Demographics,clinical characteristics and quality of life of Brazilian women with driving phobia

Driving phobia is associated with serious consequences such as restriction of freedom, career impairments and social embarrassment. The main objective of this paper is to compare clinical characteristics and quality of life between women with driving phobia and women without this phobia. These factors were assessed using structured interviews, semi-structured questionnaires, scales and inventories. We accessed diagnoses, depressive symptoms, anxiety symptoms, anxiety traits, driving cognitions and quality of life. There was no difference between groups with regard to demographic data and driving history. Both groups were also equivalent in the number of traumatic events and accidents experienced while driving or riding. The fear of driving group showed higher state and trait anxiety scores. A high frequency of cognitive distortions can explain why people with driving phobia often engage in maladaptive safety behaviors in an attempt to protect themselves from unpredicted dangers when driving. Regarding quality of life, the control group had slightly higher scores on all subscales, but significant differences were observed for only three scales: “functional capacity”, “social aspects”, and “mental health”. More studies with larger samples more instruments and other contexts are needed to further investigate the clinical characteristics and personality traits of people who have a fear of driving.     

In vivo desensitization of a severe driving phobia through radiO contact

A 55-yr-old man with a severe driving phobia was treated by in vivo desensitization. A radio transceiver was used to provide the anxiety-inhibiting effects of voice contact during exposure to phobic driving experiences. Treatment effects were maintained at 6-month follow-up.     

Clinical features of four DSM-IV-specific phobia subtypes

Seventy-three patients (ages 18 to 66) with specific phobias from one of four DSM-IV subtypes (animal, situational, blood-injection-injury, and natural environment) were assessed by experienced clinicians using a semistructured diagnostic interview. All patients were free of lifetime anxiety comorbidity. Subtype groups were compared on age of onset, mode of onset, presence of unexpected panic attacks, and focus of fear. Consistent with earlier findings, participants with situational phobia had a later age of onset and more unexpected panic attacks. No differences were found across subtypes in mode of onset. Contrary to previous findings, natural environment and situational phobias were most frequently associated with a focus on danger or harm rather than other foci such as internal sensations associated with panic attacks. Implications for the usefulness of current subtype categories are discussed.     

Efficacy of virtual reality exposure therapy to treat driving phobia: a case report

An AB case design was used to examine the efficacy of virtual reality exposure therapy (VRET) in treating driving phobia. After a one week baseline, the patient received three treatment sessions over a ten day period. Treatment included practice of four VR driving scenarios. Peak anxiety decreased within and across sessions. Ratings of anxiety and avoidance declined from pre-treatment and post-treatment, with gains maintained at seven month followup. Phobia-related interference in daily functioning similarly decreased. The results suggest that it would be useful to further evaluate the efficacy of VRET for driving phobia in controlled clinical trials.     

Clinical implications of panic symptoms in dental phobia

The occurrence of panic symptoms in various anxiety disorders has been associated with more severely impaired and difficult-to-treat cases, but this has not been investigated in dental phobia. We examined the clinical implications of panic symptoms related to sub-clinical and clinically significant dental phobia. The sample consisted of 61 patients at a university dental clinic who endorsed symptoms of dental phobia, 25 of whom met criteria for a formal diagnosis of dental phobia. Participants with dental phobia endorsed more panic symptoms than did those with sub-clinical dental phobia. In the total sample, greater endorsement of panic symptoms was associated with higher dental anxiety, more avoidance of dental procedures, and poorer oral health-related quality of life. Among those with dental phobia, certain panic symptoms exhibited associations with specific anxiety-eliciting dental procedures. Panic symptoms may serve as indicators of clinically significant dental phobia and the need for augmented treatment.     

基于艾森克人格问卷探讨社交恐惧症的人格特征

目的 探讨社交恐惧症患者的发病与人格特征的关系.方法 采用自编社会人口学资料调查表、Liebowitz社交焦虑量表（LSAS）、艾森克人格问卷（EPQ）对40例社交恐惧症（Social Phobia,SP）组患者和40名健康对照组人群进行评估.结果 社交恐惧症组与健康对照组在EPQ四个因子分及LSAS评分方面比较差异均有统计学意义（t分别为6.26,8.19,3.84,2.25,12.76;P＜0.05）,社交恐惧症组的LSAS评分与患者的神经质因子分呈正相关（r=0.545,P＜0.01）.结论 社交恐惧症患者有特别的人格特征,可能是其发病原因之一.     

