The aim of the study was to seek the prevalence of fatigue among students with trait-state anxiety in India and Iran which Ardebil of Iran and Aligarh of India was selected. The cases’ quantity was compared and the causes of their differences were studied.

1000 students of Medical Azad university of Iran branch of Ardebil and 1500 students of Medical University of Aligarh branch of India were selected by stratified sampling method and Spillberger Anxiety trait-state Questionnaire along with Croup Fatigue Questionnaire were used. When anxious subjects were known, the subject's fatigue was analyzed. Descriptive and t-test statistics were used to analyze the data.

Results showed anxiety level in students of Iran is higher than India. Trait anxiety is more than state anxiety in Iran students but both trait and state anxiety in India students are lower than Iran although fatigue is more prevalent in India anxious students. In both countries fatigue prevalence in students who had state anxiety were higher than students who had trait anxiety.

According to the results of this study and the other studies fatigue in anxious people is more than normal people. The reason of High prevalence of trait anxiety in students of west part of country, high prevalence of fatigue in anxious students of north part of the country, and other differences and similarities which have been concluded in this study, is due to cultural, political and environmental factors that have been elaborated in the full text of the study.

The aim of our study was to evaluate the relationships between alexithymia and suicidal ideation in a sample of adult outpatients with obsessive-compulsive disorder (OCD).

A sample of 90 adult outpatients with DSM-IV diagnosis of OCD were tested with tested with the Yale-Brown Obsessive Compulsive Scale, Toronto Alexithymia Scale (TAS-20), Scale for Suicide Ideation (SSI) and Montgomery-Asberg Depression Rating Scale (MADRS).

35 subjects were categorized as alexithymics and showed earlier onset, longer duration of illness and more likelihood to have a chronic course than nonalexithymics; they also scored higher on the MADRS and SSI. Results of a linear regression showed that chronic OCD course together with Difficulty in Identifying Feelings dimension of TAS-20 and higher MADRS scores were significantly associated with higher scores on the SSI.

Suicidal ideation is frequent among adult outpatients with OCD and is strongly related to the presence of alexithymia and depressive symptoms. Implications are discussed.

Assess possible differences in quality of life assessment between the group of veterans who meet the criteria for the diagnosis of chronic PTSD and the group of veterans who do not meet the criteria for the diagnosis of chronic PTSD. Compare and analyze possible differences between the two groups in socio-demographic characteristics.

The subjects were 100 adult men, veterans with combat exposure who met the inclusion criteria for the study and agreed to sign the informed consent. The subjects were divided in two groups, each comprising of 50 subjects. Experimental group consisted of 50 veterans with combat exposure who meet the criteria for the diagnosis of chronic PTSD according to ICD-10. Control group consisted of 50 veterans with combat exposure who do not meet the criteria for the diagnosis of chronic PTSD. The subjects were assessed with the following standardized psychometric instruments: MMSE, MINI, IES-90 R, MANSA; Life Stressor List and a socio-demographic questionnaire:

The subjects with PTSD assessed satisfaction with all components of the quality of life significantly lower than the subjects from the non-PTSD group. Yet, the scores assessing the satisfaction with family life, although lower than in the non-PTSD group, were relatively high in the PTSD group (4,76 ± 1,3).

The results indicate the importance of factors of both PTSD diagnosis and the posttraumatic environment on the subjective perception of the quality of life for the subjects in this study.

Several studies showed respiratory irregularities in patients with Panic Disorder (PD). This led to the development of the Breathing Therapy, a therapeutic strategy aimed to modify dysfunctional respiratory patterns. However, it remains unclear whether and how BT regularize respiration. The aim of this study was to evaluate whether and how a single performance of a specific respiratory technique could modify respiration at rest.

Twenty-eight healthy subjects were randomly assigned to two groups, performing either a slowed 9-breaths-per-minute respiration (group 1) or a “combined” respiration (group 2) so as to evaluate the most effective respiration able to produce respiratory modifications. Respiratory recording took 40 minutes including basal respiration (T1), breathing technique (T2), natural breathing (T3). We evaluated Tidal Volume (VT), respiratory frequency (RF) and end-tidal PCO2 (PetCO2) standard deviations (SD), Approximate Entropy (ApEn).

In both groups ApEn values significantly decreased from T1 to T3. However, we observed an increase of ApEn values from T2 to T3 and of VT'SD from T1 to T2. In group 2 RF'SD decreased and PetCO2'SD increased from T1 to T3. RF'SD increase in both groups from T2 to T3.

