Nineteen different slides of food items and their effects on appetite and hunger as rated on visual analogue scales were investigated in 20 bulimics and 9 anorexics (DSM-III-R) at the onset and after 8 weeks of behavioral hospital treatment; 9 controls were examined at the maximum of weight loss during a diet and at normal weight. At the onset of treatment appetite ratings were significantly lower in patients than in dieting controls. In anorexics and bulimics appetite ratings increased significantly during treatment. The sight of food did not increase reported hunger in bulimics but did so in controls. Appetite ratings, however, were significantly increased by the sight of food in bulimics as well as in controls. Despite the small sample size, it may be concluded that dieting and weight loss have different psychological implications in healthy controls and in patients with eating disorders, that dieting rather than weight per se influences appetite and that differences in hunger responsiveness to the sight of food in anorexics and bulimics seem likely.

Five endogenous depressed patients were asked to participate in a phase-shift experiment consisting of advancing, by 5 hours, the time-schedule of the major external synchronizers such as light/dark cycle, sleep/wake, meal-time and social activity cycles. Clinical and biological parameters (body temperature, plasma cortisol, TSH and norepinephrine (NE) circadian rhythms) were observed throughout this two week period. The circadian rhythms were severely altered in the pre-treatment period, with a significant reduction of amplitude. During the phase shift experiment, the clinical state of the patients improved significantly. Their circadian rhythms were dramatically impaired in the first days of the procedure and were then restored after the first week, with higher amplitude. However, the TSH circadian rhythm remained unentrained by the phase shift leading to an internal desynchronization. Our findings suggest that entrainment of internal clocks by environmental information may be impaired in depression.

The algorithms for the demonstration of shared phenomenology of psychiatric syndromes in DSM-III are resistant to quantification. In contrast, the rating scale approach quantifies clinical target syndromes in psychiatry. The two most useful statistical models for quantifying shared phenomenology by symptom rating scales have been reviewed; namely factor analysis and latent structure analysis. Results have shown that factor analysis has demonstrated dimensions of dementia, delirium, schizophrenia, mania, outward aggression, depression and anxiety. Latent structure analysis has confirmed that the items of brief rating scales (such as the Melancholia Scale) are additively related implying that their total scores are sufficient statistics for the measurement of these factors or dimensions. Latent structure analysis should be considered as a psychometric “glasnost” compared to algorithm-resistant logic of quantification in DSM-III.

Thirty-one patients, 30 girls and 1 boy, who had suffered from anorexia nervosa, were re-evaluated at a minimum of 4 years (mean 7.6 years) after onset. Follow-up information was based on a semi-structured interview and 2 self-evaluation questionnaires, EAT-26 (1979) and HSCL-90 (1976). As well as using the Garfinkel and Garner criteria (1977) for assessing outcome, 2 psychiatrists independently evaluated the psychiatric state using DSM III criteria. The results demonstrated that 54.8% of the sample had a positive and 45% (including 3 deaths) a poor outcome. Of the 25 subjects interviewed, 20% presented chronic anorexia. Seventy-two percent, on the other hand, showed an evolution in clinical diagnosis, meeting the criteria for a mental disorder other than anorexia nervosa: Affective Disorders (40%), Somatoform Disorder (16%), Anxiety Disorder (12%), and Bulimia (8%). Two variables were significant, in terms of poor long-term prognosis: a larger number of hospitalizations for anorexia and an unsatisfactory educational and/or vocational adjustment at presentation.

In 32 patients with panic disorder with or without agoraphobia, Bmax measures of 5-HT binding in platelets did not differ from normal controls at baseline. Plasmatic cortisol levels were significantly higher than controls in the morning and in the evening measures as well as in post-dexamethasone assays. Following an 8-week treatment period with alprazolam plus behavioral guidance encouraging exposure, Bmax values did not alter but cortisol measures diminished significantly. Measures of phobic avoidance were negatively correlated with 5-HT Bmax values. Plasmatic cortisol correlated positively with the number of situational panic attacks in the month before treatment. There were no correlations between cortisol and 5-HT Bmax measures. A possible link between serotonin function and phobic avoidance is discussed. Cortisol changes were interpreted as being related to the global severity of the anxious state.

