A study sample of 88 patients suffering from delusional beliefs was examined from first admission to follow-up. From the time of index admission, global functioning differs when distributed in accordance with ICD-10 categories. Patients with the discharge diagnoses affective disorder and acute and transient psychotic disorder have similar and optimistic perspective. The most pessimistic perspectives apply to patients with schizophrenia and an intermedium, but a rather pessimistic position also applies to patients with persistent delusional disorder. According to the discharge diagnosis following first admission, the score of global assessment functioning (GAF) at follow-up (8 years) is: schizophrenia 37; affective disorder 73; persistent delusional disorder 47; and acute and transient psychotic disorder 70. Generally, short-term outcome bears close resemblance to that of middle-term observation. During the observation period, 13 patients died. Amongst the surviving 75 patients, diagnosis at follow-up differed from that given at first-admission discharge, in eight cases using ICD-10 and in ten cases using DSM-III-R. Therefore, the use of ICD-10 as well as DSM-III-R enables clinicians to estimate a high stability (89%) diagnostic category with minimal delay.

A review of the literature shows that the admission rates of new cases of schizophrenia vary with a factor of two to five in North American studies as well as in European studies. Furthermore, the tendency has been decreasing for the last 40–50 years in Europe. Eighteen studies specifically analyzing the development over the last 20 years are reviewed. The studies preponderantly show significant decreases most probably due to the reduction of the number of available psychiatric beds alongside the decentralization of psychiatry, and to decreasing virulence of schizophrenia. Alternatively, a diagnostic delay of schizophrenia can hardly explain the decrease.

In this cross-sectional study we have investigated the attitudes and feelings toward the mentally ill among the residents of two Central European regions which are at considerably different stages of development in moving toward community-based care, to see if we could connect differing patterns of attitudes in the two regions to the varying levels of development of psychiatric care. By using the telephone survey method, representative samples of interviewees were presented with two complexes of questions, measuring the social distance of the interviewee to the mentally ill and his/her feelings toward the mentally ill. Social rejection and feelings of the people toward the mentally ill in both regions were similar in the direction they took, however not so much in the intensity. The population of the community care area showed a slightly stronger rejection. But factor analysis clearly suggests a more rational and sophisticated position toward the patients in this population. The people living in the custodially-oriented catchment area, on the other hand, showed a more vague pattern in their attitudes.

Depression and panic disorder co-occur in about one-third of people presenting with either condition. When they occur together they present diagnostic and treatment dilemmas for the clinician. However, this is a clinical problem that has been routinely ignored by researchers because of the diagnostic criteria before DSM-III-R, and the restrictive entry criteria in drug trials where patients must have one clearly defined illness.

The treatment of nonresponsive schizophrenia poses perennial problems. The situation is made yet more complex when the great variety of patient types, their social background, family circumstances and psychosocial requirements are taken into account. The comparative lack of response to neuroleptic therapy seen in some patients, especially those with minimal structural brain changes, further complicates the problem, provoking—as such therapy may—more EPS than are normally seen in patients without more obvious physical changes in brain structure. Until recently, the treatment of nonresponsive schizophrenia has tended to involve switching from one neuroleptic (usually a “highpotent” agent) to another of different chemical structure. However, as these “typical” neuroleptics occupy D2 receptors, the rationale for using a less conventional antipsychotic, such as clozapine, is increasingly appreciated in the management of the treatment-refractory schizophrenic.

A cross-sectional home survey on the epidemiology of drug use in Greece, with a nationwide general population sample of 4,291 respondents aged 12 to 64, was carried out. The weighted life prevalence of reported illicit drug use in the total sample was found to be 9% among males and 2.5% among females, with a ratio of 3.6: 1. Six and a half percent of males of all ages had used, at some time, licit psychotropic drugs without a doctor's order, while females presented much higher prevalence rates (14.9%). Young adults reported higher rates of both illicit and licit lifetime and past-year use, compared to the other age groups. Illicit drug use was less common, in females of all ages. Cannabis was the most common illicit drug used. Current as well as lifetime use of pain relievers without a doctor's prescription was found to be highest among all other licit substances. This holds true for all age groups and for both sexes. Tranquillizers were predominantly used by females of all ages. Certain sociodemographic variables, such as sex, educational level, marital status, place of residence and occupational status were found to be related to drug use in Greece.

