Neuronal plasticity or remodeling is most often discussed with regard to cellular and behavioral models of learning and memory. However, neuronal plasticity is a fundamental process by which the brain acquires information and makes the appropriate adaptive responses in future-related settings. Dysfunction of these fundamental processes could thereby contribute to the pathophysiology of mood disorders, and recovery could occur by induction of the appropriate plasticity or remodeling. These possibilities are supported by preclinical and clinical studies demonstrating that there are structural alterations that occur in response to stress and in patients with mood disorders. Moreover, antidepressant treatment may oppose these effects by regulation of signal transduction and gene expression pathways linked to neuronal plasticity. These findings comprise a novel conceptual framework for future studies of the etiology of mood disorders and for the development of novel therapeutic interventions.

Serotonin receptor (5HTR2A) gene polymorphism has been reported to be associated with clinical phenotypes in schizophrenia. The current study attempted to investigate a relationship between 5HTR2A 102T/C polymorphism and personality traits as well as clinical symptoms in patients with ICD-10 diagnoses of schizophrenia and affective disorders. 5HTR2A genotyping, clinical and psychological assessment were administered to 375 patients, 104 first-degree healthy relatives of the patients and 157 controls. In the patients an association was observed between the 2/2 5HTR2A genotype and scores on the Hypochondriasis scale (MMPI) (ANOVA, F = 4.56; P = 0.011) and trait anxiety (F = 4.21; P = 0.002). A significant difference between 1/1 and 2/2 genotypes has been also found for Neuroticism scores (EPI) (t = 2.18; P = 0.0031). No significant differences by 5HTR2A genotype were observed in either the control or first-degree relatives' group for all scales studied. Positive, negative and psychopathological symptoms emerged higher in the 2/2 genotype patients compared to other genotype carriers. Therefore, the 2/2 genotype may contribute to produce the phenotype, with specific clinical and pathological features in common, regardless of nosologic heterogeneity of psychoses.

The severity of traumatization seems to correlate with a more severe course of post-traumatic stress disorder (PTSD) (and other post-traumatic disorders), while firm belief systems have been found to be a protective factor against post-traumatic disorders. This study sought to determine the role of belief systems in the outcome of psychotherapy for traumatized refugees. The charts of 141 consecutively treated refugees were evaluated retrospectively. A firm belief system was found to be an important predictor for a better therapy outcome. The importance of a firm belief system as a coping factor, which should be used as an instrument in therapy, is discussed. © 2002 Éditions scientifiques et médicals Elsevier SAS

From birth to two years, preschizophrenic children show much higher rates of neuromotor abnormalities and negative affective displays than their healthy siblings. Retrospectively, parents report that preschizophrenic children show more social and interpersonal problems and more abnormalities of thought. Similar results have been found with adolescents who have schizotypal personality disorder. Adolescence appears to be a critical period for the emergence of psychopathology in general, but especially for psychotic disorders. This may in large part be through the actions of gonadal and adrenal hormones, including cortisol, and in particular their influence on the expression of genes. In the case of schizophrenia, these are presumably the vulnerability genes. Patients with schizophrenia have heightened baseline levels of cortisol, and a heightened cortisol response to some biological challenges. Cortisol levels are positively correlated with symptom severity. In addition, the hippocampus, which modulates the activity of the HPA axis, is abnormal in schizophrenia. The HPA axis and hippocampal complex are modulatory neural systems; in the case of schizophrenia, what they might be modulating is the expression of abnormalities in dopamine neurotransmission. Whilst we assume that schizophrenia has prenatal neurodevelopmental origins, neural maturational processes that occur later in life, especially in adolescence, have significant implications for the expression of the illness. It is likely that preventive interventions for schizophrenia, be they pharmacological or behavioural, will have the best chance of success if they are directed at adolescents who are showing preschizophrenic indicators.

Ambivalence to treatment and repeated suicidal behaviour are well-known problems in suicide attempters. A randomised controlled study was performed to investigate the influence of repeated telephone contacts on treatment attendance, repetition of suicidal behaviour and mental health the year after a suicide attempt.

This study concerns 81 cases of lithium poisoning and shows that deliberate intoxications are prevalent during the first 3 years of lithium treatment as well as in cases with a previous history of suicide attempt. Therapeutic intoxications could generally be avoided by education concerning hygiene and diet and careful monitoring in cases of intercurrent diseases.

Little information exists on the medium- to long-term outcome of switching patients with schizophrenia from traditional depot to atypical oral antipsychotic agents. By detailed clinical audit, we identified a representative group of 102 patients of an Irish psychiatric service with DSM-IV chronic schizophrenia and on depot neuroleptics for a mean of 15 years. Of 69 eligible to participate, 33 entered a 6-month switch study of risperidone, with limited follow-up of consenters and non-consenters at 1 and 2 years. At 6 months, 23 of 33 were still on risperidone and had small significant improvements in clinical and extrapyramidal side effects, QOL and adjunct medication measures over baseline. At 12 months, 19 of 33 were still on risperidone, reducing to 13 of 33 at 2 years. At 2 years, of 32 surviving consenters to switch, 19 had suffered clinically detrimental events and were no longer on risperidone, compared to none of the 33 surviving non-consenters, who were all still on depot. These findings suggest that switching from depot to risperidone may encounter high rates of refusal and attrition subsequent to switch. While a majority of switched patients may improve after to least 6 months, audit plus switch may have clinically unfavourable effects on others over a 2-year follow-up period.

