Pharmacological management of panic disorder

Grayscal

Pharmacological management of panic disorder

Panic disorder (PD) is a disabling condition which appears in late adolescence or early adulthood and affects more frequently women than men. PD is frequently characterized by recurrences and sometimes by a chronic course and, therefore, most patients require long-term treatments to achieve remission, to prevent relapse and to reduce the risks associated with comorbidity. Pharmacotherapy is one of the most effective treatments of PD. In this paper, the pharmacological management of PD is reviewed. Many questions about this effective treatment need to be answered by the clinician and discussed with the patients to improve her/his collaboration to the treatment plan: which is the drug of choice; when does the drug become active; which is the effective dose; how to manage the side effects; how to manage nonresponse; and how long does the treatment last. Moreover, the clinical use of medication in women during pregnancy and breastfeeding or in children and adolescents was reviewed and its risk-benefit balance discussed

Obsessive-compulsive disorder followed by psychotic episode in long-term ecstasy misuse

Aim. We report the case of two young subjects who developed an obsessive-compulsive disorder (OCD) during a heavy use of ecstasy. After several months of discontinuation of the drug, major depression with psychotic features developed in one subject and a psychotic disorder in the other individual. No mental disorder preceded the use of ecstasy in any subject. Findings. A familial and personality vulnerability for mental disorder was revealed in one subject, but not in the other, and all physical, laboratory and cerebral NMR evaluations showed normal results in both patients. Remission of OCD and depressive episode or psychotic disorder was achieved after treatment with a serotoninergic medication associated with an antipsychotic. Conclusions. The heavy long-term use of ecstasy may induce an alteration in the brain balance between serotonin and dopamine, which might constitute a pathophysiological mechanism underlying the onset of obsessive-compulsive, depressive and psychotic symptoms. The heavy use of ecstasy probably interacted with a vulnerability to psychiatric disorder in one subject, whereas we cannot exclude that an "ecstasy disorder" ex novo affected the other individual. © 2009 Informa UK Ltd All rights reserved

The biological origins of rituals: An interdisciplinary perspective

Ritual behavior is ubiquitous, marking animal motor patterns, normal and psychopathological behavior in human individuals as well as every human culture. Moreover, formal features of rituals appear to be highly conserved along phylogeny and characterized by a circular and spatio-temporal structure typical of habitual behavior with internal repetition of non-functional acts and redirection of attention to the "script" of the performance. A continuity, based on highly conserved cortico-striatal loops, can be traced from animal rituals to human individual and collective rituals with psychopathological compulsions at the crossing point. The transition from "routinization" to "ritualization" may have been promoted to deal with environmental unpredictability in non-social contexts and, through motor synchronization, to enhance intra-group cohesion and communication in social contexts. Ultimately, ritual, following its biological constraints exerts a "homeostatic" function on the environment (social and non-social) under conditions of unpredictability

Mood-congruent and mood-incongruent psychotic symptoms in major depression: The role of severity and personality

Background: Whether psychotic symptoms in major depression (MD) are better explained by a severity model or by a vulnerability model, with personality as a predisposing factor, is still debated. The aim of the present study was to evaluate in MD the relationship between the content of psychotic features (mood congruent (MC) or mood incongruent (MI)) and severity of depression or personality traits. Methods: 62 inpatients affected by MD with psychotic features were divided into three groups on the basis of the content of psychotic symptoms: MC, MI, mixed MC-MI. All subjects completed the SCID-IV, the Structured Clinical Interview for DSM-IV Personality Disorders and the Hamilton Rating Scale for Depression. Personality was assessed after MD remission. Results: MI psychotic symptoms were positively associated with schizotypal traits, whereas MC symptoms were positively related to obsessive-compulsive traits and severity of depression. Patients with both MC and MI psychotic symptoms were characterized by a personality profile and depression severity standing in a middle position between the MC and MI groups. Limitations: The main limitations of the study are represented by the small sample size, the time of assessment of personality and the inclusion of only unipolar depression. Conclusions: Our findings suggest that both depression severity and personality profile, independently from each other, model the content of psychotic symptoms, confirming the validity of subgrouping psychotic depression into two distinct MC and MI types and supporting the inclusion of a third mixed MC-MI type because of its intermediate position in personality profile and severity between the MC or MI group. © 2012 Elsevier B.V

