PERSONALIZED MEDICINE CENTER FOR ANXIETY AND PANIC DISORDERS AT HUMANITAS SAN PIO X HOSPITAL
Why anxiety disorders?
 
Anxiety disorders are the most common mental disorders in the general population. Consider that from the latest published estimates, about 1 in 3 people had the experience of an anxiety disorder that would amount to more than 20 million people in Italy. And although often the presence of an anxiety disorder is underestimated as a "minor" disorder, studies indicate that it represents the highest source of disability in industrialized countries.
The real reason why anxiety disorders are so important is related to the great suffering they induce. This suffering is particularly strong precisely because they affect people who are otherwise absolutely normal and aware and therefore people who feel the limitations and the discomfort linked to the disorder in a very clear manner 
Anxiety disorders affect the heart of one of the fundamental rights of every human being. The right to freedom. Freedom to move and be autonomous, freedom to choose where to go, freedom to meet other people, freedom to seize the opportunities that life presents, freedom to risk and, ultimately, the freedom to decide and fight for one's own happiness.
 
What is the situation regarding the treatment of anxiety and panic disorders in Italy?
 
Although there are clear international guidelines that define "evidence based" treatments, that means effective in controlled clinical studies, in clinical practice too often drugs or combinations of drugs are used that do not have a real efficacy and psychotherapies that do not have sufficient scientific evidence to be really effective in treating anxiety disorders. To date, in general, for the treatment of anxiety disorders, so-called serotonin reuptake inhibitors and serotonin and norepinephrine re-uptake inhibitors and other drugs acting on different transmitters are preferable. One of the categories of drugs that are too often used inappropriately in the treatment of anxiety and panic disorders are the atypical and typical antipsychotics which, in the vast majority of cases, are not effective and have important side effects. Alongside these, the use of mood stabilizers must also be carefully evaluated as they are often prescribed without a valid clinical reason. With regard to psychotherapy it is good to clarify that in the treatment of anxiety and panic disorders, the only psychotherapy that has proven to be clearly effective is "classic" cognitive behavioral psychotherapy.
Finally, too often, even when the correct drugs are chosen, the dosage is insufficient and the duration of therapy also or insufficient dosages are maintained for long periods. It is important to point out that the dosage of drug therapy must be gradually increased until the disappearance of the core symptoms of the treated anxiety disorders is reached and if clear positive results are not seen within 3 months of reaching the full dosage a therapy change should be considered. Likewise, it is not enough to be followed by a psychotherapist labeled "cognitive-behavioral" but the same must apply the scientifically validated protocols that find the main ingredients in behavioral exposure and "homework".
 
Why is treating anxiety disorders with proven drug therapies and psychotherapies no longer enough? 
 
Apply the treatments that science shows to be more effective than at least placebo, that is, try to apply an "evidence based" therapy that, in a nutshell, is not based only on a suggestive psychological effect, it is an essential first step to overcome an anxiety disorder.
Treatment with "evidence based" interventions guarantees an improvement in most patients but very often, by itself, it does not allow one to return to 100% wellbeing and moreover, a significant percentage of people do not respond to the "evidence based" treatment". Almost all randomized and non-clinical trials, both as regards both pharmacological and psychotherapeutic therapies, do not take as a measure of successful therapy the complete return to a state of well-being but simply a partial improvement. The goal of these studies is clinical improvement (better or less worse...) and not a 100% return to normality (feeling good!).
Applying the proven "standard" therapies cannot guarantee the return to a state of full well-being for each patient.
 
What could be the next step in treating anxiety disorders?
 
Speaking of "back to the future", taking up the title of a famous film of the eighties, could be the best way to mark the way that could increase, indeed will increase, the possibility of guaranteeing to most patients the return to a state of complete well-being also minimizing the side effects of drug and non-drug therapies.
Since ever every clinician, as he gains experience, uses less and less manuals and more and more his own personal clinical experience that allows him to frame the patient on the basis of the models he has refined over the years and to choose the most suitable therapy for the patient beyond the guidelines. This way of proceeding guarantees speed in the decisions and the use of clinical wisdom developed over time but hides one of the biggest dangers for the health of each patient: the so-called "confirmatory bias" that is the tendency of each of us to see what confirms our beliefs and does not see what goes against these. In a nutshell, we are blind to the evidence that contradicts our beliefs and we become self-referential especially when we are experts.
The antidote to this danger is the development of a personalized, tailored approach that can take inspiration from clinical experience but find in science an impartial guarantor able to prevent personal opinion and the tendency to see only what makes us feel experts that can lead us on the wrong diagnostic and therapeutic paths, which eventually will be the patients who will pay.
Personalized medicine is the new approach that integrates and surpasses evidence based medicine to consider every single person as a complex entity that cannot be reduced to a simple diagnosis but, starting from this, is defined by all those individual information (genetics, psychophysiology, neuropsychology, hematochemistry, traumatic experiences but also spiritual aspects) that allow to create a tailored profile of the pathological condition that has affected "that" person. This allows a personalized choice of treatment capable of integrating pharmacological, psychotherapeutic and other therapeutic interventions on lifestyle maximizing the outcome of the therapy and minimizing side effects and associated risks.
Therefore, therapy is no longer a standard dress to which the patient has to adapt but a sartorially defined dress that adapts to the individual characteristics of each patient.
 
