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Biomedical subjects

G Perugi

Publications and source records attributed to G Perugi.

At least 55 records · Page 3Linked to original sources
PubMed1991

[Benzodiazepine withdrawal syndrome].

Benzodiazepines (BDZ) are widely prescribed in clinical practice for many pathological conditions, because of their anxiolytic, sedative, myorelaxant and anticonvulsant properties. The effectiveness, specificity and rapidity of action, the few side effects and the virtual absence of toxicity, have contributed to the widespread use of these compounds. In the last decade, however, the attitude towards BDZ has greatly changed, due to growing awareness and concern about dependence liability, withdrawal phenomena, and long-term side effects. Withdrawal symptoms have been singled out and specified in the contest of a well-defined syndrome with foreseeable onset, duration and remission. Psychic and physical symptoms and disorders of sensory perception can be observed. These manifestations can be suppressed by resuming treatment. The symptomatic and developmental aspects of BDZ withdrawal syndrome are discussed, according to the available literature, with particular reference to clinical features of patients suffering from anxiety and mood disorders.

Anti-Anxiety Agents↗
PubMed1991

[Omega benzodiazepine receptor subtypes and new ligands].

Pharmacological and biochemical studies indicate that for many receptors, distinct subtypes exist; the multiplicity and diversity of signal reception proteins increase the information-handling capacity of neurons, thus contributing to neural plasticity. This is also the case for the allosteric modulatory-centre omega of the GABA-A receptor. Binding studies suggest the presence of at least two pharmacologically distinct omega receptors in the human brain; furthermore, molecular biological studies have confirmed the existence of genes encoding different omega subtypes. As omega receptors are the site of action of benzodiazepines and other anxiolytic compounds, this knowledge may be useful for developing new subtype-specific drugs, with more selective therapeutic effects.

Anti-Anxiety Agents↗
PubMed1990

Gender-mediated clinical features of depressive illness. The importance of temperamental differences.

In a consecutive clinical series of 538 subjects with primary mood disorders the male:female differences were most skewed (1:4) in recurrent unipolars, 1:2 in single episode and bipolar I subtypes, and about even (1:1) in bipolar II. The sexes did not differ in age at onset of depression, stressors preceding index episodes, endogenous features, psychotic symptoms, suicide attempts, and rates of chronicity. Females had lower mean number of hypomanic, and higher mean number of depressive, episodes. Females also exhibited more anxiety and somatisation, and were more likely to endorse psychopathological items on self-report instruments, which were not reflected in objective measures. Finally, they were more likely to have been admitted to hospital. These gender differences could in part be explained by the higher prevalence of the depressive temperament in women, and of the hyperthymic temperament in men.

Bipolar Disorder↗
PubMed1989

Psychopathology, temperament, and past course in primary major depressions. 1. Review of evidence for a bipolar spectrum.

In reviewing recent findings on affective conditions in the interface of unipolar and bipolar disorders, we find evidence favoring a partial return to Kraepelin's broad concept of manic-depressive illness, which included many recurrent depressives and temperamental variants. This review addresses methodologic, clinical, and familial considerations in the definition and characterization of a proposed spectrum of bipolar disorders which subsumes episodic and chronic forms. Episodic bipolar disorders are subclassified into bipolar schizoaffective, and bipolar I and II, and bipolar III or pseudo-unipolar forms. Chronic bipolar disorders could be either intermittent or persistent, and are subclassified into chronic mania, protracted mixed states, and rapid-cycling forms, as well as the classical temperaments (cyclothymic, hyperthymic, irritable and dysthymic).

Bipolar Disorder↗
PubMed1989

Psychopathology, temperament, and past course in primary major depressions. 2. Toward a redefinition of bipolarity with a new semistructured interview for depression.

We report on the utility of a new instrument to identify subtypes of major depressive episodes with special reference to pseudo-unipolar conditions. By incorporating reliable measures of depressive and hyperthymic temperamental characteristics in subtype definitions, we achieve the sharpest possible demarcation between unipolar and bipolar disorders. The new procedures also reveal that 1 out of 3 primary depressives in a consecutive series of 405 patients belong to the bipolar spectrum. Furthermore, among bipolars, bipolar II disorder (redefined as major depressions with hypomania or hyperthymic temperament) represents the most common variant. We discuss the nosologic, therapeutic, methodologic and theoretical implications of these considerations on the unipolar-bipolar dichotomy. Given that major depression emerges as the final common clinical expression of a heterogeneous group of disorders, it underscores the importance of focusing on temperament and course of illness in subclassification efforts such as attempted here.

Adult↗
PubMed1989

Depression before and after age 65. A re-examination.

Systematic and detailed psychopathological examination of 400 consecutive primary major depressives failed to confirm common clinical stereotypes which ascribe greater somatisation, hypochondriasis, agitation, psychotic tendencies, and chronicity to old age. Those above 65 were more likely to suffer from single episodes of depression that were often precipitated, whereas subjects whose illness began earlier were more likely to express depression as part of a recurrent unipolar or bipolar disorder, with higher rates of affective temperamental pathology and familial affective illness. The acute clinical picture was relatively uniform in older and younger depressives and, taken together with the other findings, tends to favour a spectrum model of primary mood disorders.

Adult↗
PubMed1988

High-affinity 3H-imipramine binding sites: a possible state-dependent marker for major depression.

Ten patients with DSM-III diagnoses of nonbipolar recurrent major depression were studied in an attempt to assess the relationship between 3H-imipramine binding site density and clinical depressive state. They were compared with eight healthy controls who had no past or family history of affective disorders. Evaluations with the Hamilton Rating Scale for Depression and the Self-Rated Scale for Depression were done on the same day as platelet collection at baseline, and also at 2 and 5 weeks after the beginning of treatment with tricyclic antidepressants. The number (Bmax) and the affinity (Kd) of platelet 3H-imipramine binding sites were highly correlated with the improvement of the clinical depression. These results raise the interesting possibility that a decrease in 3H-imipramine binding sites may be a state-dependent marker in patients suffering from nonbipolar recurrent major depression.

