Management of Recurrent Depression in Primary Care

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303

171

Background: There is increasing awareness that the goal of treatment in generalized anxiety disorder (GAD) should not simply be a response, but restoration of normal function. The aim of this study was to apply a novel psychotherapeutic approach for increasing the level of remission in GAD. Methods: Twenty patients with DSM-IV GAD devoid of comorbid conditions were randomly assigned to 8 sessions of cognitive behavioral therapy (CBT) or the sequential administration of 4 sessions of CBT followed by other 4 sessions of well-being therapy (WBT). Assessment methods included the Anxiety and Depression Scales of Paykel’s Clinical Interview for Depression, Ryff’s Psychological Well-being Scales and Kellner’s Symptom Questionnaire. A one-year follow-up was undertaken. Results: Significant advantages of the CBT-WBT sequential combination over CBT only were observed with both observer and self-rated methods after treatment. Such gains were maintained at follow-up. Conclusions: These preliminary results suggest the feasibility and clinical advantages of adding WBT to the treatment of GAD. They lend support to a sequential use of treatment components for achieving a more sustained recovery.

Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Well-Being Therapy of Generalized Anxiety Disorder

Fava

Ruini

Rafanelli

et al. 2004

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303

171

“…Accordingly, subclinical manic/hypomanic symptoms in patients who fail to meet DSM-IV diagnostic criteria for mania/hypomania may have negative effects and may lead to maladaptive lifestyle [3]. This lifestyle, however, could be amenable to change [20, 21, 22]. …”

Section: Discussionmentioning

confidence: 99%

Assessing the Community Prevalence of Bipolar Spectrum Symptoms by the Mood Disorder Questionnaire

Mangelli

Benazzi²,

Fava³

2005

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Background: The goal of this study was to assess the frequency and spectrum of symptoms related to bipolar disorders in a community sample by means of a self-rating questionnaire. Method: The Mood Disorder Questionnaire, a self-rating scale which evaluates DSM-IV manic/hypomanic symptoms, was administered to a community sample of 1,034 individuals recruited through advertisements. Symptom interrelationships were studied by factor analysis. Results: 275 individuals (26.6%) reported moderate or severe impairment due to the symptoms. Manic/hypomanic symptoms were present in a high proportion of individuals. Factor analysis found a two-factor structure of bipolar spectrum symptoms (an elevated mood overactivity factor, and an irritable behavior factor). Conclusion: The findings of this study highlight the need of complementing clinical investigations on the bipolar spectrum with community studies. Subclinical manic-hypomanic symptoms may be present also in allegedly unipolar patients and may have implications on the course of illness.

“…The diagnostic criteria are particularly helpful in setting a threshold for conditions worthy of clinical attention [41]. Accordingly, the diagnostic criteria for a major depressive disorder identify a syndrome that may be responsive to antidepressant drugs [42]. At least five of a set of nine symptoms should be present.…”

Section: The Misleading Effects Of Psychometric Theory On Clinical Asmentioning

confidence: 99%

The Intellectual Crisis of Psychiatric Research

Fava¹

2006

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The aim of this paper was to examine the intellectual crisis and the potential sources of reveille in clinical research in psychiatry. Current prevailing conceptual models in psychiatry are critically examined, with particular reference to neurobiology, clinical psychopharmacology, assessment, and the therapeutic process. Biological reductionism, neglect of individual responses to treatment, massive propaganda from the pharmaceutical industry, misleading effects of psychometric theory on clinical assessment, and lack of consideration of multiple therapeutic ingredients and of the role of psychological well-being are identified as major sources of an intellectual crisis in psychiatric research. The conceptual crisis of psychiatry is shared by other areas of clinical medicine and stems from a narrow concept of science that neglects clinical observation, the basic method of medicine. A unified concept of health and disease may yield new clinical insights in psychiatric disorders, and may result in therapeutic efforts of more enduring quality than current strategies.