Panic Disorder Symptoms Research Articles

Modulation of fear behavior and neuroimmune alterations in house dust mite exposed A/J mice, a model of severe asthma

Fear-associated conditions such as posttraumatic stress disorder (PTSD) and panic disorder (PD) are highly prevalent. There is considerable interest in understanding contributory risk and vulnerability factors. Accumulating evidence suggests that chronically elevated inflammatory load may be a potential risk factor for these disorders. In this regard, an association of asthma, a chronic inflammatory condition, with PTSD and PD has been reported. Symptoms of PD and PTSD are more prevalent in severe asthmatics, compared to those with mild or moderate asthma suggesting that factors that influence the severity of asthma, may also influence susceptibility to the development of fear-related disorders. There has been relatively little progress in identifying contributory factors and underlying mechanisms, particularly, the translation of severe asthma-associated lung inflammation to central neuroimmune alterations and behavioral manifestations remains unclear. The current study investigated the expression of behaviors relevant to PD and PTSD (CO2 inhalation and fear conditioning/extinction) in A/J mice using a model of severe allergic asthma associated with a mixed T helper 2 (Th2) and Th17 immune response. We also investigated the accumulation of Th2- and Th17-cytokine expressing cells in lung and brain tissue, microglial alterations, as well as neuronal activation marker, delta FosB (ΔFosB)) in fear and panic regulatory brain areas. HDM-exposed mice elicited higher freezing during fear extinction. CO2-associated spontaneous and conditioned freezing, as well as anxiety or depression-relevant exploratory and coping behaviors were not altered by HDM treatment. A significant increase in brain Th17-associated inflammatory mediators was observed prior to behavioral testing, accompanied by microglial alterations in specialized blood brain barrier-compromised circumventricular area, subfornical organ. Post extinction measurements revealed increased ΔFosB staining within the medial prefrontal cortex and basolateral amygdala in HDM-treated mice. Collectively, our data show modulation of brain immune mechanisms and fear circuits by peripheral airway inflammation, and is relevant to understanding the risk and comorbidity of asthma with fear-associated disorders such as PTSD.

Panic Disorder with Choking Phobia : a Case Report

Abstract
 
 Panic disorder is a form of anxiety disorder characterized by repeated panic attacks and preoccupied with worrying that a panic attack will occur. Panic attacks are characterized by fears of a disaster or loss of self-control even though there is really nothing to worry about. Other symptoms experienced during a panic attack are heart palpitations (similar to a heart attack), shortness of breath, feelings of suffocation, and the body feels weak. If this disorder is not detected early, it will affect the daily life of the patient. This case report presents the case of a 34-year-old woman who experiences symptoms of panic disorder with choking phobia that is managed with antidepressants and cognitive behavior therapy. In addition, there is discussion of differential diagnosis and the role of cognitive behavior therapy in handling this case.

Perceived stress as a mediator between personality traits and panic disorder symptoms

Perceived stress as a mediator between personality traits and panic disorder symptoms

A pilot study augmenting cognitive behavioral therapy for panic disorder with attention bias modification: Clinical and psychophysiological outcomes

Background and objectivesStudies show that attentional bias towards threat is a key maintenance factor for panic disorder (PD). Attentional bias may be an important mechanism of symptom reduction, and thus, a useful target for optimizing outcomes. The current study examined whether an attention bias modification (ABM) task enhanced CBT outcomes. Multiple methods for assessing PD were used, including physiological measurement and clinician-rated assessment. MethodsAdults with panic disorder (N = 24) received seven sessions of CBT with either ABM or sham attention tasks. Psychophysiological reaction to a loud tones startle paradigm was assessed before and after treatment. ResultsAcross both groups, panic symptom severity decreased with CBT. The ABM group showed greater reductions in PD symptoms compared to the placebo group. Notably, however, changes in attentional bias were not associated with symptom reductions across groups. No significant group differences on psychophysiological assessment were observed. LimitationsThis study is limited by the small sample size, which rendered our power to investigate mediators and moderators insufficient. More research is needed to validate the effect of attention bias modification on attentional bias to threat. ConclusionsThis pilot study suggests that future research should investigate attentional bias in conjunction with CBT. A larger sample would provide opportunity to further investigate the mechanisms through which ABM works, along with potential moderating factors and the use of psychophysiological measurements in panic disorder.

