Quality of life and clinical characteristics of patients with generalized and performance-focused social anxiety disorder: An Italian study.

Introduction. The aim of this study is to investigate quality of life (QoL) and clinical characteristics of generalized (GSAD) and performance-focused social anxiety disorder (PFSAD). Method. Our sample includes 41 outpatients with social anxiety disorder and 100 control subjects. QoL was assessed using the Quality of Life and Enjoyment questionnaire. Assessments included the MINI Neuropsychiatric Interview, the Symptom Checklist, the Work and Social Adjustment Scale and the Clinical Global Impression Scale (CGI). Using the Liebowitz social anxiety scale, patients were divided into GSAD and PFSAD. Results. QoL of subjects with GSAD was lower than in controls in most areas, while only the areas of physical health and leisure time were impaired in patients with PFSAD. Patients with GSAD were more likely to be depressed, to meet criteria for substance abuse, to have higher severity scores on the CGI and the SCL-90 compared to PFSAD. Conclusions. GSAD is associated with widespread worsening of QoL, while patients with PFSAD had a poorer QoL than controls only in the areas of physical health and leisure time.

Validity and reliability of the Italian version of the Quality of Life, Enjoyment and Satisfaction Questionnaire.

The Quality of Life, Enjoyment and Satisfaction Questionnaire (Q-LES-Q) is increasingly used in psychiatry because it gives emphasis to the subjective perspective of patients on physical, psychological and social domains. This paper reports on the validation of the Italian version of the Q-LES-Q in a large multicenter study (EQUIP) conducted at five Italian sites on outpatients in treatment for anxiety disorders. Study participants underwent a broad assessment of psychopathology including the MINI-International Neuropsychiatric Interview, the Symptom Checklist (SCL-90) and the Clinical Global Impression (CGI). Cronbach's alpha was used to determine the internal consistency of the Q-LES-Q areas and Pearson's r was used to analyze the correlation between the areas of Q-LES-Q and those of the other instruments. The internal consistency of the Q-LES-Q proved to be substantial (>0.80 in each of the areas) as well as the test-retest reliability. The convergent validity of the Q-LES-Q vs. the Work and Social Adjustment Scale was examined. High correlations were found between scales measuring similar constructs in the two instruments and lower correlation between scales measuring different constructs. In conclusion, the Italian version of the Q-LES-Q proved to be as valid and reliable as the original English version.

Melatonin in psychiatric disorders: a review on the melatonin involvement in psychiatry.

In normal subjects, the secretion of melatonin, the pineal hormone that regulates the rhythm of many functions, exhibits a circadian pattern synchronized with the day-night cycle. An alteration of this secretory pattern has been found in various psychiatric disorders (seasonal affective disorder, bipolar disorder, unipolar depression, bulimia, anorexia, schizophrenia, panic disorder, obsessive compulsive disorder). At present, it is not known if such alterations have an etiological role or are secondary to the dysfunctions underlying the different disorders. In addition, we do not know if the involvement of melatonin in several disorders has the same significance in the pathophysiology of each disorder. An understanding of the role of the pineal hormone and of its alterations in psychiatric diseases could help to identify the biological mechanisms underlying such disorders.

Electroretinogram B-wave amplitude in panic disorder.

Abnormal light-related behaviors have been described for patients with panic disorder (PD). The present study was undertaken to investigate the retinal light response in PD using electroretinography (ERG). The authors conducted b-wave ERG measurements with a bright light (after dark adaptation) in 28 patients with PD and 28 control subjects. There were no significant differences in the mean b-wave amplitude between the two groups, but the retinal response to light in PD patients was generally lower than in healthy subjects. A large interindividual variability was found; also noted was a significant difference in the mean b-wave amplitude between the right and left eyes in the control group. The data indicate subtle variation of retinal photosensitivity in a subgroup of patients with PD. Because dopaminergic retinal activity affects b-ERG amplitude, the authors hypothesize that the dopaminergic system is involved in the response to light in PD patients.

Season of birth in panic disorder.

Several studies have investigated the seasonal distribution of the birth dates of patients with psychiatric diseases. Our purpose was to verify if there is a specific distribution (by month) of birth dates in subjects with panic disorder (PD). The birth dates of 843 outpatients with a diagnosis of PD were compared with those of 1,181 subjects with other mental diseases. The birth dates of psychiatric patients were compared to those of the general Tuscane and Italian populations. The monthly distribution of birth in patients with PD (with and without comorbidity) peaked in September to December, while no relevant deviation in birth rate was observed in other mental diseases. Our results suggest a pathogenic role of birth seasonality in the development of PD.

