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Considers how Quintus captures his stance towards Homer through the presentation of family relationships. Harnessing the frequent collusion between generational and poetic succession (examined using Harold Bloom’s ‘anxiety of influence’ and very prevalent in silver Latin poetry), Quintus first depicts a series of failed rivalrous filial usurpations – Penthesilea, Ajax, Achilles, Memnon – and shows that they fail because of their violent antagonism. He then portrays the two most successful examples of succession – Neoptolemus and Athena – as characterised by impersonation, embodiment and necromantic possession. This contrast becomes a reading of Quintus’ own positive and assimilating approach to Homer. Becoming the poetic father thus becomes the surest way to achieve lasting renown.
Work in occupations with higher levels of occupational stress can bring mental health costs. Many older adults worldwide are continuing to work past traditional retirement age, raising the question whether older adults experience depression, anxiety, or burnout at the same or greater levels as younger workers, and whether there are differences by age in these levels over time.
Longitudinal survey of 1161 currently employed US clergy followed every 6–12 months for up to 66 months.
Depression was measured with the 8-item Patient Health Questionnaire (PHQ-8). Anxiety was measured using the anxiety component of the Hospital Anxiety and Depression Scale (HADS). Burnout symptoms were assessed using the three components of the Maslach Burnout Inventory: emotional exhaustion (EE), depersonalization (DP), and sense of personal accomplishment (PA).
Older participants had lower scores of depression, anxiety, EE, and DP and higher levels of PA over time compared to younger adults. Levels of EE decreased for older working adults, while not significantly changing over time for those younger. DP symptoms decreased over time among those 55 years or older but increased among those 25–54 years.
Older working adults may have higher levels of resilience and be able to balance personal life with their occupation as well as may engage in certain behaviors that increase social support and, for clergy, spiritual well-being that may decrease stress in a way that allows these older adults to appear to tolerate working longer without poorer mental health outcomes.
The aim of this study was to evaluate effects of fear and anxiety on nutrition during the COVID-19 pandemic.
Participants were recruited by an online survey in this cross-sectional study. The questionnaire included general demographic characteristics, level of fear and anxiety, nutritional habits. The FCV-19S and GAD-7 was used to determine fear and anxiety.
A total sample consisted of 1012 adults.
In pandemic, fear and anxiety caused individuals to skip breakfast and snacks less, but more at lunch. A positive significantly correlation was observed between the increase consumption of yoghurt, cheese and water and FCV-19S scores. There was a positive significantly correlation between cheese, legume, nuts-seeds, cake-cookies, dessert and tea consumption and GAD-7 scores. A 1 unit increase in FCV-19S scores affected 1.04 times of increased consumption of yoghurt, kefir, cheese, nuts-seeds, fruit (dry) and rice-pasta. A 1 unit increase in GAD-7 scores affected 1.03 times of increased consumption of egg and fruit (fresh), 1.04 times of increased consumption of cheese and other vegetables, 1.05 times of increased consumption of milk, meat, poultry, fish, legume, nuts-seeds, fruit (dry), cake-cookies and tea, 1.07 times of increased consumption of rice-pasta and coffee, 1.08 times of increased consumption of bread and dessert.
In pandemic, anxiety and fear led to changes in individuals’ nutritional habits and food preferences. Continuous surveillance of psychological consequences for outbreaks should become routine as part of preparedness efforts worldwide. In addition, the effects of these psychological problems on nutrition should be evaluated.
To assess the prevalence of mood disorders in Brazilian soldiers.
A total of 353 soldiers answered the following questionnaires: the Beck Depression Inventory (BDI), the State-Trait Anxiety Inventory (STAI), the Profile of Mood States (POMS), the medical outcomes study SF-36 questionnaire, the Baecke questionnaire to assess the level of habitual physical activity (HPA) and the socioeconomic (SE) status questionnaire. Participants were classified according to their desire to pursue a military career.
Accordingly, 246 participants were allocated to a volunteer group (VG) and 107 to a non-volunteer group (NVG). According to the BDI data for both groups, 66.5% of the soldiers showed at least mild depressive symptoms. Additionally, the STAI data revealed that 27.8% and 8.4% of the soldiers showed high scores on state anxiety and trait anxiety, respectively. The POMS scores were higher in the NVG compared to the VG (Δ% = +263%, p < 0.0001). Of the eight subscales, the SF-36 questionnaire showed statistical differences between the groups in the following five dimensions: functioning capacity (p = 0.0046), pain (p = 0.0011), vitality (p < 0.0001), role limitations due to emotional problems (p < 0.0001) and mental health (p < 0.0001).
