The paper discusses the relevance of sufficient psychometric standards for dementia rating scales. The concurrent, convergent and construct validity of the Mini Mental State Examination (MMSE), the Alzheimer's Disease Assessment Scale (ADAS) and the CAMCOG are assessed. The Clinical Global Impressions and the Global Deterioration Scale are used as global scales. The concurrent and convergent validity are satisfactory. The construct validity expressed by the Cronbach and Loevinger coefficient are very good for all scales and subscales. The Mokken's single item coefficients show that the MMSE has the best individual hierarchical fit, the item reading can be left out. The ADAS is less uni-dimensional, eight items can be left out. The CAMCOG consists of too many items to apply the Mokken's single item coefficients or the Loevinger coefficient. Instead, the CAMCOG subscales are analyzed. This results in a possible reduction of the CAMCOG by 30 items to a total of 35 items. The factor analysis reveals two factors in both the MMSE and the ADAS while the number of observations does not allow a factor analysis of the CAMCOG to be performed.

Twenty-eight dysthymic patients (82.1% with personality disorders) were investigated with questionnaires for personality and depression before and after treatment. When in asymptomatic state, defined by clinical criteria and HAM-D score 6 or lower, the personality profile of 15 patients (group I) was significantly changed from the one before treatment (avoidant, passive-aggressive, borderline and schizotypal dimensions were lower, and narcissistic dimension higher [P < 0.01]). Thirteen patients (group II) had an unchanged profile. The first group showed significant state-trait dependence, especially of the borderline personality dimension. The second group manifested a permanent characterological affective syndrome, or a core borderline personality disorder. The limitations of personality assessment during affective episodes are discussed as well as the borderline level of functioning related to it.

The authors investigated the historical and clinical variables of 159 inpatients affected by mood disorders in order to identify variables which might differentiate psychotic from non-psychotic forms. The results showed that 32% of the patients had psychotic symptoms. Although no significant difference was detected with regard to the severity of depression, psychotic depressives were younger and had a lower age at onset, as well as a shorter episode length. These features suggest that depression may express itself with or without psychotic symptoms, according to the different individual and, perhaps, biological substrate. Taken together, our findings seem to indicate that psychotic depression should not be considered a separate clinical entity, but a subtype of mood disorders.

The use of benzodiazepines seems to be associated with a deficit in the levels of arousal and attention during vigil. A number of studies have found residual effects a few hours after the intake of these drugs. This paper assesses the effects of a single dose of 10 mg diazepam on self-informed arousal (as evaluated with the Stanford Sleepiness Scale) and sustained attention (as evaluated with the Toulouse Piéron test) the morning after oral intake (11 hours later). Potential differences in the residual effects of benzodiazepines on men and women were also examined. A sample of 42 healthy young university students (21 female, 21 male) was exposed to three counterbalanced experimental conditions (control, placebo, diazepam). Diazepam only caused a reduction in arousal in women, and this deficit was similar to that caused by the intake of a placebo.

A survey of the pharmacological and psychological treatment of panic disorder and agoraphobia (PDA) was conducted among 103 physicians, psychologists and psychotherapists. It revealed that the treatments for PDA preferred by the majority of the respondents are inconsistent with the recommendations given in the international literature. Non-psychiatric physicians most frequently proposed herbal preparations as a possible treatment (46% of non-psychiatric physicians), followed by homoeopathic formulations (32%). Tricyclic antidepressants which are recommended as first-line treatment in panic disorder by the literature are preferred by 74% of the psychiatrists, but only by 24% of the non-psychiatric physicians. Benzodiazepines are prescribed by twice as many psychiatrists (45%) as non-psychiatric physicians (22%). Beta blockers and neuroleptics which are not recommended as first-line treatment in panic disorder are used quite often (psychiatrists: 15%; non-psychiatric physicians: 26%). Selective serotonin reuptake inhibitors are prescribed by 24% of the psychiatrists, but by only 3% of the non-psychiatric physicians. Among psychological therapies, psychoanalysis was proposed as first-line treatment by 44% of all professionals applying psychological therapies, while cognitive/behaviour therapy was preferred by only 28%, though proof of efficacy exists only for cognitive/behaviour therapy. In general, psychologists prefer behaviourally-orientated therapy, while physicians mostly propose psychodynamic therapy. One reason for the fact that the results of controlled studies have little influence on professionals treating PDA patients might be that 40% of the respondents do not accept the new classification of the anxiety disorders as introduced in 1980 by the DSM-III.

