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C Rafanelli

Publications and source records attributed to C Rafanelli.

18 recordsLinked to original sources
PubMed2004

An algorithm to evaluate solar irradiance and effective dose rates using spectral UV irradiance at four selected wavelengths.

The paper shows a semi-analytical method for environmental and dosimetric applications to evaluate, in clear sky conditions, the solar irradiance and the effective dose rates for some action spectra using only four spectral irradiance values at selected wavelengths in the UV-B and UV-A regions (305, 320, 340 and 380 nm). The method, named WL4UV, is based on the reconstruction of an approximated spectral irradiance that can be integrated, to obtain the solar irradiance, or convoluted with an action spectrum to obtain an effective dose rate. The parameters required in the algorithm are deduced from archived solar spectral irradiance data. This database contains measurements carried out by some Brewer spectrophotometers located in various geographical positions, at similar altitudes, with very different environmental characteristics: Rome (Italy), Ny Alesund (Svalbard Islands, Norway) and Ushuaia (Tierra del Fuego, Argentina). To evaluate the precision of the method, a double test was performed with data not used in developing the model. Archived Brewer measurement data, in clear sky conditions, from Rome and from the National Science Foundation UV data set in San Diego (CA, USA) and Ushuaia, where SUV 100 spectroradiometers operate, were drawn randomly. The comparison of measured and computed irradiance has a relative deviation of about +/-2%. The effective dose rates for action spectra of Erythema, DNA and non-Melanoma skin cancer have a relative deviation of less than approximately 20% for solar zenith angles <50 degrees .

Algorithms↗
PubMed2001

Psychological well-being and residual symptoms in remitted patients with panic disorder and agoraphobia.

BACKGROUND: Little is known about psychological well-being in remitted patients with panic disorder and agoraphobia and its interactions with residual symptoms. METHODS: Thirty patients with panic disorder and agoraphobia who displayed a successful response to exposure therapy, and 30 control subject matched for sociodemographic variables, were administered both observer-rated and self-rated scales for assessing residual symptoms and well-being. RESULTS: Patients had significantly more residual symptoms -- as assessed by the Clinical Interview for Depression (CID) and the Symptom Questionnaire (SQ) -- than controls. They also had significantly less environmental mastery, personal growth, purpose in life and self-acceptance -- as measured by the Psychological Well-being Scales (PWB) -- and less SQ physical well-being than controls. LIMITATION: The findings apply to patients with panic disorders who had been treated by behavioral methods and may be different in drug-treated subjects. CONCLUSIONS: The results indicate that successful reduction of symptomatology in panic disorder cannot be equated to a pervasive recovery (encompassing psychological well-being) and may pave the way for sequential therapeutic strategies of more enduring quality.

Adult↗
PubMed2001

Long-term outcome of panic disorder with agoraphobia treated by exposure.

BACKGROUND: There is a paucity of long-term outcome studies of panic disorder that exceed a 2-year follow-up. The aim of the study was to evaluate the long-term follow-up of patients with panic disorder with agoraphobia treated according to a standardized protocol. METHODS: A consecutive series of 200 patients satisfying the DSM-IV criteria for panic disorder with agoraphobia was treated in an out-patient clinic with behavioural methods based on exposure homework. One hundred and thirty-six patients became panic free after 12 sessions of psychotherapy and 132 were available for follow-up. A 2- to 14-year (median = 8 years) follow-up was performed. Survival analysis was employed to characterize the clinical course of patients. RESULTS: Thirty-one of the 132 patients (23%) had a relapse of panic disorder at some time during follow-up. The estimated cumulative percentage of patients remaining in remission was 93.1 after 2 years, 82.4 after 5 years, 78.8 after 7 years and 62.1 after 10 years. Such probabilities increased with younger age, and in the absence of a personality disorder, of high pre-treatment levels of depressed mood, of residual agoraphobic avoidance after exposure, and of concurrent use of benzodiazepines and antidepressant drugs. CONCLUSIONS: The findings suggest that exposure treatment can provide lasting relief to the majority of patients with panic disorder and agoraphobia. Disappearance of residual and subclinical agoraphobic avoidance, and not simply of panic attacks, should be the aim of exposure therapy.