Mood disorder levels were higher and health status and related quality of life levels were lower in the NVG as compared to the VG.
The constructs now subsumed under the label “internalizing disorders” had garnered the attention of researchers and practitioners long before the recent terminology was coined in the 1980s. Spanning decades of research, intervention, and practice, this chapter describes childhood internalizing disorders by their traits and prevalence, and then highlights the important contribution of factor analysis in marking their scientific evolution. We learn how exposure of the underlying dimensionality of internalizing disorders, along with critical refinements to terminology, precipitated the identification of early (subsyndromal) symptoms of depression and anxiety, and paved the way for the development of assessment scales that would ultimately expand our ability to intervene with precision, refine research, develop methods for prevention, identify moderator variables, and discover the potential of universal screening. The chapter concludes by providing a brief sampler of tools currently in use by practitioners and schools for the treatment, reduction of symptoms, and prevention of internalizing disorders.
Barbiturates and benzodiazepines (BZDs) can relieve insomnia and high levels of anxiety. Effects of barbiturates are similar to that of alcohol. Barbiturate use entails risk of addiction, and death from accidental or suicidal overdose. In the 1970s, the safer BZDs became available. Like barbiturates, BZDs facilitate the neural inhibitory action of the neurotransmitter GABA, but are unlikely to produce pleasurable intoxication and are less addictive than barbiturates. BZDs can impair driving and increase the probability of accidental falls, especially when used concurrently with alcohol. Stopping extended intake of BZDs can result in a withdrawal syndrome of anxiety, insomnia, and a general feeling of malaise. Addiction to BZDs occurs most often in individuals with an SUD of another addictive drug. As a secondary drug of abuse, BZDs can potentiate the effects of opioid drugs or alcohol, and relieve the anxiety and agitation of addictive stimulant use. Newer drugs including zolpidem (Ambien), benzodiazepine-receptor agonists with little abuse potential that produce a brief hypnotic effect with little residual sedation the following day, are now most often used to treat insomnia.
Originated in China in December 2019 Corona virus disease (COVID-19) has rapidly spread to around 216 countries in the world by May 2020. Dentists being at a higher risk of contacting the disease, the present study assessed the fear and anxiety among dental practitioners of COVID-19.
An online cross-sectional questionnaire survey comprising of nine questions was conducted among dental practitioners of Telangana. Age, gender, qualification, type of practice, years of practice, place of residence were the demographic variables recorded. The response to each question was recorded in a YES or NO format, mean fear score calculated to categorize into low and high levels of fear. Comparison of mean fear score was done using t- test for two variables and ANOVA for three or more than three variables. Multiple logistic regression analysis of the levels of fear with demographic variables was done. p<0.05 was considered statistically significant.
The mean fear and anxiety score of this study population reported was high 6.57 +2.07, with 58.31% of the population presenting with a low level of fear and anxiety. Only qualification (p=0.045)and gender (p=0.035) revealed a significant difference in fear to Q7and Q8 respectively. Irrespective of the age, gender, qualification, type of practice and years of practices the levels of fear reported in the present study was high similar. Respondents between 41- 60 yrs age (6.70+ 2.01) and those with individual practices (6.70+2.06) exhibited high level of fear score.
The present study demonstrates a cross sectional data of fear and anxiety among dental practitioners during the COVID-19 outbreak. Heightened levels of fear observed call for a nationwide analysis of fear among dentists and deliberate management strategies for the same.
Psychosocial factors have been implicated as both a cause and consequence of hypertension in the general population but are less understood in relation to hypertensive disorders of pregnancy (HDP). The aims of this review were to (1) synthesize the existing literature examining associations between depression and/or anxiety in pregnancy and HDP and (2) assess if depression and/or anxiety in early pregnancy was a risk factor for HDP.
