Panic

Anxiety and depressive symptoms frequently co-occur during adolescence. Physical activity is associated with adolescent mental health at the scale-score level, but its links with individual symptoms and their temporal ordering remain less clear. This study examined contemporaneous and one-year prospective associations between physical activity and individual anxiety/depression symptoms, evaluated the robustness of pooling three annual wave-pair cohorts, and compared network patterns between male and female adolescents. Three adjacent annual wave-pair cohorts (2020–2021, 2021–2022, and 2022–2023) from a Chinese national adolescent health survey were analyzed ( N = 13,785 wave-pair records). Physical activity was measured with the PAQ-A and anxiety/depression symptoms with the SCL-90. Gaussian graphical models and cross-lagged panel networks (CLPNs) were estimated. Annual-cohort invariance, missingness, centrality, bridge centrality, accuracy, stability, and male/female differences were examined. Annual-cohort comparisons showed no detectable network-structure differences (M = 0.07–0.08, p = 0.120–0.270) or global-strength differences (ΔS = 0.12–0.32, p = 0.150–0.320). Little’s test was nonsignificant (χ² = 79.39, df = 89, p = 0.531), providing no evidence against a completely-at-random missingness mechanism. In the pooled contemporaneous network, physical activity had negative partial correlations with low motivation (weight = -0.0732), low energy (-0.0651), and nervousness (-0.0532). Worthlessness (expected influence [EI] = 1.39), tension (EI = 1.38), and nervousness (EI = 1.34) were influential nodes. Panic had the highest reported bridge EI (0.659). In the CLPN, physical activity was prospectively associated with lower low motivation ( β = -0.0602) and low mood ( β = -0.0561), while nervousness was associated with lower subsequent physical activity ( β = -0.0539). Male and female networks differed in structure (M = 0.112, p < 0.001) but not global strength (ΔS = 0.19, p = 0.709). Physical activity occupied a peripheral position in the contemporaneous network but showed small prospective associations with selected anxiety and depressive symptoms. These temporal associations do not establish causality. The stable annual-cohort pattern and male/female-specific edge configuration support further confirmatory work using designs that can address unmeasured confounding and within-person change.

Background Digital mental health platforms routinely deliver self-administered symptom scales on the assumption that users with more severe symptoms are more likely to enter professional care. That assumption is rarely tested with linked participant-level data, and almost never in the Arabic-speaking Gulf. Objective To examine whether symptom severity at a user’s first self-assessment predicts booking a professional session within 90 days, across four symptom domains, on a Saudi commercial digital mental health platform. Methods Retrospective cohort analysis of 10,100 first assessments — depression, generalized anxiety, panic, and obsessive-compulsive scales — contributed by 5,524 unique users of the Talbinah platform and linked to demographic and session-booking records through a pseudonymous (SHA-256 hashed) user identifier. The primary outcome was any session booked within 90 days after the assessment. Severity was banded by the established cut-offs for the PHQ-9 and GAD-7, and by percentage of scale maximum for the panic and obsessive-compulsive measures, for which no severity thresholds are established. Per-scale multivariable logistic regression estimated adjusted odds ratios (aOR) for severity band (reference None/Minimal), adjusting for age, sex, and device type. Pre-specified sensitivity analyses used 30- and 180-day windows, an attended-session outcome, percentage-of-maximum banding applied to all four scales, and a subset with no prior booking (incident help-seeking). Reporting followed STROBE. Results Users were young (mean age 26.7 years, SD 8.1) and predominantly female (78.1%); 16.6% of first assessments were followed by a booking within 90 days. No severity band on any of the four scales was associated with higher odds of booking (severe vs None/Minimal: depression aOR 0.71, 95% CI 0.51–1.01; generalized anxiety 0.76, 0.49–1.16; panic 0.83, 0.52–1.31; obsessive-compulsive 1.01, 0.59–1.74). One severity contrast was statistically significant, in the opposite direction: moderate depression was associated with lower odds of booking (0.66, 95% CI 0.45–0.97). Older age (aOR ~1.2 per decade) and iOS device use (1.4–2.0) were associated with booking across scales. This absence of a positive severity–booking association was consistent across 30-, 90-, and 180-day windows, the attended-session outcome, and percentage-of-maximum banding; a nominal association for moderate anxiety seen under percentage banding did not persist with validated GAD-7 cut-offs. Estimates for the panic and obsessive-compulsive scales, which lack established severity thresholds, are exploratory. Conclusions On a Saudi digital mental health platform, greater self-reported symptom severity at first assessment was not followed by higher subsequent booking of professional care, consistently across specifications, and for moderate depression was associated with lower odds of booking; demographic and access-related attributes showed stronger associations with booking than symptom load did. Self-screening on its own appears insufficient as a pathway into care.