Smaller volume of right hippocampal CA2/3 in patients with panic disorder.

The hippocampus is thought to play an important role in conveying contextual information to the amygdala as the neural basis of panic disorder (PD). Previous studies have revealed functional abnormalities in the hippocampus in patients with PD compared with healthy control subjects (HC), but no study has reported volume abnormalities in the hippocampus or evaluated minute structural changes in the hippocampus in such patients. We thus investigated volume abnormalities in the subfields of the hippocampus to better understand the neurobiological basis of PD. The hippocampus was extracted from structural brain magnetic resonance images obtained from 38 patients with PD and 38 HC and then segmented into six subfields. The relative volume of each subfield was compared between the two groups. The severity of symptoms was assessed using the Panic Disorder Severity Scale (PDSS) and social functioning was assessed using the Global Assessment of Functioning (GAF) scale. Our results revealed that patients with PD had a significantly smaller volume of the right cornu ammonis (CA) 2/3 hippocampal subfield compared with HC. No significant associations were found between the volumes of the right CA 2/3 and the PDSS or GAF scores in correlation analyses. In conclusion, CA2/3 is thought to be related to contextual memory function, and our results suggest that this particular hippocampal subfield plays a role in the development of PD symptoms.

Take my breath away: Neural activation at breath-hold differentiates individuals with panic disorder from healthy controls

There is neuroanatomical evidence of an "extended fear network" of brain structures involved in the etiology of panic disorder (PD). Although ventilatory distrubance is a primary symptom of PD these sensations may also trigger onset of a panic attack (PA). Here, a voluntary breath-holding paradigm was used to mimic the hypercapnia state in order to compare blood oxygen level-dependent (BOLD) response, at the peak of a series of 18 s breath-holds, of 21 individuals with PD to 21 low anxiety matched controls. Compared to the rest condition, BOLD activity at the peak (12 - 18 s) of the breath-hold was greater for PD versus controls within a number of structures implicated in the extended fear network, including hippocampus, thalamus, and brainstem. Activation was also observed in cortical structures that are shown to be involved in interoceptive and self-referential processing, such as right insula, middle frontal gyrus, and precuneus/posterior cingulate. In lieu of amygdala activation, our findings show elevated activity throughout an extended network of cortical and subcortical structures involved in contextual, interoceptive and self-referential processing when individuals with PD engage in voluntary breath-holding.

The identification and psychological treatment of panic disorder in adolescents: a survey of CAMHS clinicians.

BackgroundPanic disorder is experienced by around 1% of adolescents and has a significant impact on social and academic functioning. Preliminary evidence supports the effectiveness of panic disorder‐specific treatment in adolescents with panic disorder; however, panic disorder may be overlooked in adolescents due to overlapping symptoms with other anxiety disorders and other difficulties being more noticeable to others. The aim of this study was to establish what training National Health Service (NHS) Child and Adolescent Mental Health Services (CAMHS) clinicians have received in psychological therapies and panic disorder and how they identify and treat panic disorder in adolescents.MethodCAMHS clinicians from a range of professions (n = 427), who were delivering psychological treatments to children and adolescents with anxiety disorders, participated. They completed a cross‐sectional, online survey, including a vignette describing an adolescent with panic disorder, and were asked to identify the main diagnosis or presenting problem.ResultsLess than half the clinicians (48.6%) identified panic disorder or panic symptoms as the main presenting problem from the vignette. The majority of clinicians suggested CBT would be their treatment approach. However, few identified an evidence‐based treatment protocol for working with young people with panic disorder. Almost half the sample had received no training in cognitive behaviour therapy (CBT), and around a fifth had received no training in delivering psychological treatments.ConclusionsOnly half of CAMHS clinicians identified panic disorder from a vignette and although CBT treatments are widely offered, only a minority of adolescents with panic disorder are receiving treatments developed for and evaluated with young people with panic disorder. There is a vital need for clinician training, the use of tools that aid identification and the implementation of evidence‐based treatments within CAMHS.Key Practitioner Message Panic disorder affects around 1% of adolescents, adversely impacting social, academic and long‐term life functioning.There is preliminary evidence for the effectiveness of a panic disorder‐specific treatment of panic disorder in adolescents.Clinicians struggle to identify panic disorder or suitable treatment protocols for treating adolescents, although most would use CBT as the treatment approach.There is a vital need for clinician training, tools that aid identification of young people with panic disorder and evidence‐based treatments that can be delivered in routine clinical settings.

