Asking psychiatric in-patients about their drug consumption is unlikely to yield reliable results, particularly where alcohol and illicit drug use is involved. The main aim of this study was to compare spontaneous self-reports of drug use in hospitalized psychiatric patients to biological measures of same. A secondary aim was to determine which personal factors were associated with the use of tobacco, alcohol, and illicit drugs as indicated by these biological measures.

The consumption of substances was investigated using biological measures (urine cotinine, cannabis, opiates, cocaine, amphetamines and barbiturates; blood carbohydrate-deficient transferrin [CDT] and gamma-glutamyl transferase [GGT]) in 486 consecutively admitted psychiatric patients, one day following their hospitalization. Patients’ self-reports of alcohol, tobacco and illicit drugs consumption were recorded. Socio-professional and familial data were also recorded.

The results show a low correlation between biological measures and self-reported consumption of alcohol and illicit drugs. Fifty-two percent of the patients under-reported their consumption of illicit drugs (kappa = .47). Patients with schizophrenia and personality disorders were more likely to disclose their illicit drug consumption relative to patients suffering from mood disorders and alcohol dependence. Fifty-six percent of patients underreported alcohol use, as evaluated by CDT (kappa = .2), and 37% underreported when using the CDT + GGT measure as an indicator. Smoking appeared to be reported adequately. In the study we observed a strong negative correlation between cannabis use and age, a strong correlation between tobacco and cannabis use, and correlations between tobacco, cannabis and alcohol consumption.

This study is the first to compare self-reports and biological measures of alcohol, tobacco and illicit drug uses in a large sample of inpatients suffering from various categories of psychiatric illnesses, allowing for cross-diagnosis comparisons.

The ZEISIG study (Ziprasidone Experience in Schizophrenia in Germany/Austria) investigated the effectiveness of ziprasidone as measured by discontinuation rates and mean changes of the BPRS total. Secondary objectives included quality of life, subjective well-being, tolerability, and safety.

Two hundred and seventy-six subjects with schizophrenia and schizoaffective disorder were treated within an open-label, 12-week, prospective, flexible-dose observational trial of ziprasidone (40–160 mg/day). Baseline and outcome assessments mainly included Brief Psychiatric Rating Scale (BPRS), Clinical Global Impressions Scale (CGI), Short-Form 12 (SF-12), and Subjective Well-being under Neuroleptic treatment (SWN-K).

Study discontinuation due to any cause was evident in 58% of subjects, most of them within the first 4 weeks after study initiation. In study completers, ziprasidone was associated with improvements in BPRS total (44.8 to 33.6; p < 0.001), CGI, SF-12, and SWN-K total scores (80.5 to 89.5). Ziprasidone was related to reduction of weight, fasting glucose, and serum lipids. No cardiovascular adverse event or significant increase of the QTc interval was observed.

Approximately 60% of subjects discontinued ziprasidone prematurely, probably related to an initial and overall underdose. The present study confirmed previous tolerability and safety data of ziprasidone as well as results of its effectiveness. Independent from reason to switch, previous antipsychotic class, and severity of illness at baseline, the recommended starting dose of 80 mg/day as well as the maximum treatment dose of 160 mg/day may not be sufficient for a selected subgroup of patients.

Burnout syndrome (BS) is a cause of concern among doctors. Although some association between BS and psychopathology or addictive behaviour has been found, few studies evaluate its incidence in impaired physicians.

To evaluate the incidence of BS and the association with psychopathological/addictive disorders among doctors treated in a Physicians Programme of Barcelona.

66 physicians were evaluated. Variables studied included demographic, clinical and psychometric data of BS (Maslash Inventory, MBI), depression (Beck Inventory), anxiety (Spielberg S/T Inventory), general psychopathology (SCL-90-R) and personality (MCMI-II).

Forty doctors were male and 26 female. Mean age was 44.6 (8.4) years. 57.6% showed emotional exhaustion (EE), 28.8% depersonalization (D) and 10.6% lack of personal accomplishment (PA), 6.1% had complete BS. No gender differences were found. Associations between MBI and SCL-90-R subscales were (r>0.5): EE with Somatisation, Hostility and Anxiety, D with Hostility and PA with the Global severity index. BDI and STAI-S/T were associated with both three MBI factors. Correlations with MCMI-II scales (r>0.5) were: EE correlated with Avoidant and Self-Defeating, Schizotypal, Anxiety, Somatoform Disorder and Depression. D with Self-Defeating, Schizotypal, Anxiety, Somatoform Disorder, and Depression. PA with Schizoid, Schizotypal and Depression. No association was found for addictive scales.

