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Background The frequent occurrence of obsessive–compulsive symptoms (OCS) in the course of schizophrenia and their impact on the functional outcome of the illness underlie the suggestion that the presence of OCS represents a separate subtype of schizophrenia, with a distinct clinical presentation and prognosis and specific neurobiological characteristics. This study investigated whether the presence of OCS in schizophrenia is associated with worse cognitive functioning in the domains of processing speed, executive functions and visuospatial memory. We also explored whether the degree of impairment in any of these cognitive domains could predict group membership (i.e. Schizophrenia with OCS [Sch-OCS] and Schizophrenia without OCS) and if there was a relationship between cognitive functioning and severity of OCS within the Sch-OCS group. Methods Forty patients with schizophrenia, 20 with and 20 without OCS, individually matched for age, gender, years of education and severity of psychotic symptoms and 20 healthy controls underwent a comprehensive neuropsychological assessment. Results Only lower performance in processing speed discriminated patients with OCS from patients without OCS. Processing speed impairment not only classified patients in OCS or non-OCS group but was also independent of the severity of OCS symptoms. Conclusions The notion of additive effects of both schizophrenia and OCD on the structural and functional integrity of the brain circuits that support cognitive functions warrants further investigation in longitudinal neuropsychological and neuroimaging studies with larger samples and sufficient variation in the severity of OCS.

Public mental health incorporates a number of strategies from mental well-being promotion to primary prevention and other forms of prevention. There is considerable evidence in the literature to suggest that early interventions and public education can work well for reducing psychiatric morbidity and resulting burden of disease. Educational strategies need to focus on individual, societal and environmental aspects. Targeted interventions at individuals will also need to focus on the whole population. A nested approach with the individual at the heart of it surrounded by family surrounded by society at large is the most suitable way to approach this. This Guidance should be read along with the European Psychiatric Association (EPA) Guidance on Prevention. Those at risk of developing psychiatric disorders also require adequate interventions as well as those who may have already developed illness. However, on the model of triage, mental health and well-being promotion need to be prioritized to ensure that, with the limited resources available, these activities do not get forgotten. One possibility is to have separate programmes for addressing concerns of a particular population group, another that is relevant for the broader general population. Mental health promotion as a concept is important and this will allow prevention of some psychiatric disorders and, by improving coping strategies, is likely to reduce the burden and stress induced by mental illness.

Psychiatry for the Person represents an initiative to place the whole person of the patient at the center of mental health care. Its aims are highlighted by the promotion of a psychiatry of the person (of the totality of the person’s health, including its ill and positive aspects), for the person (assisting the fulfillment of each person’s life project), by the person (with clinicians extending themselves as full human beings, scientifically grounded, and with high ethical aspirations), and with the person (in respectful and empowering collaboration with the person presenting for care). The person is conceived of in a contextualized manner, in line with the words of Ortega y Gasset, I am I and my circumstance.

Background Although maternity blues have been studied in many countries worldwide the factors that influence the occurrence of this clinical entity are not well understood. The purpose of this study was to investigate the prevalence, time course and symptomatology of maternity blues in a Greek urban environment as well as the relation of maternity blues with certain clinical and sociodemographic factors. Method A study of a sample of 402 women that were recruited during the first day after delivery. Each woman completed the Kennerley's Blues Questionnaire on a daily basis for the first 3 days of puerpartum. Clinical and sociodemographic data were obtained through questionnaires and personal interview. Results 179 (44.5%) women experienced severe maternity blues during the first 3 days after delivery. Delivery by caesarian section ( P = 0.006), stressful events during pregnancy ( P = 0.02), depressive feelings the last month prior to delivery( P = 0.002), anxiety on the day of delivery ( P = 0.001) and hypochondriasis ( P = 0.001) were the factors that were found to relate significantly to maternity blues. Conclusion The women's emotional condition prior and after delivery, delivery via caesarotomy, as well as fears concerning somatic health had strong impact on the occurrence of maternity blues.