Abstract This article offers a theoretical contribution which is conceptual, integrative, and model-oriented in nature, in the form of a critical literature review on empathy. Grounded in a psychodynamic perspective and situated at the intersection of phenomenological, existentialist, and structuralist frameworks, it examines the prevailing humanistic challenges across several sub-Saharan African countries. These nations are currently grappling with sociopolitical shifts, marked by instability in countries such as Mali, Guinea, Burkina Faso, Chad, Sudan, Niger, the Congo, and Cameroon, as well as natural disasters, all of which undermine interpersonal and intergroup (as well as intragroup) interactions. The primary objective is to explain how it is constructed and how it can be reconceptualized, not merely as a personality trait, but as an essential emotion and a vital skill for maintaining civil harmony during times of crisis. The aim is to demonstrate how it functions within a framework of intersubjectivity, rooted in the dynamics of our connection to others, as a means of regulating the psychological and physiological distress (such as stress, anxiety, anguish, depression, trauma, panic, addictions, mania, paranoia, etc.) that arises in contexts of social tension. It is developed as an internal capacity for empathy, structured around three developmental emotional competencies: emotional awareness, which emerges in infancy and grows in complexity into adulthood with the acquisition of a "theory of mind"; emotional expression, understood as a logical mode of verbal and non-verbal socio-affective communication; and emotional regulation, defined as a set of intra- and inter-individual processes used to avoid, transform, minimize, or de-intensify emotion. In conclusion, he establishes that a failure of empathy, characterized by a lack of acceptance of others, impaired awareness, and maladaptive coping, lies at the heart of maladjustment. Conversely, emotional empathy serves a homeostatic and anxiolytic function, operating on individual, collective, and contextual levels. It acts as a cathartic catalyst rooted in sharing, reciprocity, and altruistic awareness—a necessary condition for sustaining social cohesion within an anxiety-inducing environment. Keywords Empathysocial changesemotionconsciousnessexpressionregulation

این مقاله یک مشارکت نظری با ماهیتی مفهومی، تلفیقی و مدل‌محور ارائه می‌دهد که به صورت مروری انتقادی بر ادبیات پژوهش در زمینه همدلی انجام شده است. این پژوهش مبتنی بر رویکرد روان‌پویشی و در تقاطع چارچوب‌های پدیدارشناختی، اگزیستانسیالیستی و ساختارگرایانه قرار دارد و به بررسی چالش‌های انسان‌گرایانه غالب در چندین کشور آفریقای جنوب صحرا می‌پردازد. این کشورها در حال حاضر با تحولات اجتماعی-سیاسی، بی‌ثباتی در کشورهایی مانند مالی، گینه، بورکینافاسو، چاد، سودان، نیجر، کنگو و کامرون و همچنین بلایای طبیعی مواجه هستند که همگی تعاملات بین‌فردی و بین‌گروهی (و همچنین درون‌گروهی) را تضعیف می‌کنند. هدف اصلی، تبیین نحوه ساخت همدلی و بازتعریف آن نه صرفاً به عنوان یک ویژگی شخصیتی، بلکه به عنوان یک هیجان اساسی و مهارتی حیاتی برای حفظ نظم مدنی در دوران بحران است. هدف این است که نشان داده شود همدلی چگونه در چارچوب بین‌ذهنیت، ریشه‌دار در پویایی‌های ارتباط ما با دیگران، به عنوان ابزاری برای تنظیم آشفتگی روانی و فیزیولوژیکی (مانند استرس، اضطراب، رنج، افسردگی، تروما، وحشت، اعتیاد، شیدایی، پارانویا و غیره) که در بستر تنش اجتماعی ایجاد می‌شود، عمل می‌کند. همدلی به عنوان یک ظرفیت درونی، حول سه شایستگی هیجانی رشدی ساختار یافته است: آگاهی هیجانی که از کودکی پدیدار می‌شود و با کسب «نظریه ذهن» در بزرگسالی پیچیده‌تر می‌گردد؛ ابراز هیجانی که به عنوان شیوه‌ای منطقی از ارتباط اجتماعی-عاطفی کلامی و غیرکلامی درک می‌شود؛ و تنظیم هیجانی که به عنوان مجموعه‌ای از فرایندهای درون‌فردی و بین‌فردی برای اجتناب، تغییر، کاهش یا تضعیف هیجان تعریف می‌شود. در پایان، نویسنده نتیجه می‌گیرد که شکست همدلی، که با فقدان پذیرش دیگران، اختلال در آگاهی و مقابله ناسازگارانه مشخص می‌شود، در قلب ناسازگاری قرار دارد. در مقابل، همدلی هیجانی نقش هموستاتیک و ضداضطرابی ایفا می‌کند و در سطوح فردی، جمعی و زمینه‌ای عمل می‌کند. همدلی به عنوان یک کاتالیزور کاتارتیک مبتنی بر اشتراک، دوسویگی و آگاهی نوع‌دوستانه عمل می‌کند که شرط لازم برای حفظ انسجام اجتماعی در محیطی اضطراب‌آور است.

