The assessment of new treatment strategies such as the atypical antipsychotic agents goes far beyond the assessment of psychopathology, and includes evaluation of their effects on a variety of needs associated with living in the community. This article provides some empirical data for such a multidimensional perspective in analysing drug treatment with conventional antipsychotics. We focus on two groups of schizophrenic patients discharged from a psychiatric hospital, who were followed up for one year. One group was treated with oral and the other with depot medication. The two groups were assessed on their needs for care, quality of life, and rehospitalisation rates. We found few significant differences between depot- and orally-medicated patients. However, patients treated with depot antipsychotics were receiving higher mean daily doses. Patients taking oral medication had a lower rate of adverse effects but were more non-compliant, which resulted in a higher rehospitalisation rate, confirming our assumpt on that patients take different risk-to-benefit decisions. Orally-medicated patients did not have a better functional status than depot-medicated patients.

The increasing demand for judicial coerced treatment of sexual abusers constitutes a new challenge for mental health professionals. The discussed controversial ethical issues are the influence of coercion on the treatment, the motivation of patient as well as therapist, confidentiality and hormonal treatment. Social control is not the primary concern of therapists and any treatment must be beneficial to the individual patient. The coerced treatment of sexual abusers requests an agreement between psychiatric and judicial authorities with respect for their respective professional ethics.

In previous reports, we have observed that blood magnesium was significantly higher in drug-free patients with major depression when compared to healthy controls. This was especially true for erythrocyte magnesium. Furthermore, the most severely depressed patients had the highest intracellular magnesium content, showing that intracellular magnesium rate was related to the intensity of symptoms. We report here the results of blood magnesium measured in 88 major depressed patients as compared to 61 controls. We show that the mean erythrocyte and also plasma magnesium contents are both increased in these patients. We observe that about 40% of male and female patients have a very significant increase (25%) in intracellular magnesium content as compared to controls. However, about 60% of the hospitalised depressed patients have normal values. None of the controls has high erythrocyte magnesium. This is less evident concerning the plasma magnesium. No differences are observed between patients when classified according to the intensity of moral pain or anxiety. In contrast, the patients with mild to high psychomotor retardation score, which is an index of hypoexcitability, have significant higher erythrocyte magnesium values compared with other patients. The results of male patients without psychomotor retardation do not differ from control values. Our study suggests that central hypoexcitability might be related to an increase in intracellular magnesium observed at the peripheral level, keeping in mind that hyperexcitability, as observed in various conditions such as stress and cardiovascular disorders, is frequently associated, in contrast, with a decrease in blood magnesium.

The prevalence, symptomatology and correlates of anger attacks were studied in 103 depressed French patients, using a French version of the Anger Attacks Questionnaire. The prevalence of anger attacks during the previous month was 46.7%, and the most frequently reported symptoms were feeling of panic (85.1%), tachycardia (83.7%), and feeling out of control (81.3%). The occurrence of anger attacks was significantly associated with intensity of loss of control, and history of panic attacks. There was no significant association with age, gender, severity of depression or anxiety, history of suicidal attempts or mood disorder. Three weeks of treatment with serotoninergic antidepressants induced a significant decrease in anger attack prevalence.

In 1987, DSM-III introduced the term delusional disorder. In so doing they gave new life to a concept that had predated but was delineated in its modern form by Kraepelin and developed most notably in France in the second and third decades of this century. While the current concept of delusional disorder is defined in a manner that distinguishes it from schizophrenia, a consideration of the evolution of thinking about delusional syndromes in France suggests that current distinctions are based on descriptive convenience rather than any understanding of the mechanisms that might produce phenotypic variations. If the purpose of accurate descriptions is to assist research, this state of affairs would seem unsatisfactory.

Twenty-eight schizophrenic and other long-term mentally ill patients who were given cognitive therapy sessions twice a week in the context of a comprehensive inpatient treatment program were assessed every 5 weeks regarding perceived curative factors. The assessments were made by a self-rating questionnaire (Curative Factors Questionnaire [CFQ]) and a qualitative assessment from the patients of what they perceived as helpful in treatment. The results showed that milieu therapeutic elements and therapy sessions were perceived as the most helpful throughout the treatment period. No correlations were found between patient characteristics and perceived curative factors. The factors “instillation of hope”, “problem solution” and “learning I’m not alone” as rated in the initial phase of treatment showed a positive relationship with a favourable outcome of treatment at discharge.

Several well-known observer scales, including the Hamilton Depression Scale (HAM-D), Montgomery-Åsberg Scale (MADRS), Major Depression Rating Scale (MDS), Melancholia Scale (MES), and Inventory for Depressive Symptomatology (IDS) used for measuring severity of depressive states have been compared by their responsiveness in an open trial including patients treated with a combination of citalopram and mianserin. The patients fulfilled the Diagnostic and Statistical Manual (DSM)-IV criteria for major depressive episode, and all scored 18 or more on the HAM-D before treatment. Onset of antidepressant action was defined as an improvement of rating scale scores of 25% or more of pre-treatment scores. A response to treatment was defined as a reduction of 50% or more on the pre-treatment scores. The results showed that the number of treatment days until improvement was 11 to 13 with no difference between the scales. The days until response were between 18 and 21 with no difference between the scales. In conclusion, the depression scales were found to be equal in their ability to detect changes in depressive symptoms during treatment. The mean of days to response was 19 for the combination of citalopram and mianserin. This is similar to the response for the combination of fluoxetine and pinolol.

