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Schizophrenia research has identified deficits in neurocognition, social cognition, and sensory processing. Because a cohesive model of "disturbed cognitive machinery" is currently lacking, we built a conceptual model to integrate neurocognition, social cognition, and sensory processing. In a cross-sectional study, the cognitive performance of participants was measured. In accordance with the Schedules for Clinical Assessment in Neuropsychiatry, the participants were assigned to either the schizophrenia group or the non-schizophrenic psychosis group. Exclusion criteria included substance abuse, serious somatic/neurological illness, and perceptual handicap. The male/female ratio, educational level, and handedness did not differ significantly between the groups. The data were analyzed using structural equation modeling. Based upon the results of all possible pairwise models correlating neurocognition, social cognition, and sensory processing, three omnibus models were analyzed. A statistical analysis of a pairwise model-fit (χ(2), CFI, and RMSEA statistics) revealed poor interrelatedness between sensory processing and neurocognition in schizophrenia patients compared with healthy control participants. The omnibus model that predicted disintegration between sensory processing and neurocognition was statistically confirmed as superior for the schizophrenia group (χ(2)(53) of 56.62, p=0.341, RMSEA=0.04, CFI=0.95). In healthy participants, the model predicting maximal interrelatedness between sensory processing/neurocognition and neurocognition/social cognition gave the best fit (χ(2)(52) of 53.74, p=0.408, RMSEA=0.03, CFI=0.97). The performance of the patients with non-schizophrenic psychosis fell between the schizophrenia patients and control participants. These findings suggest increasing separation between sensory processing and neurocognition along the continuum from mental health to schizophrenia. Our results support a conceptual model that posits disintegration between sensory processing of social stimuli and neurocognitive processing., (Copyright © 2013 Elsevier B.V. All rights reserved.)

Background: The cost of mental health care has possibly risen more than costs in other sectors of health care in the Netherlands. In an attempt to control the rising costs, new policies have been implemented that include the introduction of selective financial penalties for those in need of mental health care as well as the start of performance-based mental health care reimbursement. In order to achieve the latter goal, a nation-wide large-scale data collection was introduced based on clinical routine outcome monitoring (ROM) data, with a view to using these data for benchmarking., Aim: Closer inspection of the benchmarking efforts in terms of scientific validity., Method: Qualitative review and analysis., Results: Analysis shows that the type of ROM data that is collected in the Netherlands is valid for tracking the outcomes of individual patients, but unsuitable for performance comparisons between institutions for reasons of case-mix, instrument-mix, bias and lack of sensitivity., Conclusion: Attempts to introduce benchmarking based on rom will probably have a negative impact on the practice of mental health care in the Netherlands. More input from mental health professionals and scientists is required in order to identify more rational and efficient ways of spending scarce resources.

Objective: The internal consistency, test-retest reliability, and validity of the Quick Personality Assessment Schedule (PAS-Q), as a screening instrument for personality disorders were studied in a random sample of 195 Dutch psychiatric outpatients, using the SCID-II as a gold standard., Method: All patients were interviewed with the PAS-Q. With an interval of 1 to 2 weeks, they were interviewed with the SCID-II. Three weeks later the PAS-Q was re-administered., Results: According to the SCID-II, 97 patients (50%) were suffering from a personality disorder. The PAS-Q correctly classified 81% of all participants. Sensitivity and specificity were 0.80 and 0.82, respectively., Conclusion: The results provide evidence for the usefulness of the PAS-Q as a screening instrument for personality disorders in clinical populations.

