In this study, a PstI polymorphic site with two individual alleles, namely A1 and A2, was identified within the boundary between intron 1 and exon 2 of the cholecystokinin (CCK) type A receptor gene. The PstI polymorphic site was used as a genetic marker to study its association with psychotic symptoms in schizophrenia. A significant difference in allelic frequency was found between schizophrenic patients with and without auditory hallucinations (χ2 = 6.26, df = 1, P = 0.012), and the odds ratio for the allelic association was 2.21 (95% CI 1.18–4.15) with an attributable fraction of 0.1. The frequency of A1-A1 and A1-A2 genotypes showed a significant excess in schizophrenic patients with auditory hallucinations as compared to those without such symptoms (χ2 = 5.45, df = 1, P = 0.02), and the odds ratio for the genotypic association was 2.27 (95% CI 1.13–4.57) with an attributable fraction of 0.177. The haplotype-based haplotype relative risk (HHRR) test revealed a significant difference between transmitted and non-transmitted alleles in nuclear families of schizophrenic patients with auditory hallucinations (χ2 = 4.54, df = 1,P = 0.033) but not in those of schizophrenic patients without them. The present study suggests that the CCK-A receptor gene may be associated with auditory hallucinations in schizophrenia.

This paper describes the development and the validation of a questionnaire assessing the opinions of the relatives of patients with schizophrenia on the causes and the social consequences of the disorder. The final version of the questionnaire includes 28 items, grouped in four sub-scales (social restrictions, social distance, utility of treatments, biopsychosocial causes of schizophrenia), whose intra-rater reliability ranges from 0.36 to 0.84. Cronbach's alpha coefficient, which tests the content validity of the sub-scales, ranges from 0.56 to 0.66. Factor analysis identifies two factors (opinions on social consequences and the utility of treatments, and the beliefs on the causes of schizophrenia), which account for the 73% of the total variance. This questionnaire may be particularly useful to assess relatives'beliefs about schizophrenia and to target psychosocial interventions in the families of patients with schizophrenia.

Several current hypotheses consider the process of attribution of importance to stimuli and the integration of actually perceived reality with experience as a cognitive base for the genesis of delusions. We tested these models by a comparison of deluded schizophrenics, healthy controls, and anxious patients on reasoning under uncertainty. Reasoning under uncertainty was examined in currently deluded schizophrenics (n = 29), in 16 of them also in remission, in normal control groups (n = 35), and in anxious patients (n = 31) using a probabilistic inference task. Acutely psychotic schizophrenics were less ready than normal subjects, anxious patients, and schizophrenics, in remission to modify their judgement in probabilistic situation confronted with potentially disconfirmatory data. They were also less prone than anxious patients and schizophrenics in remission to correct their estimate confronted with confirmatory data. The data support the hypothesis of a weaker influence of incoming stimuli on reasoning under uncertainty as a cognitive base of the maintenance of delusions.

Cognitive impairments in schizophrenics have been found to precede tardive dyskinesia and to co-exist with other motor deficits. However, little is yet known about the prevalence of cognitive disturbances in patients with neuroleptic-induced parkinsonism. From the literature on idiopathic parkinson, it was inferred that extrapyramidal symptoms (EPS) are accompanied by cognitive dysfunction. 85 schizophrenic in-patients were divided into EPS high and low scorers according to an established criterion (Simpson Angus Scale, cut-off score: 0.4). Cognitive impairments were assessed using a self-rating instrument measuring disturbances of information processing.

Patients with high EPS exhibited significantly elevated scores in six of ten cognitive and perceptual subscales (t = 2.1—3.1) as compared to low EPS patients. It is concluded that high EPS patients suffer from cognitive disturbances which are assumed to possess high relevance for both psycho-social and medical treatment. Cognitive problems may, when not considered, disturb compliance, insight of illness and transfer of learnt skills into everyday life.

Thirty-three schizophrenic inpatients aged 45.3 ± 13.5 years who had been found not guilty of homicide by reason of insanity were compared with 28 schizophrenic patients matched for age, sex and duration of disease who had not committed any crime. Statistical analysis revealed a high rate in the study group of individual factors associated with aggression, such as alcohol abuse, previous contact with the police, aggressive behavior and threats (P < 0.05). Significantly more of them were also immigrants (P < 0.05). There was no between-group difference in familial factors. These findings support earlier studies indicating that schizophrenic patients with the profile of alcoholism, aggressiveness and foreign country of origin are at high risk of homicidal behavior.

The goal of this prospective investigation was to study the course and the quality of patient-psychiatrist relationships during phase II / phase III clinical trials of antidepressant medication prescribed for depressive disorders. All patients who participated in the clinical trials (and subsequently in this survey) signed written informed consent statements and were subject to random double blind treatment assignment. Retrospective analysis of 118 investigations was carried out, and the patients involved were questioned concerning their experiences and impressions during and after the study. Data show that the outcome of clinical trials of antidepressant drugs are not a function of pre-existing good patient-psychiatrist relationships. On the other hand, no effects on the patient-psychiatrist relationship were found as a result of the experimental procedure, and it can be concluded that no detrimental effects on future patient-psychiatrist relationships were incurred.

We investigated the comparative efficacy of citalopram vs. citalopram administered with clomipramine, in treatment-resistant obsessive-compulsive disorder (OCD).

Sixteen adult outpatients participated in a 90-day, randomized, open-label trial. Eligible patients were aged 18 to 45 years, had moderate to severe DSM-III-R OCD of ≥ one year's duration, a baseline Yale-Brown scale (Y-BOCS) score of ≥ 25 and no other active axis I diagnosis, and had failed adequate clomipramine and fluoxetine trials.

The citalopram-plus-clomipramine group (n = 9) experienced a significantly larger percent decrease in mean Y-BOCS score by day 90 than the citalopram alone group (n = 7). Only one citalopram patient decreased her score by ≥ 35%, and two by ≥ 25%. All nine citalopram-plus-clomipramine patients experienced decreases of 35%. Side effects were mild to moderate in both groups. We also treated with citalopram six OCD patients who had not tolerated fluoxetine alone and clomipramine alone; three achieved Y-BOCS score decreases of ≥ 35% at 90 days.

Since citalopram does not significantly affect clomipramine metabolism, the improvement in the combined drug group is unlikely to have resulted from increased plasma clomipramine levels. Double-blind controlled trials are needed of citalopram in OCD, and of combining citalopram with clomipramine in treatment-resistant OCD.

An overview of the existing European trainee organizations is not easy to give. The historical tendencies as described in the first part have currently brought about many initiatives. In the second part of this article, a description of the two main European trainee organizations is given.