Treatment adherence is one of the main factors affecting the success of treatment, quality of life and social adaptation of the patients. The cross sectional study was conducted on 120 neurotic outpatients treated in University hospital Olomouc, Czech Republic. The aim of the study was to investigate association between self-stigmatization, treatment adherence and history of discontinuation of drug treatment. The following variables were evaluated: were objective and subjective CGI (Clinical Global Impression – Severity), the adherence questionnaire DAI-10 (Drug Attitude Inventory), the self-stigma scale ISMI (Internalized Stigma of Mental Illness), and the demographic data questionnaire. 98 patients completed all the questionnaires, 22 patients completed questionnaires inadequately and or did not cooperate sufficiently. Data analysis showed no correlation between self-stigmatization and age, age of onset or length of post-hospitalization phase. However, there was a statistically significant correlation between self-stigmatization and the severity of psychopathology, the arbitrary discontinuation of medication in the past and the dose of an antidepressant. Furthermore, self-stigma significantly negatively correlated with the current treatment adherence. The level of adherence negatively correlated only with the subjective and objective CGI. Our results suggest strong association between self-stigmatization and adherence to treatment in neurotic patients. We may conclude that more attention should be paid to manage self-stigmatization in this patient group.

The objective of the study was to evaluate the presence of psychopathology in fibromyalgia patients compared to a control group of rheumatic patients with pain. Forty-nine fibromyalgia patients and 33 controls were evaluated using established self-rating scales. Serotonin was determined using a radioenzymatic method. Fibromyalgia patients scored significantly higher than the controls on the majority of the subscales on the SCL-90, the two subscales on the Spielberger State and Trait Anxiety Inventory, the GHQ 12 scale and on a visual analogue pain scale. In a multivariate analysis the somatization dimension followed by the state anxiety accounted for the highest difference. Platelet-poor plasma serotonin, platelet serotonin and platelet uptake index were not significantly different between the groups. In conclusion, fibromyalgia patients presented quantitatively more psychopathology than the control group on a wide range of psychopathologic axes, and this cannot solely be accounted for by their higher level of pain.

The effect of paroxetine on symptoms of anxiety associated with depression were assessed by meta-analysis of data on the use of paroxetine (n = 2963), active control (n = 1151), and placebo (n = 554) in six-week clinical trials. Paroxetine significantly reduced psychic anxiety by comparison with placebo from week 1 and was more effective than active control from week 2. Paroxetine improved somatic anxiety from week 4 of treatment. There was no association between antidepressant therapy and the emergence of anxiety symptoms in patients with little or no baseline anxiety. Paroxetine resolved baseline symptoms of agitation from week 1 of treatment, and both paroxetine and active control prevented the emergence of agitation. There was no difference between placebo and antidepressant therapy in the frequency of adverse events indicative of increased arousal. The results indicate the utility of paroxetine in depressed patients presenting with associated anxiety symptoms.

In a cross-sectional study, the Italian Network for Research on Psychoses (INReP) found that variables relevant to the disease, personal resources and social context explain 53.8% of real-life functioning variance in a large sample of community dwelling people with schizophrenia. In a longitudinal study, the INReP aimed to identify baseline predictors of main domains of real-life functioning, i.e. work skills, interpersonal relationships and everyday life skills, at 4-year follow-up. We assessed psychopathology, social and non-social cognition, functional capacity, personal resources, and context-related factors, as well as real-life functioning as the main outcome. We used structural equation modeling (SEM) and latent change score (LCS) model to identify predictors of real-life functioning domains at follow-up and changes from baseline in the same domains. Six-hundred-eighteen subjects took part in the study. Neurocognition predicted everyday life and work skills; avolition predicted interpersonal relationships; positive symptoms work skills, and social cognition work skills and interpersonal functioning. Higher neurocognitive abilities predicted the improvement of everyday life and work skills, as well as of social cognition and functional capacity; better baseline social cognition predicted the improvement of work skills and interpersonal functioning, and better baseline everyday life skills predicted the improvement of work skills. Several variables which predict important aspects of functional outcome of people with schizophrenia are not routinely assessed and are not systematically targeted by intervention programs in community mental health services. A larger dissemination of practices such as cognitive training and personalized psychosocial interventions should be promoted in mental health care.

Electronic Health Records (EHRs) have opened up the possibility of data re-use, to support both clinical practice, and clinical research. In order to achieve this re-use, we have to address the issue that EHRs contain both structured and unstructured data. By structured data, we mean formally described and organised data, such as that entered via forms, prescriptions, and lab results. By unstructured data, we mean the free text, narrative portion of the record such as patient encounter notes, and correspondence. It is estimated that 80% of the information content of the record is in this unstructured portion. Free text enables the clinician to express complex concepts, events, and uncertainties, in a way that is not possible in the structured record. Unlike structured data, however, free text creates difficulty for re-use and for statistical analysis. These difficulties include the incompleteness of the free text record, the inherent ambiguity of natural language, the noisy nature of the data, dependence on the context in which the record was written, and the author's assumptions about the target audience. Natural Language Processing (NLP), the computerised processing of human language, provides tools and processes to tackle some of these difficulties, and is increasingly used to extract clinically significant information from the textual component of the EHR. We examine ways in which NLP has been used to this end. We review some of the NLP systems and methods used over clinical records, focusing on the techniques of Classification and Information Extraction (IE), and using examples of NLP in use on the South London and Maudsley mental health case register. We will consider some of the NLP tools and resources available to health informaticians, their benefits and their costs.

