The association between additional co-morbid axis I disorders and the following 28-month course of drinking and mental distress was explored in a nation-wide representative sample (N = 100) of treatment-seeking alcoholics with antisocial personality disorder (ASPD). Diagnoses at admission were assessed with the Diagnostic Interview Schedule and follow-up status was assessed with a questionnaire and from informants. Only 24% had no additional diagnoses, 39% had an affective disorder, 43% panic/agoraphobia, 61% other anxiety disorders, and 47% were polysubstance abusers. Polysubstance abusers had more prior admissions, and were more often involved in fights, while additional anxiety disorder was associated with lower prevalence of drunken driving arrests. Relapse (87%) was best predicted by the number of prior admissions (odds ratio [OR] = 1.3), while affective disorders reduced the risk of relapse (OR = 0.2). Readmissions (55%) were least common among those with affective disorders (44%). Identifying axis I diagnoses, and in particular affective disorders among treatment-seeking ASPD alcoholics, is of substantial importance both in research and clinical practice.

Following reunification in Germany in 1990 the new states in the Federal Republic faced the task of restructuring and rebuilding the structures of complementary care for the chronically mentally ill. First and foremost, residential facilities had to be established that would correspond to and meet the currently high need for de-hospitalization by making different types of care and care concepts available. Five groups of patients with chronic schizophrenic psychoses (N = 245 patients) who live in different types of psychiatric care facilities (psychiatric nursing home, social therapeutic hostel, sheltered community residence) or at home, either with or without a family network, were studied. In addition to the sociodemographic data, the psychopathology and the extent of social disabilities were also surveyed, as well as data on the living situation and the subjective quality of life with an emphasis on ‘social relationships’, ‘recreation/leisure activities’, and ‘general independence’.

The five groups differed with regard to various sociodemographic and disorder-related variables, particularly with regard to the extent of social disabilities. Especially relevant, however, are the differences among the patient groups in the extent of daily social life and recreational/leisure activities that are partially reflected in their statements on the subjective quality of life. Primarily for the two groups of home residents, but also in part for the patients living in sheltered community care, social contacts are more or less limited to the residential situation and patients are more or less otherwise socially isolated. This is due among other things to the fact that patients who have been hospitalized for long periods do not as a rule return to their prior area of residence; thus, the available compensatory mediation of relationships with the social environment does not suffice. Demands for the further development of complementary systems of psychiatric care derive from these findings.

The aim of this survey is to present an overview of research into psychopharmacology as regards the effects of different psychoactive drugs and neuroleptics (NL) on language in normal subjects and schizophrenic patients. Eighteen studies that have investigated the effects of different drugs (alcohol, amphetamines, secobarbital, L-dopa, psilocybin, ketamine, fenfluramine) and neuroleptics (conventional and atypical) on language are reviewed. There are no studies concerning the effects of neuroleptics on language in healthy subjects. The results of the effects of other molecules indicate that language production can be increased (alcohol, amphetamine, secobarbital), rendered more complex (d-amphetamine), more focused (L-dopa) or more unfocused (psilocybin) and clearly impaired (ketamine). For schizophrenic patients, most studies show that conventional neuroleptic treatments, at a therapeutic dosage and in acute or chronic mode, reduce language disorders at all levels (clinic, linguistic, psycholinguistic). In conjunction with other molecules, the classical NL, when administered at a moderate dosage and in chronic mode, modify language in schizophrenia, either by improving the verbal flow and reducing pauses and positive thought disorder (NL + amphetamine) or by inducing an impairment in the language measurements (NL + fenfluramine). Clinical, methodological and theoretical considerations of results are debated in the framework of schizophrenic language disorders.

The aim of the present study was to compare the cerebral activation associated with encoding and retrieval in individual subjects with the average activation in the same group of subjects. Twelve volunteers performed two paradigms: 1) intentional encoding of words, and 2) recognition of learned words intermixed with new distracters. Echo-planar magnetic resonance imaging (MRI) of BOLD signal changes was used to compare cerebral activation between active and resting conditions. During encoding, activation of the left precentral gyrus related to the motor response was observed in some subjects. Averaged data showed increased activation of the left precentral gyrus, the supplementary motor area (SMA), the left inferior frontal gyrus and in the left temporo-occipital junction. During recognition, motor response-related activity was found in the precentral cortex and SMA in most subjects. Activation in other brain areas showed considerable interindividual variation. In the entire group, recognition showed activation of the left dorsolateral prefrontal cortex, the precentral gyrus, the SMA, and the temporo-occipital junction. The total amount and the distribution of task-related cerebral activation varies considerably between individuals and might correspond to individual preferences of cognitive strategies. The investigation of these interindividual variations will be an exciting scientific challenge in the near future.

Certain studies on measures related to central neurotransmitter activity have demonstrated that in delusional (psychotic) depression there is a dopaminergic dysregulation which distinguishes it from non-psychotic depression. A neuroendocrinologic method to check the degree of DA receptor responsivity is by measuring the prolactin responses to acute intramuscular administration of haloperidol. We studied this possibility by applying the haloperidol test in seven delusional and ten non-delusional depressed patients. All patients met DSM-IV criteria for a major depressive episode, single or recurrent, with or without psychotic features. After a three-week washout period, 5 mg of haloperidol were injected i.m. and blood samples were taken at 0, 30, 60, 90 and 120 minutes. In both trials, significant time effects were observed (elevated prolactin levels, F = 11.36, P = 0.000). However, the prolactin responses to haloperidol did not differ significantly between the two patient groups (F = 0.12, P = 0.97). These data do not show a difference in D2 receptor responsivity, at least at the hypothalamus-pituitary level, between psychotic and non-psychotic depression.

Epidemiologic surveys show a high lifetime co-morbidity with psychiatric disorders (e.g., depression and anxiety) in alcoholics. However, alcoholics frequently complained about psychopathologic symptoms, particularly during alcohol withdrawal. There is some evidence that symptomatology decreases spontaneously with prolonged abstinence. Thus, the question arises whether high levels of psychopathology could be accounted for by withdrawal effects. This study was aimed at examining the impact of the alcohol withdrawal severity (assessed by the AWS scale) on psychopathologic symptoms. The psychopathologic profile of 110 alcoholics as measured by the Symptom Checklist-90 revised (SCL-90-R) was compared to that of 253 patients with adjustment, anxiety or depressive disorders (according to ICD-10 criteria). No relationship between the severity of alcohol withdrawal and psychopathology could be found which might hint at two different neurobiological processes underlying these phenomena. The comparison with patients suffering from depression or anxiety disorders revealed that the global symptom severity of alcoholics undergoing withdrawal was similar, but recovery was achieved more rapidly than in the other groups. On the other hand, the self-rated psychopathologic symptom profile of alcoholics was rather similar to that of patients with adjustment disorders. While about one-quarter of the alcoholics reported severe psychopathology on admission, only about 10% showed symptomatology at discharge about three weeks later, predominantly depression or anxiety. These results underline the notion that much of the psychopathology described by alcoholics decreases within 2–3 weeks after withdrawal without specific treatment.

This study applied 1H-MRS in the thalamus of schizophrenic patients and healthy subjects.

There were no differences in the metabolite ratios (NAA/Cr, Cho/Cr or mI/Cr) between the two groups. Relationships were noted between NAA/Cr and age in patients with a trend toward this correlation in controls, suggesting an effect of age on the metabolism of the thalamus.