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This study aimed to determine the incidence of AIDS dementia complex (ADC), the clinical data which distinguish it from other neurological complications of HIV infection, and the impact of zidovudine (AZT) therapy on the appearance and course of this condition. Data on the neurological complications of HIV patients treated at a community hospital from 1988 to 1992 were collected prospectively. Out of 500 AIDS patients treated at the hospital, there were 142 patients with neurological complications, with an average of 1.42 complications/patient There were 23 patients diagnosed as having ADC; with an estimated incidence of 4.6%, it was the most frequent neurological complication, after cerebral toxoplasmosis. Age was higher in patients with ADC as first manifestation of AIDS with respect to ADC patients with previous AIDS diagnosed. Compared with the group of patients suffering from other neurological complications, patients with ADC showed significant differences in several biological markers of progression to AIDS, such as hemoglobin, hematocrit, global lymphocyte count, serum β2-microglobulin and serum IgA. CD4 count was similar in both groups. Ten ADC patients had been treated previously with AZT. Dementia continued progressing in seven of these patients and remained stable in three. Of the other 13 cases not treated previously with the drug, eight received AZT therapy, and a favourable response was obtained in three patients (p = 0.068). ADC represents a major neurological complication in AIDS patients. AZT therapy may delay the appearance of ADC, but not prevent it. A trend towards a favourable response to AZT was observed in ADC patients who had not been treated with it previously., (1996 Lippincott Williams & Wilkins.)

In this article, we review the research carried out in Spain concerning psychiatric aspects of HIV/AIDS in general, and of suicide and suicidal ideation in particular. The paper presents available information concerning this psychopathology in patients with HIV infection, along with a review of the epidemic's dimensions and friends in Spain. Available studies are based on retrospective evaluation of patients referred for psychiatric evaluations. No longitudinal studies have been carried out, nor studies on the prevalence of psychiatric disorders in unreferred samples of HIV-infected patients. This neglected area of research is also a neglected area of care within Spain's mental health system.

The distinct quality of depressed mood is a clinical sign that has been recently excluded from both the DSM-III-R, and ICD-10 diseases classification manuals. An introduction to the depressive mood concept is carried out through a review of classical psychiatric texts, concluding that depressed mood elimination from the current, operative diagnostic criteria is most unfortunate indeed.

Twenty patients suffering from bulimia nervosa received 50-150 mg fluvoxamine daily for a period of 8 weeks. Primary end-points included the Eating Disorders Inventory (EDI), the Severity Index of Bulimic Condition (BINGE), Clinical Global Impression (CGI) scores, and the number of binge eating episodes per week. Other variables assessed included the 17-item Hamilton Depression Scale and adverse experience checklist. Compared with baseline, total EDI scores increased significantly from 137.8 to 155.3 after 8 weeks of fluvoxamine treatment (p < .001); CGI score fell significantly from 3.5 to 2.3 (p < .01) during this period. The mean number of binge eating episodes recorded by patients significantly decreased (p < .001). Further significant improvements in bulimic behavior were noted using the BINGE questionnaire. Nine of 20 patients complained of adverse experiences, all of which were mild; the most common symptoms were somnolence (n = 4) and insomnia (n = 3). Fluvoxamine appears to be a safe and effective treatment for bulimia nervosa.

This paper revises the literature which has attempted to define subgroups within the umbrella category of eating disorders, taking into account the heterogeneity of the clinical picture regarding personality structure, its linkage to eating behavior disorders, and differences in emotional expression. Research conducted over the last few years, in light of the new definition of these disorders proposed by DSM IIR, reinforces the differences between patients following a restrictive pattern and patients with bulimic episodes.

The observations that led to the creation of the concept of alexithymia were originally conducted on patients suffering from classic psychosomatic illnesses. However, the latest research has displaced the idea of an exclusive link between alexithymia and psychosomatic illness, due to findings which indicate that subjects with a wide variety of psychiatric disorders can also present alexithymic characteristics. This paper reviews research in the eating disorders field which points to a relationship between psychological deficits and alexithymic traits in anorexia nervosa and bulimia.

We review the literature on genetic factors in anxiety disorders and present data from a study in which we used the HLA system to evaluate distribution of different antigens in the members of a family with high morbidity of Panic Disorder. Our aim was to look for HLA haplotype sharing among the affected subjects. All members of the family were interviewed with the SCID interview to detect any psychiatric disorder. Third generation members under 18 were evaluated with a structured interview especially designed to identify separation anxiety disorder. In all cases we assessed 11 HLA-A, 16 HLA-B and 5 HLA-Cw antigens. The results suggest a genetic component for Panic Disorder, based on the presence of the same haplotype (A3B18) in the six members of the family suffering from Panic Disorder and Agoraphobia, compared with its absence in the others who were free of such disorders.