EE is the most prevalent condition among sick doctors followed by D and PA, only 6% had complete Syndrome. As BS seems to be associated with depressive/anxiety symptoms, hostility and Schizotypal personality traits, such patients may be a target group for prevention and training in assertiveness and communication skills.

In this study we directly compared the efficacy and tolerability of the atypical antipsychotics quetiapine and risperidone in elderly patients with dementia and symptoms of disturbed perception, thought content, mood or behaviour (behavioural and psychological symptoms of dementia—BPSD).

We conducted an 8-week, rater-blinded, randomised study of 72 outpatients (55–85 years) with BPSD (assessed by NPI baseline score), who received flexibly-dosed quetiapine (50–400 mg/day) or risperidone (0.5–2 mg/day). Primary efficacy measure: Neuropsychiatric Inventory (NPI) Parts 1 and 2; secondary efficacy measures: Clinical Global Impression (CGI), Cohen-Mansfield Agitation Inventory (CMAI), Mini-Mental State Examination (MMSE), Age-adjusted concentration test (AKT). Safety evaluations included the incidence of extrapyramidal symptoms (EPS) and adverse events (AEs).

Sixty-nine of 72 patients were evaluable for efficacy (72 were evaluated for safety), 4 patients discontinued (3 due to AEs: quetiapine 2, risperidone 1; 1 lost to follow-up). Sixty-five patients received quetiapine (n = 34; mean dose 77 ± 40 mg/day) or risperidone (n = 31; mean dose 0.9 ± 0.3 mg/day). There was no significant difference between treatments on NPI scores; within treatment groups, NPI scores decreased significantly from baseline to Week 8 (P ≤ 0.05 vs. baseline). Most patients (quetiapine arm 67.6%, risperidone arm 71.0%) experienced clinical improvement (CGI-Improvement scores); both agents reduced agitation (CMAI scores); and there was no cognitive impairment (MMSE and AKT scores). There were no significant differences between treatments in any safety measures, including EPS. Four patients experienced serious AEs (quetiapine arm 3; risperidone arm 1); none were considered treatment-related by the study investigator. There were no cerebrovascular AEs or deaths.

Quetiapine or risperidone, at low doses, were equally effective and generally well tolerated (including no cognitive impairment) in the treatment of BPSD in elderly patients.

To extensively review the European Court of Human Rights (ECHR) case law concerning psychiatric commitment, and to estimate the role of this supranational jurisprudence in the practice of contemporary psychiatry.

Using keywords to search the ECHR computerised database “HUDOC”, we reviewed all cases concerning psychiatric commitment registered between September 1953 and December 31, 2004. Four groups were identified: applications declared inadmissible; applications accepted but not judged by the Court; pending cases; and cases judged by the Court.

Of the almost 118,000 decisions taken by the ECHR in this time frame, we found 108 situations concerning psychiatric commitment. 41 of these applications were considered by the Court to be inadmissible. 24 other cases were considered admissible but not judged by the ECHR. Three admissible cases were still pending at the end of 2004. The ECHR judged 40 cases, and found in 35 of them that one or several rights as guaranteed by the Convention had been violated.

The ECHR protects the human rights of persons subjected to involuntary psychiatric commitment by creating supranational law in the following areas: definition of “unsoundness of mind”; conditions of lawfulness of detention; right to a review of detention by a Court; right to information; right to respect for private and family life; and conditions of confinement, which address inhuman and degrading treatment.

The respective number of applications submitted to the ECHR did not depend on when the Convention had entered into force in that country.

The possibility of an individual to access the ECHR depends on the degree of democracy in his country and on the access to legal assistance through non-governmental organisations or individual intervening parties.

We report clinical and social outcomes of schizophrenia in the longitudinal, population-based Northern Finland 1966 Birth Cohort, and describe associated demographic, developmental and illness-related factors.

Subjects with DSM-III-R schizophrenia (n = 59) were followed prospectively from mid-gestation up to age 35 years. Outcome measures included positive and negative symptoms, psychiatric hospitalisations, social and occupational functioning. Several definitions of good and poor outcome were explored, and developmental, socio-demographic and clinical predictors of outcomes were analysed.

Good clinical outcome varied from 10% to 59%, and good social outcome 15–46%, depending on definition. Poor clinical outcome varied 41–77% and poor social 37–54%. Lack of friends in childhood, father's high social class, lower school performance and earlier age of illness onset predicted poor outcomes.

