G A Fava

University of Bologna, Bolonia, Emilia-Romagna, Italy

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Publications (341)1709.75 Total impact

  • L Tecuta, E Tomba, S Grandi, G A Fava
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    ABSTRACT: Background: Demoralization has been described as a psychological state characterized by helplessness, hopelessness, a sense of failure and the inability to cope. Methods: We conducted a systematic review with qualitative data analysis following PRISMA criteria with the following aims: to review validated assessment instruments of the demoralization syndrome, report main findings regarding demoralization as measured by validated instruments that emerge in the literature, compare and report evidence for the clinical utility of the identified instruments. Utilizing the key word ‘demoralization’ in PubMed and PsycINFO databases, an electronic search was performed, supplemented by Web of Science and manual searches. Study selection criteria included the assessment of medical patients and use of instruments validated to assess demoralization. Seventy-four studies were selected. Results: Four instruments emerged in the literature. Main findings concern prevalence rates of demoralization, evidence of discriminant validity from major depression, factors associated with demoralization and evidence of clinical utility. The instruments vary in their definition, the populations they aim to assess, prevalence rates they estimate and their ability to discriminate between different conditions. Nonetheless, demoralization appears to be a distinctive psychological state characterized by helplessness, hopelessness, giving up and subjective incompetence. It is not limited to life-threatening diseases such as cancer, but may occur in any type of clinical situation. It is associated with stress and adverse health outcomes. Conclusions: Studies addressing the incremental value of demoralization in psychiatry and psychology are needed. However, demoralization appears to entail specific clinical features and may be a distinct condition from major depression.
    Psychological medicine. 07/2014;
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    ABSTRACT: The term "iatrogenic comorbidity" refers to unfavorable modifications in the course of an illness, with regard to its characteristics and responsiveness, which may be related to previous treatments. Some iatrogenic adverse events arising from either pharmacotherapy or psychotherapy cannot be subsumed under the traditional rubric of adverse effects and require careful evaluation. Children and adolescents are generally more likely to experience adverse health consequences after drug treatment. The use of antidepressant drugs in this age group may cause potential long-term detrimental effects, such as mood elevation that does not subside when drugs are discontinued and may predispose to the development of a bipolar disorder. The concept of iatrogenic comorbidity in children and adolescents has heuristic value in weighing potential benefits and risks associated particularly with psychotropic treatments.
    CNS Drugs 07/2014; · 4.38 Impact Factor
  • Giovanni A Fava
    Psychotherapy and Psychosomatics 06/2014; 83(4):197-204. · 7.23 Impact Factor
  • Nicoletta Sonino, Laura Sirri, Giovanni A Fava
    The Journal of clinical endocrinology and metabolism. 06/2014;
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    ABSTRACT: Current diagnostic definitions of psychiatric disorders based on collections of symptoms encompass very heterogeneous populations and are thus likely to yield spurious results when exploring biological correlates of mental disturbances. It has been suggested that large studies of biomarkers across diagnostic entities may yield improved clinical information. Such a view is based on the concept of assessment as a collection of symptoms devoid of any clinical judgment and interpretation. Yet, important advances have been made in recent years in clinimetrics, the science of clinical judgment. The current clinical taxonomy in psychiatry, which emphasizes reliability at the cost of clinical validity, does not include effects of comorbid conditions, timing of phenomena, rate of progression of an illness, responses to previous treatments, and other clinical distinctions that demarcate major prognostic and therapeutic differences among patients who otherwise seem to be deceptively similar since they share the same psychiatric diagnosis. Clinimetrics may provide the missing link between clinical states and biomarkers in psychiatry, building pathophysiological bridges from clinical manifestations to their neurobiological counterparts. © 2014 S. Karger AG, Basel.