Blended cognitive behavioural therapy for adolescents with panic disorder co-morbid with autism spectrum disorder: a case study

Abstract Cognitive behavioural therapy (CBT) is an effective treatment for improving anxiety symptoms in patients with autism spectrum disorder (ASD). However, some patients with ASD take extra time for learning, and they can find it hard to change their thinking styles and behaviour due to cognitive deficits. The therapist must be creative when implementing CBT in this context. Here, it may be helpful for the patient with ASD to understand CBT’s concepts by using visual aid material. Blended CBT during which the patient is shown visual aid material with his or her therapist has been suggested as effective for adults without ASD to reduce anxiety. Blended CBT combines face-to-face treatment with internet guided support and resource. Blended CBT may facilitate an understanding of essential knowledge and help people with ASD and anxiety acquire skills based on cognitive behavioural science. However, as far as we know, no previous studies have reported on the use of blended CBT for patients with panic disorder co-morbid with ASD. This study, therefore, consecutively performed 16 blended CBT sessions on a biweekly basis to treat panic disorder (PD) in an adolescent Japanese female co-morbid with ASD. The patient exhibited improvements in PD symptoms and agoraphobia after treatment: the Panic Disorder Severity Scale score decreased from 18 to 2. These results indicate that visual aid-assisted treatment may help patients with impaired imagination and social cognition related to ASD. Furthermore, this study’s therapist notes the need for paced treatments and repeated psychoeducation for patients with impairments in central coherence and cognitive flexibility. Key learning aims (1) Blended CBT may patients with panic disorder (PD) co-morbid with autism spectrum disorder (ASD) to understand concepts based on cognitive behavioural science and symptoms. (2) Blended CBT sessions can each be conducted in approximately 20 min (about one-third of the time needed for typical 45- to 90-min CBT sessions); in other words, it is less burdensome for the patient and therapist. (3) How to adjust blended CBT for those who have low average intelligence quotients (IQ) and/or ASD.

Altered Function of Superior Parietal Lobule Associated with Perceptive Awareness in First-Episode Drug-Naïve Panic Disorders

Background: Biased perception plays an important role in the development and maintenance of panic disorder (PD), and high levels of cardiovascular symptoms in PD produce higher levels of heartbeat perception. Methods: Currently, we investigated brain activity during interoceptive awareness in PD using functional MRI. We recruited 18 subjects with first-episode drug--naive PD and 21 age- and gender-matched healthy controls (HCs). Results: We found that the heartbeat perception scores (HPSs) were higher in individuals with PD than in HCs. When comparing greater heartbeats or greater puretones with fixation, PD patients showed higher activity in the bilateral superior parietal lobule (SPL) than HCs. Further, patients with PD exhibited a significant positive correlation between BOLD activity in the left SPL and HPS during the heartbeats vs. fixation condition and a positive correlation between BOLD activity in the right SPL and HPS, although this did not reach significance. Interpretation: We identified impaired activation in the bilateral SPL during interoception and exteroception. The increased activation during interoceptive stimuli might render PD patients more engaged in processing information associated with their internal states, which may increase the probability of panic attacks. Our study provides insight regarding PD treatment, whereby inhibition of the SPL can be used to reduce cardiac interoceptive accuracy and relieve cardiac syndromes. Funding Statement: This work was supported by grants from the National Natural Science Foundation of China (81071098), Shanghai Science and Technology Committee (15411950201， 15ZR1435500, 18ZR1432600, 18411952400), Shanghai Jiao Tong University Foundation (YG2016MS37), and Shanghai Municipal Commission of Health and Family Planning Foundation (20164Y0215). Declaration of Interests: The Authors declare that there is no conflict of interest. Ethics Approval Statement: This study was approved by the Research Ethics Committee at the SMHC, where the participants were recruited and assessed. All participants provided informed consent, and the consent was written in the study

