Fear or phobia is an old & basic instincts that may be as old as mankind. Fear is cenrtal feature in numerous mental disorders like Schizophrenia, delusional disorder, depression, anxiety disorders and as the only distressing symptom in phobic anxiety disorder.

Anatomical or physiological pathways of fear transmission also involves circuit that is primitive part of brain including amylgdolia, hippocampus, rhinenochephalon & papez circuit. In social phobia persistent & distressing anticipatory fears in the scenario where there is a chance of several strangers, or an imaginatory scrutiny by others in performnance/in appearance is so intense that the person avoid such situation or dreaded in enfronting such situations.

This study is a clinical review of such cases seen very recently, & look into the patterns of their presentation.

30 cases those were diagonosed as social phobia as per diagnostic criteria of DSM-4TR & were seen in a district clinic 126k.m far from capitol town of Kolkata during the period 1st Jan-31stoct09 are taken here for consideration. 18 males & 12 females, all in the age group of 18-42 with a median average of 25 years, were recorded. There were Panic state mimcking distress to majority of patients who were present into gathering unknown to them or in some sort of performance like public delivery of speach on some subjects, or sing or even in imaginatory situation where scope of escape was not feasible.

Reliefs were partialy achived in 3 weeks of pharmacotherapy using clonazepam, SSRI/Paroxitine/Sertaline/fluvoxamine or TCA's clomipramine & behavior therapy.

An arena of further study.

The thought of death can be frightening and cause anxiety. Death anxiety is a mankind experience, some profession such nursing face with it routinely and communication with dying patients is major problem of nurses that insufficient preparation to deal constructively with the process of dying and death effect on nurses productivity and patients outcomes. Aim of this preliminary study was compare of death anxiety in special and general ward's nurses.

This study was cross-sectional and 387 nurses (155 from general & 232 from special wards) in census method were recruited from Shariati Hospital of TUMS. Demographic information and Death anxiety (Templer's Death Anxiety Scale) were measured by self-report questionnaire then information analyzed by SPSS.

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 (p=0/046), 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.

Religiosity and spirituality are transcultural parameter of human experience with a complex, multidimensional construct. However, research shows religious commitment and practices being not only important for the personal beliefs, but also for physical and mental health. Findings suggest also other personal beliefs, such as magical ideation and paranormal beliefs similarly influencing psychiatric disorders and mental health. However, these factors are far more multidimensional than once thought.

The objective of the study is the investigation of the relation of religiosity/spirituality, magical ideation and paranormal beliefs in anxiety disorders and the specification of potential differences in beliefs between OCD and other anxiety disorders.

Unselected patients with OCD and other anxiety disorders as core diagnosis have been equally assessed within the first week after admission with self-rating tests including the Brief Multidimensional Measure of Religiosity/Spirituality (BMMRS), Magical Ideation Scale (MIS) and Revised Paranormal Beliefs Scale (RPBS).

80 patients have been recruited and classified in three groups: OCD, other anxiety disorders and healthy control group. All groups reached in average not significantly deviating RPBS, MIS and BMMRS total scores. However, the three personal belief scales did show an interesting relation to each other. RPBS score correlated significantly with BMMRS (r = .34, p < .01) and with MIS score (r = .56, p < .01), while MIS total scores have shown a significant relationship with almost every subscale of the BMMRS.

This study verifies a significant positive correlation between paranormal beliefs, overall religiosity and magical ideation.

There are many explanations as to why some people bite their fingernails. Anxiety, stress, genetics, boredom, acquired behavior and self-esteem have all been identified as potential causes. Nail biting can be anything from a bad habit to an outward symptom of a medical or emotional disorder. Nail biting is often a common reaction to stress. A child or even an adult uses nail biting as a coping mechanism to relieve pent-up emotions. The severity differs according the psychological cause is.

To identify the pattern of eating nails disorders in children and adults.

25 males patients 6-25 years old presented with shortining, non lusturing and onychoirregularity and nail deformities. Nail scraping for yeasts and fungi was negative.

The clinical data and invistigations showed the nails of those patients were eated and bitted by thier teeth.

Many chlidren and adults had onychophagia in thier nails. Anxiety, stress, genetics, boredom, acquired behavior and self-esteem have all been identified as potential causes.

Psychological disorder such as anxiety and depression have been related to increased mortality in both healthy individuals and medical patients. This study has been done for evaluation of prevalence of anxiety and depression and comparison with a control group (A&E's patients 1.

We checked three hundred patients of internal medicine and A&E (as a control group) department. They have chosen by a Purposive accessible sampling method. The psychopathological profile was assessed using the SCL-90 questionnaire by Iranian version. Data have been computed and analyzed by SPSS V.17 and we used Student t test for parametric variables and Mann-Whitney for the analysis of nonparametric variables and Linear regression was used to identify the impact of independent variables. The results have been considered significant when the two tailed p-value was less than 0.05.

In internal ward 69.3% and A&E department 42% of patient have had depression (OR= 3.5; 95% CI, 1.9 to 6.5). Anxiety were observed in 50.7% of internal medicine patients and 12% of A&E's patients (OR= 1.94; 95% CI, 5.1 to 23.7).

Prevalence of the depression and anxiety in internal ward patients was significantly higher in compare to A&E's patients. Therefore, it's necessary to consider these patients in order to diagnosing for the early treatment.

Experiential Avoidance (EA) has been conceptualised as one of the main vulnerability processes for psychopathology, including social anxiety, in the so-called ACT (Acceptance and Commitment Therapy) model - one of the “new wave” behavioral-cognitive approaches. EA refers to the degree to which an individual fuses with thoughts, avoids negative feelings, and is unable to act in the presence of difficult private events.

