Psychiatric diagnoses provide short labels for diseases or discrete symptom clusters. They should designate the same throughout the world, give information about course, outcome and indications for therapy as well as provide an heuristic basis for etiological research. Hence, the core question is how to attain an optimal representation of real morbidity in diagnosis, sets of diagnostic criteria and diagnostic classifications. Clinical observation can be improved considerably by multi-centre field trials, as applied in the preparation of ICD-10 and DSM-IV. But the approach has considerable limitations due to a lack of external measures in many psychiatric disorders and a highly limited representation of many diagnostic groups in clinical populations. Therefore, epidemiological methods are required in validating diagnosis and diagnostic criteria. The simplest way is to supplement clinical multicentre diagnostic studies by general-practice studies, but these, also, cannot fully replace population studies. Operational diagnosis and case criteria can be defined either categorically or dimensionally. Most of the categorical diagnoses in ICD-10 or DSM III also include dimensional characteristics. The impact of various diagnostic criteria, particularly cut-offs of dimensional characteristics, on the assignment of a diagnosis and, thus, on the morbidity figures of a diagnostic category is demonstrated by data from a large representative sample of first-admitted schizophrenics. Attempts at etiological validation by methods of genetic epidemiology provide limited support for Kraepelin's dichotomous model of functional psychoses. Validation by epidemiological course studies has shown that the stability of diagnosis in functional psychoses differs according to the sets of diagnostic criteria of different classification systems.

Social indices of social integration, such as divorce, were more successful in predicting the suicide rates of the elderly in the provinces of Hungary than they were in predicting the suicide rates of young adults.

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.

Part of the familial factor of alcoholism is associated with the existence of genetic vulnerability. Genetic factors which interact with the pathogenesis of alcoholism are nevertheless complex, partial and for the moment partly unknown at the biological level. Recently, many association studies have been published concerning alcohol-dependence and genes coding for the second dopamine receptor. These associations, which have had positive replications, raise many questions. First of all, should the inheritance of alcoholism be regarded as a definitive fact? Secondly what is inherited? It could be alcoholism in general, a component of this disease (for instance, dependence on, sensitivity to or the seeking-process for alcohol), a specific pattern of drinking, presence of complications linked to alcohol abuse, or more general features, common to many addiction diseases. Thirdly, how could dopamine be linked to alcoholism? Furthermore, how should these positive associations be considered, given that two of these studies were negative, and that all linkage studies were negative. Lastly, are there other clues and ways of finding genetic vulnerability factors for alcohol abuse?

The Phobic Attitude Scale (PAS) is a new 15-item inventory designed to assess sub-clinical agoraphobic attitudes as well as the severity of pathological avoidance. Its psychometric properties have been examined in three groups of subjects: 41 outpatients suffering from DSM III-R Panic Disorder, with or without agoraphobia, 62 healthy controls and 12 mixed psychiatric patients.The instrument proved to be simple and easy to use. PD patients scored significantly higher than healthy controls, with mixed psychiatric cases showing intermediate values. The Test-Retest procedure gave rise to satisfactory kappa coefficients (0.25 to 1) and the internal consistency was good (Cronbach alpha = 0.86). Factor analysis produced three factors: “crowded and social situations”,“enclosed and open spaces/riding situations” and “simple phobia”.

Les auteurs présentent une revue des tendances actuelles concernant divers aspects du suicide de I’adolescent telles qu’elles apparaissent aujourd’hui dans la littérature. L’accent est mis sur la relation entre psychopathologie et suicide, I’épidémiologie, la prévention et les problèmes thérapeutiques que pose le suicide.

Response patterns derived from dichotomized (0/1) weekly CGI ratings conducted in antidepressant drug trials (Quitkin et al, 1984) were compared with those found in the pooled data from several randomized double-blind trials comparing the relative efficacy and tolerability low-dose flupenthixol im with that of three trieyclics (amitriptyline sr, imipramine, doxepine). Using the configurational frequency analysis (Krauth and Lienert, 1973), the postulated patterns could be rediscovered in our data apart from “early onset persistent patterns” which were less frequent in Quitkin et al's (1984) drug data. However, apart from this finding no “typical” patterns in terms of drug- or placebo-dependent response patterns could be detected in either the flupenthixol or Quitkin et al's (1984) data. It is concluded that there is little empirical evidence for the assumption of placebo- or drug related change- or response patterns. Moreover, theoretical aspects do not support the usefulness of such concepts.

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.

Patients suffering from various subtypes of dysthymia were compared with regard to demographic, clinical and personality characteristics. Patients with secondary dysthymia, as compared to those with primary dysthymia, had an earlier age of onset and a higher frequency of Axis I co-diagnoses (in particular anxiety disorders). Patients with pure dysthymia, as compared to those with double depression, showed an earlier age of onset of Axis I co-diagnoses, a later age of onset of dysthymic disorder and a shorter duration of the disease.