Sensation seeking scale (SSS) scores were determined in 15 alcohol dependent men with a positive family history for alcoholism (FHP), in 15 alcohol dependent men with a negative family history for alcoholism (FHN) and in 15 well-matched healthy male controls (CONTR). Both FHPs and FHNs suffered from longlasting alcohol dependence meeting ICD-10 and DSM-III-R diagnostic criteria. Dopamine activity was neuroendocrinologically assessed by measuring the amount of growth hormone released after stimulation with the dopamine receptor agonist apomorphine. Planned comparisons within a one-way ANOVA yielded significantly elevated levels of boredom susceptibility (BOS) in both FHPs and FHNs against CONTRs. SSS total scores, while approaching statistical significance, were elevated in FHPs only. Partial correlations (controlling for age, body weight, alcohol intake and duration of dependence) were calculated to examine the relationship between SSS and dopamine activity. Among the SSS subtraits, BOS revealed the highest correlation in each group. However, only in CONTRs did the relationship between BOS and dopamine activity reach statistical significance.

The present paper deals with computer based training approaches in psychiatric rehabilitation. First an overview of programs is presented, which are currently available on the software market in Germany and appear suitable for the training of patients with information processing (including sensorimotor) deficits. Then a description follows dealing with a clinical setting which may serve to illustrate how computer based cognitive training can be organized in a group format. Finally a couple of clinical studies which have aimed to determine the efficacy of PC based training programs in schizophrenic patients are briefly reviewed.

In randomized clinical trials in patients with major depression quality of life is considered as an important dimension of treatment outcome in relation to clinical efficacy and safety. The internal validity, reliability, as well as external validity of quality of life scales have been analysed. It is concluded that such scales have their most appropriate applicability in medicine and long-term trials with antidepressants.

Over the past 15 years, researchers have shown an increasing interest in using event-related potentials (ERPs) to study depression. These studies generally fall into four classes: 1), ERPs as a means of detecting depression; 2), ERPs as a tool for distinguishing subtypes of depression; 3), ERPs as a measure of pharmacological effectiveness; 4), ERPs as indicators of defective cognitive operations in depressed subjects. Results from these heterogeneous approaches are often inconsistent and disappointing. Although some ERP components often show increased latencies and diminished amplitudes, these changes seem to reflect principally a variety of non-specific disorders affecting a wide range of cognitive functions rather than a precise and consistent deficit of a particular function. These disappointing results seem to be attributable to methodological problems (heterogeneous patient populations, disproportionate use of the odd-ball paradigm), and do not necessarily call into question the value of studying the ERPs. Furthermore, recent advances in ERP methodology have opened up new perspectives for ERP use in psychopathology.

The aim of the trial was to assess alpidem efficacy in preventing and treating the benzodiazepine (BZ) withdrawal syndrome (WS). A multicentre, double-blind, randomized versus placebo, parallel group study of six-week duration was carried out in outpatients suffering from generalized anxiety or adjustment disorder with an anxious mood and taking non-hypnotic BZ as continuous course of therapy of at least one-year duration. At the entry, the patients abruptly discontinued BZs and were treated with 50 mg/bid/tid of alpidem or placebo. Withdrawal syndrome diagnosis was (regarding treatment allocation) formulated by an independent psychiatrist, according to DSM-III-R and an appropriate scale, the SESSB. One hundred seventy-three patients were randomized and 148 completed the study. Withdrawal syndrome occurred in 27 patients of the alpidem group (31.0%) and in 38 patients of the placebo group (44.2%). A severe WS was diagnosed in 11.1% of the patients in the alpidem group and in 31.6% of the placebo group. If not having been withdrawn from the market, alpidem could have been useful for the prevention of BZ withdrawal syndrome.