Factors related to occupational rehabilitation of 40 psychiatric patients (and a subgroup of 30 schizophrenic patients) hospitalized at the Day Hospital of Athens' University Department of Psychiatry were studied. Rehabilitation was negatively associated to a statistically significant degree with: chronicity of illness, time spent in unemployment, and male sex. Time spent in unemployment was also negatively related to rehabilitation at the previous employment setting. More women than men were rehabilitated. Duration of illness and duration of present hospitalization were longer for men, commitment to the hospital's daily schedule was stronger for women, and male patients had more absences from treatment sessions in comparison to female patients.

The effect of lithium on the histochemistry of blood granulocytes was studied in 16 manic-depressive patients during lithium prophylaxis. Blood smears obtained before, at 2 months and at 12 months after initiation of treatment showed that lithium caused condensation of the chromatin in granulocytes, conformation changes in eosinophilic granules and the disappearance of basic proteins found in the cytoplasm of eosinophils in the drug-free patients. The latter findings are interpreted as indicating the involvement of lithium in histamine metabolism.

Psychotic depression is a clinical subtype of major depressive disorder in the recent editions of the psychiatric diagnostic systems ICD-10 (1992) and DSM-IV (1994). Recent evidence suggests that psychotic depressed patients are more impaired on neuropsychologic tests measuring attention as compared to nonpsychotic depressed patients. However, information on this issue between psychotic and nonpsychotic depression is limited. It has become clear that attention is not a single concept; thus we studied both selective and sustained attention using the theoretic model of automatic and controlled information processing. Thirty-two patients with major depressive disorder, 16 psychotics and 16 nonpsychotics, were investigated and compared with 20 patients with schizophrenic disorder and 20 healthy volunteers who comprised the control groups, using Ruff's 2 and 7 selective attention tests. Compared to the healthy controls, both depressed groups were impaired; however, the psychotic depressed group was more severely impaired on both measures. Attentional performance speed and accuracy scores, on both effortless and effortful conditions, were significantly lower in the psychotic depressed group than in the nonpsychotic depressed group. No significant differences were found on attentional performance between the psychotic depressed patients and those with schizophrenic disorder. Attention deficits are thus more prominent in psychotic than in nonpsychotic depression. Furthermore, taking attention as a criterion, psychotic depression, although of mood congruent subtype, lies closer to schizophrenia than to nonpsychotic depression.

Objective: Schizophrenia has been associated with a high rate of suicide. This study investigates the prevalence of suicidal ideation in a population of inpatients with acute schizophrenia, together with the clinical parameters associated with suicidal thoughts. Method: We assessed 93 schizophrenia patients. We matched subjects for age and sex and compared subjects with and without suicidal thoughts. We performed stepwise multiple regression analysis to assess the association between specific clinical symptoms and suicidal ideation. Results: Of the patients, 20.4% reported suicidal thoughts during the last 15 days. Severity of depressive symptoms, motor retardation, guilt feelings, pathological guilt, and self-depreciation predicted the patients' suicidal ideation. Conclusions: Suicidal thoughts are frequent among inpatients with acute schizophrenia. Prevention of suicidal behaviour should include helping patients improve their self-esteem and reducing depression and guilt feelings.

Relationships between Cloninger's temperament and character dimensions and plasma sex hormone levels and biogenic amine turnover were studied in male prison inmates convicted of rape (n=61) or child molestation (n=24) and normal male controls (n=25). The participants completed the Temperament and Character Inventory (TCI), which includes the temperament dimensions Novelty Seeking, Harm Avoidance, Reward Dependence and Persistence as well as the character dimensions Self-Directedness, Cooperativeness and Self-Transcendence. Plasma levels of testosterone, dihydrotestosterone, sex hormone binding globulin, luteinizing hormone (LH) and follicle-stimulating hormone were estimated in plasma samples and 5-hydroxyindoleacetic acid (5-HIAA), homovanillic acid (HVA), and 3-methoxy-4-hydroxyphenylglycol (MHPG) in urine samples. Both sex offender groups had higher Novelty, Seeking and lower Reward Dependence, Self-Directedness and Cooperativeness scores compared with the controls. Plasma levels of testosterone and dihydrotestosterone were significantly higher in rapists than in controls. Novelty Seeking scores were positively correlated with LH levels in rapists, and with testosterone levels in child molesters. Harm Avoidance scores were negatively correlated with 5-HIAA levels in rapists and with HVA levels in child molesters. In rapists, the calculated free androgen index showed a negative correlation with 5-HIAA. For the sex offender sample as a whole, the subgroup with high testosterone levels had higher Harm Avoidance scores, the subgroup with low HVA levels had lower Cooperativeness scores, and the subgroups with high 5HIAA or MHPG levels had lower Persistence scores. The results indicate that Novelty Seeking behavior in the group of rapists is associated with a hyperactive hypothalamic-pituitary-gonadal axis. In addition, low serotonin turnover and low dopamine turnover seem to be associated with a passive-avoidant behavioral style in rapists and child molesters, respectively.