Adult↗
PubMed2001

Long-term outcome of social phobia treated by exposure.

BACKGROUND: There is very little information on long-term follow-up of social phobia. METHODS: A consecutive series of 70 patients satisfying the DSM-IV criteria for social phobia was treated in an out-patient clinic with behavioural methods based on exposure homework. Forty-five patients were judged to be remitted after eight individual sessions of psychotherapy. A 2 to 12 year (median = 6 years) follow-up was performed. Survival analysis was selected to characterize the clinical course of patients. Assessments were performed before treatment, at the end of therapy, after 1 year, and subsequently on a yearly basis, and utilized selected items of Paykel's Clinical Interview for Depression. RESULTS: Six of the 45 patients (13%) had a relapse of social phobia at some time during follow-up. The estimated cumulative percentage of patients remaining in remission was 98 after 2 years, 85 after 5 years and 85 after 10 years. Such probabilities increased in the absence of a personality disorder, of residual social phobic avoidance after exposure, and of concurrent use of benzodiazepines. CONCLUSIONS: The findings suggest that, even though one patient out of three is unable to complete treatment or does not benefit sufficiently from it, exposure treatment can provide lasting effects to the majority of patients with social phobia. Disappearance of residual, subclinical social phobic avoidance appears to be the target of treatment.

Adult↗
PubMed2001

Effect of environmental factors on solar UV measurements.

For a correct understanding and interpretation of solar UV data sampled at ground level, several practical and theoretical problems of measurement are shown. In particular, the comparison between either different sites or instruments is thoroughly analysed, and the effects due to O3 level, albedo and cloudiness are discerned. The impact of clouds and their position with respect to the sun on the observation carried out both by spectral and broad-band instruments are also examined.

Environmental Exposure↗
PubMed2001

Cognitive-behavioral management of patients with bipolar disorder who relapsed while on lithium prophylaxis.

BACKGROUND: The application of cognitive-behavioral treatment (CBT) to patients with bipolar disorder who had an affective episode while on lithium prophylaxis has received little research attention. The aim of this preliminary study was to test whether reduction of residual symptomatology by cognitive-behavioral methods could yield long-term beneficial effects in patients with bipolar disorder, as was found to be the case in recurrent unipolar depression. METHOD: Fifteen patients with RDC bipolar disorder, type I, who relapsed while on lithium prophylaxis despite initial response and adequate compliance were treated by cognitive-behavioral methods in an open trial. A 2- to 9-year follow-up was performed. RESULTS: Five of the 15 patients had a new affective episode during follow-up. CBT was associated with a significant reduction of residual symptomatology. CONCLUSION: These preliminary results suggest that a trial of CBT may enhance lithium prophylaxis and improve long-term outcome of bipolar disorder.

Adult↗
PubMed2000

Explanatory therapy in hypochondriasis.

OBJECTIVE: The aim of the study was to evaluate the effectiveness of individual explanatory therapy in hypochondriasis. METHOD: Twenty patients with DSM-IV hypochondriasis were randomly assigned to 2 groups. One received explanatory therapy and was assessed again after a 6-month follow-up. The other was first assigned to a waiting list and subsequently treated with explanatory therapy. All patients received usual medical care from their physicians. Assessments involved both observer and self-rated instruments. RESULTS: In both groups, explanatory therapy was significantly associated with a reduction of hypochondriacal fears and beliefs, improvement in affective disturbances and anxiety sensitivity, and a decrease in health care utilization. Therapeutic gains were maintained at follow-up. Substantial residual symptomatology, however, remained. CONCLUSION: The results suggest that hypochondriasis is a treatable condition and that explanatory therapy is a viable therapeutic tool. Further research should disclose the actual components of the mechanism of change in hypochondriacal patients.

Adult↗
PubMed1998

Prevention of recurrent depression with cognitive behavioral therapy: preliminary findings.