Modafinil is a new psychotropic compound with central α1, adrenergic-stimulant activity in animals. In the present study, its pharmacological activity in man was evaluated in the sleep-deprivation induced psychomotor and cognitive impairment paradigm. This was a double-blind placebo-controlled study involving 12 healthy volunteers. Standard psychomotor and memory tasks were used, including critical flicker fusion frequency determination (CFF), choice reaction time and short- and long-term memory evaluation. Results revealed a clear antagonism by modafinil of the psychomotor and cognitive impairment induced by sleep-deprivation in most tasks 6 h after drug administration, and marginal effects 18 h after. These results therefore support a psychostimulant activity of modafinil in man.

There has been continued interest in the nature of the association between affective disorders and alcoholism. This may be due to the fact that during the course of alcoholism 30-70% of the patients suffer from mood disturbances meeting the criteria for severe depression, especially in periods of excessive alcohol consumption or during withdrawal. In the course of a prospective multidimensional study, Tiibinger Alkoholismusprojekt (T-ALK Study), symptoms of depression in 31 male alcohol-dependent patients (RDC diagnosis) were assessed using the Beck Depression Inventory (BDI) and the Freiburger Personlichkeitsinventar (FPI-R) at the beginning and at the end of a 6-week inpatient treatment program. There was only a moderate degree of depression (BDI) in 20% of the patients which decreased significantly during the psychotherapeutic treatment under conditions of confirmed abstinence. No correlations between the degree of depression and neuropsychological impairment were found. Although the “satisfaction with life” (FPI-R factor) was still impaired in a third of the patients at the end of that short-term treatment period, our results do not indicate a general nosological overlap between alcoholism and affective disorders in males.

Computer based quantitative evolution of the electroencephalogram (QEEG) holds promise as an adjunct in the evaluation of psychiatric patients. One such method is neurometrics (N-QEEG) in which quantitative electrophysiological features are evaluated by statistical comparison with age appropriate normative data and compared with the profile of dysfunction seen in different psychiatric populations. This paper is based upon the experiences of the senior author in using this method in a series of 88 patients seen in a clinical setting. Neurometric testing provided a unique and significant contribution to the clinical diagnosis or management of 12% of these cases and gave some clinically useful information in another 44% of this population. In the remaining 44%, the method did not provide any additional contribution to the clinical diagnosis and/or to the management of the patient. Six case histories are provided to illustrate these 3 categories. It must be emphasized that N-QEEG is not a technique that can be substituted for any part of a systematic clinical evaluation, least of all for the process itself, which remains crucial. Once embedded in a solid clinical framework, N-QEEG has the capacity to enhance one’s diagnostic efforts and therapeutic strategies by providing objective quantitative data reflecting brain dysfunction. In such a context, the nominative and cost-effective nature of this technique can further adds to its practicality.

The authors present an overview of the process for developing DSM IV which has been characterized by extensive international communication and collaboration and which includes three stages of empirical review: systematic literature reviews, analysis of unpublished data and field trials. Next, they describe in detail recently initiated DSM IV field trials. The field trials will study eleven diagnostic categories which continue to be the focus of much discussion. They include antisocial personality disorder, autism, disruptive disorders, dysthymia, insomnia, mixed anxiety and depression, obsessive-compulsive disorder, posttraumatic stress disorder, schizophrenia, somatoform disorder and substance use disorders. Each field trial compares the DSM III, the DSM III-R, ICD 10 and proposed DSM IV criteria for the disorder in question.

We present here a new instrument of measurement for systematic biases in patient response style when evaluating severity of depression, in the form of a self-rated questionnaire derived from the MMPI containing 37 items rating depressive severity (DSS), 15 items of the L scale, 27 items of the K scale, and 51 items of the F scale, making a total of 130 yes-no items. The scores of these 4 scales allow an estimation not only of depressive severity, but also of the attitude of the subject towards his own style of symptom reporting: “defense” and desire to appear “normal”, or on the contrary tendency towards exaggeration. In a population of 66 depressives, this instrument was correlated with the MADRS depression rating scale (P < 0.0001), which shows its sensitivity to depressive severity. The F scale and Gough’s index (F-K) were also shown to be correlated with MADRS scores. This self-rated questionnaire constitutes a clinical instrument that is simple and practical both to administer and to correct.

