Major depression is one of the medical disorders in which quality of life instruments have most often been applied. It is important to distinguish between disease-dependent scales (ie, scales measuring the symptoms of major depression, such as the Beck Depression Inventory) and generic scales (ie, scales measuring self-reported states without reference to a specific disorder, such as the WHO well-being scale). The empirical use of generic scales for quality of life major depression has indicated that they can predict relapse and compliance. In the future, more trials comparing the different treatments with cost-effectiveness vs quality of life in major depression are required.

Cannabis has been reported to produce acute psychiatric reactions, among these panic anxiety and derealization, which are self-limited. We report on three patients who experienced an initial panic attack during cannabis intake. Anxiety attacks reoccurred after the cessation of intake. Two of these patients had a current depressive disorder, one of them had a single Grand Mal seizure before the onset. We suggest that cannabis may trigger the emergence of recurrent panic attacks and uncover latent panic disorders in vulnerable persons.

In a double-blind multicentre study of outpatients with DSM-III-R major depressive disorder, 129 sertraline and 129 placebo patients were evaluated over a 6-week period. Sertraline exhibited a significantly greater (P < 0.001) antidepressant effect compared to placebo as measured by the HAM-D, MADRS, CGI-S and CGI-I. In the subset of patients with severe depression (baseline HAM-D ≥ 25), sertraline was also significantly more effective than placebo (P < 0.05). Side effects were more commonly reported in sertraline (59%) compared to placebo (38%) patients; the most common being nausea, headache and insomnia. A subset of 107 patients (66 sertraline; 41 placebo) who were defined as responders (CGI-I of 1 or 2) after 6 weeks treatment were entered into a 20-week continuation phase. In this responder subset, there was continuing improvement in both groups of patients, but with no significant differences in mean HAM-D or MADRS between the groups. However, a higher number of sertraline patients were associated with a persistent pattern of improvement relative to placebo (P < 0.05). The incidence of side effects was similar in sertraline (52%) and placebo (49%) treated patients in the continuation period.

The thyrotropin (TSH) and prolactin (PRL) responses to protirelin (TRH) were studied in 62 female unipolar depressive patients, 24 delusional (psychotic) and 38 nondelusional (Diagnostic and Statistical Manual [DSM]-III-R criteria). The TSH response to TRH was blunted (≤6 μlU/mL) in ten of the 24 delusional (41.6%) and in 18 of the 38 nondelusional (47.4%) patients, the difference being not significant. The TSH and PRL responses to TRH, calculated as area under the curve, were not different between the two groups. Similar results were obtained when the response patterns were compared by repeated measure analysis of covariance.

The assessment of quality of life (QoL) and economic outcomes of psychotropic medications are closely related. Both costs and QoL are important in establishing the value of new and existing drugs in order to assist patients, physicians, payors of health care, and society to make optimal decisions. These parameters may be combined, as in cost-utility analyses, or analysed separately. Although not a true reflection of normal practice, clinical trials are most often the setting for measurement of these parameters. The viability of such analyses, which often necessitate the inclusion of active comparators and additional work measuring costs and QoL, within the context of controlled studies must be established early on in the development process. If ‘registration oriented’ trials are inappropriate, alternative strategies must be pursued.

A case is described where phototherapy rapidly restored sleep-wake disturbances and concurrent symptoms of delirium in a patient who did not respond to conventional treatment with haloperidol. In this case, the delirious state may have been caused by a change in metabolism as a result of sepsis. Exposition of the patient to 8,000 Lux during 1.5 h for 5 consecutive days was sufficient to suppress all delirious symptoms and to normalize sleep. This result may encourage the setup of systematic studies towards the extent of desynchronization between various rhythmic cycles in delirium and towards the value of phototherapy for the restoration of normal circadian rhythmicity.

Young homocystinuria patients suffering from lens dislocation frequently have to undergo eye surgery. We describe a 16-year-old girl with mild mental retardation who became psychotic-delirant immediately after the last of three lentectomia operations performed under general thiopental anaesthesia. Because methionine, homocysteine, its oxidation product homocysteate and cysteine are potent glutamate agonists, the disturbance of the sulphur containing amino acid (SCAA) metabolism in homocystinuria patients may alter the function of cerebral glutamatergic transmission. The chronic and acute neurological and psychiatric symptoms of homocystinuria patients offer a clue to studies of the neurotoxic but also antipsychotic potency of glutamate agonists like the SCAAs in humans.

The limits of the role of psychiatrists are becoming increasingly vague as a consequence of the confusion on the theoretical model, the excessive size of the field and the managed care movement that is deeply altering the way psychiatric services are delivered. A thorough reflection has to be made about the need to strengthen the professional identity of future psychiatrists in the course of their training. Theoretical orientation of psychiatrists depends, to a large extent, on the training that they received during residency and the type of practice they undertake. It is necessary, therefore, to consider that the institutional path and expected activities in the program of training postgraduates is particularly important for the development of the identity of the resident as a psychiatrist. The criteria for elaborating these programs have to take into account, not only the opinion of the teachers and of the residents, but also many other parameters, one of which is the description of what makes a true psychiatrist in his or her clinical practice, so as to adapt the content of programs to the realization of inherent objectives to the activities described.