Most studies investigating emotion recognition in schizophrenia have focused on facial expressions and neglected bodily and vocal expressions. Furthermore, little is known about affective multisensory integration in schizophrenia. In the first experiment, the authors investigated recognition of static, face-blurred, whole-body expressions (instrumental, angry, fearful, and sad) with a two-alternative, forced-choice, simultaneous matching task in a sample of schizophrenia patients, nonschizophrenic psychotic patients, and matched controls. In the second experiment, dynamic, face-blurred, whole-body expressions (fearful and happy) were presented simultaneously with either congruent or incongruent human or animal vocalizations to schizophrenia patients and controls. Participants were instructed to categorize the emotion expressed by the body and to ignore the auditory information. The results of Experiment 1 show an emotion recognition impairment in the schizophrenia group and to a lesser extent in the nonschizophrenic psychosis group, and this for all four expressions. The findings of Experiment 2 show that schizophrenia patients are more influenced by the auditory information than controls, but only when the auditory information consists of human vocalizations. This shows that schizophrenia patients are impaired in recognizing whole-body expressions, and they show abnormal affective multisensory integration of bimodal stimuli originating from the same source.

Background: Deficits in emotion perception are a well-established phenomenon in schizophrenic patients and studies have typically used unimodal emotion tasks, presenting either emotional faces or emotional vocalizations. We introduced bimodal emotion conditions in two previous studies in order to study the process of multisensory integration of visible and audible emotion cues. We now build on our earlier work and address the regulatory effects of selective attention mechanisms on the ability to integrate emotion cues stemming from multisensory channels., Methods: We added a neutral secondary distractor condition to the original bimodal paradigm in order to investigate modality-specific selective attention mechanisms. We compared schizophrenic patients (n=50) to non-schizophrenic psychotic patients (n=46), as well as to healthy controls (n=50). A trained psychiatrist used the Schedules of Clinical Assessment in Neuropsychiatry (SCAN 2.1) to diagnose the patients., Results: As expected, in healthy controls, and to a lesser extent in non-schizophrenic psychotic patients, modality-specific attention attenuated multisensory integration of emotional faces and vocalizations. Conversely, in schizophrenic patients, auditory and visual distractor conditions yielded unaffected and even exaggerated multisensory integration., Conclusions: These results suggest that schizophrenics, as compared to healthy controls and non-schizophrenic psychotic patients, have modality-specific attention deficits when attempting to integrate information regarding emotions that stem from multichannel sources. Various explanations for our findings, as well as their possible consequences, are discussed., ((c) 2010 Elsevier B.V. All rights reserved.)

Introduction: Narcolepsy is a primary sleeping disorder with excessive daytime sleepiness and cataplexy as core symptoms. There is increasing interest in the psychiatric phenotype of narcolepsy. Although many authors suggest an overrepresentation of mood disorders, few systematic studies have been performed and conflicting results have been reported. Anxiety disorders in narcolepsy have only received little attention., Methods: We performed a case-control study in 60 narcolepsy patients and 120 age- and sex-matched controls from a previous population study. The Schedules for Clinical Assessment in Neuropsychiatry were used to assess symptoms and diagnostic classifications of mood and anxiety disorders., Results: Symptoms of mood disorders were reported by about one third of patients. However, the prevalence of formal mood disorder diagnoses - including major depression - was not increased. In contrast, more than half of the narcolepsy patients had anxiety or panic attacks. Thirty-five percent of the patients could be diagnosed with anxiety disorder (odds ratio=15.6), with social phobia being the most important diagnosis. There was no influence of age, sex, duration of illness or medication use on the prevalence of mood or anxiety symptoms and disorders., Discussion: Anxiety disorders, especially panic attacks and social phobias, often affect patients with narcolepsy. Although symptoms of mood disorders are present in many patients, the prevalence of major depression is not increased. Anxiety and mood symptoms could be secondary complications of the chronic symptoms of narcolepsy. Recent studies have shown that narcolepsy is caused by defective hypocretin signaling. As hypocretin neurotransmission is also involved in stress regulation and addiction, this raises the possibility that mood and anxiety symptoms are primary disease phenomena in narcolepsy., (Copyright 2010 Elsevier Inc. All rights reserved.)

