Psychiatric diagnoses provide short labels for diseases or discrete symptom clusters. They should designate the same throughout the world, give information about course, outcome and indications for therapy as well as provide an heuristic basis for etiological research. Hence, the core question is how to attain an optimal representation of real morbidity in diagnosis, sets of diagnostic criteria and diagnostic classifications. Clinical observation can be improved considerably by multi-centre field trials, as applied in the preparation of ICD-10 and DSM-IV. But the approach has considerable limitations due to a lack of external measures in many psychiatric disorders and a highly limited representation of many diagnostic groups in clinical populations. Therefore, epidemiological methods are required in validating diagnosis and diagnostic criteria. The simplest way is to supplement clinical multicentre diagnostic studies by general-practice studies, but these, also, cannot fully replace population studies. Operational diagnosis and case criteria can be defined either categorically or dimensionally. Most of the categorical diagnoses in ICD-10 or DSM III also include dimensional characteristics. The impact of various diagnostic criteria, particularly cut-offs of dimensional characteristics, on the assignment of a diagnosis and, thus, on the morbidity figures of a diagnostic category is demonstrated by data from a large representative sample of first-admitted schizophrenics. Attempts at etiological validation by methods of genetic epidemiology provide limited support for Kraepelin's dichotomous model of functional psychoses. Validation by epidemiological course studies has shown that the stability of diagnosis in functional psychoses differs according to the sets of diagnostic criteria of different classification systems.

Patients suffering from various subtypes of dysthymia were compared with regard to demographic, clinical and personality characteristics. Patients with secondary dysthymia, as compared to those with primary dysthymia, had an earlier age of onset and a higher frequency of Axis I co-diagnoses (in particular anxiety disorders). Patients with pure dysthymia, as compared to those with double depression, showed an earlier age of onset of Axis I co-diagnoses, a later age of onset of dysthymic disorder and a shorter duration of the disease.

The purpose of the present study was to examine the prevalence of symptoms of anxiety and depression reported by high-school students of a Greek provincial town. One thousand and eighty students (587 males and 497 females) of the 10th, 11th, and 12th grades completed among other psychometric instruments, the DSSI/sAD (Delusions Symptoms States Inventory/states of Anxiety and Depression) an inventory measuring symptoms of anxiety and depression. On the anxiety scale 24.5% of males and 56.4% of the females reported scores above the cut-off point, whereas 10.3% of males and 30.9% of females were very high scorers. On the depression scale, 33.4% of males and 60.6% of females reported scores above the cut-off point, whereas 13.9% of the boys and 31.1% of girls reported very high scores. Both boys and girls reported more elevated scores on the depression scale but the sex differences were more pronounced on the anxiety scale particularly in the group of high scorers. A weak positive relationship between age and dysthymic symptoms was detected in females. The findings encourage discussion on topics regarding not only the prevalence of anxiety and depressive symptoms in adolescence, but also the gender differences detected, the relationship between age and mood disorders in adolescence, the degree of diagnostic certainty of the self-report instrument used and the possible meaning of the low, medium, and high scores reported by the participants. It is proposed that data of this kind may be of some value in future comparative studies regarding small European cities.

The presence of affective symptoms in panic disorder has often been reported. Data from The Cross-National Collaborative Panic Study (second phase) were analysed to address the role of dysthymia in panic disorder with respect to previous illness, current psychopathology and the outcome during an 8-week study of alprazolam and imipramine. A group of dysthymic patients without current or past major depressive episode was studied. The prevalences of dysthymia varied markedly across participating sites: 2–13%. Only a few clinical characteristics of dysthymic panic disorder patients were found. They had suffered from panic disorder for a few years more than patients without affective disorder and they were slightly older. The outcome after the 8-week drug trial was not significantly different from that of patients without affective disorder. Hence, dysthymia was not suggested to be of major clinical relevance for the phenomenology of panic disorder or for the outcome of drug treatment.

We calculated Morbidity Risks (MR%) for the major psychiatric conditions in the families of three groups of patients, affected by Eating Disorders (ED; n = 41), Obsessive Compulsive Disorder (OCD; n = 70) and Mood Disorders (MD; n = 39). Our aim was to verify the hypothesis of a common familial pattern of aggregation. Familial risk of developing OCD was significantly increased in the families of OCD probands. Homotypic cases were also augmented in ED and MD families with respect to the rates of the general population, although without statistical significance in the crosswise comparisons. These results confirm the existence of a genetic susceptibility to the development of OCD.

The main symptoms of Gilles de la Tourette syndrome (GTS) are motor and vocal tics, but there are also several psychiatric disturbances such as obsessive compulsive symptoms (OCD) and mutilations. The etiology and pathophysiology of this basal ganglia disorder are unknown. Though many patients benefit from therapy with dopamine antagonists, the effect is often insufficient. Therapeutic efficacy of the opiate antagonist naltrexone has been described in recent years. Ten patients (three f, seven m) with GTS were invesitgated in a seven-week, open dose-response trial, using naltrexone in doses ranging from 12.5 mg to 200 mg/day. The severity of the GTS symptoms were rated with the Yale Global Tic Severity Scale (YGTSS) and the Tourette Syndrome Global Scale (TSGS); OCD was estimated by the Maudsley Obsessive Compulsive Inventory (MOCI). The course of tics and psychopathology was assessed by three self-report scales, and two scales rated by clinicians (Clinical Global Impression, CGI; Brief Psychiatric Rating Scale, BPRS). Only two patients showed improvement of the GTS. In four patients, no effect was observed, whereas the other four patients exhibited deterioration. One patient finished the complete trial, three patients dropped out because of lack of improvement, and four because of deterioration of the symptoms. Considering the mean values, no improvement of GTS could therefore be observed, and because of the unpredictable effect, the study was stopped after ten patients. Nevertheless, the effects were quite controversial. The opiate system seems to be affected only in some of the GTS patients in a clinically relevant manner, and opiate antogonists can either improve or provoke GTS symptoms. Pathophysiologically different subgroups of GTS may contribute to the controversal results.

Family rituals consisting of ceremonial acts, traditions and patterned interactions serve as a basis of communication, collective identity, and stabilizing relationships. Therefore, the measurement of rituals in a schizophrenic family is an objectification of the family's symbolic communication and integration. Based upon this, the relationship between family rituals practice in 138 families both with a schizophrenic member (71) and without (67) was examined by the use of an originally developed instrument, the “Family Rituals Scale” (FRS). The psychometric properties of this instrument were tested and proved to be reliable. Families with a schizophrenic member were less ritualizing than the “normal” families. The correlation between FRS scores and Global Assessment Scale scores in schizophrenic patients was negative (the higher the psychosocial functioning level, the lower FRS scores), which means a higher performance of family rituals. The effect of other factors on FRS scores and the therapeutic implications are discussed.

A 56 year-old man who presented with symptoms and signs of dementia was later diagnosed as having nasopharyngeal carcinoma.