Disinhibition and irritability, defined as loss of behavioral and emotional control, are frequent in the elderly. The working hypothesis for this study was that these disorders are associated with a cognitive alteration of control processes that manifests as non-routine behavior because of the dysfunction of a general executive component known as the supervisory attentional system (SAS).

The aim of the study was to search for a body dysmorphic disorder (BDD) period preceding the symptoms meeting the criteria of either anorexia or bulimia nervosa, and an evaluation of the prevalence of BDD symptoms in a control group of girls without any eating disorder. Ninety-three girls (12–21 years old) were included in the study (36 with anorexia nervosa, 17 with bulimia nervosa and 40 healthy controls). The Structured Clinical Interview (SCID), including the BDD module, and a novel questionnaire (for the presence of preceding life events) were used. We found the symptoms of BDD in 25% of anorexia nervosa sufferers for at least six months before observing a clear eating disorder picture. Moreover, other mental disorders were also present among these patients. The results may support the idea that BDD and anorexia nervosa both belong to either OCD or affective disorders spectra.

This paper investigates the prevalence of symptoms and various diagnostic criteria of DSM-IV social phobia in a French national representative population of 12,873 subjects, aged 15 or more. Respondents filled out a mailed questionnaire based on the social phobia section of the Munich-Composite International Diagnostic Interview (M-CIDI) in the year 1996. Response rate was 80.5%.

Sixty-seven point one percent of the sample acknowledge having at least once in their lifetime a strong fear of one or more of the six prototypical social fear situations that are used as the CIDI social phobia stem items. However, only a few fulfilled all DSM-IV diagnostic criteria for social phobia. Depending on the type of diagnostic algorithms used and the stringency in which these criteria are applied, the resulting prevalence varied between 1.9 and 7.3%. These findings provide some further evidence about the considerable effects of varying diagnostic criteria and thresholds on prevalence rates for social phobia, explaining why most recent surveys have reported considerably higher rates of social phobia than those in the early 1980s.

The aim of this survey is to present an overview of research into psychopharmacology as regards the effects of different psychoactive drugs and neuroleptics (NL) on language in normal subjects and schizophrenic patients. Eighteen studies that have investigated the effects of different drugs (alcohol, amphetamines, secobarbital, L-dopa, psilocybin, ketamine, fenfluramine) and neuroleptics (conventional and atypical) on language are reviewed. There are no studies concerning the effects of neuroleptics on language in healthy subjects. The results of the effects of other molecules indicate that language production can be increased (alcohol, amphetamine, secobarbital), rendered more complex (d-amphetamine), more focused (L-dopa) or more unfocused (psilocybin) and clearly impaired (ketamine). For schizophrenic patients, most studies show that conventional neuroleptic treatments, at a therapeutic dosage and in acute or chronic mode, reduce language disorders at all levels (clinic, linguistic, psycholinguistic). In conjunction with other molecules, the classical NL, when administered at a moderate dosage and in chronic mode, modify language in schizophrenia, either by improving the verbal flow and reducing pauses and positive thought disorder (NL + amphetamine) or by inducing an impairment in the language measurements (NL + fenfluramine). Clinical, methodological and theoretical considerations of results are debated in the framework of schizophrenic language disorders.