Objective: Patients with narcolepsy often experience pervasive hypnagogic hallucinations, sometimes even leading to confusion with schizophrenia. We aimed to provide a detailed qualitative description of hypnagogic hallucinations and other "psychotic" symptoms in patients with narcolepsy and contrast these with schizophrenia patients and healthy controls. We also compared the prevalence of formal psychotic disorders between narcolepsy patients and controls., Methods: We used SCAN 2.1 interviews to compare psychotic symptoms between 60 patients with narcolepsy, 102 with schizophrenia and 120 matched population controls. In addition, qualitative data was collected to enable a detailed description of hypnagogic hallucinations in narcolepsy., Results: There were clear differences in the pattern of hallucinatory experiences in narcolepsy vs. schizophrenia patients. Narcoleptics reported multisensory "holistic" hallucinations rather than the predominantly verbal-auditory sensory mode of schizophrenia patients. Psychotic symptoms such as delusions were not more frequent in narcolepsy compared to population controls. In addition, the prevalence of formal psychotic disorders was not increased in patients with narcolepsy. Almost half of narcoleptics reported moderate interference with functioning due to hypnagogic hallucinations, mostly due to related anxiety., Conclusions: Hypnagogic hallucinations in narcolepsy can be differentiated on a phenomenological basis from hallucinations in schizophrenia which is useful in differential diagnostic dilemmas.

Since Kraepelin called dementia praecox what we nowadays call schizophrenia, cognitive dysfunction has been regarded as central to its psychopathological profile. Disturbed experience and integration of emotions are, both intuitively and experimentally, likely to be intermediates between basic, non-social cognitive disturbances and functional outcome in schizophrenia. While a number of studies have consistently proven that, as part of social cognition, recognition of emotional faces and voices is disturbed in schizophrenics, studies on multisensory integration of facial and vocal affect are rare. We investigated audiovisual integration of emotional faces and voices in three groups: schizophrenic patients, non-schizophrenic psychosis patients and mentally healthy controls, all diagnosed by means of the Schedules of Clinical Assessment in Neuropsychiatry (SCAN 2.1). We found diminished crossmodal influence of emotional faces on emotional voice categorization in schizophrenics, but not in non-schizophrenia psychosis patients. Results are discussed in the perspective of recent theories on multisensory integration.

Background: Quality of life (QoL) has become an important outcome measure in health care, including in child psychiatry., Aim: To formulate assessment criteria with regard to instruments that are designed to measure QoL in children., Method: Literature search, using five key electronic databases. results When selecting an instrument, one has to consider the following aspects: its validity and reliability, the relative dimensions of QoL, its suitability for use with both the child and its parents and its cross-cultural applicability. A number of instruments were found to meet these criteria., Conclusion: The Child Quality of Life Questionnaire, the Revidierter Kinder Lebensqualit"atsfragebogen, the tno-azl Children's Quality of Life questionnaire, the Pediatric Quality of Life Inventory, the Child Health Questionnaire and in particular the kidscreen show to be suitable instruments for assessing QoL in children.

In this study, predictors of quality of life (QOL) in psychiatric outpatients (n = 410) were investigated using the psychological stress model developed by Taylor and Aspinwall (Psychosocial Stress. Perspective on Structures, Theory, Life-Course and Methods. San Diego, CA: Academic Press, 1996; pp. 71-110). External resources, personal resources, stressors, appraisal of stressors, social support, coping, and QOL were assessed with several questionnaires. The complete original Taylor and Aspinwall model was tested with SEM analyses. These analyses were not able to explain the data adequately. Therefore, initially a more exploratory data analytic strategy was followed using a series of multiple regression analyses. These analyses only partially supported the Taylor and Aspinwall model. In fact, QOL was not predicted by coping, while all other antecedents affected QOL directly, explaining considerable amounts of QOL variance. As a next step, taking the outcomes of the regression analyses as point of departure, new SEM analyses were carried out, testing a modified model. This model, without coping, had an excellent fit. Consequently, modifications of the model are recommended concerning psychiatric outpatients when QOL is the psychosocial outcome measure.

