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Psychophysiological effects of practicing static qigong meditation in breast cancer survivors

Author(s): Georgel Arhip,Ion Dafinoiu,Gabriela Monica Assante,Dan Vlad Filimon,Dănuț Constantin Irimia / Language(s): English Issue: 3/2019

Background: Cancer treatment can result in severe impairments regarding patients quality oflife, such as persistent fatigue, sleep disturbance, and a series of psychological conditionsranging from fear or sadness to anxiety or even depression. Various forms of meditation havebeen studied in association with the reduction of symptoms related to cancer and cancertherapy. The growing number of breast cancer survivors triggers the need of a betterattention in clinical practice regarding their quality of life.Objectives: The aim of the present research consists in investigating the extent to whichmeditation, specifically, static qigong as a psychotherapeutic method, is effective inameliorating impairments in breast cancer survivors.Method: Thirty-one breast cancer survivors participated in the research. The subjects thatnever practiced meditation were invited to join a research during which they had to practicestatic qigong meditation, once a day, for five weeks. Several psychophysiological indicatorssuch as, plasma cortisol level, electrodermal reaction, palms temperature, oxygen saturationin the blood, anxiety levels, illness perception were measured before and after theintervention, and social support and personality features before intervention.Results: The results of the paired samples t-tests suggest that after the five-week interventionlower cortisol levels were obtained, as well as a better electrodermal reaction, increased palms

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Current aspects on the relations that might exist between the schizophrenic pathology and gut microbiota-further metabolic relevance

Author(s): Ovidiu Ilie,Irina Dobrin,Alin Ciobîcă,Vasile Chiriță,Daniel Timofte / Language(s): English Issue: 3/2019

Considering the latest increased awareness on the connections that might exist between mostof the neuropsychiatric disorders and the gut microbiota, which is basically formed from themicroorganisms from this particular environment, in this mini-review we will try tosynthesize on the current scarce literature from this area of research, as well as to speculateon the further development and pathophysiological importance of this matter and even itsmetabolic relevance.

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Review on the Present Condition of Histrionic Personality Disorder

Author(s): Octav-Sorin Candel / Language(s): English Issue: 3/2019

Histrionic personality disorder (HPD) firstly appeared in DSM II under the name ofhysterical personality disorder. It is characterized by exhibitionist behavior, constantattention seeking, rapidly shifting emotions and high suggestibility. Although its current namefirstly appeared in the third edition of DSM, little research has been made specifically on thisdisorder. Low prevalence and high comorbidity with other personality disorders might act ascauses for the general lack of interest in this disorder. The presents study offers a multifaceted perspective on HPD, aiming at discussing its historical roots, some of the mostimportant theories that explain its causes, its prevalence and the ways to assess HPD. Inaddition, its second aim was to present the most important correlates of HPD. Althoughnarrow, previous research offers some support for maintaining HPD as a personalitydisorder, contrary to some opinions that consider it should be replaced or eliminated fromDSM. In conclusion, this paper highlights the current opinions on HPD and offers a look at itsimplication in the domain of mental health.

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Creative potential and school performance in medical universities

Author(s): Mihnea Manea,Maria Puiu,Oana Manea,Vasile Chiriță / Language(s): English Issue: 3/2019

Introduction. Creativity is a concept of individual differences which is intended to explainwhy some people have higher potential to provide new solutions to old problems than others.In turn, creative achievement refers to the actual realization of this potential in terms of reallife accomplishments (such as having made a scientific discovery,making a device, drug,diagnostic, treatment, therapeutic intervention, writing specialist books etc.). Objectives.Assessing the potential of creative students and school performance. Method. It was used aquestionnaire based on the review of those used by various authors. Subjects. The researchwas attended by a number of 160 students, second year of study, Faculty of Dental Medicine,Bucharest. Results. Analysis of the results highlights the high levels of creative potentialperceived by most students enrolled in research. Conclusions. Harnessing the creativepotential of students presupposes educational process orientation for the development andpractical application of such skills in the practical work, as well as the revaluation of thedeontological on reducing occupational risks in critical situations.

