Individuals with persecutory delusions have been reported to make external and stable attributions for negative events and to have a tendency towards internal attributions for positive events. It remains unclear whether this abnormality is present in individuals with non-persecutory delusions. Using the Attributional Style Questionnaire, we assessed the attributional style of 19 individuals with persecutory or grandiose delusions (PG), 12 individuals whose delusional beliefs were non-persecutory and non-grandiose (NPG) and 24 controls. The PG group displayed externality in their causal attributions for bad events but those in the NPG group did not differ from controls. Both deluded groups were significantly more stable in their attributions for bad events in comparison to controls. Such findings argue against a primary role for attributional biases in the genesis of delusions, although a role in shaping delusional content and maintaining the disorder and a role for external attributions in defending against reductions in self-esteem cannot be excluded.

Computed tomography (CT) studies have demonstrated that lateral ventricular size measured by ventricular brain ratio (VBR), as well as third ventricle width, is statistically enlarged in schizophrenics. Moreover, these cerebral abnormalities differ according to symptomatology evaluated with a positive and negative symptom scale. The aim of this study was to investigate, using CT scans, healthy siblings of schizophrenics, and relate the results to their ill siblings. Nineteen healthy siblings of 12 previously studied schizophrenics underwent CT scans, which were compared to those of their related schizophrenic sibling and to 17 unrelated control subjects. The results showed that in ten of 12 families, schizophrenics have larger ventricles (lateral and third ventricles) than their healthy siblings. Ventricular enlargement of healthy siblings was correlated with severity of negative symptoms of their ill sibling. Implications of a familial contribution for ventricular size and negative symptoms are discussed.

This study addresses the questions if and for which patients expressed emotion (EE) has a predictive validity in an 8 year follow-up study and if this is dependent on the residential form, especially on patients and relatives living together. Eight years after a baseline examination (Camberwell Family Interviews [CFI], global assessment scale [GAS], symptom score) 69 of 99 patients were reexamined. The number and duration of rehospitalizations as well as the symptom and GAS scores were recorded. These was no difference between outcome of high and low EE patients with a duration of illness of less than 4.5 years and for those living with partners. Patients from high EE parents with a longer duration of illness (> 4.5 years) at the outset of the study were significantly more often and longer in hospital. They had significantly higher symptom and GAS scores at the outset of the study and after 8 years. The EE effect was equal in the first and second 4 years of the follow-up and was independent from patients and parents living together. The results emphasize the significance of the EE index as a long-term predictor for the course of schizophrenic illness. The independence of the prediction from living together is an argument against a simple causal interpretation of the connection between EE and the course of schizophrenia.

Obsessive Compulsive Disorder (OCD) is increasingly recognised to be relatively common and responsive to some drug treatments (serotonin reuptake inhibitors). Clinical studies utilising recognised diagnostic criteria have identified some relevant negative prognostic factors: early age at disease onset, severe baseline disease, and failure of previous drug treatments all of which reduce the apparent success rates of SRI drugs. Furthermore, patients with comorbid tics seem to respond best to a combination of SRI activity and dopamine blockade. Short term efficacy studies are best performed with a parallel group design and a duration of around 3 months. Long term efficacy studies should probably use the relapse prevention design, with open label responders randomised to double blind continuation or placebo. Does finding has not been properly explored, and any one fixed dose will only be optimal for some patients. Efficacy can be reliably measured using the YBOCs, NIMH-OC and CGI rating scales.

In the present study, all patients who met the diagnostic criteria for a long-term functional psychosis (LFP) were identified within a defined uptake area in the northern part of the county of Uppsala, Sweden. LFP includes patients 1) with productive psychotic symptomatology, not caused by organic disease, for 1 week or more, at least once during the course of the illness; 2) having been affected by a psychosis for a continuous period of at least 6 months on the same occasion; 3) having shown psychotic features or residual symptoms during the index year; and 4) older than 18 years of age. Primarily, all diagnoses were made according to the Diagnostic and Statistical Manual of Mental Disorders (DSM)-III-R. The prevalence of schizophrenia was 4.2 per 1,000 inhabitants. The prevalence of schizoaffective disorder was 0.7 per 1,000 inhabitants and for delusional disorder, 0.1 per 1,000 inhabitants. When the patients were rediagnosed according to DSM-III, DSM-IV and International Statistical Classification of Disease (ICD)-10, it was found that the prevalence of schizophrenia, schizoaffective disorder and delusional disorder was somewhat lower according to the DSM-III criteria, while the same number of patients fulfilled the criteria according to DSM-IV. If ICD-10 was used, it resulted in a broader concept of schizophrenia and a somewhat more narrow concept of schizoaffective disorder. Thus, the introduction of the new parallel diagnostic systems, ICD-10 and DSM-IV, will result in different, but comparable, prevalence estimates concerning schizophrenia, schizoaffective disorder and delusional disorder.

