Experimental evidence suggesting that psychiatric comorbidity has important clinical and prognostic implications in bulimia nervosa has mostly been based on outpatient studies investigating a selection of co-existing psychopathological features with rather unstructured and not standardized diagnostic instruments. Using structured instruments (SCID-P, MDCL) for the diagnoses of DSM III-R axis I disorders and clinical interviews for the diagnosis of DSM III-R axis II disorders in 24 hospitalized bulimics, the present study demonstrated that more than half of the patients had two or three axis I disorders in addition to bulimia nervosa and almost half of the patients met criteria of at least one personality disorder. Subgroups of patients classified according to the type of psychiatric comorbidity did not differ significantly with respect to clinical features; regarding measures of hospital behavior therapy outcome. However, the findings provided evidence for a negative impact of anxiety disorder in addition to bulimia nervosa on the improvement of bulimic behavior and possibly also on self-rated depression.

The subjective, behavioral and physiological effects of modafinil (300 mg PO) a new central adrenergic stimulant, were compared with those of dextroamphetamine (15 mg PO), caffeine (300 mg PO) and placebo in a randomized double-blind cross-over study. Sixteen healthy volunteers participated in the study y: 8 males and 8 females with no history of drug abuse and moderate use of caffeine. Subjective and behavioral effects were studied using the Addiction Research Center Inventory (ARCI), Profile of Mood States (POMS) and Visual Analog Scales before and 1, 2, 4 and 8 h post single oral dosing. Results showed that subjective effects of modafinil (300 mg) differed markedly from those of dextroamphetamine (15 mg). They were close to those produced by caffeine (300 mg). These results indicate that modafinil (300 mg) does not possess amphetamine-like subjective effects in a healthy population. If subjective feelings are related to drug abuse liability, it could be assumed that modafinil, at the dose used in therapeutics, does not possess any abuse liability comparable to amphetamine.

Depressive conditions such as treatment-resistant depression, persistent depression and chronic mild depression have recently been the subject of much interest in Japan. The term “atypical depression” is not in common use, however depressive states falling outside the “typical” categories of the major depressive disorders (MDD) can be discussed in terms of symptomatology, etiology, and response to treatment. The term “neurasthenia” which refers to a hypochondriacal disorder with or without physical illness, as well as to a subtype of neurosis (ICD-9, 300.5), is no longer extensively used. “Dysthymia” is classically employed to signify either a dysphoric state accompanied by mild depression and irritability, as defined by the German school, or a mild depressive personality disorder; it is currently used as an alternative to “neurotic depression” (ICD-9 300.4), or “dysthymic disorder” (DSM III-R). Recurrent brief depression is not yet a prevalent concept in Japan. Despite the observation of depression with hyperphagia and/or hypersomnia, these phenomena have not received a specific designation. Therapeutic approaches to depression include both non-drug modalities (psychotherapy, environmental modification, etc) and the standard drug regimens (antidepressants, anxiolytics, etc); clinical trials are currently underway with selective serotonin reuptake inhibitors which we expect to be effective in treatment-resistant depression. Plant-based traditional remedies are still widely employed in Japan, and several of these are described. Finally, we discuss the Morita therapy, a specifically Japanese modality for treatment of mild depression with obsessive-compulsive symptoms based upon the Zen philosophy. This approach involves an initial period of absolute bed-rest, followed by gradual resumption of work and social activities with support and counseling.

The hypothesis that paranoid and non-paranoid schizophrenics are differentially associated with unilateral hemisphere dysfunction was tested on 12 paranoid and 12 non-paranoid schizophrenics, as well as on 24 affective patients and 24 normal controls. The subjects were presented for 150 ms with series of digit-pairs and open rings to the left or right visual fields. Overall recognition of digits and localization of gaps in the rings were better for the right than for the left visual field. However, performance of the paranoid and non-paranoid schizophrenics was relatively poorer in response to the right and left visual field stimuli, respectively. Since these data do not correspond to the findings obtained in the auditory modality, they were interpreted as indicating modality-specific associations of paranoid schizophrenia with left hemisphere dysfunction, and of non-paranoid schizophrenia with right hemisphere dysfunction.