    Psychotherapy and Psychosomatics 04/2014; 83(3):136-141. · 7.23 Impact Factor
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    ABSTRACT: The precipitating role of emotional stress in the development of congestive heart failure (CHF) is a long-standing clinical observation. We employed new clinimetric criteria for the assessment of allostatic overload (AO) in a sample of CHF patients, with regard to its associations with psychological distress and health status.Allostatic overload was assessed by a semi-structured interview based on clinimetric criteria in 70 consecutive outpatients with CHF. One observer-rated scale and two self-rating questionnaires for psychological distress were administered. Cardiac variables were also collected at intake.Twenty-three patients (32.9%) were classified as having AO according to clinimetric criteria. Significant differences were found with regard to gender, with women being more likely to report AO than men (23.5% versus 57.9%). Patients with AO presented significantly higher levels of psychological distress (based on scales administered) compared with those who did not. Among cardiac risk factors, hyperglycaemia was found to be significantly associated with the presence of AO.The use of the clinimetric criteria provides a global index for identifying distress that might adversely influence the course and progression of CHF. It may be of use in clinical practice, leading to therapeutic suggestions such as lifestyle modifications and psychotherapy to help patients deal with their difficulties. © 2014 The Authors. Stress and Health published by JohnWiley & Sons, Ltd.
    Stress and Health 04/2014; · 1.04 Impact Factor
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    G A Fava, C Ruini
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    ABSTRACT: Series: Cross-Cultural Advancements in Positive Psychology, Vol. 8 ▶ Discusses a neglected aspect in psychotherapy research: cultural diversity ▶ Presents and examines many therapies and interventions in a variety of settings ▶ Approaches the topic from biological, psychological, and social perspectives This volume deals with strategies aimed at increasing psychological well-being in both clinical and non-clinical settings, with a special focus on the impact of cross-cultural influences on these processes. Consisting of two parts, the book first examines clinical interventions for increasing well-being and positive functioning in adult populations. It looks at cultural differences in the experience of psychological well-being, presents an analysis of the concept of psychological well-being and discusses various interventions, including Well-Being Therapy and Cognitive Behavioral Therapy. Other concepts discussed are post-traumatic growth, wisdom and motivation. The second part of the book deals with psychological interventions in childhood and adolescence and has a strong emphasis on educational settings. It provides an overview of the main evidence-based psychotherapies for affective disorders in youths, and looks at the importance and impact of positive education, resilience, and hope. The book presents models for intervention and discusses several therapies in detail. Order online at springer.com ▶ or for the Americas call (toll free) 1-800-SPRINGER ▶ or email us at: orders-ny@springer.com. ▶ For outside the Americas call +49 (0) 6221-345-4301 ▶ or email us at: orders-hd-individuals@springer.com. The first € price and the £ and $ price are net prices, subject to local VAT. Prices indicated with * include VAT for books; the €(D) includes 7% for Germany, the €(A) includes 10% for Austria. Prices indicated with ** include VAT for electronic products; 19% for Germany, 20% for Austria. All prices exclusive of carriage charges. Prices and other details are subject to change without notice. All errors and omissions excepted.
    03/2014; Springer.
  • Giovanni A Fava
    World psychiatry: official journal of the World Psychiatric Association (WPA) 02/2014; 13(1):49-50. · 8.97 Impact Factor
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    ABSTRACT: Psychology as a science offers an enormous diversity of theories, principles, and methodological approaches to understand mental health, abnormal functions and behaviours and mental disorders. A selected overview of the scope, current topics as well as strength and gaps in Psychological Science may help to depict the advances needed to inform future research agendas specifically on mental health and mental disorders. From an integrative psychological perspective, most maladaptive health behaviours and mental disorders can be conceptualized as the result of developmental dysfunctions of psychological functions and processes as well as neurobiological and genetic processes that interact with the environment. The paper presents and discusses an integrative translational model, linking basic and experimental research with clinical research as well as population-based prospective-longitudinal studies. This model provides a conceptual framework to identify how individual vulnerabilities interact with environment over time, and promote critical behaviours that might act as proximal risk factors for ill-health and mental disorders. Within the models framework, such improved knowledge is also expected to better delineate targeted preventive and therapeutic interventions that prevent further escalation in early stages before the full disorder and further complications thereof develop. In contrast to conventional "personalized medicine" that typically targets individual (genetic) variation of patients who already have developed a disease to improve medical treatment, the proposed framework model, linked to a concerted funding programme of the "Science of Behaviour Change", carries the promise of improved diagnosis, treatment and prevention of health-risk behaviour constellations as well as mental disorders. Copyright © 2013 John Wiley & Sons, Ltd.
