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ABSTRACT: Obsessive compulsive disorder (OCD) is a chronic anxiety disorder associated with significant morbidity, social impairment and lower quality of life. Psychological treatments are a frequently used approach for OCD.
To perform a systematic review of randomised trials of psychological treatments for obsessive compulsive disorder in comparison with treatment as usual.
We conducted an electronic search of CCDANCTR-Studies (31/10/2006), and other databases. We searched reference lists, and contacted experts in the field.
Published and unpublished randomised trials of psychological treatments versus treatment as usual for adults with a diagnosis of OCD DATA COLLECTION AND ANALYSIS: Two review authors worked independently throughout the selection of trials and data extraction. Findings were compared and disagreements were discussed with a third review author. Full data extraction, using a standardised data extraction sheet, was performed on all studies included in the review. Results were synthesised using Review Manager software. For dichotomous data, odds ratios were calculated. For continuous data, effect sizes were obtained and the standardised mean difference, with 95% confidence intervals, was calculated. Fixed and random effects models were used to pool the data. Reasons for heterogeneity in studies were explored and sensitivity analyses were performed by excluding trials of lower quality.
Eight studies (11 study comparisons) were identified, all of which compared cognitive and/or behavioural treatments versus treatment as usual control groups. Seven studies (ten comparisons) had usable data for meta-analyses. These studies demonstrated that patients receiving any variant of cognitive behavioural treatment exhibited significantly fewer symptoms post-treatment than those receiving treatment as usual (SMD -1.24, 95% CI -1.61 to -0.87, I(2) test for heterogeneity 33.4%). Different types of cognitive and/or behavioural treatments showed similar differences in effect when compared with treatment as usual. The overall treatment effect appeared to be influenced by differences in baseline severity.
The findings of this review suggest that psychological treatments derived from cognitive behavioural models are an effective treatment for adult patients with obsessive compulsive disorder. Larger high quality randomised controlled trials involving longer follow up periods are needed, to further test cognitive behavioural treatments, and other psychological approaches, in comparison to each other and control conditions. Future trials should examine the predictors of response to each treatment, and also conduct cost-effectiveness evaluations.
Cochrane database of systematic reviews (Online) 02/2007; · 5.72 Impact Factor
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ABSTRACT: Among the several mental originated clinical syndromes, hypochondria is not still well understood and listed. Indeed, hypochondria is often a complicating element in other psychopathological pictures; a slight form of hypochondria can appear in phobic-obsessing neurosis, and a worse one at the beginning of psychosis. The Authors, trying to explain the complex questions about diagnosis and prognosis of hypochondria, look for common personality traits in these patients. The research instrument was the Adjective Check List (ACL), a psychological test highly standardized and diffused, composed of 300 adjectives, or adjectival sentences, used to describe a person's attributes. The ACL was given to 65 subjects divided into two groups. The first group was made of 15 subjects, 10 women and 5 men, ambulatory treated at the Psychiatric Clinic in Trieste for the following diagnosis: psychosis (4 persons), depressing syndrome (3 persons), hypochondria (6 persons), obsessive neurosis (1 persons), anxiety syndrome (1 person). The second group was made of 50 subjects, 28 women and 22 men, diagnosed as hypochondriac by their medical officers. The results point out that some personality traits rising above the others are suggesting for an apathetical patient, not ready to accept himself, easily overcome by everyday life problems. These subjects are introverted, intolerant to frustrations, and inclined to take refuge in their own imaginary world, not able to self-governing. In the considered group the Authors find a moderate tendency to change, and it could be interpreted like a good prognostic element for a psychotherapeutic treatment.
Minerva psichiatrica 07/1995; 36(2):63-9.
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ABSTRACT: Two multicentre studies are described here; the first compared moclobemide with mianserin and the second with maprotiline, both in elderly patients with a DSM-III diagnosis of major depressive episode. In the first study, 80 eligible patients were randomized to either moclobemide 300-500 mg or mianserin 75-125 mg per day for 4 weeks. Mean reduction in Hamilton Rating Scale for Depression (HRSD) score was 52% in both groups. The overall assessment of efficacy was good or very good for 60% of the patients, and tolerance was considered good or very good for 85% of the patients in both groups; no significant differences between the 2 treatments were seen. The second study comprised 39 hospitalized patients randomized to either moclobemide 150-300 mg daily or maprotiline 75-150 mg daily for 6 weeks. At the end of treatment, HRSD scores declined 85% in both groups compared with baseline. The overall assessment of efficacy was over 90% good or very good in both groups. Tolerance was rated good or very good for 80% of moclobemide and 75% of maprotiline patients; none of these results differed significantly between the groups, indicating that moclobemide is as effective in elderly patients as the 2 second-generation antidepressants. In view of the safety of moclobemide, it should be considered first-line therapy for depression in elderly people.