Season of birth in psychiatry. A review.

Numerous studies suggest that seasonal birth may play a pathogenic role in the development of mental disorders. A birth excess of 10% during winter and spring has been shown in schizophrenia. The few studies carried out on affective disorders revealed a significant increase of births in the first quarter of the year in bipolar disorders and major depressive disorder. Subjects with seasonal affective disorder show a peak of births in May. Data on personality, eating and 'neurotic' disorders are less consistent. At the moment there are no data in the literature about anxiety disorders.

Suicidality and aggressive behaviour.

Psychiatrists have always maintained that there is a relationship between aggressive behaviour and suicide in depressed patients. However, this relationship is based on inconsistent and undocumented hypotheses, not on reliable clinical experimental data. The present study was designed to investigate the relationship between aggressive behaviour assessed by means of the Buss and Durkee Hostility Inventory (BDHI), and suicide in a sample of 134 depressed out-patients. The group with a higher level of suicidal behaviour was of younger age. The association between depressive subtypes (major depression, recurrent; major depression, single episode; bipolar disorder, depressive episode; dysthymia) and suicidality was found to be statistically significant. In contrast, there was no correlation between depressive subtypes and aggressive behaviour. The relationship between suicide and guilt as measured by the BDHI suggests that, in depression, suicidal behaviour becomes part of a symptom pattern in which aggression does not appear to be the main component. The suicide dimension arises when the cognitive sphere is involved. In fact, in depression, suicide is included among the cognitive disturbances, together with guilt, paranoid and obsessive-compulsive symptoms, depersonalization/derealization and agitation.

Emotivity, personality, and task-dependent EEG asymmetry.

In order to verify if task-dependent EEG asymmetry is related to emotivity or personality traits, the relationship between EEGraphic (EEG mapping) asymmetry, personality aspects, and emotional-affective state in 12 healthy volunteers was evaluated by means of standardized methods (SAD and CPI). Our subjects show an EEG asymmetry which is currently attributed in the literature to anxiety. In our subject the absence of anxiety and the presence of hyperthymic characteristics suggests that the different individual trends observed in various studies which have used methods similar to ours, could, at least partly, depend on interference on these variables.

[Arterial hypertension during the rehabilitation phase of cerebral stroke. Study with nicardipine]. / L'ipertensione arteriosa nella fase riabilitativa dell'ictus cerebrale. Studio con nicardipina.

Arterial blood pressure was recorded in 15 hypertensive patients with ischemic cerebrovascular disease in the post-acute stage and under treatment with nicardipine, a drug with tropism for the muscular cells of cerebral vessels. Blood pressure was measured at rest and during rehabilitation sessions. Patients were periodically assessed by Doppler examination of the cerebral vessels in order to evaluate the effect of the drug on vascular resistance. A significant reduction of blood pressure was observed without changes in pulse rate and without significant side effects. Hemodynamic parameters showed reduced resistance of cerebral vessels. These findings confirm the need for accurate control of arterial blood pressure during neurologic rehabilitation; they also bear out the efficacy and safety of nicardipine in this clinical situation.

Routine electrocardiography in screening for pulmonary embolism.

In a group of 245 patients with clinical suspicion of pulmonary embolism we analyzed the ECG for 22 signs that have been associated with this disease. Subsequently, the patients were divided into two groups: those with confirmed embolism and those in whom embolism was not confirmed. The occurrence of the ECG signs was assessed separately for the two groups. Furthermore, we related ECG features to severity of embolism as estimated at lung scan. Tachycardia and S-T depression were the commonest findings in both groups. P-R displacement, late R in a VR, S1Q3T3, S slurred and T inversion in V1-V2 were more frequent in embolic than in nonembolic patients (p less than 0.05 or less). All the above mentioned signs were more frequent at diagnosis than at recovery in embolic patients (p less than 0.05 or less), whereas only tachycardia was more frequent at diagnosis than at control in nonembolic patients (p less than 0.001). S-T depression and T inversion in V1-V2 were also associated to severity of embolism. Since some ECG signs are very frequent or specific in pulmonary embolism, this condition should always be suspected when they are found and, particularly, when previously absent in the same patients and/or not explained by other conditions.