Both techniques could modify respiratory physiology, leading to reduced ApEn values and increased respiration variability. The repeated practice of such respiratory techniques could modify respiratory functioning. Further studies are needed to determine which technique has the highest likelihood to reduce breathing irregularities and its possible use for the treatment of PD.

The Kashmir Valley is a chronic conflict zone with a community prevalence of post traumatic stress disorder of 15.9%. The present study was conducted with the aim to find the psychiatric co-morbidity in patients suffering from Post Traumatic Stress Disorder seeking treatment at Government Psychiatric Diseases Hospital Srinagar, Kashmir India.

Sample comprised of 100 consecutive cases of post traumatic stress disorder (PTSD) with an age group of 16 -65 years diagnosed according to DSM - IV laid criteria. Patients with a prior history of any DSM-IV Axis- I or Axis- II disorder before the development of PTSD were excluded from the study. A detailed semi structured interview with all relevant items from MINI PLUS (MINI International Neuropsychiatric Interview based on DSM - IV), was administered to all the cases included in the study to find the co-morbidity.

Psychiatric Co-morbidity was highly prevalent in patients of Post Traumatic stress Disorder in our study. Major Depressive disorder (80%) formed the commonest co morbidity followed by Panic Disorder (32%), substance abuse and conversion disorder (16% each). Other co-morbidities include agoraphobia (8%), generalized anxiety disorder (8%), obsessive compulsive disorder (4%).

Post Traumatic Stress Disorder is a complex disorder with high prevalence of co-morbidity. The classification of PTSD as anxiety disorder with overlap in the mood disorders needs to be further studied.

There are several useful methods to induce anxiety in patients with panic disorder with agoraphobia (PDA). Our aim was to ascertain if a virtual reality simulation could induce anxiety and physiologic alterations in PDA patients.

10 healthy controls (HC) and 10 patients who fulfilled DSM-IV criteria for PDA were recruited for this study. Before and after the experiment the anxiety level was measured with the Subjective Units of Distress Scale (SUDS), the Diagnostic Symptom Questionnaire (DSQ) was used to ascertain panic attack symptoms. The heart rate, skin conductance and respiration parameters were monitored during the exposure to the VR. The virtual reality simulation was a 3D computer animation of a short bus trip, from a first person perspective. The Igroup Presence Questionnaire (IPQ) was used to measure the sense of presence.

PDA patients had higher familial history of panic disorder. From the 10 PDA patients only 3 were not taking medications. In PDA patients the VR exposure increased anxiety levels, they also had higher scores in the DSQ and two of them had panic attacks. Compared to the HC, the PDA patients had higher skin conductance levels, electrodermal response magnitude, respiratory rate, tidal volume, and respiratory rate irregularities. The heart rates were higher for patients who had panic attacks, followed by the HC and the non-panicking patients. Regarding the sense of presence the two groups were similar.

This study indicated that VR exposure may induce anxiety, electrodermal and respiratory alterations in patients with PDA.

Researchers have assumed that self-esteem operate only in a conscious mode. In the last years, researchers showed that self-esteem is determined by both explicit and implicit process and new instruments, like Implicit Association Test (IAT), has been designed to measure implicit self-esteem. IAT measures the relative strength of association between pairs of concepts. This study investigated the correlations between implicit and explicit measures of self-esteem. We also investigate which type of the implicit instrument is preferable for an application to patients with a diagnosis of Social Phobia.

A traditional IAT (IAT-A) and a single-category IAT (SC-A) measuring implicit self-esteem were structured. IAT instruments and a traditional self-reports that assessed self-esteem were administered to 25 healthy subjects. BIDR, a self-report that assess the socially desirable responding bias, was also administered.

No correlation between IAT-A and SC-A was found. IAT-A and SC-A did not show correlations with explicit self-esteem measures. Moreover, IAT-A showed a significant correlation with BIDR. At last, a significant correlations between explicit self-esteem measures was found.

Results suggested a distinction between implicit and explicit self-esteem construct. This distinction has important clinical implication. Because off IAT-A is more complex and needs more cognitive resources it could be suppose that this test leaves space to deliberative processes, so automaticity in responding could be reduced. In conclusion, above the theoretical basis of the original model, SC-A results preferable to apply in a clinical sample, for its simplicity and its low correlation with the BIDR.