BACKGROUND: Cognitive behavioral treatment (CBT) of residual symptoms after successful pharmacotherapy yielded a substantially lower relapse rate than did clinical management in patients with primary major depressive disorders. The aim of this study was to test the effectiveness of this approach in patients with recurrent depression (> or = 3 episodes of depression). METHODS: Forty patients with recurrent major depression who had been successfully treated with antidepressant drugs were randomly assigned to either CBT of residual symptoms (supplemented by lifestyle modification and well-being therapy) or clinical management. In both groups, during the 20-week experiment, antidepressant drug administration was tapered and discontinued. Residual symptoms were measured with a modified version of the Paykel Clinical Interview for Depression. Two-year follow-up was undertaken, during which no antidepressant drugs were used unless a relapse ensued. RESULTS: The CBT group had a significantly lower level of residual symptoms after discontinuation of drug therapy compared with the clinical management group. At 2-year follow-up, CBT also resulted in a lower relapse rate (25%) than did clinical management (80%). This difference attained statistical significance by survival analysis. CONCLUSIONS: These results challenge the assumption that long-term drug treatment is the only tool to prevent relapse in patients with recurrent depression. Although maintenance pharmacotherapy seems to be necessary in some patients, CBT offers a viable alternative for other patients. Amelioration of residual symptoms may reduce the risk of relapse in depressed patients by affecting the progression of residual symptoms to prodromes of relapse.

Adult↗
PubMed1998

Well-being therapy. A novel psychotherapeutic approach for residual symptoms of affective disorders.

BACKGROUND: There is increasing awareness of the prognostic value of residual symptomatology in affective disorders and of the need for specific therapeutic strategies in this phase of illness. The aims of the study were to apply a novel, short-term psychotherapeutic approach for increasing well-being, based on Ryff's conceptual model, to remitted patients with affective disorders and to compare the results with those obtained with symptom-oriented cognitive behavioural strategies. METHODS: Twenty patients with affective disorders (major depression, panic disorder with agoraphobia, social phobia, generalized anxiety disorder, obsessive-compulsive disorder) who had been successfully treated by behavioural or pharmacological methods were randomly assigned to a well-being enhancing therapeutic strategy (well-being therapy) or cognitive-behavioural treatment of residual symptoms. RESULTS: Both well-being and cognitive-behavioural therapies were associated with a significant reduction of residual symptoms. However, a significant advantage of well-being therapy over cognitive-behavioural strategies was observed with observer-rated methods. DISCUSSION: These preliminary results suggest the feasibility of well-being therapy in the residual stage of affective disorders. Further research should determine its value as a relapse-preventive strategy in specific mood and anxiety disorders.

Adaptation, Psychological↗
PubMed1998

Six-year outcome for cognitive behavioral treatment of residual symptoms in major depression.

OBJECTIVE: The authors' goal was to determine whether cognitive behavioral treatment of residual symptoms of depression might have a significant effect on relapse rate. METHOD: A 6-year follow-up assessment was conducted of 40 patients with primary major depressive disorder who had been successfully treated with antidepressants and were randomly assigned to either cognitive behavioral treatment of residual symptoms or standard clinical management. RESULTS: Ten of the patients (50%) in the cognitive behavioral treatment group and 15 (75%) in the standard clinical management group relapsed. The difference did not attain statistical significance. When multiple relapses were considered, patients in the cognitive behavioral treatment group had a significantly lower number of depressive episodes than those in the standard clinical management group. Patients responded to the same antidepressant drug used in the index episode; in two cases (4%), resistance occurred. CONCLUSIONS: The protective effects of cognitive behavioral treatment that were evident at 4-year follow-up faded afterward. Cognitive behavioral treatment of residual symptoms, however, improved the long-term outcome of major depression in terms of total number of episodes during the follow-up period.

Adult↗
PubMed1997

Overcoming resistance to exposure in panic disorder with agoraphobia.

The issue of panic disorder resistant to treatment (whether pharmacological or psychological) has attracted little research attention, despite its clinical frequency and importance. The aim of this study was to compare three treatment modalities, namely exposure alone (E), exposure associated with imipramine (EI) and cognitive therapy supplementing exposure (EC), in a sample of 21 patients with DSM-IV panic disorder and agoraphobia, who failed to respond to a first standard course of individual behavioural treatment based on exposure in vivo. Treatments were administered according to a cross-over, controlled design (E-EI-EC, EI-EC-E, EC-E-EI). Twelve of the 21 patients achieved remission (panic-free status) during the trial. In 8 cases this occurred after exposure alone (E) and in two cases each after the other treatments (EI and EC). The results revealed a significant effect of the factor time on a number of variables, and the superiority of exposure alone compared to other treatment modalities with regard to some variables. These findings suggest that long-term behavioural treatment based on exposure may be necessary in some patients, and may induce clinical remission. However, patients who do not respond to exposure show poor tolerance of and compliance with pharmacological treatment, and are unlikely to achieve remission with imipramine or cognitive therapy, even though this may occur in individual cases.

