Dizziness and Panic in China: Associated Sensations of Zang Fu Organ Disequilibrium

In China, distress is commonlyexperienced as dizziness that can develop intoacute episodes resembling Western panicattacks. These distressing sensations occur ina unique cultural context with a distinctiveset of associated symptoms, beliefs andpurported etiologies. The experience ofillness is informed by traditional Chinesemedicine (TCM), an indigenous theory thatelaborates a system of organ functioning calledzang fu. Depending on the implicatedzang fu organ disequilibrium, dizzinessand panic present with a specific constellationof associated physical and mental symptoms. This paper presents a clinical survey ofpsychiatric disorders that demonstratesdizziness to be characteristic of Chineseanxiety states, most particularly panic. Threespecific cases of dizziness-focused panicascribed to different states of zang fudisequilibrium are described. In a typicalpattern, initial dizziness and associatedsymptoms intensify until they generalize intopanic attacks. The degree of dizziness andpanic corresponds to the state ofdisequilibrium of the zang fu organsystem as well as instability of the social,interpersonal and environmental context of thepatient. This paper elucidates the dynamicinterpretants of dizziness in the Chinesecontext to contribute to a medical anthropologyof this sensation.     

The Weight of Cognitions in Panic: The Link between Misinterpretations and Panic Attacks

In cognitive theory it is hypothesized that panic attacks are provoked by catastrophic misinterpretations of bodily sensations. The aim of the present study was to investigate the ability of associated word pairs referring to catastrophic thinking (e.g. palpitations-heart attack) in producing panic attacks. Patients with PD (n = 20), patients with mixed anxiety disorders (n = 20), and a healthy control group (n = 30) participated in the present study. To enhance ecological validity we first conducted a stimulus validation experiment. Subsequently, nine suitable panic and neutral word pairs were presented in block to the participants. Anxiety levels were assessed before and after the presentation. PD patients were more anxious when reading these word pairs, compared to neutral word pairs. However, none of the participants experienced a panic attack upon reading the word pairs. From the present results it seems that catastrophic thinking is rather related to the anticipatory anxiety for panic attacks, but not necessarily with the occurrence of the panic attacks themselves.     

Comparative Phenomenology of Ataques de Nervios,Panic Attacks,and Panic Disorder

This article examines a clinicalsample of 66 Dominican and Puerto Ricansubjects who reported ataques de nerviosand also psychiatric disorder, and disentanglesthe phenomenological experiences of ataquede nervios, panic attacks, and panic disorder. In-depth cultural interviews assessed thesymptomatic phenomenology of ataqueepisodes from the local perspective as well asin terms of key panic features, such asrecurrence, rapid peaking of symptoms, and lackof provocation. Independent diagnosticassessments of panic attacks and disorder werealso used to establish the phenomenologicaloverlap between ataque and panic. Ourfindings indicate that 36 percent ofataques de nervios fulfill criteria for panicattacks and between 17 percent and 33 percentfor panic disorder, depending on the overlapmethod used. The main features distinguishingataques that fulfill panic criteria fromataques that do not include whether theepisodes were provoked by an upsetting event inthe person's life and the rapidity of crescendoof the actual attack. A key finding is thatataques often share individualphenomenological features with panic episodes,but that these features usually do not ``runtogether' during the ataque experience.This confirms previous findings thatataque is a more inclusive construct thanpanic disorder. The importance of thesefindings for the clinical diagnosis andtreatment of persons with ataques isdiscussed.     

Panic Probes and the Identification of Panic: A Historical and Cross-Cultural Perspective

This article reviews the historicaldevelopment of the category of panic disorderin the United States, particularly the shiftingperspectives on both what causes panic and howthe presence of panic should be determined. Thenotion that panic attacks of a panic-disordertype must be ``out of the blue' and``unexpected,' except in the case of triggeringby a particular place (i.e., agoraphobia), iscritiqued. The authors illustrate that ameaningful epidemiological determination ofpanic rates in other cultural groups must bepreceded by a detailed ethnography thatascertains the catastrophic cognitions, coresymptoms, and typical cues of panic attacks inthat particular context.     

Characteristics of attention-related body sensations. Temporal stability and associations with measures of body focus,affect, sustained attention,and heart rate variability

Aim: This study investigated the temporal stability and correlates of attention-related body sensations that emerge without external stimulation during rest and due to focused attention on a body part.

