The authors study the frequency of primary enduring negative symptoms in first-admission patients with schizophrenic and non-schizophrenic disorders. Carpenter's criteria for distinguishing the primary, enduring negative symptoms from the more transient negative symptoms (secondary to different factors) were applied. Furthermore, they compare negative symptom complexes between first-admission patients and patients with recurrent hospitalizations (within 5 years after first admission). There was a trend for patients with recurrent admissions to show more frequently a deficit syndrome than first-admission patients. Nevertheless, this difference was not significant (χ2 = 0.90). First-admission patients with deficit syndrome had significantly higher affective blunting (P < 0.05) and anhedonia (P < 0.001) than those with recurrent admissions. First-admission subjects with psychotic disorders had significantly higher frequency of deficit syndrome than those first-admission patients with non-psychotic disorders (P < 0.05). These results show that negative symptoms observed in first-admitted non-schizophrenic patients can also be enduring and primary. Thereby this work does not contribute to support the specificity of primary enduring negative symptoms for schizophrenia. Moreover, data suggest, that primary anhedonia and affective blunting can decrease within the first 5 years after discharge.

The purpose of this study was to investigate the relationship of social anxiety and insulin-dependent diabetes mellitus (n = 40 girls between 13 and 19 years of age). Mean duration of diabetes was 7 years. We supposed that this chronic illness may provoke feelings of friendlessness and sadness, social withdrawal and fear of social situations because diabetes entails a series of demands which differentiate the diabetic child from healthy children. Our population was compared with 35 healthy young girls. All were administered the Schedule for Affective Disorders and Schizophrenia for School-Age-Children and completed the State Trait Anxiety Inventory for Children, the Self-Consciousness Scale and the Imaginary Audience Scale. Diagnoses of anxiety disorders across DSM-IIIR do not show significant differences between groups. In self-report inventories, our findings do not support the hypothesis that social anxiety is a pathological symptom in diabetic subjects. However, they were more depressed than the control group. Furthermore, social functioning of the diabetic group did not differ from that of the control group. They were more concerned with their illness than with social anxiety.

Probably in association with changes in the economic structure and high unemployment rates in western industrialized countries, homelessness is becoming more apparent publicly and receiving increased media attention. More studies on the issue of mental illness and homelessness have been performed in recent years in North America while hardly any representative and reliable data exists concerning Germany and some other European countries. The aim of our study was 1) to assess alcohol abuse and dependency as well as other mental disorders in a representative sample of homeless men in Munich using reliable methods of case identification (Diagnostic Interview Schedule [DIS and DIS/DSM-III diagnoses); 2) to compare homeless alcoholics with homeless non-alcoholics in our sample on relevant variables and issues and 3) to compare our data from the sample of homeless men in Munich with data obtained by others using the same case identification procedure (DIS/DSM-III diagnoses). According to our results, the lifetime prevalence of any DIS/DSM-III Axis I diagnoses was 94.5% and the lifetime prevalence of substance use disorder was 91.8%. The single most prevalent diagnosis among homeless males in Munich was alcohol dependency (lifetime 82.9%), while alcohol abuse (lifetime 8.2%) and drug abuse/dependency were considerably lower (lifetime 17.8%). Data show that alcoholism and its consequences were more severe in the Munich as compared to the Los Angeles homeless sample. Homeless alcoholics showed a high comorbidity with other mental disorders (lifetime) such as affective disorders (44.4%), anxiety disorders (22.6%), drug abuse/dependence (18.8%) and schizophrenia (12.0%); 64% of those with alcoholism at some time during their life had at least one other lifetime mental disorder. Alcohol-related patterns of living and symptoms as well as social or role functioning are described for homeless alcoholics in Munich and compared with data from other relevant studies. Considering the extremely high prevalence of alcohol dependence frequently in combination with other mental disorders, the use of alcohol rehabilitation and other services as well as self-help groups was minimum among Munich homeless alcoholics. New concepts to deal with these problems are needed and if they exist, they need to be implemented.

The aim of this study was to identify possible peripheral biological markers (both lipidic and hormonal) which can be easily used for the early detection of parasuicidal behaviour and to propose a predictive biological model of such behaviour. A case-control analytical study was undertaken at least 3 months after attempted suicide. Study was made of 128 patients who presented at the University General Hospital of Oviedo (Spain) with signs of self-intoxication. Lipidic and hormonal profiles were measured under basal conditions and comparison was made with a control group of healthy volunteer donors obtained from the Oviedo General Hospital blood bank. A discriminant analysis was later made with the aim of establishing a predictive biological model. This included the following variables: cholesterol, HDL-C, LDL-C and cortisol. Sensitivity and specificity were 62.5% and 65.6%, respectively. Replication and improvement of this model, through other prospective studies, could lead to the use of serum cholesterol and cortisol levels as inexpensive and readily available markers of suicide risk.

