A minimal brain damage examination was carried out in 73 schizophrenic patients divided into three groups according to their season of birth. Results showed no statistically significant difference among groups in the prevalence of neurological soft signs.

Already at the end of the 19th century, Hughlings-Jackson suggested that positive symptoms such as hallucinations and delusions should be kept apart from negative symptoms such as anhedonia and reduced energy in all psychoses. Both Kreapelin and Bleuler regarded the negative symptoms as fundamental in schizophrenia while the positive symptoms were regarded as being accessory, accompanying the disorder. This view was maintained for 60 years (table 1) until Schneider (1959) introduced the “first rank symptoms”, all of them positive. Schneider never advocated that these symptoms should be a sufficient basis for a diagnosis of schizophrenia. In any case, the “first rank Symptoms” have been included in most later diagnostic systems (table 1).

The benefits of an antidepressant with an early or rapid onset of action include a more rapid resolution of the debilitating symptoms of depression, a potential reduction in the risk of suicide and cost savings associated with a reduction in hospitalization. While these benefits are valuable, this promise has yet to be fulfilled by any antidepressant. Venlafaxine is a unique serotonin-noradrenaline reuptake inhibitor (SNRI) which produces rapid and prolonged desensitization of β-adrenergic receptors in preclinical studies after both acute and chronic administration of venlafaxine. Results from placebo-controlled and active comparator clinical studies provide evidence that venlafaxine may have an early onset of activity which is most apparent at higher dosages. The early onset is most apparent with rapid escalation of the venlafaxine dosage, and the incidence, therefore, of side effects tends to be higher early after initiating therapy with venlafaxine. Thus, venlafaxine may fill the long awaited need for an antidepressant with an early onset of action.

L’individualisation nosographique au sein des états délirants aigus des bouffées délirantes aiguës, des schizophrénies chroniques avec troubles thymiques, psychoses maniaco-dépressives bipolaires et des états schizophreniques aigus, est, depuis les travaux de Magnan, une particularité de la psychiatrie française ; elle n’a été étayée, jusqu’à présent, que par des appréciations anamnestiques, symptomatiques et évolutives subjectives.

La revue de la littérature a mis en évidence la multiplicité des appellations diagnostiques et le polymorphisme des tableaux cliniques correspondant à ces états délirants aigus. Si la symptomatologie dans un premier temps a permis d’établir cette classification diagnostique, il semble actuellement que ce soit, pour beaucoup d’autres, l’étude de l’anamnèse et du mode évolutif de la maladie, qui pourrait permettre de fixer le diagnostic.

Afin de caractériser ces éléments anamnestiques, socio-démographiques et symptomatiques, une étude statistique a été effectuée à partir d’une population de 471 patients hospitalisés à la Clinique des Maladies Mentales et de l’Encàphale entre 1979 et 1985 se ràpartissant, selon la classification INSERM, de la façon suivante :

Groupe 1 : bouffées délirantes aiguës (BDA) : 53 sujets catégories 041, 042 et 049.

Groupe 2 : schizophrénies avec troubles thymiques (Sch. T) : 109 sujets, états de dépression ou d’excitation atypiques, catégorie 024.

Groupe 3 : psychoses maniaco-dépressives bipolaires (PMD) accès mélancolique et maniaque : 290 sujets, catégories 010, 011, 012, 019.

Groupe 4 : schizophrénies aiguës ou états délirants aigus, probablement schizophréniques (Sch. A), catégorie 040, 19 sujets.

L’ensemble de cette population a été systématiquement évalué à partir de deux instruments d’évaluation quantifiée : l’échelle abrégée d’antécédents psychiatriques (BPHF/F69) et une échelle de psychopathologie générale (BPRS, forme à 18 items, Pichot P., Overall J. E. 1967). 3 types d’analyse ont été réalisés :

• • une analyse descriptive, unidimensionnelle des caractéristiques socio-démographiques et des antécédents pathologiques de chacun des 4 groupes diagnostiques (BPHF).

• • une analyse en composantes principales avant et après rotation varimax de la BPRS, permettant d’établir la structure factorielle de chacune des catégories diagnostiques et de les comparer entre elles.

• • une analyse discriminante de la BPRS (analyses discriminante et canonique) destinée à mettre en évidence les items différenciant le mieux ces 4 groupes diagnostiques et à comparer le classement théorique des sujets sur chacune des fonctions discriminantes avec le classement réel initial.

