Objetivo: Este estudo avalia a estrutura do IDATE (Inventário de Ansiedade Traço-Estado) utilizando a análise psicométrica de Rasch, propondo-se ao refinamento e redução do instrumento. Métodos: Consiste em estudo transversal em amostra de 900 pacientes em perioperatório de cirurgias eletivas, com idade variando de 18 a 60 anos e ASA I-III. Informações demográficas foram coletadas empregando-se um questionário estruturado. O instrumento de mensuração IDATE foi aplicado na tarde que antecedia a cirurgia, antes da sedação pré-operatória. Resultados: As escalas de estado e traço de ansiedade foram analisadas separadamente pelo modelo de Rasch. A análise demonstrou invariância no nível de ansiedade traço e estado no formato original de ambas as escalas, resultando em instabilidade no desempenho dos itens. Subsequentemente, a escala refinada foi retestada em duas amostras randomizadas de 300 sujeitos cada, sendo confirmados os resultados. O desempenho foi adequado, independentemente do gênero. Na análise, alguns itens da escala estado foram eliminados (itens 3,4,9,10,12,15 e 20) devido à inadequação ao modelo estatístico. Os itens restantes mostraram unidimensionalidade, independência local e adequado índice de consistência interna. Na escala original de traço, identificaram-se muitas falhas. Primeiro, a escala de resposta tipo Likert 4 pontos provou ser inadequada, e desordens threshold foram encontradas nos 20-itens. A escala original de traço mostrou insuficiente interação e muitos itens individuais mal ajustados. Seguindo a análise e retestando a segunda amostra randomizada, alguns itens foram excluídos (itens 4, 6, 11, 14, 15 e 19). A versão refinada obteve independência local, unidimensionalidade e adequados modelos estatísticos para a fase de sedação pré-operatória. Discussão: Os resultados indicam que a aplicação do modelo de Rasch conduz ao refinamento das escalas clássicas de IDATE estado e traço, sugerindo também que as versões sucintas apresentam desempenho psicométrico mais adequado e estão livres de desordens no limiar de resposta (threshold) e DIF (funcionamento diferencial de itens). / Objetive: This study evaluates the STAI structure using a Rasch psychometric approach and it proposes a refined and shorter STAI version. Methods: A cross-sectional study was performed with 900 inpatients scheduled for elective surgery. Age varied from 18 to 60 years (ASA physical status I-III). Demographic information was collected using a structured questionnaire. The measuring instrument (the State-Trait Anxiety Inventory) was applied to all patients in the afternoon before the surgery, before of the patients Results: Rasch analysis of the state and trait anxiety scales was performed separately. This analysis demonstrated that the original format of state and trait scales fails to show invariance across the trait-state anxiety level, which results in the unstable performance of items. The refined scale was retested in two subsequent random samples of 300 subjects each, and the results were confirmed. The performance was adequate regardless of gender. In the analysis, some items of the state scale (items 3,4,9,10,12,15 and 20) were deleted due to poor fit statistics. The remaining 13 items showed unidimensionality, local independence, and adequate index of internal consistency. Also, the original trait scale displayed several weaknesses. First, the 4 point Likert response scale proved to be inadequate, and threshold disorders were found in all twenty items. Also, the original trait scale showed insufficient item-trait interaction and several individual item misfits. Following the rescoring process, and retesting in a second random sample, items were excluded (namely items 4, 6, 11, 14, 15 and 19). The refined version showed local independence, unidimensionality and adequate fit statistics.receive preoperative sedatives. Discussion: The results indicate that the application of the Rasch Model led to the refinement of the classic state and trait STAI scales. In addition, suggest that these shorter versions present more adequate psychometric performance and are free of threshold disorders and differential item functioning problems.

