Part I of this paper presents a comprehensive review of plasma level monitoring of tricyclic antidepressants (TCAs) and their relationship to clinical response to antidepressant therapy. Imipramine, nortriptyline, amitriptyline, clomipramine and desipramine are the most widely studied TCAs in this regard. Typical therapeutic plasma concentration ranges are suggested for some of these agents, although a consensus is lacking.

2275 hypertensive patients consulting their usual general practitioner were analyzed using a specifically designed questionnaire. Sixty-two percent of the subjects were already treated and 38% were untreated prior to inclusion in the study. The data, collected during the usual medical consultation, included several questions answered by the physician concerning the patient's psychological status as well as a series of behavioural scales. The aim of this study was to describe a small number of different and homogeneous psychological patterns rather than a unique profile of hypertensive out-patients. Four types were thus defined using a statistical clustering procedure and were designated as ‘everything is OK”, “hyper-reactive”, “depressed”, and “dynamic-competitive”, representing respectively 43%, 33%, 10% and 14% of the population studied. The first type consists of patients who do not express subjective complaints and claim to have no conflicts, but who have difficulty adjusting to environmental changes. The second type is characterized by emotionally unstable individuals who are easily overwhelmed by their difficulties. The third type corresponds to pessimistic subjects, still affected by previous painful life events. Finally, the fourth type, close to coronary-prone type A behaviour, is composed of subjects whose aggression is channelled into social competition. The distribution of hypertensives amongst these 4 types is the same whether previously treated or not. Under treatment throughout the 6 months’ follow-up, the evolution of mean systolic blood pressure (SUP) and of mean diastolic blood pressure (DBP) was similar in the 4 types, although the second type showed the highest SBP during this period. Second and third type subjects more frequently reported the classical symptoms of hypertension. First and third type subjects reported more side-effects with antihypertensive treatment. Each type's vulnerability to stress is discussed from a psychosomatic viewpoint of essential hypertension. This study provides evidence that several behavioural patterns can be described amongst hypertensive patients. Knowledge of these patterns may be very useful in clinical practice to manage the Patient-physician relationship, and to increase patient compliance with antihypertensive therapy.

To gain an impression of the course of affective diseases such as Anxiety and Depression in a longitudinal perspective, information was taken from the Lundby Study, Sweden. This is an epidemiological, longitudinal and prospective study of an entire population followed up over 25 years. The first prevalence study was undertaken by Essen-Möller et al. who in 1947 examined every person registered in a geographically delimited area, Lundby, in southern Sweden. They personally interviewed and described every single individual of the 2 550 inhabitants. They were as interested in healthy as in sick people. This is important, since many persons do not consult a psychiatrist, or even another doctor, for their suffering. In this way, the examining psychiatrists saw the whole panorama of mental disease. In 1957 Hagnell carried out a reinvestigation of the same people wherever they then lived, and in 1972 Hagnell and Öjesjö performed a third examination of all the probands of the 1947 cohort. On all three occasions the drop-out rate was negligible: a few percent only. Each time additional information was collected from various outside sources of relevance.

Anxiety and Depression are common diseases. Within the Lundby Study single episodes as well as relapses into the same or another mental illness are described. During the 25-year period, the total number of registered spells of Anxiety was 215 (79 for men and 136 for women), while the number of spells of Depression was 516 (189 for men and 327 for women).

The cumulative probability of contracting an affective illness at least once in a lifetime (lifetime risk) was for “Anxiety proper” in men 2.6 and in women 6.1 percent; for “Anxiety plus other psychiatric symptoms” in men 8.6 and in women 16.8 percent; for “Depression proper” in men 6.8 and in women 15.5 percent; for “Depression plus other psychiatric symptoms” in men 17.3 and in women 32.1 percent.

We found that in “Anxiety proper” relapses, the subsequent episodes contain more complicated syndromes along with the anxiety state. “Anxiety plus other psychiatric symptoms” seems to be a diagnosis that includes many symptoms which, if relapses occur, may develop into various other syndromes.

Many of those who have an initial episode of Depression proper remain within to this diagnosis if they relapse. “Depression plus other psychiatric symptoms”, on the other hand, mostly relapses into other mental diagnoses. It thus seems to be a prodromal syndrome to other mental illnesses.

