A representative sample of teachers working at the primary or secondary grade level in both public and private schools answered an anonymous questionnaire on sociodemographic information and completed the Center for Epidemiologic Studies Rating Scale for Depression (CES-D). The teachers were classified as depressed when they scored ≥ 16 on the CES-D; 27.5% of the subjects were above this cut-off score. Logistic regression was used to calculate a multivariate model with the variables school ownership, grade level and teaching experience. Working in a public school, teaching at the primary level and longer teaching experience all increased the risk of depressive symptomatology.

Panic disorder is widespread in Australia, often in combination with other psychiatric conditions such as agoraphobia or major depression. Pharmacotherapy for panic disorder in Australia commenced with benzodiazepines, and later progressed to tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs). More recently, treatment has moved towards use of the selective serotonin reuptake inhibitors (SSRIs), which are effective and better tolerated. Paroxetine is the first drug of this class to receive approval for treatment of panic disorder in Australia.

The data on efficacy and tolerance from four (phase II and III) trials of quetiapine (Seroquel® or ICI 204,636) in a total of 1,461 patients with acute exacerbations of chronic or sub-chronic schizophrenia are briefly reviewed. Together, the results of these trials have demonstrated antipsychotic efficacy in comparison with placebo and equivalent efficacy to haloperidol. In spite of its short plasma elimination half-life, quetiapine is equally effective when given in twice-daily and three-time daily doses. The optimum dose is between 300 mg and 400 mg per day, and the main and most consistent adverse effect is sedation. It has a low extrapyramidal side effect liability and does not produce sustained elevations in plasma prolactin levels.

The onset of activity of antidepressants is a clinically and theoretically important criterion of efficacy. We estimated the onset of activity by an intraindividual regression analytical approach. It is assumed that efficient treatment causes a fast shift of depression scores from a baseline level to an end level. From this assumption follows a limited number of opportunities for the onset of activity to occur. These opportunities correspond to different regression models which are estimated for each patient's depression course. The day of onset is concluded from the regression model which produces the best fit to the empirical depression curve. Results of a double-blind clinical trial comparing mianserin and amitriptyline are reported (n = 28). The methodological approach confirms that observer ratings by physicists show a significantly earlier onset of activity than self ratings by the patients. The D-S also shows a significantly earlier onset of activity of mianserin compared to amitriptyline. The discussion emphasises methodological aspects.

Seasonal variation in the births of patients with schizophrenia is a consistently replicated epidemiological finding. Few studies have investigated this phenomenon among patients with a diagnosis of affective disorder. The majority of season of birth studies have employed the chi square test for statistical analysis, a method that has been subject to some criticism. Using a Kolgomorov-Smirnov type statistic, the quarterly birth distribution of 6,646 patients with an ICD 9/10 diagnosis of affective disorder were compared to the general population. Only the births of those individuals with unipolar forms of affective disorder (n = 4,393) differed significantly from the general population, with significant excesses and deficits in the second quarter and fourth quarter respectively. These results were not altered by application of the displacement test. © 1998 Elsevier, Paris

Attention to the legal position of psychiatric patients has greatly increased during the last 25 years. The criteria for a civil commitment have been tightened and procedural guarantees have increased. In many countries major changes and improvements in the area of mental health law took place. In this paper the main developments are discussed. Attention is given to the legal protection in case of civil commitment, to the legal position of the involuntarily admitted patient during his stay in hospital and to the relationship between patients' rights and the availability of mental health care. Furthermore the impact of legal intentions to the field of psychiatry is discussed. It is argued that legal interventions should be closely monitored, in order to prevent negative consequences. Legal interventions may be necessary, but this instrument should be used with great caution.

As part of the WHO-PPGHC study aimed to better understand the form, frequency and burden of psychiatric conditions in primary care throughout the world, the clinical characteristics of dysthymic patients consulting in primary care were examined. A total of 25,916 general health care attenders at 15 sites in 14 countries were screened using the 12-item General Health Questionaire (GHQ-12). Of those screened, 5,438 were assessed in detail using a Primary Health Care version of the Composite International Diagnostic Interview (CIDI-PHC) in conjunction with among others the Brief Disability Questionnaire (BDQ) and the 28-item General Health Questionnaire (GHQ-28). General practitioners (GPs) gave their opinion on the existence of a psychological problem and indicated what therapeutic intervention was proposed to patients they recognised as psychological cases. The estimated current prevalence of dysthymia as defined by the ICD-10 was 2.1%. The social disability was found to be substantial in patients with dysthymia (52.2% of patients moderately or severely disabled) similar to that observed in patients with Depressive Episode (DE) (57.4%). When both conditions were present, the level of disability was even higher (63.6%). The symptoms presented by dysthymic patients without DE were mostly those specific for the diagnosis of dysthymia (ie, tearful, hopeless, inability to cope, pessimism) while these symptoms were less frequent when dysthymia was complicated by a DE. On the contrary, fatigue and loss of interest were more rarely observed in “pure” dysthymics. In spite of a lower symptomatic severity about half of the patients with dysthymia were recognised as cases by their GPs, a proportion similar to those with DE. However, dysthymics without DE were not, in contrast to patients with DE or with dysthymia and DE, more treated with drugs than non-depressed patients.