Diante das evidências da existência de um sistema endocanabinóide em humanos, possivelmente disfuncional em transtornos de ansiedade e do crescente interesse terapêutico no uso do canabidiol (CBD), justifica-se um estudo da comparação entre as concentrações plasmáticas do CBD, administrados por via oral na forma de pó e dissolvido em óleo, para que se defina a forma de administração ideal do CBD e sua eficácia terapêutica na dose de 150mg, baseados em estudos cinéticos e dinâmicos (PK/PD). Neste contexto, o estudo investigou 39 voluntários sadios, alocados aleatoriamente em 3 grupos, que receberam 150 mg de CBD, em cápsulas na forma de pó (Grupo 1), dissolvido em óleo de milho (Grupo 2 ) e amido de milho (Grupo placebo). A concentração plasmática do CBD, por cromatografia gasosa acoplada a espectrometria de massas, foi determinada nos tempos: 0, 0,5, 1,0, 1,5, 2,0, 2,5, 3,0, 4,0 h, após a administração do fármaco. Os instrumentos de avaliação de medidas psicológicas foram: escala analógica de humor (VAMS) e a escala de identificação de ansiedade traço estado (IDATE) e nas medidas fisiológicas foram monitoradas a pressão arterial (PA) e a frequência cardíaca (FC). O teste ansiogênico aplicado foi o Teste de Simulação de Falar em Público (TSFP). No reconhecimento de expressões faciais (REF) foi realizada a tarefa Touch, em indicar a emoção apresentada na expressão do indivíduo. Nos resultados das medidas subjetivas (VAMS e IDATE), não se constatou o efeito ansiolítico; houve elevação da PA sistólica e diastólica e da FC; a intensidade da resposta no REF foi de 93% no Grupo 1 (pó) e de 81% no Grupo 2 (óleo). O pico plasmático médio foi de 20,70±1,68 ng/mL em 2,5h (CBD pó) e CBD em óleo de 82,59±9,52 ng/mL em 2h. Desta forma, este estudo PK/PD demonstrou que a forma farmacêutica ideal para a administração do CBD foi a em óleo e no estudo de dose /resposta, 150mg não possui eficácia terapêutico em relação a ansiedade. / In the face of the existence of an endocannabinoid system in humans, possibly dysfunctional in anxiety disorders and the growing interest in the therapeutic use of cannabidiol (CBD), justified a study comparing plasma concentrations of CBD, administered orally in powder form and dissolved in oil, in ordre to define the optimal mode of administration of the CBD and their therapeutic efficacy at a dose of 150mg, based on dynamic and kinetic studies (PK/PD). In this contexto, the study researched 39 healthy volunteers, allocated randomly in 3 groups, receiving 150 mg of CBD, capsules in powder form (Group 1), dissolved in corn oil (Group 2) and corn starch (placebo group). The plasmatic concentration of CBD was determined by gas chromatography coupled to mass spectrometry at the times: 0, 0.5, 1.0, 1.5, 2.0, 2.5, 3.0, 4.0 h, after administration of the drug. Assessment instruments of psychological measures were: analogical scale mood (VAMS) and scale identification of trait anxiety state (IDATE) and physiological measures were monitored in arterial pressure (PA) and heart rate (HR). The anxiogenic test applied was Simulated Public Speaking (TSFP). In recognition of facial expressions (REF) was performed the task touch, that consists in indicate the emotion shown the facial expression of the individual. The results of subjective measures (VAMS and IDATE) was not found the anxiolytic effect; there was increase of systolic and diastolic pressure and heart frequency; the response intensity in the REF was 93% in group 1 (powder) and 81% in Group 2 (oil). The peak mean plasma was 20.70 ± 1.68 ng / mL (CBD powder) in 2.5 h and 82.59 ± 9.52 ng / mL (CBD in oil) in 2h. Thus, this study PK / PD demonstrated that the ideal pharmaceutical form for administration of the CBD has been in oil and study of dose / response, 150mg has no therapeutic efficacy in relation to anxiety.

Previous research into the accuracy of referrals for glaucoma has shown that a large number of referrals to the Hospital Eye Service are false positive. Research in areas of healthcare other than ophthalmology has shown that psychological distress can be caused by false positive referrals. The present study aimed to evaluate the quality of referrals to the HES for all ocular pathologies, and also to quantify the proportion of these referrals that were false positive. Any commonality between false positive referrals was investigated. The psychological effect of being referred to the HES was also evaluated using the Hospital Anxiety and Depression Scale (HADS) and State-Trait Anxiety Inventory (STAI). Both scales were validated in this population with Rasch analysis before use. A final aim was to develop an improvement to the present referral pathway in order to reduce numbers of false positive referrals. The accuracy of referrals to the HES appears to improve as clinicians become more experienced, and greater numbers of false positive referrals are generated by female clinicians. Optometrists refer patients with a wide range of ocular diseases and in most cases include both fundus observations and visual acuity measurements in their referrals. GPs mainly refer patients with anterior segment disorders, particularly lid lesions, based on direct observation and symptoms. Illegibility and missing clinical information reduce the quality of many optometric referrals. Patients referred to the HES experience raised levels of anxiety as measured by the STAI and raised levels of depression as measured by the HADS-Depression subscale. As a method of assessing psychological distress, the questionnaires HADS-T (all items), STAI-S (State subscale) and STAI-T (Trait subscale) show good discrimination between patients when administered to a population of new ophthalmic outpatients, despite all having a floor effect. Subsequently a referral refinement service was developed which reduced numbers of unnecessary referrals and reduced costs for the NHS.