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Characteristics of premorbid stage in patients with treatment-resistant depression

Author(s): Vasile Chiriță,Roxana Chiriță,Ghenadie Cărăușu / Language(s): English Issue: 3/2019

Introduction: The burden of treatment-resistant depression (TRD) is represented by thestrong impact on patient functionality, significant deterioration of the quality of life, isolationand stigmatization of the individual. TRD patients incur the highest direct and indirectmedical costs among those with major depressive episode, costs that increase with diseaseseverity.Purpose: To study the role of predisposing and precipitating factors in the emergence,development and maintenance of TRD.Methods: Descriptive cohort study of 612 patients with TRD, using methods of clinicalresearch, psychological tests, analytical epidemiology, descriptive epidemiology, andmathematics.Results: The factors predisposing to the development of TRD have been systematized. It hasbeen clearly demonstrated that affective, somatic, and stress-related disorders in TRD patientfamily are the most common hereditary factors. Disappointment, low level of emotionalsupport during childhood (p <0.05), loss of one parent (p <0.01), use of physical force inchildren (p <0.05), anxiety as a personality trait in the premorbid period (p <0.05), andintroversion (p <0.05) are other factors that have statistical significance.Conclusions: The determining role of precipitating factors in TRD triggering and of favoringfactors in its maintenance have been identified. The impact of personal negative stressfulevents such as abandonment, separation, divorce, death was demonstrated.

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Involuntary psychiatric admission – a comparison between legal frameworks

Author(s): Mirona-Letiția Dobri,Alina-Ioana Voinea,Ionuț-Dragoș Rădulescu,Petronela Nechita / Language(s): English Issue: 3/2019

Persons suffering from psychiatric disorders are included in a category of patients consideredas vulnerable. Therefore, mental health practitioners walk a fine line around various ethicalaspects related to these patients’ care. Consent is a fundamental part of every medical act,which makes admission and treatment without consent a delicate issue surrounded by muchdebate. Despite efforts to unify the approach to involuntary admission of the psychiatricpatient, the mental health acts vary greatly between different countries. This review describeslegal frameworks applicable in countries across Europe and America, underlining the legalprocedures and the most often used criteria that qualify the patient for involuntaryadmission. These criteria include the presence of a psychiatric disorder, the dangerousnesscriterion and the need for treatment. The differences in concept regarding the necessaryclinical criteria for a mental disorder to be included on the list of diagnoses subjectable toinvoluntary admissions create an uneven ethical and moral picture regarding the status of thepsychiatric patient amongst the different legislation frameworks, thus predisposing him toother possible issues, such as discrimination. An important aspect in the procedure ofinvoluntary admission of the patient with psychiatric disorders consists of keeping a balancebetween the right to self-determination and the care duties of the medical personnel.Therefore, managing psychiatric patients involuntarily admitted proves a challenge formental health practitioners and society, as a whole, as it touches multiple ethical and socialissues.

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Is it aortic valve sclerosis a predictor for bilateral renal artery stenosis outcome in geriatric population?

Author(s): Paloma Manea,Cristina-Luiza Gavrilescu,Manuela Ursaru,Corina Ursulescu,Irina Jari,Dragos Negru,Rodica Ghiuru / Language(s): English Issue: 3/2019

Introduction: It’s wellknown the fact that aortic valve sclerosis (AVS) is a predictor ofincreased cardiovascular risk factor, but it’s implication in renal artery stenosis (RAS)outcome hasn’t been deepened.Objective: The purpose was to establish a correlation between aortic valve sclerosis ingeriatric patients, renal artery stenosis, vascular events and depression.Methods: We’ve included 32 patients with bilateral RAS; 17 patients had also AVS (group A)and 15 patients were the control group, without AVS (group B). During 24 months, wefollowed the occurrence of cardiovascular events (myocardial infarction and stroke), renalfailure (serum creatinine level), heart failure aggravation (echocardiographical parameters)and depression.Results: During 24 months, the incidence of acute vascular events was higher among group A,comparatively to group B (confidence interval CI 95%: 2.85- 2.25).Renal function was animportant parameter in our study; we’ve observed higher serum creatinine levels for thepatients with AVS, even both groups had renovascular arterial hypertension due to bilateralRAS and a physiopathological tendency to renal dysfunction (CI 95%: 2.41 - 2.16). The heartfailure prevalence was more prominent in group A than group B, both systolic and diastolictypes (CI 95%: 2.76-2.3). High sensitivity C reactive protein (hs- CRP) levels were higher forgroup A (CI 95% : 2.62-2.41).Different severity of depression were more frequent in group A.Conclusions: Our study revealed the fact that AVS promotes unfavorable evolution for thepatients with bilateral RAS, extending its influence towards ‘’target’’ vascular territories andtowards depression outcome.