An analysis of existing studies on the expressed emotion (EE) concept shows that the predictive validity of the EE index depends on the definition of relapse. Whilst symptomatic relapses are recorded in patients from high-EE families, about 3 times as often as in patients from low-EE families, a comparison of hospitalization rates reveals a difference of only approximately 1.5 times. In the Münster Families Study, a prospective intervention study to evaluate the therapeutic impact of relatives' groups, the predictive value of the familial emotional atmosphere could be measured in a prospective design. Ninety-nine DSMIII Schizophrenics, 72 male, 27 female, mean age 27 (SD 6.6), mean duration of illness 5.5 (SD 4.3) were followed up. In the first eighteen months patients from high-EE- families had a risk of rehospitalisation approximately 1.5 (p < 0.05). Further analysis showed that relapse rates among patients from high-EE and low-EE families were roughly the same for patients with a duration of illness of less than 4.5 years but were significantly different after a longer duration (p = 0.019). Besides a high EE rating, resignation of relatives was also a significant (p = 0.000) predictor of rehospitalisation for high and — even more — low EE families. Possible causes of these findings and therapeutic consequences are discussed.

Until now, the instruments for the clinical evaluation of impulsivity have relied essentially on either personality inventories or to a lesser extent on specific questionnaires. Therefore this paper presents the preliminary results of a new rating scale: the Impulsivity Rating Scale (IRS). This is a 7-item hetero-evaluation of impulsivity based on the behaviour of the patient in usual life situations. The administration of the scale is easy and short: 15 minutes. The IRS was tested in five different population samples: 31 impulsive inpatients, 36 adults with major depressive episode, 15 healthy control subjects, 56 smokers before and after one week of tobacco withdrawal, and 47 adolescent depressed inpatients before and four weeks after antidepressant treatment. The results show good construct validity, good concurrent validity, good inter-rater reliability and sensitivity to change. A threshold of 8 for the total score (range 0 to 21) gives good specificity and sensitivity. The principal component analysis shows the existence of a main factor composed of all items, with lower correlation for two items which may belong to a second factor needing further investigations.

The aim of this study was to assess alcoholic inpatients' smoking and coffee intake variation following withdrawal. Only moderate smokers (less than 30 cigarettes/day) showed a significant increase of cigarette consumption after alcohol withdrawal. However, their urinary cotinine level did not vary, suggesting a behavioral, and not biological, compensation through smoking following alcohol withdrawal. Heavy smokers (30 cigarettes/day or more) showed no significant clinical or biological variation of smoking behavior. Coffee consumption increased after alcohol withdrawal in all patients, irrespective of smoking habits.

5-methoxypsoralen (5-MOP) stimulates pineal melatonin secretion, and a decrease in dark phase melatonin levels has been described in major depression. As exogenous melatonin has shown synchronizer properties, authors hypothesized that giving 5-MOP would have antidepressant properties.

Twenty-six inpatients meeting the criteria of major depressive disorders were enrolled in a four-week, double blind trial of 5-MOP versus amitriptyline. Clinical improvement was identical in both treatment groups but biological changes were different in each group: 5-MOP patients showed an early nocturnal surge of melatonin levels that was maintained at the fourth treatment week, while melatonin levels remained unchanged in patients treated with amitriptyline.

A questionnaire was devised to assess changes in the quality of life of insomniac patients when treated by a hypnotic. The questionnaire was validated in two groups of patients (60 non-insomniac and 52 insomniac patients). The results of this study confirmed the relevance of the questionnaire and its power to distinguish between the two groups of patients. A second study carried out simultaneously in 58 insomniac patients receiving treatment showed the internal reliability of the questionnaire and its reproducibility after 3 to 5 days.

Three groups of 342 Greek, Iberian and Belgian psychiatric patients were compared, matched for sex, age, and time of hospitalization in a university hospital in Brussels. Schizophrenia, schizoaffective disorder/atypical psychosis were diagnosed more among immigrant patients. Somatic anxiety, loss of libido, delusions and hallucinations were symptoms that clinicians observed more in immigrant than in native patients. Atypical symptomatology and change of diagnosis were more likely to occur among immigrant patients. A higher proportion of second generation immigrant patients had a diagnosis of schizophrenia than either the first generation or the Belgians. Male immigrant patients were prescribed anxiolytic drugs more frequently than male natives, but were less likely to be referred to psychotherapy. The authors query whether these findings derive from specificities in the use of psychiatric services and/or from biases in clinicians'attitudes towards patients of different ethnic origin.

