Renzo Canestrari

Prodromal symptoms in primary major depressive disorder.

Prodromal symptomatology was investigated, by means of a modified version of Paykels Clinical Interview for Depression, in 15 outpatients at their first episode of primary major depressive disorder. Compared to normals, generalized anxiety and irritability were significantly more frequent. Impaired work and interests, fatigue, initial and delayed insomnia were also reported. Four patients who relapsed upon discontinuation of antidepressant treatment displayed the same prodromal symptomatology as in the initial episode.

Prodromal symptoms in panic disorder with agoraphobia: A replication study

The majority of 20 patients suffering from panic disorder with agoraphobia reported experiencing agoraphobic avoidance, generalized anxiety, and/or hypochondriacal fears and beliefs before the first panic attack. The results replicated those of a previous investigation and are in accordance with an increasing number of studies concerned with prodromal symptoms, epidemiologic surveys, and analysis of mechanisms of change upon treatment.

Prodromal Symptoms in Obsessive-Compulsive Disorder

Prodromal symptoms were investigated in 30 patients with obsessive-compulsive disorder. The large majority of patients (93%) reported at least one prodromal symptom before disease onset. Generalized anxiety, irritability, indecision, phobic and somatic anxiety occurred in about half of patients. Also common were depressive symptoms such as fatigue, lowered self-esteem, depressed mood, pessimism, impaired work, and guilt. The results suggest a close association of obsessions and compulsions with affective symptoms.

Mechanisms of change of panic attacks with exposure treatment of agoraphobia

In vivo exposure homework was applied to a consecutive series of 30 outpatients suffering from DSM-IIIR panic disorder with agoraphobia. Assessment of the characteristics of panic attacks (the prodromal phase immediately preceding the attack, acute peak anxiety, and the residual phase immediately afterwards) was done by an independent rater before treatment, after six sessions and at the end of therapy (12 sessions). Twenty-five of the 30 patients completed treatment. All of them still reported panic attacks after six sessions, even though the characteristics of panic partially improved. At the end of therapy, panic attacks disappeared in 21 of the 25 patients (84%) and these gains were maintained to 1 year follow-up thereafter by the majority (81%) of subjects.

Treatment of social phobia by homework exposure.

Ten consecutive patients suffering from DSM-III-R social phobia were treated by homework exposure assignments, without therapist-aided exposure or other cognitive-behavioral methods. The 7 patients who completed therapy displayed highly significant decreases in social phobic symptoms and anxiety. Such improvements were maintained on a 1-year follow-up.

A Psychosomatic Outpatient Clinic

Current emphasis in clinical psychosomatic medicine is on psychiatric interventions in acute medical and surgical situations (consultation-liaison psychiatry and medical-psychiatric units). Little interest has been taken in psychosomatic interventions in chronic situations and outpatient settings. The functioning of a psychosomatic outpatient clinic (POC) is described. One-hundred consecutive referrals were analyzed. The most frequent diagnostic finding—according to DSM III criteria-was subsumed under the rubric of “psychological factors affecting physical condition,” followed by affective illness, anxiety disturbances, and somatoform disorders. The results indicate that a POC may serve a specific and definable segment of patients, whose characteristics depart from the clinical populations in consultation-liaison psychiatry and medical-psychiatric units.

Psychotherapie als Umstrukturierung des Feldes

In der Kinderpsychotherapie wenden die verschiedenen Theorien unterschiedliche Prinzipien an, mit dem gemeinsamen Ziel, bei den kleinen Patienten positive psychische und Verhaltensanderungen hervorzurufen.