Acta psychiatrica Scandinavica. Supplementum 02/1990; 360:64-6.
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ABSTRACT: The contextual method was used to identify the incidence of recent life events and difficulties among 50 suicide attempters compared with a control group selected at random from the general population. Suicide attempters experienced a significantly greater incidence of major life events, although for all life events irrespective of stressfulness, and for independent events the differences were not significant. The overall incidence of difficulties was also higher among suicide attempters. Finally, the results suggest a vulnerability effect as far as three factors are concerned: early loss of/separation from one or both parents, absence of paid employment and living in a nuclear family.
Journal of Affective Disorders 02/1990; 18(1):51-8. · 3.52 Impact Factor
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ABSTRACT: Alexithymia is a perceptive, affective, specific disturbance of the psychic functions characterized by the difficulty to verbalize emotions and sensations and by a pragmatic thought content. The presence of alexithymia has been evidenced many times as an essential element in the genesis and in the maintenance of the various psychosomatic pathologies. This has stimulated us to research the alexithymical component in subjects affected by psoriasis in order to take advantage, when it is found, of a more appropriate therapeutic response.
Acta dermato-venereologica. Supplementum 02/1989; 146:91-2.
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Drug and Alcohol Dependence 08/1982; 9(3):257-63. · 3.38 Impact Factor
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ABSTRACT: The authors have isolated, by means of factorial analysis on a specimen group of 86 stroke patients, a group of 23 subjects who showed, to a significant extent, lapses in concentration, intellectual fatigue and memory deterioration, and have therefore considered them as being subject to psycho-coronary syndrome. From the comparison made with the other coronary-thrombosis victims in this research, these subjects appeared to be attended to by authoritarian physicians, had been hospitalized for a greater length of time, had remained absent from work for longer, and had accepted restrictions upon their physical activity and habits by both their doctor and family. Furthermore, they showed a remarkable level of self-depressive tendencies and fear of improbable relapse, not corresponding to the severity of the stroke. The factorial analysis has thus allowed us to evidentiate the reality of the psycho-coronary syndrome as a clinical condition.
Schweizer Archiv für Neurologie, Neurochirurgie und Psychiatrie = Archives suisses de neurologie, neurochirurgie et de psychiatrie 02/1980; 126(1):93-102.
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ABSTRACT: Quazepam (QZP), a new long half-life benzodiazepine, seems to have a more specific hypnotic activity and a "physiological" mechanism of action. This study assessed its clinical efficacy and any withdrawal symptoms occurring after the treatment with QZP and triazolam (TRZ). Sixty-five patients (mean age 41.4 yrs +/- 12.43 SD) with sleep disorders were included in the study. The patients were treated with placebo for 4 days (run-in period) and if no amelioration of insomnia was observed, were then randomly allocated to 15 mg QZP (33 patients) or TRZ (32 patients) for 8 weeks and finally placebo for another week. Sleep quality, efficiency, side-effects and withdrawal effects were assessed by specific rating scales. In comparing data obtained from the two treatments, the following conclusions were drawn: 1) both drugs showed a hypnoinductive efficacy but patients treated with QZP had significantly fewer night awakenings; 2) at the end of treatment only patients treated with TRZ had longer awakenings and rebound symptoms; 3) a lower withdrawal symptom incidence was observed in patients treated with QZP. Therefore, QZP seems to have a good hypnotic effect without inducing withdrawal symptoms. In contrast TRZ turned out to be a merely hypno-inducing drug presenting higher risks of rebound effects after withdrawal.
Minerva psichiatrica 30(3):159-64.
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Minerva psichiatrica 23(3-4):129-32.
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Minerva psichiatrica 23(3-4):133-7.
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Minerva psichiatrica 25(2):71-4.
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Minerva psichiatrica 28(3):201-13.
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Minerva psichiatrica 20(3):181-5.
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Minerva psichiatrica 21(4):391-4.
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Minerva psichiatrica 21(4):381-4.
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Minerva psichiatrica 23(2):83-6.
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Minerva psichiatrica 22(2):85-92.
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Minerva psichiatrica 27(3):235-41.
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Minerva psichiatrica 27(2):187-92.
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Minerva psichiatrica 30(3):175-7.
