Giulio Barzega

Gender‐related differences in the onset of panic disorder

Objective: To investigate gender‐related differences in premorbid conditions and in the role of triggering events in the onset of panic disorder (PD).

Long Term Treatment of Obsessive-Compulsive Disorder

The efficacy of clomipramine and selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors (SSRIs) in treating obsessive-compulsive disorder (OCD) is now established. However, few studies are available on long term treatment strategies in patients with OCD. In this article, recent literature on drug discontinuation and maintenance treatment of OCD is reviewed and discussed.All studies which have evaluated recurrence rates after drug discontinuation have found that up to 80% of patients who respond to SSRIs relapse if the medication is withdrawn.The studies that have been performed on long term treatment of OCD with both clomipramine and SSRIs show that patients who continue medication maintain and slightly increase the level of improvement achieved in short term trials. Several authors suggest that, in maintenance treatment, drug dosages can be reduced to between 40 and 60% of those used in acute episodes without a significant difference in symptom improvement.Preliminary data concerning drug tolerability in patients receiving long term treatment for OCD indicate that SSRIs are well tolerated, and that the rate of adverse effects tends to decrease compared with short term treatment. Several recent reports suggest that patients who have taken SSRIs for at least 2 months are at risk of developing withdrawal symptoms when treatment is discontinued. However, no data are available concerning the relationship between the duration of OCD treatment and the onset of withdrawal symptoms.

Stress and managerial work: organizational culture and technological changes: a clinical study

The impact of technological and organizational changes on strategies, structures, criteria of success, leadership styles, work relations and role interactions has complex and contradictory consequences for today′s work environment. Considers all the potential and interacting stressors in working life and personal living conditions, within the framework of the biographical background and relevant experiences of subjects, in order to understand and explain the multifactoral pathogenesis of mental stress and its many side‐effects. Pursues this integrated consideration through an interdisciplinary approach, involving psychiatry and mental hygiene, organizational psychology and occupational medicine. Research is carried out on a sample of 292 subjects – male and female managers – the basic framework being an epidemiological approach, both descriptive (study of distribution) and analytical (study of determinants), which uses medical anamnesis, biographical questionnaire and psychiatric interview.

Dysthymic disorder: clinical characteristics in relation to age at onset

BACKGROUND The variability in the clinical presentation of dysthymia has given rise to a rich debate in literature, and various hypotheses have been proposed. One is that the clinical presentation differs in relation to age at onset. The aim of the study was to evaluate differences in socio-demographic and clinical characteristics in a sample of patients with dysthymia (DSM-IV), in relation to age at onset. METHOD 84 consecutive outpatients with a diagnosis of dysthymia (DSM-IV) were studied. All subjects were evaluated by a semistructured clinical interview and the following rating scales: HAM-A, HAM-D, MADRS, Paykels Interview for Recent Life Events. RESULTS 23.8% of the sample had early-onset (<21 yrs) dysthymia. Patients with early-onset disorder were significantly younger at the observation, more frequently female and single. They had a significantly longer duration of illness and in a significantly higher percentage had already received a specialist treatment before admission in the present trial. No differences in the frequency of symptoms were observed. A significantly higher percentage of patients with late-onset disease reported at least one stressful event in the year preceding the onset of dysthymia. A positive history of major depression was significantly more common among the early-onset group; social phobia, panic disorder and conversive disorder were also more frequent in this group. The late-onset patients frequently presented generalized anxiety disorder, substance abuse and somatization disorder. LIMITATION The study is retrospective and enrolls a limited number of cases. CONCLUSIONS The present study agrees with other reports on the differences in clinical presentation of dysthymia according to age at onset. Although they are not actually related to age at onset, some interesting findings emerged in the symptomatological characterization of the disorder, referring to the diagnostic criteria proposed in DSM-IV.

An open-label, randomized, prospective comparison of sertraline and amisulpride in the treatment of dysthymia in the elderly

Abstract In recent years, controlled trials have documented the efficacy of numerous antidepressant drugs in the treatment of dysthymia, particularly the selective serotonin reuptake inhibitors (SSRIs) and substituted benzamides such as amisulpride. However, very little has been published on pharmacologic approaches to this disorder in the elderly. An open-label, randomized, prospective trial was performed on 49 dysthymic patients, 65 years of age or older, assigned randomly to two different treatments: an SSRI—sertraline—or a substituted benzamide—amisulpride—both at a daily dose of 50 mg. Treatment was continued for 6 months, and clinical assessment was based on the Hamilton rating scales for depression and anxiety and on Brinks scale for depression in the elderly. Analysis of variance showed that both treatments were effective over this observation period. Comparison of the differences in mean scores and the numbers of responders after 3 and 6 months of treatment by using Students t test showed no statistically significant differences. The lack of significant differences between treatments could be attributed to the small size of the study population. Elderly patients tolerated both drugs well, and there was a low incidence of side effects and dropouts reported.

Type I and type II schizophrenia: relations between tonic electrodermal activity and clinical ratings before and after haloperidol treatment

To test the hypothesis that schizophrenic patients with positive vs. negative symptoms show different tonic electrodermal patterns, 26 patients with Type I schizophrenia and 19 patients with Type II schizophrenia were evaluated before and after 2 weeks of haloperidol treatment (standard daily dose = 4.5 mg). Clinical assessments were made with the Brief Psychiatric Rating Scale, the Scale for the Assessment of Positive Symptoms, and the Scale for the Assessment of Negative Symptoms. Skin conductance level (SCL) and spontaneous fluctuations (SF) frequency were recorded for each patient. Before treatment, Type I patients showed higher SCL and SF compared with Type II patients; after treatment, a significative decrease of clinical and psychophysiological variables was found only in Type I patients.