Adult↗
PubMed1988

A proposed new approach to the clinical subclassification of depressive illness.

This paper focuses on the classification of mood disorders. Data are reported from 227 outpatients who met DSM-III-R criteria for Major Depressive Episode. Each patient was evaluated by the Semistructured Interview for Depression (SID), which was developed and organized according to a decision tree model. The SID was used both to identify the sample with major depressive disorders and, then, to subclassify them into five subtypes. Three bipolar types (I, II, III) and two unipolar types (recurrent and single episode) were distinguished, and comparisons among the subtypes are presented. Therapeutic implications of the classification are discussed in relation to recent advances in targeting short and long-term treatments for specific subtypes.

Adult↗
PubMed1988

Imipramine binding in platelets of patients with panic disorder.

Tritiated imipramine (3H-IMI) binding was investigated in platelets obtained from nine patients suffering from panic disorder (PD), and from nine healthy controls (HC). IMI binding was studied according to a protocol provided by the WHO. Binding parameters, the maximum binding capacity (Bmax) and the dissociation constant (Kd), were measured after construction of the Scatchard plot. When the samples of the two groups were compared, significant differences between the Bmax of HC and PD were found. No significant difference was observed for the Kd. The investigation shows that panic disorder may influence 3H-IMI binding in platelets, suggesting an involvement of the serotoninergic system in this disorder.

Adult↗
PubMed1988

Panic disorder: review of the empirical and rational basis of pharmacological treatment.

The increasing interest in and clinical research on the nature and treatment of panic disorder and agoraphobia have produced and should continue to produce rapid progress in the accumulation of scientific knowledge in this field. This article reviews some basic aspects of the effective pharmacotherapeutic management of panic-agoraphobic patients. Research results with different drug classes are reviewed and their implications for effective treatment discussed. The final section deals with special issues of case management, such as choice of specific drug, length of treatment, and probability and frequency of relapse.

Fear↗
PubMed1988

Binding of imipramine to platelet membranes is reduced in panic attacks.

The binding of imipramine (IMI) to platelet membranes was investigated in 13 patients suffering from panic attacks (PA), in 5 patients affected by schizophrenic disorder (S), and in 11 healthy volunteers (V). From 6 volunteers, from 5 patients with panic attacks, and from all the schizophrenic patients, blood samples were collected in the spring, whereas from the others the samples were collected in the autumn. IMI binding was studied according to a protocol provided by the WHO. Binding parameters, the maximum binding capacity (Bmax), and the dissociation constant (Kd) were measured after construction of the Scatchard plot. The differences between V and PA and between V and S were tested by analysis of variance followed by a t-test. Overall and intragroup relationships between Bmax or Kd and diagnosis and season were assessed by a 2-way analysis of variance (ANOVA). Bmax (mean +/- SD) was 947 +/- 269 (V), 742 +/- 160 (PA), and 712 +/- 254 (S) fmol/mg protein. V was different from PA (P less than 0.04) and from S (P less than 0.01). Kd (mean +/- SD) was 1.41 +/- 0.6 (V), 1.15 +/- 0.6 (PA), and 0.79 +/- 0.20 (S) nM. V was different from S only (P less than 0.01). Our results show that panic attacks and schizophrenia decrease the binding capacity of IMI in platelets. In addition, we found a significant difference between patients and controls only for the samples taken in the spring. No statistically significant difference was detectable between the 2 groups in the autumn samples.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

A 3H-flunitrazepam binding inhibitor is present in psychiatric patients' sera.

We investigated the possible existence of endogenous compounds acting on benzodiazepine central receptors in the serum of patients with panic attacks or depression. Our results show the presence of a substance which inhibits the 3H-flunitrazepam binding specifically in the samples taken from the patients' groups, and which is not present in normal controls, in the range of concentrations used. This compound has a molecular weight below 1,000 daltons, is heat-stable, and resistant to proteolytic degradation. The demonstration of this inhibitor opens new perspectives in the study of the biochemistry of anxiety.

Adolescent↗
PubMed1986

The importance of separation anxiety in the differentiation of panic disorder from agoraphobia.

When patients with panic disorders are divided into two groups, those that are without any signs of phobic avoidance and those that are frankly agoraphobic, we see a differential premorbid history of separation anxiety in childhood with school phobia. The former group we found to be without these problems, while the latter demonstrated a history of school phobia in the majority of cases (60 per cent). This may indicate that uncomplicated panic disorder and agoraphobia with panic attacks are not always differential cross-sections of the same disease process, or different levels of severity of the same psychopathological entity, but may represent illnesses best not conceptualized as lying on a continuum. Further research will be served by separating panic disorder (DSM-III 300.01) into two groups: uncomplicated panic disorder, and panic disorder with limited phobic avoidance, which will exist along with the present agoraphobia with panic attacks, perhaps best renamed panic disorder with extensive phobic avoidance.

Adult↗
PubMedDate not supplied

The nature of depression presenting concomitantly with panic disorder.

Our data, along with the literature review we have undertaken, suggest that depression seen in the course of panic disorder most commonly represents symptomatic elaboration or complication of panic disorder. Less often it represents an associated independent entity or, more hypothetically, an alternative clinical expression of a shared underlying diathesis for both conditions. Future prospective research efforts, especially along familial-genetic lines, are needed to clarify the precise nature of the cross-sectional and longitudinal overlap of anxiety and depressive states.

Adult↗