Background Depression is associated with an increase in cardiovascular disease, but the underlying mechanisms are not well understood. The aim of this study was to examine the associations of depressive symptoms with inflammation and coagulation factors related to cardiovascular risk in persons free of cardiovascular disease. Methods A random algorithm was developed and stratified by gender–age and multistage sampling was performed during 2001–2002. In this study, we analysed data from 453 men (19–89 years old) and 400 women (18–84 years old). Inflammation markers were C-reactive protein (CRP), serum amyloid A, white blood cell (WBC) and total platelet counts; and coagulation factors including homocysteine and fibrinogen. Depression was assessed with the Zung Self-Rating Depression Scale (ZDRS range 0–100) after validation for the study population. A ZDRS score of 50 or more classified a person as mildly depressive. Statistical adjustments were made for risk factors (age, gender, smoking, diabetes mellitus, and physical activity level). Results Women had significantly higher scores on the Zung depression scale than men (47±9 vs. 43±10, \batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} \(p{

The aim of the present study was to assess androgen plasma levels and biogenic amine metabolites in a sex-offender group as well as to investigate the relationship between the biological findings and the impulsive, aggressive, and suicidal profile of the offenders. Fifty-seven males convicted for rape and 25 normal males comprised the study sample. We found that although both testosterone levels and aggression-impulsivity scores were higher in the group of rapists, testosterone levels were not associated with the aggression and impulsivity scores. Nevertheless, aggression-impulsivity scores were clearly associated with luteinizing hormone levels. This association may indicate a hyperactive hypothalamic-pituitary-gonadal axis, possibly the result of a reduced serotonergic activity.

Risperidone is a novel and atypical agent with a dual antagonistic effect on 5-HT and D receptors. Open-label reports and one controlled study suggest that risperidone addition is effective in patients with obsessive-compulsive disorder refractory to treatment with serotonin reuptake inhibitors. However, risperidone has also been implicated in the production or exacerbation of obsessive-compulsive symptoms. We report six cases (schizophrenia, five cases; psychotic depression, one case) in which risperidone was effective in the treatment of the psychotic symptoms but produced obsessive-compulsive symptoms (four cases) or caused exacerbation of previous obsessive-compulsive symptoms (two cases). In all but one case, obsessive-compulsive symptoms emerged shortly after initiation of risperidone treatment with a dose above 3 mg/day. The mechanisms and risk factors for risperidone and other atypical antipsychotics to induce or exacerbate obsessive-compulsive symptoms are as yet not clear. Risperidone-induced obsessive-compulsive symptoms appear to be dose-dependent and are probably produced by serotoninergic-dopaminergic imbalance. Close monitoring of the patients receiving risperidone, especially those vulnerable to the development of obsessive-compulsive symptoms, may be of value. Gradual escalation and low final dose may be helpful.(2) (2)

Atypical neuroleptics share a common feature, showing higher affinity for 5-HT2 receptors than for D2 dopamine receptors, but show considerable differences in their clinical and pharmacological properties. In clinical doses, they occupy serotonergic receptors near saturation, but show considerable differences regarding the D2 receptor occupancies, with clozapine showing the lowest degree of occupation. We assessed serotonergic and dopaminergic receptor responsivities in two groups of male schizophrenic patients, one treated with the atypical neuroleptic clozapine (14 patients, doses 200–600 mg/d) and the other treated with olanzapine (11 patients, doses 10–30 mg/d). We measured the prolactin responses to the acute administration of a serotonergic drug, clomipramine, and a dopaminergic one, haloperidol. Tests were first performed in the drug-free state, and were repeated after the patients had been treated with stable doses of either drug for six weeks. Clomipramine administration induced significant increases of prolactin in the drug-free state. These responses were eliminated after treatment of the patients with either drug, thereby indicating a high 5-HT receptor occupancy by both clozapine and olanzapine. The prolactin responses to haloperidol were not altered after treatment with clozapine, but were significantly reduced after the olanzapine treatment. The baseline prolactin levels were not influenced by clozapine treatment, and were moderately but significantly increased after treatment with olanzapine. The results indicate that there is a difference between the two drugs in their capacity to block dopamine receptors at the hypothalamus–pituitary level, and match the results obtained by SPECT receptor binding studies for striatal dopamine receptors.