In vivo desensitization of a severe driving phobia through radio contact with telemonitoring of neurophysiological reactions

A 34 year-old man with a severe driving phobia was treated by in vivo desensitization. A radio transceiver was used to provide the anxiety inhibiting effects of voice contact during exposure to phobic driving experiences. Transceivers were linked to a Telemonitor apparatus programmed to broadcast heartbeat and GSR readings automatically every 15 minutes or on demand, each of 10 seconds duration. The therapist was therefore in touch with the subjective and physiological arousal of the patient from distances up to 7 miles. This allowed him to conduct more efficiently a program of in vivo graduated exposure. Treatment effects were maintained at a 9-month follow-up.     

Sleep characteristics associated with drowsy driving

ObjectiveThe aim of this study was to evaluate sleep characteristics associated with drowsy driving in an adult population.MethodsThe study subjects consisted of 1675 adults aged 19 years or older who completed a population-based questionnaire survey on sleep habits. Experiences of drowsy driving were obtained from self-reported data. We investigated sleep-related variables including sleep duration, sleep efficiency, chronotype, subjective sleep perception, daytime sleepiness, sleep quality, and snoring. We performed multivariate logistic regression analysis to determine sleep characteristics independently associated with drowsy driving.ResultsThe mean age of the subjects was 43.2 years, and 66.3% were men. The prevalence of self-reported drowsy driving was 23.6% (396 of 1675), and 33.1% of subjects experienced dozing at the wheel at least once a month. Multivariate analysis demonstrated that men, office and manual workers, excessive daytime sleepiness, depression, habitual snoring, and perceived insufficient sleep were independently associated with drowsy driving. Subgroup analyses revealed that reduced weekday sleep duration was a risk factor of drowsy driving in adults with perceived sufficient sleep. On the other hand, frequent alcohol drinking significantly increased risk of drowsy driving in the subgroup with perceived sleep insufficiency. Furthermore, ordinal regression analyses confirmed the association between sleep characteristics and drowsy driving across different drowsy driving frequencies.ConclusionExcessive daytime sleepiness, depression, habitual snoring, and perceived insufficient sleep were sleep-related risk factors for drowsy driving. In addition to maintaining healthy sleep habits, individuals at high risk should be encouraged to evaluate underlying sleep disorders or psychiatric problems to prevent drowsy driving.     

30例学校恐惧症人格和情绪特征研究

目的：探讨学校恐惧症的临床特征。方法：对30例学校恐惧症患儿（研究组）和30名正常对照儿童（对照组）进行艾森克个性问卷（EPQ）,儿童焦虑性情绪障碍筛选量表（SCARED）,焦虑自评量表（SAS）及抑郁自评量表（SDS）评估。结果：研究组患儿EPQ结果显示神经质得分显著高于对照组,掩饰程度得分显著低于对照组（P均〈0.05）;SCARED、SAS、SDS的评估显示,与对照组相比,研究组存在明显焦虑和抑郁症状（P〈0.05）。结论：学校恐惧症患儿可能具有神经症的个性特点,普遍存在焦虑和抑郁症状。     

Work characteristics and social phobia in a nationally representative employed sample

OBJECTIVE: Social phobia is associated with long-term impairment and disability. Environmental and genetic influences may be important in etiology and persistence. This is the first study to examine the association of work characteristics with social phobia in a representative nationally employed population. METHOD: Self-reported work characteristics were linked to 12-month social phobia diagnosed by the World Mental Health Composite International Diagnostic Interview in 24 324 employed individuals from the Canadian Community Health Survey. RESULTS: High job strain (OR = 1.62, 95%CI, 1.06 to 2.49) and job insecurity (OR = 2.47, 95%CI, 1.73 to 3.51) were associated with an increased risk of 12-month social phobia, adjusting for sociodemographic variables, prevalent depression, and other work characteristics. CONCLUSIONS: Work characteristics are associated with social phobia. Characteristics such as job insecurity may be a consequence of illness in employed populations, while high job strain may increase the risk of symptoms. More investigation is needed of the relation between work and social phobia to understand how to reduce occupational disability.     