This study is aimed at exploring the role of EA in subjects with social anxiety.

Participants were 113 subjects recruited from the general population and with high levels of social anxiety as measured by means of the Liebowitz Social Anxiety Scale. Participants were classified into high and low experiential avoiders according to results from the Italian version of the Acceptance and Action Questionnaire.

The two groups did not differ in gender, marital status, educational level, or age distributions. Between-groups differences on several psychological measures, including depression, general psychopathology, quality of life and well-being were explored. Results indicated that individuals with social anxiety reporting higher levels of EA showed higher levels of depression and psychopathology, and lower levels of quality of life and well-being than low-EA participants.

Consistent with theoretical predictions in the ACT model, these findings suggest that EA may play a significant role in moderating negative psychological outcomes in subjects with social anxiety.

Individuals’ self-image and how they view their personal qualities can be of great importance for how and where they seek help for their health problems. Few have studied in-depth the connection between self-image and the use of text-based Internet communication.

We examined how members of two Internet-based Alcoholic Anonymous groups explained their preferences for using Internet-based AA groups, either alone or in combination with face-to-face AA groups.

Data were obtained over the course of one year by means of participant observation and in-depth e-mail interviews with 11 members from different countries. The first author participated in two online AA groups by posting and responding to the topics in the e-mail meeting, bulletin board and discussion forum. The 11 e-mail interviews were semi-structured and asynchronous, that is, they were not conducted in real-time but over a period ranging from five weeks to three months.

Online AA members explain their preferences for using Internet-based self-help groups by referring to their self-image and personal qualities as well as their self-diagnoses (e.g. social anxiety, aspergers syndrom, compulsiveness and impulsiveness). Some use a combination of online and face-to-face groups which helps them to overcome their social phobia.

Internet self-help groups seem to represent an important alternative for people who experience difficulties with face-to-face communication. Participation in online AA groups is easier to combine with everyday life. The Internet groups provide a more anonymous context for people who want to be heard, but not necessarily seen.

The aim of the current study is to analised our clinical experience with pregabalin, evaluate his efficacy and safety in the treatment of generalised anxiety disorder in elderly people.

And safety in the treatment of generalised anxiety disorder in elderly people.

The patients sample was selected of 3 psychogeriatric centers, considering patients 65 years and older with a clinical diagnosis of generalised anxiety disorder with or without psychiaric comorbidity.

The treatment with pregabalin has improved both somatic and mental symptoms of generalised anxiety disorder in the 15 patients analised.

The mean age was 71 years (women 68%). Significant improvement has been observed in the control of psychic and somatic anxiety symptoms in 10 of the 15 patients. In 3 patients the control of the symptoms was partial.

The tolerability of the product has been good in medium doses of 250 mg/day. The most frequently adverse events were somnolence and dizzeness. Discontinuations due to adverse events were in 2 patients

Pregabalin is a novel compound, a structural analogue of gamma-aminobutyric acid (GABA), one of the key inhibitory neurotrnsmitters in the brain. Its mode of action is believed to be mediated by alpha-2-delta-1 subunit protein of voltage-gated calcium channels to bring about its anxiolytic, anticonvulsant and antinociceptive effects.

Pregabalin has been shown to be safe, well tolerated and effective in the treatment of generalised anxiety disorder in patients 65 years old and older.

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.

To point out to the medical community who believes in, ‘Prevention is better than cure’ that the alarming report of cause of sudden increase in PTSD sufferers, especially in young war veterans is very clear. The memory of human suffering imprints an indelible legacy in the minds of the young people for the rest of their life ultimately voiding them into a life of social burden. As health workers like always and ironically we deal with the victims of various socio-political decisions made by world leaders, dictators and even by the terrorists. Now do we think it's a time to give a lonely message to all that ‘war should be stopped?’

This is a personal audit on studying over 500 news reports and published papers written on PTSD incidence after a major war in the last decade.

Remove the cause PTSD will be eradicated. On the other PTSD victims i.e. abused in childhood, rape victims, road traffic accident victims or witnesses, fire fighters, policemen we hardly can manoeuvre in the field of prevention. However weak it is; we can give a message to the warring powers to save youngsters from future PTSD.

• • PTSD is preventable but has very bleak curative achievement.

• • We should not deprive our youngsters of the peaceful life, most of us are enjoying in our 40s, 50s and 60s.

• • European congress can raise a voice against the proven cause of PTSD.

This study aims at scrutinizing the action of Behavior-Brain systems in patients with obsessive-compulsive disorder and patients with Phobia by comparing them. The study is based on Jeffry Gary personality Theory.

20 patients with obsessive-compulsive disorder and 20 patients with Phobia that matched together by age, education level and gender were selected from patients referred to consulting clinics in Ardebil in 2008. Gary & Wilson personality questionnaire administered for assessing the Behavior-Brain systems action. The collected data were analyzed using descriptive and independent T-test to test the hypothesis generated in the study.

Analyzing the collected data shows that there is no significant difference between Phobic and obsessive patients in behavior activating systems and behavior inhabitation systems; but there is significant difference between two groups in fight -flight system.

The results of this study are in agreement with basic hypothesis of Gary's Reinforcement Sensitivity Theory and neuro-psychological status of patients with disorders. The reason of no significant difference between two behavior activating systems and behavior inhabitation systems in phobic and obsessive patients might be due to the similarity of behavior roots in these two disorders.

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.