What we ordinarily call pain can arise either as a consequence of physical events or as a result of psychological processes. Both situations can be covered in one definition by treating pain as a word which applies only to subjective experience and not to nociception or to physiological processes. A definition of pain, framed in this fashion by the subcommittee on taxonomy of the International Association for the Study of Pain (IASP), was adopted by the IASP in 1979 and has been widely accepted since that date. Behavioural phenomena should not be confused with this definition. It implies a monistic view of the experience of pain and it is inappropriate to encumber it with concepts of “pain behaviour”. At the same time dual or multiple causes of pain are recognized. Thus physical causes, psychological causes or both may produce the unitary experience.

Healing through emotional arousal is an ancient idea. Abreaction may yield lasting, brief, or no improvement, or alternatively sensitization. The predictors of outcome are unclear. The emotional experience of relevant exposure therapy yields more reliable improvement; forgotten traumas may surface, which ease as exposure proceeds. High arousal does not enhance the gains, but emotional engagement in exposure seems crucial for habituation to occur. Habituation is specific to the fear cues presented, marked generalization being unusual. Emotional experience irrelevant to a phobia can also improve the phobia, but the duration of such relief is unclear and different mechanisms may be involved. Fear-reduction is unreliable with non-exposure methods. Though counterproductive during exposure, dissociation and denial may have some uses. Optimal gains may come from being able to modulate activation or suppression to suit particular circumstances.

We present the construction of an expert system (ES) for the diagnosis of Obsessive-Compulsive Disorders (OCD). It concerns an artificial intelligence tool, in Lisp language compatible with any personal computer (PC) with a hard disk. The ES asks the user 50 questions in natural language, on the patient or on a clinical history. It is provided with 115 rules of reasoning. Using single or multivaluate variables, the ES reaches the diagnosis of the Obsessive-Compulsive Disorders or the recommendations of differential diagnosis with related patterns or involucred with obsessive pathology: phobic, affective, schizophrenic and Gilles de la Tourette disorders. Finally, the perspectives for the utilisation of the ES in psychopathology are disscussed, in conjunction with the 2 serious problems created, design difficulty and user acceptance.

Thirty-one patients, 30 girls and 1 boy, who had suffered from anorexia nervosa, were re-evaluated at a minimum of 4 years (mean 7.6 years) after onset. Follow-up information was based on a semi-structured interview and 2 self-evaluation questionnaires, EAT-26 (1979) and HSCL-90 (1976). As well as using the Garfinkel and Garner criteria (1977) for assessing outcome, 2 psychiatrists independently evaluated the psychiatric state using DSM III criteria. The results demonstrated that 54.8% of the sample had a positive and 45% (including 3 deaths) a poor outcome. Of the 25 subjects interviewed, 20% presented chronic anorexia. Seventy-two percent, on the other hand, showed an evolution in clinical diagnosis, meeting the criteria for a mental disorder other than anorexia nervosa: Affective Disorders (40%), Somatoform Disorder (16%), Anxiety Disorder (12%), and Bulimia (8%). Two variables were significant, in terms of poor long-term prognosis: a larger number of hospitalizations for anorexia and an unsatisfactory educational and/or vocational adjustment at presentation.

We present here a new instrument of measurement for systematic biases in patient response style when evaluating severity of depression, in the form of a self-rated questionnaire derived from the MMPI containing 37 items rating depressive severity (DSS), 15 items of the L scale, 27 items of the K scale, and 51 items of the F scale, making a total of 130 yes-no items. The scores of these 4 scales allow an estimation not only of depressive severity, but also of the attitude of the subject towards his own style of symptom reporting: “defense” and desire to appear “normal”, or on the contrary tendency towards exaggeration. In a population of 66 depressives, this instrument was correlated with the MADRS depression rating scale (P < 0.0001), which shows its sensitivity to depressive severity. The F scale and Gough’s index (F-K) were also shown to be correlated with MADRS scores. This self-rated questionnaire constitutes a clinical instrument that is simple and practical both to administer and to correct.

Results of the dexamethasone suppression test (DST) in demented nondepressed patients have varied considerably, and there is evidence that these depend on the type of dementia, ie, Alzheimer’s disease (AD) or multi-infarct dementia (MID). AD is characterized by decreased central acetylcholine (Ach) activity, while MID is thought to be vascular in etiology. Pirecetam normalizes cerebral blood flow, along with other positive hemorheological properties. It may also increase central Ach levels. We performed the DST twice, 1 week apart, on 96 stable, demented geriatric inpatients. In 33 (21 AD, 11 MID), piracetam was started at an oral dose of 4.8 g/d 4-6 months before the first DST. The remaining 64 (39 AD, 25 MID) were untreated. Among untreated patients, those with MID were less suppressible (P < 0.001 and P= 0.01) and had more week-to-week variability (P = 0.0006) in the DST than AD patients. This is consistent with our previous findings. However, treated patients showed no difference in either postdexamethasone cortisol levels or reproducibility of DST results. We interpret these findings to mean that piracetam, by increasing central Ach, makes AD patients less suppressible on the DST, and by maintaining more constant limbic blood flow, makes MID patients more DST stable.

The hypothesis that tardive dyskinesias observed after long-term administration of neuroleptics are due to the formation of free radicals following this medication has prompted studies on the use of vitamin E (α-tocopherol), an antioxidant to treat patients suffering from such side-effects. The present study aimed at reproducing earlier encouraging results in treating 23 patients with vitamin E, using a double-blind crossover design. Inclusion criteria were: duration of tardive dyskinesia for at least 3 months, appearance of the symptoms during neuroleptic treatment or after stopping this kind of medication. The 10 subjects in the first group (Gl) were treated for 14 days with 1 200 mg vitamin E per day and then for 14 days with placebo. For the second group (G2) with 9 subjects, the treatment periods were inversed. The 2 dropouts in each group were not due to experimental problems: there was no complication due to vitamin E intake, or only negligible side-effects. Side-effects were rated on the AIM scale on days 0, 14 and 28. The results of the present study do not confirm earlier reports: there was no significant difference in the therapeutic effect between placebo and vitamin E in any of the groups. However, the fact of taking these symptoms into account in the physician-patient relationship has contributed significantly to a decrease of tardive dyskinesia in both groups, from the beginning until the end of the investigation period, during which both neuroleptic and tranquilizing treatments were kept constant. Further studies should include longer treatment periods with vitamin E or even test the preventive effect of vitamin E in the production of tardive dyskinesia by neuroleptics.