Adult↗
PubMed1997

Cognitive-behavioral management of drug-resistant major depressive disorder.

BACKGROUND: The application of cognitive-behavioral treatment to drug-resistant major depression has received little research attention. METHOD: Nineteen patients who failed to respond to at least two trials of antidepressant drugs of adequate dosages and duration were treated by cognitive-behavioral methods in an open trial. RESULTS: Three patients dropped out of treatment. The remaining 16 patients displayed a significant (p < .001) decrease in scores on the Clinical Interview for Depression after therapy. Twelve patients were judged to be in remission at the end of the trial; only 1 of these patients was found to have relapsed at a 2-year follow-up. Antidepressant drugs were discontinued in 8 of the 12 patients who responded to cognitive-behavioral treatment. CONCLUSION: These preliminary results suggest that a trial of cognitive-behavioral therapy by an experienced therapist should be performed before labeling an episode of major depression as "refractory" or "treatment resistant." These latter terms should apply only when a psychotherapeutic effort has been made. Until then, it seems more appropriate to define depression as "drug refractory" or "drug treatment resistant."

Adult↗
PubMed1996

Hypochondriacal fears and beliefs in obsessive-compulsive disorder.

The relationship of obsessions and compulsions with hypochondriasis is receiving increasing attention, but has not been substantiated by adequate research. The Illness Attitude Scales (IAS), which identify hypochondriacal patients, were administered to 30 patients with DSM-IV obsessive-compulsive disorder and 30 healthy control subjects matched for sociodemographic variables. All IAS scales were significantly higher in patients with obsessions and compulsions. However, there were no significant differences between patients and controls in the number of subjects whose symptom intensity exceeded a clinical threshold for hypochondriasis and disease phobia. Furthermore, hypochondriacal fears and beliefs were poorly correlated with obsessions and compulsions. The results suggest the presence of mild abnormal illness behaviour in patients with obsessive-compulsive disorder, unlike the situation in patients with panic disorder and depression.

Adolescent↗
PubMed1996

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.

Adult↗
PubMed1996

Four-year outcome for cognitive behavioral treatment of residual symptoms in major depression.

OBJECTIVE: The authors' goal was to determine whether cognitive behavioral treatment of residual symptoms of depression might have a significant effect on relapse rate. METHOD: In an earlier study, 40 patients with primary major depressive disorder who had been successfully treated with antidepressant drugs were randomly assigned to either cognitive behavioral treatment of residual symptoms or standard clinical management. In both types of treatment, antidepressant drugs were gradually tapered and discontinued. In this study, a 4-year follow-up assessment was performed. RESULTS: Cognitive behavioral treatment resulted in a substantially lower relapse rate (35%) than did clinical management (70%). CONCLUSIONS: Cognitive behavioral treatment of residual symptoms reduces the risk of relapse in depressed patients, probably by affecting the progression of residual symptoms to prodromes of relapse.

Antidepressive Agents↗
PubMed1993

Hostility and irritable mood in panic disorder with agoraphobia.

Twenty patients suffering from panic disorder with agoraphobia were administered the hostility subscale of Kellner's Symptom Questionnaire and the irritability scales of Paykel's Clinical Interview for Depression and of Kellner's Anxiety Rating Scale before and after behavioral treatment of agoraphobia. A matched control group of normal subjects had the same assessments at two similar points in time. Hostility and irritable mood decreased and friendliness increased in patients with panic disorder after treatment; upon recovery, there were no significant differences in hostility between patients and controls, whereas such differences were striking during the illness. The results suggest that increased hostility and irritable mood may be symptoms of panic disorder and improve with the treatment of agoraphobia.

Agoraphobia↗
PubMed1992

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.

Adolescent↗