Personality deviations and deficits in cognitive executive function are common among forensic populations. The present study on incarcerated offenders explored whether there are links between the two domains. Personality was assessed using the Temperament and Character Inventory (TCI). Neuropsychological performance, including visual working memory, attentional set-shifting and planning, were tested with the Cambridge Neuropsychological Test Automated Battery (CANTAB). Subjects with personality disorders scored high on harm avoidance, and low on self-directedness and cooperativeness. Personality disordered offenders did not differ from the comparison groups (offenders without personality disorder, and non-criminal controls) with regard to CANTAB measures of visual working memory (delayed matching to sample, spatial working memory) and planning (Stockings of Cambridge), but they made a larger number of errors on the attentional set-shifting task. Dimensional analysis of the personality and neuropsychological variables revealed significant associations between self-directedness and cooperativeness on the one hand, and attentional set-shifting on the other. Intellectually disabled, non-criminal individuals (marginal mental retardation) who performed poorly on attentional set-shifting also scored low on self-directedness and cooperativeness. The results indicate that poor development of certain personality traits may be associated with deficits in neuropsychological functioning.

The clinical characteristics of bipolar I disorder (BD1) have prognostic and therapeutic importance. The aim of this study was to examine the effect of demographic and clinical variables on the course of BD1. We reviewed the case notes of all BD1 patients (n = 63) receiving treatment in a London psychiatric service during a 1-month period. Depressive and manic onsets were equally likely without any gender difference. The earlier the age of onset, the more likely it was for patients to experience psychotic features. Only depressive onsets predicted a higher number of episodes of the same polarity. Male gender and substance abuse were associated with younger age at first presentation, while women with co-morbid substance abuse had more manic episodes. Male patients were more likely than females to be unemployed or single.

This study examined gender differences in the short-term (2 years) course of schizophrenia in a sample of 200 schizophrenic (DSM-IV criteria) outpatients (74 women and 126 men). Number and length of hospitalizations during the prospective follow-up were recorded. After 2 years, men were found to have more hospitalizations and longer stays than women. Among subjects who had at least one hospitalization (12 women and 38 men), men had greater length of hospitalization. In conclusion, schizophrenic women had a significantly better short-term outcome.

Functional neuroimaging using techniques such as positron emission tomography (PET) and single photon emission computerised tomography (SPECT) provide a direct in vivo assessment of the expression and function of neuroreceptors, transporters and enzymes. This article examines the technical aspects of molecular imaging and the application of those techniques in drug development.

Two groups of non- and “quasi-depressives”—the latter corresponding to high depression scorers—German adolescents were examined to determine the effect of gender and depression in predicting physical ailments, self-image and attitudes towards parents. Quasi-depressive adolescents displayed higher frequencies of physical complaints across all five subscales of the Giessen physical complaints inventory compared to the non-depressive counterparts. Females generally reported more ailments (exhaustion, gastrointestinal, circulatory, and colds) than males. In contrast to males who showed scarce difference between depressives and non-depressives, female depressives exhibited substantially higher gastrointestinal ailments than non-depressive females. Depressives emerged as displaying inferior self-images, lower paternal acceptance, and somewhat higher maternal rejection, compared to non-depressives. Female adolescents displayed lower self-image, lower paternal acceptance (but not maternal rejection/acceptance), lower mathematical competency, and higher linguistic competency, when compared to male adolescents.

Patients with bipolar disorders experience cyclical changes in mood that present as a range of different syndromes. In classical mania, patients experience episodes of euphoria, whereas in depressive episodes they suffer from depression. In hypomania, patients experience a milder form of mania, and in mixed mania, patients may experience both manic and depressive symptoms simultaneously, or alternate between them rapidly. Because of this wide range of symptoms, bipolar disorders can appear to overlap with other mental disorders, especially personality disorders.

This study tested suicidality in relation to cerebrospinal fluid (CSF) 5-hydroxyindoleacetic acid (5-HIAA) and the dexamethasone suppression test. Patients with nonsuppression of cortisol had the highest scores of the Suicide Assessment Scale (SUAS) and the Montgomery Asberg Depression Rating Scale (MADRS), respectively (P < 0.05; P < 0.01). The results persisted when analysed for covariance with CSF-5-HIAA. We have previously noted an elevated suicide risk in suicide attempters with high SUAS-scores, why a large part of nonsuppressors may be at high risk for future suicide.

The move towards the use of second-generation antipsychotics for the treatment of schizophrenia has provoked much discussion over how to differentiate between the various second-generation agents available on the market. The aim of this review is to provide information that may help clinicians in the decision-making process. The results of comparative studies on general efficacy measures (such as the Positive and Negative Syndrome Scale [PANSS] and the Brief Psychiatric Rating Scale [BPRS]) and comparative studies on cognition do not clearly favour one second-generation agent over another. However, some differences between second-generation agents have become apparent from studies which have examined specific symptoms such as hostility, suicidal ideation and depression/anxiety. There are also differences between second-generation agents with regard to specific aspects of tolerability. For example, in a number of studies olanzapine is associated with fewer extrapyramidal symptoms (EPS) than risperidone, but treatment with risperidone or amisulpride is associated with less weight gain and somnolence. Some studies have investigated the results of switching patients from one antipsychotic agent to another. They have generally reported a successful switch to a second-generation agent.

