Effects of gradual discontinuation of selective serotonin reuptake inhibitors in panic disorder with agoraphobia.

The aim of this investigation was to explore the prevalence and features of discontinuation syndromes ensuing with gradual tapering of selective serotonin reuptake inhibitors (SSRIs), in optimal clinical conditions in patients with panic disorder and agoraphobia. Twenty-six consecutive outpatients met the DSM-IV criteria for panic disorder and agoraphobia while taking SSRIs. Twenty remitted upon behavioural treatment. Antidepressant drugs were then tapered at the slowest possible pace and with appropriate patient education. Patients were assessed with the Discontinuation-Emergent Signs and Symptoms (DESS) checklist 2 wk, 1 month and 1 yr after discontinuation. Nine of the 20 patients (45%) experienced a discontinuation syndrome, which subsided within a month in all but three patients who had been taking paroxetine for a long time. Discontinuation syndromes appeared to be fairly common even when performed with slow tapering and during clinical remission. In some cases disturbances persisted for months after discontinuation

Las polaridades del bienestar psicológico y su respuesta al tratamiento

An increasing number of investigations in the positive psychology area has suggested the benefits of improving well-being and positivity. However, observations from clinical domains raised some concerns on the effectiveness and utility of such interventions, because excessively elevated levels in positive domains could become detrimental and impede flourishing. The aim of this article is to describe these polarities in well-being and to suggest specific therapeutic strategies to promote flourishing and resilience. Well-being therapy (WBT) is a psychotherapeutic technique based on Ryff's conceptual model, that has been developed and tested in a number of randomized controlled trials. The differential technical characteristics and indications of WBT are described, with special reference to the promotion of an individualized and balanced path to achieve optimal human functioning, avoiding the polarities in positive psychological dimensions. Un número creciente de investigaciones en el área de la Psicología positiva sugiere que incrementar el bienestar y la positividad conlleva beneficios. Sin embargo, observaciones del ámbito clínico han suscitado algunas cautelas sobre la efectividad y utilidad de dichas intervenciones ya que niveles excesivamente elevados en los dominios positivos pudieran ser perjudiciales e impide el florecimiento. El objetivo de este artículo es describir estas polaridades en el bienestar y sugerir estrategias terapéuticas para promover el florecimiento y la resiliencia. La terapia del bienestar (TB) es una técnica de psicoterapia, basada en el modelo conceptual de Ryff, que ha sido desarrollada y sometida a prueba en una serie de ensayos clínicos aleatorizados. Se describen las características técnicas diferenciales y las indicaciones de la TB, con especial referencia a la promoción de una vía individualizada y equilibrada para conseguir un funcionamiento humano óptimo, evitando las polaridades en las dimensiones psicológicas positivas

Analisi multivariata per osservazioni appaiate con dati mancanti: un caso studio

All parametric approaches require that analysis should be done on complete data sets and so, in presence of missing data, parametric solutions are based either on the so-called deletion principle or imputation methods. But when we delete incomplete vectors we also remove all information they contain, which may be valuable and useful for analysis. And when we replace missing data by suitable functions of actually observed data, that is imputing method, we may introduce biased information which may negatively infuence the analysis. On the other hand, non-parametric solutions in a permutation framework consider data as they are, and units with missing data participate in the permutation mechanism as well as all other units, without deletion or imputing. In this paper we provide a comparison between a parametric solution, represented by ITT principle, and a non parametric one, in a testing problem with multivariate paired observations

Psychosocial determinants of recovery in depression

There is a growing body of literature on residual symptoms after apparently successful treatment The strong prognostic value of subthreshold symptomatology upon remission and the relationship between residual and prodromal symptomatology (the rollback phenomenon) have been outlined. Most residual symptoms also occur in the prodromal phase of depression and may progress to become prodromes of relapse. These findings entail important implications. It is necessary to closely monitor the patient throughout the different phases of illness and to assess the quality and extent of residual symptoms. A more stringent definition of recovery, which is not limited to symptomatic assessment, but includes psychological well-being, seems to be necessary. Wen therapeutic strategies for improving the level of remission, such as treatment of residual symptoms that progress to become prodromes of relapse and/or increasing psychological well-being, appear to yield more lasting benefits. The sequential model may provide room for innovative treatment approaches, including the use of drugs for specifically addressing residual symptoms. As occurs in other medical disorders (such as diabetes and hypertension), the active role of the patient in achieving recovery (self-therapy homework) should be pursued

Le pratiche musicali presso le chiese di Udine in epoca pre-napoleonica

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Historical Geoanthropology: Book Reviews

Reviews of Renn, The Evolution of Knowledge: Rethinking Science for the Anthropocene, Princeton UP 2020; Malm, The Progress of this Storm: Nature and Society in a Warming World, Verso 2020; Foster, Capitalism in the Anthropocene: Ecological Ruin or Ecological Revolution, Monthly Review Press 2022

Well-being therapy: Conceptual and technical issues

Abstract Well-being therapy is a short-term, well-being-enhancing psychotherapeutic strategy. It is based on Carol D. Ryff's multidimensional model of psychological wellbeing, encompassing environmental mastery, personal growth, purpose in life, autonomy, self-acceptance and positive relations with others. Its conceptual and technical issues are described. It may be applied as a relapsepreventive 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 and psychotherapeutic treatments, in body image disorders and in psychosomatic medicine. The first validation studies appeared to be promising. The technique is in its preliminary stage of development and may undergo major changes in the next years. It is hoped it may herald a new trend of psychotherapy research and practice in the current symptom-oriented settings

Clinimetrics

'Clinimetrics' is the term introduced by Alvan R. Feinstein in the early 1980s to indicate a domain concerned with indexes, rating scales and other expressions that are used to describe or measure symptoms, physical signs and other clinical phenomena. Clinimetrics has a set of rules that govern the structure of indexes, the choice of component variables, the evaluation of consistency, validity and responsiveness. This review illustrates how clinimetrics may help expanding the narrow range of information that is currently used in clinical science. It will focus on characteristics and types of clinimetric indexes and their current use. The clinimetric perspective provides an intellectual home for clinical judgment, whose implementation is likely to improve outcomes both in clinical research and practice

Inflammatory Cutaneous Diseases in Renal Transplant Recipients.

Kidney transplant recipients frequently suffer from skin infections and malignancies, possibly due to the effects of long-term immunosuppressive therapy. While the relationships between immunosuppression and these pathological conditions have been widely investigated, little is known about the relative incidence and characteristics of inflammatory skin diseases in this type of patient. In this study, we analyze the incidence of a number of inflammatory cutaneous diseases in a cohort of patients who underwent kidney transplantation. Although our study shows a relatively low incidence of these pathologies in transplanted patients-in agreement with the general action of immunosuppressant therapies in reducing inflammation-we scored a different efficacy of the various immunosuppressive regimens on inflammatory and autoimmune skin diseases. This information can be key for designing immunosuppressive regimens and devising accurate follow-up protocols