The contribution of EEG to theory as well as to psychiatric practice of depression is negligible. The prevailing view is that no ‘abnormal’ characteristic can be demonstrated in affective disorders. Since ‘abnormal’ is generally taken in a neurological sense, all those EEG characteristics are faded out which cannot be regarded as neurologically abnormal but which nevertheless may be useful for psychiatric concerns. Thus, early observations concerning the spatio-temporal aspect of the EEG have essentially gone unnoticed, thereby evading systematic scrutiny. It has been maintained that periodically melancholic patients more often exhibited a dynamically rigid EEG than patients with neurotic forms. Our retrospective study involved 314 inpatients with depressive disorders who were subdivided into an ‘endogenous’ and a ‘non-endogenous’ subgroup using both IC'D 9 diagnoses as well as RDC criteria. The EEGs were designated to one of the three categories, rigid, labile, or physiomorphic. Forty-two percent of the patients in the ‘endogenous’ subgroup exhibited a dynamically rigid EEG (DR) compared to 20% of those from the ‘non-endogenous’ subgroup. Symptoms of psychomotor retardation positively correlated with DR, whereas ‘anxiety’ positively correlated with non-DR (labile or physiomorphic EEG dynamics). In addition, there was a positive correlation between DR and both the number of manifestations of depressive disorders and the number of previous hospitalizations. We interpret DR as a personality-bound characteristic which, far from being pathognomonic of a certain syndrome or even diagnosis, instead indicates a higher degree of vulnerability towards manifestation of melancholic syndromes with psychomotor retardation. This does not exclude the possibility of a state-dependent intensification of DR.

The stability of symptomatology and of eleven schizophrenic diagnostic systems was studied in patients initially in an acute phase (group 1) compared to patients in a residual phase (group 2). The patients were evaluated over a period of 1 year with a standardized checklist and PANSS in both groups. The number of patients included by the Carpenter, Calego, 1CD9, New-Haven, Schneider and Vienne systems decreased significantly between admission and discharge in group 1, whereas no variation was observed in group 1 between discharge and one year later, or in group 2 over a period of 1 year. The instability of schizophrenic diagnostic systems such as New-Haven, Schneider and Vienne could be due to the variation of positive or general symptomatology. The number of patients included by Feighner or Langfeldt did not vary significantly between admission and discbarge in group 1, in spite of a significant decrease in symptomatology, probably because certain criteria, such as duration of illness, hindered the systems from changing. The results showed the importance of specifying in every study on schizophrenia the time of inclusion (admission, discharge) or the phase of illness (acute or residual phase).

Serotonin uptake by platelets was determined in 11 patients suffering from carcinoma of the pancreas, eleven patients hospitalized for chronic physical disease, 19 patients suffering from major depression unipolar type, and 19 healthy volunteers. The Vmax values of serotonin uptake were significantly lower in patients suffering from carcinoma of the pancreas (F = 18.6, df = 28, Ρ < 0.001) and chronic physical disease (F = 21.3, df = 28, Ρ < 0.0001) than in healthy volunteers. The Vmax values of the depressed patients were also significantly lower (F = 4.27, df = 36, Ρ < 0.05) than those in the control group. No difference was found between the carcinomatous and the chronically ill patients. Km values of serotonin uptake by platelets were significantly decreased in both groups of patients with organic disease (F = 5.91, df = 28, Ρ < 0.025; F = 4.44, df = 28, Ρ < 0.045 respectively) as compared to the control group, but were similar in the depressed and the control groups (F = 0.42, df = 20, P = 0.52). Since the patients with chronic disease were chronically medicated, the decreased serotonin uptake may not be disease-dependent but rather associated with medication. However, the carcinomatous patients were drug-free and in this group the decreased uptake and serotonin transporter hypersensitivity may have been disease-dependent. These results suggest the involvement of the presynaptic serotonergic system in the susceptibility of pancreatic carcinomatous patients to prodromal depression.

