortisol levels, as well as changes in pro- and anti-inflammatory cytokines. The present commentary will systematically assess the scientific literature within the past decade in regard to the psychoneuroimmunology of anxiety, posttraumatic stress, and obsessive compulsive disorders. Understanding the mechanisms of these disorders is essential in order to determine efficacious and targeted treatment strategies, which may lead to substantial improvements in overall functioning…

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Anxiety disorders and onset of cardiovascular disease: the differential impact of panic, phobias and worry.

Anxiety has been linked to onset of cardiovascular disease. This study examines the differential impact of types of anxiety (panic, phobia and worry) on 3-year onset of non-fatal cardiovascular disease (CVD). By investigating anxiety disorders as opposed to anxiety symptoms and by using a reliable diagnostic instrument to assess anxiety, limitations of previous studies are considered. 5149 persons at risk for CVD were interviewed using the Composite International Diagnostic Interview. The panic-type included panic disorder and panic attacks; the phobic-type included agoraphobia and social phobia, and the worry-type included generalized anxiety disorder. CVD was self-reported and required treatment or monitoring by a doctor. Analyses were adjusted for sociodemographics, behavioral variables, and comorbid somatic and psychiatric disorders. During follow-up, 62 persons (1.2%) developed CVD.…

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The Role of Early Life Stress in HPA Axis and Anxiety.

Substantial evidence from various studies suggests a preeminent role for early adverse experiences in the development of psychopathology. The most recent studies reviewed here suggest that early life stressors are associated with an increased risk for anxiety disorders in adulthood. Early life stress predisposes individuals to develop a number of psychiatric syndromes, particularly affective disorders, including anxiety disorders, and is therefore a significant health problem. This review examines the emerging literature on the relationship between stress, hypothalamic-pituitary-adrenal (HPA) axis function, and generalized anxiety disorder (GAD), panic disorder, and phobias and the role of early life stress as an important risk factor for HPA axis dysfunction. The most consistent findings in the literature show increased activity of the HPA axis in depression associated with hypercortiso…

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Oxytocin and Anxiety Disorders.

In the present chapter, we review the literature focusing on oxytocin (OT)-centered research in anxiety spectrum conditions, comprising separation anxiety disorder, specific phobias, social anxiety disorder (SAD), panic disorder, generalized anxiety disorder, and anxiety-related endophenotypes (e.g., trust behavior, behavioral inhibition, neuroticism, and state/trait anxiety). OT receptor gene (OXTR) polymorphisms have been implicated in gene-environment interactions with attachment style and childhood maltreatment and to influence clinical outcomes, including SAD intensity and limbic responsiveness. Epigenetic OXTR DNA methylation patterns have emerged as a link between categorical, dimensional, neuroendocrinological, and neuroimaging SAD correlates, highlighting them as potential peripheral surrogates of the central oxytocinergic tone. A pathophysiological framework of OT integrating t…

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Can Interoception Improve the Pragmatic Search for Biomarkers in Psychiatry?

Disrupted interoception is a prominent feature of the diagnostic classification of several psychiatric disorders. However, progress in understanding the interoceptive basis of these disorders has been incremental, and the application of interoception in clinical treatment is currently limited to panic disorder. To examine the degree to which the scientific community has recognized interoception as a construct of interest, we identified and individually screened all articles published in the English language on interoception and associated root terms in Pubmed, Psychinfo, and ISI Web of Knowledge. This search revealed that interoception is a multifaceted process that is being increasingly studied within the fields of psychiatry, psychology, neuroscience, and biomedical science. To illustrate the multifaceted nature of interoception, we provide a focused review of one of the most commonly …

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Tinnitus and anxiety disorders: A review.

Background: The most common form of tinnitus is a subjective, auditory, and distressing phantom phenomenon. Comorbidity with depression is high but other important psychiatric disorders such as anxiety disorders have received less attention. The current paper reviews the literature on the associations between tinnitus and anxiety disorders and the underlying pathophysiology, and discusses the clinical implications. Methodology: PubMed and Web of Science were searched for all articles published up until October 2014 using combinations of the following search strings "Tinnitus", "Anxiety disorder", "Panic Disorder", "Generalized Anxiety Disorder", "Post traumatic stress disorder", "PTSD" "Social Phobia", "Phobia Disorder", "Obsessive Compulsive Disorder", "Agoraphobia". Results: A total of 117 relevant papers were included. A 45% lifetime prevalence of anxiety disorders is reported in tinn…

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Emerging drugs for the treatment of anxiety.

Introduction: Anxiety disorders are among the most prevalent and disabling psychiatric disorders in the United States and worldwide. Basic research has provided critical insights into the mechanism regulating fear behavior in animals and a host of animal models have been developed in order to screen compounds for anxiolytic properties. Despite this progress, no mechanistically novel agents for the treatment of anxiety have come to market in more than two decades. Areas covered: The current review will provide a critical summary of current pharmacological approaches to the treatment of anxiety and will examine the pharmacotherapeutic pipeline for treatments in development. Anxiety and related disorders considered herein include panic disorder, social anxiety disorder, generalized anxiety disorder and post-traumatic stress disorder. The glutamate, neuropeptide and endocannabinoid systems s…

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How psychotherapy changes the brain--the contribution of functional neuroimaging.