Background – Suicide and suicide attempts have been associated to psychiatric illnesses; however, little is known about the role in suicide risk of those symptoms that do not meet the full criteria for a DSM-IV disorder. The aim of this study was to examine the prevalence of subthreshold psychiatric disorders among suicide attempters in Hungary. Methods – Using a modified structured interview (Mini International Neuropsychiatric Interview) determining 16 Axis I psychiatric diagnoses and their subthreshold forms defined by the DSM-IV and a semistructured interview collecting background information, the authors examined 140 consecutive suicide attempters, aged 18–65 years. Results – Eighty-three-point-six percent of the attempters had one or more current threshold diagnoses on Axis I and in addition more than three-quarters (78.6%) of the subjects had at least one subthreshold diagnosis. Six-point-four percent of the subjects (N = 9) had neither subthreshold nor threshold diagnoses at the time of their suicide attempts. Ten percent of the subjects (N = 14), not meeting the full criteria for any DSM-IV diagnoses, had at least one subthreshold diagnosis. In 68.6% of the subjects (N = 96), both subthreshold and threshold disorders were diagnosed at the time of their suicide attempts. The number of subthreshold and threshold diagnoses were positively and significantly related (χ2 = 5.12, df = 1, P < 0.05). Sixty-three-point-six percent of the individuals received two or more current threshold diagnoses on Axis I and 44.3% of the individuals (N = 62) had two or more subthreshold diagnoses at the time of their suicide attempts. Limitations – The subthreshold definitions in this study included only those forms of the disorders which required the same duration as the criteria DSM-IV disorder with fewer symptoms. Conclusions – Suicide attempts showed a very high prevalence of subthreshold disorders besides psychiatric disorders meeting the full criteria required according to the DSM-IV. Subthreshold forms of mental disorders need to be taken into account in suicide prevention.

Alleles of the D2 dopamine receptor (DRD2) and the alcohol dehydrogenase 2 (ADH2) genes were determined in 69 French Polynesian alcoholic patients and 57 controls matched for racial origin. Three racial groups were studied: pure Polynesians (PP), Polynesians mixed with Caucasian (PCA) ancestry and Polynesians mixed with Chinese (PCH) ancestry. DRD2 A1 allele frequencies in the alcoholics compared to their controls in these groups were: PP,.26 vs .32 (P = .69); PCA, .44 vs .35 (P = .46); PCH, .40 vs 0.39 (P = .88). ADH2 1 allele frequencies in alcoholics compared to their controls groups were: PP, .56 vs .62 (P = .66); PCA, .75 vs .56 (P = .09); PCH, .78 vs .32 (P = .009). In the PCA group, the combination of the DRD2 A1 genotypes and the ADH2 1 homozygotes was strongly associated with alcoholism (P = .0027). This preliminary study shows the importance of ascertaining racial ancestry in molecular genetic association studies. Moreover, it suggests that a combination of genes are involved in susceptibility to the development of alcoholism.

Personality disorders are frequently associated with socially unacceptable behaviours that might not be always considered deviant. On the other hand, envy has been linked with various forms of maladjustment such as interpersonal conflicts, low self-esteem, depression, anxiety, aggressiveness, and even criminal behaviour such as vandalism and even murder. According to the DSM-IV, none of the personality disorders, except the narcissistic personality, is formally associated with envy. Nevertheless, this ‘deadly sin’ is so omnipresent in human relationships that it cannot be restricted only to the narcissistic personalities. Most scholars recognise that people would deny that they envy someone else since envy is socially considered as highly undesirable; verbal reports are expected to be biased. To circumvent this difficulty, a projective questionnaire is proposed. We constructed two questionnaires: a direct version (DV) and an indirect version (IV). The sample consisted of 786 students from high school and university. Results suggest that the indirect version provides a more accurate assessment of envy.