This study evaluates the relationship between stress of captivity and subsequent presence of Post Traumatic Stress Disorder (PTSD) has been evaluated in a homogeneous population of 817 Alsatian World War II veterans who were imprisoned in the USSR during and after the war. Data were collected in 1988 by a questionnaire structured to investigate the presence of DSM-III-R criteria for PTSD as well as events experienced in captivity. The presumptive diagnosis of PTSD was found to be significantly associated with longer internment and with higher scores on a severity of POW experience index.

Twenty five asymptomatic HIV-1 seropositive subjects were matched with 25 healthy seronegative low-risk individuals to evaluate emotional patterns. Seropositive subjects scored significantly higher, and an important emotional deficit was noticed. Sensation seeking subscores were significantly lower in the seropositive group.

The aim of this study was to test whether a positive and a negative component could be found in broadly defined schizophrenic patients. Therefore, 70 patients either in an exacerbated or in a stabilized phase were selected according to the criteria of at least 1 of the 4 following diagnostic systems: DSM III-R, Schneider, Carpenter, Langfeldt; principal component analyses (PCA) were carried out with the 9 global ratings of the Scales for Assessment of Negative and Positive Symptoms (SANS and SAPS) and with the Positive and Negative Syndrome Scale (PANSS). The PCA of the SANS-SAPS global ratings yielded a 3-factor solution explaining 72.14% of the total variance, depicting a negative, a positive and a disorganization component. The PCA of the PANSS provided a 5-factor solution with a total explained variance of 55.98%. The first 3 factors were similar to those of the SANS-SAPS global rating analysis. The results showed that the positive and negative components described in a homogeneous schizophrenic population could be replicated in a larger and more heterogeneous group of schizophrenic patients. The question regarding the sufficiency of the positive-negative dichotomy was strengthened by the presence of a third disorganization component which explained as much of the variance as the positive component.

The chapter dealing with the classification of mental disorders in the Tenth Revision of the International Classification of Diseases (ICD-10) has been developed after consultation with experts in many countries. Each of the categories has been clearly defined so as to facilitate the assignment of diagnoses. The descriptions of categories and the diagnostic guidelines have then been tested in 110 centres located in over 40 countries, and the results have been used to finalize the text. The classification will be issued in several versions - one for statistical purposes, one for clinicians, one for researchers and one for general practitioners. A multiaxial presentation of the classification is being tested at present and will be made available in early 1993. The paper describes the requirements and principles which led to the classification, depicts the process outlined above and gives prospects for the future.

The Autoradiographical Memory Test elaborated by Williams and Scott (1988) consists of presenting positive and negative cue words to subjects, and asking them to retrieve specific personal memories in response to each cue in under 60 s. This method was applied to 20 subjects who met the DSM III criteria for Major Depressive Episode, and 20 volunteers paired for age (± 3 years), sex and instructional level. In general, our data confirm the results obtained by Williams and Scott (1988): the number of specific memories is significantly lower in depressive patients than in control subjects, especially in response to positive cues.

Results of the dexamethasone suppression test (DST) in demented nondepressed patients have varied considerably, and there is evidence that these depend on the type of dementia, ie, Alzheimer’s disease (AD) or multi-infarct dementia (MID). AD is characterized by decreased central acetylcholine (Ach) activity, while MID is thought to be vascular in etiology. Pirecetam normalizes cerebral blood flow, along with other positive hemorheological properties. It may also increase central Ach levels. We performed the DST twice, 1 week apart, on 96 stable, demented geriatric inpatients. In 33 (21 AD, 11 MID), piracetam was started at an oral dose of 4.8 g/d 4-6 months before the first DST. The remaining 64 (39 AD, 25 MID) were untreated. Among untreated patients, those with MID were less suppressible (P < 0.001 and P= 0.01) and had more week-to-week variability (P = 0.0006) in the DST than AD patients. This is consistent with our previous findings. However, treated patients showed no difference in either postdexamethasone cortisol levels or reproducibility of DST results. We interpret these findings to mean that piracetam, by increasing central Ach, makes AD patients less suppressible on the DST, and by maintaining more constant limbic blood flow, makes MID patients more DST stable.