Background: It has been established that depressed patients manifest a higher risk of committing suicide. The role of delusional experiences accompanying depressive symptomatology as a risk factor for suicidal behaviour has been investigated but the results are inconsistent. Method: In the present study, 40 elderly depressed inpatients with psychotic features (DSM-IV criteria) were compared to 64 elderly depressed patients without such features in terms of suicide attempts. Results: The results of univariate and multivariate analyses were negative: Psychotic and nonpsychotic depressed patients did not differ with respect to attempted suicide. Conclusion: The results of the present study support the notion that psychotic features do not increase the risk for the elderly depressed patients to attempt suicide.

Vitamin B(12) and folate deficiency is often associated with affective disorders mainly of the depressive type. We report a case of a 42-year-old woman with a mood disorder with mixed depressed/manic features that was due to vitamin B(12) and folate deficiency. The psychopathology developed over a five-year period without hematologic or other overt clinical characteristics of pernicious anemia. Replacement treatment with vitamin B(12) and folate was rapidly followed by full clinical remission, electroencephalographic normalization and neuropsychological improvement. At a one-year follow-up this condition was stable. Consequently, patients who respond poorly to psychopharmacologic treatment and/or present with atypical mood symptoms would warrant determination of vitamin B(12) and folate serum levels.

A key challenge for person-centred psychiatry is to combine the generalised findings of objective science with responsiveness to the diverse values of each individual patient. There are two main ethical resources for responding to this challenge, substantive and analytic

An Erratum has been published for this article in International Journal of Geriatric Psychiatry 16(11) 2001, 1085–1091. Background Psychotic (delusional) major depression (PMD) in the elderly is a common condition in inpatient settings. There is evidence that late age onset depressives are more likely to be psychotic. Objectives The aim of this study was to investigate the frequency, sociodemographic, and clinical characteristics of PMD in hospitalized elderly depressives. Methods The sample consisted of 118 elderly patients consecutively admitted at three different clinics. All patients fulfilled DSM-IV criteria for major depression disorder and were diagnosed on the basis of Structured Clinical Interview for DSM-IV (SCID). The subjects were also assessed using the Hamilton Rating Scale for Depression, the Mini Mental State Examination (MMSE) and a physical health rating scale. Results PMD was positively associated with age of onset of depression. The PMD patients were also more severely depressed, more psychomotorically retarded and referred more past psychotic depressive episodes. Furthermore, age at onset influenced the type of delusions, so that PMD patients with aged over 60 at onset expressed delusions of hypochondriacal and nihilistic content more frequently. Conclusions The results of our study demonstrated that PMD in the elderly has a later age at onset. Copyright © 2001 John Wiley & Sons, Ltd.

There is some evidence that repetitive transcranial magnetic stimulation (rTMS) may be effective in treating depression. Using an intensive methodology of rTMS in two drug-resistant patients, we observed a good antidepressant effect, but also, induction of manic symptoms.

The authors followed 32 delusional and 41 unipolar non-delusional depressed patients 6 years after hospital discharge. Long-term outcome, as determined by the frequency of the relapses, number of hospitalizations, chronic course of illness as well as clinical status and global functioning at the end of the 6-year period, failed to differentiate the two patient groups. Discontinuation of maintenance medication in both groups or of antipsychotics in the delusional group was associated with a high rate of relapses. Our findings indicate that delusional depression has a similar clinical course to that of non-delusional depression, underline the importance of psychoprophylactic treatment and question the efficacy of monotherapy with antidepressants in the prevention of relapses of delusional depression.