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Chronic fatigue and psychiatric comorbidities in patients with rheumatic disorders

Author(s): Luana Andreea Macovei,Irina Dobrin,Vasile Chiriță,Alexandra Burlui,Romeo Petru Dobrin,Elena Rezuș / Language(s): English Issue: 3/2019

The onset of fatigue has a major impact on the individual and social development of a person,due to its negative effects on health. Chronic fatigue leads to decreased immunity andneuropsychiatric disorders. Chronic fatigue can manifest itself as a neurosis with mental orpsychosomatic symptoms, such as ulcer or blood pressure, sleep disturbances, psychoemotional disorders, sensory disturbances and various neurovegetative changes. Fatigueoccurs after periods of stress, intense physical activity, lack of sleep or prolonged illness.Chronic fatigue syndrome is found in cases where a few weeks of rest do not improve thecondition. The treatment of chronic fatigue is individualized according to the underlyingcause of fatigue. By helping patients with rheumatic diseases to adopt healthier and moreactive lifestyle habits, cognitive behavioural therapy has proved to be effective for reducingfatigue in these cases characterized by intense pain and poor prognosis.

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Fairy-tales and father Freud. Is psychoanalysis the right tool to understand folk imaginary?

Author(s): Ioana Repciuc / Language(s): English Issue: 3/2019

The paper reviews the bibliography in the field of psychoanalytical analyses of fairy talessince the instrumental works of Sigmund Freud to today’s approaches. Folk and fairy tales aswell as mythological narratives were analyzed by the proponents of the psychoanalytic studyof fairy tales through two main approaches: the psychoanalyst could either analyze the fairytale creator’s psychology, or examine the psychological motivations underneath the fairytale’s characters narrative behavior. From the post-Freudians and post-Jungians to feministrevisionists, the recent fairy tale scholarship is apparently losing its connection with the actualcontent of these texts created according to a certain worldview and folk imaginary.

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Catatonic syndrome – positive and differential diagnostic controversies. Case study

Author(s): Diana Cătălina Aniculăesei,Dania Andreea RADU,Alexandra Bolos,Ilinca UNTU,Roxana Chiriță / Language(s): English Issue: 3/2019

The present paper is the presentation of a case that exposes a positive and differentialdiagnosis controversy, in the context of a catatonic syndrome with a sudden onset, occurringin an apparent state of mental health, in a patient of 42 years old, without personal orheredocolateral psychiatric history, with normal premorbid functioning. Its purpose is toemphasize the importance of excluding organicity in the case of catatonic syndrome and tomake it aware that the impact of the often impressive psychotic symptoms should notovershadow the detection of potentially life-threatening somatic symptoms. The presentedcase underlines precisely the dilemma of establishing the etiology of catatonic syndrome,between endogenous causes and underdiagnosed meningeal reaction.

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Studying the effects of Salvia spp. extract in a valproic-acid induced rat model of autism and its possible metabolic relevance

Author(s): Samson Guenne,Nabèrè Ouattara,Radu Lefter,Daniel Timofte,Adama Hilou,Martin Kiendrebeogo / Language(s): English Issue: 4/2019

Autism or autism spectrum disorder (ASD) is a human neuropsychiatric disorder with socialand communication difficulties. Medicinal plants have a diversified and inexhaustibletherapeutic potential. The aim of this study was to evaluate potentials of Salvia spp. essentialoils on rat model of ASD memories. Social interaction test was used to confirm that ratstreated with valproic acid have produced rats with autism spectrum disorder. Y-maze taskand Radial arm-maze task were used to evaluate the effects of salvia spp. essential oils on ratwith ASD memory. The most time spent by the rat in the empty box (25.33 ± 8.55 s) and theleast time (58.53±6.07 s) spent with the new rat by the test rat compared to the control rat,showed that valproic acid had an effect on pregnant rats who gave pups with ASD. Thepercentage of spontaneous alternation increasing in Y-maze for rats with ASD treated withSalvia spp. essential oil (79.27+ 3.08%; P = 0.03, F=6.29) compared to control rats and ratstreated only with valproic acid showed that Salvia spp. essential oil significantly improvedshort-term memory in rats and corrected rat learning memory. This research showed thatSalvia plant extracts have shown in vivo pharmacological properties and have proven themerits of various traditional uses of these plants in psychiatric disorders.