The psychopathological profile in a sample of 43 adult chronic asthmatic outpatients is analyzed. The SCL-90-R Self-Report Questionnaire was applied. The symptomatic profile in our sample is characterized by a main elevation of the dimension of somatization (1.80) followed by the areas of depression (1.64), obsession-compulsion (1.53) and anxiety (1.45). These dimensions contribute to the leading features of psychopathology in our patients.

Atypical depression differs from typical (endogenomorphic) depression not only in terms of the primary determinant, mood reactivity, but also by the presence of at least one of four atypical symptoms, hyperphagia, hypersomnia, rejection sensitivity and leaden paralysis. In addition to the differential therapeutic response reported by various authors, these two types of depression can be differentiated by various biological measures including the dexamethasone suppression test, tyramine excretion following loading, REM latency, etc. A series of studies comparing phenelzine with imipramine and placebo in subgroups of atypical depressives showed better results with the tricyclic than with placebo; however phenelzine consistently gave the best results in this type of depression. The hypothesis is advanced that the difference between typical and atypical classes of depression could be accounted for by the loss of the ability to experience both “anticipatory” or “consummatory” pleasure in typical depression, but only anticipatory pleasure in atypical depression.

The authors conducted a home survey investigating the prevalence of self-reported symptoms of depression, suicidal ideation and suicidal attempts among a probability nationwide sample of 1316 adolescents aged 12-17 and 1114 young adults aged 18-24. Depressive symptoms were detected by the use of the Center for Epidemiologic Studies-Depression scale. 20.3% of adolescents and 35.7% of young adults were characterized as being depressed. Similar differences between the two age groups in the prevalence rates of suicidal ideation and attempts were observed. Suicide attempters of both age groups reported a higher number of depressive symptoms compared with the non attempters. Characteristics that distinguished the suicide attempters from the total sample were low rates of school attendance, use of substances, previous psychiatric help-seeking and additional mental health problems in families.

The cognitive effects of bromocriptine (10 mg/day) in chronic neuroleptic-treated schizophrenic patients were studied in a 4-month trial. Ten neuropsychological variables were used for the evaluations. Nine patients and seven controls completed the study. They were tested three times: before the beginning of the study, and after 2 and 4 months of treatment. The results showed that treated patients globally performed significantly better than the controls (P < 0.05), and that the digit symbol substitution test was significantly improved (P < 0.03). The WAIS performance score was also significantly improved (P < 0.02). The picture arrangement test was improved, but did not reach significance (P < 0.07). Verbal tests were not improved. It therefore appears that addition of a D2 dopamine agonist in neuroleptic-treated patients can improve some of their cognitive functions. Two explanations can be proposed: i) bromocriptine decreases neuroleptic-induced motor side effects or ii) has an effect on a putative hypodopaminergic function in schizophrenia.

Repeated administrations of tianeptine (10 mg·kg-1 im, twice daily, for 15 days) did not globally influence sleep-wakefulness cycles and cortical EEG activity overnight in rhesus monkeys. This antidepressant agent neither inhibited paradoxical sleep nor increased slow wave sleep. However, tianeptine induced a slight, but significant increase in wakefulness during the first hour following its administration, and had no sedative effects. The influence of tianeptine on sleep patterns in the monkey could be related to other arousal or sleep modifications observed in rats and cats, and to certain electrophysiological data reported in rat studies.

The P3 components (P3a and P3b) of the event-related potentials have been analysed in sixteen in-patients with a major depressive episode (DSM III-R) according to their subtype - anxious-agitated and impulsive versus retarded and blunted-affect - assuming that these two opposite dimensions of the depressive mood would rely on different physiopathological mechanisms. The P3a component, which indexes automatic cognitive processes, was dramatically decreased in the retarded and blunted-affect group. This suggests that this special type of cognitive dysfunction in depression is rather related to negative symptoms than to depression itself.