The study examined psychological development in 250 children at the age of 6–7 and 10–12 years who had been exposed in the prenatal period at the time of the Chernobyl accident in 1986. These children were compared to a control group of 250 children of the same age from non- and slightly contaminated areas of Belarus. The examination included psychiatric examination and intellectual assessment as well as the estimation of thyroid exposure in utero. The mean value of thyroid doses from 131I 0.39 Gy was estimated for the prenatal exposed children. The children of the exposed group had a lower mean full-scale IQ compared to the control group (89.6 ± 10.2 vs 92.1 ± 10.5 at the age of 6–7 years, P = 0.007; and 94.3 ± 10.4 vs 95.8 ± 10.9 at the age of 10–12 years, P = 0.117). Average IQ for the subgroup of highly exposed children (thyroid doses more than 1 Gy) was lower in comparison with average IQ for the whole exposed group (85.7 ± 6.4 vs 89.6 ± 10.2 at the age of 6–7 years, P = 0.014; 89.1 ± 7.1 vs 94.3 ± 10.4 at age 10–12 years, P = 0.003). No statistically significant distinctions in average IQ were found between the different subgroups of children in relation to the gestational age at the time of the Chernobyl accident. We notice a positive moderate correlation between IQ of children and the educational level of their parents (in exposed group – mothers: r = 0.50, P < 0.01 and fathers: r = 0.52, P < 0.01; in control group – mothers: r = 0.41, P < 0.05 and fathers: r = 0.42, P < 0.05). There was a moderate correlation between high personal anxiety in parents and emotional disorders in children (for mothers r = 0.38, P < 0.05; for fathers r = 0.43, P < 0.01). The relative risk of mental and behavioural disorders has been estimated for emotional disorders OR = 2.67, P < 0.001. The frequency of the formation of mental retardation, hyperkinetic disorders and other mental and behavioural disorders in children from both groups was approximately the same. We conclude that in the genesis of borderline intellectual functioning and emotional disorders in the exposed group of children a significant role was probably played by unfavourable social-psychological and sociocultural factors such as a low educational level of the parents, the break of microsocial contacts and difficulties adapting, which appeared following the evacuation and relocation from the contaminated areas.

The aims of the present study were to compare the current and lifetime prevalences for major and subthreshold affective disorders in elderly subjects in the general population, to assess the influence of demographic variables on prevalence rates, and to examine co-morbidity between these disorders. Major and subthreshold disorders were diagnosed in 286 subjects (aged ≥ 60 years). Four-point-nine percent of the subjects had a lifetime diagnosis of major depression, 31.8% either minor or recurrent brief depression, 6.6% a major anxiety disorder, and 18.5% a subthreshold anxiety disorder. The risk for current and lifetime subthreshold anxiety was higher in females than in males, the lifetime prevalence for subthreshold anxiety disorders was increased in elderly subjects and subjects with low professional levels. Increased co-morbidity between major and subthreshold depressive and anxiety disorders could not be observed. In the elderly, subthreshold depressive and anxiety disorders are frequent, more so than major affective disorders. The presence of subthreshold anxiety disorders, but not subthreshold depression, is influenced by age, gender, and previous professional level. Further research focusing on detection, evaluation of risk factors and the relevance for the quality of life in the elderly general population is needed.

The Suicide Assessment Scale (SUAS), a scale constructed to measure suicidality over time, was administered to 191 suicide attempters. Its predictive validity was tested.

SUAS ratings were compared to ratings from other scales, and related to age and psychiatric diagnoses including co-morbidity. Eight patients committed suicide within 12 months after the SUAS assessment. Apart from advanced age, high scores in the SUAS were significant predictors of suicide. From a receiver operating characteristic (ROC) analysis, we identified cutoff SUAS scores which alone and in combination with certain diagnostic and demographic factors are of apparent value in the clinical evaluation of suicide risk after a suicide attempt.

Physicians have a higher suicide rate than the general population or other academics. Little is known about the reasons for this. Analysing risk factors may be a valuable way of identifying reasons for the high suicide rate among physicians, thereby leading to preventive efforts. The present study is one of the first papers on suicidal thoughts and attempts among physicians. A questionnaire about suicidal thoughts (developed by E.S. Paykel) was completed by 1,063 of 1,476 active Norwegian physicians (72%). Lifetime prevalence ranged from 51.1% for feelings that life was not worth living to 1.6% for a suicide attempt. Risk factors were being female, living alone, and depression. Suicidal thoughts, however, were hardly attributed to working conditions. A high rate of suicide and a low rate of suicidal attempts support the hypothesis that physicians do not ‘cry for help,' but are inclined to act out their suicidal impulses.