Past studies examining the prevalence of psychiatric disorders among migrants have described a higher rate of schizophrenia, whereas the only major German study found a lower rate. Considering the changed composition of migrants today, a new assessment has become necessary. All admission records of migrants to a psychiatric clinic in 1993 and 1994 were assessed for diagnosis, symptomatology and treatment. Two hundred sixty-three migrant admissions, 8.4% of total admissions, were assessed. Of these 41.4% received a diagnosis of a schizophrenic disorder, significantly more than other clinic patients. The mean age at admission was 33.8 years, at onset of illness 28.6 years and at time of migration 20.3 years. Only 7.9% were mentally ill at the time of migration. Of those with psychotic and depressive symptoms at admission, 70% received a diagnosis of a schizophrenic disorder and 78% were treated with antipsychotics. Antidepressants were prescribed only to 47% of those with a diagnosis of a depressive disorder and only 33% of those with depressive and no psychotic symptoms. An underrepresentation of migrants shows differences in the use of psychiatric services. The higher rate of schizophrenia may be due to misdiagnosis, an artifactual effect of underrepresentation of other disorders or an actual higher rate among migrants. The reluctance to use antidepressants underlines the necessity of training, so as not to withhold treatment options due to cultural barriers.

Memory loss is the most common early symptom of Alzheimer's disease (AD). For this study, we chose the hippocampi as regions of interest. The hippocampus, which is closely associated with memory processing, is known to be vulnerable to damage in the early stage of AD. We considered both inter-group (patients vs controls) and intra-group (right vs left hippocampus) comparisons. We examined seven patients meeting the DSM-III-R criteria of senile dementia and the National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association (NINCDS — ADRDA) criteria of probable AD, and II aged controls. This study focused on the measurement of phosphorus 31 (31P) Nuclear Magnetic Resonance (NMR) spectroscopy metabolites in each hippocampus. We found significant differences in phosphorus metabolites for both intra-group comparison (pH shifted towards relative alkalosis in the left hippocampus of patients) and inter-group consideration (reduced phosphodiesters [Pde]and elevated gamma adenosine triphosphate (ATP) in the right hippocampus, higher inorganic phosphate (pHi) in the left hippocampus for patients as compared to controls). We suggest energy failure and membrane functional breakdown in patients compared to aged controls.

Both clinical experience and earlier research have indicated that an increased number of violent incidents in a psychiatric ward may be strongly associated with the use of new staff. In 1991 a substantial number of staff was recriuted to a ward for commited patients. Incidents of violence were registered over the following 12-month period. The results of this study were compared with early registered violent incidents in a previous setting. It was found that the frequency of violent incidents could be kept at a low and stable level despite the new situation. In conclusion, a certain number of factors may be expected to affect the results: the specific pharmacotherapy in the treatment of acute psychosis, the physical environment of the ward, and, in particular, staff training.

The joint development of the Dutch and English versions of the Quality of Life in Depression Scale (QLDS) is described. The QLDS is based on the needs model of quality of life developed by Hunt and McKenna. The scale has good reliability and internal consistency. Test-retest correlation coefficients were 0.94 and 0.87 in the United Kingdom and the Netherlands, respectively. Internal consistency alpha-coefficients were 0.95 and 0.92, respectively. The validity of the scale is highly acceptable. The QLDS was shown to correlate relatively highly with established measures of well-being, and scores obtained with the measure were related to severity of depression as assessed by the Hamilton Rating Scale for Depression. The QLDS was shown to be responsive to change in an open study with fluoxetine in 540 patients with major depression. The scale has wide applicability and has been shown to be user-friendly, both for respondents and administrators. It has been, or is in the process of being, tested for reliability and validity in the following additional countries: Australia, Austria, Belgium, Canada, Denmark, France, Germany, Italy, Morocco, Spain and the United States.

In an open-label study, famotidine was added to the regular neuroleptic regimen of 11 schizophrenic patients for 4 weeks. Each patient was scored weekly with SAPS, SANS, CGI and HAM-D-17 scales. The results suggest that famotidine is indeed effective as an adjunctive drug to neuroleptics in the treatment of schizophrenia.

In this symposium the nature, epidemiology and extent of psychiatric disorders comorbid with addictions, especially alcoholism, was exposed. Internationally reknown authors from several European countries highlight the diversity and complexity of this problem in particular for depression, anxiety and suicide. The conclusion is that every psychiatrist should be well acquainted with addiction disorders and that no addiction center be allowed to refuse treatment to patients with a psychiatric comorbid disorder. Comorbidity of schizophrenia with addictions should be a future focus of research. Multicultural Europe is an exciting area for further research of the comorbidity problems.

We report a cerebrovascular accident after Ecstasy (MDMA) intake which induced a frontal dementia in a young man.

The purpose of this study was to examine the relationship of sleep panic to major depression in patients with panic disorder. We found that the patients with sleep panic had a higher prevalence of major depression than subjects of other panic disorders.