Parental bonding and personality disorder: The mediating role of alexithymia

This study explored whether alexithymic features mediate the effect of perceived adverse parenting during childhood on being diagnosed with a PD in adulthood. Two hundred sixty-five psychiatric outpatients were evaluated with the Toronto Alexithymia Scale (TAS-20), the Parental Bonding Instrument (PBI), the Structured Interview for DSM-IV Personality, the Structured Clinical Interview for DSM-IV Axis I Disorders, the Clinical Global Impression scale, and the Global Assessment of Functioning scale. The statistical model for mediation proposed by Baron and Kenny (1986) was employed to detect whether the TAS scores account for the relation between PBI scores and a PD diagnosis. The results indicated that although altered parental bonding (and specifically, excessive maternal protection) may enhance the risk of PD, its effect is completely mediated by the alexithymic feature Difficulty Describing Feelings to Others (DDF), after controlling for gender, age, educational level, type, severity and age of onset of Axis I disorders. Therefore, this study suggests that the presence of DDF accounts for the effect of maternal overprotection risk factor for PD. © 2008 The Guilford Press

The effect of severity and personality on the psychotic presentation of major depression

The aim of the present study was to evaluate whether symptom severity or personality traits are associated with psychotic symptoms in major depression (MD), since it is still debated whether psychotic depression represents the most severe form of depression or the effect of personality structure. The study included 163 patients affected by MD who were divided into four groups on the basis of the presence/absence of melancholic features and psychotic symptoms. All subjects completed the Structured Clinical Interview for DSM-IV Disorders (SCID-IV), the Structured Clinical Interview for DSM-IV Personality Disorders (SIDP-IV) and the Hamilton Rating Scale for Depression (Ham-D). Personality was assessed after MD remission (absence of DSM-IV criteria and Ham-D score lower than 7 for at least 2 months). Psychotic symptoms were positively associated with symptom severity (higher Ham-D total score) and with paranoid and schizotypal traits and negatively related to histrionic traits. Our data support the view that the effect of paranoid-schizotypal traits and symptom severity on the presence of psychotic symptoms in MD occurs separately and they are independent of each other. © 2011 Elsevier Ltd

The TAS-20 more likely measures negative affects rather than alexithymia itself in patients with major depression, panic disorder, eating disorders and substance use disorders

Background This study evaluates whether the difference in Toronto Alexithymia Scale-20 item (TAS-20) between patients with major depression (MD), panic disorder (PD), eating disorders (ED), and substance use disorders (SUD) and healthy controls persisted after controlling for the severity of anxiety and depression. Methods Thirty-eight patients with MD, 58 with PD, 52 with ED, and 30 with SUD and 78 healthy controls (C) completed the TAS-20, the Hamilton Rating Scale for Anxiety (Ham-A), the Hamilton Rating Scale for Depression (Ham-D). Results The differences in TAS-20 scores observed between patient groups, regardless of the type of their disorders, and controls disappeared after controlling for the effect of anxiety and depression severity. In contrast, the differences in severity of anxiety and depression between patients and controls were still present, after excluding the effect of alexithymic levels. Conclusions Our data suggest that alexithymic levels, as measured by the TAS-20, are modulated by the severity of symptoms, supporting the view that alexithymia can represent a state phenomenon in patients with MD, PD, ED and SUD, because the TAS-20 seems overly sensitive to a general distress syndrome, and it is more likely to measure negative affects rather than alexithymia itself. \ua9 2014 Elsevier Inc

Late-onset obsessive-compulsive disorder associated with left cerebellar lesion

The onset of obsessive-compulsive disorder (OCD) after age 50 is rare and generally related to an organic etiology. An involvement of fronto-striatal circuits has been strongly suggested, whereas cerebellum remains so far scarcely explored. We present here the description of a "pure" late-onset OCD associated with a cerebellar lesion, neither comorbid with other mental disorders nor with neurological syndromes. To our knowledge, this condition was not previously described in literature. The patient is a 62-year-old woman who developed a late-onset OCD associated with a left cerebellar lesion due to an arachnoid cyst in the left posterior fossa. We debate the possible role of the cerebellar lesion in favoring a transition from a predisposing liability (namely an obsessive-compulsive personality disorder and a depressive status) to the onset of OCD in this woman. \ua9 2014 Springer Science+Business Media