[show abstract][hide abstract] ABSTRACT: This study aimed to investigate 1) the relationship between subjective perception of quality of life (QoL) and clinician-rated levels of psychosocial functioning and 2) the relationship of these indicators with neuropsychological performances, in a sample of 117 subjects with mood and anxiety disorders hospitalized for a 4-week psychiatric rehabilitation program. At the beginning of the hospitalization, QoL and clinician-rated functioning were respectively measured by the World Health Organization Quality of Life Assessment-Brief Form (WHOQOL-BREF) and the Global Assessment of Functioning (GAF) scale, and subjects were administered a neuropsychological battery evaluating verbal and visual memory, working memory, attention, visual-constructive ability, language fluency and comprehension. We did not find any association between WHOQOL-BREF and GAF scores and between cognitive impairment and lower QoL or clinician-rated functioning. Our results suggest that 1) the individuals' condition encompasses different dimensions that are not fully captured by using only clinician-rated or self-administered evaluations; 2) the GAF scale seems unable to indicate the cognitive impairments of our subjects and the WHOQOL-BREF does not appear to be influenced by these deficits. Overall, our findings suggest the need of simultaneously use of multiple assessment tools, including objective evaluations of functioning and different measures of QoL, in order to obtain a more complete clinical picture of the patients. This may allow to identify more specific targets of therapeutic interventions and more reliable measures of outcome.
[show abstract][hide abstract] ABSTRACT: To investigate the effects of cigarette smoking on neuropsychological performance in patients with mood disorders.
One hundred depressed patients with DSM-IV-TR-defined major depressive disorder (n = 61) or bipolar disorder (n = 39), hospitalized for a 4-week psychiatric rehabilitation program, were included. Forty-five were active regular smokers, and 55 were nonsmokers who had never smoked in their lifetime. At the beginning and the end of the hospitalization, patients were administered a comprehensive neuropsychological battery (evaluation of verbal and visual memory, working memory, attention, visual-constructive ability, language fluency, and comprehension) as primary outcome measures and psychometric scales (evaluation of depression and illness severity). Smoking status was assessed by personal interviews. Investigators were blind to the results of neuropsychological tests and to the smoking status of the patients. Data were collected from February 2011 to January 2012.
At the beginning of the hospitalization, smokers showed significantly better performance in verbal memory, language fluency, and working memory (all P values < .01) than nonsmokers. No interaction between smoking and diagnosis was found. At the end of the hospitalization, the whole group of patients significantly improved in several cognitive domains, with smokers maintaining significantly better performance in verbal memory, language fluency, and working memory (all P values < .01) than nonsmokers.
Our preliminary results indicate a better performance by smokers in verbal memory and working memory domains than by nonsmokers, suggesting that a cognitive enhancement may be associated with nicotine use in depressed patients with MDD or bipolar disorder. Smoking may be a form of cognitive self-medication mediating the association between smoking and mood disorders. Further studies with larger samples are needed.
The Journal of Clinical Psychiatry 02/2013; 74(2):e130-6. · 5.81 Impact Factor
[show abstract][hide abstract] ABSTRACT: BACKGROUND: The presence of abnormalities in baseline respiratory function of subjects with panic disorder (PD) is expected according to PD respiratory theories. We aimed to meta-analyze results from studies comparing baseline respiratory and hematic parameters related to respiration between subjects with PD and controls. METHODS: A literature research in bibliographic databases was performed. Fixed-effects models were applied for all parameters while random-effects models only when suitable (at least 10 independent studies). Several moderator analyses and publication bias diagnostics were performed. RESULTS: We found significantly higher mean minute ventilation and lower et-pCO(2) in subjects with PD than controls. Moreover we also found evidences of reduced HCO(3)(-) and PO(4)(-) hematic concentrations, higher indexes of respiratory variability/irregularity and higher rate of sighs and apneas. Evidence of heterogeneity was partly explained by moderator analyses. No relevant publication bias was found. LIMITATIONS: Several shortcomings affected the included studies, such as over-inclusive recruitment criteria, samples unbalanced for socio-demographic characteristics, lack of statistical details and small number of studies available for several parameters. DISCUSSION: Our results support the idea of abnormalities in respiratory function of subjects with PD. Compared to controls, they showed baseline hyperventilation; the results from hematic parameters suggest that hyperventilation may be chronic and not simply caused by their high anxiety levels during respiratory assessment. Evidences of higher variability and irregularity in respiratory patterns of subjects with PD were also found. It is unclear to what extent the higher rate of sighs and apneas may explain the other baseline respiratory abnormalities found in PD.