This case note sludy examined the clinical features and outcome of 30 patients with dysmorphophohia (perhaps (he largest series so far) who had behavioural (exposure) therapy. Method: The clinical Features and treatment outcome on standard contemporary measures were reviewed. Results: All palienls had social avoidance and dysmorphophohia, with abnormal beliefs, often of delusional intensity. For up lo 1-12 months follow-up after exposure, most patients improved in avoidance, work and social adjustment, and in beliefs even if these had initially been delusional. Gains were less than after exposure therapy for non-dysmorphophobic problems such as agoraphobia, specific phobia, social phobia and obsessive-compulsive disorder (OCT)). Conclusions: The importance of separating delusional from delusional dysmorphophohia can be questioned. Exposure therapy appeared useful for dysmorphophohia, but this must be confirmed in a controlled trial and in patients who attend dermatology, plastic surgery and general psychiatric clinics.

Starting from the hypothesis that alcoholics have a specific semantic network which causes a perceptual-processing bias, we tested 30 male inpatients and 20 healthy male controls. Our modified card version of the Stroop color-naming task consisted of a neutral and critical word condition. The results revealed that alcoholic patients showed a small information processing bias under the critical experimental condition (alcohol-related words); although this was only a trend in the expected direction and statistically not significant. However, neuropsychological impairment of the patients was demonstrated with the “standard Stroop procedure”. The most significant deficits were found in the interference task, which requires cognitive flexibility.

The method of evaluation we describe attempts to establish the criteria applied by clinicians when recommending psychoanalytical psychotherapy or psychoanalysis. A questionnaire was constructed and a study of inter-rater agreement using this research tool was carried out. The results of inter-rater agreement as well as the variations concerning each rater are discussed. Continuation of this study will provide the opportunity to examine the validity of general principles underlying the psychoanalysts’ perceptions of their patients.

The purpose of the present study was to examine the prevalence of symptoms of anxiety and depression reported by high-school students of a Greek provincial town. One thousand and eighty students (587 males and 497 females) of the 10th, 11th, and 12th grades completed among other psychometric instruments, the DSSI/sAD (Delusions Symptoms States Inventory/states of Anxiety and Depression) an inventory measuring symptoms of anxiety and depression. On the anxiety scale 24.5% of males and 56.4% of the females reported scores above the cut-off point, whereas 10.3% of males and 30.9% of females were very high scorers. On the depression scale, 33.4% of males and 60.6% of females reported scores above the cut-off point, whereas 13.9% of the boys and 31.1% of girls reported very high scores. Both boys and girls reported more elevated scores on the depression scale but the sex differences were more pronounced on the anxiety scale particularly in the group of high scorers. A weak positive relationship between age and dysthymic symptoms was detected in females. The findings encourage discussion on topics regarding not only the prevalence of anxiety and depressive symptoms in adolescence, but also the gender differences detected, the relationship between age and mood disorders in adolescence, the degree of diagnostic certainty of the self-report instrument used and the possible meaning of the low, medium, and high scores reported by the participants. It is proposed that data of this kind may be of some value in future comparative studies regarding small European cities.

The authors examined whether substance abusers have more maladaptive thinking patterns than controls. The Dysfunctional Attitude Scale (DAS) was administered to 38 substance abusers and 30 healthy age-matched controls. Nineteen substance abusers (50%) were depressed and 19 were non-depressed. Both depressed and non-depressed substance abusers had significantly higher DAS scores than controls. Depressed substance abusers had higher scores than non-depressed substance abusers. There was no correlation between age, sex, age of onset or the nature of the substance used and DAS scores in either group of patients. There was a trend for an elevation of DAS scores with chronicity of dependence among depressed substance abusers. The results support the hypothesis of the presence of maladaptive thinking patterns among substance abusers, and suggest a need for further exploration of their cognitive styles and of the use of cognitive therapy in the treatment of addiction.

Platelet serotonin-binding (Bmax), using tritiated-seroionin as the ligand, was determined in 75 patients suffering from major depression with melancholia and in 26 patients diagnosed from dysthymic disorder. Twenty-five normal subjects were used as a control group. The melancholic group had significantly lower Bmax values (mean: 6.7 ± 6.1 pmol/108 platelets) than either dysthymic (9.3 ± 3.9 pmol/108 platelets) or control (9.2 ± 4.8 pmol/108 platelets) groups, while there were no significant differences between the two latter groups. There was also a significant difference on postdexamethasone Cortisol between melancholic (6.3 ± 7.1 μg/dL) and dysthymic (1.4 ± 1.4 μg/dL) groups, with a higher rate of nonsuppressors in melancholic groups. Although both tests were abnormal in the melancholic group, no relationship was found between platelet serotonin-binding and the dexaniethasone suppression test.