The Phobic Attitude Scale (PAS) is a new 15-item inventory designed to assess sub-clinical agoraphobic attitudes as well as the severity of pathological avoidance. Its psychometric properties have been examined in three groups of subjects: 41 outpatients suffering from DSM III-R Panic Disorder, with or without agoraphobia, 62 healthy controls and 12 mixed psychiatric patients.The instrument proved to be simple and easy to use. PD patients scored significantly higher than healthy controls, with mixed psychiatric cases showing intermediate values. The Test-Retest procedure gave rise to satisfactory kappa coefficients (0.25 to 1) and the internal consistency was good (Cronbach alpha = 0.86). Factor analysis produced three factors: “crowded and social situations”,“enclosed and open spaces/riding situations” and “simple phobia”.

This case note sludy examined the clinical features and outcome of 30 patients with dysmorphophohia (perhaps (he largest series so far) who had behavioural (exposure) therapy. Method: The clinical Features and treatment outcome on standard contemporary measures were reviewed. Results: All palienls had social avoidance and dysmorphophohia, with abnormal beliefs, often of delusional intensity. For up lo 1-12 months follow-up after exposure, most patients improved in avoidance, work and social adjustment, and in beliefs even if these had initially been delusional. Gains were less than after exposure therapy for non-dysmorphophobic problems such as agoraphobia, specific phobia, social phobia and obsessive-compulsive disorder (OCT)). Conclusions: The importance of separating delusional from delusional dysmorphophohia can be questioned. Exposure therapy appeared useful for dysmorphophohia, but this must be confirmed in a controlled trial and in patients who attend dermatology, plastic surgery and general psychiatric clinics.

The authors investigated the relationship between personality dimensions and 35% CO2, reactivity. Fifty-one patients with PD and 26 healthy controls were assessed by the Tridimensional Personality Questionnaire and inhaled one-vital capacity of a gas mixture of 35% CO2, and 65%; 02. PD patients showed stronger reactivity to 35%. CO2, and higher scores on Harm Avoidance personality dimension. No significant relationship between reactivity to 35% CO2, and Harm Avoidance, Novelty Seeking and Reward Dependence personality dimensions were found in PD patients or controls. These results suggest that the reactivity to 35% CO2, might not be related to personality.

Psychiatric morbidity was assessed in 55 HIV seropositive women who were attending either an HIV centre in Paris (n = 30) or a genitourinary clinic in London (n = 25). Demographic data and information concerning HIV disease, openness about diagnosis, counselling received, social and family support, sexual behaviour and attitudes towards fertility and pregnancy were recorded using a semi-structured interview. Moderate or severe levels of psychiatric distress were found in 60% of the women in Paris and 28% of those in London. Overall, these rates are higher than those found in comparable studies of HIV seropositive men. Psychiatric disorder was associated with a past history of intravenous drug use and older age. Over half of the women were in regular sexual relationships but safe sex precautions were frequently not used. Sixteen subjects among those of child bearing age were prepared to consider having children.

In recent years an enhanced catabolism of serine, with or without the existence of porphyria, has been demonstrated in relation to a specific subtype of psychosis, according to ICD-10 criteria, the acute polymorphic psychosis with or without symptoms of schizophrenia. Since sensory perceptual distortions play a key role in the symptomatology, patients with this disorder are referred to as Acute Polymorphic Psychosis plus psychosensory phenomena (APP+). In a retrospective study, including a total of 140 chronic psychiatric patients, we investigated the prevalence of Acute Intermittent Porphyria (AIP) and APP+. No subjects with AIP were found. In two patients APP+ could be demonstrated, based on both clinical characteristics and positive biochemical markers, ie lowered plasma serine concentration and increased TSM-ratio (100 × Taurine (μmol/l)/Serine concentration * Methionine concentration). In three patients the psychotic disorder was suspected to be present. It is concluded that careful psychiatric diagnosing may reveal specific psychotic disorders with a distinct biological pathogenetic factor, ie a disturbed serine metabolism.

Cognitive impairment in long-term high-dose diazepam abusers (dose > 30 mg diazepam/day; duration of abuse > 12 months) was examined by administering four memory-related tests and comparing the outcomes with those of matched controls. Deficits were found in spatial and visual learning, spatial and visual short-term memory (STM) as well as for spatial and visual long-term memory (LTM). As for verbal aspects of memory, solely the acquisition of novel verbal material (verbal learning) was impaired, Furthermore, deficits in a concentration task were observed. In chronic abuse the established memory deficits are similar to cognitive impairment after single doses. Relaxing or anxiety-reducing effects of diazepam were no longer present. The results of this experimental study demonstrate the risks of diazepam use beyond therapeutic range.

Four pregnancies in three panic disorder patients are described. In three pregnancies panic symptoms improved initially, but worsened in the second half. One patient developed panic disorder in the second half of her pregnancy. Changes in balance between progesterone and estrogen could explain this clinical course.

Suicide rates were found to decline during the major world wars of this century in both men and women and in both participating and non-participating nations. The increase in suicide rates after the conclusion of the wars, however, was not as pronounced.

In May 1992 the German Council of Physicians decided that in the future there will no longer be a specialist in psychiatry, but, only a specialist in psychiatry and psychotherapy. This decision has enormous consequences for the psychiatric training of residents specializing in the field in Germany. Psychotherapy is now an integral part of psychiatry and must be completely included in training programs. The period of advanced training in the future will encompass five years instead of four years. The future curriculum for psychiatrists is far more structured and includes many more regulations than was formerly the case. The specialist in the field must acquire equal competence on the somatic, social-psychiatric, psychopathological and psychotherapeutic levels, followed by their subsequent integration into diagnosis and therapy. Practical experience in psychotherapy must be acquired in both a primary and secondary method. The only methods capable of recognition as the primary method are psychodynamic psychotherapy and behaviour-cognitive therapy. The secondary method will be restricted to psychodynamic psychotherapy, behaviour-cognitive therapy and client-centered therapy. The principle aim of the new specialist physician regulations in Germany is to achieve a multi-dimensional approach to the diagnoses and treatment of psychiatric disorders corresponding to the complex nature of psychiatric illness.