Different forms of insomnia are present as symptoms of many psychiatric and other disorders. The first step for a treatment strategy is therefore a correct diagnosis. As insomnia is more common in patients with psychiatric disorders than in the general population, a careful consideration should be given, depressive and anxiety disorders should especially be carefully investigated. There are reasons to believe that even in so-called insomnia not obviously related to psychiatric disorders, stressful life situations may play a role. Therefore a co-morbidity with emotional disorders which may follow these events is worth considering. Insomnia should always be considered as pan of a sleep-wake schedule disturbance and this has an impact on the importance of the pharmacological properties of the drugs used to treat insomnia. The recent trend for more specific agents both on receptor sub-populations and on relevant sites of the GABA receptor complex will help very much in selecting the most appropriate drug for treating patients.

Regional cerebral blood flow (rCBF) values were measured by single photon emission computed tomography (SPECT) in different regions of the brain in 27 patients with DAT. Significant correlations were found between rCBF in left parieto-temporooccipital regions and psychometric test scores. Patients with hemisphere asymmetry in SPECT performed worse on psychometric tests. SPECT did not permit prediction of or differentiation between depressive and psychotic symptoms.

This study is the first part of the validation of a French version of the Dutch Eating Behaviour Questionnaire (DEBQ), among a population of obese and normal-weight patients. The questionnaire was administered to 166 subjects. Construct validity was assessed by orthogonal factor analysis with a varimax procedure and reliability was measured by Cronbach's alpha coefficient. Results showed the presence of three major factors (“emotional”, “restrained” and “external eating”) with loadings similar to those of the original questionnaire. A high internal consistency was found in the different scales. This study clearly demonstrates the factorial validity and the reliability of a French version of the DEQB.

In the course of the international development of tianeptine (T), depressed patients were recruited by 18 centres from Belgium, Italy, Mexico, Portugal, Spain and Switzerland in a double-blind parallel group study versus placebo (P) and imipramine (I). Efficacy and safety of tianeptine were evaluated in 187 depressed inpatients (56% female, 44% male), who fulfilled criteria for either major depression, single episode (24.6%) or recurrent (66.8%), or depressed bipolar disorder (8.6%). After a seven-day run-in placebo pre-inclusion period, patients were treated in double-blind conditions with tianeptine (37.5 mg/d) or imipramine (150 mg/d) or placebo for 14 days, including an increasing daily dose period of three days. After the fourteenth day and until the end of the sixth week of treatment, a flexible dosage was introduced in accordance with the therapeutic efficacy and/or the potential adverse events (T: 25–50 mg/d; I: 100–200 mg/d; P; 2–4 capsules). Discontinuation of treatment occurred in 57 patients (30.5%) with more inefficacy on placebo and tianeptine (P: 16/23; T: 11/17; I: 7/17), and more side-effects on imipramine (P: 1/23; T: 1/17; I: 7/17). Final MÅDRS scores in intention-to-treat analysis were 22.3 ± 1.5, 17.3 ± 1.6 and 18.4 ± 1.5 for placebo, tianeptine and imipramine, respectively. Statistical analysis demonstrated the antidepressive efficacy of tianeptine and imipramine versus placebo (P = 0.012 and P = 0.034, respectively), and no difference between tianeptine and imipramine. In patients treated for 42 days (n = 129) the MÅDRS scores dropped from 62.3% on tianeptine, 54.2% on imipramine and 48.5% on placebo. These results confirmed the efficacy of tianeptine (37.5 mg/d) in the treatment of major depression and depressed bipolar disorder when compared to placebo. No difference was found between tianeptine and imipramine (150 mg/d) for the efficacy and between tianeptine and placebo for all safety criteria. The following adverse events were significantly more frequent with imipramine than with tianeptine or placebo: dry mouth (P < 0.001), constipation (P = 0.007), and hot flushes (P = 0.011). No difference in adverse events was found between tianeptine and placebo. While the usual cardiovascular signs of tricyclic antidepressants were observed in the imipramine group, no difference between tianeptine and placebo was shown in respect to heart rate or blood pressure (supine or standing). The assessment of haematological, renal, metabolic and hepatic parameters confirmed the safety of tianeptine.

