Biomedical subjects
Publications and source records attributed to C Faravelli.
The situations in which the first panic attack occurred were investigated in 44 patients affected by panic disorder. Although the first panic attack was reported to be unexpected and no avoidance was present before it, 75.8% of patients (N = 22) with panic disorder with agoraphobia had their first panic attack in phobogenic situations, compared with 20% of patients (N = 3) with panic disorder without agoraphobia.
Thirty-two patients with a DSM-III-R diagnosis of panic disorder (PD) were administered the Parental Bonding Instrument (PBI), a 25-item self-report questionnaire devised to evaluate parental rearing practices. Compared with 32 matched healthy controls, PD patients scored both their parents as being significantly less caring and more overprotective. Moreover, the consistency of parental attitudes between the 2 parents was significantly lower, indicating lesser uniformity in the rearing patterns.
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The contextual method was used to identify the incidence of recent life events and difficulties among 50 suicide attempters compared with a control group selected at random from the general population. Suicide attempters experienced a significantly greater incidence of major life events, although for all life events irrespective of stressfulness, and for independent events the differences were not significant. The overall incidence of difficulties was also higher among suicide attempters. Finally, the results suggest a vulnerability effect as far as three factors are concerned: early loss of/separation from one or both parents, absence of paid employment and living in a nuclear family.
A structured interview designed to detect affective disorders and to produce both DSM-III and DSM-III-R diagnoses was administered to a community sample of 1000 people living in Florence. The interviews were carried out by physician-psychiatrists (qualified psychiatrists or 3rd-4th-year trainees) trained in the use of operational diagnoses. The 1-year prevalence and point prevalence were, respectively: 1.7% and 0.6% for bipolar disorder; 0.4% and 0.4% for cyclothymia; 6.2% and 2.8% for major depression; 2.6% and 0.8% for dysthymia; 5.2% and 1.8% for depressive disorder not otherwise specified. Most of the cases affected by mood disorder sought medical help, primarily through their GP. The large majority of them were specifically treated for it and, in almost 60% of the cases with a major form, were referred to a psychiatrist.
A structured interview designed to diagnose anxiety disorders according to DSM-III (plus infrequent panic attacks and generalized anxiety disorder using DSM-III-R criteria) was given to 1110 people registered with 6 general practitioners (GPs), whether they consulted the doctor or not. As each citizen in Italy has to be registered with a GP, the sample was representative of the population. The interviews were carried out by the GPs, who were also third- or fourth-year trainees in psychiatry. The lifetime prevalence and point prevalence were: 0.36% and 0.27% for agoraphobia; 0.90% and 0.72% for agoraphobia with panic; 1.35% and 0.27% for panic disorder; 0.63% and 0.45% for simple phobia; 0.49% and 45% for social phobia, 5.41% and 2.79% for generalized anxiety disorder; and 0.72% and 0.63% for obsessive-compulsive disorder. These figures are lower than those reported in other surveys; possible explanations may be the use of a hierarchical diagnostic model and the fact that diagnosticians were psychiatrists instead of lay interviewers as in most studies in the United States. On the whole, 62% of anxiety cases consult a GP, 50% consult a psychiatrist and 7% are hospitalized.
The authors assessed life events during the 12 months before the onset of panic disorder in 64 patients. Compared with a control group of 78 healthy subjects, patients with panic disorder had higher scores however life events were assessed, i.e., number of events, weighted normative scores, contextual scores, and number of subjects with major events. Independent life events (those beyond the subject's control) were also more numerous and more severe among the patients. The larger number of events experienced by the patients was due to the more frequent occurrence of life stress in the month before the onset of panic disorder. Loss events had the strongest relationship to panic disorder.
Viqualine dihydrochloride is a new molecule, which possesses strong serotonin reuptake inhibition properties and, at the same time, diazepam-like actions, such as [3H]-diazepam-binding inhibition and antipunishment effect. The drug was administered double-blindly to 10 patients suffering from major depression resistant to previous treatments with tricyclics. The comparison group (10 patients) received placebo. Lorazepam (10 mg/day) was also given to both groups. Viqualine proved to be significantly superior to placebo in the 4th week of treatment on all the three rating scales which were used. Tolerability of viqualine was good both objectively and on subjective grounds.
22 patients with panic disorder (PD) were compared with 42 cases suffering from agoraphobia with panic attacks for a number of variables. The two groups did not differ for age, sex ratio, age of onset, social class, severity of nonsituational anxiety and personality profiles. On the other hand agoraphobics showed lower education and worse social adaptation. A higher prevalence of traumatic life events was also observed for agoraphobics compared with subjects suffering from PD.
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The efficacy of captopril in the treatment of Raynaud's phenomenon was observed in an open study in 53 patients with primitive Raynaud's disease and in 18 patients with Raynaud's associated with scleroderma. Each patient was given captopril 25 mg three times a day for three months. The drug significantly decreased the frequency and the severity of ischaemic attacks in patients with Raynaud's disease, but did not affect the attacks in patients with scleroderma. These subjective ratings were supported by the results of digital strain gauge plethysmography during cold challenge. The therapy was discontinued in six patients (one because of an allergic skin reaction and five owing to orthostatic hypotension), but no serious side-effects were noticed.
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Of 101 patients suffering from primary unipolar depression who were followed up for at least 1 year after recovery from the index episode, 51 relapsed into a new depressive episode within the year of recovery. Only those variables related to the period immediately after discharge distinguished nonrelapsers from relapsers; relapsers showed higher levels of residual symptoms, inferior social adaptation, a more pathological mean personality profile, and lower tricyclic plasma levels, despite similar dosage. The data are consistent with the hypothesis of an incomplete recovery from the index episode as a risk factor for relapse within 1 year.
The incidence of traumatic events during the first ten years of life was investigated in two groups of patients suffering from major affective disorder, as well as in mixed psychiatric patients and in healthy subjects. While there were no significant differences between the two groups of affective patients or between the two control groups, the incidence of subjects who underwent such trauma was significantly higher in depressives, compared with controls. These differences are small and are further reduced if events secondary to psychiatric disturbances of family members are excluded.
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The life events experienced in the 12 months prior to the first panic attack were studied in 23 patients with a DSM-III diagnosis of panic disorder as well as in 23 healthy subjects matched for age, sex, social and educational level. Patients showed significant excess of life events compared to controls, however life events were assessed. Panic patients in fact scored higher on the number of events, the weighted scores (according to Paykel's scale) and the number of subjects who underwent a major life event (death or severe illness, either personal or of a cohabiting relative) in the two months preceding the onset of symptoms.
A structured interview designed to detect affective disorders according to operational diagnostic criteria was administered to a representative sample of 639 people living in Florence. The 1 year prevalence percent was 1.7 for bipolar disorder, 0.31 for atypical bipolar disorder, 5.2 for major depression, 1.4 for cyclothymic disorder, 2.3 for dysthymic disorder (all diagnosed according to DSM III criteria) and 4.5 for minor depression (RDC criteria). The corresponding figures relative to the point prevalence were: 0.6, 0.16, 3.8, 0.47, 1.2, 0.31. The use of care services on the part of affective cases (none, GP, public psychiatric facilities, private psychiatrist, hospital) was also recorded.
The rate of traumatic early life events in 31 agoraphobic subjects with panic attacks was significantly higher than that in matched control subjects. Experience of maternal separation, parental divorce, and events occurring after the age of 4 years was significantly more common.