Materials: To assess attention-related body sensations, participants were asked to focus on a freely chosen body area with closed eyes, and had to report whether the sensation of that area had changed. Self-report questionnaires were used to assess various aspects of body focus (body awareness, body responsiveness, somatosensory amplification, subjective somatic symptoms), and positive and negative affectivity. Previous experiences in body–mind therapies were also measured. PEBL Continuous Performance Test was used to assess sustained attention. Heart rate variability scores were based on a 3-minute long resting heart rate measurement.

Methods: Fifty-eight university students (22.3?±?3.95 years; 34 females) participated in the study. The stability of attention-related body sensations was measured 8?weeks later on a randomly chosen sub-group (n?=?28).

Results: Attention-related body sensations showed a mediocre temporal stability (r_ρ?=?0.47, p?=?0.012). People reporting attention-related body sensations showed significantly higher body awareness, somatosensory amplification, and resting heart rate; and marginally higher somatic symptoms. No relation was found with body–mind practice, body responsiveness, positive and negative affect, the vagal component of heart rate variability, and performance in the sustained attention task.

Conclusion: Attention-related sensations are relatively stable over time. They are connected to some, but not to all of the aspects of body focus. Further studies are needed to elaborate the influencing stable and situational factors.     

Attenuation of self-generated tactile sensations is predictive, not postdictive

When one finger touches the other, the resulting tactile sensation is perceived as weaker than the same stimulus externally imposed. This attenuation of sensation could result from a predictive process that subtracts the expected sensory consequences of the action, or from a postdictive process that alters the perception of sensations that are judged after the event to be self-generated. In this study we observe attenuation even when the fingers unexpectedly fail to make contact, supporting a predictive process. This predictive attenuation of self-generated sensation may have evolved to enhance the perception of sensations with an external cause.     

Orthostatic panic as a key Vietnamese reaction to traumatic events: the case of September 11, 2001

This article discusses a culturally specific response to traumatic events: orthostatic panic attacks among Vietnamese refugees. We compared the rate and severity of orthostatic panic as well as the rates and severity of associated flashbacks a month before and a month after September 11, 2001. After that date, the rate and severity of orthostatic panic greatly increased, as did the rate and severity of associated flashbacks. The central role of orthostatic panic as a response to traumatic events is illustrated through a patient's vignette. An explanation of why September 11 so profoundly influenced this population is adduced, including an explanation of why it resulted in considerable worsening of orthostatic panic.     

Capsaicin cross-desensitization on the tongue: psychophysical evidence that oral chemical irritation is mediated by more than one sensory pathway

Psychophysical measurements were made of the perceived intensityand quality of sensations of chemical irritation before andafter the tip of the tongue had been desensitized to capsaicin(10 ppm). The results of the first experiment showed that capsaicindesensitization tended to reduce the perceived intensity ofirritation produced by approximately equipotent concentrationsof capsaicin (3 ppm), ethanol (30%), cinnamic aldehyde (2.5%)and NaCl (5M) applied to the tongue on filter paper disks; however,the reduction in irritation was less for the latter three compoundsthan for capsaicin and failed to reach statistical significancefor ethanol. Ratings of sensation quality suggested that thefour irritants produced different quality ‘profiles’,and that ethanol and cinnamic aldehyde were characterized bysensations of numbness as well as by sensations of burning andstinging/pricking. Follow-up experiments in which subjects ratedthe perceived intensity of individual sensation qualities showedthat desensitization dramatically reduced the burning and stinging/prickingcomponents of irritation, but left the sensations of numbnessand chemogenic warmth unchanged. It is concluded that lingualchemesthetic sensations are multidimensional, and mediated byboth capsaicinsensitive and capsaicin-insensitive sensory pathways.     

