In the present study, all patients who met the diagnostic criteria for a long-term functional psychosis (LFP) were identified within a defined uptake area in the northern part of the county of Uppsala, Sweden. LFP includes patients 1) with productive psychotic symptomatology, not caused by organic disease, for 1 week or more, at least once during the course of the illness; 2) having been affected by a psychosis for a continuous period of at least 6 months on the same occasion; 3) having shown psychotic features or residual symptoms during the index year; and 4) older than 18 years of age. Primarily, all diagnoses were made according to the Diagnostic and Statistical Manual of Mental Disorders (DSM)-III-R. The prevalence of schizophrenia was 4.2 per 1,000 inhabitants. The prevalence of schizoaffective disorder was 0.7 per 1,000 inhabitants and for delusional disorder, 0.1 per 1,000 inhabitants. When the patients were rediagnosed according to DSM-III, DSM-IV and International Statistical Classification of Disease (ICD)-10, it was found that the prevalence of schizophrenia, schizoaffective disorder and delusional disorder was somewhat lower according to the DSM-III criteria, while the same number of patients fulfilled the criteria according to DSM-IV. If ICD-10 was used, it resulted in a broader concept of schizophrenia and a somewhat more narrow concept of schizoaffective disorder. Thus, the introduction of the new parallel diagnostic systems, ICD-10 and DSM-IV, will result in different, but comparable, prevalence estimates concerning schizophrenia, schizoaffective disorder and delusional disorder.

The Mini International Neuropsychiatric Interview (MINI) is a short diagnostic structured interview (DSI) developed in France and the United States to explore 17 disorders according to Diagnostic and Statistical Manual (DSM)-III-R diagnostic criteria. It is fully structured to allow administration by non-specialized interviewers. In order to keep it short it focuses on the existence of current disorders. For each disorder, one or two screening questions rule out the diagnosis when answered negatively. Probes for severity, disability or medically explained symptoms are not explored symptom-by-symptom. Two joint papers present the inter-rater and test-retest reliability of the MINI the validity versus the Composite International Diagnostic Interview (CIDI) (this paper) and the Structured Clinical Interview for DSM-III-R patients (SCID) (joint paper). Three-hundred and forty-six patients (296 psychiatric and 50 non-psychiatric) were administered the MINI and the CIDI ‘gold standard’. Forty two were interviewed by two investigators and 42 interviewed subsequently within two days. Interviewers were trained to use both instruments. The mean duration of the interview was 21 min with the MINI and 92 for corresponding sections of the CIDI. Kappa coefficient, sensitivity and specificity were good or very good for all diagnoses with the exception of generalized anxiety disorder (GAD) (kappa = 0.36), agoraphobia (sensitivity = 0.59) and bulimia (kappa = 0.53). Interrater and test-retest reliability were good. The main reasons for discrepancies were identified. The MINI provided reliable DSM-III-R diagnoses within a short time frame, The study permitted improvements in the formulations for GAD and agoraphobia in the current DSM-IV version of the MINI.

The Mini International Neuropsychiatric Interview (MINI) is a short diagnostic structured interview, developed in clinician (MINI-CR) and patient-rated (MINI-PR) formats, for 17 Diagnostic and Statistical Manual (DSM)-III-R Axis I psychiatric disorders. This study, which investigates the validity of the MINI in relation to the Structured Clinical Interview for DSM-III-R Patients (SCID-P), was conducted in conjunction with a similar study, investigating the validity of the MINI in relation to the Composite International Diagnostic Interview (CIDI) for International Statistical Classification of Disease (ICD)-10. Both studies also examined the inter-rater and test-retest reliability of the MINI. Three hundred and seventy subjects (330 in Florida and 40 in Paris) participated in the validation of the MINI versus the SCID-P. Of these, 308 had at least one psychiatric disorder and 62 were non-patient adult controls. Eighty of the subjects (40 in Florida and 40 in Paris) also participated in the parallel study of the validity of the MINI versus the CIDI. The 330 Florida subjects first completed the patient-rated version of the MINI. All subjects were administered the MINI-CR (after the MINI-PR in the case of the Florida subjects), followed by the SCID-P. The MINI-CR was rated by two interviewers for 42 subjects in Florida and 42 in Paris (inter-rater reliability test) and readministered by a third blind interviewer one to two days after the initial rating (test-retest reliability test). Overall, the results supported the validity and reliability of the MINI. In addition, administration of the MINI-CR took half as long as administration of corresponding sections of the SCID-P. The application of short structured interviews in clinical and research settings is discussed.

