3 results
Virtual City for Exposure Therapy in Phobias: Case Studies of Agoraphobia
- M. Jablonská, A. Francová, K. Janků, P. Stopková, E. Nosková, I. Fajnerová
-
- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S194-S195
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Introduction
A phobia is a type of anxiety disorder that causes an individual to experience extreme, irrational fear about a situation, living creature, place, or object. The most common in the treatment of phobic disorders are in vivo exposures (IVEs) consisting of confrontation with feared stimulus until distress has decreased. Virtual reality exposure therapy (VRET) is a modern alternative to IVEs where patients are exposed to virtual anxiety-provoking environments, and its effectiveness has already been demonstrated in the treatment of most phobias (Freitas et al. Psychiatr q. 2021; 92(4):1685–1710).
ObjectivesThis paper aims to present a complex virtual city developed for VRET in different types of phobia. The VRET system is composed of several interactive environments (a skyscraper, a subway, a cinema, and a hospital) that can be combined in form of different scenarios targeting various phobias, allowing controlled and gradual exposure. Selected virtual environments will be presented in case studies of agoraphobic patients (F40 by ICD-10).
MethodsThe number of VRET sessions is individual, based on the need of each patient, starting with an introductory session including stimulus mapping and VR control explanation. Each session lasts about 30 minutes. During exposure, Subjective Units of Discomfort (SUDS) are assessed at various points. The scenarios for agoraphobia are typically composed of an elevator or subway ride, open spaces (city streets, the roof), or crowded interiors (the cinema). Environments allow various effects, elevator trembling, getting stuck situations and adjusting the number of people. All the scenes contain authentic ambient sounds.
ResultsWe present a case of a 33-year-old male patient experiencing intense fear of getting stuck or locked, turning into panic attacks. During 10 VRET sessions, the patient was exposed to different environments (subway, underground parking, elevator, cinema) focusing primarily on elevator rides, sometimes in combination with IVE, consisting of locking the door in the experimental room. Another case is a 59-year-old female patient with a fear of open spaces and crowd situations. This patient had 5 VRET sessions combining exposure to open spaces with subway rides. In addition, the patient was instructed to watch short 360° videos of crowd situations. The last case is a 20-year-old female patient with an intense fear of subway tunnels and sounds, enclosed spaces, and heights. During 4 VRET sessions, we mainly focused on the subway with additional IVEs in a real elevator.
ConclusionsSubjective evaluations during exposures indicate a reduction of anxiety across sessions. Based on the patient’s feedback we can conclude on a good acceptance of the technology and an improvement in real-life situations. These case studies demonstrate the valuable use of variable combinations of virtual scenarios in the treatment of agoraphobia.
Disclosure of InterestNone Declared
1H-MRS of the anterior cingulate cortex in obsessive-compulsive disorder: metabolic abnormalities in pgACC - controlled study
- E. Nosková, I. Fajnerová, D. Pajuelo, P. Stopková, J. Horáček
-
- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S105-S106
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Introduction
Obsessive-compulsive disorder (OCD) is connected with increased activity in cortico-striatal-thalamic-cortical (CSTC) loop. The anterior cingulate cortex (ACC) is a part of this loop and plays a role in error detection and monitoring and processing of conflicting information, core OCD clinical signs. This area also contains a high density of Von Economo neurons. Biochemistry in this area is closely connected with the pathophysiology of OCD.
ObjectivesDecreased concentrations of total N-acetylaspartate (tNAA) have been reported in ACC in patients with OCD compared to healthy controls (HC), with increase after successful treatment. Findings by other metabolites: choline-containing compounds (tCho), total creatine (tCr) and myo-inositol are not consistent. Differences in levels of tNAA, tCho, tCr would correlate with the severity of symptoms measured by Y-BOCS. In the comparison in the subgroup of patients with/ without medication, there will be differences in levels of metabolites.
Methods54 patients diagnosed with OCD according to ICD-10 and DSM-IV criteria, and 54 HC matched for age and sex were included in the study. They underwent MRI and MR Spectroscopy on a 3T Magnetom Prisma scanner (Siemens, Germany) equipped with a 64-channel volume head coil (Fig. 2). After spectral quality control, 28 OCD and 28 HC subjects were included in the statistical analysis. OCD subjects were interviewed using the Y-BOCS to evaluate the severity of the symptoms. Patients enrolled in the study were without medication at least 5 days before MRI or on a stable dosage of SSRI antidepressants. To assess the intergroup differences Wilcoxon Rank Sum test or Kruskal-Wallis test was used as appropriate. The correlation between metabolite levels and clinical characteristics was assessed by Spearman’s rank correlation coefficient. The statistics were calculated using R, version 4.1.1.
ResultsWe found no differences in levels of tNAA in ACC in OCD vs. HC (p=0,21; see Tab.1, Fig.1). We found significantly increased level of tCho, tCr and Ins in OCD vs. HC (p=0,03; p=0,004 resp.; p=0,017 resp.). tCr levels corelated negatively with YBOCS compulsions subscale (p=0,046; cor=-0,38). tCho levels showed a trend to negative correlation with Y-BOCS compulsions subscale (p=0,067; cor=-0,35). Analysis on the subgroup with (13 subjects, 46,43 %) and without (13 subjects, 46,43 %) stable SSRI medication did not reveal significant differences.
Image:
Image 2:
ConclusionsOur study found difference in ACC by OCD patients compared to HC, mainly increased tCho, tCr and Ins. Also, the study shows a significant correlation between the severity of compulsions and tCr levels. We can see this trend also in the correlation of the tCho and Y-BOCS compulsions subscale. Similar tNAA level by OCD and HC groups could indicates correctly adjusted medication or stable state by enrolled patients.
Disclosure of InterestNone Declared
Histamine intolerance and anxiety disorders: pilot cross-sectional study of histamine intolerance prevalence in cohort of patients with anxiety disorders
- E. Nosková, K. Vochosková, V. Knop, P. Stopková, M. Kopeček
-
- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, pp. S387-S388
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Introduction
Histamine intolerance (HI) is a disorder associated with an impairment of ability to metabolize ingested histamine. The incidence of HI in general population is 1-3%. Clinical manifestation of HI contains nonspecific predominantly gastrointestinal, but also extraintestinal symptoms. HI could be primary with genetic predisposition, or secondary with lower activity of diaminooxidase (DAO) without positive genetic screening.
ObjectivesThis study aims to evaluate the prevalence of HI by patients with anxiety disorders. HI can imitate anxiety symptoms, therefore we predict higher prevalence HI in patients with anxiety disorders than in general population.
MethodsIt is observational cross-sectional study on cohort of anxious patients for detecting the prevalence of HI. Patients were screened by scale for histamine intolerance questionnaire. Patients with positive questionnaire were examined for serum DAO and genetically examined.
Results113 patients fulfilled the HI questionnaire. From this cohort 35.4% (40 subjects) were positive at screening. Biomarkers of HI were screened only in case of positivity in this questionnaire. Table No. 1: Results of our study from cohort with positive screening, 35.4 % (40 subjects).
Genetic predisposition positivity in risk allele negativity in risk allele altogether Serum level of DAO positive screening (DAO<10 U/ml) 5 (4.4%) primary-genetically determined HI 5 (4.4%) secondary HI 10 negative screening (DAO≥10 U/ml) 14 (12.4%) 16 (14.2%) 30 altogether 19 21 ConclusionsThis pilot study shows that the prevalence of HI could be higher in group of patients with anxiety disorders than in general population. For further confirmation other studies with control group and larger cohort should be done.
DisclosureNo significant relationships.