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Mini-review on the psychiatric comorbidities in epilepsy – possible relevance for some metabolic changes?

Author(s): Raluca Elena Duță,Cristina-Elena Nedelcu,Alin Ciobîcă,Daniel Timofte / Language(s): English Issue: 4/2019

Epilepsy is one of the most important neurological disorders nowadays, with a variety ofstudies describing its mechanisms and complex pathophysiology. However, lately there is alsoan increased interest in understanding the psychiatric comorbities associated with theepileptic pathology. Thus, we will describe here aspects such as the importance of anxiety,depression, personality disorders, the suicidal ideation in epilepsy, as well as the correlationsthat might exist between the specific treatment for epilepsy and its psychiatric-related effects.In conclusion, it seems that the associated psychiatric manifestations from epilepsy have anincreased important in the pathophysiology of this disorder and deserve further investigation.

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The renin-angiotensine system and psychiatric disorders in pregnancy and post- partum

Author(s): Roxana Mihaela Barbu,Cristina-Luiza Gavrilescu,Elena Cojocaru,Cringuta Paraschiv,Ionuț R. Popescu,Walther Bild / Language(s): English Issue: 4/2019

The renin-angiotensin system is one of the most important general and local hormonalsystems in the body. Circulating angiotensinogen, under the action of renal or extrarenalrenin is transformed into angiotensin I. Angiotensin I is a nonapeptide, which is not active perse but by transforming into angiotensin II and by stimulating the secretion of aldosterone.The AT2 receptors are present mainly in the uterus, adrenal gland, but also in the fetus,neonate and in the brain. The renin-angiotensin system is an endocrine system of majorimportance in physiology and physiopathology, with huge implications in differentpathologies, including psychiatric ones. Psychiatric diseases in the perinatal period are apublic health problem because of the prevalence, the relative ignorance on this type ofpathology and because of the double effect on the mother and on the fetus. Perinatalpsychopathology studies the psychological difficulties and psychiatric disorders that can occurduring pregnancy and postpartum. It has consequences on the early mother-child relationshipas well as the psychotropic treatments that can be given during pregnancy and lactation andtheir short, medium and long term effect on the newborn, as well as the risks that may occurwhen treatment is stopped abruptly at the beginning of pregnancy. Conclusions: Consideringthat the status and type of the myometer angiotensin receptors is very unclear and littlestudied and that hormonal changes are the main cause for both baby blues and postnataldepression, further physiological, physiopathological and clinical studies are needed tothoroughly assess the involvement of renin-angyotensine-aldosteron system in the psychiatricdisorders in pregnancy and postpartum.

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Importance of CAIDE risk score for the early diagnosis of Alzheimer dementia

Author(s): Ioana A. Sandu,Adina C. Ilie,Ramona Ștefăniu,Anca I. Pîslaru,Ioana D. Alexa,Cristinel Stefanescu / Language(s): English Issue: 4/2019

Alzheimer’s disease is the most common type of dementia and accounts for about 60%–80%of diagnosed dementias. Currently, there are 5.3 million people in the United States diagnosedwith AD, and this number is expected to increase markedly by 2050. In Romania the numberof diagnosticated cases went up to 4.4 million in 2011, which represents 20.5% of the totalpopulation.Alzheimer's disease (AD) is a critical public health problem with a significant social andfinancial burden on society. Paradoxically, the more the disease is detected later, the higherthe overall cost of care, without taking into account the quality of life of the patient and thefamily, the actual human suffering caused by the disease. The most important thing is thatthere is no single test for Alzheimer's disease, so early identification of risk factors forAlzheimer's dementia is very important because the neurodegenerative processes of thedisease can begin in the middle of life. Identifying these risk factors can shed light on thepathophysiology of Alzheimer's disease, thus providing new potential ways to prevent andtreat it.