The trend towards the establishment of community psychiatric services seems to be universal. However, before closing down a mental hospital, it is necessary to establish the appropriate alternative facilities in the community. Every de-institutionalization program should have a diachronic component, and cultural issues should be taken into consideration. Care for each patient has to be decided upon on the basis of the characteristics of that patient. Finally, de-institutionalization is just one aspect of psychiatric reform. Primary psychiatric prevention is equally or even more important.

The delusional misidentification syndromes (Capgras’ syndrome, Fregoli syndrome, intermetamorphosis syndrome, syndrome of subjective doubles) are rare psychopathologic phenomena that occur primarily in the setting of schizophrenic illness, affective disorder, and organic illness. They are grouped together because they often co-occur and interchange, and their basic theme is the concept of the double (sosie). They are distinguished as hypoidentifications (Capgras’ syndrome) and hyperidentifications (the other three syndromes). In this review, we present the basic hypotheses that have been put forward to explain these syndromes and propose that the appearance of these syndromes must alert physicians to investigate the existence of possible organic contributions.

Early interventions aiming at prevention from future psychopathology are critically evaluated. These interventions include: genetic psychiatric counselling, family planning, improvement of the physical health of the population, prenatal care, intervention in childhood, improvement of the physical health of the child, improvement of the home environment and improvement of the school environment. Although concrete evidence about the effectiveness of many of the above methods is lacking, they are nevertheless worth applying because on an individual basis they often contribute to the alleviation of human suffering. It is pointed out that early preventive interventions are particularly indicated in predisposed individuals (e.g. persons with hereditary predisposition for schizophrenia who must be protected from perinatal complications in order to be prevented from future development of this illness) or high-risk groups (e.g. the siblings of 'battered' children who have a greater probability of being abused by their parents, or 'battered' children who, when becoming parents, have a raised probability of abusing their own children).

Background The aim of the current study is to investigate the relationship between physical anhedonia and psychopathological parameters, pharmacological parameters or motor side-effects in a sample of inpatients with schizophrenia in an acute episode of their illness. Method Eighty one patients with schizophrenia, consecutively admitted, with an acute episode of their illness, at the Eginition Hospital, Department of Psychiatry, University of Athens, during a one-year period were investigated regarding possible relationships between physical anhedonia, social-demographic data and clinical parameters as well as motor side-effects, induced by antipsychotic agents. All patients were assessed using the Chapman Revised Physical Anhedonia Scale (RPAS), the Positive and Negative Syndrome Scale (PANSS), the Rating Scale for Extrapyramidal Side-Effects (EPSE), the Barnes Akathisia Rating Scale (BARS) and the Abnormal Involuntary Movement Scale (AIMS). Simple cross tabulations were initially employed. Subsequently, multiple regression analysis was performed. Results Both positive and negative symptoms were associated with physical anhedonia. A positive association between physical anhedonia and the non-paranoid sub-category of schizophrenia was also proved. Conclusion According to these results, it seems that in the acute phase of schizophrenia, physical anhedonia may be a contributing factor to patient's psychopathology.

BackgroundPatients with psychosis have activation of the hypothalamic-pituitary-adrenal (HPA) axis during the acute phase of the psychosis. Whether this has any morphological consequences for the pituitary gland is currently unknown.AimsTo examine pituitary volume variation in people at different stages of psychotic disorder.MethodPituitary volume was measured using 1.5 mm, coronal magnetic resonance images in 24 people with first-episode psychosis, 51 with established schizophrenia and 59 healthy controls.ResultsCompared with the control group, the people with first-episode psychosis had pituitary volumes that were 10% larger, whereas those with established schizophrenia had pituitary volumes that were 17% smaller. In both of the groups with psychosis, there was no difference in pituitary volume between those receiving typical antipsychotic drugs and those receiving atypical antipsychotics.ConclusionsThe first episode of a psychosis is associated with a larger pituitary volume, which we suggest is due to activation of the HPA axis. The smaller pituitary volume in the group with established schizophrenia could be the consequence of repeated episodes of HPA axis hyperactivity.

