There is a high rate of depression in patients with medical or other psychiatric disorders. This comorbid depression is associated with an increased morbidity and mortality from medical illness, poor compliance with treatment, a worsening of somatic symptoms, and often a decrease in functional status. Several recent studies have demonstrated that comorbid depression is highly treatable and that effective treatment often enhances patients' adaptive coping with medical illness. However, when choosing antidepressant therapy, care must be taken to evaluate the patient's illness fully and to avoid potential drug-drug interactions and drug-related illness. This review investigates the use of antidepressants in depressed patients with medical and psychiatric disorders and their effect on prognosis and morbidity, and suggests that there is a place for the use of antidepressant medications in the treatment of comorbid conditions. Generally, the greater safety and tolerability of the selective serotonin reuptake inhibitors provides improved options for the treatment of depression in the medically and psychiatrically ill.

The reconceptualisation of German traditional constructs of subaffective personality disorders (PDs) was stimulated by clinical and some empirical evidence of mild and enduring alterations of mood and drive in patients who never developed one of the full-blown mood disorders. The aim of the study was to clarify the status of historical concepts of subaffective PDs (as there are the depressive, hyperthymic, cyclothymic, and asthenic type) in relation to the modern Diagnostic and Statistical Manual (DSM)-III-R conceptions of personality disorders and the five factor theory of personality. A consecutive psychiatric sample and a normal control sample were used to investigate these relationships. By means of a non-metric multi-dimensional scaling procedure, and facet theoretical interpretation, the depressive and asthenic PDs were demonstrated to correspond highly with the global construct of PD as well as with the personality factor neuroticism which proved to be elevated in most types of PDs within the clinical sample. The hyperthymic and cyclothymic categories displayed differences to most DSM-III-R constructs of PD in the clinical but not in the control sample. The findings may explain the chronic course of some depressive or somatization disorders that are difficult to influence by pharmacotherapy and that may require special treatment strategies.

Panic attacks and the antipanic effect of antidepressants are claimed to distinguish panic disorder (PD) from generalised anxiety disorder. However, most studies showing neurochemical disturbances in PD overlook the non-panic state. We compared panic patients in the non-panic state with controls on biochemical, psychological and physiological measures. There were no differences on the neuroendocrine tests. Self-ratings of bodily and psychological symptoms of anxiety were significantly higher in patients and they scored worse on word recall. Patients had significantly more skin conductance fluctuations and slow wave activity in the electroencephalogram, a sign of hyperventilation which may have implications for brain activity. Discrepancies between patients' self-ratings and objective measures of pulse rate and psychomotor performance indicated that panic patients have distorted perceptions of both physical and mental functioning. Hyperventilation and cognitive distortions in the non-panic state may facilitate panic attacks and are part of the pathophysiology of PD.

To characterise frequent use of psychiatric emergency outpatients services, this paper reports results from a prospective investigation of use of psychiatric services by new patients in two Nordic psychiatric services, Frederiksberg in Denmark and Oulu in Finland. One year treated incidence cohorts were used. Total number of patients included was 1,055. The repeat user was defined as a patient having at least three emergency outpatient contacts during a 1-year follow-up. The repeat users constituted 15.8% of the sample and 70.8% of all the emergency contacts in Frederiksberg. In Oulu the respective figures were 9.3% and 33.8%. The number of planned outpatient contacts or the number of hospital admissions of the repeat users did not differ from the non-repeaters. Repeaters in Frederiksberg were more likely to be self-referrals, male, divorced or unmarried, living with their parents, without their own housing, unemployed, aged between 25 and 44 years, and to have a diagnosis of dependency or personality disorder. In Oulu they did not differ from the other patients with regard to sociodemographic or diagnostic characteristics.

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.

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.