The results of a cross-sectional study on N = 212 elderly in- and outpatients are presented including sociodemographic data, physical findings, CAT-scan and EEG, as well as psychological tests for cognitive performance and affective symptoms. Forty-one percent of the patients showed mild and 13% severe cognitive deficits. Depression was diagnosed in 23% of the severely impaired and in 16% of the cognitively mildly impaired or unimpaired patients. Statistical analysis revealed that increasing age, female sex and low premorbid intellectual level were significantly associated with loss of cognitive function. Dementia and depression were not significantly associated with each other. The only risk factor for depression was a history of affective illness, but not cognitive deficits or social situation. CAT-scan and EEG were abnormal in 50% of the patients; however, this did not correlate with cognitive impairment or the presence of depression. From this study it is concluded that depression and dementia coincide frequently in elderly patients, but that they are associated with different risk factors It is suggested that dementia and depression are treated as two distinct disease entities.

Nowadays, the rehabilitation of schizophrenic patients is a major issue for psychiatry. Regarding the role of conventional neuroleptics, the following points will be considered in this paper: the role of neuroleptics in the number, length and frequency of hospitalisations; the role of neuroleptics in the number, degree and length of relapses; the clinical effects of neuroleptics focusing particularly on their disinhibitory action, the most controversial and least studied of the clinical effects of these drugs; and the side effects, which have been intensively studied and particularly criticised during these last years, leading to the development of new drugs discussed in the next article. All the published data relating to the psychosocial profile of schizophrenic patients clearly demonstrate the need for further research in order to improve the familial, social and professional rehabilitation of these patients

The distribution of 282 Research Diagnostic Criteria (RDC) and of 224 DSM-III-R schizophrenic patients, respectively, by month of their birth was studied. The winter-spring birth rate excess was confirmed with a maximum from January to March. Winterborn and summer-born schizophrenics were compared. No convincing differences were found with regard to a larger set of demographic, psychosocial and clinical variables in univariate comparisons, nor did we succeed in separating and identifying a special winter-born schizophrenia subgroup using the method of cluster analysis. Negative results were obtained in spite of the fact that many of the included variables reflected the course of the illness and the degree of chronicity. Either the set of the variables we used has not been ‘correct’ enough or the separation of a winter-born subgroup is not clinically feasible.

The first breakthrough in the treatment of obsessive-compulsive disorder (OCD) came in 1967, when Fernandez and Lopez-Ibor reported on the efficacy of clomipramine (CMI) in the treatment of 16 patients with OCD (Fernandez and Lopez-Ibor, 1967). However, controlled studies with CMI were not published until 1980 (Montgomery, 1980; Thoren et al, 1980), and only in the last 5 years have large well-controlled studies been published (Clomipramine Collaborative Study, 1991). Several studies demonstrated that among the tricyclics (TCA), only CMI is effective in OCD, while effective antidepressants with a noradrenergic profile, such as desipramine (DMI), appear to be totally ineffective (Zohar and Insel, 1987; Goodman et al, 1990; Leonard et al, 1989). This selective response to TCA with a serotonergic profile led to the formulation of the serotonergic hypothesis of OCD and to the development and use of other serotonergic agents in the treatment of this disorder. Several drugs, possessing a serotonergic profile are currently being studied worldwide, among them CMI, fluoxetine, fluvoxamine, sertraline, paroxetine and citalopram. Currently, as the knowledge regarding the pharmacological approach to OCD is only beginning to accumulate, very little is known regarding treatment duration in OCD. In this review we shall attempt to examine the existing data regarding treatment duration in OCD.

In this retrospective pragmatic study, we define the necessary conditions that allow outpatient low dose intravenous neuroleptization, when hospitalization should otherwise be required. Intravenous neuroleptization is infrequently used in the outpatient treatment of acute psychotic decompensation. Rapid tranquilization with high dosage neuroleptics is controversial, and has a high risk of side effects. The indications for and potential advantages of this method in the perspective of a long-term ambulatory treatment are discussed by comparing a group of outpatients treated with infusions to a group of hospitalized patients. The method offers a satisfactory alternative to hospitalization for subjects who are not in imminent danger (current GAF rating between 20 and 40) and whose normal functioning is good (past year GAF rating = 70). Previous repeated hospitalizations favor the choice of hospitalization over infusion. Its potential advantages are the rapid evolution of the condition, with controlled regression but without psychosocial withdrawal, and an improvement in the patient's attitude towards treatment.

