Anxiety Disorders: Salvatore P

Salvatore P, Tohen M, Khalsa HM, Baethge C, Tondo L, Baldessarini RJ. · No affiliation provided · Epidemiol Psichiatr Soc. · Pubmed #17619540 No free full text.

Abstract: Longitudinal assessment of the course of major psychiatric disorders has been advanced by studies from onset, but only rarely have large numbers of patients with a range of psychotic and major affective disorders been studied simultaneously and systematically from illness-onset. The decade-long McLean-Harvard First Episode Project & International Consortium for Bipolar Disorder Research has systematically followed-up large numbers of patients with DSM-IV bipolar or psychotic disorders from first-hospitalization. Major findings among patients with bipolar I disorder include: [a] full functional recovery from initial episodes was uncommon, and full symptomatic recovery, much slower than early syndromal recovery; [b] risks of relapse, recurrence, and switching were very high in the first two years; [c] most early morbidity was depressive-dysphoric, as reported in mid-course; [d] initial depression or mixed-states predicted more later depressive and overall morbidity, whereas initial mania or psychosis predicted later mania and a better prognosis; [e] based on within-subject modeling, most patients did not show progressive cycling over time, and illness-course was rather chaotic within and among patients; [f] treatment-latency or episode-counts were unassociated with responsiveness to long-term mood-stabilizing treatment; [g] very high rates of suicidal behavior and accidents occurred early; [h] early substance-use comorbidity associated with anxiety; [i] factor-analysis of prodromal symptoms predicted bipolar disorder much better than non-affective psychotic disorders. Project findings indicate that the course of bipolar I disorder is much less favorable than had been believed formerly, despite clinical treatment with modern mood-stabilizing and other treatments.

Salvatore P, Bhuvaneswar C, Ebert D, Maggini C, Baldessarini RJ. · Department of Psychiatry, Harvard Medical School, Massachusetts, USA. · Harv Rev Psychiatry. · Pubmed #18569038 No free full text.

Abstract: Emil Kraepelin proposed to separate psychiatric disorders with psychotic features into two major categories, dementia praecox (later schizophrenia) and manic-depressive insanity (later bipolar disorder and major depression). Over the past century, there have been many efforts to categorize conditions that do not fit readily in either group. These conditions include many cases of acute psychotic illnesses of limited duration, with recovery between recurrences. For some of these conditions, Karl Kleist proposed the term cycloid psychosis: acute features were psychotic, as in schizophrenia, but the course was episodic, as in manic-depression. His concept was later elaborated by Karl Leonhard and Carlo Perris, and validated by modern studies. Leonhard described three overlapping cycloid subtypes (anxiety-beatific, excited-inhibited confusional, and hyperkinetic-akinetic motility dysfunction forms); Perris proposed a more unitary syndrome with operational diagnostic criteria; and recent investigators have considered relatively affective versus thought-disordered subtypes. The cycloid concept is not explicitly included in standard international diagnostic schemes, but both DSM-IV and ICD-10 have broad categories for acute, recurrent psychotic disorders, whose validity remains insecure. We present two cases of probable cycloid psychosis, review the history of the concept, and propose that it be reconsidered as a clinically useful category whose validity and utility for prognosis and treatment can be further tested.

Nykiel SA, Baldessarini RJ, Bower MC, Goodwin J, Salvatore P. · Harvard Medical School and McLean Hospital, Belmont, MA 02478, USA. · Harv Rev Psychiatry. · Pubmed #18306099 No free full text.

This publication has no abstract.

De Panfilis C, Cero S, Dall'Aglio E, Salvatore P, Torre M, Maggini C. · Unit of Psychiatry, Department of Neurosciences, Parma University Hospital, Parma, Italy. · Acta Biomed. · Pubmed #17687813 links to  free full text

Abstract: BACKGROUND: To detect pre-treatment psychopathological predictors of compliance and outcome in a behavioural weight-loss program for obesity. METHODS: 68 consecutive obese outpatients were evaluated on a wide range of psychopathological variables before entering a behavioural weight reduction program. Baseline assessment included detection of psychiatric (Axis I) and personality (Axis II) disorders, anxiety and depression levels, temperament and character patterns, alexithymia, and eating attitudes. These variables were then tested as predictors of compliance and weight loss after eight months of active treatment. RESULTS: Baseline presence of Axis I diagnoses was found to enhance the likelihood of good compliance to treatment but to lower probability of good outcome. Different psychopathological (and specifically personality) predictors of outcome were found among patients with and without psychiatric disorders. CONCLUSIONS: These data suggest the need to perform a full psychiatric evaluation, including personality assessment, to implement obesity treatment strategies.