This study examines the relationship between personality and quality of life (QOL) in psychiatric outpatients (N=495). Personality was conceptualized using two-dimensional models, respectively, the five-factor model (FFM) and Cloninger's seven-factor model. The WHOQOL-100 was used for assessing QOL. Neuroticism and Harm Avoidance had negative correlations with QOL, whereas Extraversion, Conscientiousness and Self-Directedness correlated positively with QOL. A considerable part of the QOL variance was explained by personality; Cloninger's character factors were superior to the FFM domains. Although not fully comparable, in general our findings are in accordance with earlier studies. Therefore, paying attention to personality and temperament is recommended in future diagnostic procedures, treatment policies, and program evaluations.

Background: The relationship between social functioning and QOL in psychiatric patients has not been explicitly investigated before., Aims: To investigate the relationship between social functioning and QOL in a population of psychiatric outpatients (N = 410) with a broad spectrum of psychiatric disorders., Method: Social functioning was assessed with the Groningen Social Behavior Questionnaire-100 (GSBQ-100) and the Global Assessment of Functioning (GAF) scale. QOL was measured with the WHO Quality of Life Assessment Instrument (WHOQOL-100)., Results: The study population experienced a wide range of problems concerning all aspects of social functioning. The numbers of problems were significantly higher compared with healthy controls and (partly) also compared with a norm group of psychiatric outpatients. Almost all scales of the GSBQ-100 were negatively correlated with all QOL aspects, whereas the GAF score correlated positively with all QOL aspects. In general, participants with problems on aspects of social functioning had lower QOL scores than those without such problems, even after a correction for the presence of psychopathology according to DSM-IV classification., Conclusion: In addition to the presence of psychopathology, social functioning is significantly related to QOL. Therefore, it should be considered more systematically in psychiatric assessment, treatment and program evaluation.

Objective: Quality of life (QOL) has become a topic of growing interest in medical and psychiatric practice in general, and in research in particular. Although the body of knowledge about the complex relationship between QOL and psychiatric disorders is growing, understanding this relationship still remains difficult. Therefore, the aim of the present study was to get more and new insights into this relationship. It was hypothesized that QOL would be negatively related to the presence as well as the severity of psychopathology., Method: A random sample of Dutch adult psychiatric outpatients (n=410) completed the World Health Organization Quality of Life assessment instrument, abbreviated version (WHOQOL-Bref). In addition, DSM-IV axis I and II diagnoses were obtained. Comparisons were made between scores of the psychiatric outpatients, diagnostic subgroups within this population, and the scores of a general population., Results: Compared with the general population, psychiatric outpatients scored significantly worse on all aspects of QOL. Within the group of outpatients, participants with DSM-IV diagnoses had worse scores than those without. Participants with comorbidity had the worst QOL., Conclusions: It is concluded that QOL scores are negatively related to both the presence and the severity of psychopathology, and that the presence of a personality disorder plays a role in subjectively experienced QOL.

Our objective was to investigate explicitly the relationship between mood-related disorders (MRDs) and quality of life (QOL), while trying to overcome the limitations of earlier research. QOL scores of psychiatric outpatients with MRDs were compared with QOL scores of outpatients without MRD and a sample of the general Dutch population (GDP). QOL was assessed with the World Health Organization Quality of Life assessment instrument, long version (WHOQOL-100), and depressive symptoms were assessed with the Symptom Checklist-90 (SCL-90). Outpatients with MRD had lower scores on all aspects of the WHOQOL-100 compared with the GDP. Compared with outpatients without MRD, the outpatients with MRD scored lower on most aspects of the WHOQOL-100. Within the group with MRDs, patients with major depressive disorder (MDD) had lower QOL scores compared with patients with dysthymic disorder or adjustment disorder with depressed mood. Severity of MRD and MDD was negatively related to QOL. Comorbid personality disorders worsened QOL. Within the group with MRDs, common variance between depressive symptoms and QOL did not exceed 25%. MRDs are negatively related with QOL. Severity of MRD and comorbidity of personality disorders decrease QOL further. MRDs affect all domains and facets of QOL. The relationship found between MRDs and QOL was not caused by an overlap between the concepts depressive symptoms and QOL, shown by the relative small common variance between (depressive) symptoms and QOL.