The life and work of Hölderlin confront the psychiatrist with the age-old problem of the relationship between artistic creation and mental illness. This theme has inspired multitud of writings, many of which fail to stand up to serious analysis. Although in the last century interest centred on the literary value of his work, more recently various authors have approached his life and work from a psychopathological standpoint, generally choosing one of two perspectives. The first tries to find the schizophrenic aspects of his poetry, and how it changed after the illness appeared. The other tries to find biographical clues which could throw some light on the development of his psychosis or, at least, on his reactions to its progression. The following study review several works which focus on the poet's illness, by authors ranging from Jaspers to Jung, Laplanche, Peters and others.

The results of a study about psychiatric morbility in patients suffering from HIV infection treated in a psychiatric consulting department of a general hospital are presented. Out of one hundred of individuals studied, 93 showed a diagnosis in Axle I according to DSM-IIIR criteria for mental disorders classification. The diagnosis most frequently found was the one of disorders due to drugs dependence, in 41%; organic mental disorder in 29%; adaptation disorders in 15% and affective one in 5% of cases. In sixteen patients of the sample a follow-up was carried out finding ad evolution towards dementia. Diagnostic difficulties of this population and usefulness of carrying out a revision of diagnostic classifications usually employed are debated.

The study describes the psychiatric disorders found in 100 HIV-positive patients, in different stages of the illness, at the psychiatric consultation service of a general hospital in Madrid. Eighty-five percent of the sample fell within the intravenous drug addicts risk group, which coincides with the epidemiological characteristics of Spain's HIV-positive population. The most frequently noted psychiatric diagnosis was substance dependence disorder (41%), followed by organic mental disorder (29%), adjustment disorder (15%), and affective disorder (5%). Fifteen percent of the subjects had depressive symptoms, and 11% expressed suicidal ideation. A follow-up conducted on part of the sample showed a development towards dementia, emphasizing diagnostic difficulties in the initial evaluation of these patients.

Since the time of Kraepelin, in continental Europe the sadness of depression has been considered to have a "distinct quality' basic to the diagnosis of pathological depression. This distinct quality has been interpreted by observers but patients have been noted to have difficulty verbalizing differences from normal sadness. The authors have used a discriminant analysis to study how patients define pathological sadness and as a result have developed a Pathological Sadness Index with a sensitivity of 0.94, a specificity of 0.96 and a total misclassification rate of 5% (kappa w = 0.90).

The paper reports on the clinical characteristics, treatment and results of a group of 41 patients suffering from anorexia nervosa. All patients were diagnosed according to DSM-III criteria. Mean age was 18.6 years, within a range from 12 to 33 years. The group was formed by 40 female patients and 1 male. Twenty-nine percent of the patients had previously received treatment. Duration of treatment fell within a range of 10-36 months, 18-24 being the most frequent. Forty-four and a half percent of the patients were admitted to hospital with a 59-day mean time of hospitalization and treatment was positive in over 80% of cases. Two patients suffered a relapse during the first 2 or 3 years, but later recovered. Five years after the beginning of treatment, 1 patient suffered a relapse and received supplementary treatment.

The authors develop a Pathological Sadness Index. It recognize between pathological and normal sadness with a sensitivity of 0.94, a specificity of 0.96, and 5% of misclassified cases. Its diagnostic reliability is kw = 0.90.

The authors have investigated the real existence of "distinct quality" of pathological sadness in depressed subjects. This paper, show a discriminant function that recognize the "distinct quality" with a 100% of cases correctly classified.

Cardiovascular symptoms are often present in descriptions of patients with panic disorder, and are considered a central element in current diagnostic criteria. These patients often visit emergency wards complaining of chest pain or discomfort. In many cases, a possible psychiatric diagnosis is not considered, and these patients are often incorrectly diagnosed and treated. The aim of this study is to examine the presence of panic disorder in those patients who visit a general hospital emergency ward with chest pain, and are then released after no organic pathology is found. We present the results obtained from the examination of 112 patients with these characteristics who were given a structured interview developed for the diagnosis of affective and anxiety disorders. In the sample studied, panic disorder was found in 47.3% of the subjects.