The role of the neuropeptide cholecystokinin in schizophrenia has been widely explored because of its modulating action on midbrain dopamine neurons. The recent discovery of more specific receptor subtype cholecystokinin antagonists should be considered as potential treatment for schizophrenia with fewer side effects. This paper reviews cholecystokinin/dopamine interactions in animal and human studies. Clinical trials with cholecystokinin agonists and antagonists in schizophrenia are updated.

Research on repetitive transcranial magnetic stimulation (rTMS) indicates that the treatment of non-psychotic depression is comparable to electroconvulsive therapy (ECT) in terms of short-term outcome. We report on a woman who exerted a recurrent moderate major depressive episode, 6 months after discontinuation of maintenance ECT. She responded to acute rTMS treatment which was followed by the rTMS maintenance-protocol. Within 2 months of continuation rTMS she relapsed suffering from a severe non psychotic depressive episode and had to be switched to a successful ECT. In this patient rTMS had a good clinical impact as an acute treatment strategy, but failed to prevent relapse as the continuation ECT previously did in the same patient.

This paper summarizes several issues related to the mental health aspects of the International Classification of Impairments, Disabilities, and Handicaps (ICIDH) and its use in the field of rehabilitation. Rehabilitation is characterized by multiple interventions, demanding extensive communication and coordination among different care providers. The ICIDH will be useful in the field of rehabilitation by providing a sound framework for consequences of diseases or disorders if clear descriptions and assessment guidelines of the categories are given. The development of dedicated assessment instruments linked to the ICIDH will be useful to many health workers to assess the needs of the patients, to evaluate services and to measure the outcomes of rehabilitation interventions, thus creating a common language for disablements.

Lateral gaze aversions which follow reflective or thought provoking questions are called conjugated lateral eye movements (CLEMs). This response was studied in 20 schizophrenic patients, 20 depressive patients and 20 healthy controls. Frontal and parietal EEG measures were recorded simultaneously with the question/answer task. There were no differences in CLEMs among the 3 groups. Schizophrenic and depressive patients demonstrated a significantly reduced EEG-power on the left and an increased power on the right in comparison with healthy controls. This may point to a functional interhemispheric ‘disconnection’ in patients. Comparative correlations revealed EEG-power increase during the occurrence of contralateral CLEMs in the whole 10 min task.

The difficulty to recruit homogeneous samples of insomniacs requires alternative approaches for sleep studies. Acoustic perturbation in healthy volunteers made it possible to determine an experimental model of acute situational insomnia in order to investigate the effects of classic and novel hypnotic compounds. Unfortunately, the traditional scoring parameters of sleep are inadequate to provide reliable information for defining the neurophysiological bases of insomnia and for evaluating the efficacy of hypnotic drugs. Recent studies on the microstructure of sleep have permitted to identify a specific EEG feature, the cyclic alternating pattern (CAP), correlated with the subjective appreciation of sleep quality. Comparing placebo, zolpidem, zopiclone, lorazepam and triazolam, given at equivalent therapeutic doses in middle-aged healthy volunteer subjects under basal conditions and under acute situational insomnia, provided non-significant information when using classical sleep parameters whereas CAP rate (the percentage ratio of CAP time to non-REM sleep time) permitted to discriminate the basal nights from the perturbed nights and the drug nights from the placebo nights. These data have been confirmed in clinical studies using zolpidem versus placebo in chronic insomniacs.

The presence of affective symptoms in panic disorder has often been reported. Data from The Cross-National Collaborative Panic Study (second phase) were analysed to address the role of dysthymia in panic disorder with respect to previous illness, current psychopathology and the outcome during an 8-week study of alprazolam and imipramine. A group of dysthymic patients without current or past major depressive episode was studied. The prevalences of dysthymia varied markedly across participating sites: 2–13%. Only a few clinical characteristics of dysthymic panic disorder patients were found. They had suffered from panic disorder for a few years more than patients without affective disorder and they were slightly older. The outcome after the 8-week drug trial was not significantly different from that of patients without affective disorder. Hence, dysthymia was not suggested to be of major clinical relevance for the phenomenology of panic disorder or for the outcome of drug treatment.

We report the case of a patient suffering from dysthymia. He underwent successful ECT treatment and was medicated with nefazodone and midazolam. Comparing the EEG and motor seizure duration in the periods with and without midazolam, no significant differences were recorded, but the dosage of thiopental and of succinylcholine had to be increased markedly after midazolam was discontinued (P < 0.05; ANOVA). This case indicates a substantial pharmacodynamic interaction between nefazodone, midazolam, thiopental, and succinylcholine.

