Utility of Fear Severity and Individual Resilience Scoring as a Surge Capacity, Triage Management Tool during Large-Scale, Bio-event Disasters

Threats of bioterrorism and emerging infectious disease pandemics may result in fear related consequences. Fear based signs and symptoms, if left undetected and untreated, may be extremely debilitating and lead to chronic problems with risk of permanent damage to the brain’s locus coeruleus stress response circuits. The triage management of susceptible, exposed, and infectious victims seeking care must be sensitive and specific enough to identify individuals with excessive levels of fear in order to address the nuances of fear-based symptoms at the initial point of contact. These acute conditions, which include hyper-vigilant fear, are best managed by timely and effective information, rapid evaluation, and possibly medication that uniquely addresses the locus-coeruleus driven noradrenalin overactivation. This article recommends that a fear and resilience (FR) checklist be included as an essential triage tool to identify those most at risk. This checklist has the utility of rapid usage and capacity to respond to limitations brought about by surge capacity requirements. Whereas the utility of such a checklist is evident, predictive validity studies will be required in the future. It is important to note that a unique feature of the FR Checklist is that in addition to identifying individuals who are emotionally, medically, and socially hypo-resilient, it simultaneously identifies individuals who are hyper-resilient who can be asked to volunteer and thus rapidly expand the surge capacity

The human fear-circuitry and fear-induced fainting in healthy individuals The paleolithic-threat hypothesis

The Paleolithic-Threat hypothesis reviewed here posits that habitual efferent fainting can be traced back to fear-induced allelic polymorphisms that were selected into some genomes of anatomically, mitochondrially, and neurally modern humans (Homo sapiens sapiens) in the Mid-Paleolithic because of the survival advantage they conferred during periods of inescapable threat. We posit that during Mid-Paleolithic warfare an encounter with “a stranger holding a sharp object” was consistently associated with threat to life. A heritable hard- wired or firm-wired (prepotentiated) predisposition to abruptly increase vagal tone and collapse flaccidly rather than freeze or attempt to flee or fight in response to an approaching sharp object, a minor injury, or the sight of blood, polymorphism for the hemodynamically “paradoxical” flaccid- immobility in response to these stimuli may have increased some non-combatants’ chances of survival. This is consistent with the unusual age and sex pattern of fear-induced fainting. The Paleolithic-Threat hypothesis also predicts a link to various hypo-androgenic states (e.g. low dehydroxyepiandrosterone-sulfate. We offer five predictions testable via epidemiological, clinical, and ethological/primatological methods. The Paleolithic-Threat hypothesis has implications for research in the aftermath of man-made disasters, such as terrorism against civilians, a traumatic event in which this hypothesis predicts epidemics of fear-induced faintin

Bruxism and autonomic activity

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Reevaluating the Management of Chronic Temporomandibular Pain Are We Treating PTSD with Debridement and Lavage?

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A surgical treatment for anxiety-triggered palmar hyperhidrosis is not unlike treating tearfulness in major depression by severing the nerves to the lacrimal glands

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Preventing post-disaster PTSD: Watch for autonomic signs

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The Locus Ceruleus in PTSD

NO ABSTRACT: This is 750 word encyclopedia entr

The STRS (shortness of breath, tremulousness, racing heart, and sweating): A brief checklist for acute distress with panic-like autonomic indicators; development and factor structure

Background: Peritraumatic response, as currently assessed by Posttraumatic Stress Disorder (PTSD) diagnostic criterion A2, has weak positive predictive value (PPV) with respect to PTSD diagnosis. Research suggests that indicators of peritraumatic autonomic activation may supplement the PPV of PTSD criterion A2. We describe the development and factor structure of the STRS (Shortness of Breath, Tremulousness, Racing Heart, and Sweating), a one page, two-minute checklist with a five-point Likert-type response format based on a previously unpublished scale. It is the first validated self-report measure of peritraumatic activation of the autonomic nervous system.\ud \ud Methods: We selected items from the Potential Stressful Events Interview (PSEI) to represent two latent variables: 1) PTSD diagnostic criterion A, and 2) acute autonomic activation. Participants (a convenience sample of 162 non-treatment seeking young adults) rated the most distressing incident of their lives on these items. We examined the factor structure of the STRS in this sample using factor and cluster analysis.\ud \ud Results: Results confirmed a two-factor model. The factors together accounted for 68% of the variance. The variance in each item accounted for by the two factors together ranged from 41% to 74%. The item loadings on the two factors mapped precisely onto the two proposed latent variables.\ud \ud Conclusion: The factor structure of the STRS is robust and interpretable. Autonomic activation signs tapped by the STRS constitute a dimension of the acute autonomic activation in response to stress that is distinct from the current PTSD criterion A2. Since the PTSD diagnostic criteria are likely to change in the DSM-V, further research is warranted to determine whether signs of peritraumatic autonomic activation such as those measured by this two-minute scale add to the positive predictive power of the current PTSD criterion A2. Additionally, future research is warranted to explore whether the four automatic activation items of the STRS can be useful as the basis for a possible PTSD criterion A3 in the DSM-V