Journal of affective disorders 10/2012; · 3.76 Impact Factor
[show abstract][hide abstract] ABSTRACT: Adult patients with panic disorder (PD) show high levels of harm avoidance and anxiety sensitivity. Peculiar temperament profiles and high anxiety sensitivity have been proposed as developmental risk factors for PD in adult age. Since familial-genetic influences play a role both in PD and in anxiety sensitivity and temperament profiles, this study aims to investigate the possible association between family history of PD and peculiar temperament-character profiles or high anxiety sensitivity in offspring of patients with PD.
Thirty-four children of patients with PD with/without agoraphobia and 30 children of healthy subjects were compared. Temperament and character dimensions and anxiety sensitivity levels of children were obtained by the Junior Temperament and Character Inventory and the Childhood Anxiety Sensitivity Index.
Children of patients with PD and children of healthy subjects differed neither in temperament and character dimensions nor in anxiety sensitivity levels.
Our results show that family history of PD is not associated with peculiar temperament and character profiles or high anxiety sensitivity in children, suggesting that these factors may not be early expressions of familial vulnerability to PD. Since the sample is small and the study has a cross-sectional design, longitudinal studies in larger samples are warranted to confirm these findings and to clarify the role of anxiety sensitivity and temperament-character dimensions in the development of PD.
[show abstract][hide abstract] ABSTRACT: INTRODUCTION: Panic disorder (PD) is a common anxiety disorder impairing strongly quality of life with high social costs. Effective anti-panic medications exist but a substantial proportion of patients do not fully respond, the available drugs have several side effects and most medications have a delayed onset of their therapeutic effect. Thus, further advances are needed. AREAS COVERED: We review available data on emerging drugs for the treatment of PD including those in development, such as metabotropic glutamate II receptor agonists, D-cycloserine and levetiracetam, and new compounds with potential efficacy that may be relevant for future developments, such as modulators of cholinergic and orexin systems. EXPERT OPINION: To date, the pharmacological research on PD appears to be relatively limited and probably still needs more time before making available new advances beyond the currently used medications. Many reasons may explain these difficulties, including the heterogeneity of the disorder, the incomplete understanding of its underlying pathophysiological mechanisms and difficulties in the selection of appropriate animal models in preclinical studies. Defining biomarkers and endophenotypes in PD may offer advantages in both understanding the pathophysiology of the disorder and selecting appropriate targets and outcomes for planning future pharmacological research.
[show abstract][hide abstract] ABSTRACT: To investigate the possible influence of psychological variables on cardiorespiratory responses and perceived exertion of patients with Panic Disorder (PD) during a submaximal exercise test.
Ten outpatients with PD and 10 matched healthy subjects walked up on a treadmill slope at a speed of 4 km/h in order to reach 65% of their maximum heart rate. Cardiorespiratory variables were continuously recorded. Before the exercise, the state and trait anxiety (State-Trait Anxiety Inventory scores), fear of physical sensations (Body Sensation Questionnaire scores), and fear of autonomic arousal (Anxiety Sensitivity Index scores) were assessed; during the exercise, levels of anxiety (VAS-A) and exertion (Borg Scale CR 10) were measured.
Compared to controls, patients reached earlier the target HR and the ventilatory threshold, showed lower oxygen consumption, higher HR and lower within-subject standard deviations of HR (a measure of cardiac variability). Exertion was also higher, and there was a significant correlation between breathing frequency, tidal volume and HR. No significant associations were found between cardiorespiratory response, perceived exertion, and psychological variables in patients with PD.
Although patients with PD presented poor cardiorespiratory fitness and were required to spend more effort during physical exercise, this did not appear to be related to the psychological variables considered. Further studies with larger groups are warranted.
Revista Brasileira de Psiquiatria 12/2011; 33(4):385-9. · 1.86 Impact Factor
[show abstract][hide abstract] ABSTRACT: Agoraphobia in panic disorder (PD) has been related to abnormal balance system function. Vision influences balance and behavioural adaptations; peripheral vision influences orienting and fast defensive reactions whereas central vision analyzes details of objects. We have hypothesized that the abnormal balance function in PD could be mainly related to peripheral vision as part of a defensive alarm system in the brain. In 25 patients with PD and agoraphobia and 31 healthy controls we assessed, by posturography, balance system reactivity to video-films projected in peripheral and central visual fields (randomized sequence). Length, velocity and surface of body sway were calculated. Patients increased their body sway during peripheral stimulation, whereas controls did not; the two groups showed a similar increase of body sway during central stimulation. Anxiety levels during peripheral stimulation significantly influenced the postural response in the group of patients. These preliminary results suggest that the higher visual sensitivity to peripheral stimulation in patients with PD and agoraphobia may be linked to a more active "visual alarm system" involving visual, vestibular and limbic areas that might influence the development of agoraphobia in situations where environmental stimuli are uncertain.