A comprehensive search of Medline, Embase, CINAHL, and PsycINFO was conducted from inception to March 2020 using terms related to ‘pregnancy’, ‘anxiety’, ‘depression’, and ‘hypertensive disorders’. English-language cohort and case-control studies were included if they reported: (a) the presence or absence of clinically significant symptoms of depression/anxiety, or a medical record diagnosis of depression or an anxiety disorder in pregnancy; (b) diagnosis of HDP; and/or (c) data comparing the depressed/anxious group to the non-depressed/anxious group on HDP. Data related to depression/anxiety, HDP, study characteristics, and aspects related to study quality were extracted independently by two reviewers. Random-effects meta-analyses of estimated pooled relative risks (RRs) were conducted for depression/anxiety in pregnancy and HDP.
In total, 6291 citations were retrieved, and 44 studies were included across 61.2 million pregnancies. Depression and/or anxiety were associated with HDP [RR = 1.39; 95% confidence interval (CI) 1.25–1.54].
When measurement of anxiety or depression preceded diagnosis of hypertension, the association remained (RR = 1.27; 95% CI 1.07–1.50). Women experiencing depression or anxiety in pregnancy have an increased prevalence of HDP compared to their non-depressed or non-anxious counterparts.
Cognitive behavior therapy (CBT) is effective for most patients with a social anxiety disorder (SAD) but a substantial proportion fails to remit. Experimental and clinical research suggests that enhancing CBT using imagery-based techniques could improve outcomes. It was hypothesized that imagery-enhanced CBT (IE-CBT) would be superior to verbally-based CBT (VB-CBT) on pre-registered outcomes.
A randomized controlled trial of IE-CBT v. VB-CBT for social anxiety was completed in a community mental health clinic setting. Participants were randomized to IE (n = 53) or VB (n = 54) CBT, with 1-month (primary end point) and 6-month follow-up assessments. Participants completed 12, 2-hour, weekly sessions of IE-CBT or VB-CBT plus 1-month follow-up.
Intention to treat analyses showed very large within-treatment effect sizes on the social interaction anxiety at all time points (ds = 2.09–2.62), with no between-treatment differences on this outcome or clinician-rated severity [1-month OR = 1.45 (0.45, 4.62), p = 0.53; 6-month OR = 1.31 (0.42, 4.08), p = 0.65], SAD remission (1-month: IE = 61.04%, VB = 55.09%, p = 0.59); 6-month: IE = 58.73%, VB = 61.89%, p = 0.77), or secondary outcomes. Three adverse events were noted (substance abuse, n = 1 in IE-CBT; temporary increase in suicide risk, n = 1 in each condition, with one being withdrawn at 1-month follow-up).
Group IE-CBT and VB-CBT were safe and there were no significant differences in outcomes. Both treatments were associated with very large within-group effect sizes and the majority of patients remitted following treatment.
Smoking rates in people with depression and anxiety are twice as high as in the general population, even though people with depression and anxiety are motivated to stop smoking. Most healthcare professionals are aware that stopping smoking is one of the greatest changes that people can make to improve their health. However, smoking cessation can be a difficult topic to raise. Evidence suggests that smoking may cause some mental health problems, and that the tobacco withdrawal cycle partly contributes to worse mental health. By stopping smoking, a person's mental health may improve, and the size of this improvement might be equal to taking antidepressants. In this article we outline ways in which healthcare professionals can compassionately and respectfully raise the topic of smoking to encourage smoking cessation. We draw on evidence-based methods such as cognitive–behavioural therapy (CBT) and outline approaches that healthcare professionals can use to integrate these methods into routine care to help their patients stop smoking.
Prior theory and research has implicated disgust as relevant to some, but not all phobias.
The current study examined whether anxiety sensitivity is more relevant to certain specific phobias and whether disgust sensitivity is more relevant to other specific phobias.
Participants (n = 201) completed measures of anxiety sensitivity, disgust sensitivity and measures of aversive reactions in the presence of two fear-relevant stimuli (i.e. heights and small, enclosed spaces) and two disgust-relevant stimuli (i.e. spiders and blood/injury).
Results of multiple linear regression analyses revealed that disgust sensitivity showed significant associations with aversive reactions in all four stimulus domains after controlling for anxiety sensitivity. After controlling for disgust sensitivity, anxiety sensitivity showed associations with the two fear-relevant phobias but not with the two disgust-relevant phobias included in this study. Anxiety sensitivity also showed an association with variance specific to one of the two fear-relevant specific phobias included in the study. Disgust sensitivity also showed associations with variance specific to both of the disgust-relevant phobias included in the study but not with variance specific to either of the fear-relevant specific phobias.