Previous research into the accuracy of referrals for glaucoma has shown that a large number of referrals to the Hospital Eye Service are false positive. Research in areas of healthcare other than ophthalmology has shown that psychological distress can be caused by false positive referrals. The present study aimed to evaluate the quality of referrals to the HES for all ocular pathologies, and also to quantify the proportion of these referrals that were false positive. Any commonality between false positive referrals was investigated. The psychological effect of being referred to the HES was also evaluated using the Hospital Anxiety and Depression Scale (HADS) and State-Trait Anxiety Inventory (STAI). Both scales were validated in this population with Rasch analysis before use. A final aim was to develop an improvement to the present referral pathway in order to reduce numbers of false positive referrals. The accuracy of referrals to the HES appears to improve as clinicians become more experienced, and greater numbers of false positive referrals are generated by female clinicians. Optometrists refer patients with a wide range of ocular diseases and in most cases include both fundus observations and visual acuity measurements in their referrals. GPs mainly refer patients with anterior segment disorders, particularly lid lesions, based on direct observation and symptoms. Illegibility and missing clinical information reduce the quality of many optometric referrals. Patients referred to the HES experience raised levels of anxiety as measured by the STAI and raised levels of depression as measured by the HADS-Depression subscale. As a method of assessing psychological distress, the questionnaires HADS-T (all items), STAI-S (State subscale) and STAI-T (Trait subscale) show good discrimination between patients when administered to a population of new ophthalmic outpatients, despite all having a floor effect. Subsequently a referral refinement service was developed which reduced numbers of unnecessary referrals and reduced costs for the NHS.

Approximately 52% of cancer patients require radiation therapy during the progression of their illness. Radiation therapy is a safe procedure; however, errors may occur and have the potential to harm patients. Recent studies have looked at patient engagement as a means of preventing errors in healthcare. Through interviews and focus groups, this study looks at patients’ and radiation therapists’ current perceptions of safety in radiation therapy and whether they feel that patient engagement in the form of a patient-provider collaborative checklist can improve its safety or the perception of safety. Through workflow observations and literature reviews, a patient-provider collaborative checklist was developed. Furthermore, STAI surveys were conducted to document the progression of patient anxiety through treatment. Feedback from radiation therapists demonstrated their opinions on the usability of the final iteration of the patient-provider collaborative checklist and how it could fit into the clinical setting.

Approximately 52% of cancer patients require radiation therapy during the progression of their illness. Radiation therapy is a safe procedure; however, errors may occur and have the potential to harm patients. Recent studies have looked at patient engagement as a means of preventing errors in healthcare. Through interviews and focus groups, this study looks at patients’ and radiation therapists’ current perceptions of safety in radiation therapy and whether they feel that patient engagement in the form of a patient-provider collaborative checklist can improve its safety or the perception of safety. Through workflow observations and literature reviews, a patient-provider collaborative checklist was developed. Furthermore, STAI surveys were conducted to document the progression of patient anxiety through treatment. Feedback from radiation therapists demonstrated their opinions on the usability of the final iteration of the patient-provider collaborative checklist and how it could fit into the clinical setting.

No description available.

