RESUMO
Heart rate variability (HRV) and end tidal CO2 (ETCO2) in relation to treatment response have not been studied in Latino populations or in comorbid asthma and panic disorder (PD). An extension of previously published research, the current study explored psychophysiological variables as possible mediators of treatment response. Latino treatment completers (N = 32) in the Bronx with asthma-PD received either Cognitive-Behavioral Psychophysiological Therapy (CBPT) or Music Relaxation Therapy (MRT). CBPT included HRV-biofeedback (HRVB); in-the-moment heart rate data to help an individual learn to influence his/her own heart rate. The sample was primarily female (93.8%) and Puerto Rican (81.25%). Treatment groups did not differ on demographics, except for less education in CBPT. The Panic Disorder Severity Scale (PDSS) and Asthma Control Questionnaire (ACQ) assessed changes in symptoms. HRV and ETCO2 were measured at four of eight therapy sessions. Baseline ETCO2 and changes in HRV from first to last of psychophysiology sessions were investigated as mediators of change on ACQ and PDSS. Mixed model analyses indicated in the CPBT group, changes in both asthma control and PD severity were not mediated by changes in HRV. In the CBPT and MRT groups combined, changes in PD severity were not mediated by baseline ETCO2. These findings may be due to the brevity of HRVB in CBPT, multiple treatment components, ETCO2 not directly targeted, and/or unique physiological pathways in Latinos with asthma-PD.
Assuntos
Asma/reabilitação , Biorretroalimentação Psicológica , Dióxido de Carbono/metabolismo , Terapia Cognitivo-Comportamental , Frequência Cardíaca/fisiologia , Hispânico ou Latino , Musicoterapia , Avaliação de Resultados em Cuidados de Saúde , Transtorno de Pânico/reabilitação , Terapia de Relaxamento , Adulto , Idoso , Asma/etnologia , Asma/metabolismo , Asma/fisiopatologia , Biorretroalimentação Psicológica/métodos , Terapia Cognitivo-Comportamental/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Musicoterapia/métodos , Cidade de Nova Iorque/etnologia , Transtorno de Pânico/etnologia , Transtorno de Pânico/metabolismo , Transtorno de Pânico/fisiopatologia , Porto Rico/etnologia , Terapia de Relaxamento/métodosRESUMO
OBJECTIVE: To examine baseline measures of illness-specific panic-fear (ie, the level of anxiety experienced specifically during asthma exacerbations) as a protective factor in pediatric asthma outcomes over a 1-year period. STUDY DESIGN: The sample comprised 267 children (Mexican, n = 188; Puerto Rican, n = 79; age 5-12 years) from a longitudinal observational study conducted in Phoenix, AZ and Bronx, NY. Assessments were done at baseline and 3, 6, 9, and 12 months. The Childhood Asthma Symptom Checklist was administered at baseline to children and caregivers to assess children's illness-specific panic-fear. Asthma outcome variables quantified longitudinally included pulmonary function, the Asthma Control Test, acute healthcare utilization, and medication adherence, measured by devices attached to inhaled corticosteroids. RESULTS: Child report of illness-specific panic-fear at baseline predicted higher forced expiratory volume in 1 second (FEV1) % across 1-year follow-up in Mexican children (ß = 0.17, P = .02), better asthma control in Puerto Rican children (ß = 0.45, P = .007), and less acute healthcare utilization for asthma in both groups (Mexicans: ß = -0.39, P = .03; Puerto Ricans: ß = -0.47, P = .02). Caregiver report of child panic-fear predicted higher FEV1% in Mexican (ß = 0.30; P = .02) and Puerto Rican (ß = 0.19; P = .05) children. Panic-fear was not related to medication adherence. CONCLUSIONS: Illness-specific panic-fear had beneficial effects on asthma outcomes in both groups of Latino children. The heightened vigilance associated with illness-specific panic-fear may lead children to be more aware of their asthma symptoms and lead to better strategies for asthma management.
Assuntos
Adaptação Psicológica , Asma/psicologia , Medo/psicologia , Hispânico ou Latino , Americanos Mexicanos , Transtorno de Pânico/etnologia , Medição de Risco/métodos , Asma/complicações , Asma/etnologia , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Incidência , Masculino , Transtorno de Pânico/etiologia , Transtorno de Pânico/psicologia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Estados Unidos/epidemiologiaRESUMO
La comuna San Pedro de Atacama (SPA) tiene alta población rural y étnica, grupos vulnerables, según la literatura, a problemas de salud mental. El objetivo de este trabajo es conocer la prevalencia de síntomas ansiosos en escolares e investigar sus diferencias respecto de variables étnicas, de edad y género. Para ello se utilizó la escala de auto reporte de ansiedad para niños y adolescentes (AANA). La muestra quedó constituida por 416 alumnos, de ellos se analizaron 335 escalas, cuya media de edad fue de 10 años. Un 60,3 por ciento obtuvo sobre el punto de corte para sospecha de trastorno de ansiedad. El género femenino tenía mayor sintomatología ansiosa, junto con el grupo etario de 7 a 11 años. No existió diferencias significativas para la variable étnica. Respecto a las subescalas, la distribución etaria de la fobia social fue diferente a lo reportado en la literatura, lo que podría derivar del contexto sociocultural, necesario de investigaren futuros trabajos.
