In 55 chronic schizophrenics, the occurrence of infectious diseases during their mothers’ pregnancies was investigated. Different psychiatric diagnostic systems were compared. Infections were reported by the mothers of familial and sporadic DSM III-R schizophrenics in equal proportion. However, applying Leonhard's classification, the frequency of infections was found to be significantly increased in ‘systematic’ schizophrenia (mainly exogenously induced in the view of Leonhard) compared to ‘unsystematic’ schizophrenia (mainly genetically determined according to Leonhard's findings). Most of the infections occurred during the second trimester (nine out of 13). Thus, in the ‘systematic’ forms of schizophrenia (low genetic loading), maternal infections in this crucial period of neurodevelopmenl would appear to be important causative factors in the cytoarchitectural deviance delected in the central nervous system of schizophrenics.

The prognostic significance of an index episode of affective disorder with delusions was assessed in a longitudinal study of a cohort of adolescent psychiatric inpatients (n = 43). Part I of a study has been reported in a previous article. Initial assessmentdata (anamnestic variables, clinical assessment) did not discriminate between onset of affective disorder and schizophrenia. Part II of the study provides a longitudinal perspective of the cohort's diagnostic and life adjustment: diagnoses of schizophrenia increased, schizophreniform disorders disappeared, affective disorders were stable and a schizo-affective category emerged. Patients in the schizophrenic category had severely impaired life adjustment, while the level of functioning in unipolar and bipolar patients was consistently satisfactory. Compared to the initial diagnosis, the cohort showed a tendency to develop into schizophrenia. It is too early to affirm that every adolescent with delusional symptoms at onset will later develop schizophrenia, however, this risk appears real.

Schizophrenic patients seem to react sensitively to expressed affect. Expressed emotion research has shown the negative impact of specific family communication styles on the course of illness. Further studies have discussed its relation to gender. This study examines the dyadic aspects of the therapist-patient relationship, the interaction between therapist's ratings and patient's psychopathology, and the predictive value concerning the course of illness. Results show a significant association with gender. Male therapists were inclined to reduce their therapeutic commitment when being confronted with patients who suffered from disturbances Of ego-function, attention, or perception. Female therapists felt rejected by patients with delusions and with formal thought disorders, but perceived themselves as competent when dealing with anergic patients. Furthermore, patients with a less favorable course of illness at the 2-year follow-up could be discriminated by the quality of the therapist-patient relationship at the end of the primary therapeutic intervention.

Performance of patients with schizophrenia (n = 15) was compared to that of patients with vascular ischemic lesions of the dorsolateral prefrontal cortex (n= 10) and to age-matched controls (n= 15) in delayed reaction tasks known to be specific markers of the functions of the frontal lobe. The performance of patients with schizophrenia was similar to that of patients with prefrontal lesions in the delayed response task (DR) and the spatial discrimination-reversal task (SD and RV) but not in the delayed alternation task (DA) in which they performed as well as controls. The behavioural profile of responses in delayed reaction tasks for the schizophrenic patients was identical to that of patients with basal ganglia lesions reported in a previous study. These results suggest that in some patients with schizophrenia, a frontal lobe deficit could be indirectly induced by a dysfunction of the basal ganglia. This problem could be due either to the pathological process itself or to the effect of the neuroleptic treatment.

Nimodipine was administered at the daily dose of 90 mg po, for 30 days, to ten chronic undifferentiated schizophrenics, eight men and two women, aged 31-35 years, maintained on previously longlasting neuroleptic treatments. In five patients, a placebo period of 15 days preceded the administration of the drug. Monitoring of psychiatric symptomatology by the Brief Psychiatric Rating Scale (BPRS) revealed significant nimodipine-induced improvement. However, the Andreasen Rating Scale for Positive Symptoms (SAPS) showed favourable effects only in the five patients who had not received placebo, while in the others both SAPS and the Andreasen Rating Scale for Negative Symptoms (SANS) showed no significant effect of therapy. The Tardive Dyskinesia Scale revealed no improvements of neurological symptoms after either placebo or drug treatment. Measurement of plasma MHPG concentrations revealed no significant changes induced by either placebo or nimodipine, while HVA plasma levels showed a trend toward decrease, and prolactin a trend toward increase, after nimodipine.

Psychiatric morbidity was measured in a prospective follow-up study of 51 patients admitted to hospital after minor head injury. By means of self report questionnaires (eg General Health Questionnaire (SHQ) and Impact of Event Scale), semistructured interviews and symptom-checklists, it was found that nearly half of the patients suffered considerable discomfort after 1 week. Improvement during the 3 months follow-up was generally poor. Both concussional symptoms and stress response contributed to the compromised well-being as measured by the GHQ, but outcome did not correlate to severity of injury. The GHQ-60 score of 1 week showed a strong positive correlation with outcome after 3 months. The incidence of post-traumatic stress disorder was low.

The usefulness of the dexamethasone suppression test (DST) in the prediction of treatment response to selective antidepressants was tested in 56 major depressive inpatients. Following DST, patients were randomly assigned to treatment by either nomifensine, a catecholaminergic antidepressant, or zimeldine, a serotonergic antidepressant during a 3-week period and assessed by means of the second part of the Clinical Global Impressions (CGI-2). No significant difference was present between the 27 DST suppressor and the 29 DST non-suppressor patients in their overall clinical outcome. Moreover, no preferential response to nomifensine or zimeldine was noted in any of the two groups defined according to DST status. Therefore, these results do not support the usefulness of the DST in the prediction of the treatment response to antidepressants in general and to selective antidepressants in particular.