Marchiafava-Bignami disease (MBD) is a rare complication of chronic alcoholism. We describe a regressive form of MBD in which a primary decrease in CD4+ cells was improved by amineptine treatment. No significant change in the CD4 : CDS ratio was observed in a few major depressed subjects receiving this drug.

Platelet monoamine oxidase (MAO) activities were assessed in 82 patients, 57 females and 25 males, who were admitted to the medical ward of a general hospital after a suicide attempt. The enzyme activities were compared to the activities of healthy subjects, 35 females and 26 males. In addition, MAO activities were analyzed in relation to sex, psychiatric diagnosis, mode of attempt, drugs ingested, and previous attempts. Compared to normal controls, only female patients showed lower MAO activities. In the male population, lower activities were found in the subgroup of patients who had made previous attempts. In relation to diagnosis, analysis performed in the female population revealed lower MAO activities in the dysthymic and personality disorder, and not in the adjustment or major affective disorder subgroups. MAO activities were not related to the violent mode of attempt, the type of medication used, or the score in the Beck Suicidal Intent scale. The finding of low platelet MAO activities in dysthymic disorder, indicates the need for further studies of biological variables in this underdiagnosed and undertreated diagnostic group.

The authors describe the occurrence of a small deletion localised on the short arm of chromosome 18 in a young female with a diagnosis of paranoid schizophrenia.

It has been suggested that low serum cholesterol interferes with brain serotonergic functioning, which results in increased suicidal and aggressive tendencies. To test this hypothesis we investigated the relationship between serum cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL) and triglyceride levels, and serotonin uptake by blood platelets in 17 healthy men aged 39.5 ± 10.2 years. Platelet serotonin uptake and serum lipids were assayed concomitantly for each individual. Serum cholesterol levels and other serum lipid levels did not correlate with serotonin uptake by platelets at the concentration of 2 × 10−5 M (a concentration within the maximal uptake capacity range). The results indicate no influence of cholesterol on serotonin uptake, as opposed to some investigators who suggested that high risk of suicide and aggressiveness in hypocholesterolemic individuals is related to impaired serotonin transport.

Two cases of sexual addiction for more than five years treated with psychological treatment and clomipramine showed marked improvement after six to nine months. It is postulated that these disorders could be variants of obsessive compulsive disorder.

Increases in psychosocial stress and disruption of the biological clock due to irregular sleep-wake schedules as well as an increase in the elderly population have resulted in an increase in sleep disorders, most notably insomnia. In order to manage insomnia, correction of a poor sleep environment is of primary importance. We now have many good GABA A receptor agonists such as benzodiazepines and cyclopyrrolones (zopiclone) for use as hypnotics, but to achieve improvements in nocturnal sleep and restoration of daytime functions, short- or ultra-short acting hypnotics are recommended. Zopiclone has been reported to show weaker effects on sleep architecture than other benzodiazepines and does not exacerbate mild or moderate sleep apnea syndrome. Some patients are therapeutic-dose dependent on hypnotics or anxiolytics without showing detectable side effects. It may be possible for some insomniacs, particularly forelderly people, to use the minimum necessary dose of hypnotics to achieve good sleep and live a happy life from the standpoint of good quality of life.

Akathisia, dystonia, dyskinesia and parkinsonism, the four main categories of neuroleptic-induced extrapyramidal syndromes (EPS), represent major disadvantages in antipsychotic therapy. In vulnerable patients, acute EPS may progress into potentially irreversible forms such as tardive dystonia and tardive dyskinesia. In the psychiatric clinic, these EPS are often insufficiently recognised or permitted to exist without treatment. In order to ensure a better EPS diagnosis, a simple examination procedure is described. EPS rating scales may serve as an aid in this process. Guidelines are given to prevent and treat EPS. Thus, EPS are best prevented by a course of neuroleptic medication involving as little antidopaminergic D2 effect as possible, including the use of the lowest effective dose (sometimes obtained by addition of a benzodiazepine or carbamazepine) and with antipsychotic drugs which produce low D2 receptor blockade. Treating EPS also consists of using the lowest effective dose and antipsychotics with a low D2 dopamine receptor occupancy. At present, clozapine is the only drug that produces antipsychotic benefits at doses that cause far less D2 receptor antagonism in the basal ganglia of the brain than that seen with standard neuroleptics; however, newer drugs, such as olanzepine, seroquel and sertindole, are on the way.