The high co-morbidity between bipolar disorder and alcohol dependence may have different explanations, one of them being the existence of common genetic factors for the two disorders. Several candidate genes may be involved but the genes acting in the dopaminergic pathway may be more specifically involved. We have thus tested the role of the gene encoding the D2 dopamine receptor (TaqI A1 allele) in the potentially shared vulnerability to alcohol dependence and bipolar disorder.

One hundred and twenty-two French (for at least two generations) patients were recruited on the basis of hospital or outpatient files and were interviewed with the DIGS. The A1 allele frequencies were compared between four groups, namely, with bipolar patients and co-morbid alcohol dependence (N = 21), with bipolar patients without alcohol morbidity (N = 31), with alcohol dependence without mood disorder (N = 35) and unaffected controls (N = 35).

The Hardy Weinberg equilibrium for the DRD2 Taq1 A1 genotypes was respected for the sample as a whole, and for each subsample. We observed that 42.9% of control subjects have at least one A1 allele, a frequency which is not significantly different from the one observed in the affected sample as a whole (39.1%), neither from patients with alcohol dependence (37.1%), patients with bipolar disorder (48.4%) nor patients with alcohol dependence and bipolar disorder (28.6%). The regression analysis based on the three variables (bipolar disorder, alcohol dependence and interaction between these two disorders) does not explain the presence of the A1 allele of the DRD2 gene.

We thus found no evidence for a significant role of the A1 allele of the D2 dopamine receptor gene in the specific association between bipolar disorder and alcohol dependence in our sample.

The main problem of depression is not only the high prevalence of the disorder but also its serious consequences on the patient’s quality of life and the associated social costs in terms of health care resource utilization and productivity losses. In recent years, there has been a considerable improvement in the knowledge of depression from the pathogenic, clinical and therapeutic perspectives. The present study analyzes whether such advances are reflected in a positive evolution of the treatment of depression in Spain. To this effect we have contrasted the results of two socio-sanitary studies published in this country: the White Book editions of 1982 and 1997 (WB82 and WB97, respectively). From the methodological perspective, the physician selection criteria employed were very uniform (structured questionnaires delivered to 128 (WB82) and 300 (WB97) randomly selected psychiatrists). The origin of patients consulting for specialized care has varied over this 15-year period. In effect, WB82 patients were essentially referred by friends (87.5%) and from the primary care setting (44.5%), whereas in the WB97 study referral from primary care predominated (50.1%), followed by the patient’s personal decision (24.8%). In turn, 40.7% and 51.7% of the psychiatrists in WB97 respectively considered the diagnostic and therapeutic means available in primary care to be insufficient. The priorities for improving patient quality of life, as reflected by both editions of the study, were the training of primary care physicians and the adequate provision of means in the mental health care centers. On the other hand, fewer problems for establishing a correct diagnosis were referred in the 1997 edition of the study (28.7%) than in 1982 (48.4%). In this sense, the main problem reported in WB82 was the lack of specialized training, whereas the masking of depression by some other disease process or symptoms was the main problem in WB97 (67.6% vs 21.1% according to WB82). The main symptoms upon which the diagnosis of depression are based do not seem to have evolved much in the past 15 years. The most frequently cited manifestations were a worsening of mood, loss of interest and leisure capacity, sleep alterations and diminished vitality. A comparative analysis of the therapeutic resources used was not possible, for prior to 1982 the only drugs available to physicians were the classical tricyclic agents and some MAO inhibitors; the selective serotonin reuptake inhibitors (SSRIs) – possibly the greatest advance in the treatment of depression in these 15 years – had not yet been introduced. Nevertheless, it should be pointed out that 98% of the psychiatrists consulted in WB97 considered pharmacologic treatment to be the most widely adopted form of management once depression has been diagnosed.