Psychiatry Research 05/2011; 187(3):387-91. · 2.46 Impact Factor
[show abstract][hide abstract] ABSTRACT: Although there are controversial issues (the "American view" and the "European view") regarding the construct and definition of agoraphobia (AG), this syndrome is well recognized and it is a burden in the lives of millions of people worldwide. To better clarify the role of drug therapy in AG, the authors summarized and discussed recent evidence on pharmacological treatments, based on clinical trials available from 2000, with the aim of highlighting pharmacotherapies that may improve this complex syndrome.
A systematic review of the literature regarding the pharmacological treatment of AG was carried out using MEDLINE, EBSCO, and Cochrane databases, with keywords individuated by MeSH research. Only randomized, placebo-controlled studies or comparative clinical trials were included.
After selection, 25 studies were included. All the selected studies included patients with AG associated with panic disorder. Effective compounds included selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, selective noradrenergic reuptake inhibitors, and benzodiazepines. Paroxetine, sertraline, citalopram, escitalopram, and clomipramine showed the most consistent results, while fluvoxamine, fluoxetine, and imipramine showed limited efficacy. Preliminary results suggested the potential efficacy of inositol; D-cycloserine showed mixed results for its ability to improve the outcome of exposure-based cognitive behavioral therapy. More studies with the latter compounds are needed before drawing definitive conclusions.
No studies have been specifically oriented toward evaluating the effect of drugs on AG; in the available studies, the improvement of AG might have been the consequence of the reduction of panic attacks. Before developing a "true" psychopharmacology of AG it is crucial to clarify its definition. There may be several potential mechanisms involved, including fear-learning processes, balance system dysfunction, high light sensitivity, and impaired visuospatial abilities, but further studies are warranted.
Neuropsychiatric Disease and Treatment 01/2011; 7:621-37. · 2.00 Impact Factor
[show abstract][hide abstract] ABSTRACT: The objective of the study was to investigate and compare the brain cortical activity, as indexed by quantitative electroencephalographic (qEEG) power, coherence and asymmetry measures, in panic disorder (PD) patients during an induced panic attack with a 35% CO(2) challenge test and also in a resting condition. Fifteen subjects with PD were randomly assigned to both 35% CO(2) mixture and atmospheric compressed air, in a double-blind study design, with EEG being recorded for a 20-min period. During induced panic attacks we found a reduced right-sided frontal orbital asymmetry in the beta band, a decreased occipital frontal intra-hemispheric coherence in the delta band at both right and left sides, a left-sided occipital delta inter-hemispheric asymmetry and an increased relative power in the beta wave at T4. Our data showed a disturbed frontal cortical processing, pointing to an imbalance of the frontal and occipital sites, common to both hemispheres, and an increased right posterior activity related to the high arousing panic attack condition. Those findings corroborate the Neuroanatomical hypothesis of PD.
The World Journal of Biological Psychiatry 12/2009; 11(2 Pt 2):357-63. · 3.57 Impact Factor
[show abstract][hide abstract] ABSTRACT: This study sought to establish the prevalence of vestibular disorders, migraine and definite migrainous vertigo in patients with psychiatric disorders who were referred for treatment of dizziness, without a lifetime history of vertigo.
Out-patients in a university hospital.
Fifty-two dizzy patients with panic disorders and agoraphobia, 30 with panic disorders without agoraphobia, and 20 with depressive disorders underwent otoneurological screening with bithermal caloric stimulation. The prevalence of migraine and migrainous vertigo was assessed. The level of dizziness was evaluated using the Dizziness Handicap Inventory.