The rapid cycling (RC) pattern of a mood disorder is characterized by at least four affective episodes (manic, hypomanic or major depressive) during the last year; different episodes must be demarcated by a switch to an episode of opposite polarity or by a period of remission of at least 2 months. RC is very rare in unipolar patients; its prevalence, however, in bipolar patients is 10-30% with the majority being women (70-90%). Patients with RC usually suffer from bipolar II disorder with onset with a depressive episode. Genetic studies have not convincingly shown that the condition is genetically determined. Major abnormalities of thyroid function have not been shown to be related to RC, but recent studies propose that latent subclinical hypothyroidism might play a role in the acceleration of cycles. Perturbations of the circadian biological and social rhythms might influence the expression of RC. No major effect of the menstrual cycle has been found. Despite the absence of firm empirical data, the possible contribution of the kindling phenomenon on the acceleration of cycles cannot be excluded. Finally, there is evidence that RC can be induced by the use of antidepressant drugs, especially for women.

Disaster research related to earthquakes has almost exclusively dealt with their long-term psychosocial impact; besides, diagnoses were previously based only on DSM criteria. Therefore, it is pertinent to assess stress-related reactions of earthquake victims during the early post-disaster period through the application of ICD-10 criteria. For the first 3 weeks following an earthquake, 102 help-seekers were assessed based on a checklist of sociodemographic variables and a semi-structured interview for the detection of acute stress reaction (ASR) and posttraumatic stress disorder (PTSD) according to ICD-10. Forty-four subjects (43%) fulfilled the ICD-10 criteria for PTSD; all but one of them had suffered ASR. Moreover, among a series of potential predictors for PTSD, ASR was found to be the only significant one; this indicates a definite association between ASR and early development of PTSD. Logistic regression to predict group membership (PTSD/no PTSD) based on specific ASR symptoms showed that accelerated heart rate and feelings of derealization were the only significant predictors for early PTSD. Individuals who fulfill the ICD-10 diagnostic criteria for ASR following an earthquake are at high risk for subsequent occurrence of early PTSD. Increased heart rate and feelings of derealization within the first 48 h after the traumatic event appear to be the principal factors associated with the development of early PTSD. In addition to their potential value for timely prevention and treatment, these findings raise important nosological issues pertaining to the current diagnostic classification of stress-related disorders (ICD-10 versus DSM-IV).

This is the first report of two partners in a folie à deux situation manifesting identical Capgras delusions. It is postulated that the Capgras syndrome developed as a result of interaction between a dominant patient with primarily paranoid psychopathology and a submissive one with primarily organic dysfunction. The submissive "neuro-organic" partner experienced a non-delusional misidentification that acquired a delusional component and developed into the Capgras syndrome as a result of elaboration by the dominant paranoid partner, who subsequently "imposed" the Capgras delusion on the submissive partner. The submissive patient, and, to a lesser extent the dominant patient, had evidence of organic cerebral dysfunction.

Panic disorder was introduced in the standard psychiatric nosology with the publication of the DSM-III in 1980. The myriad of earlier medical and psychiatric names describing anxiety attacks and related conditions were all abandoned, being housed under the term `panic attack and panic disorder.' In this paper, the rationale and the appropriateness of this term are critically examined from a historical perspective. First, a brief historical account of anxiety that comes in the episodic form, and the medical and psychiatric terminology that emerged during the last two centuries regarding this condition, are presented. Next, the origins of the concept of panic as a collective or individual fear reaction are traced from a mythological and historical standpoint, up to its current, almost accidental, introduction into the official psychiatric diagnostic systems. Since the word `panic' has its roots in the Greek god Pan and the unpleasant states inflicted by him, this god is described, as well as St Gilles - also known as St Aegidios, the Athenian - the healing saint for those suffering from panic, horror and phobias. Finally, the current diagnostic features of panic disorder are systematically compared with the corresponding troubles inflicted on people by the mythical god Pan. It is concluded that the introduced term `panic' appropriately and successfully replaced the old ones.

