Attempting an update of the epidemiology of schizophrenia, it is pointed out that schizophrenia seems to occur with the same core symptoms and almost at the same frequency in all countries and cultures studied. Methodologically sound studies have failed to produce evidence for a secular trend of the morbid risk. The genotype of schizophrenia is expressed as psychosis, personality disorders and non-specific disorders or it goes without manifest psychopathology. Minor brain anomalies are present in most cases. The British Child Development Study showed that behavioural, cognitive, emotional and neuromotor antecedents occur in 50% of cases, thus pointing to disordered brain development, very likely not specific to schizophrenia, since found in many other mental disorders as well. A look into the hidden early course of schizophrenia revealed a significant sex difference in age of onset and a prodromal phase of some 3 to 4 years throughout the cases. A case-control study showed that it is mainly during this early course before first admission that social disadvantage in schizophrenia arises. In the prephase a disease-related lack of social ascent plays a greater role than steps of social decline. The early social course differs between the sexes mainly due to an earlier onset of the disorder in males. The actual disease variables, that is, core symptoms and type of course, do not show any essential differences between males and females. These results indicate that schizophrenia is one of the rare uniform patterns of response of the brain, capable of being triggered by a large number of causes or favoured by non-specific risk factors. In this context the protective effect of estrogens will be discussed.

The course of negative and positive symptoms was studied in neuroleptic-treated patients over a 3-year period, in consideration also of the initial phase of illness (post-acute or chronic). This study was carried out in a broadly defined schizophrenic sample, in order not to give preference to one diagnostic subgroup over another. Forty-six patients were evaluated every year for 3 years, 23 in the post-acute group and 23 in the chronic group. Aggravations of the Clinical Global Impression (CGI) and of the SANS total score were observed, regardless of the group (chronic or post-acute). This global aggravation confirmed Kraepelin's concept of dementia praecox; moreover, this aggravation was not due to an increase in the number of patients relapsing, or to an aggravation of akinesia. Three types of negative and positive symptom courses were observed: i) the mean sub-scores of positive symptoms, such as hallucinations, delusions, positive formal thought disorders, and of negative symptoms such as flattening affect, avolition/apathy and attentional impairment, did not vary significantly over time in either group; ii) the mean sub-scores of bizarre behavior and alogia fluctuated over time (p < 0.05) and only poverty of speech was perfectly stable among the items constituting alogia; iii) the mean subscores of anhedonia/asociality worsened significantly over time irrespective of the groups (p < 0.05), and among the items constituting anhedonia, recreational interest-activities and intimacy-closeness abilities worsened (p < 0.05 and p < 0.01, respectively). This aggravation was neither due to an increase in neuroleptic doses nor to the duration and chronicity of illness. However, negative symptoms, except anhedonia, can be reversible in some patients. The very strong stability of anhedonia, whatever the group, emphasize the importance of taking anhedonia into account in future diagnostic classifications.

Three groups of 342 Greek, Iberian and Belgian psychiatric patients were compared, matched for sex, age, and time of hospitalization in a university hospital in Brussels. Schizophrenia, schizoaffective disorder/atypical psychosis were diagnosed more among immigrant patients. Somatic anxiety, loss of libido, delusions and hallucinations were symptoms that clinicians observed more in immigrant than in native patients. Atypical symptomatology and change of diagnosis were more likely to occur among immigrant patients. A higher proportion of second generation immigrant patients had a diagnosis of schizophrenia than either the first generation or the Belgians. Male immigrant patients were prescribed anxiolytic drugs more frequently than male natives, but were less likely to be referred to psychotherapy. The authors query whether these findings derive from specificities in the use of psychiatric services and/or from biases in clinicians'attitudes towards patients of different ethnic origin.

The Composite International Diagnostic Interview (CIDI) was used to assess the prevalence of psychiatric disorders in a French population of 46 inpatients with diabetes mellitus. According to DSM-III-R criteria, 52.2% of subjects presented at least one psychiatric diagnosis in their lifetime and 41.3% did so less than six months before the study. Affective and anxiety disorders represented at least 83% of the psychiatric diagnoses. The risk for those disorders seems to be restricted to a predisposed group as only one of the 16 subjects who had suffered from an anxiety or depressive episode within the previous six months had never experienced such an episode before.

Borna disease virus (BDV) appears to cause meningoencephalitis and schizophreniform psychosis in sporadic cases according to earlier cerebrospinal fluid (CSF) inoculation experiments (Rott et al, 1991). However, CSF parameters in BDV seropositive psychiatric patients proved nearly all normal; only the most sensitive CSF/serum index I-BDV for intrathecally produced BDV specific IgG was pathologic in 10.5–29.0% (according to different methodological limits) of patients. An increase in sensitivity was attempted to detect specific IgG in CSF in a part of the cases by concentration. Concentration procedure does not significantly increase methodological bias according to a statistical analysis of the results. Our findings support the hypothesis that BDV may cause or contribute to the pathogenesis of a diagnostically broad pattern of psychiatric syndromes. The occurence of a spectrum of diagnoses is expected from non-specificity of psychiatric symptoms in other infectious diseases of the brain as well as from results in experimental Borna disease (BD) in animals, when a majority of the animals showed rather unspecific symptomatology due to slight, preferentially limbic encephalitis. Slight deficiencies from an earlier BDV infection could explain continuing symptoms in a part of the cases. Recurrences years after infection are well known in experimental and natural BD in animals. It remains open, whether this mechanism could play a more prominent role in a form of “symptomatic” cyclothymia and “symptomatic” schizophrenia, although the results of CSF investigations are more clear in BDV seropositive patients with major psychoses.

In an open prospective study, the stabilizing effects of carbamazepine on agitation, impulsivity and affective lability were investigated in 15 severely demented patients, who had failed to respond to prior neuroleptic medication. Because of leukopenia and allergic reactions in two subjects, carbamazepine treatment was discontinued. In nine patients a clinically relevant improvement was observed.

Two cases of sexual addiction for more than five years treated with psychological treatment and clomipramine showed marked improvement after six to nine months. It is postulated that these disorders could be variants of obsessive compulsive disorder.

A patient with multiple psychosomatic disorder developed a steroid induced rare bipolar mood disorder (both mania and depression). The “unmasking effect” of steroids and a positive family history of psychiatric disorder as a possible risk factor, hitherto undocumented, is suggested in steroid induced psychosis.