Background: Work-related stress (WRS) is associated with musculoskeletal pain (MSP), changes in the autonomic nervous system (ANS) and anxiety. Objective: To determine the feasibility of a follow-up study and treatment efficacy of the Reaset Approach on MSP, ANS and State-Trait anxiety. Methods: 15 subjects with WRS and MSP were assigned into 3 groups (Body, Head-Neck, Head-Neck-Body). Each group received a single 25 minute ‘Reaset Approach’ intervention. Heart rate variability (HRV), electro-dermal activity (EDA), State Trait Anxiety (STAI) and MSP were measured. Results: HRV parameters: SDNN increased in 13 of 15 subjects while SD1 and SD2 increased in 12 of 15 subjects. EDA reduced in 10 of 14 subjects. State Anxiety reduced in all subjects and Trait Anxiety reduced in 14 of 15 subjects. MSP reduced in all subjects after the intervention and were still lower three days afterwards. Conclusions: This pilot study determined that a follow-up study can ensue provided minor modifications are implemented and that the ‘Reaset Approach’ has an influence on the ANS, anxiety and MSP. Results do differ between groups. The intervention groups including the head and neck modalities demonstrated better results. / Hintergrund: Arbeitsbedingter Stress (ABS) ist verbunden mit muskelschmerzen, Veränderungen im autonomen Nervensystem (ANS) und Angst. Ziel: Machbarkeit einer Follow-up-Studie und Wirksamkeit der Behandlung des Reaset Ansatzes auf ANS, Muskelschmerzen und State und Trait- Angst bestimmen. Methoden: 15 Patienten mit ABS und Muskelschmerzen wurden in 3 Gruppen eingeteilt (Körper, Kopf-Hals, Kopf-Hals-Körper). Jede Gruppe erhielt eine einzige 25 Minuten dauernde 'Reaset Approach’-Behandlung. Herzfrequenzvariabilität (HRV), elektro-dermale Aktivität (EDA), State-Trait-Angstsinventar (STAI) und Muskelschmerzen (SF-MPQ) wurden gemessen. Ergebnisse: Die HRV-wert: SDNN ist bei 13 von 15 Probanden erhöht, während SD1 und SD2 bei 12 von 15 Probanden zugenommen hat. EDA war bei 10 von 14 Probanden reduziert. Die State-Angst hat bei allen Probanden und die Trait-Angst bei 14 der 15 Probanden abgenommen. Muskelschmerzen waren bei alle Probanden anschließend an und drei Tage nach der Intervention reduziert. Schlussfolgerung: Diese Pilotstudie hat gezeigt, dass eine Follow-up-Studie fortgesetzt werden kann, sofern kleinere Änderungen durchgeführt werden. Die 'Reaset Approach’ hat einen günstigen Einfluss auf die ANS, State-Trait-Angst und Muskelschmerzen. Ergebnisse zwischen den Gruppen sind unterschiedlich. Die Interventionsgruppen mit einschließlich der Kopf-Hals-Modalitäten zeigten bessere Ergebnisse..

Background: Work-related stress (WRS) is associated with musculoskeletal pain (MSP), changes in the autonomic nervous system (ANS) and anxiety. Objective: To determine the feasibility of a follow-up study and treatment efficacy of the Reaset Approach on MSP, ANS and State-Trait anxiety. Methods: 15 subjects with WRS and MSP were assigned into 3 groups (Body, Head-Neck, Head-Neck-Body). Each group received a single 25 minute ‘Reaset Approach’ intervention. Heart rate variability (HRV), electro-dermal activity (EDA), State Trait Anxiety (STAI) and MSP were measured. Results: HRV parameters: SDNN increased in 13 of 15 subjects while SD1 and SD2 increased in 12 of 15 subjects. EDA reduced in 10 of 14 subjects. State Anxiety reduced in all subjects and Trait Anxiety reduced in 14 of 15 subjects. MSP reduced in all subjects after the intervention and were still lower three days afterwards. Conclusions: This pilot study determined that a follow-up study can ensue provided minor modifications are implemented and that the ‘Reaset Approach’ has an influence on the ANS, anxiety and MSP. Results do differ between groups. The intervention groups including the head