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Impact of cardiac anomalies in the prognosis of patients with velo-cardio-facial syndrome

Author(s): Alexandra MASTALERU,Maria-Magdalena LEON-CONSTANTIN,Irina Abdulan,Alexandra Jitaru,Eva Gavril,Florin Mitu / Language(s): English Issue: 4/2019

One of the most common multiple anomaly syndromes in human is the velo-cardio-facialsyndrome (VCFS). A very important step in managing a patient with a 22q11.2 deletion is toidentify the exact phenotypic manifestations so that appropriate counseling and anticipatorycare can be provided. Patients with VCFS have a 25 times higher rate of psychosis thangeneral population. Therefore, it is almost certain that a genomic factor or factors in thedeleted region influence brain development and/or function. Childhood psychiatricmanifestations of VCFS include mood dysregulation, anxiety disorders, attention deficithyperactivity disorder (ADHD) and autism spectrum disorders. VCFS is the most commonly known genetic risk factor for schizophrenia. The 25% risk of developing schizophrenia is agreat concern of the patients and their families given its gravity and social stigma. Regardingthe psychopharmacological treatment, the therapies need to be carefully chosen, taking intoaccount literature data on tolerability and efficacy. Thus, it is particularly important to knowthe features and symptoms of the disease in order to a good evaluation and monitoring of thepatient. A multidisciplinary approach is fundamental to ensure that the patient will be able toattain his or her maximal potential.

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Alternative therapies and management of dementia in Alzheimer’s disease

Author(s): Laura Popa,Laura Crisitina Popa,Dana Făget,Delia Podea,Roxana Chirita,Mirela Manea / Language(s): English Issue: 4/2019

Neurocognitive disorders are defined by an "significant cognitive impairment in one or moreareas: complex attention, executive function, learning and memory, language, perceptualmotor ability and social cognition. These dysfunctions represent a decline from a previouslevel of functioning, so dementia. does not refer to low or reduced intellectual functioning, ormental retardation, which are developmental and static disorders. "(1)Dementia of the Alzheimer's type is the most common nosological form of dementia,characterized by memory loss and other cognitive skills severe enough to interfere with dailylife. Dementia of the Alzheimer's type has a prevalence of 60-80% of dementia cases. (2)The factors that differentiate the dementia subtypes are: “evolution over time, the specificareas affected and the associated symptoms” (5)The therapeutic strategies are based on the increase of the cholinergic transmission and onthe modeling of the glutamatergic transmission, validated etiopathogenic hypotheses indementia Alzheimer's focus on acetylcholine transmission deficiency and NMDA receptorhyperactivity. (19)Patients diagnosed with a neurocognitive disorder such as dementia of theAlzheimer's type, represent a special group, with special needs, in which the concept ofquality of life differs from that used for patients diagnosed with conditions that are certainlyless disabling.A series of prospective cohort studies have suggested that in addition to anti - dementiapsychotropic therapy, regular physical activity associated with standardized herbal oily maceration such as garlic (Allium sativum), hawthorn (Crataegus oxyacantha - linne) andwhite mistletoe (Viscum album) may have a real effect on risk factors (diabetes, HTA,cerebrovascular disorders, X-metabolic syndrome).This paper proposes an analysis of both current psychotropic therapy, risk factors and theimpact of non-pharmacological treatment on the quality of life of people affected by thispathology.

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The impact of biochemical control on the quality of life of patients with acromegaly

Author(s): Emilia Solomon,Cristina Preda,Cristina-Luiza Gavrilescu,Radu Gheorghe Solomon,Dumitru Brănișteanu / Language(s): English Issue: 4/2019

Purpose: Quality of life (Qol) is undoubtedly important for patient case management. Thecurrent goal of a treatment extends therefore beyond biochemical monitoring, including thephysical, mental and social state of wellbeing. We aimed to correlate disease activity with theperception of Qol in acromegalic patients.Methods: We performed a single center cross-sectional study on 26 patients: 9 men (34.6%)and 17 women (65.4%), with a mean age of 53 ± 11.5 years. Eleven patients (42.3%) had abiochemically controlled disease, while 15 subjects (57.7%) had an active disease.Results: The mean total score of the quality of life was 60.9 ± 12.6 in women, ranging from 40to 85, while for men, the mean total score was of 64.04 ± 14.78, ranging from 42 to 85(p=0.575). There was no significant difference between the mean AcroQol scores of patientswith controlled or active disease (62.54 ± 13.42 vs 61.23 ± 13.46, p = 0.804). Patients youngerthan 60 had a significantly lower total score compared to older patients, (58.36 ± 14.17 vs64.26 ± 12.44, p=0.047). Rural residents also scored lower than patients belonging to theurban region: (58.18 ± 11.21 vs 67.19 ± 14.39, p=0.048). Disease duration was negativelycorrelated with total score on AcroQol (r = -0.253, p= 0.045). We did not find significantcorrelations between GH and IGF1 levels and AcroQol (p=0,622 and p = 0.844, respectively).Conclusions: We found no significant differences between males and females, as well asbetween patients with active and controlled disease regarding the Qol, but other factors like age or locality provenience may play some role for the perceived health status and quality oflife in acromegalic patients