Panic disorder is a chronic condition for many patients and can be socially, emotionally and occupationally disabling. Until recently, clomipramine and alprazolam were the only drugs approved for its treatment. While widely used in the US and Europe, both belong to drug classes (tricyclics and benzodiazepines) with well-recognised side effects that can be problematic and thus limit their use. Recently, paroxetine became the first selective serotonin reuptake inhibitor to receive approval and licensing for panic disorder.

The short- and long-term efficacy and tolerability of paroxetine in panic disorder has been established in clinical trials of almost 1,000 patients meeting Diagnostic and Statistical Manual (DSM)-IIIR criteria for panic disorder, with or without agoraphobia. In a 12-week double-blind study of 120 panic patients receiving standardised cognitive therapy, paroxetine was significantly more effective than placebo in reducing panic attack frequency. In a 12-week placebo-controlled comparison in 367 panic patients, paroxetine was at least as effective as clomipramine and better tolerated. There was also some evidence that paroxetine had an earlier onset of action than clomipramine.

A 9-month extension of the placebo-controlled comparison with clomipramine showed that the efficacy of paroxetine and clomipramine is maintained when treatment is continued into the longer term. In a relapse prevention study, 105 responders to 3 months' treatment with paroxetine or placebo were re-randomised, either to continue existing treatment or to receive placebo for 3 months. Only 5% of patients who continued to take paroxetine experienced a relapse compared with 30% of those who switched to placebo (P = 0.002). Paroxetine was generally well tolerated. In the short-term trials, the frequency of withdrawals due to adverse events (7.3%) was lower than that for placebo (11.4%) or clomipramine (14.9%). In the longer term, the dropout rate due to adverse events increased in the clomipramine group (19.0%) but was unchanged in the paroxetine group (7.4%). Since most patients with panic disorder will require prolonged treatment, the long-term tolerability of paroxetine and its lack of potential for dependence are important advantages that will encourage good compliance with treatment and improve the quality of life of patients.

Open trials with tricyclics, classical monoamine oxidase inhibitors (MAOIs) or lithium in dysthymia yielded a response rate in 45% of subjects. A long-term treatment of dysthymia with 276 patients treated during 4 years with either moclobemide, tranylcypromine or a combination of amitryptiline plus chlordiazepoxide is described. After discontinuation there was a relapse rate of 89.1%. The controlled studies with tricyclics, MAOIs, reversible inhibitors of monoamine oxidase (RIMAs), specific serotonin reuptake inhibitor (SSRIs) or benzamides showed that drugs well-tolerated work better in dysthymia, due to the fact that the treatment must be long-term. Sertraline was studied vs placebo or imipramine in primary dysthymia. Moclobemide, imipramine and placebo were also studied in 315 patients. Mean doses were 650 mg/d of moclobemide and 203.2 mg/d of imipramine. Moclobemide and sertraline were both efficacious and well tolerated. In a long term treatment the clinician should assess the risk-benefit ratio. Dysthymic patients are very sensitive to unwanted effects and compliance is a serious issue.

In order to identify clinical and demographic variables that predict response to antidepressants and to analyse prediction of outcome as a function of definition of outcome we analysed pooled data of two independent, multicentre, double blind parallel group studies. Study I compared the efficacy of mianserin with that of fluoxetine in 65, and study II compared mianserin with fluvoxamine in 60 patients with depression. Improvement was defined as at least 20% decrease in MADRS by day 14. Patients were considered as responders if they had greater than 50% decrease and non-responders if they had ≤ 50% decrease from baseline in the MADRS at day 56. Complete remission was defined as MADRS score ≤ 6 at day 56. Patients' characteristics did not differ between mianserin and SSRI groups. Early improvement predicted response in 92% and complete remission in 55% of the patients improved at day 14. Multivariate forward stepwise logistic regression analysis showed that response to treatments at day 56 was significantly (P = 0.0003) associated with early improvement, age (responders had higher age than non-responders) and weight (responders weighted more than non-responders). Complete remission was only predicted by early improvement. Treatments could not be differentiated when data were analysed according to responder/nonresponder status or complete remission/no complete remission. However, when the same data were analysed by analysis of variance a significant treatment effect (P = 0.02, mianserin > SSRIs) and a quadratic type treatment by time interaction (P = 0.023) were found. The robustness of the analysis was further improved by inclusion of covariates (age, weight). Early clinical improvement seems to be the best predictor of 2 month response to antidepressants (mianserin, SSRIs). Younger age and lower weight may predict non-response. Quantitative analysis differentiates treatments better than analysis of responder status. As obtenation of complete remission is a realistic objective with current antidepressants, studies longer than 2 months are needed to assess effectiveness of these drugs in the obtenation of complete remission.

