Secrets, lies, and disguise: The case of andy warhol.

The life and works of the great American artist Andy Warhol (1928-1987) are examined in the context of Warhol's compulsive and often gratuitous lying. Elements of early trauma-contracting St. Vitus Dance at age of 7, his father's death at age of 13, and the abject poverty in which he grew up as the son of immigrants-are viewed as central antecedents of his deceptiveness. The relevance of these dynamics to the clinical situation is examined.

The history of generalized anxiety disorder as a diagnostic category.

From the 19th century into the 20th century, the terms used to diagnose generalized anxiety included "pantophobia" and "anxiety neurosis." Such terms designated paroxysmal manifestations (panic attacks) as well as interparoxysmal phenomenology (the apprehensive mental state). Also, generalized anxiety was considered one of numerous symptoms of neurasthenia, a vaguely defined illness. Generalized anxiety disorder (GAD) appeared as a diagnostic category in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) in 1980, when anxiety neurosis was split into GAD and panic disorder. The distinct responses these two disorders had to imipramine therapy was one reason to distinguish between the two. Since the revised DSM-III (DSM-III-R), worry about a number of life circumstances has been gradually emphasized as the distinctive symptom of GAD. Thus, a cognitive aspect of anxiety has become the core criterion of GAD. The validity of GAD as an independent category has been questioned from DSM-III up to preparation of DSM-5. Areas of concern have included the difficulty to establish clear boundaries between GAD and (i) personality dimensions, (ii) other anxiety-spectrum disorders, and (iii) nonbipolar depression. The National Institute of Mental Health has recently proposed the Research Domain Criteria (RDoC), a framework destined to facilitate biological research into the etiology of mental symptoms. Within the RDoC framework, generalized anxiety might be studied as a dimension denominated "anxious apprehension" that would typically fit into the research domain called "negative valence systems" and the more specific construct termed "potential threat."

Desde el sigh XIX y hasta el siglo XX, los términos empleados para diagnosticar la ansiedad generalizada incluyeron la "pantofobia" y la "neurosis de ansiedad". Tales términos designaron manifestaciones paroxísticas (ataques de pánico) como también fenomenología interparoxística (el estado mental de aprensión). También la ansiedad generalizada fue considerada uno de Ios numerosos síntomas de la neurastenia, una enfermedad definida vagamente. El trastorno de ansiedad generalizada (TAG) apareció como una categoría diagnóstica en la tercera edición del Manual Diagnóstico y Estadístico de Ios Trastornos Mentales (DSM-III) en 1980, cuando la neurosis de ansiedad fue dividida entre el TAG y el trastorno de pánico. Una de las razones para distínguir estos dos trastornos fue la respuesta diferente que tuvieron a la terapia con imipramina. A partir de la edición revisada del DSM-III (DSM-III-R), la preocupación People Like Us - situaciones de vida se ha enfatizado gradualmente como el síntoma distintivo del TAG. En consecuencia, un aspecto cognitivo de la ansiedad ha llegado a ser el criterio central del TAG. La validez del TAG como una categoría independiente ha sido cuestionada desde el DSM-III hasta la preparación del DSM-5. Algunos aspectos tornados en cuenta han incluido la dificultad para establecer límites claros entre el TAG y 1) dimensiones de la personalidad, 2) otros trastornos del espectro ansioso y 3) la depresión no bipolar. Recientemente, el Instituto National de Salud Mental de EE.UU. propuso Ios Research Domain Criteria (RDoC), un sistema destinado a facilitar la investigación biológica acerca de la etiología de Ios síntomas mentales. Dentro del sistema RDoC, la ansiedad generalizada podría ser estudiada como una dimensión denominada "aprensión ansiosa", la cual podría ajustar típicamente con el dominio de investigación llamado "sistemas de valencía negativa" y más específicamente con el constructo llamado "amenaza potencial".

