The descriptive diagnostics constitute the first step, the base and the prerequisite for the psychodiagnostic process and the treatment of depression. Within the descriptive diagnostics, two approaches are distinguished, namely (1) the differentiation between dimensional and categorical levels of measurement and (2) the consideration of the influence of the applied method: questionnaire versus interview. Departing from these approaches, a review of the most widely used instruments on depression is given, with a focus on the reliability and validity of the dimensional depression instruments, based on the findings of our research group. The importance of the differentiation between dimensional and categorical levels of measurement can also be recognised within the discussion on quantitative/dimensional versus qualitative/categorical taxonomic views on depression. The Integrated Threshold Model, which integrates both the quantitative and the qualitative view on the classification of depressive disorders, is considered. By way of conclusion, a diagnostic multi level/modality/method strategy is discussed and a specific test battery, which can be particularly useful within a research context, is presented.

The relationship between myocardial infarction (MI), depression and cardiac death is not well understood. There is evidence that poly unsaturated fatty acid (PUFA) metabolism and composition in phospholipids and cholesterylesters are involved in the pathophysiology of affective disorders and cardiac dysregulation. In this paper the relationship of PUFAs with 1) cardiac events 2) depressive disorder and 3) the inflammatory response system (IRS) will be reviewed. The underlying pathophysiologic mechanisms relate to the effects of dietary fatty acids on the IRS, the HPA-axis, serotonin metabolism and platelet reactivity. These effects are the result of the important effects of PUFAs on the structure and function of localized membrane domains, their involvement in eicosanoid synthesis and their influence on intra-cellular signalling pathways and gene expression. Antidepressive treatment has been shown to have immunosuppressive effects in healthy volunteers. In patients with bipolar disorder or schizophrenia, PUFA supplementation resulted in significant symptom reduction. In the ongoing substudy of the MIND-IT, the effects of antidepressive treatment on immune status, PUFA composition in serum phospholipids and cholesterylesters and whole blood serotonin in depressive post-MI patients will be investigated. More knowledge on the relationships between PUFAs in diet, IRS parameters and serotonin metabolism may alter treatment strategies in the prevention of both cardiac death and the occurrence of depressive disorder in cardiac patients.

Objectives: To extend the hypothesis that late auditory EP shifts represent pathophysiologcial markers in schizophrenia. Methods: Early negative (±100 μs) and late positive (>300 ms) auditory oddball and CNV responses are topographically compared in 3 medicated schizophrenic subtypes.

Results: Only late cortical responses differentiate between paranoid, residual and disorganised schizophrenia. Core features of the deficit residual state encompass low-voltage N2P3 responses and missing central initial CNV components. Both paranoid and disorganised schizophrenics show a distinctive reactivity of the frontal cortex. Paranoid schizophrenia is characterized by an extensive frontal spread of the task-related P3 response. Disorganised schizophrenia shows a specifically increased frontal CNV component indicating a nonspecific arousal reaction.

Conclusion: Combinations of late auditory EP-patterns fairly fit with the cognitive/behavioral status observed in schizophrenia spectrum disorders.

Background: To a large extent, discussions about dissociative identity disorder (DID) revolve around the way in which identity states (alters) that are thought to be typical for this condition should be interpreted: are they metaphors or are they genuine actors? Recent literature offers some fine examples of studies demonstrating that alters differ in their physiological profile. On the basis of this type of evidence, some authors have concluded that alters are more than just metaphors.

Objective: Drawing upon an experimental example, we argue that such a line of reasoning is highly problematic.

Method & Results: Our example demonstrates that normal subjects are perfectly able to simulate alters such that these alters are accompanied by different physiological profiles.

This is especially true for subjects scoring high on fantasy proneness.

Conclusions: Psychobiological research on DID should include normal controls, preferably controls who are fantasy prone. Unless such a strategy is adopted, psychobiological research on alter activity will not be very informative.

A patient is presented showing an altered oddball response while suffering from auditory hallucinations. The nontarget stimulus evokes a compound negative potential encompassing a normal early N1 component and an additional negativity within the categorization N2 range. These findings are discussed in reference to impaired mismatch processes and the deranged monitoring of inner speech theory, proposed in schizophrenia.

Klinefelter syndrome is a genetically determined disorder characterized by an additional X-chromosome. Apart from the phenotypical features, the literature about this disorder mentiones a psychopathological phenotype comprising mainly psychoses, depressive diseases and personality disorders. A substantial number of patients presents with mild to moderate mental retardation.

In this paper, two case reports are described and their psychopathology is compared with the data from the existing literature.

The clinical observation that patients with an alcohol amnestic disorder get grey hair at a higher age was investigated by comparing a group of Korsakov patients and patients with alcohol abuse with a reference sample from the literature. Korsakoff patients appeared to be significantly less grey than age-matched alcoholics and controls. Some putative etiological factors including the mechanism of apoptosis are discussed.

We describe the clinical history of a 49-year old woman, who demonstrated progressive personality changes more than twenty years after radiation of a pituitary adenoma (prolactinoma), with apathy, loss of initiative, memory deficits, postural instability, dysarthria and faecal incontinence. Neuropsychological assessment showed impulsivity, loss of overview, desinhibition, fluctuating deficits of attention, and memory disturbances. MRI-scanning of the brain revealed a cystic lesion along the right ventricle. The clinical picture and the findings of the other investigations are typical for dementia due to radiation encephalopathy. Such a long period between radiation and cognitive deterioration is rare, although it has been described before.

Chronic pain is a phenomenon with important psychiatric aspects from a diagnostic as well as a therapeutic point of view. The place of chronic pain in the different versions of the Diagnostic and Statistical Manual of Mental Disorders, and the differential-diagnosis are critically discussed. The comorbidity with depression, anxiety disorders, substance abuse and personality disorders is extensively treated. Finally, the essential role of the psychiatrist in the multidisciplinary therapeutic approach of these patients is emphasised.

Drug-induced psychiatric conditions are a common and severe problem in the treatment of patients with Parkinson's disease. Psychotic symptoms are the most frequent reason for nursing home placement of patients with Parkinson's disease. The psychotic symptoms seem to present themselves in a continuum where alterations in dreaming patterns often precede visual hallucinations, which often progress into delusional syndromes and, finally, into confusional organic syndromes. When evaluating a patient on dopaminergic treatment, it is important to inquire systematically about abnormal sleep related phenomena, for these are important clues in the early detection of psychotic symptoms. The pathogenesis of the psychotic symptoms is not yet fully understood but complex adaptations of various neurotransmitter systems seem to be involved. In the treatment of these drug-induced psychotic symptoms, the atypical antipsychotic drug clozapine plays an important role. Drug-induced mania, hypersexuality and anxiety, although less frequent than the psychotic symptoms, also occur as a complication of dopaminergic treatment. Depressive symptoms, although common in Parkinson's disease, are less likely to occur as a side effect of the drug treatment.

The unrestricted use of the DSM as diagnostic instrument for psychiatric disorders results in an arbitary and over the time inconsistent application of labels whether or not accompanied by the adjective NOS. Moreover, the European psychiatric tradition is often regarded as irrelevant and the results from modern genetics, behavioural neurology and other neuroscience research are not considered. The neuropsychiatric paradigm and the need to focus on psychological dysfunctions and their putative neurobiological substrate are discussed on the basis of four case reports. This paper illustrates the pitfalls of a careless use of the DSM.