Medical research with incompetent patients which is expected to yield only questionable or no individual benefit (and which is often wrongly equated with non-therapeutic research) remains a difficult and controversial problem. This is reflected in the fact that such research is legally admissible in some countries such as France and England, but is questionable or prohibited in other countries, eg, Germany. Such research can only be justified ethically if the need for it is set forth according to defined criteria, and if defined protective criteria are fulfilled, particularly to ensure that the research-related instrumentalisation of the patient is held in check by observing respect for the patient's dignity, to ensure that research does not involve more than minimal risks and negligible stress for the individual participant, and that the patient's refusal to participate is accepted. A broad international consensus exists with regard to these criteria [9, 21, 26, 41]. But concepts and definitions as to what constitutes benefits and risks, as well as criteria and procedures in weighing benefits against risks, and, not least of all, the weighing of individual benefit against societal benefit, require clarification. The question must also be satisfactorily answered: who is to do the weighing? But above all, it must be ensured by professional education that this process of checks and controls is effectively carried out in day-to-day medical-scientific life.

In May 1992 the German Council of Physicians decided that in the future there will no longer be a specialist in psychiatry, but, only a specialist in psychiatry and psychotherapy. This decision has enormous consequences for the psychiatric training of residents specializing in the field in Germany. Psychotherapy is now an integral part of psychiatry and must be completely included in training programs. The period of advanced training in the future will encompass five years instead of four years. The future curriculum for psychiatrists is far more structured and includes many more regulations than was formerly the case. The specialist in the field must acquire equal competence on the somatic, social-psychiatric, psychopathological and psychotherapeutic levels, followed by their subsequent integration into diagnosis and therapy. Practical experience in psychotherapy must be acquired in both a primary and secondary method. The only methods capable of recognition as the primary method are psychodynamic psychotherapy and behaviour-cognitive therapy. The secondary method will be restricted to psychodynamic psychotherapy, behaviour-cognitive therapy and client-centered therapy. The principle aim of the new specialist physician regulations in Germany is to achieve a multi-dimensional approach to the diagnoses and treatment of psychiatric disorders corresponding to the complex nature of psychiatric illness.

An hypothesis based on the original stress model of depression, learned helplessness, proposed that exposure to uncontrollable stress provides the basis, in animals as in humans, for learning that stress is uncontrollable (helplessness); this learning has a number of debilitating consequences, including depression. This study suggests that rats subjected to daily restraint sessions (1h × 5 d, in 20 × 10 × 10 cm boxes) displayed a quiescent behavior vvith few attempts to escape from the box during the restraint periods, and subsequently exhibited escape deficits in a shuttle-box. These deficits were eliminated by clomipramine (8 or 16 mg/kg), imipramine (16 mg/kg) and nialamide (16 mg/kg) given twice daily subsequent to the last restraint session. In contrast, diazepam (2 mg/kg/d) or sulpiride (8 mg/kg/d) did not reduce helpless behavior induced by daily restraint sessions. In addition reduction in locomotor activity has been reported in rats subjected to restraint. It is suggested that the experience of loss of control thought to result from unsuccessful attempts to escape the stressor could be the critical aspect of behavior sensitive to antidepressants.

Assessments of early response to antidepressant therapy based on condition severity have been contradictory due to the poor measurement properties of the instruments employed and the inappropriateness of condition severity as a criterion of improvement. It is argued that a more valid approach would involve the assessment of improvements in quality of life (QoL) associated with effective therapy. QoL instruments should reflect the views of the patients themselves, the only group able to comment authoritatively on whether they feel benefit from treatment. Research shows that it is the perceptions of the patients that determine whether treatment is sought, how far clinical advice is followed and whether treatment is discontinued. It is argued that the Quality of Life in Depression Scale is the only instrument available that has the required conceptual basis and psychometric properties to investigate the onset of response to antidepressant therapy.

Twelve outpatients with seasonal affective disorder were treated by 1-h morning bright light exposure for 5 days. The light treatment intervention produced a significant phase advance of self-rated sleepiness rhythm, a significant decrease of the mean level of subjective sleepiness, and a significant reduction of depression scores. No significant objective circadian rhythm phase shift nor amplitude changes would account for the antidepressant effect.

Various historical aspects of resistant schizophrenia are described: limitations of treatment efficacy, attempts at proposing therapeutic strategies in non-responding patients, first attempts to define resistance in schizophrenia, and first attempts to distinguish resistance factors. Interest in treatment-refractory schizophrenia was stimulated by several studies in the period 1985–1990, including a pivotal study of clozapine. The need to include biological and psychosocial factors when defining resistance was emphasised by a group who defined a systematic approach to treatment resistance in schizophrenia, including degrees of resistance. The concept of a continuum from full remission to complete refractoriness was proposed by an international study group in 1990. Difficulties in identifying patients with refractory schizophrenia include: variability of schizophrenia diagnostic criteria, lack of consensus concerning good treatment practice with neuroleptic agents, and confusion between resistance, chronicity and severity. A better definition of refractoriness is needed, not only for pharmacological studies but also for a more precise characterisation of a possible subgroup of schizophrenia termed ‘Kraepelinian’.

Benzodiazepines were first used in schizophrenia because of their anxiolytic properties. At high doses, or in association with neuroleptics, diazepam and estazolam also appears to exhibit an antihallucinatory effect, whereas alprazolam preferably acts on negative symptomatology due to its antidepressant properties.