Among HIV patients treated for AIDS-related adjustment, major depressive disorders and other affective disorders, we assessed in an open study the feasibility of using a serotonergic antidepressant (fluvoxamine). Thirty-five seropositive patients with the above conditions (22 men and 13 women) were followed over a minimum period of four weeks. At the end of the treatment, a large number of patients (77%) showed marked improvement. “Nuclear” depressive and anxiety symptoms remitted, while the “somatic” ones seemed less sensitive to treatment. Treatment had to be terminated prematurely due to side effects in only two patients (6%).

A naturalistic study was conducted in general practice in Portugal on the efficacy and tolerance of low doses of amisulpride in the treatment of dysthymia. A total of 109 patients received low doses (50 – 100 mg) of amisulpride for four weeks. A global evaluation showed good or very good efficacy and tolerance in more than 80% of the patients. The social disability observed at baseline was significantly improved after the four-week treatment period. Few adverse events were observed and only four patients dropped out due to side effects. Our results suggest that low doses of amisulpride might be a safe and effective treatment for dysthymia in clinical practice.

The case of fetal malformations with bilateral agenesis of the kidneys and severe cardiac defect under continuous lithium treatment during the first trimester is presented.

Two cases of patients with acute mania who responded to combined electroconvulsive therapy (ECT) and clozapine are described. This report further demonstrates the efficacy and safety of clozapine-ECT co-administration in schizoaffective patients.

Long-term (minimum six months) safety and efficacy studies with an anti-anxiety agent are aimed at identifying the emergence of any clinical effects not observed during shorter periods of treatment including the identification of late occurring adverse events, loss of therapeutic benefit, or post-treatment withdrawal effects. There is the need to establish diagnostic criteria for persistent anxiety for patients who truly benefit from long-term therapy. Risk factors predisposing to drug dependence should be assessed prior to continuous use. Ideally, long-term continuous studies should be blinded, comparative and placebo-controlled, with an adequate duration of the withdrawal phase. The treatment response of the elderly in comparison to the overall patient sample should be emphasised.

Four patients with DSM-IV bulimia nervosa were treated in a crossover trial with naltrexone alone, fluoxetine alone, and a fluoxetine-naltrexone combination. Three patients presented a complete remission when treated with the fluoxetine-naltrexone combination.

To examine the prevalence of obsessive-compulsive symptoms, we evaluated 69 outpatients with panic disorder. We found a 30% prevalence of obsessive-compulsive symptoms. The patients with obsessive-compulsive symptoms had an earlier onset of illness and were more likely to have current and past major depression than the other ones.

Therapeutic effects of neuroleptics (NLP) in schizophrenia are well established in numerous international studies. Varying modalities of evolution under NLP treatment are described and require a clinical analysis. Neuroleptics are a necessary but insufficient condition for the therapy of schizophrenia. Via NLP treatment, other therapeutic approaches, such as psychotherapy, or sociotherapy become more effective. Consecutively, we present the effects of two compounds with dopaminergic selective activity (amisulpride, remoxipride) and of two other compounds with non-selective activity (risperidone, clozapine) regarding rehabilitation in schizophrenic patients. Data were collected from international studies with a medico-economic perspective and from French experience of clozapine in refractory schizophrenic patients. All these data stress the importance of several areas of study: clinical features, everyday life consequences and therapeutical effects observed with the atypical neuroleptics.

Sera from patients with major depressive disorder and paranoid schizophrenia were screened for antinuclear antibodies (antigens: ds-DNA, ENA, histone H3) and circulating immune complexes (CIC-Cq1) by ELISA. Controls were healthy blood donors. Only a few of the patients' sera were positive for anti-ds-DNA and anti-ENA antibodies. There was no significant result. In paranoid schizophrenia 20.5% of sera were positive for antibodies against histone H3. In the case of CIC-Cql, 7% of the patients with major depressive disorder and 11 % of those with paranoid schizophrenia were positive. Controls showed positive sera in 39%. This study disagrees with former studies which could demonstrate a series of antinuclear antibodies in mental disorders. In the case of antihistone antibodies, the present results could indicate an autoimmune process in a subgroup of schizophrenic patients.

In acquired peripheral demyelinating disease only few publications point out the possibility of simultaneous involvement of the CNS. We describe two patients with chronic polyneuropathy and monoclonal gammopathy of undetermined significance (MGUS) developing a progressive dementia syndrome with extensive cerebral white matter alterations.

A meta-analysis of the published literature was performed in order to quantify the efficacy of low-dose neuroleptic therapy in reducing extrapyramidal side effects in schizophrenic patients. A low-dose regimen between 50–100 mg equivalents of chlorpromazine, in comparison to a standard-dose regimen between 200–500 mg reduced extrapyramidal side effects by a 0.30 (±0.12) standard deviation, which is only a limited effect.

To examine the relationship between suicidality and panic disorder, we evaluated 91 patients with panic disorder. Patients with comorbid diagnosis were more suicidal than patients with pure panic disorder. These data suggest that among patients with panic disorder, suicidal behavior is associated with comorbid diagnosis.

Psychiatric rehabilitation at present has a focus on the prevention of chronic disability and on active rehabilitation of socalled new long-stay patients. This is a major public health problem, concerning about one-third of all disabled persons in need of rehabilitation. Close co-operation between the various agencies concerned, with funding organizations, patients organizations etc, is of high priority in assuring effective rehabilitation. Various structures and models have been realized in order to facilitate such cooperation. The main axes of rehabilitation are lodging, occupation, financial independence/support, need for out-patient psychiatric care and quality of life. Rehabilitation results are measured along those axes, based on an assessment of patients' needs and satisfaction. Specific programmes have been implemented for various diagnostic groups, especially schizophrenic psychosis, mental retardation, substance dependence and organic brain damage. Specifications of these diversified programmes are described. Evaluation of rehabilitation efforts uses different designs, methods and instruments; a harmonization on the level of instruments is intended. A few examples regarding evaluation results (concerning schizophrenic and drug dependent patients) are presented. Finally, external factors limiting the efficacy of rehabilitation efforts are described.