A thorough investigation of the neural effects of psychotherapy is needed in order to provide a neurobiological foundation for widely used treatment protocols. This paper reviews functional neuroimaging studies on psychotherapy effects and their methodological background, including the development of symptom provocation techniques. Studies of cognitive behavioural therapy (CBT) effects in obsessive-compulsive disorder (OCD) were consistent in showing decreased metabolism in the right caudate nucleus. Cognitive behavioural therapy in phobia resulted in decreased activity in limbic and paralimbic areas. Interestingly, similar effects were observed after successful intervention with selective serotonin reuptake inhibitors (SSRI) in both diseases, indicating commonalities in the biological mechanisms of psycho- and pharmacotherapy. These findings are discussed in the context of current neuro…

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Pathological worry, anxiety disorders and the impact of co-occurrence with depressive and other anxiety disorders.

The Penn State Worry Questionnaire (PSWQ) was administered to 123 outpatients with principal diagnoses of generalized anxiety disorder (GAD), social anxiety disorder (SAD), panic disorder with agoraphobia, and panic disorder without agoraphobia (PD) to examine the specificity of pathological worry for GAD. The mean PSWQ scores in patients with GAD and SAD were significantly higher than the mean PSWQ scores in patients with PD, while not differing significantly in the subgroups without any co-occurring depressive or anxiety disorders. Patients with any co-occurring depressive or anxiety disorder scored significantly higher on the PSWQ. In a logistic regression analysis, high PSWQ scores independently predicted only GAD and SAD diagnoses. The study suggests that pathological worry is specific not only for GAD, and indicates that a significant relationship exists between pathological worry,…

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Differentiating hypochondriasis from panic disorder.

Hypochondriasis and panic disorder are both characterized by prevalent health anxieties and illness beliefs. Therefore, the question as to whether they represent distinct nosological entities has been raised. This study examines how clinical characteristics can be used to differentiate both disorders, taking the possibility of mixed symptomatologies (comorbidity) into account. We compared 46 patients with hypochondriasis, 45 with panic disorder, and 21 with comorbid hypochondriasis plus panic disorder. While panic patients had more comorbidity with agoraphobia, hypochondriasis was more closely associated with somatization. Patients with panic disorder were less pathological than hypochondriacal patients on all subscales of the Whiteley Index (WI) and the Illness Attitude Scales (IAS) except for illness behavior. These differences were independent of somatization. Patients with hypochondr…

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Cognitive Behavioral Therapy, Mindfulness-Based Cognitive Therapy and Acceptance Commitment Therapy for Anxiety Disorders: Integrating Traditional with Digital Treatment Approaches.

Anxiety disorders are an enormous societal burden given their high lifetime prevalence among adult populations worldwide. A variety of anxiety disorders can be successfully treated with psychological treatments such as cognitive behavioral therapy (CBT), mindfulness-based cognitive therapy (MBCT), and acceptance and commitment therapy (ACT), either as stand-alone individual or group treatment or as adjunctive treatment to pharmacotherapy. Furthermore, a growing body of evidence suggests that therapist-guided Internet-delivered CBT (iCBT) and, to some degree, digitalized mindfulness- and acceptance-based interventions may be an efficacious complement to traditional face-to-face therapy. In view of the current advances regarding the integration of traditional and innovative treatment approaches, this chapter provides an overview on the theory and evidence base for different delivery modes …

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Long-term effects of internet-supported cognitive behaviour therapy.

Introduction: Internet-supported and therapist-guided cognitive behaviour therapy (ICBT) is effective for a range of problems in the short run, but less is known about the long-term effects with follow-ups of two years or longer. Areas covered: This paper reviews studies in which the long-term effects of guided ICBT were investigated. Following literature searches in PubMed and other sources meta-analytic statistics were calculated for 14 studies involving a total of 902 participants, and an average follow-up period of three years. Studies were from Sweden (n = 11) or the Netherlands (n = 3). Long-term outcome studies were found for panic disorder, social anxiety disorder, generalized anxiety disorder, depression, mixed anxiety and depression, obsessive-compulsive disorder, pathological gambling, stress and chronic fatigue. The duration of the treatments was usually short (8-15 weeks). T…

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Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders.

Background: Anxiety and related disorders are among the most common mental disorders, with lifetime prevalence reportedly as high as 31%. Unfortunately, anxiety disorders are under-diagnosed and under-treated. Methods: These guidelines were developed by Canadian experts in anxiety and related disorders through a consensus process. Data on the epidemiology, diagnosis, and treatment (psychological and pharmacological) were obtained through MEDLINE, PsycINFO, and manual searches (1980-2012). Treatment strategies were rated on strength of evidence, and a clinical recommendation for each intervention was made, based on global impression of efficacy, effectiveness, and side effects, using a modified version of the periodic health examination guidelines. Results: These guidelines are presented in 10 sections, including an introduction, principles of diagnosis and management, six sections (Secti…

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Insular cortex and neuropsychiatric disorders: a review of recent literature.