The aim of this study was to compare the efficacy, safety, and tolerability of sertraline and clomipramine in the treatment of obsessive-compulsive disorder (OCD). Outpatients with DSM-III-R defined OCD for 1 year or longer and scores of ≥ 20 on the YaleBrown Obsessive Compulsive Scale (Y-BOCS), ≥ 7 on the National Institute of Mental Health Global Obsessive-Compulsive Scale (NIMH-OC), ≥ 4 on the Clinical Global Impression Severity of Illness Scale (CGI-S) and ≤17 on the Hamilton Depression Scale (17 item HAMD) were randomized to sertraline (n = 86) or clomipramine (n = 82) once daily for 16 weeks. Initial daily doses of sertraline and clomipramine were 50 mg. After a minimum of 4 weeks, these doses could be increased by 50 mg increments every 2 weeks to a maximum of 200 mg daily if the response was thought inadequate. Efficacy was assessed at the end of 1, 2, 4, 6, 8, 12 and 16 weeks of therapy using the Y-BOCS, NIMH-OC, CGI-S, CGI Improvement Scale (CGI-I) and Clinical Anxiety Scale (CAS). One hundred sixty-eight patients were randomized and received at least one dose of double-blind medication; 86 received sertraline and 82 clomipramine. Mean final daily doses at final visit were clomipramine 90 mg (efficacy evaluable patients 101 mg, completers 110 mg), and sertraline 129 mg (efficacy evaluable patients 132 mg, completers 136 mg). Mean baseline Y-BOCS, NIMH-OC and CGI-S totals were 27.7, 10.1 and 5.5, respectively, for sertraline and 27.4, 9.9 and 5.5, respectively, for clomipramine. Sertraline demonstrated greater efficacy than clomipramine in the intent-to-treat patient group: mean baseline to final visit changes were 50.8% (Y-BOCS), 41.9% (NIMH-OC) and 37.7% (CGI-S) for sertraline and 42.9% (Y-BOCS), 33.8% (NIMH-OC) and 30.0% (CGI-S) for clomipramine (P < 0.05). The number of patients withdrawing because of adverse events was substantially greater for clomipramine (26%) than sertraline (11%) (P < 0.05). The most frequent adverse events for clomipramine were dry mouth (20%), anxiety (17%), constipation (16%), nausea (15%) and somnolence (11%), and for sertraline, diarrhea (12%) and nausea (12%). In this study, sertraline was more effective than clomipramine in the intent-to-treat analysis. The difference in efficacy between the treatments is almost wholly accounted for by a greater number of clomipramine withdrawals due to the poor patient acceptance of clomipramine. The superior tolerability of sertraline and the lower rate of premature treatment withdrawal relative to clomipramine may offer considerable quality of life and compliance benefits in the long-term management of a chronic disorder such as OCD.

The authors investigated the post-halfway house outcome of a sample of 41 former residents of the halfway house of the Department of Psychiatry, Athens University. Two criteria were used: hospital recidivism and global ratings of outcome (which was assessed on the basis of three parameters: rehospitalization, employment and independent living). Mean duration from the time of departure was 32 months (range: 8–52 months). Within this period good outcome and non-recidivism were related with compliance to pharmacotherapy. Most recidivists also had a shorter stay in the halfway house and cases with successful outcome tended to be evaluated higher on the “Behaviour in Halfway House Scale” at the end of the residency.

Young homocystinuria patients suffering from lens dislocation frequently have to undergo eye surgery. We describe a 16-year-old girl with mild mental retardation who became psychotic-delirant immediately after the last of three lentectomia operations performed under general thiopental anaesthesia. Because methionine, homocysteine, its oxidation product homocysteate and cysteine are potent glutamate agonists, the disturbance of the sulphur containing amino acid (SCAA) metabolism in homocystinuria patients may alter the function of cerebral glutamatergic transmission. The chronic and acute neurological and psychiatric symptoms of homocystinuria patients offer a clue to studies of the neurotoxic but also antipsychotic potency of glutamate agonists like the SCAAs in humans.

In this symposium the nature, epidemiology and extent of psychiatric disorders comorbid with addictions, especially alcoholism, was exposed. Internationally reknown authors from several European countries highlight the diversity and complexity of this problem in particular for depression, anxiety and suicide. The conclusion is that every psychiatrist should be well acquainted with addiction disorders and that no addiction center be allowed to refuse treatment to patients with a psychiatric comorbid disorder. Comorbidity of schizophrenia with addictions should be a future focus of research. Multicultural Europe is an exciting area for further research of the comorbidity problems.