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Biomedical subjects

Giovanni A Fava

Publications and source records attributed to Giovanni A Fava.

14 recordsLinked to original sources
PubMed2003

Development and characteristics of a well-being enhancing psychotherapeutic strategy: well-being therapy.

This article describes the main characteristics and technical features of a novel psychotherapeutic strategy, well-being therapy. This paper outlines the background of its development, the structure of well-being therapy, its key concepts and technical aspects. Well-being therapy is based on Ryff's multidimensional model of psychological well-being, encompassing six dimensions: autonomy, personal growth, environmental mastery, purpose in life, positive relations and self-acceptance. The goal of this therapy is improving the patients' levels of psychological well-being according to these dimensions, using cognitive-behavioral techniques. It may be applied as a relapse-preventive strategy in the residual phase of affective (mood and anxiety) disorders, as an additional ingredient of cognitive-behavioral packages, in patients with affective disorders who failed to respond to standard pharmacological or psychotherapeutic treatments and in body image disturbances. The clinical studies supporting its efficacy are illustrated.

Humans↗
PubMed2003

Can long-term treatment with antidepressant drugs worsen the course of depression?

BACKGROUND: The possibility that antidepressant drugs, while effectively treating depression, may worsen its course has received inadequate attention. METHOD: A review of the literature suggesting potential depressogenic effects of long-term treatment with antidepressant drugs was performed. A MEDLINE search was conducted using the keywords tolerance, sensitization, antidepressive agents, and switching. This was supplemented by a manual search of Index Medicus under the heading "antidepressant agents" and a manual search of the literature for articles pointing to paradoxical effects of antidepressants. RESULTS: A number of reported clinical findings point to the following possibilities: very unfavorable long-term outcome of major depression treated by pharmacologic means, paradoxical (depression-inducing) effects of antidepressant drugs in some patients with mood and anxiety disturbances, antidepressant-induced switching and cycle acceleration in bipolar disorder, occurrence of tolerance to the effects of antidepressants during long-term treatment, onset of resistance upon rechallenge with the same antidepressant drug in a few patients, and withdrawal syndromes following discontinuation of mood-elevating drugs. These phenomena in susceptible individuals may be explained on the basis of the oppositional model of tolerance. Continued drug treatment may recruit processes that oppose the initial acute effects of a drug and may result in loss of clinical effect. When drug treatment ends, these processes may operate unopposed, at least for some time, and increase vulnerability to relapse. CONCLUSION: The possibility that antidepressant drugs may worsen the course of depression needs to be tested, even though its scientific exploration is likely to encounter considerable methodological and ideological difficulties. The clinical implications of this hypothesis in depression are considerable. Antidepressant drugs are crucial in the treatment of major depressive episodes. However, appraisal of paradoxical effects that may occur in susceptible patients during long-term treatment may lead to more effective use of the drugs.

Acute Disease↗
PubMed2002

Residual symptoms in depression an emerging therapeutic concept.

Cushing's syndrome is due to chronic glucocorticoid excess that may have various etiologies. The most common endogenous form is pituitary-dependent bilateral adrenal hyperplasia, which is termed Cushing's disease. Major depression occurs in more than half of the cases. The presence of depressive symptoms connotes severity of clinical presentation and, in patients with hypothalamic-pituitary forms, entails prognostic value. Medical treatment may be used while awaiting more definitive solutions for the illness by surgery. The inhibitors of steroid production (e.g., ketoconazole, metyrapone and aminoglutethimide), rather than antidepressant drugs, are generally successful in lifting depression as well as other disabling symptoms. Since central serotonergic regulation could have a role in the course of Cushing's disease, serotonin antagonists (e.g., cyproheptadine, ritanserin and ketanserin) have been employed. Findings related to the pharmacological response of depression in Cushing's disease were found to have implications for the pathophysiology of depression and the potential involvement of the hypothalamic-pituitary-adrenal axis (HPA axis) in resistance and tolerance to antidepressant drugs. The use of serotonergic drugs in Cushing's disease may yield important insights in the understanding of serotonergic regulation both in Cushing's disease and in the HPA axis in nonendocrine major depression.

Animals↗
PubMed2002

Erratum to "CNS drugs in Cushing's disease: pathophysiological and therapeutic implications for mood disorders" [Prog. Neuro-Psycol. Biol. Psychiatry, 26, 763 (2002)].

Cushing's syndrome is due to chronic glucocorticoid excess that may have various etiologies. The most common endogenous form is pituitary-dependent bilateral adrenal hyperplasia, which is termed Cushing's disease. Major depression occurs in more than half of the cases. The presence of depressive symptoms connotes severity of clinical presentation and, in patients with hypothalamic-pituitary forms, entails prognostic value. Medical treatment may be used while awaiting more definitive solutions for the illness by surgery. The inhibitors of steroid production (e.g., ketoconazole, metyrapone and aminoglutethimide), rather than antidepressant drugs, are generally successful in lifting depression as well as other disabling symptoms. Since central serotonergic regulation could have a role in the course of Cushing's disease, serotonin antagonists (e.g., cyproheptadine, ritanserin and ketanserin) have been employed. Findings related to the pharmacological response of depression in Cushing's disease were found to have implications for the pathophysiology of depression and the potential involvement of the hypothalamic-pituitary-adrenal axis (HPA axis) in resistance and tolerance to antidepressant drugs. The use of serotonergic drugs in Cushing's disease may yield important insights in the understanding of serotonergic regulation both in Cushing's disease and in the HPA axis in nonendocrine major depression.