Entre le XIXe et le XXe siècle, plusieurs termes ont été utilisés pour dénommer l'anxiété généralisée, notamment la «pantophobie¼ et la «névrose d'angoisse¼. Ces termes désignaient à la fois des manifestations paroxystiques (les attaques de panique) ainsi que les symptômes intercritiques (l'état mental d'appréhension). D'autre part, l'anxiété généralisée était aussi considérée comme l'un des nombreux symptômes de neurasthénie, une maladie de définition imprécise. Le trouble anxieux généralisé (TAG) est apparu pour la première fois en tant que diagnostic dans la 3e édition du manuel statistique et diagnostique des troubles mentaux (DSM-III) en 1980 quand la névrose d'angoisse a été divisée en TAG et trouble panique. Ces deux troubles ont été distingués sur la base d'une réponse différente au traitement par imipramine. À partir de la révision du DSM-III (DSM-III-R), l'inquiétude face à un certain nombre de situations de la vie courante a été conceptualisée petit à petit comme le symptôme cardinal du TAG. Ainsi, un aspect cognitif de l'anxiété est devenu le critère primordial du TAG. La validité du TAG en tant que catégorie diagnostique indépendante a été mise en doute depuis le DSM-III jusqu'à la préparation du DSM-5. Les questionnements reposaient sur la difficulté à établir des frontières claires entre le TAG et (1) les dimensions de personnalité, (2) les autres troubles du spectre de l'anxiété et (3) la dépression non-bipolaire. L'institut national de la santé mentale aux États-Unis a récemment mis en place le Research Domain Criteria [RDoC], un cadre destiné à faciliter les recherches biologiques dans le domaine de l'étiologie des troubles mentaux. Dans le cadre du RDoC, l'anxiété généralisée pourrait être étudiée comme une dimension appelée «appréhension anxieuse¼, qui appartiendrait typiquement au domaine de recherche dénommé «systèmes de valences négatives¼ et plus spécifiquement au concept dit de «menace potentielle¼.

Galen's Anxious Patients: Lype as Anxiety Disorder.

Galen describes a syndrome he associates with an emotion called lype, with specific symptoms and a course that may lead to humoral imbalance, disease, and death. Lype is an emotion that encompasses distress at a loss, as the death of a close friend or the destruction of one's books by fire; but Galen also associates it with chronic worry about a future threat, and a physiology between the emotions of worry and fear (that is, 'anxiety'). Lype can cause a progressive syndrome characterised by insomnia, fever, pallor, and weight loss that can kill patients or degenerate into psychotic illness. This syndrome can be described in modern terms as an anxiety disorder.

El retorno a Eleusis: ¿tienen los alucinógenos un papel en terapéutica? / The return to Eleusis: do hallucinogens have a role to play in therapeutics?

Desde los años 70, y tras la explosión de la psicodelia, el interés por el poder terapéutico de los alucinógenos (o 'psicodélicos') se había desvanecido de manera paralela a su inclusión dentro del extenso grupo de las drogas de abuso o recreativas. Recientemente han vuelto a situarse en el foco de la atención psiquiátrica por su papel en el tratamiento de la ansiedad, la depresión, las adicciones y el trastorno de estrés postraumático (TEPT). En el trabajo de Tupper et al. que se comenta se revisan las bases de este uso y los principales estudios que soportan las indicaciones terapéuticas mencionadas. Cuando se piensa en este tipo de sustancias lo habitual es situarlas en un contexto recreativo, en el que los usuarios las utilizan fuera de cualquier control médico. Sin embargo, las nuevas tendencias que propugnan su uso terapéutico refuerzan la importancia de la actitud (set), del escenario (setting) y de la relación médico-paciente como elementos críticos facilitadores de la terapia. Tupper et al. dividen las sustancias 'psicodélicas' de manera un tanto simple en sustancias clásicas y entactógenas. Dentro del primer grupo se encontrarían los psicodislépticos clásicamente conocidos (LSD, psilocibina, dimetiltriptamina, mescalina), de origen generalmente vegetal, agonistas de los receptores de la serotonina y utilizados tradicionalmente en ceremonias religiosas o de sanación en todo el mundo desde hace milenios. Por su parte, los entactógenos ejercen su efecto sobre la liberación de serotonina y su máximo representante sería la MDMA (metilendioximetanfetamina) o 'éxtasis' (AU)

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Epidemiology of anxiety disorders in the 21st century.