The San Pedro de Atacama (SPA) district has an important number of rural and ethnic population, which according to the literature, is more vulnerable to mental health problems. The aim of this research is to determine the prevalence of anxiety symptoms in school age children and to study its differences in relation to ethnicity, age and gender. The AANA (self report anxiety scale for children and adolescents) was applied in a sample of 416 students, from which 335 questionnaires were analyzed (mean age: 10 years). A 60.3 percent of the students were above the cut point for suspicion of an anxiety disorder. Females had a higher number of symptoms of anxiety, as did the group with ages 7 to 11 years. There were no statistically significant differences for ethnicity. In the subscales, the age distribution for social phobia was found to be different from the one previously reported; this could be explained by the sociocultural context, which remains to be studied in future research.
Assuntos
Humanos , Masculino , Feminino , Criança , Psiquiatria Infantil , Transtornos de Ansiedade/etnologia , Distribuição por Idade e Sexo , Estudos Transversais , Chile/etnologia , Epidemiologia Descritiva , Etnicidade , Saúde Mental , Prevalência , Transtorno de Pânico/etnologia , Transtornos Fóbicos/etnologia , Transtornos de Ansiedade/epidemiologiaRESUMO
We investigated the relative importance of "fear of arousal symptoms" (i.e., anxiety sensitivity) and "dissociation tendency" in generating ataque de nervios. Puerto Rican patients attending an outpatient psychiatric clinic were assessed for ataque de nervios frequency in the previous month, and they completed the Anxiety Sensitivity Index (ASI) and the Dissociation Experiences Scale (DES). ASI scores were especially high in the ataque-positive group (M=41.6, SD=12.8) as compared with the ataque-negative group (M=27.2, SD=11.7), t(2, 68)=4.6, P<.001. Among the whole sample (N=70), in a logistic regression analysis, the ASI significantly predicted (odds ratio=2.6) the presence of ataque de nervios, but the DES did not. In a linear regression analysis, ataque severity was significantly predicted by both the ASI (beta=.46) and the DES (beta=.29). The theoretical and clinical implications of the strong relationship of the ASI to ataque severity are discussed.
Assuntos
Transtornos de Ansiedade/etnologia , Nível de Alerta , Características Culturais , Transtornos Dissociativos/etnologia , Medo , Hispânico ou Latino/psicologia , Transtorno de Pânico/etnologia , Transtornos Somatoformes/etnologia , Adulto , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/psicologia , Estudos Transversais , Transtornos Dissociativos/diagnóstico , Transtornos Dissociativos/psicologia , Feminino , Humanos , Masculino , Massachusetts , Pessoa de Meia-Idade , Transtorno de Pânico/diagnóstico , Transtorno de Pânico/psicologia , Inventário de Personalidade , Porto Rico/etnologia , Papel do Doente , Transtornos Somatoformes/diagnóstico , Transtornos Somatoformes/psicologiaRESUMO
Within somatization, unexplained neurological symptoms (UNSs) have been shown to mark a distinct subgroup with greater clinical severity. However, some UNSs resemble ataque de nervios somatic symptoms. This raises questions about cultural factors related to Hispanics with somatization characterized by UNSs. To examine cultural factors, preliminary analyses examined the relationship between Hispanic ethnicity, UNSs, and ataque de nervios. Data were obtained from 127 primary care patients (95 Hispanic, 32 European American) with somatization. The Composite International Diagnostic Interview provided somatization data, whereas the Primary Care Evaluation of Mental Disorders was used for data on Axis I disorders. Ataque de nervios was assessed via a proxy measure. Within each ethnic group, cross-tabs examined the relationship between ataque de nervios and multiple UNSs, and ataque de nervios and selected Axis I disorders. Only among Hispanics, a significant overlap was found between ataque de nervios and having four or more UNSs (p < .001), and ataque de nervios and a diagnosis of panic disorder (p = .05). Although equal percentages of European Americans and Hispanics experience multiple UNSs, these results show that the presentation of UNSs among some Hispanics may be qualitatively different, because it may involve features related to ataque de nervios. A diagnosis of panic disorder also appears to interact with cultural factors.