What does it mean to treat those who suffer from an anxiety disorder with personalized medicine?
 
First of all, it means remembering that only the patient has experience of what he is experiencing, so one must start from listening and once a diagnostic hypothesis is made, discuss with the patient whether this hypothesis is valid or not. If the patient is not fully in agreement with our feeback, we should still listen to him until there is complete agreement between the diagnostic hypothesis proposed by us and the patient's perception of having been fully understood. Once a diagnosis has been made, it will be important to collect the information, both with the interview and with any other blood and instrumental tests needed, which will allow us to understand "that" patient and then trace his personalized profile starting from the diagnostic hypothesis to include a series of individual aspects and personal experiences that will be crucial for tailored choosing the most suitable treatment for that person that can maximize his well-being and minimize side effects.
In the specific case of anxiety disorders, for example, it will be important to evaluate the profile of symptoms (e.g. respiratory, cardiovascular, vestibular, depersonalization), the psychophysiological profile (e.g. cardiac variability, postural function, respiratory pattern), the blood chemistry tests profile (e.g. inflammatory indices, lipid indexes, hyperventilation indexes). In addition to these, assessments of brain images and the neuropsychological and personal set-up can also be useful. It is true that the solidity and reliability of a science of personalization of treatments in patients suffering from anxiety disorders still has a long way to become a clinical practice but the elements that scientific research proposes are such as to allow us to start right now this path. Even 5% more clinical improvement and 5% fewer side effects can affect the quality of life and make the difference between being chronically less worse but still conditioned by an anxiety disorder to feel good by getting rid of the conditionings that anxiety disorders impose.
 
Why choose the Humanitas San Pio X team?
 
The team is directed by Prof. Giampaolo Perna, one of the leading international experts on anxiety disorders who has been dedicated to anxiety disorders for over 25 years as a clinician, researcher and lecturer as demonstrated by his professional history:
1. In over 25 years of clinical experience in the diagnosis and treatment of anxiety disorders, he has never stopped visiting personally at least 30-40 patients every week and has directed centers for anxiety disorders of prestigious institutions such as San Raffaele Hospital in Milan and the Sisters Hospitallers in Milan and Como.
2. For several years, the American rating agency Expertscape, evaluating the scientific research carried out in the last 10 years, has identified Giampaolo Perna as the leading Italian and European scientific expert in panic disorder and among the top three worldwide, as well as one of the top 3 Italian experts in anxiety disorders. In over 25 years of scientific activity, he has published over 150 scientific articles and held more than 85 reports at national and international conferences mainly on anxiety disorders.
3. Giampaolo Perna is one of the world references of personalized medicine being for 5 years the Chair of the Section on Personal Psychiatry of the World Psychiatric Association (WPA) and co-editor-in-chief of the international scientific journal "Personalized Medicine in Psychiatry" published by Elsevier, the number one scientific publisher worldwide.
4. At the academic level, Giampaolo Perna has taught in 7 different national and international universities and is currently professor at Humanitas University (Milan), University of Miami (USA) and Maatricht University (Netherlands).
Giampaolo Perna’s team includes psychiatrists and psychotherapists who apply scientifically validated methods in the treatment of anxiety disorders and collaborate with him for over a decade having developed a great clinical and scientific experience.
 
What message of hope can we send to the millions of Italians who are still prisoners of anxiety? 
 
Dear person who suffers for an anxiety disorder, do not be content with feeling better, pretend to feel good. Today, science has the tools to help you find the freedom that anxiety disorders have taken away from you. Trust science and those who offer scientifically proven therapies. You are not alone seeing the army of researchers who every day commit to studying these disorders by publishing 20 new scientific studies every day.