The aim of the present study was to compare the cerebral activation associated with encoding and retrieval in individual subjects with the average activation in the same group of subjects. Twelve volunteers performed two paradigms: 1) intentional encoding of words, and 2) recognition of learned words intermixed with new distracters. Echo-planar magnetic resonance imaging (MRI) of BOLD signal changes was used to compare cerebral activation between active and resting conditions. During encoding, activation of the left precentral gyrus related to the motor response was observed in some subjects. Averaged data showed increased activation of the left precentral gyrus, the supplementary motor area (SMA), the left inferior frontal gyrus and in the left temporo-occipital junction. During recognition, motor response-related activity was found in the precentral cortex and SMA in most subjects. Activation in other brain areas showed considerable interindividual variation. In the entire group, recognition showed activation of the left dorsolateral prefrontal cortex, the precentral gyrus, the SMA, and the temporo-occipital junction. The total amount and the distribution of task-related cerebral activation varies considerably between individuals and might correspond to individual preferences of cognitive strategies. The investigation of these interindividual variations will be an exciting scientific challenge in the near future.

This prospective study provided a direct comparison of French and American samples concerning a cognitive diathesis for depression. Using the Experience Sampling Method and identical measures across sites, subjects were signaled five times daily by electronic devices to provide in vivo reports of negative events, attributions, and depressed moods. After controlling for effects associating clinical and demographic variables, and despite differences attributable to national origin, attributional style emerged as a highly significant predictor of the numerous specific attributions made to negative events within the course of daily life. However, consistent with the cognitive mediation hypothesis, attributional style did not directly explain depression levels. The results are discussed in terms of the predictive power of cognitive and personality assessments in understanding the day-to-day experience of depression.

Previous analysis of data from the U.S. National Comorbidity Survey (NCS) suggested that the lifetime prevalence of social phobia in the community has increased significantly in recent cohorts. Furthermore, a latent class analysis of NCS data revealed two primary classes of persons with social phobia: those with exclusive speaking fears and those with one or more other social-evaluative fears. Social phobia in the other social fear group is more persistent, more impairing, and more highly co-morbid with other DSM-III-R disorders. The current report presents data on whether the cohort effect is a general aspect of social phobia or is specific to one of the NCS social phobia subtypes, and whether the cohort effect varies as a function of socio-demographic characteristics. Data were drawn from the NCS. Social phobia was assessed with a revised version of the Composite International Diagnostic Interview. Retrospective age of onset reports were used to estimate Kaplan-Meier survival curves for first onset of social phobia in each cohort represented in the survey. Comparison of these curves allowed us to make synthetic estimates based on retrospective reports of intercohort trends in lifetime prevalence. The lifetime prevalence of social phobia appears to have increased in recent cohorts. However, this increase does not exist among social phobics with exclusive fears of speaking. The increase is most pronounced among white, educated, and married persons, and it is not explained by increased co-morbidity with other mental disorders. The fact that the cohort effect is more pronounced for social phobia with one or more non-speaking fears is important in that this is generally a more severe form of the disorder with an earlier age of onset than social phobia with pure speaking fears. The fact that the cohort effect is most pronounced among people with social and economic advantage (i.e., white, married, well-educated) is intriguing and raises questions about the etiologic process that warrant further study in future research.

Panic attacks can be observed in a wide range of situations, but most common are those providing complex and unstructured stimulations, suggesting an impairment in attentional processing of visuo-spatial information. This study evaluated agoraphobics’ attentional processing of neutral (i.e., not anxiety-provoking) visuo-spatial stimulation. Twelve patients suffering from panic attacks with agoraphobia were compared with 22 normal controls on a computerized visual target discrimination task specifically designed for this study. Psychometric measures assessed the phobic avoidance, the level of depression and anxiety. The numbers of errors and reaction times were analysed with a three-way ANOVA (Group x target modality x number of stimulations). No between-group significant difference was found for the reaction time performance and the mean number of detection errors. However, an interaction effect was observed for this last variable depending on the target modality: agoraphobic patients made fewer omission errors than control subjects when the target was present among distractors, while they made more commission errors when the target was absent. Outcomes are discussed in terms of attentional hyperactivation related to anxiety and perseverative decision process in agoraphobic patients.