The mitogen induced lymphocyte responses were measured in 33 depressed patients categorized according to the DSM-III into minor (300.40, 309.00), simple major (296.X2) and major depression with melancholia and/or psychotic features (296.X3, 296.X4). Three distinct mitogens were used, i.e. phytohemaglutinin (PHA), pokeweed mitogen (PWM) and concanavalin A (CON A). We found that major depressives with associated features showed significantly lower mitogen induced lymphocyte responses to PHA and PWM as compared to all other depressed patients. The severity of illness was significantly inversely related to the lymphocyte responses to PHA. Cortisol nonsuppressors exhibited significantly lower PHA and PWM induced lymphocyte responses as compared with suppressors. There were significant and negative correlations between the postdexamethasone Cortisol values and the PHA and PWM stimulated lymphocyte responses.

The growing populations of the elderly is frequently regarded as a homogeneous entity. In this retrospective study 140 patients above 60 years, first admitted to a psychiatric hospital, were screened for individual psychiatric symptoms. This was done according to the D.S.M.-III-R criteria and with the european ADMP-IV scoring system.

As expected dementia and related disorders are characteristic of the “older” categories, depressieve disorders were seen more frequently in the “younger” categories. Screening the elderly for psychiatric symptoms also shows differentiation within the group of the older patients.

Symptoms related to dementia increase in frequency, also increasing are e.g. visual hallucinations. A decrease was found for hypochondriasis and phobia. So, the group patients above 60 years is clearly heterogeneous.

In this case report of a patient with carcinoid carcinoma we discuss the normal metabolism of tryptophan, one of the essential amino acids.

We also examined the changes of this metabolism due to the metastasis of the carcinoid carcinoma and its psychiatric complications based on a central tryptophan deficiency.

A less frequent complication of the changes in the tryptophan metabolism due to carcinoidosis is the disease pellagra. This disease is always accompanied with psychiatric symptoms. It plays an important role in the development of the transmethylation hypothesis of schizophrenia.

In an introduction the evolution of a neuropsychological and neuropsychiatrie approach in the two last decades is discussed. The role of the basal ganglia, the thalamus and their cortical connections in aphasia is discussed. This review is given as a paradigm to demonstrate a neuropsychiatrie approach of psychiatric disorders. The role of corticosubcortical relations in depression is discussed.

The author describes the development of a neurotoxicity syndrome in a 68 year old women treated for 1½ years with lithium for recurrent depressions. The syndrome developed after 10 mgr. haloperidol per day was added, during a manic episode, for 10 days. The lithium levels were 0.71 ± 0.19 MEq/L. After 19 days all medications were discontinued. The neurotoxicity consisted succes-sivily of confusion, somnolence, agitation, extrapyramidal symptoms, cerebellair ataxia and EEG abnormalities. After 10 weeks memory impairmments were still present. At four months, memory function was restored. After five months, the patient was discharged without residual symptoms. The patient reported amnesia for the first six weeks of the syndrome. The author points out that while patients may develop tolerance to lithium maintenance after several years, they still may develop a neurotoxicity syndrome when haloperidol is added to treat a manic episode.

The present review summarizes the prevalence, clinical phenomena, and pathogenesis of sleep and wake disorders in shift workers. Insomnia and hyper-somnolence occur in more than 50% of shift workers, mainly in association with the night shift. Circadian rhythm disruption is the major determinant of these disorders. Furthermore they are frequently associated with psycho-social problems and somatic diseases. In more than 20% of the shift workers problems are so pronounced, that they fail to adapt to the rotating schedules. This is defined as ‘shift maladaptation syndrome’.

Several lines of evidence suggest that there may be abnormal brain serotonin metabolism in habitually biolent and impulsive offenders. These personality disorders are usually connected with early onset, male limited type 2 alcoholism in which one central feature is the abnormal tendency to behave aggressively and impulsively under the influence of alcohol repeatedly. Low CSF 5-HIAA has been found to correlate with familial alcoholism tendencies; paternal alcoholism. Both this and with it the tendency to abnormal oral glucose tolerance test (tendency to low blood glucose nadir) predict the new violent and impulsive crimes under the influence of alcohol. Also peripheral measures such as platelet MAO, abnormal tryptophan/LNAA ratio in plasma, whole blood serotonin, blood platelet uptake of serotonin, platelet 3H-IMI dinging (Bmax), abnormal prolactin and Cortisol secretion in fenfluramine challenge, and possibly daily urinary free Cortisol secretion correlate with impulsive aggressive behavior.

For all controlled studies that bear upon the analgesic-effect of antidepressants, a meta-analysis was conducted to get an estimation of the effect size and to get a sight on the possible modes of action. For this purpose both content and methodological variables were coded for each study. The mean size of the analgesic effect is 0.63. This means that the average patient getting an antidepressant has less pain than 74% of the patients getting a placebo. However because of selective drop-out and the use of psychometri-cally inadequate pain scales, this may be an over-estimation. Real analgesic qualities of antidepressive agents seem to offer the most plausible explanation for the effect, but the importance of serotonin reuptake blocking is not confirmed. A main objection, however, is that in all studies the depression variable was insufficiently controlled at inclusion. Because both the estimation of the effect size as the explanation of the effect are confounded with methodological doubts, it is concluded that further studies need to be done to overcome these difficulties.