Dizzy patients with panic disorders and agoraphobia had a significantly p = 0.05 regarding the prevalence of peripheral vestibular abnormalities in the group of subjects with PD and agoraphobia and in those with depressive disorders. Migraine was equally represented in the three groups, but panic disorder patients had a higher prevalence of migrainous vertigo definite migrainous vertigo. Almost all patients with a peripheral vestibular disorder had a final diagnosis of definite migrainous vertigo according to Neuhauser criteria. These patients had higher Dizziness Handicap Inventory scores. The Dizziness Handicap Inventory total score was higher in the subgroup of patients with panic disorders with agoraphobia also presenting unilateral reduced caloric responses or definite migrainous vertigo, compared with the subgroup of remaining subjects with panic disorders with agoraphobia (p < 0.001).
Our data support the hypothesis that, in patients with panic disorders (and especially those with additional agoraphobia), dizziness may be linked to malfunction of the vestibular system. However, the data are not inconsistent with the hypothesis that migrainous vertigo is the most common pathophysiological mechanism for vestibular disorders.
The Journal of Laryngology & Otology 12/2009; 124(3):285-90. · 0.68 Impact Factor
[show abstract][hide abstract] ABSTRACT: Anticipatory anxiety can be described as a conditioned response with a defensive posture of freezing and autonomic activation. The purpose of this study was to assess the postural control analysis and autonomic activation in panic disorder (PD) patients presented with visual stimuli.
PD patients (n=29) and healthy controls (n=27) stood on a force platform while viewing a series of anxiogenic, mutilation, and neutral pictures. Skin conductance responses and the displacements of the center of pressure were measured.
Overall, the PD patients demonstrated significantly reduced body sway, increased mean power frequency, and increased skin conductance compared to control group throughout the experiment (P<.05). PD patients also showed a negative correlation between anticipatory anxiety and mean sway area throughout the experiment. However, there was no significant difference in body sway velocity compared to healthy controls while viewing the anxiogenic block of pictures or the neutral block.
Our data shows that PD patients experiencing anticipatory anxiety may present with lower mobility, consistent with the freezing behavior of the defense cascade. The data also shows that PD patients do not have a postural instability when confronted with specific anxiogenic context. The importance of this study is that it objectively demonstrates freezing-like behavior in PD patients.
Depression and Anxiety 08/2009; 26(10):917-21. · 4.61 Impact Factor
[show abstract][hide abstract] ABSTRACT: To assess the efficacy of rehabilitation for dizzy patients after recent acute vestibular disturbance.
Forty patients recently hospitalised for an acute episode of rotational vertigo which lasted days were randomly divided into two groups. The first group (20 patients; group R) underwent active rehabilitation, while the second group (20 patients; group C) were told only to 'perform their daily activities'. Group R subjects underwent a total of 10 sessions of rehabilitation, including exercises on a stabilometric platform, point de mire and a series of five exercises repeated five times daily. All patients performed static stabilometry (posturography), undertook the dynamic gait index test, and completed a dizziness handicap questionnaire and a visual analogue scale for anxiety, at baseline and on completion.
At 25 days, the rehabilitated patients obtained better results for all recorded outcomes, compared with the control group. The greatest difference in the rehabilitated subjects, compared with the control group, was for the dynamic gait index test; however, this difference was not statistically significant. The visual analogue scale anxiety score was statistically significantly more reduced in rehabilitated patients compared with control patients. Control patients maintained a higher visual dependence for postural control.
These results would appear to support the effectiveness of a supervised exercise programme for patients following acute onset of vestibular disturbance. A correlation was found in both groups between dynamic gait index results and anxiety. In our experience, a rehabilitation programme seems to reduce dependence on visual cues for postural control.
The Journal of Laryngology & Otology 07/2008; 123(4):397-402. · 0.68 Impact Factor
[show abstract][hide abstract] ABSTRACT: Panic attacks are psychopathological phenomena with a strong emotional activation that often induces subsequent anticipatory anxiety and phobic avoidance. Impairment in emotional processing in patients with Panic Disorder (PD) has been hypothesized. Emotional Intelligence (EI) involves the individual abilities to perceive, understand and manage emotions in order to cope with changes in internal and external environment. We examined EI in 42 patients with PD with Agoraphobia compared to 49 healthy controls and investigated if clinical severity of Agoraphobia is related to EI performance. We assessed EI by Mayer-Salovey-Caruso Emotional Intelligence Test and Agoraphobia by Mobility Inventory for Agoraphobia. Patients with PD and Agoraphobia showed lower Strategic EI ability than healthy controls, in both Understanding and Managing emotion abilities, and a general propensity to attribute negative emotional valence to different stimuli. These preliminary results suggest that impaired mechanisms of understanding and integrating emotions may be involved in the phenomenology of PD. These features might be the target of psychological interventions in PD. On the contrary, Emotional Intelligence did not appear to affect the clinical severity of Agoraphobia.
