A young previously healthy male student suddenly experienced a fear of incapability of breathing while waiting for release from an isolation chamber at the end of a circadian rhythm experiment. He has since manifested recurrent episodes of panic disorder and has also shown slight depressive symptoms as an associated feature during the course of illness. Although it is not clear whether the disorder was induced by the 3 weeks of isolation, by the condition of living on his innate circadian rhythm or some other factor, this case appears to offer an explanation of the mechanism of panic disorder.

We investigated the presence of antinuclear antibodies (ANA) in 63 drug free and lithium treated bipolar patients as compared to 37 healthy controls. Increased frequency of positive ANA was detected in bipolar patients in comparison to controls (19% vs 5%, respectively, P < 0.05). This finding was unrelated to lithium treatment. No antinative DNA antibodies or antihistone reactive antibodies were detected among the ANA positive subjects.

We report the case of a 68-year-old depressive patient who developed severe thrombocytopenia during hospitalization. EDTA-associated thrombocytopenia and psychodrug-induced thrombocytopenia are illustrated as potential causes of low platelet counts, particularly in regard to psychiatric patients.

Development of treatments for dementia is beset by special problems in defining the diagnosis, establishing efficacy criteria, and specifying the necessary duration of study. There is need for agreement among clinicians and scientists on diagnostic subgroups of dementia. Similarly, there is a need for harmonization of the regulatory guidelines in Europe, Japan, and the United States regarding the decision set of variables on which to base efficacy claims. The duration of trials must be based upon the intended claim: transient symptomatic benefit, maintained symptomatic benefit, or a therapeutic effect on disease progression. Claims other than transient benefit require long-term trials, suggested to be of at least six months in duration. Problems with long-term studies include slow patient accrual, high dropout rates, changing milieu, low return on investment, and lack of unanimity regarding regulatory requirements. Regulatory authorities must come to some accord, consonant with current clinical/scientific wisdom and consensus, regarding diagnosis, efficacy criteria, and feasible study duration, in order to attract continued sponsor investment in the development of antidementia treatments.

A clinical and biological pattern similar to that of neuroleptic malignant syndrome is reported in a depressed patient treated with trimipramine, without any concomitant use of neuroleptics. The antidopaminergic properties of this drug, one of the tricyclic antidepressants, may account for this uncommon side effect.

The future and present day state of psychosocial and sociobiological rehabilitation depends on scientific research, the differing rates of development within the autonomous communities, and the “administrative reform”. In the rehabilitation of the chronic mentally ill, these three factors complement existing psycho and sociobiological therapy and cognitive methodology training.

This paper provides a brief overview of issues to consider in evaluating patient benefit from health care. Different types of measures are described and it is noted that the choice of measure is dependent upon the purpose of the study. The cost-utility approach to evaluation is discussed in more detail. This approach is often criticised but it raises important issues in medical decision-making and has considerable potential in the evaluation of patient benefit from health care.

The Charles Bonnet syndrome is characterized by the occurrence of visual hallucinations in elderly people, but without any mental disorders. Two clinical cases are described. An etiological and physiopathological theory is proposed, based on vascular pathology, lack of visual stimulation and a psychodynamic component.

This paper considers some of the theoretical and practical problems of conducting cost-utility analyses alongside clinical trials. In order to measure utilities of different health states in a clinical trial a number of critical assumptions have to be made. Some of these assumptions are questionable on a theoretical level, others empirically invalid. The practical problems of measuring utilities are discussed. The standard gamble is shown to be the most validated method of utility measurement, but still based on very strong assumptions. The standard gamble instrument is also costly and difficult to administer in clinical trials. Other instruments are found to be less valid than the standard gamble. It is concluded that although cost-utility analysis seems relevant in some instances, investigators should avoid this assessment of utility and instead measure cost-effectiveness, cost-benefit and quality of life.

Since the beginning of the 1980s the five Nordic countries: Denmark, Finland, Iceland, Norway and Sweden have gone through a process of decentralization. This process has taken place at a different pace and according to slightly varying decentralization models, but in all five of the countries the reduction in capacity of psychiatric hospitals has leveled out, whereas the establishing of decentralized treatment functions are not yet sufficiently developed. Furthermore, all five countries focus on rehabilitation of the most severe mentally ill. Examples of different models from the Nordic countries are mentioned.