Placebo controlled studies in patients suffering from exacerbation eg acute productive episode of schizophrenia and performed in the period between 1963-1993 are reviewed and analysed with respect to study designs; size of studies; improvement rate under placebo and drop-outs due to inefficacy under placebo. The aim of the analysis was to find out if the reported data permit some realistic estimates for a priori assumptions needed for proper planning of such studies, particularly in view of the numerous ethical and other difficulties which their performance encounters in the practice. Literature research revealed a rather limited number of rigorous, placebo-controlled, monotherapy studies (without intermittent or concomitant additional neuroleptics) in acute schizophrenia. Across comparison of findings from these studies was difficult due to differences in duration of treatment, assessment instruments and criteria of efficacy which illustrated a lack of methodological standards for studies in this indication. The improvement rate under placebo, if measured by Clinical Global Assessment (CGI) appeared, however, not to exceed 25%, whereas BPRS score reduction as efficacy criterion mostly provided higher response rates (up to 40%). Of interest however, is the finding that the response rate to conventional neuroleptics at the end of 4-6 weeks of treatment in some studies hardly exceeded 40%. The most sensitive measure of placebo effect seemed to be the drop-out rate due to inefficacy (up to 100%) and it is suggested to consider this measure and the survival analysis approach in designing future studies. The review demonstrated many unresolved methodological problems in testing antipsychotic drugs in acute schizophrenia and, particularly, the need of scientific evidence of validity and sensitivity of measures of antipsychotic efficacy. The findings reported up to now do not offer cues for rational estimates of the effect size differences between placebo and active drugs after short-term treatment in acute schizophrenia.

During a period of one year, 157 first ever admitted psychiatric patients in the age group 18-49 years from a catchment area of 217,649 persons were interviewed with the Present State Examination 10th edition, development version and the Personality Disorder Examination, 1988 version. Of the sample, 23% received at least one DSM III-R personality disorder (PD) diagnosis. Rates avoidant PD, very few borderline PDs were found. Almost all patients with PDs also had major psychiatric disorders and the sample was biased towards younger individuals with more severe Axis I symptomatology compared with first ever admitted psychiatric patients aged 18-49 years in Denmark. Cluster A was associated with schizophrenia, cluster B with alcohol or other substance use disorders, and cluster C with anxiety disorders. Within Axis II, schizotypal PD was associated with avoidant and dependent PD, and paranoid with antisocial and dependent PD.

Looking for a substantial increase in the reliability and validity of voice analysis measurements in depression, we have developed a new experimental paradigm. The paradigm is based on two vocal tasks with different levels of cognitive processing and a baseline verbal task. It has been applied to 40 subjects, 20 patients with affective disorders and 20 normal individuals. We have found that an important set of vocal parameters, at different intervals, discriminates patients from normal subjects. Here, we discuss four of them – those that have been especially consistent; the patients had longer reaction times, a higher proportion of relative spectral energy (at a very low frequency band), narrower fundamental frequency range and higher proportion of omissions. Under the proposed paradigm, the acoustic analysis could be a promising instrument for the development of quantitative indicators of depression.

We compared the rate of DST non-suppression in two samples of 26 Brazilian and 26 Belgian female depressive patients, matched for age, diagnostic subtype and severity of depression. This rate was significantly lower in São Paulo than in Liège (P = 0.04). The differences observed in DST can be explained by the complexity of familial, personal and clinical factors. A role of a latitude effect through melatonin secretion on adrenocortical function of depressed patients is also suggested.

Serum β2-microglobulin (β2m) levels were increased in ten out of 52 patients on chronic lithium treatment, while creatinine levels were within the normal range in all of them and creatinine clearance was below the normality in only five. We propose serum β2m assessment as a possible precocious indicator of glomerular filtration impairment, and recommend its frequent determination in patients chronically treated with lithium to prevent the occurrence of renal insufficiency.

We describe a simple method to objectively identify the threshold for edge detection in morphometric measurement of brain structures. This method correlates highly with the subjective operator-driven approach to edge detection. While the objective approach, using a histogram of pixel intensities, reduces rater bias and may reliably identify brain-CSF boundaries, its value in morphometric measurements of smaller cerebral structures may be somewhat limited.

Vitamin B12 deficiency can result in a variety of neurological and psychiatric disorders. We describe a young patient in whom vitamin B12 deficiency presented as dementia with only mild hematological disease and no spinal cord disease.

This study is part of a more extensive research conducted by a group of scientists from different countries, who have joined forces to conduct an international study on the development of the therapist, and to develop a novel instrument for therapists, the “Development of Psychotherapists’ Common Core Questionnaire” (CCQ). We report here the results based on the answers of a French-speaking sample to this questionnaire. Data were analyzed using univariate (non parametric tests) and multivariate analyses (Principal Component Analysis and Multiple Correspondence Analysis). The perceived effects of psychoanalytical training were examined. The therapists’ own perception on their current skills and the type of difficulties they experienced were very similar, whether or not they had received psychoanalytical training. However, striking and significant differences in coping strategies were observed between the two groups.