De Panfilis C, Cero S, Torre M, Salvatore P, Dall'Aglio E, Adorni A, Maggini C. · Unit of Psychiatry, Department of Neuroscience, Parma University Hospital, Italy. · Obes Surg. · Pubmed #16839480 No free full text.

Abstract: BACKGROUND: Research about personality factors involved in successful outcome after bariatric surgery has led to contrasting results. The reasons for such discrepancies may include the lack of assessment of adaptive personality traits and of psychiatric co-morbidity, which may limit the reliability of personality findings. This study aimed to provide exploratory data regarding preoperative personality dimensions and weight loss prediction 1 year after laparoscopic adjustable gastric banding (LAGB). Both normal and deviant personality patterns were assessed by means of the Temperament and Character Inventory (TCI). Moreover, co-morbid psychiatric disturbances were evaluated both categorically and dimensionally. METHODS: 65 morbidly obese subjects applying for LAGB were evaluated preoperatively by means of the TCI, standardized diagnostic interview, rating scales and questionnaires to assess co-morbid psychopathology. After intake screening, 35 subjects (mean age 41.2, mean BMI 45.5) were accepted for and underwent LAGB. BMI reduction 1 year following LAGB was used as an outcome measure and entered as a dependent variable in a stepwise multiple regression analysis. TCI scores, presence and severity of eating, depressive and anxiety disorders, sex, age, level of education and BMI at baseline were tested as independent variables. RESULTS: Preoperative TCI 'Persistence' scores explained >40% of variance of BMI reduction 1 year following LAGB, irrespective of preoperative BMI, age, gender, educational level, psychiatric co-morbidity, psychopathology severity and other temperament and character features. CONCLUSIONS: Some personality dimensions, as measured by the TCI, may be involved in successful weight control after LAGB.

Baethge C, Baldessarini RJ, Khalsa HM, Hennen J, Salvatore P, Tohen M. · Department of Psychiatry, Harvard Medical School, Boston, MA, USA. · Am J Psychiatry. · Pubmed #15863809 links to  free full text

Abstract: OBJECTIVE: This study clarified the early characteristics of substance use disorders in patients with first-episode bipolar I disorder. METHOD: The authors evaluated substance use disorders, associated factors, and clinical course, prospectively, in the first 2 years of DSM-IV bipolar I disorder with standardized methods. RESULTS: Baseline substance use disorder was found in 33% (37 of 112) of the patients at baseline and in 39% at 24 months. Anxiety disorders were more frequent in the patients with than without substance use disorder (30% and 13%, respectively). Associations of alcohol dependence with depressive symptoms and cannabis dependence with manic symptoms were suggested. Patients using two or more substances had worse outcomes. CONCLUSIONS: Since substance use disorders were frequent from the beginning of bipolar I disorder and were associated with anxiety disorders and poor outcome, early interventions for substance use disorder and anxiety might improve later outcome.

Salvatore P, Gariboldi S, Offidani A, Coppola F, Amore M, Maggini C. · Instituto di Clinica Psichiatrica, University of Parma, Parma, Italy. · Fertil Steril. · Pubmed #11384636 No free full text.

Abstract: OBJECTIVE: To compare the psychopathology, personality features, and marital relationships of women undergoing in vitro fertilization (IVF) with those of control patients, and to compare IVF inductees with program veterans. DESIGN: Cross-sectional clinical study. SETTING: A university hospital. PATIENT(S): One hundred and one women undergoing IVF treatment. INTERVENTION(S): Psychometric tests were administered at first visit (baseline) of index treatment cycle. MAIN OUTCOME MEASURE(S): Achievement of pregnancy. RESULT(S): Women undergoing IVF show higher levels of anxiety and emotional tension than do controls. Although the infertile women showed no abnormal personality dimensions, the IVF group did have a particular psychological profile and a different marital relationship pattern when compared with the control participants. Between IVF veterans and inductees, there are significant differences with respect to psychopathology, psychological dimensions, and couple dynamics. The achievement of pregnancy is not associated with any special psychopathological, personality, or marital characteristics among the IVF women. CONCLUSION(S): The most crucial period in IVF procedures may immediately follow the end of the first cycle because of the high risk of patients dropping out of the program. To determine the most effective supporting therapies for women undergoing fertilization procedures it could be useful to consider the psychological and relational differences between veterans and inductees.