This study describes an inquiry concerning patients (65 in all) who were referred to the Socio-Professional Rehabilitation Department (CHS Le Vinatier, Bron) over 14 months. The aim was to study the influence of occupational therapy on the clinical evolution of psychotic patients, and more specifically on their quality of life. Two evaluations using questionnaires filled out both by the patients and the medical staff were performed. One evaluation was carried out at admission, and the second 3 months later. The studied variables were the patients' symptoms, quality of life and ability to perform a task. Validation studies showed the answers to questionnaires to be reliable indicators. It was found that this group of psychotic patients was anxious rather than depressed, and fairly autonomous; their dissatisfaction mainly concerned material conditions. The initial factors most related to quality of life after 3 months of treatment were mainly connected with their ability to perform a task, and to a lesser extent with the initial gravity of symptoms.

The proposed distinction between familial and sporadic schizophrenia has proved a useful tool for research into the aetiology of the disorder although evidence for the proposed association between large cerebral ventricles and the sporadic form has been contradictory. We have reviewed the literature and found evidence that in the context of brain structure, the familial — sporadic distinction may apply to men but not women with schizophrenia. This may explain some of the observed sex differences in schizophrenia and some of the confusion in the literature. Based upon this review, we examined our own data on 138 schizophrenic subjects with no family history (sporadic) and 24 with such a history (familial). As predicted, cerebral ventricle size was largest in men with sporadic schizophrenia, there being no effect in women. We propose a meta-analysis of existing data in order to pursue this phenomenon further.

The purpose of this study was to examine characteristics of Yugoslav patients with neurasthenia diagnosed according to the ICD-10 Diagnostic Criteria for Research (ICD-10-DCR), and to examine the ICD-10-DCR symptoms of neurasthenia and applicability of the corresponding diagnostic criteria to Yugoslav patients with this condition. Thirty-four patients with the ICD-10-DCR neurasthenia and 31 patients with mixed anxiety and depressive disorder were compared in terms of demographic variables, results of several questionnaires, symptom profiles and comorbidity with other mental disorders. Patients with neurasthenia were less educated and more often held jobs as unskilled and semiskilled workers; they had a more chronic course of illness, tended to report more symptoms, manifested more hostility, somatization and hypochondriacal tendencies and received a comorbid diagnosis of hypochondriasis more frequently. In addition to exhaustion and weakness, the most prominent features of neurasthenia were irritability, anger, nervousness, various somatic symptoms and tension. An ICD-10-DCR diagnosis of neurasthenia could not be made in slightly over one-third of patients who would have otherwise met criteria for this diagnosis because of the imposed diagnostic hierarchy, ie, due to current comorbidity with affective disorders and generalized anxiety disorder in such patients. It is concluded that the ICD-10-DCR concept of neurasthenia is generally suitable for Yugoslav patients, except for the diagnostic hierarchy requirement. The diagnostic criteria therefore require revision in order to reflect more accurately the variability in clinical presentation of neurasthenia in different countries.

A survey of the pharmacological and psychological treatment of panic disorder and agoraphobia (PDA) was conducted among 103 physicians, psychologists and psychotherapists. It revealed that the treatments for PDA preferred by the majority of the respondents are inconsistent with the recommendations given in the international literature. Non-psychiatric physicians most frequently proposed herbal preparations as a possible treatment (46% of non-psychiatric physicians), followed by homoeopathic formulations (32%). Tricyclic antidepressants which are recommended as first-line treatment in panic disorder by the literature are preferred by 74% of the psychiatrists, but only by 24% of the non-psychiatric physicians. Benzodiazepines are prescribed by twice as many psychiatrists (45%) as non-psychiatric physicians (22%). Beta blockers and neuroleptics which are not recommended as first-line treatment in panic disorder are used quite often (psychiatrists: 15%; non-psychiatric physicians: 26%). Selective serotonin reuptake inhibitors are prescribed by 24% of the psychiatrists, but by only 3% of the non-psychiatric physicians. Among psychological therapies, psychoanalysis was proposed as first-line treatment by 44% of all professionals applying psychological therapies, while cognitive/behaviour therapy was preferred by only 28%, though proof of efficacy exists only for cognitive/behaviour therapy. In general, psychologists prefer behaviourally-orientated therapy, while physicians mostly propose psychodynamic therapy. One reason for the fact that the results of controlled studies have little influence on professionals treating PDA patients might be that 40% of the respondents do not accept the new classification of the anxiety disorders as introduced in 1980 by the DSM-III.

We assessed the relative efficacy and effectiveness of low-versus standard-dose neuroleptic therapy in reducing relapse rate in schizophrenic patients. Six long-term randomized controlled trials were retrieved through a MEDLINE search. A dose regimen between 50 and 100 mg equivalent of chlorpromazine, compared to a conventional one between 200 and 500 mg, was found to increase the likelihood of relapse in chronic schizophrenic patients. Differences, however, were statistically significant at 12 but not at 24 months of treatment.

Regional cerebral blood flow (rCBF) values were measured by single photon emission computed tomography (SPECT) in different regions of the brain in 27 patients with DAT. Significant correlations were found between rCBF in left parieto-temporooccipital regions and psychometric test scores. Patients with hemisphere asymmetry in SPECT performed worse on psychometric tests. SPECT did not permit prediction of or differentiation between depressive and psychotic symptoms.

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.

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.