Fear conditioning (FC) has been proposed as crucial factor in the etiology and maintenance of panic disorder (PD). This study compared the acquisition of discriminative fear learning between PD patients and healthy subjects (CTR). The main purpose was to test the hypothesis that abnormalities in this process may exist in this population, particularly referred to conditioned responses (CRs) and discriminative fear learning acquisition.

Aversive discriminative conditioning paradigm was administered to 45 patients with a DSM-IV diagnosis of PD with agoraphobia and to 43 healthy subjects. The visual-auditory conditioning paradigm is composed by four visual stimuli as conditioned stimulus (CSs) and a startlingly loud sound as the unconditioned stimulus (US). Only one stimulus (CS+) was followed by the US, instead remainder stimuli were never paired with the US (CS-). The protocol consisted of 3 phases: habituation (HAB), acquisition (ACQ) and extinction (EXT). Skin conductance response (SCR) was used as dependent variable.

During HAB phase no differences were found in response to all stimuli. During ACQ phase, the two groups did not differ in response to CS+; instead patients showed significantly greater reactivity to CS- than controls.

Results suggest equal level of fear acquisition and impaired discriminative fear learning in PD population; moreover discriminative deficit is driven by enhanced safety learning rather than any abnormality in excitatory danger learning. Enhanced responding to CS- among PD may also be interpreted as over-generalization of conditioned fear. Our result have important clinical implication, particularly for behaviour cognitive therapy in Panic Disorder.

To study the prevalence of social anxiety problem and potential risk factors that may be associated with social anxiety among Malaysian medical undergraduate students.

Social Phobia Inventory (SPIN) and a questionnaire assessing gender, religion, number of siblings, type of previous school and partner status were given to 167 final year medical students at University Malaya.

There were 101 respondents of which 56% of the medical students scored > 19 in the Social Phobia Inventory (SPIN) suggesting that they may be having social anxiety. However, none of the variables analysed were significantly associated with social anxiety.

More than half of the medical students have significant social anxiety symptoms. Students with social anxiety symptoms may find clinical training difficult and this may lead to additional stress and anxiety. This may further decrease academic performance. There is also evidence to suggest that stress during undergraduate training may result in psychological or emotional impairment during professional life and therefore affect the quality of patient care. Furthermore, untreated social anxiety may lead to other complications such as depression and substance abuse. It may also affect their choice of future specialties and prevent them from pursuing what they really want. It is recommended that medical undergraduates be routinely screened for social anxiety in view of its high prevalence, and interventive measures can then be instituted.

30 SAD patients (diagnosed with the MINI) and 30 healthy controls were administered the Liebowitz Social Anxiety Scale, The Automatic Thoughts Questionnaire (ATQ - Negative and ATQ-Positive), the Sheehan Disability Scale and the Beck Depression Inventory.

SAD patients had higher total scores on the ATQ-Negative and lower total scores on the ATQ-Positive. Many items differentiated the two study groups. The interaction with depression will be presented.

Automatic thoughts are an important area of research and therapeutic intervention. The strengthening of positive thinking and the ablation of negative thinking are crucial in the treatment of this shy disorder.

Menopausal symptoms of hot flushes and night sweats are defined as vasomotor symptoms. They are markers of declining serum estradiol, are not universal in menopausal women and may occur in women who are sensitive to the effects of estradiol on thermoregulatory centers and serotonergic, adrenergic, and norepinephrine neurotransmitters. The aim of this research was to find out if vasomotor symptoms were associated with anxiety in perimenopausal women.

We examined perimenopausal women with anxiety and a comparison group of asymptomatic perimenopausal women. One hundred and two (102) women participated in the study, 44 suffering from anxiety and 58 normal controls. All women were between the ages 40 and 58 and presented with a history of menstrual cycle irregularity of at least six months duration but not longer than one year of amenorrhea. The diagnosis of anxiety was determined by an interview and the Hamilton Anxiety Rating Scale (HAM-A). Vasomotor symptoms were assessed with the Menopause Rating Scale (MRS). The association between vasomotor symptoms and anxiety in perimenopausal women was made using Wilcoxon-Mann-Whitney test.

A significant relationship between vasomototor symptoms and anxiety was found in perimenopausal women. The severity of vasomotor symptoms was strongly associated with the severity of anxiety (p< 0.001).

It appears that hot flushes and night sweats are associated with anxiety in perimenopausal women.

Anxiety in pregnancy and the evil following results in the pregnancy process is a problem for pregnant woman and their families. The aim of this study is the investigation of prevalence of anxiety in pregnancy and communicating factors.

