A review of the literature on placebo-controlled studies in schizophrenia reveals, that the percentage of placebo responders in short-term trials amounts to 0–40%; on active treatment the response rate is 40–60%. In relapse prevention studies 18–100% of patients on placebo relapsed as compared to 0–40% on active treatment. Factors of importance for the variability between studies are discussed. Desirable designs of explanatory and pivotal studies, the importance of placebo controlled relapse prevention studies, and more rigorous assessment methods, eg video-taped and structured interviews for diagnostic and symptom rating purposes, are proposed as a means to improve the quality of the clinical documentation of new drugs.

The authors investigated the relationship between personality dimensions and 35% CO2, reactivity. Fifty-one patients with PD and 26 healthy controls were assessed by the Tridimensional Personality Questionnaire and inhaled one-vital capacity of a gas mixture of 35% CO2, and 65%; 02. PD patients showed stronger reactivity to 35%. CO2, and higher scores on Harm Avoidance personality dimension. No significant relationship between reactivity to 35% CO2, and Harm Avoidance, Novelty Seeking and Reward Dependence personality dimensions were found in PD patients or controls. These results suggest that the reactivity to 35% CO2, might not be related to personality.

Looking for a substantial increase in the reliability and validity of voice analysis measurements in depression, we have developed a new experimental paradigm. The paradigm is based on two vocal tasks with different levels of cognitive processing and a baseline verbal task. It has been applied to 40 subjects, 20 patients with affective disorders and 20 normal individuals. We have found that an important set of vocal parameters, at different intervals, discriminates patients from normal subjects. Here, we discuss four of them – those that have been especially consistent; the patients had longer reaction times, a higher proportion of relative spectral energy (at a very low frequency band), narrower fundamental frequency range and higher proportion of omissions. Under the proposed paradigm, the acoustic analysis could be a promising instrument for the development of quantitative indicators of depression.

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.

This uncontrolled study presents 188 patients primarily diagnosed as addictive alcoholics and fulfilling the DSM III diagnostic criteria for panic disorder or major depression, 104 and 84 patients, respectively. The study focused on clinical outcome of pharmacological intervention with combined fluoxetine and disulfiram treatment. The patients were followed for (up to) 40 months. A good clinical outcome for both groups was found in 70%. In a subgroup of 37 patients ‘quality of life’ was assessed using quality of life scales. An appropriate correlation emerged between clinical judgement of outcome and the patients’ self-rating. Although the study was limited by being uncontrolled, the results have shown, that specific treatment in a group of alcoholics with comorbid psychopathology within the anxiety and depression spectrum is possible even after many years of addictive alcohol abuse. The necessity for proper psychiatric assessment is stressed.

In order to determine the usage pattern of light therapy (LT), we performed a survey of all psychiatric hospitals in Germany in 1992. Our data reveal that 13% of all psychiatric hospitals perform LT and another 7% indicate their interest in this treatment. Stratification into different treatment facilities demonstrates that 57% of the psychiatric university hospitals use LT. The usage of LT started in Germany in 1982 and there was a sharp rise from 1987 onwards. The majority of hospitals (89% of those hospitals which use LT) use LT successfully for the treatment of seasonal affective disorder (SAD) and its subsyndromal form followed by non-SAD depression (68%). LT is used as monotherapy in 71% of SAD patients compared with 34% in non-SAD depression.

We compared the rate of DST non-suppression in two samples of 26 Brazilian and 26 Belgian female depressive patients, matched for age, diagnostic subtype and severity of depression. This rate was significantly lower in São Paulo than in Liège (P = 0.04). The differences observed in DST can be explained by the complexity of familial, personal and clinical factors. A role of a latitude effect through melatonin secretion on adrenocortical function of depressed patients is also suggested.

Le trouble anxieux et dépressif mixte (ADM) représente une nouvelle catégorie diagnostique regroupant essentiellement des patients vus dans le cadre des soins primaires. Ces patients se définissent comme des sujets présentant des symptômes d’anxiété et de dépression d’intensité limitée et comparable, s’accompagnant au moins de quelques signes neurovégétatifs. En outre, ces patients sont censés ne pas répondre aux critères diagnostiques spécifiques de troubles anxieux ou dépressifs. Cependant, les cas de dépression anxieuse ne sont pas limités aux patients entrant dans cette nouvelle catégorie « sous-syndromale ». De nombreux patients qui répondent aux critères soit de troubles dépressifs soit de troubles anxieux peuvent également présenter des symptomes, un syndrome ou répondre à un diagnostic d’anxiété ou de dépression. On ne sait pas encore si les symptômes d’anxiété et de dépression sont deux expressions différentes d’un même processus psychopathologique sous-jacent. La description récente d’un « syndrome névrotique généralisé » (Tyrer, 1990) représente une tentative de réunification de syndromes séparés dans nos classifications actuelles. Avec cette approche globale, les états d’anxiété,de dépression ou d’ADM sont associés, à un moment ou à un autre, à des traits de personnalité spécifiques et on considère qu’ils expriment différents niveaux d’hyperréactivité à diverses situations stressantes. Cette hypothèse expliquerait le rapport étroit entre ces deux catégories de symptômes, et I’efficacité dont témoignent certains agents psychopharmacologiques à la fois sur les troubles anxieux et dépressifs.