Self-management of Stress Using Virtual Reality Environment Configuration

The purpose of this study was to find out the usefulness of VREC (Virtual Reality Environment Configuration) as a self-help stress management technique. The subject of this study was a middle-aged woman who had the early symptoms of panic disorder due to stress. CoSpaces Maker and Edu were used as research tools to analyze a total of 34 VE (Virtual Environment) configured by the subject during 1 year and 8 months. The NVivo12 program was used for qualitative analysis of the data. An analysis of the VE components showed that the subject used an average of 11 minutes to configure VE and the basic background and the day time was selected most frequently. The most common symbol used by the subject to configure VE was a tree. Next, an analysis of storytelling revealed four themes such as ‘harsh life’, ‘waiting’, ‘journey for rest’, and ‘entanglement of memories and reality’ which emerged over time. Lastly, after VE configuration, the subject’s psychological state changed from ‘anxiety’ to ‘comfort’ and the frequency of using negative words decreased from 80% to 28%. The usefulness of VR-based psychotherapy to improve mental health was discussed.

MANUAL THERAPY AS AN ALTERNATIVE TREATMENT FOR PANIC ATTACKS


 
 
 In worldwide medical practice panic attacks are treated mainly by psychological methods and medication. Cognitive-behavioral therapy combined with selective serotonin reuptake inhibitors is considered to be the most effective method of their treatment. However, it has been proven that about a third of patients with panic attacks are treatment resistant. Such people continue experiencing panic attacks and various other symptoms of panic disorder even after receiving the aforementioned treatment. It is this group of patients who are being targeted by the proposed research – manual therapy as an alternative treatment for panic attacks.
 
 

Relationships between depressive symptoms and panic disorder symptoms during guided internet-delivered cognitive behavior therapy for panic disorder

Aims: The current study explore the relationship between the trajectories of primary panic disorder symptoms and secondary depressive symptoms during guided internet-delivered cognitive behaviour therapy for panic disorder.Materials and methods: The patients (N=143) were recruited from an ongoing effectiveness study in secondary mental health outpatient services in Norway. Weekly self-reported primary panic disorder symptoms and secondary depressive symptoms were analysed.Results: primary panic disorder symptoms and secondary depressive symptoms improved significantly during the course of treatment, and at six months follow-up. Parallel process latent growth curve modelling showed that the trajectory of depressive symptoms and trajectory of panic disorder symptoms were significantly related. A supplementary analysis with cross-lagged panel modelling showed that (1) pre-treatment depressive symptoms predicted a positive effect of panic disorder symptoms early in treatment; (2) high early treatment panic disorder symptoms predicted low depressive symptoms at post-treatment.Conclusions: Guided ICBT for panic disorder is effective for both primary panic disorder symptoms and secondary depressive symptoms. Patients with high pre-treatment secondary depressive symptoms may constitute a vulnerable subgroup. A high level of panic disorder symptoms early in treatment seems beneficiary for depressive symptoms outcome. A time-dependent model may be necessary to describe the relationship between PAD symptoms and depressive symptoms during the course of treatment.