Central Nervous System Agents↗
PubMed2002

Cognitive behavior approach to loss of clinical effect during long-term antidepressant treatment: a pilot study.

OBJECTIVE: The aims of this investigation were to explore the feasibility of a cognitive behavior approach to loss of clinical effect during long-term antidepressant therapy and to compare it with dose increase. METHOD: Ten patients with recurrent depression who relapsed while taking antidepressant drugs were randomly assigned to dose increase and clinical management or to cognitive behavior therapy and maintenance of the antidepressant drug at the same dose. RESULTS: Four of five patients responded to a larger dose, but all had relapsed again on that dose by the 1-year follow-up. Four of five patients responded to cognitive behavior therapy, and only one relapsed during follow-up. CONCLUSIONS: The data suggest that application of a cognitive behavior therapy approach is feasible when there is a loss of clinical effects during long-term antidepressant treatment and may carry long-term benefits. The results need to be confirmed with large-scale controlled studies.

Antidepressive Agents↗
PubMedDate not supplied

Circadian blood pressure patterns and life stress.

BACKGROUND: Scarce data are available on the influence of psychological aspects on 24-hour ambulatory blood pressure patterns either in normotensive or hypertensive subjects. This study was designed to evaluate the relationship between psychological profile and changes in daytime/nighttime blood pressure rhythm. METHODS: Nocturnal dipping was defined as the night/day ratio of ambulatory mean systolic and/or diastolic blood pressure < or =0.87. Three-hundred and two outpatients (M/F = 174/128; mean age = 49.8 years, SD = 13.6; range, 16-80 years) underwent 24-hour ambulatory blood pressure monitoring. They were administered a self-rating scale, the Psychosocial Index, as an indicator of stress, psychological distress, sleep disturbances, well-being, abnormal illness behavior and quality of life. There were 242 patients taking antihypertensive medication (146 adequately controlled and 96 not controlled) and 60 who were drug free (33 never-treated hypertensive and 27 normotensive subjects). Patients were divided according to the presence (n = 125) or absence (n = 177) of night blood pressure dipping. The two groups were compared using analysis of covariance, with age as a covariate. RESULTS: Dippers had lower (p < 0.001) nocturnal systolic and diastolic blood pressure than nondippers, and higher (p < 0.05) daytime diastolic blood pressure. Patients with nocturnal blood pressure decline had a markedly higher (p < 0.001) level of stress than nondippers. When the sample was divided according to the presence or absence of hypertension, only subjects with normal blood pressure showed nocturnal dipping associated with increased stressful life circumstances. CONCLUSIONS: Our findings indicate that dippers experience stressful life circumstances, both in terms of life events and chronic stress. This suggests that stress-reducing techniques may be particularly helpful in the setting of hypertension characterized by nighttime blood pressure dipping.

Adolescent↗
PubMedDate not supplied

The relationship of psychological well-being to distress and personality.

BACKGROUND: The concept of psychological well-being has been neglected for a long time in scientific literature. Over the last decades, however, many psychometric instruments have been developed to measure it. The aim of the present study was to analyze the concept of psychological well-being and its relationship to distress and personality traits. It is clinically and empirically important to establish where the measures of well-being are located in relation to symptomatology indices and personality traits. METHODS: A sample of 450 subjects in the general population completed three self-rating scales for the assessment of symptomatology (Kellner's Symptom Questionnaire), psychological well-being (Ryff's Psychological Well-Being Scales, PWB), and personality traits (Cloninger's Tridimensional Personality Questionnaire). The assessment was repeated after 1 month. Pearson's coefficient was used to analyze PWB test-retest reliability and correlations between well-being, distress and personality indicators. Exploratory factor analysis was performed for both assessments. RESULTS: Test-retest Pearson's coefficients were satisfactory for all six PWB scales. Exploratory factor analyses showed a 4- or 5-factor structure, where well-being, distress and personality remained separated. PWB scales were negatively and significantly correlated with all symptom scales, but only with one personality dimension, TPQ Harm Avoidance. Mean-level differences by gender showed that in general women significantly presented with lower levels of well-being (except in Positive Relations) and higher levels of distress and personality disturbances. CONCLUSIONS: The results suggest that the relationship of well-being to distress and personality is complex. Psychological well-being could not be equated with the absence of symptomatology or with personality traits. PWB scales measure an attitude toward optimal functioning that is crucial for a comprehensive consideration of individuals in clinical settings.

Adolescent↗