and neck modalities demonstrated better results.:I. Abstract (En) III II. Abstract (De) IV III. Table of Contents V IV. Index of figures VIII V. Index of tables IX VI. Index of abbreviations X 1 Introduction 1 2 Background 2 2.1 Work-related musculoskeletal pain 2 2.2 Work-related stress 3 2.3 Osteopathy and the autonomic nervous system 3 2.4 Stress, pain and osteopathy 4 3 Questions 6 3.1 Feasibility 6 3.2 Treatment effect 6 4 Methods 7 4.1 Study design 7 4.2 Participants 8 4.2.1 Inclusion criteria 8 4.2.2 Exclusion criteria 8 4.2.3 Recruitment 8 4.2.4 Randomization 10 4.3 Parameters 11 4.3.1 Heart rate variability 11 4.3.2 Electro-dermal activity 11 4.3.3 State anxiety 11 4.3.4 Trait anxiety 12 4.3.5 Perceived pain 12 4.4 Measuring Instruments 13 4.4.1 Heart rate variability 13 4.4.2 Electro-dermal Activity 13 4.4.3 State-Trait Anxiety Inventory 13 4.4.4 Short-Form McGill Pain Questionnaire 13 4.5 Interventions 14 4.5.1 Intervention ‘B’: Body 14 4.5.2 Intervention ‘HN’: Head and Neck 16 4.5.3 Intervention ‘HNB’: Head, Neck and Body 16 4.6 Study flow 18 4.7 Statistics 20 5 Results 21 5.1 Autonomic nervous system: Heart rate variability 21 5.1.1 SDNN 22 5.1.2 SD1 25 5.1.3 SD2 28 5.2 Autonomic Nervous System: Electro-dermal activity 31 5.3 Anxiety 34 5.3.1 State anxiety 34 5.3.2 Trait anxiety 37 5.4 Musculoskeletal pain 39 5.4.1 Visual analogue scale 40 5.4.2 Total Short-Form McGill Pain Questionnaire 43 6 Discussion 46 6.1 Discussion of the method 46 6.2 Discussion of the results 50 6.2.1 Autonomic nervous system 50 6.2.1.1 Heart rate variability 50 6.2.1.2 Electro-dermal activity 51 6.2.2 Anxiety 51 6.2.2.1 State anxiety 51 6.2.2.2 Trait Anxiety 52 6.2.3 Musculoskeletal pain 52 6.3 Suggestions for future research 53 7 Conclusion 54 8 Literature 55 9 Addendum 63 9.1 Table: SF-MPQ with Sensory, Affective and Evaluative dimension 63 9.2 Patient Information Sheet 64 9.3 Structured telephone interview 70 9.4 Structured pre-treatment interview 72 9.5 SF-MPQ permission 73 9.6 SF-MPQ 74 9.7 STAI License 76 9.8 STAI forms Y-1 and Y-2 77 / Hintergrund: Arbeitsbedingter Stress (ABS) ist verbunden mit muskelschmerzen, Veränderungen im autonomen Nervensystem (ANS) und Angst. Ziel: Machbarkeit einer Follow-up-Studie und Wirksamkeit der Behandlung des Reaset Ansatzes auf ANS, Muskelschmerzen und State und Trait- Angst bestimmen. Methoden: 15 Patienten mit ABS und Muskelschmerzen wurden in 3 Gruppen eingeteilt (Körper, Kopf-Hals, Kopf-Hals-Körper). Jede Gruppe erhielt eine einzige 25 Minuten dauernde 'Reaset Approach’-Behandlung. Herzfrequenzvariabilität (HRV), elektro-dermale Aktivität (EDA), State-Trait-Angstsinventar (STAI) und Muskelschmerzen (SF-MPQ) wurden gemessen. Ergebnisse: Die HRV-wert: SDNN ist bei 13 von 15 Probanden erhöht, während SD1 und SD2 bei 12 von 15 Probanden zugenommen hat. EDA war bei 10 von 14 Probanden reduziert. Die State-Angst hat bei allen Probanden und die Trait-Angst bei 14 der 15 Probanden abgenommen. Muskelschmerzen waren bei alle Probanden anschließend an und drei Tage nach der Intervention reduziert. Schlussfolgerung: Diese Pilotstudie hat gezeigt, dass eine Follow-up-Studie fortgesetzt werden kann, sofern kleinere Änderungen durchgeführt werden. Die 'Reaset Approach’ hat einen günstigen Einfluss auf die ANS, State-Trait-Angst und Muskelschmerzen. Ergebnisse zwischen den Gruppen sind unterschiedlich. Die Interventionsgruppen mit einschließlich der Kopf-Hals-Modalitäten zeigten bessere Ergebnisse..:I. Abstract (En) III II. Abstract (De) IV III. Table of Contents V IV. Index of figures VIII V. Index of tables IX VI. Index of abbreviations X 1 Introduction 1 2 Background 2 2.1 Work-related musculoskeletal pain 2 2.2 Work-related stress 3 2.3 Osteopathy and the autonomic nervous system 3 2.4 Stress, pain and osteopathy 4 3 