Internet-delivered cognitive behavioral therapy for panic disorder with or without agoraphobia: a systematic review and meta-analysis

ABSTRACT The current systematic review and meta-analysis examined the efficacy and effectiveness of internet-delivered cognitive behavioral therapy (iCBT) on panic disorder and agoraphobia symptom severity. Twenty-seven studies were identified. Results from nine randomised controlled trials (RCTs) showed that iCBT outperformed waiting list and information controls for panic (g = 1.22) and agoraphobia (g = .91) symptoms, but the quality of RCTs varied and heterogeneity was high. Results from three RCTs suggested iCBT may have similar outcomes to face-to-face CBT in reducing panic and agoraphobia symptoms. Within-group effect sizes between baseline and post-treatment were large for panic (n = 29, g = 1.16) and medium for agoraphobia symptom severity (n = 18, g = .73). Subgroup analyses of within-group pre/post treatment effect sizes showed larger within-group effect sizes for efficacy studies (n = 15) compared to effectiveness studies (n = 14) for panic severity (g = 1.38 vs. g = .98) but not agoraphobia severity. There was no impact of program length, inclusion or arousal reduction techniques, or degree of clinician support. Within-group effects of iCBT suggest the reduction in panic and agoraphobia symptom severity is maintained at 3–6 month follow-up (n = 12).

Social Media Use Subgroups Differentially Predict Psychosocial Well-Being During Early Adolescence.

Despite the salience of the social media context to psychosocial development, little is known about social media use patterns and how they relate to psychological and social functioning over time during early adolescence. This longitudinal study, therefore, identified subgroups of early adolescents based on their social media use and examined whether these subgroups predicted psychosocial functioning. Adolescents (N = 1205; 11-14 years; 51% female; 51% white) completed surveys at baseline and a six-month follow-up. There were three social media use subgroups at baseline: high overall social media use (8%); high Instagram/Snapchat use (53%); and low overall social media use (39%). The high social media use subgroup predicted higher depressive symptoms, panic disorder symptoms, delinquent behaviors, family conflict, as well as lower family and friend support, than the High-Instagram/Snapchat and low social media use subgroups. The high Instagram/Snapchat use subgroup predicted higher delinquent behaviors and school avoidance than the low social media use subgroup, but also higher close friendship competence and friend support as compared to both the high social media use and low social media use subgroups. Social media use patterns appear to differentially predict psychosocial adjustment during early adolescence, with high social media use being the most problematic and patterns of high Instagram/Snapchat use and low social media use having distinct developmental tradeoffs.

The Role of Safety Behaviors in Panic Disorder Treatment: Self-Regulation or Self-Defeat?

Safety behaviors (SBs) are generally perceived as ‘dysfunctional’ emotion-regulation strategies that reduce physical symptoms and prevent unrealistic feared consequences of panic attacks. However, it is unclear whether all types of SBs are a hindrance or whether some may promote self-regulation in treatment. We propose that the type of SBs might explain some of the variability between panic disorder (PD) patients, and might help to predict why treatment is more successful for some than for others. In this secondary analysis of a subsample of 65 PD patients who received Cognitive Behavioral Therapy in a two-site randomized controlled trial, we examined the associations between type of SB and pre-treatment characteristics and their predictive value on trajectories of change in treatment process and outcome (panic symptoms, interpersonal problems, alliance). An observer-rating system for five types of SBs (avoidance/distraction/control-function and object/people-focus) was developed and applied to videotaped early treatment sessions, with high reliability. Patients with higher levels of people-focused SBs reported higher levels of panic symptoms pre-treatment at both treatment sites. These people-focused SBs predicted poorer treatment response on panic symptoms at one of two sites. Avoidance, control, or distraction-function and object-focused SBs were not associated with treatment process or outcomes. People-focused SBs may worsen PD symptoms, and possibly slow treatment progress, although this latter finding was not consistent across sites. This study differentiated between types of SBs and identified people-focused SBs as possible predictor of symptom change in CBT for PD—potentially relevant for efforts to improve treatment response.

Examining the Hierarchical Influences of the Big-Five Dimensions and Anxiety Sensitivity on Anxiety Symptoms in Children.