Background: Social anxiety disorder is fairly prevalent among alcohol abusing/dependent subjects. The objective of the present study was to investigate: (a) the incidence of social anxiety symptoms in inpatient alcoholics, (b) the effect of alcohol detoxification on these symptoms, and (c) whether a combined psychotherapeutic/mirtazapine treatment during the post-detoxification phase of alcoholism has a greater impact on the aforementioned symptoms than a non-pharmacological approach. Method: Social anxiety symptoms were assessed through the Liebowitz Social Anxiety Scale (LSAS) following a 4–5-week detoxification period in two groups: group A (n=21) that followed a detoxification protocol of cognitive–behavioral orientation and group B (n=33) that was assigned to mirtazapine in addition to the standard protocol. Concomitant psychopathology was monitored through the HARS and HDRS, and level of functioning through the GAS. Results: A marked reduction of social anxiety symptoms was evidenced in both groups. However, patients on mirtazapine improved significantly more compared to controls. Limitations: A single measure of social anxiety, i.e., the LSAS was used. Also, a longer follow-up period is needed to ascertain remission of social anxiety symptoms. Conclusions: The present study found a rather high incidence of social anxiety symptoms in inpatient alcoholics which subsided following alcohol detoxification; moreover, it provides preliminary evidence that a combined psychotherapeutic/mirtazapine treatment (30–60 mg/daily) has a greater impact on the aforementioned symptoms than non-pharmacological treatment alone.

Zolpidem is a short-acting imidazopyridine hypnotic that is an agonist at the γ-aminobutyric acid A type (GABAA) receptor. It has been suggested that it acts selectively on α1 subunit-containing GABAA benzodiazepine (BZ1) receptors presenting (contrary to classic benzodiazepines) low or no affinity for other subtypes. Therefore, it has been proposed that it lacks the benzodiazepines-like side-effects, having minimal abuse and dependence potential. Nevertheless, there is a considerable number of zolpidem dependence case reports in the literature. We present eight cases of zolpidem abuse and dependence without criminal record, without history of substance abuse (except for one alcohol abuser), with minor psychiatric disorders, who took zolpidem after physicians prescription in order to deal with their insomnia. However, they became zolpidem abusers not craving its sedative, but its anxiolytic and stimulating action, which helped them to cope with everyday activities. It is possible that, in the high doses that our patients used, zolpidem abandons its selectivity for BZ1 receptors and demonstrates all the actions of classic benzodiazepines. Molecular biology, via possible mutations on GABA receptors, may provide some answers as to why our eight patients (who did not differ much from the thousands of insomniacs who use zolpidem) and other zolpidem abusers, raised the dose progressively, and sought something from the drug other than hypnotic action.

IntroductionPostnatal depression is a serious disorder affecting 10–20% of postpartum women. It has a negative impact on the whole family system and on the child's development.ObjectivesIt is important to identify possible risk factors for PND, due to its frequency and severity. It has been hypothesized that the hormonal fluctuatios of the immediate postpartum period could be a risk factor for the appearance of PND.AimsThis study aimed at inquiring the possible correlation of hormonal parameters in the 1st week postpartum with the appearance of PND.Methods95 postpartum women were recruited, in the process of validating the Greek EPDS. Of them, 40 consented to give blood on the second postpartum day, so that the plasma levels of TSH, T4, T3, FSH, LH, Progesterone, Estradiol, Prolactin and Cortisol were measured. 81/95 women consented to be reassessed at 8 weeks postpartum, and 10/81 were diagnosed with depression, major or minor. Plasma levels of the hormones were correlated with the diagnosis of PND and with the EPDS.ResultsWomen who suffered from PND did not differ from the non-PND subjects in the levels of all measured hormones. There was a statistically significant negative correlation of the levels of prolactin with the EPDS on the second postpartum day (p < 0.001, correlation coefficient -0.56).ConclusionsOur study failed to show a definite correlation of the hormonal levels in the immediate postpartum period with PND. In other studies the role of hormones in the appearance of PND remains as well questionable.

The therapeutic effect of total sleep deprivation (SD) given twice a week, for 4 weeks, was investigated in 16 drug-free patients with major affective disorders. The response was excellent in five patients, satisfactory in three and minimal in eight patients. Six of these patients were treated prophylactically once a week, and four had an excellent response. Additionally, out of five normothymic drug-free patients with affective illness treated prophylactically with SD, without prior therapeutic SD treatment, three had an excellent response. The majority of responders were rapid cycling patients. This method is worth applying to patients resistant to classical treatment.

Although free-thyroxine index is commonly used as a reliable method of thyroid function investigation,1,2 only Rybakowski and Sowinski3 have used this method for the assessment of thyroid function in mania. In depression, determination of free-thyroxine index by four research groups3,6 revealed contradictory results. For these reasons, it was thought that further research in this area would be justified.