These results provide evidence that the distinction between fear-relevant and disgust-relevant specific phobias is meaningful and also implicate disgust sensitivity as relevant to aversive reactions to all stimuli included in this study.
Generalised anxiety disorder and symptoms are associated with poor physical, emotional and social functioning and frequent primary and acute care visits. We investigated recent temporal trends in anxiety and related mental illness in UK general practice.
The aims of this analysis are to examine temporal changes in recording of generalised anxiety in primary care and initial pharmacologic treatments.
Annual incidence rates of generalised anxiety diagnoses and symptoms were calculated from 795 UK general practices contributing to The Health Improvement Network (THIN) database between 1998 and 2018. Poisson mixed regression was used to account for age, gender and general practitioner practice. Subsequent pharmacologic treatment was examined.
Generalised anxiety recording rates increased in both genders aged 18–24 between 2014 and 2018. For women, the increase was from 17.06 to 23.33/1000 person years at risk (PYAR); for men, 8.59 to 11.65/1000 PYAR. Increases persisted for a composite of anxiety and depression (49.74 to 57.81/1000 PYAR for women; 25.41 to 31.45/1000 PYAR for men). Smaller increases in anxiety were seen in both genders age 25–34 and 35–44. Anxiety rates among older patients remained stable, although a composite of anxiety and depression decreased for older women. About half of drug-naïve patients were prescribed anxiety drugs within 1 year following diagnosis. The most common choice was a selective serotonin reuptake inhibitor. Benzodiazepine prescription rate has fallen steadily.
We observed a substantial increase in general practitioner consulting for generalised anxiety and depression recently, concentrated within younger people and in particular women.
The Geriatric Anxiety Inventory (GAI) and its short form (GAI-SF) are self-reported scales used internationally to assess anxiety symptoms in older adults. In this study, we conducted the first critical comprehensive review of these scales’ psychometric properties. We rated the quality of 31 relevant studies with the COSMIN checklist. Both the GAI and GAI-SF showed adequate internal consistency and test-retest reliability. Convergent validity indices were highest with generalized anxiety measures; lowest with instruments relating to somatic symptoms. We detected substantial overlap with depression measures. While there was no consensus on the GAI’s factorial structure, we found the short version to be unidimensional. Although we found good sensitivity and specificity for detecting anxiety, cut-off scores varied. The GAI and GAI-SF are relevant instruments showing satisfactory psychometric properties; to broaden their use, however, some psychometric properties warrant closer examination. This review calls attention to weaknesses in the methodological quality of the studies.
Maternal antenatal anxiety is very common, and despite its short- and long-term effects on both mothers and fetus outcomes, it has received less attention than it deserves in scientific research and clinical practice. Therefore, we aimed to estimate the prevalence of state anxiety in the antenatal period, and to analyze its association with demographic and socioeconomic factors.
A total of 1142 pregnant women from nine Italian healthcare centers were assessed through the state scale of the State–Trait Anxiety Inventory and a clinical interview. Demographic and socioeconomic factors were also measured.
The prevalence of anxiety was 24.3% among pregnant women. There was a significantly higher risk of anxiety in pregnant women with low level of education (p < 0.01), who are jobless (p < 0.01), and who have economic problems (p < 0.01). Furthermore, pregnant women experience higher level of anxiety when they have not planned the pregnancy (p < 0.01), have a history of abortion (p < 0.05), and have children living at the time of the current pregnancy (p < 0.05).
There exists a significant association between maternal antenatal anxiety and economic conditions. Early evaluation of socioeconomic status of pregnant women and their families in order to identify disadvantaged situations might reduce the prevalence of antenatal anxiety and its direct and indirect costs.
Social anxiety disorder (SAD) is characterized by anxiety regarding social situations, avoidance of external social stimuli, and negative self-beliefs. Virtual reality self-training (VRS) at home may be a good interim modality for reducing social fears before formal treatment. This study aimed to find neurobiological evidence for the therapeutic effect of VRS.
Fifty-two patients with SAD were randomly assigned to a VRS or waiting list (WL) group. The VRS group received an eight-session VRS program for 2 weeks, whereas the WL group received no intervention. Clinical assessments and functional magnetic resonance imaging scanning with the distress and speech evaluation tasks were repeatedly performed at baseline and after 3 weeks.