Anxiety sensitivity (AS), namely the fear of anxiety symptoms, has been described as a precursor of sub-threshold anxiety levels. Sexton et al. (2003) posited that increased AS would arise from an elevated neuroticism and that both would act as vulnerability factors for panic disorder (PD), obsessive-compulsive disorder (OCD), and generalized anxiety disorder (GAD) symptoms. Accordingly, this study aimed to (1) evaluate the applicability of this model to a pediatric population and (2) examine the influences of the other Big-Five personality dimensions on the four lower-order dimensions of AS (cognitive, physical, control, and physical) and on social phobia (SP), separation anxiety disorder (SAD) and depression symptoms. 200 children (104 girls) aged between 8 and 12 years old (mean age = 132.52 months, SD = 14.5) completed the Childhood Anxiety Sensitivity Index (Silverman et al., 1991), the Big Five Questionnaire for Children (Barbaranelli et al., 2003), and the Revised’s Children Anxiety and Depression Scale (Chorpita et al., 2000). Regression analyses confirmed that AS and neuroticism together significantly predicted the presence of PD, OCD, and GAD symptoms but also SP, SAD, and depression symptoms. Moreover, neuroticism interacted with extraversion, conscientiousness and agreeableness to significantly predict SP, GAD, and depression. Surprisingly, the global AS score was only predicted by agreeableness, while AS dimensions also specifically related to openness. Finally, AS dimensions did not predict the presence of specific anxiety symptoms. To conclude, the predicting model of anxiety symptoms in children sets neuroticism and AS on the same level, with an unexpected influence of agreeableness on AS, raising the importance of other trait-like factors in the definition of such models. Moreover, AS should be considered as a unitary construct when predicting the presence of anxiety symptoms in children. Future interventions must consider these associations to help children detect and recognize the symptoms of their anxiety and help them to interpret them correctly.

The Use of Prolonged Exposure Therapy Augmented With CBT to Treat Postpartum Trauma

Approximately 1% to 2% of women suffer from posttraumatic stress disorder (PTSD) following childbirth, with obstetric emergencies being a key risk factor for birth-related PTSD. The current study augmented prolonged exposure (PE) with cognitive behavioral therapy (CBT) to treat symptoms of PTSD, anxiety, depression, panic disorder, and agoraphobia in a 28-year-old married Hispanic female following a life-threatening case of postpartum preeclampsia. To target distressing symptoms and reach treatment goals, the patient engaged in two preparatory sessions, 12 active PE sessions, and five supplementary CBT sessions. Posttreatment assessment indicated a significant reduction of anxiety and depressive symptoms. Panic attacks reduced in frequency and severity, and by the end of treatment, the patient no longer met criteria for PTSD, major depressive disorder (MDD), or agoraphobia. In the case of postpartum PTSD, CBT can augment PE treatment to reduce symptomatology.

Physical activity is indirectly associated with pain in college women through associations with somatization and panic disorder symptoms: a cross-sectional study

PurposeThis study tested whether the severity of somatization, panic, generalized anxiety, and depression symptoms mediated relationships between physical activity and pain using structural equation modeling. MethodsCollege women (n = 1036; mean = SD age of 19.7 ± 3.0 years) reported past week physical activity and the presence of persistent pain (≥1 month). The Psychiatric Diagnostic Screening Questionnaire assessed hypothesized mediators of physical activity effects on pain via symptoms of generalized anxiety, panic, major depressive disorder, and somatization disorder. ResultsThe percentage of the sample screening positive was 15.7% for generalized anxiety, 5.8% for panic, 11.0% for major depressive, and 16.0% for somatization. The hypothesized model had good fit and accounted for a significant amount of variance in pain (9.1%). Direct paths from physical activity to somatization, generalized anxiety, major depressive disorder, and panic disorder were significant. Paths to pain were significant from somatization and panic disorder. The path from physical activity to pain was not direct but indirect and through significant paths to pain from somatization and panic disorder. Each standard deviation increase in physical activity decreased the probability of pain by 11.0% through panic disorder and 10.7% through somatization disorder. ConclusionsPhysical activity is associated with pain indirectly through associations with panic disorder and somatization disorder symptoms in college women.

The Prevalence of patients with panic attacks (PAs) and panic disorder (PD) visiting Emergency Departments of the Verona Hospital.