The insular cortex is located in the centre of the cerebral hemisphere, having connections with the primary and secondary somatosensory areas, anterior cingulate cortex, amygdaloid body, prefrontal cortex, superior temporal gyrus, temporal pole, orbitofrontal cortex, frontal and parietal opercula, primary and association auditory cortices, visual association cortex, olfactory bulb, hippocampus, entorhinal cortex, and motor cortex. Accordingly, dense connections exist among insular cortex neurons. The insular cortex is involved in the processing of visceral sensory, visceral motor, vestibular, attention, pain, emotion, verbal, motor information, inputs related to music and eating, in addition to gustatory, olfactory, visual, auditory, and tactile data. In this article, the literature on the relationship between the insular cortex and neuropsychiatric disorders was summarized following a c…

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A review of the possible relevance of inositol and the phosphatidylinositol second messenger system (PI-cycle) to psychiatric disorders--focus on magnetic resonance spectroscopy (MRS) studies.

Myo-inositol is an important part of the phosphatidylinositol second messenger system (PI-cycle). Abnormalities in nerve cell myo-inositol levels and/or PI-cycle regulation has been suggested as being involved in the pathophysiology and/or treatment of many psychiatric disorders including bipolar disorder, major depressive disorder, panic disorder, obsessive-compulsive disorder, eating disorders and schizophrenia. This review examines the metabolism and biochemical importance of myo-inositol and the PI-cycle. It relates this to the current in vivo evidence for myo-inositol and PI-cycle involvement in these psychiatric disorders, particularly focusing upon the magnetic resonance spectroscopy (MRS) findings in patient studies to date. From this review it is concluded that while the evidence suggests probable relevance to the pathophysiology and/or treatment of bipolar disorder, there is mu…

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Anxiety Disorders

Importance: Anxiety disorders have a lifetime prevalence of approximately 34% in the US, are often chronic, and significantly impair quality of life and functioning. Observations: Anxiety disorders are characterized by symptoms that include worry, social and performance fears, unexpected and/or triggered panic attacks, anticipatory anxiety, and avoidance behaviors. Generalized anxiety disorder (6.2% lifetime prevalence), social anxiety disorder (13% lifetime prevalence), and panic disorder (5.2% lifetime prevalence) with or without agoraphobia are common anxiety disorders seen in primary care. Anxiety disorders are associated with physical symptoms, such as palpitations, shortness of breath, and dizziness. Brief screening measures applied in primary care, such as the Generalized Anxiety Disorder-7, can aid in diagnosis of anxiety disorders (sensitivity, 57.6% to 93.9%; specificity, 61% t…

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The history of generalized anxiety disorder as a diagnostic category.

From the 19th century into the 20th century, the terms used to diagnose generalized anxiety included "pantophobia" and "anxiety neurosis." Such terms designated paroxysmal manifestations (panic attacks) as well as interparoxysmal phenomenology (the apprehensive mental state). Also, generalized anxiety was considered one of numerous symptoms of neurasthenia, a vaguely defined illness. Generalized anxiety disorder (GAD) appeared as a diagnostic category in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) in 1980, when anxiety neurosis was split into GAD and panic disorder. The distinct responses these two disorders had to imipramine therapy was one reason to distinguish between the two. Since the revised DSM-III (DSM-III-R), worry about a number of life circumstances has been gradually emphasized as the distinctive symptom of GAD. Thus, a cognitive a…

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A proposal for a dimensional classification system based on the shared features of the DSM-IV anxiety and mood disorders: implications for assessment and treatment.

A wealth of evidence attests to the extensive current and lifetime diagnostic comorbidity of the Diagnostic and Statistical Manual of Mental Disorders (4th ed., DSM-IV) anxiety and mood disorders. Research has shown that the considerable cross-sectional covariation of DSM-IV emotional disorders is accounted for by common higher order dimensions such as neuroticism/behavioral inhibition (N/BI) and low positive affect/behavioral activation. Longitudinal studies indicate that the temporal covariation of these disorders can be explained by changes in N/BI and, in some cases, initial levels of N/BI are predictive of the temporal course of emotional disorders. The marked phenotypal overlap of the DSM-IV anxiety and mood disorders is a frequent source of diagnostic unreliability (e.g., temporal overlap in the shared features of generalized anxiety disorder and mood disorders, situation specific…

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Association between anxiety, health-related quality of life and functional impairment in primary care patients with chronic pain.

Objective: Anxiety and chronic pain are prevalent and frequently co-occur. Our purpose was to examine the association between anxiety, health-related quality of life (HRQL) and functional impairment in primary care patients with chronic musculoskeletal pain. Methods: Data were drawn from baseline interviews of the 250 primary care patients enrolled in the Stepped Care to Optimize Pain care Effectiveness trial. Validated measures were used to determine the proportion of patients screening positive for five common anxiety disorders: generalized anxiety, panic, social anxiety, posttraumatic stress and obsessive-compulsive disorder. Bivariate analyses examined associations between the type and number of anxiety disorders for which patients screened positive and representative pain, psychological and other HRQL outcomes. Multivariable models controlling for major depression and other covariat…

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