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Anxiety levels and related pharmacological drug treatment: a memorandum for the third millennium
No full textAnxiety disorders frequently affect the general population and have a lifetime prevalence ranging from 13.6% to 28.8%. This paper reviews full articles dealing with the pharmacological treatments of generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), panic disorder (PD) and post-traumatic stress disorder (PTSD). This review also attempts to evaluate the use of new drugs acting on several neurotransmitters involved in the pathophysiology of anxiety disorders. Major advances include the development of glutamatergic drugs for treating GAD and OCD. Further randomized controlled trials to test the effect of glutamatergic agents in the treatment of OCD and GAD would be warranted.Anxiety disorders frequently affect the general population and have a lifetime prevalence ranging from 13.6% to 28.8%. This paper reviews full articles dealing with the pharmacological treatments of generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), panic disorder (PD) and post-traumatic stress disorder (PTSD). This review also attempts to evaluate the use of new drugs acting on several neurotransmitters involved in the pathophysiology of anxiety disorders. Major advances include the development of glutamatergic drugs for treating GAD and OCD. Further randomized controlled trials to test the effect of glutamatergic agents in the treatment of OCD and GAD would be warranted
Dimensional psychopharmacology in somatising patients
No full textDespite the recent DSM-5 review of somatoform disorders, which are now called somatic symptom and related disorders, the categorical definitions of these syndromes have inherent limitations because their causal mechanism or presumed aetiologies are still unknown. These limitations may affect everyday clinical practice and decision-making abilities. As a result, physicians have limited
information at their disposal to treat these patients. Furthermore, the clinical presentations of somatic disorders may vary a lot. The purpose of this chapter is to illustrate a psychopathological dimensional approach to the somatising patient. This approach is constantly unconsciously applied in clinical practice using continuous variables, such as rating scales. Moreover, treatment
strategies might be improved by adding a dimensional approach, simply recognising the prominent components
of the presenting psychopathology of a given patient and addressing them with drugs according to their different mechanisms, targeting circuits and neurotransmitters. Some authors have proposed a shift from the nosological to functional application of psychotropic drugs, in which functional psychopharmacology will be dysfunction oriented and therefore inevitably geared towards utilising drug combinations. Here, we present a summary of the advantages of functional/dimensional psychopharmacology for the treatment of somatic symptoms and related disorders
Persistent Depressive Disorder (Dysthymia) and Recurrent Unipolar Major Depressive Disorder
No full textThe term depression comes from the Latin “depressio” and indicates a state of dejection perceived by the subject accompanied by extreme suffering and discomfort. “Melancholia” (melas means black and cholé means bile), the term historically used to describe this condition, was first introduced by Hippocrates in the treatise On the Nature of Man [1] based on the humoral theories of Alcmaeon of Croton and then resumed by Galen, who described a melancholic temperament characterized by a black bile excess. This belief was still solid in the sixteenth century, when the French physician Andreas Laurentius related the cause of this pathology to the “coldness and darkness of this humor.” In the nineteenth century, Pinel eventually proposed a new theory discontinuing the connection between humor and black bile and describing four new mental disorders, which included Melancholia and Mania [2]. Kraepelin unified all types of affective disorders in the unitary concept of manic-depressive illness, which included “periodic circular insanities,” “mania,” and “melancholy” [3]. In opposition to this view, Wernicke distinguished five different types of melancholia, going back to taking into consideration the possibility of single episodes of melancholia [4]. Nowadays, the term melancholic represents a subtype of major depressive disorder
Dimensional psychopathologi of schizophrenia: SVARAD dimensional profiles in an acute inpatient sample
No full textObjective:
This study aimed at describing the dimensional profile of schizophrenia in an acute inpatient sample, and at exploring the different components of psychopathological suffering within this single diagnostic category according to a dimensional perspective.
Methods:
The sample consisted of 81 schizophrenic patients consecutively admitted to a psychiatric inpatient care unit. Each patient was administered the rapid dimensional assessment scale SVARAD (acronym for the Italian name “Scala per la VAlutazione RApida Dimensionale”) and the Global Assessment of Functioning scale. Dimensional profiles were obtained from mean scores on each SVARAD item. Analysis of variance was used to test for differences between groups in mean SVARAD item scores.
Results:
The findings indicated that age, sex, psychosocial functioning, involuntary nature of the admission, and predominance of positive or disorganisation symptomatology are associated with differences in the mean dimensional profile. Also, sizable subgroups of patients with clinically significant levels of psychopathological dimensions (e.g., Sadness/Demoralisation, Anger/Aggressiveness, Impulsivity) that have limited overlap with the traditionally acknowledged domains of positive symptoms, negative symptoms, and disorganisation, were identified. No differences in any psychopathological dimension were found between the classical schizophrenia subtypes.
Conclusions:
The dimensional assessment with SVARAD helps appreciate the singularity of each patient within the same diagnostic category. The study suggests that recognising different dimensional profiles with the SVARAD may allow more personalised choices of treatment
Il Disturbo Ossessivo Compulsivo (DOC): dalla clinica alle valutazioni medico legali nella valutazione di disabilità.
No full textObsessive-compulsive disorder (OCD) is among the leading causes of disability in adults. Despite growing evidence provided by genetic, clinica! and neuroimaging studies, the pathophysiology of this disorder is
stili a matter of debate. Further complexity comes from the great variability in individuai response to psychiatric treatment as well as pharmacoresistance. Moreover, the variable burden of OCD is associated with the heterogeneous psychopathological symptoms and course characteristic of the disease. In the present study, we will first discuss the clinica! features of OCD, then we will focus on the most reliable assessment procedures that can be used to evaluate patients' disability within a medico-legai context
CBT group intervention for depression, anxiety, and motor symptoms in Parkinson's disease. Preliminary findings
No full textNonpharmacological therapies, like cognitive behavioral therapy (CBT), for the treatment of non-motor symptoms (NMS) in Parkinson's disease (PD) have received only little attention. Promising results derive from a few studies that examined the efficacy of individual CBT for depression and anxiety in Parkinson's disease. To date no trial has evaluated the utility of CBT group for NMS in Parkinson's disease. The aim of the present preliminary study was to observe whether CBT group therapy is useful for both NMS and motor symptoms (MS) in patients affected by Parkinson's disease. The results suggested that CBT group was effective in treating depression and anxiety symptoms and can reduce the severity of MS in patients suffering from PD
Analisi psicopatologica dimensionale del Disturbo ossessivo-compulsivo: appartiene realmente ai Disturbi d’ansia?
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