Data from six randomised, controlled, comparative studies of risperidone and conventional neuroleptics (haloperidol, zuclopenthixol and perphenazine) in the treatment of 911 patients with chronic schizophrenia were analysed to estimate the benefits and risks of treatment. Efficacy and risk of treatment were assessed by means of the Positive and Negative Syndrome Scale (PANSS) and the Extrapyramidal Symptom Rating Scale (ESRS). An effect size (difference between treatments) was calculated from the PANSS and ESRS scores. The effect size of antipsychotic effect favoured risperidone (sizes ranged from 0.22 to 0.37 on the PANSS subscales), and the effect size of safety also favoured risperidone (sizes ranged from 0.18 to 0.36 on the ESRS). An analysis of the proportions of patients requiring antiparkinsonian medication produced an effect size of 0.37 (20% of risperidone patients and 38% of patients receiving a conventional neuroleptic required antiparkinsonian medication). These data indicate that risperidone is a more effective antipsychotic than the conventional agents and causes less severe extrapyramidal symptoms.

This article analyses the historical and psychosocial background of the sterilisation of mentally handicapped individuals in France and investigates the relationship between their sexuality and their sterilisation. Sterilisation of the mentally handicapped has been used as a method for controlling their sexual activity. The processes and situations leading to the sterilisation of the mentally handicapped are described and discussed.

Although only a few studies have been performed and published data are scarce, it seems clear that sexual dysfunctions frequently occur during treatment with antipsychotics in 30–60% of patients with schizophrenia. It is important to evaluate the occurrence of sexual dysfunction and its relation to antipsychotic treatment.

To characterise frequent use of psychiatric emergency outpatients services, this paper reports results from a prospective investigation of use of psychiatric services by new patients in two Nordic psychiatric services, Frederiksberg in Denmark and Oulu in Finland. One year treated incidence cohorts were used. Total number of patients included was 1,055. The repeat user was defined as a patient having at least three emergency outpatient contacts during a 1-year follow-up. The repeat users constituted 15.8% of the sample and 70.8% of all the emergency contacts in Frederiksberg. In Oulu the respective figures were 9.3% and 33.8%. The number of planned outpatient contacts or the number of hospital admissions of the repeat users did not differ from the non-repeaters. Repeaters in Frederiksberg were more likely to be self-referrals, male, divorced or unmarried, living with their parents, without their own housing, unemployed, aged between 25 and 44 years, and to have a diagnosis of dependency or personality disorder. In Oulu they did not differ from the other patients with regard to sociodemographic or diagnostic characteristics.

This study was conducted to investigate the corticotropic axis in anorexia nervosa. In 93 female inpatients who met DSM-III-R criteria for anorexia nervosa, subsample (n = 64) with DSM-III criteria was also considered. Using stepwise regression analysis, this study examined the relationship between independent variables ie, age, body mass index, scores on depression scales and postdexamethasone serum cortisol, considered as a dependent variable. In patients who met DSM-III criteria, 16.7% of the variance of serum cortisol can be explained. The main predictors are depressive retardation, emaciation and age. Using stepwise logistic regression the main categorical predictors of the test suppression vs non suppression are of the same nature. The condition of realisation of DST are discussed.

The validation of the French version of the Edinburgh Postnatal Depression Scale (EPDS), conducted on a sample of 87 women in the first 4 months of post-partum, is presented. The study of the sensitivity, specificity and predictive values versus research diagnosis criteria provide the cut-off score of 10.5 as the best (sensitivity: 0.80; specificity: 0.92). The EPDS as an index of severity of postnatal depression (PND) also had good criterion validity compared to the psychiatrist's assessment. Factor analysis shows that the internal structure of the EPDS is composed of two subscales which underline a more accurate description of PND. The reliability study confirms the good internal consistency of the global scale (Cronbach's alpha: 0.76) and its good short term test-retest reliability (0.98).