This investigation is a descriptive and correlation studies those 156 pregnant women in Sabalan hospital in Ardabil as the accident samples by questionnaire are collected. First part of questionnaire id the demographic information and the second part is the state-trait anxiety test. Result of this investigation study by application apss and statistical analysis.

Between 156 pregnant women in this study, 57.1 percent had state anxiety and 52.5 percent of them had trait anxiety in high medium, low severe, severe, high severe of limitation. In this study, between economic problems in family, pregnancy problems such as Hypertension in pregnancy, bleeding and the others, not having reliable friend, physical disease in pregnant women and their husbands, and both of the state and trait anxiety have meaning relation. Between not intended pregnancies, psychiatric diseases in pregnant women and trait anxiety have meaning relation.

This investigation shows sizable prevalence of anxiety in pregnancy and the effect of different interfering factors. we make a tender for studying controlled in vestigation by equal number of women in first, second and third trimester such as these studies that the women and different interfering factors in anxiety in pregnancy are studied by equal numbers.

Earthquake disaster of Pakistan in 2005 caused massive destruction. Death toll was more than 70000. Many survivors were diagnosed as having variable anxiety disorders including panic disorder and PTSD. Frequency of female patients was much higher than male. The major factors responsible are loss of life and property and uncertainty regarding future, harsh weather and repeated tremors.

Data was collected from various agencies including WHO, Turkish Red Crescent, Canadian team of relief and some other NGOs working with earth quake hit area. Diagnosis was made using semi-structured interviews.

Data analyses of women (1056), men (281) and children (204) indicate high prevalence of anxiety disorders including PTSD (853 women, 153 men) and depression (73 women, 31 men). Results vary from the observations made from other disasters. Sex ratio shows huge difference in prevalence between males and females.

Patients with PTSD have dysregulation of HPA axis response. This alteration is more pronounced in case of women. Studies show that estrogen plays important role in the genesis of disease. Dexamethasone suppression test also indicates greater dysregulation of glucocorticoid receptor. Studies reveal predisposition in women for PTSD and depression.

Women and children were affected most because most of them were at home and in schools. Hence, they sustained more physical injuries and psychiatric consequences.

In our study depression came out to be more prevalent in females. This can be explained as comorbidity of PTSD and because of its own dynamics.

After exposure to trauma male and female respond differently.

To examine the clinical and cost-effectiveness of a lifestyle-based approach to treating anxiety and Panic Disorder in Primary Care. To present evidence from an explanatory model.

A Pragmatic Randomised Controlled Trial was conducted comparing a lifestyle intervention with routine GP care. The lifestyle intervention used patient diary data focusing on diet, fluid intake, habitual lifestyle drug use (alcohol, nicotine and caffeine) and exercise, to influence mood and behaviour change. Following the MRC (2008) recommendation on developing and evaluating complex interventions, an explanatory model was developed.

31 Lifestyle arm and 36 GP care arm patients completed to analysis. A significant improvement in Beck Anxiety Inventory scores was observed at end of treatment (Lifestyle 29.5 to 9.2; GP 29.4 to 17.2; p< 0.001) although non-significant at 10 month follow-up (Lifestyle 13.3: GP 16.4; p=0.167). Results were comparable with full CBT and improved compared with medication. Cost-effectiveness analysis showed that If maximum willingness to pay peradditional QALY is £30,000, this represents an 86% chance that a lifestyle intervention provides value for money over 10 months. Modeling shows a broad range of factors influencing anxiety and panic responses, indicating that lifestyle interventions impact at a different point in the system to medication and psychological approaches.

Evidence shows that a lifestyle-based intervention provides an additional, cost-effective intervention and significantly improved symptom profile for anxiety and panic disorder compared with routine GP care. It impacts on both physiological and cognitive symptoms. Modeling suggests broader application to other mental health problems.

The potential efficacy of various antiepileptic drugs in the treatment of Panic Disorder (PD) with (PDA) or without Agoraphobia has been studied in clinical trials, though not as yet that of lamotrigine (LTG).

We administered LTG to four outpatients with PDA according to DSM-IV-TR criteria, as an augmentation therapy (three patients with chronic and severe agoraphobia) or monotherapy (one drug-naïve patient with first-onset PD and moderate agoraphobia). LTG was titrated up to 200 mg/day within a 6-week period and remained at that dosage for another eight weeks. The patients were clinically monitored every week, while standard psychometric evaluations were completed at baseline and after the end of the trial.