The present study describes the results of neuropsychiatric consultations in 70 institutionalized mentally retarded patients. On the basis of their major complaint, patients were assigned to eight overlapping categories. Diagnoses of a certain probability were established during multidisciplinary consensus meetings and classification was achieved according to ICD-10 criteria. In ten patients mental retardation was related to a specific syndrome; seizures or somatic comorbidity were present in 40 patients. The most frequent psychiatric diagnoses were: unspecified bipolar affective disorder (n = 14), depressive disorder (n = 6), impulse control disorder (n = 12), cycloid, transient, or schizoaffective psychotic disorder (n = 14), and (atypical) autism (n = 7). Recent history revealed a high occurrence of serious side effects of psychotropics or pharmacokinetic interactions. Appropriate pharmacological intervention resulted in an amelioration of the behavioural condition in about half of the patients. It is emphasized that psychiatric disorders frequently present with an atypical psychopathology and that stress- and anxiety-related disorders are most probably underdiagnosed.

The allergic reactivity of atopic type was investigated in 54 patients with mood disorders in the course of depressive episode and in 39 patients with schizophrenia. The assessment was done by three methods: intradermal tests, determination of IgE concentration and determination of specific immunoglobulin E (IgE) antibodies. The hypersensitivity to three or more allergens on intradermal tests was found in 40% of depressive and in 27% of schizophrenic patients. The concentration of IgE > 100 IU/mL was found in 45% of patients with depression and in 46% of patients with schizophrenia, more frequently in subjects with hyperactivity of hypothalamic-pituitary-adrenal axis, and in depression, in patients with higher intensity of symptoms. The positive results of the Phadiatop test which detects specific antibodies for inhalatory antigens, were found in 46% of depressive and in 40% of schizophrenic patients The indices of atopy for all three tests were higher in males than in females in both mood disorders and in schizophrenia. However, these indices were similar for unipolar and bipolar depressed patients as well as for patients with paranoid or residual schizophrenia.

There is currently no simple and morbidity-free procedure available to determine opiate dependence in patients. There is preliminary evidence, however, that the naloxone conjunctival test may be useful in this regard. This test consists of instilling a drop of saline solution of naloxone hydrochloride (an opiate-receptor antagonist) into the subject's eye. This causes significant homolateral mydriasis (anisocoria) in the eye of a chronic opioid-dependent subject and not in that of a non-dependent subject. We reviewed the international literature on the naloxone conjunctival test using the Medline database and a manual search of major scientific journals specialized in the field of substance abuse. Up to March 1995, we identified six articles dealing specifically with the use of opiate antagonist ophthalmic solutions in populations of chronic opioid addicts. Four of the articles reported the occurrence of mydriasis when a solution of naloxone is used in opioid addicts. Two of the articles reported that there was no differential change in pupil size when the naloxone solution is used; however, one study used a much weaker and the other a much stronger solution of naloxone than reported in the other studies. From our review of the literature, it appears that the naloxone conjunctival test holds great promise as a simple and morbidity-free method of testing for chronic opioid addiction and, therefore, it should be studied further and its usage eventually developed.

The thyrotropin (TSH) and prolactin (PRL) responses to protirelin (TRH) were studied in 62 female unipolar depressive patients, 24 delusional (psychotic) and 38 nondelusional (Diagnostic and Statistical Manual [DSM]-III-R criteria). The TSH response to TRH was blunted (≤6 μlU/mL) in ten of the 24 delusional (41.6%) and in 18 of the 38 nondelusional (47.4%) patients, the difference being not significant. The TSH and PRL responses to TRH, calculated as area under the curve, were not different between the two groups. Similar results were obtained when the response patterns were compared by repeated measure analysis of covariance.

In an open-label study, famotidine was added to the regular neuroleptic regimen of 11 schizophrenic patients for 4 weeks. Each patient was scored weekly with SAPS, SANS, CGI and HAM-D-17 scales. The results suggest that famotidine is indeed effective as an adjunctive drug to neuroleptics in the treatment of schizophrenia.