A two-part survey of French General practitioners was carried out to determine attitudes and diagnostic criteria for definition of atypical depression, major depressive episodes, and anxiety disorder. Following a preliminary phase in which 90 physicians were interviewed, 500 general practitioners received detailed questionnaires based upon DSM III-R criteria, as well as supplementary questions based upon the Leibowitz and Akiskal criteria. Principal criteria analysis and regression analysis were carried out on the 280 analyzable files received. Results showed that anxiety disorders were primarily defined in terms of somatic criteria, and that there were a number of factors common to anxiety and depression. Minor depression was also defined primarily on the basis of somatic complaints, together with loss of energy and fatigue. Major depression was defined primarily by asthenia, apragmatism and loss of drive, together with less strongly weighted cognitive factors (sadness, Pessimism, inhibition, etc). From a dimensional standpoint, depression is defined as a “vital deficit”, with a failure to cope with social and environmental demands. It is interesting to note that the duration criterion was not considered to be of nosological relevance by the physicians, and was generally ignored in the definition of mental pathologies. The international subtyping of depressive disorders does not form part of the Practice of French practitioners, who prefer to retain the older, psychosocial models.

We administered the Personality Disorder Examination (PDE) to 31 patients meeting DSM III criteria for obsessive-compulsive disorder (OCD) and to an age-and sex-matched healthy control group. Seventeen patients (54.8%) and four controls (12.9%) met criteria for one or more DSM III Axis II diagnoses. The most frequent Axis II diagnoses in patients were avoidant, passive-aggressive and compulsive personality disorder. Compulsive personality disorder was diagnosed in 6 OCD patients (19.3%). The prevalence of this disorder did not change according to sex, age of onset or duration of OCD, and severity of obsessive-compulsive symptoms.

In 61 schizophrenic patients divided into subgroups according to DSM III-R, positive/negative symptoms and Leonhard's classification of systematic and non-systematic schizophrenia, the severity of illness (BPRS) and affective blunting (MARS and RSEB scales) were measured before and after neuroleptic therapy. The evaluation of affective blunting with the use of RSEB revealed more significant differences within schizophrenic subgroups than with the use of MARS. The severity of illness did not differentiate the subgroups studied. The affective blunting was more severe in patients with systematic than with non-systematic schizophrenia as well as in mixed and negative than in positive schizophrenia. The severity of illness correlated however with the severity of affective blunting. Clinical improvement after neuroleptic treatment was more favorable in patients with positive schizophrenia. The diminution of affective blunting after neuroleptic therapy varied among the subgroups.

We report on the case of a patient who developed an acute meningitis and, after a period of about two weeks, without any neuropsychiatric problems, an acute paranoid-hallucinatory and catatonic syndrome. The symptomatology is discussed, in relation with the diagnostic difficulties of differentiating between a biphasic meningo-encephalitis with an organic psychosis or a first manifestation of an endogenous psychosis.

In Germany a major distinction is made between endogenous and neurotic depression. While traditionally neurotic depression was seen as being amenable only to psychotherapy, there is an increasing tendency to treat neurotic patients presenting the full depressive syndrome with antidepressant drugs. Those psychiatrists who are aware of the concept of atypical depression in the stricter sense (anxiety-depression, depression with reversed somatic symptoms, etc) tend to treat these patients with monoamine oxidase inhibitors. The diagnosis of “dysthymia”, Possibly equivalent to “neurotic depression”, has not yet come into common usage. While the term “neurasthenia” is traditional, general Practitioners prefer other designations; treatment involves supportive psychotherapy, benzodiazepines and sedative antidepressants. Mixed anxiety-depression is treated with anxiolytic antidepressants, sedatives or, for the milder cases, with low-dose neuroleptics. This indication for neuroleptics is controversial, and a treatment protocol has been codified for use by the general practitioners so as to avoid the potential major adverse reactions seen with the class. The new concept of recurrent brief depression is confined to academic milieu, where treatment is the same as for unipolar depression.

The case reports of two DSM III-R schizophrenic patients with a family history of bipolar disorder are presented. The two patients had a history of severe obstetric complications (OCs). These cases are discussed in the light of neurodevelopmental theories of schizophrenia and in the continuum view of psychosis.

Schizophrenics with “symptomatic trans-sexualism” may present themselves with the request for sex reassignment surgery. Two case reports illustrate that DSM III-R diagnosis for trans-sexualism offers insufficient guidelines for therapy management. The relation between schizophrenia and trans-sexualism is discussed.

CT findings in 17 patients and MRI in one patient with post partum psychiatric disorder (PPPD; psychosis: n = 17, depressive neurosis: n = 1) were compared with randomly selected CT scans in non-PPPD patients matched for age and sex. In the PPPD group, 13 examinations (controls: 8) revealed one or several abnormal findings such as sulcal widening, ventricular enlargement and asymmetry. There was a higher prevalence of abnormal CT/MRI findings in the PPPD group (trend, P < 0.1).

In an attempt to better delineate demographic and clinical characteristics of mild chronic depressions, 46 outpatients fulfilling DSM III-R criteria for dysthymia were compared with patients suffering from a chronic major depressive episode. The profile obtained from our dysthymic sample matches with those reported by other authors. The comparison between “minor” and major chronic depression was also carried out by subdividing these latter into unipolar - recurrent and single episode - and bipolar depression. Dysthymics showed a bipolar family history closer to that of bipolar chronic major depressives which was significantly higher than that recorded in the other sub-categories.