The patient under LTG monotherapy exhibited a complete remission of his panic attacks and a significant improvement in agoraphobic avoidances and other outcome measures. Some improvement was evident after the clinical trial in one more patient who exhibited a complete remission of her spontaneous panic attacks and in another patient who exhibited reductions in both her anxiety levels and PD-related cognitions.

Although anecdotal and thus in need of replication in well-designed large studies, our preliminary findings suggest that LTG as monotherapy (at 200 mg/day) might improve significantly PDA symptomatology in a proportion of drug-naïve patients with recent-onset PD and moderate agoraphobia, while LTG as augmentation agent (at 200 mg/day) might improve at least some aspects of the clinical psychopathology of PD patients with chronic and severe agoraphobia.

Studying defensive styles is typically associated with dynamic theory and therapy. The present study was designed to examine the efficacy of adding two individual sessions of Motivational Interviewing (MI) and Thought Mapping (TM) to cognitive-behavioral group therapy (CBGT) to promote changes in the use of defense mechanisms among obsessive-compulsive disorder (OCD) patients.

Forty outpatients meeting OCD DSM-IV criteria were randomly assigned to either a MI+TM group or a control group, before 12 weekly CBGT sessions. To evaluate changes in defense mechanisms, the Defense Style Questionnaire (DSQ) was administered before and after treatment.

The use of the mature defense mechanisms increased in the MI+TM group at post-treatment, and there were significant differences in the decrease of use of the neurotic defense mechanisms. In addition, patients who achieved full remission differed in the use of the immature defense mechanisms. The control group presented no significant decrease in the use of any defense mechanisms.

These findings suggest that adding two individual sessions of MI and TM to CBGT can facilitate changes in use of defense mechanisms in OCD adult outpatients, as measured by a specific instrument.

We report the case of a patient with treatment-resistant obsessive-compulsive disorder (OCD) that had a significant reduction in obsessive-compulsive symptoms after the addition of the atypical antipsychotic to the Selective serotonin reuptake inhibitors (SSRIs)

Ms. A, a 31-year-old woman, with no family history of psychiatric disorders has been suffering from OCD for 4 years. His main obsession was contamination, and his compulsions (washing rituals) occupied 12 hours a day, rendering him unfit for work in there house or employment. Various treatments had been ineffective. His Yale-Brown Obsessive Compulsive Scale total score (Y-BOCS) at his first psychiatric interview was 38. He was taking clomipramine, sertraline, haloperidol, amisulpride, and alprazolam. Previous trials did not result in clinically meaningful responses (side effects prevented titration to higher doses), however all psychiatric drugs were discontinued except sertraline (100 mg/day) associated with olanzapine (5 mg/day).

After 10 days, Ms. A reported significantly lessened anxiety and, after three months, significantly lessened obsessive-compulsive symptoms. By the fourth month, his symptoms were occurring for only few hours week (Y-BOCS total score of 16). At this point, the addition of olanzapine would appear to be a useful short- and long-term strategy for augmenting SRI effectiveness in resistant OCD patients.

Current options for treatment-resistant OCD include switching to an alternative selective serotonin reuptake inhibitor or augmentation with other agents. Our case suggests that olanzapine may be an option for treatment-resistant OCD, but controlled studies are needed to substantiate this observation.

Death is a daily, several and important occurrence in nursing. Nurse's death anxiety is effect agent on quality of communication and caring of patients especially dying patients. Death Anxiety has excellent effect on job satisfaction and mental health of nurses. Only few studies have been done in this issue.Aim of this preliminary study was compare of death anxiety in special and general ward's nurses.

This was a cross-sectional analytical study that 387 practitioner nurses in census method were recruited from selected Hospital of TUMS 2007. The data were collected using a personal - social questionnaire and Templer Death Anxiety Scale. The data were analyzed using descriptive & inferential (Pearson, ANOVA, Regression…) statistical.

Results show significant difference between mean score of Death anxiety in special (8/262/1) and general (8/302/4) ward's nurses and was correlated with some variables such as marriage statues (p< 0/04), education level (p< 0/03), organizational situation (p< 0/001) and the ward which nurses now worked (p< 0/02). But has not significantly correlated with age, sex, shift, care of end stage patients, partnership in CPR and etc.

Death anxiety effect physical and emotional aspects of nurse's life and so effect process of caring present by them. Results show death anxiety was higher in special ward nurses and they faced more than general ward nurses to dying and death so they need special attention to death anxiety and investigation causes of it, development of institutional support to enable nurses to provide good quality care for patients.