Anxiety disorders, including panic disorder with or without agoraphobia, generalized anxiety disorder, social anxiety disorder, specific phobias, and separation anxiety disorder, are the most prevalent mental disorders and are associated with immense health care costs and a high burden of disease. According to large population-based surveys, up to 33.7% of the population are affected by an anxiety disorder during their lifetime. Substantial underrecognition and undertreatment of these disorders have been demonstrated. There is no evidence that the prevalence rates of anxiety disorders have changed in the past years. In cross-cultural comparisons, prevalence rates are highly variable. It is more likely that this heterogeneity is due to differences in methodology than to cultural influences. Anxiety disorders follow a chronic course; however, there is a natural decrease in prevalence rates with older age. Anxiety disorders are highly comorbid with other anxiety disorders and other mental disorders.

Los trastornos de ansiedad, que incluyen el trastorno de pánico con o sin agorafobia, el trastorno de ansiedad generalizada, el trastorno de ansiedad social, las fobias específicas y el trastorno de ansiedad por separación son los trastornos mentales más prevalentes y están asociados con inmensos costos de atención de salud y una alta carga de enfermedad. De acuerdo con investigaciones basadas en grandes poblaciones, hasta un 33,7% de la población presenta un trastorno de ansiedad durante su vida. Se ha demostrado que el subdiagnóstico y el subtratamiento de estos trastornos es significativo. No existe evidencia acerca del cambío en las frecuencias de prevalencia de los trastornos de ansiedad en los últimos años. En comparaciones interculturales las frecuencias de prevalencía son altamente variables. Es más probable que esta heterogeneidad se deba a diferencias en la metodología más que a influencias culturales. Los trastornos de ansiedad siguen un curso crónico; sin embargo, hay una disminución natural en las frecuencias de prevalencia a mayor edad. Los trastornos de ansiedad son altamente comórbidos con otros trastornos ansiosos y otros trastornos mentales.

Les troubles anxieux, dont le trouble panique avec ou sans agoraphobie, le trouble anxieux généralisé, l'anxiété sociale, les phobies spécifiques et l'anxiété de séparation, sont les troubles mentaux les plus prévalents avec des coûts immenses en termes de santé et une charge élevée. D'après de grandes études basées sur la population, jusqu'à 33,7 % de la population souffre d'un trouble anxieux au cours de la vie. Ces pathologies sont manifestement sous-diagnostiquées et sous-traitées. Leur prévalence n'a pas montré de modification ces dernières années et est très variable dans les comparaisons interculturelles. Cette hétérogénéité est probablement plus due à des biais méthodologiques qu'à des influences culturelles. L'évolution des troubles anxieux est chronique mais leur prévalence diminue cependant naturellement avec l'âge. Leur comorbidité avec les autres troubles anxieux et les autres maladies mentales est très élevée.

[Suicidal ideation and completed suicide in The Decameron]. / Decameron'da intihar düsüncesi ve tamamlanmis intihar.