Background: Research concerning the psychometric properties of the WHO Quality of Life Assessment Instrument (WHOQOL-100) in general populations of psychiatric outpatients has not been performed systematically., Aims: To examine the content validity, construct validity, and reliability of the WHOQOL-100 in a general population of Dutch adult psychiatric outpatients., Method: A total of 533 psychiatric outpatients entered the study (438 randomly selected, 85 internally referred). Participants completed self-administered questionnaires for measuring quality of life (WHOQOL-100), psychopathological symptoms (SCL-90), and perceived social support (PSSS). In addition, they underwent two semi-structured interviews in order to obtain Axis-I and Axis-II diagnoses, according to DSM-IV., Results: The drop-out percentage was low (7.1%). Of the 24 facets of the WHOQOL-100, 22 had a good distribution of scores, leaving out the facets physical environment and transport. Exploratory factor analysis revealed a four-factor structure, which was similar to earlier findings in patients with specific somatic diseases and depressive disorders. Various-a priori expected-positive and negative correlations were found between facets and domains of the WHOQOL-100, and dimensions of the SCL-90 and the PSSS-score, indicating good construct validity of the WHOQOL-100. The internal consistency of all facets and the four domains of the WHOQOL-100 was good (Cronbach's alpha's ranging from 0.62 to 0.93 and 0.64 to 0.84, respectively). Sparse and relatively low correlations were found between demographic characteristics (age and sex) and WHOQOL-100 scores., Conclusions: Content validity, construct validity, and reliability of the WHOQOL-100 in a population of adult Dutch psychiatric outpatients are good. The WHOQOL-100 appears to be a suitable instrument for measuring quality of life in adult psychiatric outpatients.

Background: Examinations of the role of demographic characteristics in quality of life (QOL) in psychiatric samples are not new. However, serious limitations of previous research have been that (1) QOL was not assessed according to current recommendations, (2) assessment of QOL was often hampered by a substantial overlap in content between symptoms and QOL measures, and (3) the majority of the study samples had quite specific characteristics hampering the generalizability of results, as a result of which clinical implications of the results remained unclear. The aim of the present study was to investigate explicitly the relationships between demographics and QOL in a sample reflecting the general population of psychiatric outpatients, QOL being assessed in a comprehensive, culturally sensitive, and subjective way, paying attention to the relative importance of its various facets. The main hypothesis was that these relationships would be rather weak., Method: From a population of 533 adult Dutch psychiatric outpatients, 495 participants completed the World Health Organization Quality of Life (WHOQOL)-Bref for assessing QOL. Furthermore, several demographic characteristics were recorded., Results: Statistically significant correlations were found between partner relationship, habitual status, work, and sick leave and the WHOQOL-Bref domains social relationships and environment. Psychological health was associated to partner relationship, educational level, and sick leave. The total amount of QOL variance explained by demographics was rather low., Conclusion: Amongst factors determining QOL, demographic characteristics are relatively unimportant. Therefore, paying attention to demographics during psychiatric treatment will probably have little effect on improvement of QOL.

Background: Follow-up studies of childhood ADHD have shown persistence of the disorder into adulthood, but no epidemiological data are yet available., Method: ADHD DSM-IV symptoms were obtained by self-report in an adult population-based sample of 1813 adults (aged 18-75 years), that was drawn from an automated general practitioner system used in Nijmegen, The Netherlands. The structure of ADHD symptoms was analysed by means of confirmatory factor analyses. Other data used in this report are the General Health Questionnaire (GHQ-28), information about the presence of three core symptoms of ADHD in childhood, and about current psychosocial impairment., Results: The three-factor model that allowed for cross-loadings provided the best fit in the entire sample. This result was replicated across gender and age subsamples. Inattentive and hyperactivity symptom scores were significantly associated with measures of impairment, even after controlling for the GHQ-28. Subjects with four or more inattentive or hyperactive-impulsive symptoms were significantly more impaired than subjects with two, one and no symptoms. The prevalence of ADHD in adults was 1.0% (95% CI 0.6-1.6) and 2.5% (1.9-3.4) using a cutoff of six and four current symptoms respectively, and requiring the presence of all three core symptoms in childhood., Conclusions: These results support the internal and external validity of ADHD in adults between 18 and 75 years. ADHD is not merely a child psychiatric disorder that persists into young adulthood, but an important and unique manifestation of psychopathology across the lifespan.