This study considers the question of whether relapse rates among schizophrenic patients can be reduced by means of relatives' groups. In a randomized, controlled intervention study, two therapeutic strategies (therapeutic relatives' groups, initiated relatives' self-help groups) were compared with each other and with a control group. Interventions were confined to the relatives, with the patients continuing their standard treatment. The study involved 151 relatives of 99 chronic DSMIII schizophrenics. Data were collected before and after a 1-year intervention phase and in a 2-year follow-up. No difference existed between the groups with respect to rehospitalization data. However, numerous differences recorded in the psychopathological findings and in living and working circumstances suggest that therapeutic work with relatives is of clinically significant benefit.

Clinical assessments of sleep and subjective state upon waking were performed in normal controls and patients with generalised anxiety disorder, panic disorder, obsessive-compulsive disorder, primary dysthymia and major depression. Subjects were selected according to DSM-III-R criteria. As compared to normal controls, patients with generalised anxiety, dysthymia and major depression exhibit pervasive and intense complaints of insomnia, and no clear distinctions can be drawn among these groups. Patients with panic disorder do not differ from normal controls, whereas obsessive compulsive patients present limited sleep symptoms. These findings suggest that subjective sleep variables are relevant for the diagnostic discrimination of panic and obsessive-compulsive disorders.

All of the components of quality of life can be altered in insomniacs because of sleep disorders themselves but theoretically also in consequence to side effects from hypnotic agents. The presented international study, carried out with a multicentre, randomised and double-blind design, investigated zopiclone effects on quality of life in insomniac patients as compared to placebo. A total of 458 patients completed the study, 231 receiving zopiclone 7.5 mg and 227 receiving placebo, with mean treatment durations of 48 and 44 days. Sleep parameters and quality of life, measured with extensive and validated scales, were assessed at baseline and at 14, 28 and 56 days after admission. Zopiclone showed hypnotic efficacy and significantly greater improvement of quality of life as compared to placebo, both at 14 days and at endpoint.

The Composite International Diagnostic Interview (CIDI) was used to assess the prevalence of psychiatric disorders in a French population of 46 inpatients with diabetes mellitus. According to DSM-III-R criteria, 52.2% of subjects presented at least one psychiatric diagnosis in their lifetime and 41.3% did so less than six months before the study. Affective and anxiety disorders represented at least 83% of the psychiatric diagnoses. The risk for those disorders seems to be restricted to a predisposed group as only one of the 16 subjects who had suffered from an anxiety or depressive episode within the previous six months had never experienced such an episode before.

The principal management strategy for patients with panic attacks and agoraphobia has traditionally been behavioural therapy, but the delineation of panic disorder as a distinct diagnostic entity has stimulated psychopharmacological research on this psychiatric condition. As a result, the treatment of panic disorder has diversified. Effective pharmacological treatment of this disorder began with the antidepressant imipramine, but today a wide variety of efficacious agents are available for treating the symptoms of panic disorder. The four primary classes of agents for panic disorder are the tricyclic antidepressants (TCAs), the serotonin reuptake inhibitors (SSRIs), the monoamine oxidase inhibitors (MAOIs) and the high-potency benzodiazepines (BZs). Effective non-pharmacological treatments are primarily behavioural, although cognitive approaches have also been shown to be successful.

Tests of both structure and function of the corpus callosum have revealed abnormalities in schizophrenic patients. One such functional test employed lateralised Stroop stimuli presented tachistoscopically, to measure the transfer of interference and facilitation between the cerebral hemispheres. An attempt was made to relate indices of callosal transfer to clinical and demographic variables, including family history, as well as to indices of brain morphology. The latter included ventricle: brain ratio (VBR) measured by computed tomography (CT) scanning on 31 DSMIII schizophrenics, and the cross-sectional area of the corpus callosum from magnetic resonance imaging (MRI), obtained from 20 of these patients. VBR did not relate to functional measures; however, anterior callosal area correlated with indices of callosal connectivity. Patients with auditory hallucinations had smaller anterior callosal areas and tended to show less connectivity. The results show links between functional and structural measures of the corpus callosum, but their precise nature remains unclear.

The study aimed to describe coping strategies in a sample of key-relatives of schizophrenic patients, and to explore their relationships with the following variables: patients' and key-relatives' socio-demographic characteristics; patients' and key-relatives' clinical status; and key-relatives' subjective burden. Significant correlations were found between the scores on coercion items and those on Present State Examination (PSE-9) factors “disorganized syndrome” and “psychomotor poverty syndrome”. A long duration of illness was found to be associated with relatives' strategies characterized by positive communication and patient's social involvement. Coercion, avoidance and resignation coping strategies were significantly associated with the occurrence of anxiety and depressive symptoms in patients' key-relatives.