The natural history of alcoholism is still a matter of debate. Very few studies have addressed the issue of the post-treatment course longitudinally. We present the results of a long-term follow-up study in ninety-six alcohol dependent patients who were treated in a combined in-patient and out-patient treatment programme. Two, five and ten years after the initial treatment in 1976, they were re-investigated. Ninety-four percent of the patients could be located ten years after treatment. Fifty-one percent were abstinent, 22% were deceased, 14% of the patients’ drinking was unchanged and 7% had improved. This outcome is discussed and compared with the results of other long-term studies.

We assessed the lifetime prevalence of major depression in a sample of 145 patients with a current diagnosis of panic disorder and/or social phobia. The prevalenee tended to be higher in patients with both diagnoses. Patients with panic disorder and social phobia had an earlier onset of the former condition. Familial rates of panic were higher in patients with pure panic disorder, and the rate of depression was increased in relatives of probands who had a lifetime diagnosis of depression.

In a double-blind study carried out on elderly patients (older than 65 years) the efficacy and tolerability of the new antidepressant moclobemide was compared. Moclobemide belongs to a new class of substances called RIMA (Reversible inhibitor of the monoamine oxidase type A). Fluvoxamine, a selective reuptake-inhibitor of 5-HT, belongs to a class of antidepressants known for their better tolerability compared to tricyclic especially with elderly patients. Forty elderly patients (mean age 75 years) with major depression (according to DSM III) were randomized to receive either moclobemide (300 mg) or fluvoxamine (100 mg) twice daily. Dosages were increased when necessary on day 8, to a maximum of 450 mg moclobemide or 200 mg fluvoxamine and in most cases were maintained at these levels for the remainder of the study period (four weeks). Moclobemide was more effective than fluvoxamine showing a marked antidepressant effect and an earlier effect on psychomotor retardation. The two drugs were well tolerated showing a low incidence of side effects.

More than half of all patients consulting at public health facilities in Cali, Colombia have been shown to present mental disorders, the majority of which were non-psychotic; there is a high female preponderance amongst the affective disorders. As in other developing countries, in Colombia depressive disorders tend to present as somatic complaints, rather than as mood disturbances. The nomenclature used to describe these disorders is poorly codified, with most patients classed as “neurotic” or “depressed”; the diagnosis of “dysthymia” is very seldom encountered. Mental disorders are frequently misdiagnosed in primary care settings; when identified, treatment of depression by GPs generally involves TCAs or MAOIs, sometimes in conjunction with anxiolytics or neuroleptics. Only very severe cases are referred to psychiatrists, and many patients purchase drugs upon the recommendation of a pharmacist. Diagnostic trends and treatment results of a comparative study of amisulpride and viloxazine carried out in 80 patients assessed by DSM III-R criteria are reported.

Ten men and one woman aged 27 to 52 years and presenting chronic evolution of their psychotic disorders benefited from a treatment which associated lithium sulfate at a plasmatic level of 0.5 to 0.8 meq/L with clozapine (mean posology: 300 mg/day). Five patients presented chronic disorganized schizophrenia (295.14), five a schizoaffective disorder (295.70) and one patient chronic undifferentiated schizophrenia (295.94) according to DSM III-R. Nine of the eleven patients showed mood disorders in addition to their psychotic and dissociative symptomatology. The remaining two presented chronic disorganised schizophrenia with aggressive behaviour. The clozapine-lithium association led to stabilization and improvement in the condition of all patients. Nine patients are still undergoing treatment with satisfactory results. The mean duration of the clozapine-lithium treatment, which has proved to be well tolerated with regard to side-effects, is about five years.

A case is presented in which asthma and panic disorder co-existed, and in which the mislabeling of the latter as the former proved dangerous.