Rivista di Psichiatria 01/2008; 45(5):320-5. · 0.20 Impact Factor
[show abstract][hide abstract] ABSTRACT: In order to investigate the relationship between chronic dizziness and vestibular function in patients with panic disorder, in the present study neurotologic findings in 15 patients with panic disorder and chronic dizziness were compared with those in 15 patients with chronic dizziness, without panic disorder. All underwent neurotologic screening for spontaneous, positional and positioning nystagmus with head-shaking and head-thrust tests, an audiometric examination and electronystagmography with bithermal stimulation according to Freyss. A significantly higher number of patients with panic disorder and chronic dizziness showed pathological neurotologic findings in comparison to subjects with chronic dizziness only (9 and 2 patients, respectively; p < 0.05). Most patients with panic disorder showed signs of peripheral vestibular disorders. These results suggest that the complaint of dizziness in patients with panic disorder may be linked to a malfunction of the vestibular system and vestibular disorders may play a role in the pathophysiology of panic disorder. Possible mechanisms underlying this finding are discussed. In patients with panic disorder and chronic dizziness between panic attacks, a careful neurotologic examination is warranted.
Acta otorhinolaryngologica Italica: organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale 10/2007; 27(5):243-7. · 0.79 Impact Factor
[show abstract][hide abstract] ABSTRACT: Serotonergic agents have greater effectiveness than noradrenergic ones in the treatment of Panic Disorder (PD). However preliminary studies suggested that reboxetine might be effective in the treatment of PD. We compared the effectiveness and tolerability of reboxetine and paroxetine in the treatment of PD.
Sixty-eight patients with PD were assigned to treatment groups in a single-blind, randomized design. Each patient was assessed at day 0 and 90 by the Panic Associated Symptoms Scale (PASS), the Sheehan Disability Scale (SDS) and the Fear Questionnaire (FQ). Side effects were also recorded.
Reduction of PASS scores was significantly greater in the paroxetine group than in the reboxetine one. Vice versa we did not find any significant differences for other outcome measures. Sexual dysfunction and weight gain were significantly less frequent in the reboxetine group.
The results showed a greater effect of paroxetine on panic attacks than reboxetine, while no differences for anticipatory anxiety and avoidance were found, suggesting a different role of noradrenaline and serotonin in the treatment of PD.
[show abstract][hide abstract] ABSTRACT: The biological mechanisms underlying the link between smoking and panic attacks are unknown. Smoking might increase the risk of panic by impairing respiratory system function.
We evaluated the effect of smoking on respiratory irregularity in patients with panic disorder (PD) and healthy comparison subjects and the role of the respiratory disorders in this effect. We applied the Approximate Entropy index (ApEn), a nonlinear measure of irregularity, to study breath-by-breath baseline respiratory patterns in our sample.
Both smoker and nonsmoker patients had more irregular respiratory patterns than healthy subjects. Smoker patients showed higher ApEn indices of baseline respiratory rate and tidal volume than nonsmoker patients (R = 5.4, df = 2,55, p < .01), whereas smoking in healthy subjects did not influence the regularity of respiratory patterns. Respiratory disorders did not account for the influence of smoking on respiratory irregularity. Smokers had more severe panic attacks than nonsmokers.
Smoking may impair vulnerable respiratory function and act as disruptive factor on intrinsic baseline respiratory instability in patients with PD, possibly influencing the onset or maintenance of the disorder.
[show abstract][hide abstract] ABSTRACT: The effects of short treatments (7 days) with paroxetine and with reboxetine on the reactivity to inhalations of 35% carbon dioxide (CO2)/65% oxygen (O2) were compared in 28 patients with Panic Disorder who had positive responses to 35% CO2 inhalations. A double-blind, randomized design was applied. Each patient was given the 35% CO2 challenge on days 0 (before starting the treatment) and 7. Anxiety reactivity to CO2 decreased significantly with both drugs but the decrease was significantly stronger in the group treated with paroxetine. The rate of patients whose reactivity has reduced of at least 50% after 7 days was significantly higher in the group treated with paroxetine (10/14, 71.5%) than in the one treated with reboxetine (3/14, 21.5%). These results indicate that the modulation of the serotonergic system is more relevant for CO2 hyperreactivity than the modulation of the noradrenergic one.
Journal of Clinical Psychopharmacology 07/2004; 24(3):277-82. · 3.51 Impact Factor