The significance of a history of anorexia nervosa as regards the diagnosis and treatment outcome for bulimia is unclear. In a retrospective analysis of medical records of 59 inpatients with bulimia (DSM-III), variables related to personal and psychiatric family history did not reveal any differences in bulimics subtyped according to previous anorexia nervosa as defined in the criteria of Russell (1979). These anamnestic data support the results of studies indicating that no specific clinical and outcome variables are correlated with a history of anorexia nervosa in bulimia. The lower body weight and longer duration of bulimia found in bulimic inpatients with a history of anorexia nervosa, however, should be further examined.

According to pharmacological and neurophysiological data, inhibition of activity can be considered to be a characteristic feature of anxiety. There is a general inhibition regarding plans of action in carrying out daily routine, as distinct from the particular phobic avoidance inhibition.

To study this inhibition, an evaluation scale has been developed (appendix). Applied to 156 anxious patients in this multicentric study, it shows good sensitivy in terms of bromazepam's therapeutic action. The intensity of inhibition is as high in non-phobic anxious patients as in phobic anxious patients.

A measure of the efficacy of an anxiety-relieving drug on inhibition could constitute a useful complement to assessments generally based on subjective experience and physical symptoms.

Aucune réponse claire n'a été apportée, à ce jour, à la question du type de désorganisation du langage schizophrénique. Les résultats concernant les compétences lexicales et syntaxiques des schizophrènes restent controversées. Cependant l'existence de données en faveur d'une atteinte de ces compétences impose de ne pas abandonner trop vite ce champ d'études mais d'interroger plutôt les conditions méthodologiques dans lesquelles elles ont été réalisées. L'hétérogéneité probable des malades évalués dans ces études nous à conduit a opter pour une étude de cas individuel. Il est en effet permis de penser que seuls certains schizophrènes peuvent présenter ce type d'anomalies. L'utilisation de plusieurs tâches expérimentales mettant toutes en jeu les compétences lexicales et syntaxiques mais évaluant chacune des stratégies lexicales et syntaxiques différentes devait permettre une meilleure caractérisation des stratégies linguistiques employées par les sujets de notre échantillon. Afin d'apprécier les performances des 10 sujets schizophrènes éva-lués, par rapport aux performances de sujets normaux, nous avons suivi la méthodologie utilisée par J. Segui (1974, 1976) et M. Kail (1974, 1979) et pris comme point de référence pour l'intérpretation des résultats ceux obtenus chez des sujets normaux par ces auteurs lors de tâches similaires. Les résultats de l'ensemble des sujets de notre échantillon sont comparables. Dans les tâches de production d'énoncés à partir d'une suite de lexèmes et dans les tâches de complétement de phrases, les performances des schizophrènes sont comparables à celles du sujet normal, Dans les tâches de rappel, les performances de nos sujets sont moins bonnes que celles du sujet normal, mais il existe chez le schizophréne comme chez le sujet normal une tendance à organiser le matériel et les stratégies d'organisation impliquant les compétences lexicales et syntaxiques qui possèdent, quand elles sont mises en œuvre, les mêmes caractéristiques que celles miscs en évidence chez le sujet normal (organisation hiérarchique ou organisation formelle). Ces résultats (résumés dans le Tableau III) vont davantage dans le sens d'une difficulté à découvrir ou à appliquer des stratégies permettant d'exploiter les caractéristiques structurelles du matériel plutôt que dans celui d'une atteinte de ces compétences ellesmêmes chez nos sujets schizophrènes.

Les travaux de P. Bech sont principalement axés vers l’amélioration des qualités psychométriques des échelles d’évaluation psychiatrique déjá existantes. Dans ce but, P. Bech propose plusieurs techniques:

• – la plus importante, résidant dans l’utilisation du modéle logistique de Rasch: le modéle de Rasch permet de s’assurer, á l’encontre de l’analyse factorielle, de la valeur d’une somme de notes d’item en vue de la mesure d’une dimension. La position (paramétre) des item sur la dimension est estimée indépendamment de la population, et les estimations sont donc théoriquement absolues. Par conséquent, si le modéle est bien adapté, les paramétres d’un item doivent rester stables, quelles que soient les caratéristiques de l’échantillon (sexe, age, diagnostic par exemple). De surcroît, le test d’ajustement du modéle de Rasch permet une vérification de l’unidimensionnalité de l’échelle;

• – l’introduction, pour tous les degrés d’un item, d’une définition opérationnelle précise;

• – et enfin, la recommandation de regrouper les scores globaux d’une échelle en un nombre restreint de catégories.

Bech propose également que plusieurs échelles ainsi remaniées soient réunies au sein d’un inventaire de psychopathologie générale qui posséderait plusieurs avantages, dont celui de dimensions mieux individualisées, sur les inventaires classiques.