OBJECTIVE: To extend our understanding of suicidal ideation and completed suicide via examination of a medieval Italian text-in particular, examination of the role of social and environmental triggers in such events. Previous studies have successfully examined the texts of ancient Greco-Roman, Old Norse, and Finnish civilizations to better understand the circumstances associated with suicidal ideation and completed suicide. Those texts included depictions of suicide by people without any apparent mental disorder in response to painful social/environmental circumstances. MATERIALS AND METHODS: The Decameron, a collection of 100 short stories written by Giovanni Boccaccio in 1349-51, was examined in detail. The setting of The Decameron is during the Black Death and concerns a group of 10 people that leave plague-ridden Florence for a holiday in the countryside. On each of the 10 days of their trip, each individual tells a story, which in total form the 100 stories of Boccaccio's work. For the present study, all mentions of suicidal ideation and completed suicide were listed and arranged with appropriate headings. RESULTS: In total, 9 accounts of suicidal ideation and 4 accounts of completed suicide were identified, all of which were in response to social stressors, particularly romantic problems. CONCLUSION: Suicidal ideation and completed suicide in response to social stressors was a feature of The Decameron and it is feasible that this may have been a feature of medieval Italian culture. This would be in agreement with the findings of other studies that suggest that although commonly occurring in response to mental disorder, suicide can occur independently of such disorder as a result of a predicament in which an individual finds him/herself.

Hysterical again: the gastrointestinal woman in medical discourse.

This article suggests increased attention to how medical discourses of gastrointestinal (GI) disorder and distress are fraught with social assumptions and consequences by examining nineteenth-century and contemporary medical texts focused on chronic constipation and Irritable Bowel Syndrome (IBS). I suggest that these medical discourses present what I call the "gastrointestinal woman," who is characterized as having unjustified anxiety and is to blame for her condition. My approach to understanding, and ultimately revising, the representation of the gastrointestinal woman is shaped by disability studies scholarship, which encourages intervention in problematic medical discourses and more active shaping of discourses of chronic pain and illness by those who have these conditions.

Fitting in: the roles of social acceptance and discrimination in shaping the daily psychological well-being of Latino youth.

OBJECTIVES: We examine how acculturation experiences such as discrimination and social acceptance influence the daily psychological well-being of Latino youth living in newly emerging and historical receiving immigrant communities. METHODS: We use data on 557 Latino youth enrolled in high school in Los Angeles or in rural or urban North Carolina. RESULTS: Compared to Latino youth in Los Angeles, Latino youth in urban and rural North Carolina experienced higher levels of daily happiness, but also experienced higher levels of daily depressive and anxiety symptoms. Differences in nativity status partially explained location differences in youths' daily psychological well-being. Discrimination and daily negative ethnic treatment worsened, whereas social acceptance combined with daily positive ethnic treatment and ethnic and family identification improved, daily psychological well-being. CONCLUSIONS: Our analysis contributes to understanding the acculturation experiences of immigrant youth and the roles of social context in shaping adolescent mental health.

Narcolepsy and psychiatry: an evolving association of increasing interest.

Gélineau originally described narcolepsy as a disease with an organic cause. However, the disorder had undeniable emotional triggers and psychiatric-like expressions, and soon a psychiatric etiology of narcolepsy became a seriously considered option. In fact, the psychiatric view dominated scientific thinking for a long time, not necessarily to the benefit of patients. When hypocretin (orexin) defects were proven to be the cause of narcolepsy Gélineau's original disease model was shown to be right. However, the psychiatric symptoms of the disease were not forgotten afterwards, but gained a different significance: as psychiatric expressions of a brain disease. These symptoms, such as anxiety and eating disorders, can be highly debilitating and warrant clinical attention. Here, we describe the role of psychiatry in the history of narcolepsy, showing their evolving association.

The discovery of chlordiazepoxide and the clinical introduction of benzodiazepines: half a century of anxiolytic drugs.

The clinical introduction of chlordiazepoxide half a century ago was one of the major breakthroughs in the history of psychopharmacology, as it opened the door for the benzodiazepine saga, the pharmacological family par excellence in the treatment of anxiety disorders. This review analyses the discovery of this drug, which was filled with chance events, and numerous chemical and clinical errors of approach. Chlordiazepoxide, initially called methaminodiazepoxide, was patented in 1958 and introduced in clinical treatment in 1960 under the brand name Librium®. The benzodiazepines became the most widely prescribed drugs worldwide, provided truly effective treatment for "minor forms" (neuroses) of mental disorders for the first time, increased the quality of scientific methodology in clinical research, and enabled the development of new etiopathogenic theories for anxiety disorders, especially after the discovery in 1977 of their high-affinity receptor complex.