We report a 27-year-old female patient with prior history of Graves' disease and relapsing episodes of tachycardia, hyperpyrexia, muscular rigidity and coma. With the subsequent manifestation of an acute schizophreniform psychotic disorder unresponsive to neuroleptics, the primary syndrome was re-classified as febrile catatony. Hyperthyroidism was ruled out with normal serum thyroid hormone levels, as were toxic effects of thyrostatic treatment, drug-induced hypothyroidism and a malignant neuroleptic syndrome. All psychiatric symptoms subsided completely following subtotal thyroidectomy. Febrile catatatony has to be added to the spectrum of psychotic phenomena that may be caused by Graves' disease, irrespective of serum thyroid hormone levels.

A 40-year-old woman initially considered as suffering from anorexia nervosa was later diagnosed as having achalasia and megaesophagus.

The use of a placebo control group in the evaluation of a new product is today considered by most as a necessary condition of experimental drug research. Placebo response is an essential consideration in all clinical trials. If not properly controlled, incorrect and dangerous conclusion may be inferred for a product efficacy and safety profile. However, the inclusion of a placebo group in clinical trials in neuropsychiatric research raises several ethical and scientific questions. Whereas in certain indications, such as suicidal patients and severe and psychotic depression, the use of a placebo is generally not accepted, it is difficult to assess drug efficacy. This article discusses the concept of placebo in clinical trials, the occurrence of adverse events after placebo treatment and the high response rate of placebo in neuropsychiatric clinical research. The experimental methodology to adequately control all the factors involved is also analysed and discussed.

Authors recently have suggested that family enrneshment is not synonymous with high levels of closeness or cohesion. A model proposed by Green and Werner clarifies the cohesion-enmeshment domain by distinguishing between closeness-caregiving and intrusiveness as separate relationship processes. This paper examines the cross-cultural applicability of this perspective through a study of 61 married couples in France. The French version of the California Inventory for Family Assessment (CIFA), a self-report measure designed to assess clinically relevant marital dimensions, was employed. In general, spouses' reports of their marital process demonstrated high internal consistency reliabilities. Factor analysis showed meaningful factor structures distinguishing closeness-caregiving and intrusiveness, as predicted, as well as openness of communication. Significant correlations were obtained between CIFA scales and scores on the Marital Adjustment Test. These results are similar for French and American couples. Research implications for studying relationships among French-speaking couples are underlined.

We present two cases of Charles Bonnet syndrome in comorbidity with Parkinson’s disease. Patients developed visual hallucinosis before starting any antiparkisonian treatment. We briefly discuss the possible physiopathological mechanisms involving low visual acuity and Parkinson’s disease with visual hallucinosis.

The inter-rater reliability of the French versions of the MADRS and the DRRS was studied on the basis of 58 videotape records of structured standardised interviews of depressed inpatients under antidepressant treatment. Each patient was assessed by two trained raters, from the same videotape recording. The inter-rater reliability of total scores was high with both scales (intra-class correlation coefficients: 0.86 for MADRS and 0.77 for DRRS). However, the inter-rater reliability for individual items was higher and more homogeneous for the MADRS than for the DRRS. Finally, the structured interview in French appears to be relevant for the MADRS, but it should be improved for the DRRS.

The authors examined the effect of tandospirone on tardive dyskinesia (TD) and parkinsonian symptoms in an open study. Tandospirone did not bring about any favourable effect on TD, but it had a good effect on the parkinsonian symptoms.

Schizophrenia has a major impact on the quality of life of sufferers, and its broader impact on families and on society are well known, although less thoroughly documented. The majority of sufferers require long-term treatment and support, and there are depressingly frequent media stories about violent incidents involving people with the illness. Consequently the costs of schizophrenia, broadly defined, loom large, not just from the perspective of health care decision-makers and governments, but also from that of sufferers and their families, to many other people with only indirect experience of the disease.

The problem of contraception, sterilisation and the mentally ill is one of the key questions in medical ethics. Even if these two aspects bring into question a person's autonomy in two of the most intimate and fundamental aspects of life — sexuality and motherhood — they should not be confused as they differ greatly in terms of their reversibility. The essential question is rather one of individual freedom and its defence in situations where the subject is unable to defend himself either temporarily or in the long term. The fine line between individual and collective interests poses questions in terms of where to draw this line and the way in which it is defined in care situations. From this viewpoint, carers — that is, doctors and nurses, but also social workers and the patient's entourage — play an important role, not only in theory but also in day-to-day reality.

Clozapine was administered to 28 resistant schizophrenics at psychiatric services in Bologna. At 26 weeks 62% responded. Positive and negative symptoms improved, but decrease of negative symptoms partially depended upon improvement of positive and EPS. No cases of agranulocytosis were seen. Some drop-outs were related to difficulties with psychopathological improvement.