The Mannheim Cohort Study, from which the results to be displayed below are taken, is an epidemiologic field survey on the prevalence of psychogenic disorders, i.e. the psychoneurotic, psychosomatic, and personality disorders listed as ICD items 300-306 in the 8th revision of the WHO. A representative sample of 600 randomly selected citizens from the city of Mannheim were examined twice from 1979-1985 by means of comprehensive sociological instruments in a semi-standardized psychoanalytical interview.

Instead of a wide birth range, we decided to investigate age classes, and each time took a 200-person sample from the records of the municipal registration office for individuals (both sexes) born in 1935, 1945 and 1955. The aim of this research strategy was to determine the possible influence of various historical and social conditions of development on the pathogenesis of psychogenic disorders.

The qualified interviewers involved in the project went to see the individuals at home. The examination, a biographical investigation which lasted for at least 3 hr, took the form of a semi-standardized structured interview as in dynamic psychotherapy. Thus, a quantity of findings concerning present and past morbidity, development, stress in infancy, aspects of present occupational and family life, and the organization of leisure time interspersed with sociological, psychological and psychoanalytical questions were included. A number of questionnaires (list of complaints, critical life events, personality inventories, measures of attitudes) were also inserted.

The criteria to be met for assessment as a “case” (sick person) were:

1. 1, the temporal criterion of point prevalence, referring to the 7 days prior to examination;

2. 2, the qualitative criterion of assessing an ICD diagnosis (Nos 300-306; 8th revision;

3. 3, the quantitative criterion: grading the psychogenic impairment (Impairment Score = IS).

Five points plus had to be scored, or over 20 points according to the Goldberg-Cooper Interview.

The IS was designed as a conceptual complex rating in order to determine primarily psychogenic (non-organic) impairment on a somatic, psychic, and communication-related dimension. The individual's impairment is graded between 0-4 on each dimension, so that 3 single ratings add up to a maximum score of 12.

According to this definition, 156 out of 600 individuals examined were assessed as cases in the first survey. This means a point prevalence of 26%.

Meta-analyses of 417 patients diagnosed either prospectively (316 US patients) or retrospectively (101 European patients) as suffering from melancholia according to DSM III criteria have shown that paroxetine was significantly better than placebo with respect to all outcome measures. There was no significant difference between active control and placebo in these analyses. In a group of 216 severely depressed hospitalised patients with a HAMD score of 25 or more, paroxetine was as effective as active control.

In acquired peripheral demyelinating disease only few publications point out the possibility of simultaneous involvement of the CNS. We describe two patients with chronic polyneuropathy and monoclonal gammopathy of undetermined significance (MGUS) developing a progressive dementia syndrome with extensive cerebral white matter alterations.

The case of fetal malformations with bilateral agenesis of the kidneys and severe cardiac defect under continuous lithium treatment during the first trimester is presented.

The emergency admissions to hospital care in six psychiatric services in four Nordic countries were explored as a part of a Nordic comparative study on sectorised psychiatry. One year treated incidence cohorts were used, with the total cohort comprising 2,454 patients. Of the 803 patients who were admitted to inpatient care during a 1-year follow-up, 82% had at least one emergency admission and 23% repeated emergency admissions. The definition for the repeated emergency admissions was at least two admissions during the follow-up. The mean length of stay in emergency inpatient care per treatment episode for this patient subgroup was 28 days. Their emergency inpatient episodes constituted 30% of all inpatient days during the follow-up. However, the variations between the services and diagnostic subgroups were large. The results of a logistic regression analysis indicated that the following variables predicted repeated emergency admissions: inpatient care at index contact, emergency outpatient contacts or no planned hospital admissions during the follow-up, psychiatric service, age under 45 years, and a diagnosis of psychosis, personality disorder or dependency. The repeated emergency admissions were related to the existence of a special service unit for abusers but not to the rates of outpatient staff or acute beds in the services, to geographical distances, referral practice or existence of emergency services.