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Antipsychotic treatment in patients with dementia receiving palliative care: efficiency, fall risk and cognitive impact

Author(s): Tudor Florea,Elena Rodica Popescu,Matei Palimariciuc,Roxana Chirita / Language(s): English Issue: 4/2019

Antipsychotics are widely used in treatment of elderly related psychiatric disorders such asdelirium, organic hallucinosis. The long-term uses of such drugs are related with increasedrisks. The objective of this study is to determine efficiency of small doses of antipsychotics inrelieving target symptoms and monitoring short-term use in patients diagnosed with dementiareceiving palliative care. The study was conducted in a clinical department for palliative carereserved for patients with severe dementia over a period of 1 year. The study samplecomprised 56 patients, 31 of which received antipsychotics. Measures used included MiniMental State Exam (MMSE), Neuropsychiatric Inventory Nursing Home Version (NPI-NH),Fall-Risk (FR) Scale, patient records, medication records and fall incidents. We found asignificant improvement on NPI-NH Scale (p<0.05) for patients that received antipsychoticsand had psychosis, agitation, aggressiveness in accordance with clinical observations. Therewere no significant changes for MMSE (p=0.56) or FR Scale (p=0.87). Small doses ofantipsychotics have a beneficial impact in treating psychosis and agitation with aggressivebehavior in patients with Dementia receiving palliative care. The study showed that the use ofantipsychotic medication doesn’t correlate with increased cognitive degradation or fall risk.The particularities of these cases need to be further explored.

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Pemphigus vulgaris triggered by psychological stress

Author(s): Ioana A Popescu,Tatiana Taranu,Dan VÂŢĂ,Laura Stătescu,Ioana Alina Halip,Elena Andrese,Laura Gheucă Solovăstru / Language(s): English Issue: 4/2019

Pemphigus vulgaris (PV) is a rare but severe autoimmune disease caused by autoantibodiesdirected against desmosomes, and clinically characterized by bullae and painful erosions ofthe skin and mucous membranes.While the morphology is well defined, its etiopathogenesis remains a subject of research. PV,the most frequent and representative form of the autoimmune bullous dermatoses, has a poorprognosis in the absence of medical treatment. The onset and course of PV depend on avariable interaction between predisposing and inducing factors. Thus, drugs, viral infections(herpes simplex virus), physical agents, contact allergens, vaccinations, dietary factors, andpsychological stress have been implicated in the disease. Stressful life events have beenassociated with the course of several autoimmune skin diseases and reported a possible factorin triggering and aggravating for pemphigus in predisposed patients. Psychological care,associated with the immunosuppressive treatment, should entail a better management of thesepatients.

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Anxiety and panic disorders in the dental office

Author(s): Cringuta Paraschiv,Irina Esanu,Roxana Mihaela Barbu,Diana Luchian,Cristina-Luiza Gavrilescu / Language(s): English Issue: 4/2019

Background: Panic attack is a frequent clinical situation that all physicians can faceregardless of their specialty and that can raise special diagnostic problems because it maymimic other medical conditions, some of them life threatening. Objective: The purpose of thispaper is to provide a summary of symptoms and signs and differential diagnosis problems ofthe panic attack. Methods: We present the clinical case of a 59-year-old hypertensive andpreviously treated by radiofrequency catheter ablation for paroxysmal supraventriculartachycardia who had a panic attack in the waiting room of a dental office. Discussions: Dataon trigger factors (including dental procedure or situations), differential diagnosis andtreatment implications are discussed. Conclusions: The diagnostic of the panic attack requirescaution due to symptoms that may lead to confusion with other diseases and due tocomorbidities that may accompany or predispose to it. Dentists should make the distinctionbetween ordinary dental anxiety or fear and panic disorder in order to be able to provideappropriate treatment.

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