儿童青少年学校恐惧症的相关因素及心理治疗特点

<正>1概述儿童青少年因害怕学习和学校而拒绝上学,俗称厌学。Johnson于1941年首先提出学校恐惧症(school phobia)一词[1],特指那些对学校环境产生异常恐惧,强烈拒绝上学的儿童,认为其是儿童情绪障碍的一种类型。20世纪50年代,一些教育界学者发现,由于心理因素造成的拒绝上学行为,其背景是由于儿童与母亲的分离焦虑而导致对学校的恐惧,与逃学有本质区别,后者往往伴有品行问题和反     

Specific phobia

This article describes specific phobia of childhood and its clinical presentation, discusses issues related to the differential diagnosis of specific phobia, considers the issue of comorbidity among phobic and anxiety disorders and developmental trends in the manifestation of fears, summarizes the epidemiology, causes, and course of specific phobia, and presents assessment and treatment issues. Finally, a case study is offered that serves to illuminate the major topics outlined in the article.     

Clinical predictors of driving status in Huntington's disease

The aim of this study was to identify the motor, cognitive, and behavioral determinants of driving status and risk factors for driving cessation in Huntington's disease (HD). Seventy-four patients with HD were evaluated for cognitive, motor, psychiatric, and functional status using a standardized battery (Unified Huntington's Disease Rating Scale [UHDRS] and supplemental neuropsychological testing) during a research clinic visit. Chart review was used to categorize patients into two driving status categories: (1) "currently driving" included those driving and driving but with clinician recommendation to restrict, and (2) "not driving" included those with clinician recommendation to cease driving and those not currently driving because of HD. Multi- and univariate logistic regression was used to identify significant clinical predictors of those driving versus not driving. Global cognitive performance and UHDRS Total Functional Capacity scores provided the best predictive model of driving cessation (Nagelkerke R(2) = 0.65; P < 0.0001). Measures of learning (P = 0.006) and psychomotor speed/attention (P = 0.003) accounted for the overall cognitive finding. In univariate analyses, numerous cognitive, motor, and daily functioning items were significantly associated with driving. Although driving status is associated with many aspects of the disease, results suggest that the strongest association is with cognitive performance. A detailed cognitive evaluation is an important component of multidisciplinary clinical assessment in patients with HD who are driving. ? 2012 Movement Disorder Society.     

Prognosis of cardiac phobia

The 36 inpatients who entered this prospective study were admitted to hospital because of cardiac phobia. Their treatment consisted of a behavior therapy program. Twenty-nine of them could be reexamined after 2 1/2 years: 41% were free of symptoms during more than 75% of the follow-up period; 59% suffered recurrences of their anxiety. One patient had committed suicide. A lower educational level, being single, and interpersonal difficulties and conflicts were the sociodemographic factors associated with a poor prognosis; a long pretreatment period of illness and the presence of depression or agoraphobia on admission were significantly more frequently correlated with an unfavorable outcome. The onset sequence of depression, agoraphobia and anxiety attacks was also of prognostic relevance.     

Pharmacotherapy of social phobia

OBJECTIVE: To review placebo-controlled medication trials in social phobia (SP). METHOD: Published and/or presented placebo-controlled trials of medication were reviewed and summarized. RESULTS: Phenelzine is effective in 60-70% of patients with SP and always superior to placebo. Although reversible inhibitors of monoamine oxidase type A (RIMAs) are safer, their benefits are unpredictable. SSRIs, fluvoxamine, paroxetine and sertraline are superior to placebo in generalized SP. Gabergic drugs are useful, e.g. clonazepam, gabapentin and pregabalin. Promising effects have been found with venlafaxine, a serotonin-norepinephrine reuptake inhibitor, and the results of larger studies should be forthcoming in the next 2 years. Drugs such as buspirone, tricyclics and beta-blockers are either ineffective or have limited use. SP is a chronic disorder, and early termination of successful pharmacotherapy is associated with a greater likelihood of relapse. Studies with paroxetine, clonazepam, sertraline and brofaromine show that continued treatment is associated with better maintenance of response. Special populations that require further study include children, those with comorbid Axis I disorders and the population with discrete (non-generalized) SP. CONCLUSION: MAOI and SSRI are most uniformly effective in treating SP. Clonazepam and gabapentin may also be useful. Other drugs are of more limited value. Long-term treatment is recommended to reduce rates of relapse.