We report a 27-year-old female patient with prior history of Graves' disease and relapsing episodes of tachycardia, hyperpyrexia, muscular rigidity and coma. With the subsequent manifestation of an acute schizophreniform psychotic disorder unresponsive to neuroleptics, the primary syndrome was re-classified as febrile catatony. Hyperthyroidism was ruled out with normal serum thyroid hormone levels, as were toxic effects of thyrostatic treatment, drug-induced hypothyroidism and a malignant neuroleptic syndrome. All psychiatric symptoms subsided completely following subtotal thyroidectomy. Febrile catatatony has to be added to the spectrum of psychotic phenomena that may be caused by Graves' disease, irrespective of serum thyroid hormone levels.

A case is described where phototherapy rapidly restored sleep-wake disturbances and concurrent symptoms of delirium in a patient who did not respond to conventional treatment with haloperidol. In this case, the delirious state may have been caused by a change in metabolism as a result of sepsis. Exposition of the patient to 8,000 Lux during 1.5 h for 5 consecutive days was sufficient to suppress all delirious symptoms and to normalize sleep. This result may encourage the setup of systematic studies towards the extent of desynchronization between various rhythmic cycles in delirium and towards the value of phototherapy for the restoration of normal circadian rhythmicity.

Dysthymia is the last diagnostic label introduced after a series of precursors to describe a disorder whose nosological status has long been dubious. The results of published epidemiological, as well as clinical studies about its presentation, course and outcome partly support the validity of this construct — although their interpretation is limited by methodological difficulties: same prevalence in many locations in the world, always lower than that of major depression, somewhat specific clinical pattern, course and outcome.

There is no accepted definition of what constitutes onset of antidepressant effect, and this limits evaluation of the validity of many comparative reports. In order to clarify the nature of the comparative methodology required, it is proposed that two distinct research questions are separated conceptually: 1) when do antidepressant drugs begin to clinically act? and 2) do all antidepressant drugs produce relief of symptoms in patients within a similar time period? A methodological distinction may also be made in terms of whether to assess the onset of effect of an antidepressant as having an absolute quality (“fast”) or as being fast relative to other treatments (“faster”). The choice of aim will help to define the methodological approach, the applicability of the findings and the difficulties to be addressed. Describing an antidepressant as showing a “fast” or “faster” onset of response requires that any description attempts to define (in terms that may be generalised) the nature of the comparison (faster than what?), the nature of the effect (faster to do what?) and the population in whom this effect may be expected (faster in whom?). Some details of methodological approaches are reviewed, and suggestions for study designs are made.

Investigations in the field of gender dysphoria (GD) have been mostly related to psychiatric comorbidity and severe psychiatric disorders, but have focused less on personality traits and personality disorders (PDs).

We aimed to assess personality and the presence of PDs in a sample of 25 persons with GD attending the Psychiatric Clinic or the Department of Endocrinology of the University of Cagliari requesting sex reassignment therapy. They were assessed through the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and the Structured Clinical Interview for DSM-IV Axis II (SCID-II).

The sample consisted of 14 MtF and 11 FtM, with a mean age of 29.6 ± 9.5. Overall, 39.1% of the sample met the criteria for at least one PD, more frequently cluster-B PD (21.7%). MtF met a higher number of SCID-II criteria than FtM, especially regarding histrionic personality traits (P = 0.001). A total of 20 persons (9 MtF and 11 FtM) completed the MMPI-2. Mean T scores did not differ from the general population, except for the Psychopathic Deviate (Pd) scale (mean T = 66.2 ± 11.2). The Masculinity-Femininity (Mf) scale was slightly increased, and its score reduced after correction for perceived sex (P = 0.037). MtF scored significantly higher at the Family Problems (FAM) scale (P = 0.052) and lower at the Social Discomfort (SOD) scale (P = 0.005) compared to FtM.

The high prevalence of PDs confirms that this kind of assessment in GD is of great importance, as a key part of personalized treatment plan tailoring. The high scores on the Pd scale suggest misidentification with societal standards.