Panic Disorder in African-Americans: Symptomatology and Isolated Sleep Paralysis

While attention has been paid to thestudy of panic disorder (PD) with or withoutagoraphobia among Caucasians, surprisinglylittle empirical research within the UnitedStates has looked at the phenomenology of PDamong minority groups. In this paper wepresent data we have collected and review otherresearch on the phenomenology, social supports,and coping behavior among African-Americanswith panic disorder. Our studies indicate that,in comparison to Caucasians, African-Americanswith PD reported more intense fears of dying orgoing crazy, as well as higher levels ofnumbing and tingling in their extremities. African-Americans reported higher rates ofcomorbid post traumatic disorder and moredepression. African-Americans also usedsomewhat different coping strategies (such asreligiosity and counting one's blessings), lessself-blame, and were somewhat more dissatisfiedwith social supports. The incidence ofisolated sleep paralysis was, as per previousreports, higher in African-Americans. Thesefindings, results of other research, and theimplications for assessment and treatment arediscussed within a semantic network analysis of panic (Hinton and Hinton 2002, thisissue).     

Influence of skin temperature distribution on thermal sensation in a cool environment

Thermal sensation and distribution of skin temperatures in persons exercising at 36.5 W on a bicycle ergometer and resting in a cool environment (10 degrees C) in two different clothings, one with the insulation mainly over the trunk (1.22 clo), and one with well insulated limbs (1.67 clo), were studied. Their general thermal sensations varied from slightly warm to slightly cool. The placing of the insulation had a decisive influence on skin temperature distribution, so that skin temperature was always high in well-insulated areas. When the insulation was placed over the limbs, a greater amount of heat was lost than if a similar insulation was placed on the trunk. Neither Tsk nor skin temperature distribution correlated with general thermal sensation. Instead, mean body temperature seemed to be the determinant of general thermal sensation in these conditions. The best prediction of general thermal sensation was obtained by adding Tre with a weighting factor of 0.8-0.9 and Tsk with a weighting factor of 0.1-0.2.     

Regional distribution of thermal sensitivity to cold at rest and during mild exercise in males

Although several studies have compared thermal sensitivity between body segments, little is known on regional variations within body segments. Furthermore, the effects of exercise on the thermal sensation resulting from a cold stimulus remain unclear. The current experiment therefore aimed to explore inter- and intra-segmental differences in thermal sensitivity to cold, at rest and during light exercise. Fourteen male participants (22.3±3.1 years; 181.6±6.2 cm; 73.7±10.3 kg) were tested at rest and whilst cycling at 30% VO_2 max. Sixteen body sites (front torso=6; back=6; arms=4) were stimulated in a balanced order, using a 20 °C thermal probe (25 cm²) applied onto the skin. Thermal sensations resulting from the stimuli were assessed using an 11-point cold sensation scale (0=not cold; 10=extremely cold). Variations were found within body segments, particularly at the abdomen and mid-back where the lateral regions were significantly more sensitive than the medial areas. Furthermore, thermal sensations were significantly colder at rest compared to exercise in 12 of the 16 body sites tested. Neural and hormonal factors were considered as potential mechanisms behind this reduction in thermal sensitivity. Interestingly, the distribution of cold sensations was more homogenous during exercise. The present data provides evidence that thermal sensitivity to cold varies within body segments, and it is significantly reduced in most areas during exercise.     

Regional differences in temperature sensation and thermal comfort in humans

Sensations evoked by thermal stimulation (temperature-related sensations) can be divided into two categories, "temperature sensation" and "thermal comfort." Although several studies have investigated regional differences in temperature sensation, less is known about the sensitivity differences in thermal comfort for the various body regions. In the present study, we examined regional differences in temperature-related sensations with special attention to thermal comfort. Healthy male subjects sitting in an environment of mild heat or cold were locally cooled or warmed with water-perfused stimulators. Areas stimulated were the face, chest, abdomen, and thigh. Temperature sensation and thermal comfort of the stimulated areas were reported by the subjects, as was whole body thermal comfort. During mild heat exposure, facial cooling was most comfortable and facial warming was most uncomfortable. On the other hand, during mild cold exposure, neither warming nor cooling of the face had a major effect. The chest and abdomen had characteristics opposite to those of the face. Local warming of the chest and abdomen did produce a strong comfort sensation during whole body cold exposure. The thermal comfort seen in this study suggests that if given the chance, humans would preferentially cool the head in the heat, and they would maintain the warmth of the trunk areas in the cold. The qualitative differences seen in thermal comfort for the various areas cannot be explained solely by the density or properties of the peripheral thermal receptors and thus must reflect processing mechanisms in the central nervous system.     

The Influence of Rate of Skin Indentation on Threshold and Suprathreshold Tactile Sensations

The effects of skin indentation depth and rate on threshold and suprathreshold tactile sensations were investigated. Indentation rates between 0.3 and 10 mm/sec had little effect on the absolute tactile thresholds measured in terms of indentation depth. Slower rates resulted in increased absolute thresholds.

