I Have a Fear of Negative Evaluation,Get Me Out of Here! Examining Latent Constructs of Social Anxiety and Autistic Traits in Neurotypical and Autistic Young People

Journal of Autism and Developmental Disorders - Understanding shared and unique constructs underlying social communication difficulties in autism spectrum disorder (ASD) and social anxiety disorder...     

Monitoring of Cerebrovascular Autoregulation: Facts, Myths, and Missing Links

The methods for continuous assessment of cerebral autoregulation using correlation, phase shift, or transmission (either in time- or frequency-domain) were introduced a decade ago. They express dynamic relationships between slow waves of transcranial Doppler (TCD), blood flow velocity (FV) and cerebral perfusion pressure (CPP), or arterial pressure (ABP). We review a methodology and clinical application of indices useful for monitoring cerebral autoregulation and pressure-reactivity in various scenarios of neuro-critical care. Facts: Poor autoregulation and loss of pressure-reactivity are independent predictors of fatal outcome following head injury. Autoregulation is impaired by too low or too high CPP when compared to autoregulation with normal CPP (usually between 60 and 85 mmHg; and these limits are highly individual). Hemispheric asymmetry of the bi-laterally assessed autoregulation has been associated with asymmetry of CT scan findings: autoregulation was found to be worse ipsilateral to contusion or lateralized edema causing midline shift. The pressure-reactivity (PRx index) correlated with a state of low CBF and CMRO₂ revealed using PET studies. The PRx is easier to monitor over prolonged periods of time than the TCD-based indices as it does not require fixation of external probes. Continuous monitoring with the PRx can be used to direct CPP-oriented therapy by determining the optimal CPP for pressure-reactivity. Autoregulation indices are able to reflect transient changes of autoregulation, as seen during plateau waves of ICP. However, minute-to-minute assessment of autoregulation has a poor signal-to-noise ratio. Averaging across time (30 min) or by combining with other relevant parameters improves the accuracy. Myths: It is debatable whether the TCD-based indices in head injured patients can be calculated using ABP instead of CPP. Thresholds for functional and disturbed autoregulation dramatically depends on arterial tension of CO₂—therefore, comparison between patients cannot be performed without comparing their PaCO₂. The TCD pulsatility index cannot accurately detect the lower limit of autoregulation. Missing Links: We still do not know whether autoregulation-oriented therapy can be understood as a consensus between CPP-directed protocols and the Lund-concept. What are the links between endothelial function and autoregulation indices? Can autoregulation after head injury be improved with statins or EPO, as in subarachnoid hemorrhage? In conclusion, monitoring cerebral autoregulation can be used in a variety of clinical scenarios and may be helpful in delineating optimal therapeutic strategies.     

Facing Fear and Change

The intervention of seclusion is meant to be a measure of last resort, and there is increasing pressure within the mental health system to reduce or eliminate the use of seclusion and restraint for a number of persuasive reasons. This article describes the successful experience of integrating an unpredictably violent patient with autism who had been in seclusion on a forensic ward twenty-three hours per day on average, seven days per week, for seven years into the ward milieu and into the community with no further use of seclusion. Two of the authors are the main behavioral therapists who described the steps taken and the struggles faced in this process. Systemic barriers are reviewed, including concerns about staff and patient safety, the fear and resistance of front-line staff, and the culture shift needed to allow this patient the opportunity to make independent decisions and improve his quality of life.     

Fear of AIDS

A specter is haunting our streets--the specter of AIDS, a remorseless and incurable disease whose nature, transmission and effects still contain elements of mystery. The fear of AIDS is pervasive. Most of us experience this fear as an uneasy but usually abstract awareness of its presence in the society. This awareness, however, may be jolted into something more concrete and immediate when we need to make or react to such decisions as whether our children should attend school with an AIDS victim or whether to require tests for the presence of AIDS antibodies (ELISA test) in food handlers and health workers. But populations at risk of infection with AIDS face a fear of a different quality. For hemophiliacs requiring the transfusion of blood products, for users of contaminated needles, even under certain circumstances for those who engage in heterosexual intercourse, infection with AIDS has to be a real issue. For homosexuals with an active sex life the fear is constant; ways must be found to come to terms with it. In this presentation I shall offer a series of vignettes illustrating reactions to the threat of AIDS that range from the distinctly maladaptive to the appropriately adaptive. I shall discuss some of the psychodynamic mechanisms operative in these cases and make general observations about the fear of AIDS in target populations.     

Shame and the Fear of Feeling

TOPIC: Toxic shame and the concomitant fear of feeling are core issues needing to be addressed during group therapy with adult survivors of childhood sexual abuse. PURPOSE: To increase awareness of the toxic shame that survivors experience and to describe the impact of group therapy based on a family systems model. SOURCE: The authors' clinical experiences. CONCLUSIONS: Symptom management, repatterning of cognitive distortions, and the improvement of self-care strategies are identified as crucial aspects of healing shame-based feelings and behaviors. Group treatment offers members the opportunity to cease reenacting family rules and roles that create toxic shame.     

Your Fear is My Fear: The Relationship Between Parental and Offspring Anxieties

Child Psychiatry & Human Development - Contrary to the well-documented link between parental and offspring clinical anxiety, little is known about the relationship between parental...     

Fear in Fear-of-crime

In this article, fear-of-crime research is integrated with multidisciplinary knowledge on fear and phobias. At present, many of the practical applications stemming from criminological research have treated fear-of-crime as a crime phobia and have attempted to reduce or even eliminate it from the community. Using Rachman's three components of fear to discuss reported experiences of this phenomenon, it is shown that little is known about the fear in fear-of-crime. The difference between a normal fear and a phobia rests on a continuum of emotional intensity. The placement of the fear within fear-of-crime on that continuum cannot be established from current research. It is recommended that further work be done to determine how people respond emotionally to crime and why such a response is elicited. It is also suggested that the assumption that fear-of-crime be treated as a crime phobia and eliminated from the community be tested through greater knowledge of the fear in fear-of-crime.