The political role psychiatry plays in mental health strategies in the 20th century is discussed as well as the dangers of abuse when totalitarian ideologies rule supreme. The author comments on positive developments in the sectors of applied psychiatry and psychotherapy after World War II and the implementation of uniform requirements for the classification of psychopathological disorders as well as their limitations. Psychiatry as a scientific discipline relies on two fundaments: the conclusions drawn from the collective, present and past experience of psychiatric medicine and the impulses given by neighbouring disciplines such as neurobiology, psychology and sociology. These influences are necessary for the advancement of psychiatry, but can be restrictive in that they lead to tunnel vision by giving simple explanations for mental disorders of complex or unknown etiology. A multidimensional approach is required for the elaboration of adequate therapies and research must avoid dogmatism and short-sightedness.

The cortical metabolic patterns of 12 schizophrenics experiencing hallucinations and/or pseudo-hallucinations were investigated using positron tomography and 18F-fluoro-deoxy-glucose. Andreasen's scales were scored and the patients (all “mixed“) were classified in a “positive” or a “negative” group and compared to a group of 6 normal controls. The data were analyzed across groups for absolute metabolic rates, metabolic indices (cortical region/whole studied cortex), and specific indices exploring the sensory non-association/posterior parietal association and the prefrontal association/posterior parietal association dimensions. Whole-cortex metabolic rate in the negative group was found to be lower than both the control (P=0.02) and the positive group (P = 0.002) while the positive group did not differ significantly from the controls. We found “hypofrontality” to be without difference between the positive and the negative group (controls: 7±0.7, positive: 5.9±0.2, negative: 4.9±0.15, mean±SEM in mg/min/100 g). However, the prefrontal association/posterior parietal association ratio was increased in the negative group (P=0.02). A major finding was an increase in the posterior non-association/posterior parietal association ratio in the whole schizophrenic group as compared to the controls (P = 0.004), this being more marked in the negative (P=0.01) than in the positive group. Arguments are given to support the hypothesis that this particular increase could be related to the hallucinatory activity of the patients.

Five endogenous depressed patients were asked to participate in a phase-shift experiment consisting of advancing, by 5 hours, the time-schedule of the major external synchronizers such as light/dark cycle, sleep/wake, meal-time and social activity cycles. Clinical and biological parameters (body temperature, plasma cortisol, TSH and norepinephrine (NE) circadian rhythms) were observed throughout this two week period. The circadian rhythms were severely altered in the pre-treatment period, with a significant reduction of amplitude. During the phase shift experiment, the clinical state of the patients improved significantly. Their circadian rhythms were dramatically impaired in the first days of the procedure and were then restored after the first week, with higher amplitude. However, the TSH circadian rhythm remained unentrained by the phase shift leading to an internal desynchronization. Our findings suggest that entrainment of internal clocks by environmental information may be impaired in depression.

In 32 patients with panic disorder with or without agoraphobia, Bmax measures of 5-HT binding in platelets did not differ from normal controls at baseline. Plasmatic cortisol levels were significantly higher than controls in the morning and in the evening measures as well as in post-dexamethasone assays. Following an 8-week treatment period with alprazolam plus behavioral guidance encouraging exposure, Bmax values did not alter but cortisol measures diminished significantly. Measures of phobic avoidance were negatively correlated with 5-HT Bmax values. Plasmatic cortisol correlated positively with the number of situational panic attacks in the month before treatment. There were no correlations between cortisol and 5-HT Bmax measures. A possible link between serotonin function and phobic avoidance is discussed. Cortisol changes were interpreted as being related to the global severity of the anxious state.

This study evaluates the relationship between stress of captivity and subsequent presence of Post Traumatic Stress Disorder (PTSD) has been evaluated in a homogeneous population of 817 Alsatian World War II veterans who were imprisoned in the USSR during and after the war. Data were collected in 1988 by a questionnaire structured to investigate the presence of DSM-III-R criteria for PTSD as well as events experienced in captivity. The presumptive diagnosis of PTSD was found to be significantly associated with longer internment and with higher scores on a severity of POW experience index.

To study the reliability of two depression assessment scales, the Montgomery-Asberg Depression Rating Scale and the Psychomotor Retardation Scale, 30 patients with depression according to Feighner's criteria were evaluated, by two groups of raters: 5 were trained psychiatrists or psychologists, and 6 were untrained raters. The experiment lasted three months. The patients were recorded on video-tape by two psychiatrists who did not take part in the experiment, during pre-designed interviews. Each scoring was discussed by the trained group but not by the untrained group. The Kappa test and the sign-test were used for the statistical analysis of global and itemized results, respectively. Intraclass coefficient Q3 was applied to global scores. With regard to global scores, there was no significant difference among the members of the trained group, who scored higher than those of the untrained group; a significant difference between some of the untrained raters, induced a significant difference with the trained group. With regard to each item of both scales, reliability appeared to be slight to moderate, and there was no significant difference between trained and inexpert raters. These results are discussed and modifications are proposed to improve the consistency of the two scales. The authors emphasize the necessity for therapeutic trials to be conducted with permanent groups of assessors who continue training even outside of trial procedures.

Two cases of bipolar psychosis presented a rapid manic switch following administration of tricyclic antidepressants. In both cases the oxidation capacity was genetically deficient. The role of oxidation deficit is discussed in the pathogenesis of switch process and preventive measures are considered.

Disturbances in the verbal communication patterns of manic and schizophrenic patients have been identified as two tools borrowed from quantitative linguistics: the Cloze Procedure and the Type Token Ratio (TTR). The Cloze Procedure, which measures the communicability of a message, consists of suppressing systematically every “nth” word of a text and in asking raters to try and guess the missing words. The Cloze Score of each text is then evaluated. The TTR measures the index of repetitiveness of a text or, in other words, its verbal richness. The degree of communicability, or overall comprehension, and the index of verbal richness are obtained through the analysis of a corpus of oral texts which have been recorded and transcribed. The patients are all paired with suitable controls. It was shown that low Cloze Scores (CS) and low TTR identify schizophrenic patients, whereas low CS and high TTR indicate a manic state. Control subjects show both high CS and high TTR. These results suggest that the Cloze Procedure linked with TTR can provide substantial aid to the differential diagnosis of mania and schizophrenia.