Psychiatric morbidity was assessed in 55 HIV seropositive women who were attending either an HIV centre in Paris (n = 30) or a genitourinary clinic in London (n = 25). Demographic data and information concerning HIV disease, openness about diagnosis, counselling received, social and family support, sexual behaviour and attitudes towards fertility and pregnancy were recorded using a semi-structured interview. Moderate or severe levels of psychiatric distress were found in 60% of the women in Paris and 28% of those in London. Overall, these rates are higher than those found in comparable studies of HIV seropositive men. Psychiatric disorder was associated with a past history of intravenous drug use and older age. Over half of the women were in regular sexual relationships but safe sex precautions were frequently not used. Sixteen subjects among those of child bearing age were prepared to consider having children.

The prolactin (PRL) responses to 5 mg im haloperidol were assessed in the drug-free state and after one month treatment with neuroleptics in 14 male schizophrenic patients who had never received drug treatment, and in 20 male patients who had discontinued their neuroleptic treatment for periods of two months to one year. Drug experienced patients showed lower PRL increases after acute haloperidol (mean 31.7 ng/ml) than drug-naive patients (mean responses 43.4 ng/ml). After treatment with neuroleptics in doses appropriate for the best clinical response, the baseline PRL levels were similar in the two groups, and im haloperidol did not cause any further PRL increases. The results provide evidence that after discontinuation of neuroleptics, the hypothalamic-pituitary dopamine receptors are subsensitive, and remain in that state for long periods of time.

In recent years an enhanced catabolism of serine, with or without the existence of porphyria, has been demonstrated in relation to a specific subtype of psychosis, according to ICD-10 criteria, the acute polymorphic psychosis with or without symptoms of schizophrenia. Since sensory perceptual distortions play a key role in the symptomatology, patients with this disorder are referred to as Acute Polymorphic Psychosis plus psychosensory phenomena (APP+). In a retrospective study, including a total of 140 chronic psychiatric patients, we investigated the prevalence of Acute Intermittent Porphyria (AIP) and APP+. No subjects with AIP were found. In two patients APP+ could be demonstrated, based on both clinical characteristics and positive biochemical markers, ie lowered plasma serine concentration and increased TSM-ratio (100 × Taurine (μmol/l)/Serine concentration * Methionine concentration). In three patients the psychotic disorder was suspected to be present. It is concluded that careful psychiatric diagnosing may reveal specific psychotic disorders with a distinct biological pathogenetic factor, ie a disturbed serine metabolism.

We calculated Morbidity Risks (MR%) for the major psychiatric conditions in the families of three groups of patients, affected by Eating Disorders (ED; n = 41), Obsessive Compulsive Disorder (OCD; n = 70) and Mood Disorders (MD; n = 39). Our aim was to verify the hypothesis of a common familial pattern of aggregation. Familial risk of developing OCD was significantly increased in the families of OCD probands. Homotypic cases were also augmented in ED and MD families with respect to the rates of the general population, although without statistical significance in the crosswise comparisons. These results confirm the existence of a genetic susceptibility to the development of OCD.

Several studies have reported immune cellular and humoral dysfunction during depression. We specifically focused on the study of the monocyte as it has a key role in the activation of the immune response. To examine the association between severity of depressive symptoms and values of monocyte parameters (HLA-DR, CD35, phagocytic activity and vimentin filaments), we used a longitudinal design and assessed monocyte markers at intake and at follow-up 12 weeks after discharge from the hospital in 49 depressed patients. Seventy percent of patients showed pretreatment a marked monocyte dysfunction (82.5% had at least one parameter altered). After treatment, alterations in immunological variables were significantly associated (P < 0.05) with depression scores higher than 15. The findings indicate that the monocyte dysfunction is temporally associated with the state of depression. Before and after treatment the immunoreactive vimentin filaments significantly increased (P < 0.01) after incubation of monocytes with naloxone, suggesting that an increased opioid activity might account for the monocyte dysfunction.

Serum β2-microglobulin (β2m) levels were increased in ten out of 52 patients on chronic lithium treatment, while creatinine levels were within the normal range in all of them and creatinine clearance was below the normality in only five. We propose serum β2m assessment as a possible precocious indicator of glomerular filtration impairment, and recommend its frequent determination in patients chronically treated with lithium to prevent the occurrence of renal insufficiency.

A short review of placebo response in double-blind placebo-controlled therapeutic panic disorder studies published since 1985 is given. The main result is that the inefficacy-related drop-out rate of the placebo group of almost all clinical studies grows to more than 30% after 4-5 weeks of treatment and that often the results of placebo responders do not widely differ from that of the treatment groups. Except in some studies with very large sample sizes, the described response of the placebo group will not lead to significant differences between placebo and drug in completer analysis, making last observation carried forward (LOCF) analysis necessary. However, the large drop-out rates may lead to invalid efficacy results in later stages of the studies. As it can be shown that the inefficacy-related drop-out rates between placebo and target drug groups are as good an efficacy characteristic as any other, more conventional efficacy parameters, it is proposed to use the inefficacy related drop-out rate as the main efficacy parameter in placebo-controlled panic disorder studies of more than 4-5 weeks.