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Ascoli Piceno, Italy

Alciati A.,Hermanas Hospitalarias | Sgiarovello P.,University of Milan | Atzeni F.,University of Milan | Sarzi-Puttini P.,University of Milan
Reumatismo | Year: 2012

Objective. To review the literature addressing the relationship between mood disorders and fibromyalgia/chron-ic pain and our current understanding of overlapping pathophysiological processes and pain and depression circuitry. Methods. We selectively reviewed articles on the co-occurrence of mood disorders and fibromyalgia/chronic pain published between 1990 and July 2012 in PubMed. Bibliographies and cross references were considered and included when appropriate. Results. Forty-nine out of 138 publications were retained for review. The vast majority of the studies found an association between depression and fibromyalgia. There is evidence that depression is often accompanied by symptoms of opposite polarity characterised by heights of mood, thinking and behaviour that have a considerable impact on pharmacological treatment. Recent developments support the view that the high rates of fibromyalgia and mood disorder comorbidity is generated by largely overlapping pathophysiological processes in the brain, that provide a neurobiological basis for the bidirectional, mutually exacerbating and disabling relationship between pain and depression. Conclusions. The finding of comparable pathophysiological characteristics of pain and depression provides a framework for understanding the relationship between the two conditions and sheds some light on neurobio-logical and therapeutic aspects. Source

Perna G.,Hermanas Hospitalarias | Perna G.,University of Miami | Perna G.,Maastricht University
Journal of Psychopathology | Year: 2012

Panic disorder (PD) is a clinical entity which complexity can be organized in a "march of panic" whose organizing psychopathological principle is represented by the unexpected panic attacks. Panic phenomenology is defined not only by full blown and limited symptoms panic attacks but also by aborted panic attacks and shadows of panic. All together these phenomena are the expression of the psychobiological mechanisms abnormally activated in PD. The target of psychopharmacological treatment should be focused on panic phenomenology while the only effective psychotherapeutic intervention, cognitive behavioral therapy, should correct the cognitive distortions and the avoidant and protective behaviors that limit panic patient's freedom. A complete therapeutic approach should include also regular aerobic exercise and evidence based breathing therapy. Often the chronicization of PD is the results of mistakes in the diagnostic and therapeutic processes rather than a true treatment resistance. Source

Atzeni F.,University of Milan | Salli S.,University of Palermo | Benucci M.,Rheumatology Unit | Di Franco M.,University of Rome La Sapienza | And 3 more authors.
Reumatismo | Year: 2012

Fibromyalgia (FM) is a chronic pain syndrome that affects at least 2% of the adult population. It is characterised by widespread pain, fatigue, sleep alterations and distress, and emerging evidence suggests a central nervous system (CNS) malfunction that increases pain transmission and perception. FM is often associated with other diseases that act as confounding and aggravating factors, such as rheumatoid arthritis (RA), spondyloarthritides (SpA), osteoarthritis (OA) and thyroid disease. Mechanism-based FM management should consider both peripheral and central pain, including effects due to cerebral input and that come from the descending inhibitory pathways. Rheumatologists should be able to distinguish primary and secondary FM, and need new guidelines and instruments to avoid making mistakes, bearing in mind that the diffuse pain of arthritides compromises the patients' quality of life. Source

Alciati A.,Hermanas Hospitalarias | Atzeni F.,Ospedale Universitario cco | Sgiarovello P.,Ospedale Universitario cco | Sarzi-Puttini P.,Ospedale Universitario cco
Reumatismo | Year: 2014

Medically unexplained symptoms are considered 'somatoform disorders' in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). The introduction of this nosographic category has been helpful in drawing attention to a previously neglected area, but has not been successful in promoting an understanding of the disorders' biological basis and treatment implications, probably because of a series of diagnostic shortcomings. The newly proposed DSM-V diagnostic criteria try to overcome the limitations of the DSM-IV definition, which was organised centrally around the concept of medically unexplained symptoms, by emphasising the extent to which a patient's thoughts, feelings and behaviours concerning their somatic symptoms are disproportionate or excessive. This change is supported by a growing body of evidence showing that psychological and behavioural features play a major role in causing patient disability and maintaining high level of health care use. Pain disorders is the sub-category of DSM-IV somatoform disorders that most closely resembles fibromyalgia. Regardless of the diagnostic changes recently brought about by DSM-V, neuroimaging studies have identified important components of the mental processes associated with a DSM- IV diagnosis of pain disorder. Source

Iasevoli F.,University of Naples Federico II | Valchera A.,Hermanas Hospitalarias | Di Giovambattista E.,Hermanas Hospitalarias | Marconi M.,Hermanas Hospitalarias | And 11 more authors.
Journal of Affective Disorders | Year: 2013

Background The aim of this study was to assess whether different affective temperaments could be related to a specific mood disorder diagnosis and/or to different therapeutic choices in inpatients admitted for an acute relapse of their primary mood disorder. Method Hundred and twenty-nine inpatients were consecutively assessed by means of the Structured and Clinical Interview for axis-I disorders/Patient edition and by the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego auto-questionnaire, Young Mania Rating Scale, Hamilton Scale for Depression and for Anxiety, Brief Psychiatry Rating Scale, Clinical Global impression, Drug Attitude Inventory, Barratt Impulsiveness Scale, Toronto Alexithymia Scale, and Symptoms Checklist-90 items version, along with records of clinical and demographic data. Results The following prevalence rates for axis-I mood diagnoses were detected: bipolar disorder type I (BD-I, 28%), type II (31%), type not otherwise specified (BD-NOS, 33%), major depressive disorder (4%), and schizoaffective disorder (4%). Mean scores on the hyperthymic temperament scale were significantly higher in BD-I and BD-NOS, and in mixed and manic acute states. Hyperthymic temperament was significantly more frequent in BD-I and BD-NOS patients, whereas depressive temperament in BD-II ones. Hyperthymic and irritable temperaments were found more frequently in mixed episodes, while patients with depressive and mixed episodes more frequently exhibited anxious and depressive temperaments. Affective temperaments were associated with specific symptom and psychopathology clusters, with an orthogonal subdivision between hyperthymic temperament and anxious/cyclothymic/ depressive/irritable temperaments. Therapeutic choices were often poorly differentiated among temperaments and mood states. Limits Cross-sectional design; sample size. Conclusions Although replication studies are needed, current results suggest that temperament-specific clusters of symptoms severity and psychopathology domains could be described. © 2013 Elsevier B.V. Source

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