Estimates of the growth in intensity of tactile sensations were made as functions of indentation depth and rate. The fastest rate used (10 mm/sec), for a given depth of indentation, produced the most intense sensation; the slowest (0.1 mm/sec), the least intense sensation. The tactile sensation magnitude estimates, with rate as the parameter, could be described by power functions. At the slowest indentation rate the exponent of the function was 1.36. At faster indentation rates (0.4, 1.0, and 10 mm/sec), two functions of markedly different slopes were required to describe the estimates. The exponents of the power functions were between 0.38 and 0.49 for indentation depths up to about 0.9 mm, and between 1.07 and 1.43 for deeper indentation depths.     

The effects of heat-induced pain on the detectability,discriminability, and sensation magnitude of vibrotactile stimuli

The effects of heat-induced pain on absolute thresholds, sensation magnitudes and amplitude-difference thresholds were measured at 10 and 100 Hz. Consistent with previous results, heat-induced pain elevated the absolute thresholds by approximately 8.0 dB and lessened the magnitudes of tactile sensations during pain as compared to the non-painful condition. In contrast to these effects, the discriminability of change in the intensity of the vibrotactile stimuli was unaffected by the presence of pain indicating that the effect of pain on tactile sensations is more likely due to sensory rather than cognitive processes (i.e., attention) and that the mechanisms underlying tactile sensitivity as compared to discriminability are different.     

The effects of heat-induced pain on the detectability, discriminability, and sensation magnitude of vibrotactile stimuli

The effects of heat-induced pain on absolute thresholds, sensation magnitudes and amplitude-difference thresholds were measured at 10 and 100 Hz. Consistent with previous results, heat-induced pain elevated the absolute thresholds by approximately 8.0 dB and lessened the magnitudes of tactile sensations during pain as compared to the non-painful condition. In contrast to these effects, the discriminability of change in the intensity of the vibrotactile stimuli was unaffected by the presence of pain indicating that the effect of pain on tactile sensations is more likely due to sensory rather than cognitive processes (i.e., attention) and that the mechanisms underlying tactile sensitivity as compared to discriminability are different.     

CCK-4-Induced Calcium Mobilization in T Cells Is Enhanced in Panic Disorder

Abstract: We investigated the effects of brain cholecystokinin (CCK) receptors on the intracellular calcium concentration and protein kinase C in human T cells. CCK-4 produced a transient increase in calcium in the absence of extracellular calcium. CCK-B agonists stimulated calcium mobilization in a dose-dependent manner in T cells. CCK-B antagonists suppressed CCK-4-induced calcium mobilization more potently than CCK-A antagonist. The recovery of desensitization of the CCK-4-induced response was delayed by a phosphoserine/phosphothreonine phosphatase inhibitor, calyculin A. The responsiveness to CCK-4 was also reduced by phorbol 12,13-dibutyrate (PDBu), and this effect of PDBu was abolished completely by preincubation with staurosporine. CCK-4-induced calcium mobilization was too small to attribute the desensitization to the protein kinase C transduction pathway. T cells from patients with untreated panic disorder exhibited significantly higher cholecystokinin-4-induced calcium mobilization than those from healthy controls or patients with treated panic disorder. These results suggest that cholecystokinin-B receptor function in T cells of patients with panic disorder is enhanced. Cholecystokinin-4-induced calcium mobilization in T cells may be state dependent and useful as a biological marker of panic disorder.     

Identification of local thermal conditions for sleeping comfort improvement in neutral to cold indoor thermal environments

The effect of the thermal environment on sleep quality has attracted considerable attention, as sleep forms one-third of human lifetime and the occupied space is largely constrained during sleep. With an increasing development of partial space regulation and task air conditioning systems and devices, thermal comfort demand concerning local thermal conditions has attracted more and more attention. In the present study, experiment was conducted and data mining technologies were performed to investigate correlations between local thermal conditions and whole body thermal comfort in sleeping state. The identification of local thermal condition included two steps: the first step was to clarify thermal sensation links between local and covered body, and the second step was to identify local thermal sensation inclination towards different thermal comfort levels. Thermal sensation correlations among local body parts and covered body were obtained. Back, face, and thigh were identified as three dominant linear-correlated local parts with weighting factors 0.488, 0.388, and 0.152, respectively; in addition, chest, arm, leg and foot were found as non-negligible local parts in the estimation of covered body thermal sensation. By dividing the sleeping human body into three parts as head, trunk and extremity, the proper local thermal sensations and their coupling relationships for whole body sleeping thermal comfort have been elaborated by three rules. The present study provides implications in sleeping thermal environment regulation in neutral to cold indoor conditions.     

