There have been repeated reports that Afro-Caribbean people living in the UK are more prone than white people to be diagnosed as having schizophrenia and mania, along with some evidence that they are less likely to receive a diagnosis of depression. We attempted to replicate these findings in a population of patients on lithium prophylaxis. We therefore assessed the clinical characteristics of people under the age of 55 from three ethnic groups attending a lithium clinic in south London, those of (1) white British (n = 88); (2) Afro-Caribbean (n = 31); and, (3) African (n = 15) origin.

Nineteen of the white patients met DSM-IV criteria for unipolar depression (UP) and eight met the criteria for bipolar II disorder (BP II); in contrast, only two black patients met the criteria for unipolar depression and none met the criteria for BP II. Among patients diagnosed as BP I, Africans were significantly more likely than whites to show exclusively or mainly manic presentations while Afro-Caribbeans were more likely to have had mood-incongruent delusions. On the other hand, white patients were significantly more likely than Afro-Caribbeans to have had suicidal ideas or actions, and showed a similar but not significant excess when compared with Africans.

Our findings could reflect either genuine ethnic differences in the presentation of severe affective disorder or be produced by the failure of British doctors to detect depression and deliver appropriate treatment to their black patients. The frequency with which Afro-Caribbean patients with mania present mood-incongruent delusions probably contributes to the high rates of diagnosed schizophrenia in this population.

A total of 28 long-term mentally ill patients, the majority schizophrenic, treated with cognitive therapy in the context of milieu-therapy and group therapy, were investigated at admission and discharge with regard to changes in symptomatology, quality of life, global functioning, need for medication, and perceived target complaints. The results showed a significant relief in perceived burden of illness and an improvement in quality of life. A better pre-admission functioning with regard to social functioning, occupational function, and symptoms predicted a more favourable outcome.

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.

Both poor insight and depressive symptomatology are common features of schizophrenia that may be independent of positive and negative symptoms. Forty-six patients with DSM-III-R schizophrenia were evaluated for level of insight (schedule for unawareness of mental disorder), depression (Calgary depression scale for schizophrenia, Beck depression inventory), and self-deception or denial (balanced inventory of desirable responding). Patients with a greater unawareness of their illness had relatively less depressive symptomatology and relatively greater self-deception. This relationship was particularly strong for unawareness of the social consequences of having a mental disorder. These results suggest that the presence of depressive symptomatology in schizophrenia is related to the level of insight, and contingent at least in part on the absence of self-deception as a denial defense.

This objectives of this study were three-fold: retrospectively evaluate anxiolytic/hypnotic consumption by psychiatric inpatients, identify the risk factors of prolonged intakes, and prospectively measure the impact of hospitalisation on the use of those drugs. Three hundred and seventy-six patients hospitalised in 11 psychiatric departments in the Paris region were studied using a structured interview for the anxiolytic/hypnotic treatments, DSM-III-R criteria, GHQ-12, HAD, Spiegel's questionnaire, COVI's anxiety scale and the CGI. Eighty-five per cent of the patients had taken one anxiolytic/hypnotic or more in the 3 months preceding hospitalisation. Hospitalisation induced little change in anxiolytic/hypnotic use: dosage frequency increased from 77% to 84% between the week preceding hospitalisation and that preceding discharge; 26% of consumers were taking at least two anxiolytics or two hypnotics in the first period vs. 23% in the second. The absence of withdrawal during hospitalisation was related to the high age and a diagnosis of depression rather than schizophrenia, to the existence of continuous intake over the 3 months preceding hospitalisation and to higher drug doses during the 7 days preceding hospitalisation. Prescription of treatment at the end of hospitalisation in previously non-user subjects was related to a higher HAD anxiety score at discharge.

Different studies report non-attendance to treatment of between 20 to 70% of patients after a suicide attempt. However, few studies have analyzed the characteristics of this non-attending population. To determine therefore the characteristics or profile of individuals who do not attend outpatient centres to which they are referred after a suicide attempt, we performed this study.

A total of 232 patients who had attended the Emergency Department of our general hospital were interviewed. Instruments used included the suicide risk scale, the violent behaviour scale, the impulsivity scale, the hopelessness scale, and the Beck's depression scale.

Seventy-three percent of the sample did not attend the mental health centre to which they had been referred. In comparison to the attending group, the non-attending group had the following characteristics: unmarried, residing in an urban area, took less precautions not to be discovered, were more critical of the attempt, and the purpose of the attempt was to resolve a conflict. Our data emphasize the importance of social and interpersonal aspects in determining the nature of the psychiatric care required by these types of patients.

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.

Dissociative Identity Disorder (DID) is a controversial diagnosis and empirical data on the efficacy of treatment modalities are scanty. The objective of this study was to explore the frequency of the diagnosis, the types and efficacy of prevailing treatment practices, and to examine demographic data on patients in the Netherlands.