In the past serendipity and good clinical observation were essential for the discovery of new drug treatments for mental disorders. Today, neurochemical and pharmacological research allows development of compounds starting from hypothesis on the origin of the disorders and the actions of available drugs. The new compounds are cleaner from the pharmacological point of view, more specific and therefore with less undesired effects. Venlafaxine is one of these drugs and provides antidepressant efficacy in a broad range of depressed patients, including the most severe ones, with a good safety and tolerability profile.

Psychiatric comorbidity in alcoholics admitted to a rehabilitation center on either a voluntary or a coerced basis were studied. A group of 104 alcoholics (37 coerced and 35 voluntarily admitted men; and 21 coerced and ten voluntarily admitted women) with a mean age (SD) of 43 ± 8 years were assessed by means of a Structural Clinical Interview in accordance with the Diagnostic and Statistical Manual (DSM)-III-R (SCID). The interview took place a mean of 7 days after admission. The frequencies of lifetime/current axis I psychiatric comorbidity (substance use disorders excluded) were 66 and 61%, respectively. Drug dependence was present in 41 and 39%, respectively, of the cases. Thirty-seven percent had a lifetime diagnosis, and 33% a current diagnosis of affective disorders, 27 and 23%, respectively, of anxiety disorders and 20 and 13%, respectively, of non-organic psychotic disorders. In a subsample of 20 subjects, depressive symptoms were found to be stable during the course of treatment. No differences in frequency of psychiatric comorbidity were found between coerced and voluntarily admitted patients (67 and 56%, respectively) or between men and women (65 and 52%, respectively). The combination of psychiatric comorbidity and drug dependence was overrepresented among the coerced patients (50 vs 16%). It was concluded that the frequencies of psychiatric comorbidity were high in the present group. The co-occurrence of alcohol dependence, drug dependence and psychiatric comorbidity was more frequent among subjects who were coercively treated.

The authors study the frequency of primary enduring negative symptoms in first-admission patients with schizophrenic and non-schizophrenic disorders. Carpenter's criteria for distinguishing the primary, enduring negative symptoms from the more transient negative symptoms (secondary to different factors) were applied. Furthermore, they compare negative symptom complexes between first-admission patients and patients with recurrent hospitalizations (within 5 years after first admission). There was a trend for patients with recurrent admissions to show more frequently a deficit syndrome than first-admission patients. Nevertheless, this difference was not significant (χ2 = 0.90). First-admission patients with deficit syndrome had significantly higher affective blunting (P < 0.05) and anhedonia (P < 0.001) than those with recurrent admissions. First-admission subjects with psychotic disorders had significantly higher frequency of deficit syndrome than those first-admission patients with non-psychotic disorders (P < 0.05). These results show that negative symptoms observed in first-admitted non-schizophrenic patients can also be enduring and primary. Thereby this work does not contribute to support the specificity of primary enduring negative symptoms for schizophrenia. Moreover, data suggest, that primary anhedonia and affective blunting can decrease within the first 5 years after discharge.

In 1962 William Sargant and his colleagues described the therapeutic value of phenelzine, a monoamine oxidase inhibitor (MAOI), in chronic anxiety disorders and in the same year Klein and Fink reported the treatment of similar conditions with imipramine, a tricyclic antidepressant. Subsequent research has confirmed these findings and demonstrated the range of similar drugs that are effective in anxiety disorders. At the time of these original observations about the drug treatment of anxiety, there were no psychological treatments of proven value but in the intervening years much progress has been made in developing behavioural and cognitive procedures. The progress in determining the mode of action of these pharmacological and psychological treatments is reviewed and the implications of the findings are considered in relation to research into the causes of the anxiety disorders and to the treatment of patients.

Health care policies are subject to scientific and economic constraints. It is necessary to develop research and evaluation policies, particularly in mental health services. In the area of drug treatment, new methodologies in phase II studies, and a true research program of phase IV, are needed. Furthermore, evaluation of practices needs new scientific programs. This last point is also relevant for psychotherapies. Comparative studies about criteria of indications must be developed.

We studied the characteristics of religious practice in a cohort of 67 first admission schizophrenic patients over 5 years. Thirty percent of these patients were involved in religious activities, either with an established religion or in a marginal group. They were mostly women, who had a good premorbid psychosocial adaptation and tended not to be substance abusers. Their social adaptation was improved at year 5. They were as compliant with their ambulatory treatment as the other patients. However, when controlling for the inclusion characteristics, a similar outcome was shown between the group of practicing patients and the nonpracticing group. Religious activity may not be by itself the cause of this favorable outcome, as it is probable that only the patients who are less symptomatic and relatively well adapted could actually join a religious movement. The fact that many schizophrenic patients find an occupation and relationships in religious activities that they would not find elsewhere should encourage the psychiatric community target its occupational goals.