The efficacy and safety of low doses of amisulpride (50 mg/day) and of fluoxetine (20 mg/day) were compared respectively in 139 and 129 outpatients with dysthymia during three months in a multi-centre double-blind trial. No statistically significant difference between the two groups was found in the number of responders at study-end with the Montgomery and Asberg Depressive Rating Scale, which was the main criterion for efficacy. In addition, amisulpride was well tolerated. These preliminary results suggest that low doses of amisulpride may be effective in the treatment of dysthymic patients.

The addition of a dose-escalated regimen of transdermal nicotine patches (TNP) improved tics of a non-smoker patient with Tourette's syndrome, whose tics did not respond to sulpiride. This improvement, as assessed by the Yale Global Tic Severity Scale, lasted for up to 8 weeks, but not 16 weeks. An explanation for the efficacy of TNP is presented.

This paper discusses the need for a health economics perspective and some of the central methodological issues raised by economic appraisals, including cost-effectiveness and cost-utility analyses. It illustrates how cost-effectiveness studies can inform policy and practice decisions concerning the treatment of schizophrenia, focusing on five generic evaluation questions commonly raised. Examples are drawn from recent and current UK research.

This study investigated the attitudes of medical students towards psychiatry, both as a subject on the medical curriculum and as a career choice. Three separate questionnaires previously validated on medical student populations were administered prior to and immediately following an 8-week clinical training programme. The results indicate that the perception of psychiatry was positive prior to clerkship and became even more so on completion of training. On completion of the clerkship, there was a rise in the proportion of students who indicated that they might choose a career in psychiatry. Attitudes toward psychiatry correlated positively with the psychiatry examination results. Those that intended to specialise in psychiatry achieved significantly higher examination scores in the psychiatry examination.

A 27 year-old man initially considered as a schizophrenic patient was later diagnosed as having Kleine-Levin syndrome.

The aim of this article is to describe the cognitive-behavioral methods for social rehabilitation and psychotherapy of chronic psychotic patients which are nowadays available in French-speaking countries, then to propose a theoretical framework to help integrate these various methods for use in our duly pratice and, finally, to expose our research in this field, especially concerning the topic of quality of life and social skills training programs. We present a study we designed in order to assess the impact of a comprehensive social skills training program upon quality of life of chronic schizophrenic patients. Starting from the point of view that a good psychosocial rehabilitation program is one that improves social skills and social functioning without negative effects on quality of life, we tried to show such qualities in a quite comprehensive rehabilitation program using social skills training methods corresponding to the social readaptative “modules” from Liberman and Wallace's Social and Independant Living Skills Program — “medication management module” — followed by “basic conversational skills module”, and finally, a brief adapted version of “interpersonal problem solving skills module”. We were able to observe the evolution of social skills and functioning of eight schizophrenic patients having benefited from this program, over a one year period, and we compared results regarding quality of life with two control groups made of schizophrenic patients, one of them having benefited from a supportive group therapy in order to study the impact of non-specific factors. The results indicate a clear dissociation between direct benefits of social skills training (knowledge, social skills, social functioning and symptomatology) which all showed a significant improvement in the experimental group, and subjective benefits (self-esteem, sense of self-efficacy, quality of life) which showed no change, as well when consider no intra-group as well as between group comparisons.

Among HIV patients treated for AIDS-related adjustment, major depressive disorders and other affective disorders, we assessed in an open study the feasibility of using a serotonergic antidepressant (fluvoxamine). Thirty-five seropositive patients with the above conditions (22 men and 13 women) were followed over a minimum period of four weeks. At the end of the treatment, a large number of patients (77%) showed marked improvement. “Nuclear” depressive and anxiety symptoms remitted, while the “somatic” ones seemed less sensitive to treatment. Treatment had to be terminated prematurely due to side effects in only two patients (6%).