Panic Attacks (PAs) and Panic Disorder (PD) represent a heavy burden not only because of the difficulty in distinguishing them from other pathologies and in treating them appropriately but also because of their impact on public health worldwide. In Europe, PD constitutes one of the five most common mental disorders adversely affecting quality of life. The aim of this study is to evaluate the period prevalence of visits to the Emergency Departments of the University Hospital of Verona (North East of Italy) over the period between 2012-2016 because of symptoms of PAs or PD in order to quantify the burden of the disorder. This study was carried out by retrospectively collecting data from the medical records of all the patients assessed at the Emergency Departments (EDs) of the Verona Hospital because of symptoms of PAs or PD over a 5-year period (1 January 2012 - 31 December 2016). The search words used in reviewing the medical records registered in the hospital discharge reports from the Gynecological, Pediatric and General Medicine Emergency Departments were: "Anxiety" and/or "Panic". A multiple logistic regression model was also created to evaluate the predictors of ED visits for PAs or PD over the period that was investigated. The study identified 3,771 cases of PAs or PD; 62.3% were females and 37.7% were males. The female-to-male ratio was 1.7:1. The mean age was 44 years (46 for the females and 41 for the males). The majority of the patients fell into two age categories: 30 to 39 (20.6%) and 40 to 49 (23.8%). The proportion of visits to the EDs for PAs or PD was approximately 20% per year, with an average of approximately 754 patients visiting the EDs every year. The period prevalence of accesses for PAs or PD over the five year period studied in the mean resident population (1.4%) and the mean visits to the EDs (2.5%) were calculated. Study results showed that the majority of the patients (80.9%) were referred to their general practitioner (GP) at the end of the assessment protocol at the EDs. According to the regression logistic model, the following variables were significant (p<0.05) risk factors for PAs or PD: being female vs. male (OR 1.899; 95% CI 1.785-2.020), being Italian vs. Foreigner (OR 1.292; 95% CI 1.174-1.421), having a white or green priority code at arrival (low urgency) vs. the other ones (OR 1.195; 95% CI 1.100-1.297), and being aged ≤42 years old (OR 1.091; 95% CI 1.024-1.161). The role of the GP is crucial in the management of PD and PAs. Given the difficulty of implementing primary and secondary prevention programs for these conditions, public health officials should make every effort to promote tertiary prevention in order to reduce the burden of the ailment and societal cost.

Reciprocal associations between screen time and emotional disorder symptoms during adolescence.

Screen-based sedentary behaviors and emotional disorders are associated with one another in youth. Yet, the direction of the association is unclear, as is whether specific types of screen-based sedentary behaviors and emotional disorder symptoms are more closely linked. This study estimated the bi-directional associations between two types of screen-based sedentary behaviors and four types of self-reported emotional disorder symptoms, and tested whether physical activity buffered these associations in a Los Angeles high school student cohort (N = 2525, baseline Mage = 14.6 years). Participants completed baseline (9th Grade, 2013) and 12-month follow-up (10th grade, 2014) surveys reporting on: television viewing and computer/videogame use (≥4 h/day; yes/no), physical activity (≥60 min/day for ≥5 days/week), and Major Depressive Disorder (MDD), Generalized Anxiety Disorder (GAD), Panic Disorder (PD), and Social Phobia (SP) symptoms (meet/exceed [sub]clinical symptom threshold; yes/no). After adjusting for baseline screen-based sedentary behavior and covariates, students with (sub)clinical baseline MDD and GAD were at increased odds of high computer/videogame use one year later (OR = 1.36[95%CI, 1.07–1.73]; OR = 1.36[95%CI,1.09–1.71], respectively). Baseline SP was marginally related to increased computer/videogame use at follow-up (OR = 1.33[95%CI,1.04–1.69]). Greater baseline computer/videogame use was associated with increased odds of (sub)clinical GAD (OR = 1.54[95%CI,1.23–1.94]) and (sub)clinical SP (OR = 1.64[95%CI 1.27–2.12]) at follow-up; these associations were suppressed among baseline physically active students. Television viewing was unrelated to emotional disorder symptoms and PD was not associated with screen-based sedentary behaviors. Thus, only reciprocal associations between computer/videogame use, SP, and GAD during a one-year period of adolescence were observed. Interventions reducing computer/videogame use and increasing physical activity may improve adolescent emotional health.