Overall, there is not enough scientific evidence available to clearly favour one second-generation antipsychotic agent over another in terms of general efficacy or tolerability. Therefore, clinicians must make an individualised treatment decision, and select the most appropriate antipsychotic agent for each patient.

The objective of the present study was to conduct a systematic inquiry into the frequency and impact of patients’ suicide on psychiatric trainees, and the availability and usefulness of training courses. Data were collected from 114 psychiatric trainees of the Dutch-speaking part of Belgium, representing a 70% response rate. A self-report questionnaire developed in the UK was adapted to the Flemish situation. A Dutch version of the Impact of Event Scale (IES) inquiring about post-traumatic stress symptoms was also used. The frequency of suicide experience was considerably higher in the present study than in similar studies in the USA and the UK. Thirty percent of first year trainees had been confronted with patient suicide. Personal and professional impact of patient suicide, as well as post-traumatic stress scores were considerably lower in Flemish psychiatric trainees. They considered informal support to be of more value than formal support to come to terms with the event. Finally, postgraduate training in post-suicide management was found to be largely insufficient. The results of the present study show that psychiatric trainees in the Dutch-speaking part of Belgium are at a high risk of experiencing patient suicide, whereas the impact of this experience appears to be relatively low. Only a small minority of trainees has received adequate training on procedures to follow after patient suicide.

Rather high prevalence rates of alcohol abuse in the elderly have been reported in the literature. However, there is some evidence that many elderly persons with alcohol problems are not identified, probably due to the nonspecificity of alcohol-related presentations in old individuals. Thus, there is an ongoing discussion on appropriate diagnostic criteria for alcohol dependence in elder people who frequently begin to abuse alcohol in late life. This study was aimed to explore whether alcoholics with late onset (beginning after the age of 45) differ from those with an early onset (prior the age of 25). Two hundred and sixty eight subjects consecutively referred to a ward of a general hospital specialized for alcohol detoxification were divided into three groups by the age at onset of harmful alcohol consumption. The duration of harmful drinking was rather similar in all groups. However, alcohol dependence according to the ICD-10 criteria (three or more have to be fulfilled) was diagnosed in 94.1% of the alcoholics with an early onset (≤ 25 years), but only in 62.2% of those with late onset (P < 0.0001). Significant differences between these groups were found for the following criteria: preoccupation with drinking (P < 0.0001), impaired capacity to control drinking (P < 0.01), strong desire to drink alcohol (P < 0.01), and a trend towards a lower rate of lifetime psychiatric comorbidity. The alcoholics with late onset reported fewer previous detoxifications and a lower actual alcohol consumption. Moreover, they showed a higher rate of abstinence in the 12 month follow-up. Regarding the difficulties in comparing groups of different ages at onset of harmful alcohol use our results suggest that the alcoholics with late onset differ in many ways from those with early onset.

This study investigated the nature of factor structure of schizophrenia syndromes using a sample of 151 patients with schizophrenia according to DSM-IV. The patients were assessed on the Scale for the Assessment of Positive Symptoms (SAPS), the Scale for the Assessment of Negative Symptoms (SANS), Hamilton Depression Rating Scale (HDRS) and the Phillips Rating Scale of Premorbid Adjustment in schizophrenia. Three factors—negative syndrome, reality-distortion syndrome and disorganized syndrome were extracted when only SAPS and SANS were analysed. Addition of the Phillips Rating Scale scores to SAPS and SANS ratings in the factorial equation led to splitting of the negative syndrome though reality-distortion and disorganized syndromes remained stable. Factor analysis of the HDRS scores with SAPS and SANS ratings resulted in the HDRS loading highly on reality-distortion syndrome and splitting of negative syndrome. Factor analysis of all the variables taken together resulted in delineation of four factors. The study suggests a link between depression and reality distortion. Apathy and anhedonia seem to be linked to premorbid adjustment.

Mood disorders that have no medical or pharmacological causes are divided into depressive disorders (unipolar, or major depressive disorder) and bipolar disorders. In bipolar disorders, both depressive and manic episodes occur sequentially.

A manic episode is characterised as an abnormally excited mood that is experienced by a patient for a distinct period (at least a week). Diagnosis of mania requires that a patient’s work and social life be significantly affected, or that the patient needs hospitalisation. Diagnosis also requires the presence of three or more of the following symptoms: inflated self-esteem or grandiosity; decreased need for sleep; increased talkativeness; racing thoughts/ideas; distraction; increased goal-directed activity; excessive involvement in pleasurable activities [1].