This study aimed to explore the burden on the key-relatives of a sample of patients with obsessive-compulsive disorder and a control sample of patients with major depression. The level of burden of relatives of obsessive-compulsive patients was moderate to severe in most of the explored situations, and did not differ significantly from that of the relatives of depressives. Social relationships were compromised in 74% of cases, and feelings of depression were recorded in 84% of cases. The level of subjective burden changed according to the relatives' sex, age and position in the family. The degree of objective burden correlated with the level of patients' disability, whereas that of subjective burden correlated with the severity of patients' obsessive-compulsive symptomatology.

We assessed the relative efficacy and effectiveness of low-versus standard-dose neuroleptic therapy in reducing relapse rate in schizophrenic patients. Six long-term randomized controlled trials were retrieved through a MEDLINE search. A dose regimen between 50 and 100 mg equivalent of chlorpromazine, compared to a conventional one between 200 and 500 mg, was found to increase the likelihood of relapse in chronic schizophrenic patients. Differences, however, were statistically significant at 12 but not at 24 months of treatment.

Studies on long-term efficacy and safety should be a main concern in the evaluation of novel antipsychotics. The present paper is a review of important issues related to the design and performance of such trials. The variability of the natural course of schizophrenia, the variability in treatment response, and the variability of actions of different neuroleptics need to be considered. Long-term studies need to address maintenance of efficacy, prevention of relapse and recurrence, health economics, quality of life and a large number of safety issues in order to get approval for new drug applications and reimbursement on expensive new medicines. Assessment instruments for efficacy, tolerability and safety, need to be supplemented with rating scales for various aspects of psychopathology (positive, negative, deficit symptoms), social and work functioning, drug induced mental side effects, quality of life and accounts of total treatment costs.

The authors examine the situation of rehabilitation of schizophrenic patients in France. After describing the methodology of their survey, the results are given. The housing facilities include halfway houses, “therapeutic” flats. The rehabilitation facilities include outpatient clinics with vocational units and rehabilitation centres such as vocational centres and sheltered workshops. In addition, a few centres provide placement and follow-up in the workplace. This type of centre is a recent innovation which helps stabilized schizophrenic patients find a regular job. The Fondation Santé des Étudiants de France (the health foundation of French students) deserves particular mention because it provides rehabilitation to high school and university students. In the discussion, the authors emphasize the insufficient number of such facilities, due to French psychiatrists only quite recently becoming aware of the importance of rehabilitation, which in turn, leads to insufficient funding of public mental health. As a result, most of the rehabilitation facilities were created and are now managed by private associations such as Les Croix Marines, UNAFAM, MGEN, Fondation Santé des Étudiants, Route Nouvelle Alsace, CAPPA Clermont-Ferrand, etc. In addition, their administrative tutelage is so complex that very few new facilities are developed. In view of their experience, the authors suggest that a large number of vocational centres should be built since they provide an essential service. Thus schizophrenic patients could enjoy a decent life in our society and not become one of the already many homeless. The European Union and the Council of Europe ought to consider the increase of such centres as a significiant aspect of their mental health policy.