Developing a new individualized 3-node model for evaluating the effects of personal factors on thermal sensation

Individual differences, such as weight, height, gender, age, and Basal Metabolic Rate (BMR), between human subjects can significantly affect body thermoregulatory mechanisms. Therefore, application of common population-based thermal comfort models cannot provide accurate results for an individual's thermal sensation. Based on the standard thermal models, including those of Fanger and Gagge, individual parameters are not considered in the evaluation of thermal sensations. Thus, these simplified standard models have some limitations under varied individual conditions. In this study, a new individualized thermal comfort model is presented on the basis of a simplified 3-node model. This model was developed by regarding the effects of individual characteristics, such as age, gender, Body Mass Index (BMI), and BMR on the thermal sensations of the bare and clothed parts of the body. A good agreement was found in the current model, which was verified based on the experimental data. In conclusion, the results indicated that the mean error in the prediction of skin temperature decreased from 1.2 °C to 0.4 °C when using the new individual model instead of a non-individualized 3-node model.     

Childhood Internalizing and Externalizing Problems Predict the Onset of Clinical Panic Attacks over Adolescence: The TRAILS Study

Background

Panic attacks are a source of individual suffering and are an independent risk factor for later psychopathology. However, much less is known about risk factors for the development of panic attacks, particularly during adolescence when the incidence of panic attacks increases dramatically. We examined whether internalizing and externalizing problems in childhood predict the onset of panic attacks in adolescence.

Method

This study is part of the TRacking Adolescents’ Individual Lives Survey (TRAILS), a Dutch longitudinal population cohort study (N = 1,584). Internalizing and Externalizing Problems were collected using the Youth Self-Report (YSR) and the parent-report Child Behavior Checklist (CBCL) at baseline (age 10–12). At age 18–20, DSM-IV defined panic attacks since baseline were assessed with the Composite International Diagnostic Interview (CIDI). We investigated whether early adolescent Internalizing and Externalizing Problems predicted panic attacks between ages 10–20 years, using survival analysis in univariate and multivariate models.

Results

There were N = 314 (19.8%) cases who experienced at least one DSM-IV defined panic attack during adolescence and N = 18 (1.2%) who developed panic disorder during adolescence. In univariate analyses, CBCL Total Problems, Internalizing Problems and three of the eight syndrome scales predicted panic attack onset, while on the YSR all broad-band problem scales and each narrow-band syndrome scale predicted panic attack onset. In multivariate analyses, CBCL Social Problems (HR 1.19, p<.05), and YSR Thought Problems (HR 1.15, p<.05) and Social Problems (HR 1.26, p<.01) predicted panic attack onset.

Conclusion

Risk indicators of panic attack include the wide range of internalizing and externalizing problems. Yet, when adjusted for co-occurring problem behaviors, Social Problems were the most consistent risk factor for panic attack onsets in adolescence.     

Evacuation of Pedestrians with Two Motion Modes for Panic System

In this paper, we have captured an underlying mechanism of emergence of collective panic in pedestrian evacuations by using a modification of the lattice-gas model. We classify the motion of pedestrians into two modes according to their moods. One is gentle (mode I), the other is flustered (mode II). First, to research the cause for crowd, we fix the motion modes of pedestrians and increase the proportion of pedestrians with motion mode II (ρ_II). The simulation results show that the pedestrians with motion mode II are lack of evacuation efficiency and cause more casualties. Further, we use the SIS (susceptible-infective-susceptible) model to describe the spreading of the panic mood. The system can be in the high-mix state when the infection probability λ is greater than a fuzzy threshold. In addition, the distances S from wounded people to the exit are researched, the number of wounded people gets maximum at the internal S = 5 ∼ 10, which is independent of ρ_II and λ. This research can help us to understand and prevent the emergence of collective panic and reduce wounds in the real evacuation.