Midazolam is a short acting benzodiazepine that has been used for electroconvulsive therapy (ECT) anesthesia. The purpose of this study was to determine whether midazolam used for this purpose would impair the antidepressive efficacy of ECT. In a double-blind random-assignment study midazolam was compared to methohexital on the antidepressive efficacy of bilateral ECT as measured by the reduction in the Montgomery Asberg Depression Rating Scale (MADRS) scores and seizure duration. Sixteen DSM-III-R major depressive disorder patients with melancholia were included. Midazolam and methohexital did not differ in their effects on the MADRS score or seizure duration; no correlation was found between seizure duration and outcome of depression for either group. Our preliminary findings do not support the claim that benzodiazepines should not be used during bilateral ECT.

The clinical features and symptoms of postpartum psychoses are presented in relation to the classification according to the Research Diagnostic Criteria (RDC) and the concept of “puerperal psychosis”. A number of symptoms, ie confusional symptoms, depersonalization, misrecognitions and the “kaleidoscopic” picture are shown to be prominent features. In schizoaffective disorder and unspecified functional psychosis a higher frequency of confusional symptoms, misrecognitions, thematic delusions and a “kaleidoscopic” course of illness was found compared to schizophrenia, mania or depression. The findings of this study support a special status for postpartum psychosis and suggest a link with the concept of cycloid psychosis. In the management of postpartum mental disorder the risk of child-directed aggression, suicide and sudden relapses into psychosis requires special attention.

The development, evaluation and use of biological markers with a diagnostic purpose in psychiatry is extremely important. However, with certain exceptions, truly sensitive and specific markers have not yet emerged. In order to investigate the relationship between the immune apparatus and the hypothalamic-pituitary activity on the one hand, and the psychopathological state of the patients on the other, we used a longitudinal design and assessed monocyte parameters (HLA-DR, CD 35, vimentin filaments, and phagocytosis index) and neuroendocrine tests (dexamethasone suppression test [DST] and thyrotropin-releasing hormone [TRH] stimulation test) at intake and at follow-up in 49 depressed patients. Immunological parameters were compared with neuroendocrine tests in both phases of the study. The combined use of both immunological and neuroendocrine tests did not add sensitivity to the immunological identification of depressed patients. The findings lead us to consider the role of the monocyte parameters as sensitive depressive state markers, while the combined use of both neuroendocrine and immunological tests in current clinical practice would be debatable.

The objective of the study was to evaluate the presence of psychopathology in fibromyalgia patients compared to a control group of rheumatic patients with pain. Forty-nine fibromyalgia patients and 33 controls were evaluated using established self-rating scales. Serotonin was determined using a radioenzymatic method. Fibromyalgia patients scored significantly higher than the controls on the majority of the subscales on the SCL-90, the two subscales on the Spielberger State and Trait Anxiety Inventory, the GHQ 12 scale and on a visual analogue pain scale. In a multivariate analysis the somatization dimension followed by the state anxiety accounted for the highest difference. Platelet-poor plasma serotonin, platelet serotonin and platelet uptake index were not significantly different between the groups. In conclusion, fibromyalgia patients presented quantitatively more psychopathology than the control group on a wide range of psychopathologic axes, and this cannot solely be accounted for by their higher level of pain.

A patient with multiple psychosomatic disorder developed a steroid induced rare bipolar mood disorder (both mania and depression). The “unmasking effect” of steroids and a positive family history of psychiatric disorder as a possible risk factor, hitherto undocumented, is suggested in steroid induced psychosis.

Endogenous substances resulting from interactions between alcohol and possibly opioid metabolites and neurotransmitters (dopamine, indolamines) could be mediators of the pathochemical process towards dependence. Beta-carbolines (harman/norharman) are increased in alcoholics and — according to the presented results — in heroin addicts. Psychopathological disorders such as anxiety or depression do not seem to influence the level of beta-carbolines.