A questionnaire, including questions on one selected DID patient, was mailed to 1,452 Dutch psychiatrists. The response rate was 46.7%. A total of 273 psychiatrists reported having made the diagnosis at least once. The diagnosis was made in a statistically significant manner more frequently by female psychiatrists, by psychiatrists aged 50 years or younger, and by those certified after 1982. No correlation was observed with primary theoretical orientation or the type or topography of work facility.

The mean age of the selected patients was 33.2 and the male:female (M:F) ratio 1:9. The majority of patients were seen once a week in an outpatient setting. Individual psychotherapy and adjunctive anxiolytic or antidepressant medications were the most widely endorsed treatment modalities. Hypnosis was rarely used.

We conclude that the diagnosis of DID is not to be dismissed as a local eccentricity. It is warranted as an explanatory framework in the context of a psychotherapeutic treatment.

Since body dissatisfaction is an essential part of anorexia/bulimia nervosa, we wanted to assess the patient’s body experience before and after intensive treatment. Body experience was studied in 290 eating disorder patients, admitted to a specialised unit, after six months and again after one year using the Body Attitude Test (BAT), the Eating Disorder Inventory (EDI), and the Eating Disorder Evaluation Scale (EDES). The clearly negative body experience of eating disorder patients evolved in a positive way after therapy and this improvement lasted for up to one year after admission. EDI scores and Body Mass Index at the time of admission appeared to be the strongest predictors of the total BAT score at follow-up. Athough body dissatisfaction can be quite persistent in eating disorders, intensive treatment can substantially improve the patient’s body experience.

The identification of the brain structures and neurotransmitters responsible for the generation and/or modulation of P300 could lead to important clinical implications. Since serotonin disturbances seem to play a critical role in depression, the aim of the study was to assess the possible relationships between the P300 event-related brain potential and serotonergic activity in depression. The study was conducted among 45 major depressive inpatients, and serotonergic activity was assessed by prolactin (PRL) response to flesinoxan (a 5-HT1A agonist). Results showed a significant negative correlation between P300 amplitude and PRL response to flesinoxan (r = –0.40, P = 0.007 at Cz; r = –0.47, P = 0.001 at Pz). In contrast, both P300 latency and reaction time were not related to endocrine response. This study supports a role for serotonin-1A in the neurobiological modulation of P300 amplitude.

The quality of life concept has been increasingly used as a major tool for patient care and clinical investigations. The Heinrichs quality of life scale (QLS) is the quality of life assessment method widely used in schizophrenic patients. The QLS was translated into its French version by J.D.Guelfi according the back-translation method. This version of the validation study included 60 schizophrenic inpatients. The scale possesses acceptable psychometric qualities. The test-retest reliability is good for nearly all items of the scale and for the categories and overall score. The internal consistency alpha-coefficients were 0.9 for the global score and varied between 0.6 and 0.9 according to the category. Factor analysis elicited four factors. Convergent validity is good. Recommendations for future use of the QLS are proposed.

To identify which improvements in cognitive function are associated with symptom resolution in schizophrenic patients treated with atypical antipsychotics. Design: a prospective open trial with atypical neuroleptics (risperidone, clozapine, quetiapine). Setting: Inpatient and outpatient units, Institute of Psychiatry. Patients: Thirty-nine patients with schizophrenia according to DSM-IV criteria were included. Clinical and cognitive assessment were done at baseline (T0) and again after six months of treatment (T2). Twenty-five patients completed the trial. Interventions: New-generation antipsychotics during six months. Patients were considered as responders if their PANSS score decreased at least 20% (n = 15) and non-responders if it did not (n = 10). Outcome measures: a computerized cognitive assessment comprised tests of short-term-memory (digit span), explicit long-term memory (word pair learning), divided attention, selective attention and verbal fluency (orthographic and semantic). Clinical assessment included PANSS and ESRS. Results: A discriminant function analysis was performed to determine which changes in cognitive performance predicted symptomatic response status. Semantic fluency and orthographic fluency were significant predictors. Together they correctly predicted responder status in 88% of cases. Memory was not a significant predictor of symptomatic response. Conclusion: Verbal fluency discriminated the responder from the non-responder group during a pharmacological treatment.

The apolipoprotein E (ApoE) genotype has been found to affect the expression of several neuropsychiatric disorders. We determined ApoE genotype frequencies and their relationship to primary negative symptoms in 61 non-deficit and 45 deficit schizophrenic patients, and compared them with 98 control subjects. No difference was observed when genotype or allele frequencies were compared between the three groups. Our data do not support a role for ApoE in the phenotypic expression of schizophrenia.