    International Journal of Methods in Psychiatric Research 01/2014; 23(1):28-40. · 1.76 Impact Factor
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    ABSTRACT: Comorbidity is a well-established and documented phenomenon in mental disorders and medicine with heuristic value. The concept of comorbidity remains however poorly defined and lacks a comprehensive and coherent theoretical framework. There is a need to develop coherent methodological strategies in order to promote a fuller understanding of the implications of comorbidity and to exploit its potential value with regard to etiopathogenic and therapeutic issues. This position paper makes recommendations of improved methodological standards and procedures and discusses a range of options that can provide incremental information that is likely to improve therapeutic outcomes. Copyright © 2013 John Wiley & Sons, Ltd.
    International journal of methods in psychiatric research. 01/2014; 23 Suppl 1:92-101.
  • Giovanni A Fava
    Psychotherapy and Psychosomatics 11/2013; 83(1):1-5. · 7.23 Impact Factor
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    Emanuela Offidani, Jenny Guidi, Elena Tomba, Giovanni Andrea Fava
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    ABSTRACT: Background: Placebo-controlled trials showed that both benzodiazepines (BDZ) and antidepressant drugs (AD) are effective in treating anxiety disorders. However, in the last years a progressive shift in the prescribing pattern from BDZ to newer AD has taken place. The aim of this systematic review and meta-analysis is to analyze whether controlled comparisons support such a shift. Methods: CINHAL, the Cochrane Library, MEDLINE, PubMed and Web of Science were searched from inception up to December 2012. A total of 22 studies met the criteria for inclusion. They were mostly concerned with tricyclic antidepressants (TCA; 18/22) and involved different anxiety disorders. In order to reduce clinical heterogeneity, only the 10 investigations that dealt with the comparison between TCA and BDZ in panic disorder were submitted to meta-analysis, whereas the remaining papers were individually summarized and critically examined. Results: According to the systematic review, no consistent evidence emerged supporting the advantage of using TCA over BDZ in treating generalized anxiety disorder (GAD), complex phobias and mixed anxiety-depressive disorders. Indeed, BDZ showed fewer treatment withdrawals and adverse events than AD. In panic disorder with and without agoraphobia our meta-analysis found BDZ treatments more effective in reducing the number of panic attacks than TCA (risk ratio, RR = 1.13; 95% CI = 1.01-1.27). Furthermore, BDZ medications were significantly better tolerated than TCA drugs, causing less discontinuation (RR = 0.40; 95% CI = 0.20-0.57) and side effects (RR = 0.41; 95% CI = 0.34-0.50). As to newer AD, BDZ trials resulted in comparable or greater improvements and fewer adverse events in patients suffering from GAD or panic disorder. Conclusions: The change in the prescribing pattern favoring newer AD over BDZ in the treatment of anxiety disorders has occurred without supporting evidence. Indeed, the role and usefulness of BDZ need to be reappraised. © 2013 S. Karger AG, Basel.
    Psychotherapy and Psychosomatics 09/2013; 82(6):355-362. · 7.23 Impact Factor
  • Psychotherapy and Psychosomatics 08/2013; 82(5):285-291. · 7.23 Impact Factor
  • Giovanni A Fava
    Psychotherapy and Psychosomatics 05/2013; 82(4):201-203. · 7.23 Impact Factor
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    ABSTRACT: OBJECTIVE: To use the Diagnostic Criteria for Psychosomatic Research (DCPR) for characterizing alexithymia in a large and heterogeneous medical population, in conjunction with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and other DCPR criteria. METHOD: Of 1305 patients recruited from 4 medical centers in the Italian Health System, 1190 agreed to participate. They all underwent an assessment with DSM-IV and DCPR structured interviews. A total of 188 patients (15.8%) were defined as alexithymic by using the DCPR criteria. Data were submitted to cluster analysis. RESULTS: Five clusters of patients with alexithymia were identified: (1) alexithymia with no psychiatric comorbidity (29.3% of cases); (2) depressed somatization with alexithymic features (23.4%); (3) alexithymic illness behavior (17.6%); (4) alexithymic somatization (17%) and (5) alexithymic anxiety (12.8%). CONCLUSIONS: The results indicate that DCPR alexithymia is associated with a comorbid mood or anxiety disorder in about one third of cases; it is related to various forms of somatization and abnormal illness behavior in another third and may occur without psychiatric comorbidity in another subgroup. Identification of alexithymic features may entail major prognostic and therapeutic differences among medical patients who otherwise seem to be deceptively similar since they share the same psychiatric and/or medical diagnosis.