The Brief Psychiatric Rating Scale (BPRS) is expected to provide a valuable instrument for routine evaluation of the patient's status and correct interpretation of concentrations measured during therapeutic monitoring of antipsychotic drugs. Inpatient files were searched for information relative to acute episodes and BPRS items were scored every 10 days until discharge from the hospital according to a retrospective scheme. Eighty patients were included, who met DSM III criteria for schizophrenia and bipolar disorder. Clusters of symptoms that tend to appear together were identified through principal components analysis and are in keeping with factors described previously. Differences with respect to diagnosis further suggest that such clusters convey clinically relevant information. The time course of haloperidol action was also investigated: an average 51 % improvement was observed over the first 10 days, while the proportion of patients showing a 50% or larger BPRS decrease at the time of discharge reached 90%. The prominent contribution of changes in positive, florid symptoms to global improvement is also described. Finally, association of clinical improvement with a shorter period of hospitalization is shown. These results indicate that the BPRS represents a level of abstraction compatible with the way clinicians communicate and that its introduction into routine practice may allow for better description of the course of illness

The hypothesis that tardive dyskinesias observed after long-term administration of neuroleptics are due to the formation of free radicals following this medication has prompted studies on the use of vitamin E (α-tocopherol), an antioxidant to treat patients suffering from such side-effects. The present study aimed at reproducing earlier encouraging results in treating 23 patients with vitamin E, using a double-blind crossover design. Inclusion criteria were: duration of tardive dyskinesia for at least 3 months, appearance of the symptoms during neuroleptic treatment or after stopping this kind of medication. The 10 subjects in the first group (Gl) were treated for 14 days with 1 200 mg vitamin E per day and then for 14 days with placebo. For the second group (G2) with 9 subjects, the treatment periods were inversed. The 2 dropouts in each group were not due to experimental problems: there was no complication due to vitamin E intake, or only negligible side-effects. Side-effects were rated on the AIM scale on days 0, 14 and 28. The results of the present study do not confirm earlier reports: there was no significant difference in the therapeutic effect between placebo and vitamin E in any of the groups. However, the fact of taking these symptoms into account in the physician-patient relationship has contributed significantly to a decrease of tardive dyskinesia in both groups, from the beginning until the end of the investigation period, during which both neuroleptic and tranquilizing treatments were kept constant. Further studies should include longer treatment periods with vitamin E or even test the preventive effect of vitamin E in the production of tardive dyskinesia by neuroleptics.

Clinical psychiatrists face the dilemma of ‘humanism’ versus ‘reductionism’ when confronting the problem of diagnosing and classifying patients. The introduction of ‘operational’ or ‘explicit’ diagnostic criteria (ODC) should provide a middle-ground enabling the clinician to combine person-oriented approach with a more rigorous application of knowledge-based decision rules. More than a decade of world-wide experience with ODC should enable at least a preliminary evaluation of their utility and cost not only from the point of view of the clinician and researcher but also from the position of mental health care consumers. In order to maximize usefulness, the developpers and users of ODC should avoid their ‘reification’ as the ultimate standard in psychiatric diagnosis and retain an attitude of epistemological openness.

Ten outpatients with panic disorder were treated over an 8 week-period with milnacipran, an antidepressant active on both noradrenergic and serotonergic systems, at a dose between 100 and 150 mg/d. Clinical assessments included the Hamilton Anxiety Scale and the Cottraux Rating Scale for phobias, panic attacks, and generalized anxiety. Results showed very significant improvements in the frequency and intensity of panic attacks and in the level of generalized anxiety. A good or excellent response was noted in 7 patients. Only 3 patients complained of side-effects, mostly of the digestive type. These promising results of milnacipran in panic disorder need to be confirmed in controlled studies.