In order to assess the therapeutic efficacy of amisulpride in dysthymic disorder, two randomised double-blind trials were conducted in France. Both studies included outpatients meeting DSM-III-R criteria for primary dysthymia. Cases of double depressed patients with a mild or moderate major depressive episode superimposed to dysthymia were also eligible. The first study of a three-month duration compared amineptine (200 mg/day) to amisulpride (50 mg/day) and placebo. The second study of a six-month duration compared the therapeutic effects of imipramine (100 mg/day) to amisulpride (50 mg/day) and placebo. Results of the intention to treat analysis and of the end-point analysis were compelling and very similar: significant differences were demonstrated for all primary criteria between amisulpride and placebo and between imipramine and placebo but not between amisulpride and imipramine. For both primary criteria and the responder rate (CGI), statistically significant differences were evidenced between amisulpride and placebo and amineptine and placebo. The same differences were evidenced for SANS subscores. Beneficial effects of low doses of amisulpride in chronic depressive condition can therefore be discussed.

The purpose of this chronoepidemiologic study was to investigate the time-relationships between the yearly variations in occurrence of violent suicide in Belgium and the yearly variations in various biochemical, metabolic and immune variables in the Belgian population. The weekly mean number of deaths due to violent suicide for all of Belgium for the period 1979–1987 was computed. Twenty-six normal volunteers had monthly blood samplings during one calendar year for assays of plasma L-tryptophan (L-TRP), competing amino acids (CAA), and melatonin levels, maximal [3H]paroxetine binding to platelets, serum total cholesterol, calcium, magnesium, and soluble interleukin-2 receptor concentrations, and number of CD4+ T, CD8+ T and CD20+ B lymphocytes. The annual rhythm in violent suicide rate is highly significantly synchronized with the annual rhythms in L-TRP, [3H]paroxetine binding, cholesterol, calcium, magnesium, CD20+ B cells, and CD4+/CD8+ ratio; the mean peak (violent suicide, [3H]paroxetine binding) or nadir (all other variables) occurs around 3 May. There were significant inverse time-relationships between the time series of violent suicide rate and L-TRP, L-TRP/CAA ratio, total cholesterol, calcium and magnesium, CD4+/CD8+ T cell ratio and number of CD20+ B cells. Maximal [3H]paroxetine binding to platelets was significantly and positively related to the time series of violent suicide. An important part (56.4%) of the variance in mean weekly number of violent suicide rate was explained by the time series of L-TRP, cholesterol and melatonin.

The influence of an adrenal medullary transplant into the lumbar subarachnoid space on learned helplessness, an animal model of depression, was examined. The transplanted rats were found to be less susceptible than sham-operated animals to become helpless after administration of inescapable shocks. The effect was attributed to release of opioid peptides by chromaffin cells as it was reversed by naloxone. The viability of the transplanted tissue was verified by electron microscopy.

The purpose of this review was to analyze the literature for potential next-day residual effects of zolpidem, a non-benzodiazepine hypnotic, following nighttime administration. Based on more than 30 international clinical trials involving more than 2,600 subjects/patients, it can be concluded that at the recommended doses of zolpidem 10 mg for adults and zolpidem 5 mg for the elderly, at single or repeated dosing, in healthy subjects or insomniac patients, zolpidem appears to induce minimal next-day residual effects. As for all sedative hypnotics, zolpidem is indicated for the short-term treatment of insomnia and is recommended to be taken only when the patient is able to get a full night's sleep before resuming usual activities.

Recently, much effort has been directed towards reaching a consensus on the use of antipsychotic medication in the United Kingdom (UK) and in France. Anecdotal evidence suggests, however, that any differences that may exist between practitioners in the UK are only minor in comparison to those between practitioners in the various countries in the European Union. A comparison was conducted of the number of prescribed antipsychotic compounds, as well as their way of administration, in two samples of schizophrenic patients in the UK and France. French patients were much more likely to have been prescribed two or more antipsychotic compounds, either alone (relative risk: RR = 26.3; 95% CI: 3.8-190.6), or in combination with a depot preparation (RR = ∞; Fisher's exact test P = 0.04). British patients were more likely to have been prescribed a single depot preparation (RR = 4.7; 95% CI: 2.3-9.9). These disparities are related to contrasting views on the properties and indications of antipsychotics in the two countries. Given these disparities, working towards a European consensus appears essential.