    General hospital psychiatry 05/2013; · 2.67 Impact Factor
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    ABSTRACT: Background: The prevalence, characteristics and implications of excessive arousal-activation in children and adolescents treated with antidepressants for specific illnesses have not been systematically examined. Methods: We compared reports of antidepressant trials (n = 6,767 subjects) in juvenile depressive (n = 17) and anxiety disorders (n = 25) for consensus-based indications of psychopathological mood elevation or behavioral activation. Results: Rates of excessive arousal-activation during treatment with antidepressants were at least as high in juvenile anxiety (13.8%) as depressive (9.79%) disorders, and much lower with placebos (5.22 vs. 1.10%, respectively; both p < 0.0001). The antidepressant/placebo risk ratio for such reactions in paired comparisons was 3.50 (12.9/3.69%), and the meta-analytically pooled rate ratio was 1.7 (95% confidence interval: 1.2-2.2; both p ≤ 0.001). Overall rates for 'mania or hypomania', specifically, were 8.19% with and 0.17% without antidepressant treatment, with large drug/placebo risk ratios among depressive (10.4/0.45%) and anxiety (1.98/0.00%) disorder patients. Conclusions: Risks of excessive mood elevation during antidepressant treatment, including mania-hypomania, were much greater than with placebo, and similar in juvenile anxiety and depressive disorders. Excessive arousal-activation in children or adolescents treated with antidepressants for anxiety as well as depressive disorders calls for particular caution and monitoring for potential risk of future bipolar disorder.
    Psychotherapy and Psychosomatics 03/2013; 82(3):132-141. · 7.23 Impact Factor
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    ABSTRACT: Context:Most of the estimates of the prevalence of hyperandrogenic states refer to the general adult population.Objective:The objective of the study was to estimate the prevalence of hyperandrogenic states in late adolescence and youth and to evaluate potential independent predictors.Design:This was a cross-sectional study.Setting:The study was conducted in high schools.Patients:Patients included female students, aged 16-19 years.Main Outcome Measures:The study protocol was designed with 3 possible levels of participation: the first level consisted of a self-compiled questionnaire; the second level added a medical examination; and the third level added a blood sample for laboratory testing. Liquid chromatography-tandem mass spectrometry was used to measure total testosterone, and a reference interval was established in-house.Results:We offered participation to 2052 students, and 1469 of those compiled the questionnaire. Of these, 1038 were examined, and 519 also provided blood samples. Two hundred three of the 1038 examined students and 125 of the 519 students who provided blood samples were subsequently excluded because of treatment with oral contraceptives or because of endocrine disorders. In the sample of women with a questionnaire + a medical examination, 13% were affected by isolated menstrual irregularity, 16.1% by isolated clinical hyperandrogenism, and 3.8% by both states. A similar prevalence of isolated menstrual irregularity (10.2%) and isolated clinical hyperandrogenism (16.7%) was found in the subsample of women with laboratory tests; in addition, 6.6% showed isolated hyperandrogenemia, and 4.3% proved to be affected by polycystic ovary syndrome.Conclusions:This study provides for the first time a reliable assessment of the prevalence of hyperandrogenic states in late adolescent and young females and confirms that hyperandrogenic disorders originate at a young age.
    The Journal of clinical endocrinology and metabolism 02/2013; · 6.50 Impact Factor
  • Laura Sirri, Giovanni A Fava
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    ABSTRACT: Abstract The Diagnostic Criteria for Psychosomatic Research (DCPR) were introduced in 1995 by an international group of investigators to expand the traditional domains of the disease model. The DCPR are a set of 12 'psychosomatic syndromes' which provide operational tools for psychosocial variables with prognostic and therapeutic implications in clinical settings. Eight syndromes concern the main manifestations of abnormal illness behaviour: somatization, hypochondriacal fears and beliefs, and illness denial. The other four syndromes (alexithymia, type A behaviour, demoralization and irritable mood) refer to the domain of psychological factors affecting medical conditions. This review describes the conceptual bases of the DCPR and the main findings concerning their application, with particular reference to the incremental information they added to the customary psychiatric classification. The DCPR were also compared with the provisional DSM-5 somatic symptom disorders. The DCPR were found to be more sensitive than DSM-IV in identifying subthreshold psychological distress and characterizing patients' psychological response to medical illness. DSM-5 somatic symptom disorders seem to neglect important clinical phenomena, such as illness denial, resulting in a narrow view of patients' functioning. The additional information provided by the DCPR may enhance the decision-making process.