In this study, the psychometric properties of a quality of life scale, the WHOQOL-Bref, were examined in a population of 533 Dutch adult psychiatric outpatients. Participants underwent two semistructured interviews in order to obtain Axis-I and II diagnoses, according to DSM-IV. Besides the WHOQOL-Bref they also completed questionnaires for measuring psychopathological symptoms (SCL-90) and perceived social support (PSSS). Scores on 25 of the 26 questions of the WHOQOL-Bref had a good distribution. Similar to previous findings, exploratory factor analysis revealed a four-factor structure. A priori expected associations were found between the domains of the WHOQOL-Bref, on the one hand, and dimensions of the SCL-90 and the PSSS-score, on the other hand, indicating good construct validity. The internal consistency of the four domains of the WHOQOL-Bref ranged from 0.66 to 0.80. Domain scores of the WHOQOL-Bref correlated around 0.92 with the WHOQOL-100 domain scores. Relatively low correlations were found between demographic characteristics (age and sex) and WHOQOL-Bref domain scores. It is concluded that the content validity, construct validity, and the reliability of the WHOQOL-Bref in a population of adult Dutch psychiatric outpatients are good. The WHOQOL-Bref, therefore, is an adequate measure for assessing quality of life at the domain level in a population of adult psychiatric outpatients.

Background: Decades of psychiatric epidemiology have shown a wide variation in prevalence rates, but a consistent relationship between psychiatric disorder and sociodemographic variables. In this repeated cross-sectional survey, the prevalence of psychiatric disorders and their distribution in the general population of the same area was assessed in 1983 and 1997., Methods: With an interval of 14 years, 2 two-phase studies of psychiatric prevalence were carried out among the inhabitants of a Dutch Health Area (Nijmegen). In phase 1, a random sample of persons answered the General Health Questionnaire (GHQ-30). In phase 2, the respondents were interviewed using a clinical semi-structured interview. Only phase 1 data will be reported here., Results: The mean overall GHQ-score changed significantly from 3.1 (+/-1.0) in 1983 to 4.6 (+/-1.8) in 1997. On a bivariate level, higher score rates were found consistently in the age categories > or = 50 years, among divorced persons, the lower educational levels, the unemployed/chronically ill and in the urban areas. On a multivariate level (second order effect), however, the variance explained by these sociodemographic variables doubled, revealing the importance of complex interactions., Limitations: Our aim to ensure identical designs in 1983 and 1997 could not completely be achieved., Conclusions: In the course of time, psychiatric prevalence increased in all sociodemographic categories, despite the improved socioeconomic conditions in the survey population as a whole. The increasing complexity of life apparently takes its toll, even of the socially best equipped.

Aims: To estimate the risk of, and risk factors for, hyponatraemia associated with the use of selective serotonin reuptake inhibitors (SSRIs) compared with the use of other antidepressant drugs., Methods: A case-control study of psychiatric in- and out-patients on antidepressant drugs performed in the mid-southern part of The Netherlands over a 2 year period. Cases (n=29) were all using antidepressant drugs with a serum sodium concentration of < or = 130 mmol l(-1) while controls (n=78) were patients on antidepressants with a normal sodium concentration (136-144 mmol l(-1)). Information on blood sodium concentrations was obtained from clinical chemistry data while information on drug use was obtained from community and hospital pharmacy databases. Medical records were used to ascertain possible risk and confounding factors. Unconditional multivariate logistic regression was used to estimate odds ratios for hyponatraemia in patients on SSRIs compared with patients on other antidepressant drugs., Results: SSRIs were associated with an increased risk of hyponatraemia (OR 3.3; 95% CI 1.3, 8.6) compared with other classes of antidepressant drugs. Stratified and interaction analyses revealed that elderly patients using diuretics concomitantly with SSRIs were at the highest risk of experiencing hyponatraemia (OR 13.5; 95% CI 1.8, 101)., Conclusions: SSRIs are more frequently associated with hyponatraemia than other classes of antidepressant drugs. This adverse drug reaction was more common in older patients (> or = 65 years) and in those using diuretics.