When selecting an antidepressant, a number of factors must be considered. These considerations are summarized under the mnemonic STEPS: Safety, Tolerability, Efficacy, Payment (eg, cost-effectiveness), and Simplicity of use. Venlafaxine is the first of a new class of antidepressants that selectively blocks the serotonin and noradrenaline uptake pumps without blocking muscarinic, histaminergic and adrenergic receptors or inhibiting sodium fast channels. Because venlafaxine avoids these mechanisms of action, it has a wide therapeutic index, an improved tolerability profile and a reduced risk of causing pharmacodynamically mediated drug-drug interactions when compared to tricyclic antidepressants (TCAs). In contrast to some other new antidepressants, venlafaxine also avoids effects on cytochrome P450 which are likely to cause clinically meaningful, pharmacokinetically mediated drug-drug interactions. The effects on the uptake pumps of both serotonin and noradrenaline appear to be responsible for some of venlafaxine's unique features in terms of antidepressant efficacy, including its ascending antidepressant dose-response curve and its apparent rapid onset of antidepressant action at the upper end of its clinically relevant dosing range. Venlafaxine is effective in a broad spectrum of patients, including outpatients and inpatients, those with and without melancholia, patients with symptoms of anxiety or agitation or retardation and patients with first time or recurrent episodes of major depression. An important factor when selecting an antidepressant is the simplicity of the dosing regimen and the ability to rapidly and confidently achieve the optimal dose for the patient. In this regard, venlafaxine can be initiated at a clinically effective dose from the beginning. If the patient fails to respond to this dose, there is evidence that increased antidepressant efficacy can be achieved by increasing the dose rather than having to resort to an augmentation strategy or switch to another class of antidepressants. In the immediate release form, venlafaxine has proven antidepressant efficacy when using a twice-or three-times-a-day schedule. A sustained release formulation is expected to be marketed soon and will permit once-a-day-dosing.

Subjects with anxiety disorders display substantial disabilities in health-related quality of life. The Sheehan Disability Scale (SDS) and SF-36 Questionnaire (SF-36) have been administered to subjects with anxiety disorders participating in psychopharmacology clinical trials and observational studies to evaluate their impaired functioning. The SDS does not address and does not include all the disabilities important to subjects with anxiety disorders and susceptible to being affected by drugs with anxiolytic effects, all of which are associated with significant problems. As a single-state-in-time rating, the SDS is often inadequate to discern subtle, but important,changes which may occur between measurements. The SF-36 as a measure of health status can, on the other hand, assess only the patient's behavior most directly affected by the disorder and treatment. As a result, the SF-36 enables the differentiation of functioning and well-being of subjects with anxiety disorders from diverse populations. There is little documentary evidence that demonstrates the value and actual performance of the SDS and SF-36 for the intended purpose. In the absence of a general consensus concerning operational definition, the measurement of disability in this patient population with these scales may be obsolete. There is the need for more specific and simple instruments capable to assess the distinct pattern of impairment associated with subjects with anxiety disorders.

Recent epidemiological surveys that have attempted to include the need for treatment of mental disorders are reviewed, and it is concluded that the greatest unmet need is for those with non-psychotic disorders. Recent studies on factors that influence the natural history of such disorders reveal that these are largely social and environmental; one study suggests that genetic factors are only important in the group that have longer time courses. Those factors within the medical encounter that produce better outcomes are reviewed, and non-specific factors and supportive therapy are found to be important. Some additional advantages are to be obtained with specific antidepressant treatments (either pharmacological or problem-solving) and with re-attribution skills for psychologically determined somatic symptoms. The implications of these findings are discussed from the standpoint of the primary care team, the community mental health team and self-help materials.

The issues of timing in antidepressant treatment are of great theoretical and practical relevance, even more so since recent meta-analyses yielded no evidence for a specific mode of action of antidepressants, which, according to the theory of delayed onset of action, is expected to emerge after 2 weeks of therapy. To address the issues of timing on a methodologically sound basis, future trials should adapt a ‘longitudinal’ rather than ‘cross-sectional’ design, standardized with respect to a washout period, baseline and first 2 week assessments. With this in mind, special attention should be paid to parameters which potentially enable the identification of placebo responders, true drug responders and patients at risk of non-improvement. Results and methods of the Zurich meta-analyses may serve as a starting point for further steps in this direction.

In recent years a two types classification of male alcoholism has been proposed by several authors. The study aimed at a testing of type I/type II classification of alcoholism in an independent sample. A total of 351 Research Diagnostic Criteria (RDC) male alcoholics consecutively admitted for an inpatient psychiatric treatment were studied. Type II characteristics were extracted from the pertinent literature; 19 available variables best representing these characteristics were selected. The data was collected using the method of a retrospective evaluation of clinical records. Cluster analysis yielded two clusters which were well separated from each other. Heterogeneity of the male inpatient population of alcoholics was demonstrated and the existence of broadly defined type I and type II alcoholism was confirmed.

In an attempt to assess the universal applicability of the International Classification of Disease (ICD-10), two psychiatrists from different socio-cultural backgrounds and training independently performed a chart review of 238 Chinese patients. Inter-rater reliability figures were comparable to those found in the WHO-coordinated ICD-10 field trials. The results suggest that ICD-10 has good ‘universality’ in routine clinical practice.