La grande majorité des inventaires d’auto-évaluation spécifiques concerne la symptomatologie dépressive ou anxieuse. Les principaux questionnaires de dépression, évalués et utilisés par diverses équipes internationales, sont passés en revue dans cet article, l’accent étant mis sur leur profil et leurs emplois. Parmi ceux-ci, certains cherchent à évaluer globalement la sévérité de la symptomatologie dépressive; d’autres tentent d’effectuer un diagnostic; d’autres enfin se destinent à apprécier des aspects particuliers, tels que l’humeur, l’anhédonie, ou les cognitions associées à la dépression : ces derniers ont fait l’objet de développements récents parallèles à la recherche dans le domaine des thérapies cognitives ou comportementales. Selon leur construction et leurs qualités métrologiques, parfois en cours d’évaluation, ces inventaires peuvent être employés en recherche clinique, notamment comme critère de jugement d’essais thérapeutiques, ou en épidémiologie, pour des estimations de prévalence dans des populations non cliniques ou pour une première étape du dépistage de cas. Devant l’abondance actuelle de ces instruments, des indications générales sont finalement proposées selon les objectifs des recherches.

In a study of the general population, Weissman et al (1989), found that panic disorder is associated with an increased risk of suicide attempt. We estimated the lifetime prevalence of suicidal ideations or suicide attempts in 100 consecutive referrals for treatment of panic disorder. Sixty per cent of these patients had had suicidal ideation and 42% had attempted suicide during their lifetime. With regard to the season of onset of panic attack, we found a very skewed distribution of first panic in late spring or summer. Furthermore, patients who had their first attack in spring or summer had a higher rate of suicidal ideation and an increased risk of suicide attempt.

The present study was conducted to investigate whether several GABAergic drugs could affect immobility in the behavioral “despair” test (swimming test). The subacute (3 injections) treatment with the GABA-B agonist baclofen 0.5 mg/kg (BC05) partially antagonised the antiimmobility action of imipramine (IMI), whereas muscimol 0.00125 mg/kg (MU ; GABA-A agonist) did not affect the imipramine effect on immobility. The highest doses of baclofen alone increased immobility time, and no effect of muscimol alone was observed on this measure. Other experiments indicated that different doses of δ-α-aminovaleric acid (a GABA-B antagonist and GABA-A agonist) or progabide (a GABA A/B agonist with clinical antidepressive properties) did not modify immobility time. On the other hand, sodium valproate (VPA), chronically administered, was effective in reducing the time of immobility of rats in the swimming test, at doses which did not alter motor activity in an open field test. Since there is evidence indicating that valproate can be considered as a GABA-mimetic agent, the present data is consistent with other results showing an antidepressant-like activity of agents which enhance GABAergic transmission.

The tolerability and safety of treatment with paroxetine have been assessed by analysis of a clinical trial database that extends to 4126 patients treated with paroxetine, 1954 patients on active control, and 625 placebo patients. A total of 451 patients were exposed to paroxetine for periods of 1 or more years. Paroxetine was generally better tolerated than active control and was associated with a lower frequency of manic reactions in bipolar patients and fewer seizures than active control. Paroxetine appears to offer a differential advantage in reducing suicidal thoughts; the number of suicides and attempted suicides per patient exposure year were lower for paroxetine than for other antidepressants or placebo.

Regional cerebral blood flow (rCBF) values were measured by single photon emission computed tomography (SPECT) in different regions of the brain in 27 patients with DAT. Significant correlations were found between rCBF in left parieto-temporooccipital regions and psychometric test scores. Patients with hemisphere asymmetry in SPECT performed worse on psychometric tests. SPECT did not permit prediction of or differentiation between depressive and psychotic symptoms.

Tianeptine is a new antidepressant that, in animals, has a faciliting effect on both working and reference memory. To investigate the effects of tianeptine on vigilance and memory in humans, a placebo-controlled cross-over study was performed in 20 healthy volunteers. The duration of each treatment period was 7 days and the dosage of tianeptine 37.5 mg per day. The evaluations consisted of 3 computerized tests assessing alert function, continuous recognition and semantic facilitation. A memory questionnaire and the Rey test (15 words) were added. The analysis of variance (cross-over type) performed on the results did not show any significant difference between the evolution of these tests on tianeptine and on placebo in young healthy subjects, at the height of their intellectual capacities. In this study, tianeptine respected the vigilance as well as the performances of the healthy volunteers and did not impair their memory and cognitive processes, which distinguishes it from many psychotropic drugs. Nevertheless, tianeptine did not produce a faciliting effect on these processes in healthy volunteers. These results allow us to propose new clinical trial with tianeptine in order to investigate its effects on older volunters and patients complaining of memory disorders.