Background: The Schedules for Clinical Assessment in Neuropsychiatry (SCAN), the successor of the ninth version of the Present State Examination (PSE-9), is one of the latest instruments developed by the World Health Organisation for the assessment of psychiatric disorders. So far, the psychometric properties have only been established for certain sections of the instrument. The present study is the first to test the psychometric properties of SCAN-2.1 for most of the disorders covered by the SCAN, and was carried out prior to a survey conducted in the Nijmegen Health Area (the Netherlands)., Methods: Interviewers were psychology graduates with little clinical experience. Two designs were used. In one design, pairs of independent live interviews with the same respondent were compared (test-retest situation). In the other, ten videotaped interviews by experts were rated by each of the interviewers (standardized situation), and the outcomes were compared with those of the other interviewers as well as with a reference score., Results: In the test-retest situation the kappa coefficient for diagnostic caseness was qualified as substantial (0.62) and for diagnostic categories and diagnostic groups as moderate to good (0.24 to 0.64). In the standardized situation using videotaped interviews by experts, sensitivity as well as specificity proved to be substantial to almost perfect. The agreement per interviewer with regard to the reference diagnoses ranged from 87% (diagnostic group) to 94% (diagnostic caseness). Agreement on the syndrome level (without duration and interference criteria of DSM-IV) was excellent., Conclusions: Although the instrument is traditionally used by experienced clinicians, this study shows that less experienced (but well trained) interviewers can apply SCAN reliably. Special attention should be paid to the items without explicit interview questions, as they tend to be more sensitive to neglect than the items with interview questions.

The different forms of antidepressive continuation therapy, used in the Netherlands, to prevent relapse after electroconvulsive therapy, were examined by sending a questionaire to all ECT centers. Common practice is in agreement with the results of current research. However, recent studies suggest that pharmacological continuation therapy is less usefull to prevent relapse when pharmacotherapeutic resistance has been proven in the past. In these cases ECT-continuation therapy might bring a solution. On the effect of ECT-continuation therapy are few valid research results available.

To investigate the role which standardised, patient related data play in indicated admission to a psychogeriatric nursing home, we compared the data of 120 indicated with those of 68 not-indicated patients. High scores on subscales 'helplessness' and 'inactivity' of the Dutch version of the Stockton Geriatric Rating Scale were the best predictors of indicated admission to a certain extent (21.6%). Furthermore a history of cardiac diseases and the state of being unmarried increased the probability of indicated admission to a small degree. Only a limited percentage of the variance in the decision of the indication committee could be explained. The limited availability of data which are collected in a standardised way, especially data concerning the caregiving system and the absence of valid and reliable instruments for the investigation of indicated admission are the most probable causes of this fact.

In order to replicate and elaborate the two-dimensional model of depression and anxiety underlying the structure of common psychiatric symptoms proposed by Goldberg et al. (1987), we carried out latent trait analyses on PSE symptom data of the original Manchester study and two recent Dutch studies. We used the same analytical strategy as Goldberg et al. to facilitate comparison with the earlier work. It was found that a more comprehensive set of common psychiatric symptoms caused an extra, third dimension to emerge, so that the earlier anxiety dimension became split between a specific anxiety axis characterized by situational and phobic anxiety and avoidance, and a non-specific anxiety axis characterized by free-floating anxiety, various symptoms relating to tension, irritability and restlessness. It is argued that three dimensions are sufficient to account for the covariance between common psychiatric symptoms. A fairly consistent correlation between the non-specific anxiety and the depression dimension was found across sites, as well as independence of the specific anxiety dimension from the other two dimensions. Furthermore, the depression dimension was robust with similar symptom profiles across samples, but there appeared to be local differences in the structure of anxiety symptoms.