Questions 6 3.1 Feasibility 6 3.2 Treatment effect 6 4 Methods 7 4.1 Study design 7 4.2 Participants 8 4.2.1 Inclusion criteria 8 4.2.2 Exclusion criteria 8 4.2.3 Recruitment 8 4.2.4 Randomization 10 4.3 Parameters 11 4.3.1 Heart rate variability 11 4.3.2 Electro-dermal activity 11 4.3.3 State anxiety 11 4.3.4 Trait anxiety 12 4.3.5 Perceived pain 12 4.4 Measuring Instruments 13 4.4.1 Heart rate variability 13 4.4.2 Electro-dermal Activity 13 4.4.3 State-Trait Anxiety Inventory 13 4.4.4 Short-Form McGill Pain Questionnaire 13 4.5 Interventions 14 4.5.1 Intervention ‘B’: Body 14 4.5.2 Intervention ‘HN’: Head and Neck 16 4.5.3 Intervention ‘HNB’: Head, Neck and Body 16 4.6 Study flow 18 4.7 Statistics 20 5 Results 21 5.1 Autonomic nervous system: Heart rate variability 21 5.1.1 SDNN 22 5.1.2 SD1 25 5.1.3 SD2 28 5.2 Autonomic Nervous System: Electro-dermal activity 31 5.3 Anxiety 34 5.3.1 State anxiety 34 5.3.2 Trait anxiety 37 5.4 Musculoskeletal pain 39 5.4.1 Visual analogue scale 40 5.4.2 Total Short-Form McGill Pain Questionnaire 43 6 Discussion 46 6.1 Discussion of the method 46 6.2 Discussion of the results 50 6.2.1 Autonomic nervous system 50 6.2.1.1 Heart rate variability 50 6.2.1.2 Electro-dermal activity 51 6.2.2 Anxiety 51 6.2.2.1 State anxiety 51 6.2.2.2 Trait Anxiety 52 6.2.3 Musculoskeletal pain 52 6.3 Suggestions for future research 53 7 Conclusion 54 8 Literature 55 9 Addendum 63 9.1 Table: SF-MPQ with Sensory, Affective and Evaluative dimension 63 9.2 Patient Information Sheet 64 9.3 Structured telephone interview 70 9.4 Structured pre-treatment interview 72 9.5 SF-MPQ permission 73 9.6 SF-MPQ 74 9.7 STAI License 76 9.8 STAI forms Y-1 and Y-2 77

Anxiety disorders are very common and the primary feature is abnormal or inappropriate anxiety. Fear and anxiety is often mediated by the amygdala, a brain structure rich in substance P (SP) and neurokinin 1 (NK1) receptors. To learn more about how the human amygdala is modulated by fear and anxiety in event-triggered anxiety disorders and to investigate if the SP/NK1 receptor system is affected, regional cerebral blood flow (rCBF) ([15O]-water; Study I and II) and the SP/NK1 receptor system ([11C]GR205171; Study III and IV) were studied with positron emission tomography (PET). In Study I we investigated the neural correlates of affective startle modulation in persons with specific phobia by measuring rCBF during exposure to fearful and non-fearful pictures, paired and unpaired with acoustic startle stimuli. Fear-potentiated startle was associated with activation of the affective part of the anterior cingulate cortex and the left amygdaloid–hippocampal area. In Study II short-term drug treatment effects on rCBF in patients diagnosed with social phobia was evaluated, comparing the NK1 receptor antagonist GR205171 to the selective serotonin reuptake inhibitor citalopram and placebo. Social anxiety and neural activity in the medial temporal lobe including the amygdala was significantly reduced by both drugs but not placebo. In Study III we investigated if activity in the SP/NK1 receptor system in the amygdala would be affected by fear provocation in individuals with specific snake or spider phobia. Fear provocation was associated with a decreased uptake of the NK1 antagonist [11C]GR205171 in the amygdala, possibly explained by an increase in endogenous SP release occupying the NK1 receptors. Study IV was conducted to explore the resting state NK1 receptor availability in PTSD patients as compared to healthy controls. Increased resting state binding of the tracer [11C]GR205171 in the amygdala of patients with PTSD suggested an increased amount of available receptors. In summary, fear and fear-potentiated startle modulates the human amygdala, possibly through the SP/NK1 receptor system.