    International Review of Psychiatry 02/2013; 25(1):19-30. · 1.80 Impact Factor
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    Fiammetta Cosci, Giovanni A Fava
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    ABSTRACT: Background: The staging method, whereby a disorder is characterized according to its seriousness, extension, development and features, is attracting increasing attention in clinical psychology and psychiatry. The aim of this systematic review was to critically summarize the tools that are available for reproducing and standardizing the clinical intuitions that are involved in a staging formulation. Methods: A comprehensive research was conducted on the MEDLINE, PsycINFO, EMBASE and Cochrane databases from inception to May 2012. The following search terms were used: 'stage/staging' AND 'psychiatric disorder/mental disorder/schizophrenia/mood disorder/anxiety disorder/substance use disorder/eating disorder'. Results: A total of 78 studies were identified for inclusion in the review. We discussed studies addressing or related to the issue of staging in a number of mental disorders (schizophrenia, unipolar depression, bipolar disorder, panic disorder, substance use disorders, anorexia and bulimia nervosa). The literature indicates that disorders have a longitudinal development or a treatment history that can be categorized according to stages. We proposed staging formulations for the above-mentioned psychiatric disorders. Conclusion: Staging models offer innovative assessment tools for clinical psychologists and psychiatrists. Characterizing each stage of an illness demarcates major prognostic and therapeutic differences among patients who otherwise seem to be deceptively similar since they share the same psychiatric diagnosis. A stage 0 to denote an at-risk condition does not appear to be warranted at the current state of research.
    Psychotherapy and Psychosomatics 01/2013; 82(1):20-34. · 7.23 Impact Factor
  • Laura Sirri, Giovanni A Fava, Nicoletta Sonino
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    ABSTRACT: The concept of illness behavior was introduced to indicate the ways in which given symptoms may be perceived, evaluated and acted upon at an individual level. Illness behavior may vary greatly according to illness-related, patient-related and doctor-related variables and their complex interactions. In the past decades, important lines of research have been concerned with illness perception, frequent attendance at medical facilities, health care-seeking behavior, treatment-seeking behavior, delay in seeking treatment, and treatment adherence. They have, however, mostly investigated single aspects separately. In this concise review, we suggest that the concept of illness behavior may provide a unifying framework and useful insights to observations and findings that would otherwise remain scattered and unrelated in the medical literature. The wide range of expressions of illness behavior is likely to affect the presentation of any disease and its identification, course and treatment. Assessing illness behavior and devising appropriate responses by health care providers may contribute to the improvement of final outcomes.
    Psychotherapy and Psychosomatics 12/2012; 82(2):74-81. · 7.23 Impact Factor

Publication Stats

5k Citations
1,709.75 Total Impact Points

Institutions

  • 1980–2014
    • University of Bologna
      • • Department of Psychology PSI
      • • Department of Experimental, Diagnostic and Specialty Medicine DIMES
      Bolonia, Emilia-Romagna, Italy
  • 2012–2013
    • IRCCS Saverio de Bellis
      Bari, Apulia, Italy
  • 2010–2013
    • University of Florence
      • Dipartimento di Scienze della Formazione e Psicologia
      Florence, Tuscany, Italy
    • Università degli Studi di Siena
      Siena, Tuscany, Italy
  • 1989–2009
    • University of Padova
      • • Department of Statistical Sciences
      • • Department of Medicine DIMED
      Padova, Veneto, Italy
  • 1982–2009
    • University at Buffalo, The State University of New York
      • Department of Psychiatry
      Buffalo, New York, United States
  • 2007
    • University of Ferrara
      Ferrare, Emilia-Romagna, Italy
  • 2006
    • Istituto Dermopatico dell'Immacolata
      Roma, Latium, Italy
  • 2002
    • Addis Ababa University
      • Department of Psychiatry
      Addis Ababa, Adis Abeba Astedader, Ethiopia
  • 1987
    • Spokane VA Medical Center
      Spokane, Washington, United States
  • 1985
    • Erie County Medical Center
      New York City, New York, United States