While psychedelic experiences are often reported as positive, adverse psychological reactions can occur. We present the case of a 19-year-old Caucasian male who presented to the ER with suicidal thoughts after taking lysergic acid diethylamide (LSD) alone. He was diagnosed with anxious state associated with panic attacks, and suicidal thoughts without ideation or behaviors. He was admitted to the psychiatric ward and treated with trazodone, a serotonin antagonist and reuptake inhibitor antidepressant, and brexpiprazole, an atypical antipsychotic. He responded well and was discharged after 12 days with recommendations to continue therapy with brexpiprazole and attend follow-up at the territorial mental health services. Five days later, he engaged in alcohol consumption with a roommate met during the psychiatric admission, and suicidal thoughts re-emerged. He presented again to the ER but was not admitted to the inpatient unit, since he improved with supportive conversation and medication. One month later, he returned to the ER a third time due to pervasive doubt and confusion that distressed him to the point of triggering unstructured suicidal thoughts. After one week of hospitalization, he was discharged and citalopram (a selective serotonin reuptake inhibitor [SSRI]) was added to the therapy. Following the third admission, the clinical suspicion strengthened that he may have an underlying obsessive functioning pattern that became clinically apparent following LSD use, although the contribution of other vulnerability factors could not be excluded. This case highlights the importance of set and setting, underscores the relevance of harm reduction strategies for both recreational and clinical users, and highlights a potentially negative interaction between serotonergic psychedelics and alcohol.

اگرچه تجربه‌های روان‌گردان اغلب به‌عنوان تجربه‌هایی مثبت گزارش می‌شوند، واکنش‌های روان‌شناختی نامطلوب نیز می‌توانند رخ دهند. در این مقاله، مورد یک مرد قفقازی ۱۹ ساله ارائه می‌شود که پس از مصرف لیسرجیک اسید دی‌اتیل‌آمید (LSD) به‌تنهایی، با افکار خودکشی به بخش اورژانس مراجعه کرد. او با وضعیت اضطرابی همراه با حملات پانیک و افکار خودکشی بدون تمایل یا رفتار تشخیصی شد. وی در بخش روان‌پزشکی بستری و با ترازودون، یک داروی ضدافسردگی آنتاگونیست سروتونین و مهارکننده بازجذب، و برکسپیپرازول، یک داروی ضدروان‌پریشی غیرمعمول، درمان شد. او به درمان پاسخ مناسبی داد و پس از ۱۲ روز با توصیه ادامه درمان با برکسپیپرازول و پیگیری در خدمات سلامت روان منطقه‌ای ترخیص شد. پنج روز بعد، او با هم‌اتاقی‌ای که در مدت بستری با او آشنا شده بود، الکل مصرف کرد و افکار خودکشی مجدداً ظاهر شد. او بار دیگر به اورژانس مراجعه کرد اما به دلیل بهبود با گفت‌وگوی حمایتی و دارو بستری نشد. یک ماه بعد، برای بار سوم به دلیل شک و تردید فراگیر و سردرگمی که او را تا حد بروز افکار خودکشی بدون ساختار آزار می‌داد، به اورژانس مراجعه کرد. پس از یک هفته بستری، ترخیص شد و سیتالوپرام (یک مهارکننده انتخابی بازجذب سروتونین [SSRI]) به درمان او افزوده شد. پس از سومین بستری، ظن بالینی تقویت شد که ممکن است او الگوی عملکرد وسواسی زمینه‌ای داشته باشد که پس از مصرف LSD به‌صورت بالینی آشکار شده است، اگرچه نقش سایر عوامل آسیب‌پذیری نیز قابل رد نیست. این مورد اهمیت شرایط ذهنی و محیطی، لزوم راهبردهای کاهش آسیب برای مصرف‌کنندگان تفریحی و بالینی، و همچنین احتمال تعامل منفی بین روان‌گردان‌های سروتونرژیک و الکل را برجسته می‌کند.