Assuntos
Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/etnologia , Comparação Transcultural , Hispânico ou Latino/estatística & dados numéricos , Transtornos Somatoformes/diagnóstico , Transtornos Somatoformes/etnologia , Adulto , Transtornos de Ansiedade/psicologia , Comorbidade , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/etnologia , Transtorno Depressivo/psicologia , Feminino , Hispânico ou Latino/psicologia , Humanos , Modelos Logísticos , Masculino , New Jersey , Transtorno de Pânico/diagnóstico , Transtorno de Pânico/etnologia , Transtorno de Pânico/psicologia , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Porto Rico/etnologia , Índice de Gravidade de Doença , Transtornos Somatoformes/psicologia , Inquéritos e Questionários , População Branca/estatística & dados numéricosRESUMO
This article examines a clinical sample of 66 Dominican and Puerto Rican subjects who reported ataques de nervios and also psychiatric disorder, and disentangles the phenomenological experiences of ataque de nervios, panic attacks, and panic disorder. In-depth cultural interviews assessed the symptomatic phenomenology of ataque episodes from the local perspective as well as in terms of key panic features, such as recurrence, rapid peaking of symptoms, and lack of provocation. Independent diagnostic assessments of panic attacks and disorder were also used to establish the phenomenological overlap between ataque and panic. Our findings indicate that 36 percent of ataques de nervios fulfill criteria for panic attacks and between 17 percent and 33 percent for panic disorder, depending on the overlap method used. The main features distinguishing ataques that fulfill panic criteria from ataques that do not include whether the episodes were provoked by an upsetting event in the person's life and the rapidity of crescendo of the actual attack. A key finding is that ataques often share individual phenomenological features with panic episodes, but that these features usually do not "run together" during the ataque experience. This confirms previous findings that ataque is a more inclusive construct than panic disorder. The importance of these findings for the clinical diagnosis and treatment of persons with ataques is discussed.
Assuntos
Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/etnologia , Cultura , Hispânico ou Latino/psicologia , Transtorno de Pânico/diagnóstico , Transtorno de Pânico/etnologia , Adolescente , Adulto , Idoso , Comorbidade , Diagnóstico Diferencial , República Dominicana/etnologia , Feminino , Hospitais Psiquiátricos , Humanos , Entrevista Psicológica , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , New York , Psiquiatria , Porto Rico/etnologia , Sociologia MédicaRESUMO
The comparatively high salaries made in Japan are attractive to many Japanese-Brazilians. The number of individuals from this ethnic group being treated in Japanese mental hospitals has increased. We hypothesized that Japanese-Brazilian patients with panic disorders adjusted better to Japanese society and culture than those with other mental disorders. The subjects in the present study are 40 Japanese-Brazilian patients undergoing treatment at the Department of Psychiatry at Jichi Medical School, Japan, from May 1990 to September 1998. Patients were divided into a panic disorder group, a schizophrenic group, a mood disorder group and a neurosis group. Demographic data (Japanese language ability, duration of residence in Japan etc.) were collected. A comparison was made among the four groups. Patients in the panic disorder group showed a significant tendency to be fluent speakers of Japanese. Patients in the panic disorder group also had been in Japan for a significantly longer period of time than those in the other three groups. Japanese ability and length of residence in Japan rule out exacerbating factors due to a foreign living environment. Panic disorder patients usually have resolved the problems inherent in living and working in a foreign country. In general, Japanese-Brazilians are more comfortable both financially and socially in Japan than other foreign laborers because of their cultural and family background. The emotional conflict experienced by such patients may result from concern over whether to live in Brazil or Japan in the future. Their ethnic and cultural identity may be confused, fluctuating between identifying with Brazil and with Japan, and this may cause vague feelings of anxiety.
Assuntos
Cultura , Transtorno de Pânico/etnologia , Adulto , Brasil/etnologia , Feminino , Humanos , Japão/epidemiologia , Acontecimentos que Mudam a Vida , Masculino , Transtorno de Pânico/diagnóstico , Transtorno de Pânico/psicologia , Características de Residência , Índice de Gravidade de Doença , Fatores de TempoRESUMO
This article examines the treatment of a Jamaican woman with panic disorder, with a specific focus on the role of culture and the use of multiple formulations of the clinical problem. The work suggests that complex decisions are sometimes called for in assessing whether treatment should advocate against a cultural norm of the clients. The work further suggests that conceptualization of the problem from the vantage point of multiple frameworks is warranted in some instances, but that it requires considerable thought in order to achieve an integrated, coherent treatment plan.