The post-VRS assessment showed significantly decreased anxiety and avoidance scores, distress index, and negative evaluation index for ‘self’, but no change in the negative evaluation index for ‘other’. Patients showed significant responses to the distress task in various regions, including both sides of the prefrontal regions, occipital regions, insula, and thalamus, and to the speech evaluation task in the bilateral anterior cingulate cortex. Among these, significant neuronal changes after VRS were observed only in the right lingual gyrus and left thalamus.
VRS-induced improvements in the ability to pay attention to social stimuli without avoidance and even positively modulate emotional cues are based on functional changes in the visual cortices and thalamus. Based on these short-term neuronal changes, VRS can be a first intervention option for individuals with SAD who avoid society or are reluctant to receive formal treatment.
Questions have been raised regarding differences in the standards of care that patients receive when they are admitted to or discharged from in-patient units at weekends.
To compare the quality of care received by patients with anxiety and depressive disorders who were admitted to or discharged from psychiatric hospital at weekends with those admitted or discharged during the ‘working week’.
Retrospective case-note review of 3795 admissions to in-patient psychiatric wards in England. Quality of care received by people with depressive or anxiety disorders was compared using multivariable regression analyses.
In total, 795 (20.9%) patients were admitted at weekends and 157 (4.8%) were discharged at weekends. There were minimal differences in quality of care between those admitted at weekends and those admitted during the week. Patients discharged at weekends were less likely to be given sufficient notification (48 h) in advance of being discharged (OR = 0.55, 95% CI 0.39–0.78), to have a crisis plan in place (OR = 0.65, 95% CI 0.46–0.92) or to be given medication to take home (OR = 0.45, 95% CI 0.30–0.66). They were also less likely to have been assessed using a validated outcome measure (OR = 0.70, 95% CI 0.50–0.97).
There is no evidence of a ‘weekend effect’ for patients admitted to psychiatric hospital at weekends, but the quality of care offered to those who were discharged at weekends was relatively poor, highlighting the need for improvement in this area.
In this article, I provide an analysis of the widespread, intellectually fascinating, and existentially challenging phenomenon of self-reflexive anxiety in which we feel threatened by what or who we are (or have been or will become). I focus on those cases in which we take an event or action whose possible occurrence we attribute to ourselves to be expressive or constitutive of our identity. As I argue, depending on the kind of event we are dealing with, our descriptive self-conception, our self-esteem, or our evaluative self-conception are at stake. In all cases, we are confronted with a dialectic between self and other, activity and passivity inherent in our personhood or even in our agency. I demonstrate how my analysis is not only of intrinsic value, but it can also help us in achieving a better understanding of self-reflexive emotions in general and ‘traditional’ self-reflexive emotions like shame in particular.
The aim of this chapter is to highlight the impact of trauma and intervention with Palestinian children. A reanalysis of secondary data of previous work in the field using the words trauma, Palestinians, intervention, PTSD, anxiety, depression, Gaza Strip, and West Bank was entered in web-based research databases including Medline, PsycINFO, and Scholar Portal. The severity of traumatic events is changing and the types of traumatic experiences now include seeing mutilated bodies on TV, hearing and seeing shelling, exposure to sonic bombs, and witnessing home bombardment and demolition. PTSD prevalence ranged in children from 10 percent to 71 percent while the rate of PTSD in the West Bank ranged from 35 percent to 36 percent. The rate of anxiety ranged from 28.5 percent to 33.9 percent, and depression ranged from 40 percent in children of Gaza and the West Bank to 50.6 percent. The general mental health of children rated by parents and teachers was 20.9 percent and 31.8 percent. Studies showed risk factors that interfered with well-being such as being a boy, living in a large family, low socioeconomic status of the family, exposure to domestic and political violence, and being an orphaned child. Other risk factors included children in the labor force, with physical problems, and living near the border areas. Intervention studies had equivocal results when using psychodrama, school mediation, writing for recovery, and teaching children recovery techniques. This review showed that Palestinian children’s exposure to war and conflict leads to negative outcomes including mental health problems that triggered the start of community intervention programs. These programs did not change the negative impact of trauma, which highlights the need to find other ways to protect children in Palestine and help them cope with their daily life adversities and war.