Current computerized tools allow detailed exploration of the structure and functioning of the “black box,” i.e., human cognitive and affective systems as well as thought. This technology was used to study the visual perception of facially expressed emotions. Morphological transition from one canonical emotion to another led to the creation of a continuum of intermediary pictures, and the identification of perceived emotions by 65 normal subjects was measured. We call this application “MARIE” (in French: Méthode d’Analyse et de Recherche de l’Intégration des Émotions; Method of Study and Analysis of Integration of Emotions). Our study examined the relationship between the quantitative modification of the continuum and the quantitative variation of the responses. Standardization of graphs led to the assessment of the two parameters of a Laplace-Gauss curve, i.e., mean and standard deviation. It is argued that such a tool could be very useful in the clinical assessment of the emotional state of subjects and/or of patients.

Sinistrality, characterized by an excess of non-right-handedness, has been reported in schizophrenic patients, but the findings are controversial.

The increasing evidence that bipolar and unipolar affective disorders have different biological etiologies and courses of illness has been associated with an intensifying interest in specific treatment regimens for both disorders during the last decade. In this context, the question arose whether antidepressants exert similar efficacy in the acute treatment of bipolar compared to unipolar depression. Although the clinical impression does not indicate substantial differences in the efficacy of antidepressants between these groups of patients, empirical databases concerning this topic are rare. The present study compared the efficacy of antidepressants in 50 unipolar and 50 bipolar depressed inpatients (ICD-9 criteria) under naturalistic treatment conditions. Both groups of patients were mahed for age, gender and duration of illness. Clinical assessments of status at the time of admission and at discharge were used to rate response to antidepressant treatment. Analyses of the data revealed that both groups of patients needed the same time for treatment response and did not show any significant differences in ouome measures at discharge. These findings do not concur with the hypothesis formulated by some experts in the field of affective disorders that antidepressants are less effective in the acute treatment of bipolar depressed patients compared to unipolar depressed patients.

Stress-induced structural and cellular alterations in the hippocampus can contribute to the pathophysiology of depression. The reversal of these alterations may be a mechanism by which antidepressants achieve their therapeutic effect. The aim of the present study was therefore to investigate  the effect of tianeptine on stress-induced structural changes and alterations in cerebral metabolites. To this end, psychosocially stressed male tree shrews were treated with tianeptine. A combination of in vivo and postmortem methods was used to evaluate the antidepressant treatment on the preservation of neuronal plasticity. It was found that all stress-induced effects were prevented by the administration of tianeptine. It is concluded that these findings provide experimental evidence for recent theories that impairment of neuronal viability and neuroplasticity might be important causal factors in mood disorders, suggesting tianeptine as a potential stimulator of neural resilience.

The authors have investigated the frequency of illicit drug use, and spontaneous and drug-provoked panic disorder symptoms in Hungarian youths. A semi-structured self-reporting questionnaire (with questions about drug usage and the persistence of some DSM-IV panic disorder symptoms) was filled out in discos/nightclubs, secondary schools and universities. Almost 17% of the total sample (n = 1298) reported on illicit drug-use at least once in their life, and this rate was significantly higher among males. Regardless of the illegal drug use 14.6% of the total sample reported on four or more DSM-IV symptoms of panic disorder, and this rate was significantly higher among females. Analyzing the panic disorder symptoms only among drug-users (n = 219), the frequency of persons with four or more anxiety symptoms was 14.1% before drug use, and it increased to 30.6% during the period of drug use (P < 0.001). The findings support previous results showing (i) higher prevalence of anxiety symptoms among females; (ii) higher rate of illicit drug use among males; and (iii) a possible anxiety-provoking effect of illicit drugs.

For young people experiencing a first-episode of schizophrenia, the first and most important matter to be attended to, once the diagnosis of schizophrenia has been made and patients have entered the care system, is to establish a treatment alliance. The next step is to conceive an individually tailored treatment programme (non-pharmacological as well as pharmacological). The use of antipsychotic drugs needs to be carefully discussed with both patients and families, as medication tends to have a poor public perception. Maintaining treatment is vitally important in terms of relapse prevention, but people who suffer a first-episode tend to terminate treatment early. Patients often discontinue their medication because of side-effects, although a number of other factors can also exert a negative influence on the continuous intake of medication. Among others, these include insufficient information provided to patients and significant others as well as lack of insight and problems in the doctor-patient-relationship. The published data indicate that the outcome of treatment is better for younger patients in a first-episode of schizophrenia than it is for patients who are more chronically ill. However, young patients are much more sensitive to compliance problems than older patients. The main challenge in this phase of the illness is therefore to convince patients that maintenance treatment is necessary in order to assure the best possible outcome.