The outcomes of schizophrenia in this study depended on definitions used but were relatively poor. The age of illness onset, father's social class, school performance and poor social contacts in childhood were only statistically significant predictors.

Definitions of outcome have a major effect on estimates for proportions of good and bad outcomes and on the predictors of outcomes. However, regardless of which definitions were used, the outcome of schizophrenia in this population-based sample was generally bleak.

Previous studies regarding internet addiction have investigated associated psychological variables such as shyness, loneliness, self-consciousness, anxiety, depression and interpersonal relations. Few studies about the relationship between internet Addiction and impulsivity have been done. This study aimed to assess whether internet addiction is related to impulsivity among Chinese adolescents.

This study was performed in two stages. We screened for the presence of internet Addiction among 2620 high school students(age ranging from 12 years to 18 years) from four high schools of Changsha City using Diagnostic Questionnaire for internet Addiction (YDQ). According to the modified YDQ criteria by Beard, 64 students were diagnosed as internet addiction. Excluding current psychiatric comorbidity, 50 students who were diagnosed as internet Addiction (mean age, 14.8 ± 1.4 years) and 50 normal students in internet usage(mean age, 14.5 ± 1.8 years) were included in a case control study. The two groups were assessed using Barratt Impulsiveness Scale 11 (BIS-11) and behavioral measure of impulsivity (GoStop Impulsivity Paradigm).

Sixty-four students met the modified YDQ criteria by Beard, of whom 14 students suffered from comorbid psychiatric disorders, especially comorbid ADHD. The internet Addiction group had significantly higher scores on the BIS-11 subscales of Attentional key, Motor key, and Total scores than the control group (P < 0.05). The internet Addiction group scored higher than the control group on the failure to inhibit responses of GoStop Impulsivity Paradigm (P < 0.05). There was a significant positive correlation between YDQ scores and BIS-11subscales and the number of failure to inhibit responses of GoStop Impulsivity Paradigm.

This study suggests that adolescents with internet addiction exhibit more impulsivity than controls and have various comorbid psychiatric disorders, which could be associated with the psychopathology of internet addiction.

Females care for individuals with chronic illness more commonly than males and have different attitudes to illness. Additionally, they experience greater burden and reduced quality of life, when compared to their male counterparts. Since knowledge has been shown to be related to burden, we sought to determine whether there were gender differences in knowledge acquisition during a six-week caregiver psychoeducation programme (CPP).

Caregivers of people with schizophrenia completed a 23-item adapted version of the self-report Family Questionnaire (FQ) before and after the six-week CPP. Using a Generalized Linear Mixed Model, we studied the differences in proportions of correct answers before and after the programme by gender.

Over a 46-month study period, 115 caregivers (58% female) participated in the programme. There was an overall improvement in knowledge with an effect size of 1.12. The improvement was statistically significant (P < 0.001) within each of six specific areas of knowledge. However, female caregivers gained more knowledge overall and specifically regarding signs and symptoms, recovery and especially caregiver support. Knowledge gains regarding medication were roughly equal, while male caregivers gained more knowledge about risk factors.

Our findings indicate that there are gender differences in the amount and type of knowledge gained during a CPP, with female caregivers showing greater knowledge acquisition than their male counterparts in most areas. Interventions designed to assist caregivers may be improved by targeting areas of knowledge specific to each gender. Such an approach might further reduce burden and improve the outcome for their relatives affected by schizophrenia.

In bipolar-II (BP-II) disorder impulsivity (defined as excessive risky activities by DSM-IV-TR) is one of the symptoms of hypomania. It is unclear if impulsivity is also a trait in BP-II.

The aim was to test if impulsivity was also a trait in BP-II.

Consecutive 136 remitted BP-II outpatients (assessed when presenting for depression by a mood disorder specialist psychiatrist using the Structured Clinical interview for DSM-IV), self-assessed trait impulsivity during follow-ups, using the Personality Questionnaire of the Structured Clinical interview for DSM-IV Axis II Disorders, in a private practice. Trait mood swings were also self-assessed, using the TEMPS-A. A trait nature of impulsivity in BP-II could be supported by finding (1) a relatively high frequency, (2) association between trait impulsivity and symptoms of past hypomania, especially impulsivity, (3) dose–response relationship between number of past hypomania symptoms and trait impulsivity, and (4) association between trait impulsivity and trait mood swings (a trait feature of BP-II).