Abnormalities in the serotonergic system have been implicated in the pathophysiology of depressive disorders. Human platelets possess serotonin-2A (5-HT2A) receptors, and previous research using LSD or ketanserin as ligands have indicated that their number is increased in depressed patients. Compared to other ligands previously used in platelet studies, DOI is highly selective for the 5-HT2A receptor and binds to its high-affinity state, therefore labeling only the receptors that are biologically coupled to the G-protein. We determined the density (Bmax) and the affinity (Kd) of 5-HT2A receptors labeled by [125I]-DOI in platelets from 21 untreated patients with major depression and 21 healthy volunteers. The density of the 5-HT2A binding sites was found to be increased in platelets from female depressed patients as compared to controls. No changes were observed in the Kd. We did not find any relationship between the binding parameters and either the severity of the depressive episode or the suicidal tendencies of the patients. Our results show that the number of coupled platelet 5-HT2A receptors is increased in depressed patients, indicating that platelet 5-HT2A receptor function is enhanced in depression.

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.

There are great variations in the way psychotropic drugs are prescribed. Most experts are in favour of psychopharmacological monotherapy, but little is known about the extent to which it is actually practised. A survey of the psychopharmacological medication of all patients under treatment was carried out in three Austrian psychiatric clinics of various types on two separate days. A psychiatric university clinic, the psychiatric department of a general hospital and a regional mental hospital were selected for the survey.

It was established that only 8% to 22% of the patients underwent psycho-pharmacological monotherapy and that the patients received 2.2 to 3.3 psychotropics on average. Five to 22% of the patients received five or more psychotropic agents. The results are presented in more detail in relation to the diagnoses of schizophrenia and depression.

The rare occurence of monotherapy might be due to unsound treatment regimens in some instances, but much more to a general trend in psychiatry fostering polydrug use.

A high prevalence of thyroid hypofunction has been found in bipolar patients. However, the samples used in previous studies included a high percentage of patients in treatment with lithium and carbamazepine. Since the use of these drugs may explain the high prevalence of thyroid disturbances found in bipolar patients, we designed the present study to assess thyroid function in a sample of bipolar patients who had not been treated previously with lithium or carbamazepine. Patients included in the sample met Research Diagnostic Criteria for bipolar affective disorder. Assessment included determination of serum levels for total tyroxine (T4), total triiodothyronine (T3), and thyrotropin both basally and in response to infusion of 500 mg of Protilerin. The rate of thyroid hypofunction in the total sample (9.2%) was considerably lower than that reported in other studies with bipolar patients undergoing lithium therapy. Five patients (9.2%) showed some thyroid hyperfuncion parameter. Our results do not show significant differences in thyroid function indices between long-term and short-term duration of illness, between outpatients and inpatients, between high and low number of episodes, and between rapid- and non-rapid-cycling cases. Comparison between bipolar I and bipolar II patients shows a statistically significant difference in the values of TSH levels, with the bipolar II group having a higher mean value. Our data suggest that thyroid dysfunction is not related to gender, duration of illness, number of episodes, or rapid-cycling course of illness. The higher TRH-stimulated TSH levels in the bipolar II group could be considered a differential biological feature.

The aim of this study was to confirm the high prevalence of three frequent psychiatric disorders : anxiety, depressive illnesses, and alcohol dependence among ancillary staff, and to examine for occupational risk factors. Two hundred and forty-six women were randomly selected from the ancillary staff of the regional hospital centre of Bordeaux, and 186 subjects were interviewed between June 1996 and October 1997. First, a self-administrated questionnaire was completed concerning socio-economic status, lifestyle, health, and working conditions. Second, the two sections of the composite international diagnosis interview (CIDI), devoted to explore anxiety and depression, and the short Michigan alcoholism screening test (S-MAST) were used.

Mean age of the subjects was 40.8 years (SD = 8.3 years). During the year preceding the interview, 77 (42.5 %) subjects had stopped their job because of illness. Prevalence of the psychiatric disorders studied was 33.9 % (95 % confidence interval, 27.1-40.7 %). These disorders were related to sickness absence. This is why the use of drugs raises questions for work physicians. Two protective factors associated against depression in logistic regression analysis were found: training at the time of employment, and the task ‘cleaning sickroom’.

A high prevalence of psychiatric disorders was confirmed and occupational risk factors for the prevalence of increased psychiatric disorders were isolated that could have practical consequences, such as for the training at time of employment.

With the purpose of comparing temperament traits in subjects who have been violent towards others and with subjects who have shown self-directed violence, 34 male suicide attempters and 34 male violent offenders were matched for age and psychiatric diagnosis. Violent offenders with a history of suicide attempts were excluded. Temperament traits were assessed by means of the Karolinska Scales of Personality.

The temperament profiles of suicide attempters and violent offenders were very similar, with high trait anxiety and very low socialization. Violent offenders displayed significantly higher social desirability (P < 0.001). Suicide attempters tended to have higher indirect aggression and monotony avoidance. Impulsiveness, verbal aggression, and inhibition of aggression were within the normal range in both groups. There were substantial temperamental similarities between suicide attempters and violent offenders. In order to disentangle the differential mechanisms behind aggression towards self and others, we probably need to consider historical as well as current situation factors in a systematic way.