Unexplained medical symptoms are common in children. They constitute the main feature of somatoform disorders of childhood (i.e. pain disorders, conversion disorder and chronic fatigue syndrome or neurasthenia).

To describe assessment and treatment strategies for severe somatoform disorders of childhood.

Review of recommendations for clinical practice and clinical trials.

A number of specific techniques have been described. Clinical accounts indicate that many children benefit and can recover. There is some empirical evidence supporting the beneficial effects of techniques such as family cognitive-behavioural therapy and relaxation technique for the less severe disorders.

Existing helpful clinical guidelines require empiric validation.

Interictal psychosis is a serious comorbid condition in epilepsy patients that would benefit from treatment with psychotropic medication.

This paper gives an overview of the pathophysiology, symptomatology and treatment of the schizophrenia-like psychosis of epilepsy. Use of the term ‘interictal chronic psychosis’ is suggested, to conform to current DSM-IV classification of schizophrenia.

Literature review supplemented by clinical experience. There is a lack of randomized control trials (RCTs) concerning effectiveness and side-effects of neuroleptics in epilepsy patients.

Hypotheses concerning the pathophysiology of the interictal chronic psychosis are discussed. The concept of forced normalization and alternative psychosis is based on case descriptions, and was not substantiated by systematic research. The kindling hypothesis seems promising, but was never confirmed in humans. A third theory, supported by some studies, suggests that inhibitory cerebral mechanisms enhance psychotic symptoms in epilepsy patients. Treatment strategies are based on case studies and open studies by lack of RCTs. Treatment should consider the optimalization of the dosage of antiepileptics in combination with one or two antidepressants, mood stabilizers and/or atypical neuroleptics. Surgery plays no significant role in the treatment of treatment-refractive epilepsy with interictal chronic psychotic symptoms.

There is a prominent role of antidepressant or double antidepressant treatment strategies in patients with epilepsy and interictal chronic psychosis compared with treatment guidelines of chronic psychotic patients in general psychiatry.

Personality disorder, mental retardation and aggression are frequently encountered therapeutic problems in epilepsy patients.

This paper gives an overview of symptomatology and treatment of personality disorder, interictal aggression and mental retardation in epilepsy.

Literature review supplemented by clinical experience.

Personality changes in patients with epilepsy are often symptoms of an organic psychosyndrome. Aggression is not more frequent among epilepsy patients than in the general population, but if it does happen it is often more severe. There is a need for controlled treatment studies. A treatment strategy is suggested. In the mentally retarded, diagnostic instruments should be used to overcome diagnostic difficulties.

Prevalence studies based on DSM-IV personality disorder, conducted in the community, are needed, as well as systematic research on diagnosis and treatment of personality disorder in epilepsy patients. Randomized controlled trials (RCTs) considering the effectiveness and adverse effects of antidepressants and neuroleptics in epileptic patients with mental retardation are seriously needed. In the meantime, the Expert Consensus Guideline Series on Treatment of Psychiatric and Behavioural Problems in Mental Retardation is useful. The use of neuroleptics for the treatment of aggressive or destructive behaviour in nonpsychotic mentally retarded patients remains controversial.

To explore the relation between Parkinson's disease (PD) and depression from a conceptual point of view.

Discussion of the relevant literature on the conceptual, phenomenological and therapeutical aspects of depression in Parkinson's disease.

Both semantic confusion and an erroneous belief in the mind-body distinction have contributed to some common misunderstandings of the nosology and etiology of depression in Parkinson's disease.

The consequences of a different, integrated, neuropsychiatric approach for both diagnosis and treatment are discussed.

To evaluate the tolerability and efficacy of risperidone in childhood autistic disorder.

A multicenter, open-label, dose-titration study involving seven autistic children (mean age 7.6 years) receiving risperidone for 4 weeks.

Mean dose was 0.01 mg/kg/day on day 1, 0.019 mg/kg/day on day 7 (range 0.01–0.041 mg/kg/day) and 0.035 mg/kg/day on day 28 (range 0.014–0.064 mg/kg/day). Over the 4-week period, the Ritvo–Freeman Real Life Rating Scale total score measuring autistic behavior was significantly decreased (P = 0.019), as was the affectual reactions subscale (P = 0.029). Aberrant Behavior Checklist total score was significantly improved (P < 0.001), as were all subscales except inappropriate speech. Visual Analog Scale for individual target symptoms was significantly decreased (P = 0.001), and Clinical Global Impression severity of illness score was significantly improved (P = 0.006). The incidence of adverse effects was low, and no extrapyramidal symptoms were observed. No significant changes or clinically relevant abnormalities occurred in laboratory tests, vital signs or electrocardiograms. Plasma concentrations of the drug were similar to those in adult patients.

These favorable results suggest that larger controlled trials of risperidone should be performed in autistic or mentally retarded patients with behavioral disturbances.