Trait impulsivity was present in 41.1% of BP-II. BP-II with, versus BP-II without, trait impulsivity had significantly more males, trait mood swings, past hypomania symptoms (irritable mood, talkativeness, increased goal-directed activity), and excessive risky activities (i.e. state impulsivity), corresponding to an irritable risky overactivity. Past state impulsivity and trait impulsivity were significantly associated. Number of past hypomania symptoms and trait impulsivity were significantly correlated. A dose–response relationship was found between number of past hypomania symptoms and trait impulsivity.

Findings suggest that trait impulsivity may be a feature of BP-II. Limitation of self-assessment of personality traits should be taken into account. Findings may have treatment impacts, as the combination of trait impulsivity and mood swings may facilitate relapses and mixed states, which mood stabilising agents could prevent/delay.

The prevalence rates of depression and generalised anxiety disorders (GAD) have consistently been found to be higher in women than men. The question is whether this is a true difference or an artefact of definition.

In the Zurich study, a young adult sample representative of a geographic area was investigated by six interviews from age 20/21 to 40/41. Major depressive episodes (MDE) were diagnosed by DSM-III-R and GAD by DSM-III criteria. 27 symptoms of depression and 21 symptoms of anxiety were assessed; in addition eight self-assessments were carried out with the Symptom-Checklist 90-R including the depression sub-scale (13 items) and the anxiety scale (10 items).

192 subjects suffered from MDE (72 males, 120 females) and 105 from GAD (43 males, 62 females). Up to the age of 40/41 the cumulative incidence rates for MDE were 22.8% (16.9% males, 28.6% females) and for GAD 14% (12.2% males, 15.6% females).

In both diagnostic groups women suffered more often than men from work impairment, social impairment and distress; they also reported more symptoms than men in the interviews and self-assessments. The greatest gender differences were found in the following symptoms of depression: worse in the morning, fearful, fear of bad luck, lack of sexual desire, low self-esteem, guilt, hopelessness, crying easily, muscle tension, tiredness, increased appetite, weight gain and loss, and symptoms of anxiety: easily startled, dizziness and frequent urination,.

Compared to men, women suffer more often and more severely from both major depression and generalised anxiety disorder.

The objective of this study was to determine the prevalence of sexual dysfunction in patients with schizophrenia under antipsychotic therapy and to investigate the effect of various parameters on sexual dysfunction.

A total of 827 stabilized outpatients who met DSM-IV criteria for schizophrenia, were recruited in the study. Arizona Sexual Experience Scale (ASEX) and the subscale on sexual function of the UKU Side Effects Rating Scale were applied at a single interview.

In total, 52.6% of the patients had sexual dysfunction, 54.2% reported a low sexual desire and 41.7% reported problems in having an orgasm. Erectile dysfunction and ejaculation problems were seen in 48.1% and 64.2% of the men, respectively; amenorrhea was seen in 24.9% of the women. ASEX score and severity of disease were found to be correlated (p = 0.02). Higher ASEX scores were observed in patients who smoked (p = 0.01). Men receiving atypical monotherapy had lower ASEX scores than those receiving a combination of atypical and conventional antipsychotics (p = 0.017). Patients on combination therapy had more ejaculation problems than the atypical group (p = 0.001). Low sexual desire was more prevalent among women using conventional drugs than those on atypical drugs (p = 0.004). In linear regression analyses, ASEX was affected significantly and independently by the severity of the disease only in men (p = 0.005).

Our results show that sexual dysfunction is widespread among patients with schizophrenia on antipsychotic medications.

The present study investigates different three inhibitory control functions in patients with obsessive-compulsive disorder (OCD). Selective motor response inhibition was tested in a GO/NO-GO paradigm, the inhibition of a triggered motor response in a STOP paradigm and the ability to inhibit cognitive interference in a motor STROOP paradigm.

27 patients who met DSM-IV criteria for OCD and 25 age, handedness and IQ-matched healthy control subjects were tested in the GO/NO-GO, STOP and motor STROOP tasks.

OCD patients performed significantly worse than controls in the selective inhibition of their motor responses (GO/NO-GO) and in the inhibition of cognitive interference (STROOP), and also showed worse performance in suppressing previously triggered motor responses (STOP).

Patients with OCD are impaired in motor and cognitive inhibitory mechanisms. The findings are consistent with psychobiological and neuropsychological models of OCD suggesting impairment of frontostriatal circuitries that mediate functions of inhibitory control.