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Attack of Nerves
Published in Paul Ian Steinberg, Psychoanalysis in Medicine, 2020
By applying object relations theory, both examiners and candidates can increase understanding of anxiety in oral certification examinations in order to enhance the fairness and validity of the examinations. Unconscious images of self and others that examiners and candidates may project on to each other can affect the examination. The examiner must observe himself, the candidate, and the other examiner, lest a transference affecting the process of the examination occur, and to avoid an enactment that might interfere with the examination. The result of these observations should appropriately support the candidate in functioning at an optimal level of competence. Unconscious processes may prejudice the examiner’s attitude towards a candidate, thus jeopardizing the examination’s fairness and validity. The candidate’s anxiety, based on projections onto the examiners, may interfere with her optimal functioning and affect the outcome. If a candidate’s anticipatory anxiety is excessive, she needs to decide if it needs to be managed on a symptomatic or psychotherapeutic basis. Candidates and examiners both need to monitor their feelings during the examination in order to optimize the latter’s fairness and validity. All these issues may also be considered in the relationship between psychiatric educators and trainees.
Anxiolytics: Predicting Response/Maximizing Efficacy
Published in Mark S. Gold, R. Bruce Lydiard, John S. Carman, Advances in Psychopharmacology: Predicting and Improving Treatment Response, 2018
Assessment of response to anxiolytic medications in general requires that specific anxiety symptoms are measured as targets of drug action. Where and when does the patient experience anticipatory anxiety and how much of it is experienced? In the measurement of anxiety in various mental disorders, we recommend the use of mood adjective checklists, or some other validated anxiety scale. Izard’s mood adjective checklist, the Differential Emotive Scale-State Anxiety Inventory is particularly useful because it measures all seven fundamental motions simultaneously and only requires about 5 min for the patient to fill out.4 These are filled out when or shortly after anxiety is experienced, and they enable good quantification of target anxiety. Even with mood adjective checklist results, it is important to question the patient carefully about changes in target symptoms, the presence of new symptoms, or possible side effects. At the time the lorazepam script is given, the patient is instructed about anxiety record keeping and when and how to fill out the mood adjective checklist. A fairly accurate quantification of the patient’s anxiety can often be estimated from clinical history, and this provides part of the baseline. If laboratory tests are pending, it is possible to have patients delay starting the medications until a small baseline anxiety record can be obtained.
Children, Cancer, and Child Life
Published in Lawrence C. Rubin, Handbook of Medical Play Therapy and Child Life, 2017
Meredith Cooper, Melissa Hicks
Additionally, many children may experience anticipatory anxiety prior to procedures or hospital visits. Cognitive coping strategies, such as thought stopping and cognitive reframing, have been extremely useful for this author when addressing anticipatory anxiety. While it is not about the process, sometimes a concrete finished product can serve as a reminder for children of the skills learned. For example, creating a first aid kit for coping is one such concrete intervention. After discussing coping strategies that the child may find useful and practicing such skills, the child can ‘add’ them to their first aid kit. The opportunity for creativity is endless and at the discretion of the clinician and child. Bubbles, party blowers, a magic wand, timers, lists with positive reframe statements, and small aromatherapy containers are a few examples of what some children choose. The activity can be as simple as the child drawing a suitcase-type figure on paper and drawing or writing the skills inside it, or creating an actual first aid kit like the cardboard or metal ones purchased from a craft store. This author has even had different containers, such as boxes that are empty inside, each representing a different strategy the child can employ.
Hypnotic Ego-strengthening: Where We’ve Been and the Road Ahead
Published in American Journal of Clinical Hypnosis, 2020
Many medical treatments utilize ego-strengthening suggestions for preparation for procedures to reduce anxiety, to enhance relaxation during procedures, and to promote healing and follow-up care after treatment. For example, Philip Shenefelt (Shenefelt, 2017) utilizes ego- strengthening suggestions for relaxation and relief of discomfort during surgical procedures for skin disorders. While the patient is in trance, he includes positive suggestions for effectiveness and self-worth. He also provides posthypnotic suggestions to target further strengthening of the effects and makes recordings to reinforce direct suggestions for patients to use for self-hypnosis. There are numerous applications of ego-strengthening techniques for dealing with anticipatory anxiety that can occur with the anticipation of medical and dental procedures as well as experiences such as test-taking, air flights, public speaking, and performance anxiety in general (Frederick & McNeal, 1999).
Misophonia and comorbid psychiatric symptoms: a preliminary study of clinical findings
Published in Nordic Journal of Psychiatry, 2019
Mercede Erfanian, Christiana Kartsonaki, Azita Keshavarz
The similarity between misophonia and agoraphobia may relate to the anticipatory anxiety. In both conditions, the anticipatory anxiety is followed by physiological reactivity. With continued neurophysiological discomfort as such, an individual with misophonia may become isolated [42]. However, there are two remarkable differences. While agoraphobics avoid the public places and crowded area for fear of scrutiny and humiliation by others in case of panic attacks in public [43], misophonia sufferers seem to avoid these situations only if ‘the disturbing triggers’ are present. The dominant negative emotion in agoraphobia is anxiety and intense fear (DSM-5).
Risks and benefits of medications for panic disorder: a comparison of SSRIs and benzodiazepines
Published in Expert Opinion on Drug Safety, 2018
Laiana A. Quagliato, Rafael C. Freire, Antonio E. Nardi
PD is a chronic condition with relevant effects on patients’ quality of life, and requires long-term management. For the individual patient, the goal of therapy is complete cessation of panic attacks and associated anticipatory anxiety, along with the treatment of any comorbidity and reduction in functional disability. The review of the benefits and the risks associated with a drug is basically an evaluation of two dimensions. The dimension of benefits is measured primarily in terms of the successful treatment of the condition for which the drug is indicated. The dimension of risks includes the safety profile observed in the form of the sum of all adverse drug reactions. The current review showed strong evidence of the effectiveness of SSRIs and benzodiazepines in the treatment of PD. Few studies to date have performed head-to-head comparisons of these two drug classes. When looking at the comparison between individual benzodiazepines, the available evidence, suggests that there is no significant difference between individual benzodiazepines in terms of response rate and dropout due to any reason [60]. Furthermore, no evidence suggests a differential efficacy within the SSRIs class [60]. Therefore, the main question of whether there are differences between antidepressants and benzodiazepines, and between individual antidepressants and individual benzodiazepines, remains unanswered. Future studies on the pharmacological treatment of PD should include direct comparison of risks and benefits of these medications. This could help improve the evidence-based pharmacotherapy of PD. Although extremely important, evidence-based medicine is population-based medicine, whereas clinical medicine is practiced one patient at a time. What is right for the average patient is not always right for the individual patient. Therefore, knowing the risks and benefits of the most widely prescribed medications in PD is not only crucial for evolving guidelines, but is also highly important for individual physicians to choose the most adequate drug for each patient and thus achieve the most successful treatment.