[The concept of "vegetative depression" (1949) by Rudolf Lemke--an obsolete concept?]. / Das Konzept der "vegetativen Depression" (1949) von Rudolf Lemke--Ein obsoletes Konzept?

OBJECTIVE: In 1949 East German psychiatrist Rudolf Lemke presented his concept of a vegetative, i. e., anxious depression due to a vegetative dysfunction, in which the mental symptoms are dominated and oppressed by somatic complaints. METHODS: The strengths and weaknesses of Lemke's concept will be analysed with particular reference to earlier, similar theories, such as those by Cimbal, Hempel, and Rosenfeld. RESULTS/CONCLUSIONS: The fact that, due to the dominance of physical symptoms, many patients suffering from this disease consult a general practitioner even today proves that Lemke dealt with a problem most significant both for psychiatry and general medicine.

Fear, anxiety and their disorders: past, present and future neural theories

This paper reviews the historical development of a two-dimensional (direction x distance (?)) neural model of defense. It begins with Miller's (1944) analysis, and model, of approach, avoidance and conflict; adds Hinde's (1966) ethological perspective and Flynn's (1967) neural model of fear; and then considers Gray's (1967, 1970) work linking barbiturate action to the hippocampus, McNaughton's (1977) extension of this to other classes of anxiolytics, and Gray & McNaughton's (1983) detailed behavioral comparison of anxiolytics and hippocampal lesions. This work led to Gray's (1982) detailed model of the neuropsychology of anxiety. Rapoport's (1989) model of the control of obsession by the cingulate cortex, and Ledoux's (1994) model of the control of both fear and anxiety to the amygdala, suggested a more complex organisation of defense systems. McNaughton (1989) argued that evolutionary function defines an emotion, and Blanchard and Blanchard (1990) argued for its assessment via ethoexperimental analysis. Graeff (1994) then produced a neural model that mapped defensive distance to neural level, treating all anxiety as being at a greater defensive distance than fear. Seeing this, and the treatment of anxiety as due to uncertainty (which is inconsistent with Miller's data), as being unsatisfactory, Gray and McNaughton (2000) and then McNaughton and Corr (2004) developed the two-dimensional model of defensive systems. This model is clearly incomplete at the present time and its links with neuroeconomics, personality, and stress and greater specification of frontal cortical contributions are suggested as directions for future development.(AU)

Fear, anxiety and their disorders: past, present and future neural theories

This paper reviews the historical development of a two-dimensional (direction x distance (?)) neural model of defense. It begins with Miller's (1944) analysis, and model, of approach, avoidance and conflict; adds Hinde's (1966) ethological perspective and Flynn's (1967) neural model of fear; and then considers Gray's (1967, 1970) work linking barbiturate action to the hippocampus, McNaughton's (1977) extension of this to other classes of anxiolytics, and Gray & McNaughton's (1983) detailed behavioral comparison of anxiolytics and hippocampal lesions. This work led to Gray's (1982) detailed model of the neuropsychology of anxiety. Rapoport's (1989) model of the control of obsession by the cingulate cortex, and Ledoux's (1994) model of the control of both fear and anxiety to the amygdala, suggested a more complex organisation of defense systems. McNaughton (1989) argued that evolutionary function defines an emotion, and Blanchard and Blanchard (1990) argued for its assessment via ethoexperimental analysis. Graeff (1994) then produced a neural model that mapped defensive distance to neural level, treating all anxiety as being at a greater defensive distance than fear. Seeing this, and the treatment of anxiety as due to uncertainty (which is inconsistent with Miller's data), as being unsatisfactory, Gray and McNaughton (2000) and then McNaughton and Corr (2004) developed the two-dimensional model of defensive systems. This model is clearly incomplete at the present time and its links with neuroeconomics, personality, and stress and greater specification of frontal cortical contributions are suggested as directions for future development.