Objectives were to assess the relations of various sleep complaints with depressive and anxiety complaints in a non-clinical population. Four-hundred-and-two randomly approached adults received three questionnaires. Results showed a high interrelatedness between sleep and depressive/anxiety complaints. Both assessment and treatment of depressive and anxiety complaints should address sleep problems.

Approximately 40–70% of treatment-resistant schizophrenic patients fail to benefit from clozapine monotherapy or are partial responders. During the last years several clozapine adjunctive agents have come into clinical practice. This study aims to critically review all published randomized, double-blind, placebo-controlled clinical trials (RCTs) regarding the efficacy and safety of adjunctive agents in clozapine-resistant schizophrenic or schizoaffective patients. A MEDLINE search for RCTs on clozapine adjunctive agents published from January 1980 to February 2004 was conducted. All identified papers were critically reviewed and examined against several methodological features as well as clinical and pharmacological parameters. Eleven trials including 270 patients, partial or non-responders to clozapine, assessed the efficacy of sulpiride, lithium, lamotrigine, fluoxetine, glycine, d-serine, d-cycloserine and ethyl-eicosapentanoate (E-EPA) as clozapine adjuncts. There were eight parallel-group and three crossover trials. The inclusion criteria varied widely. The duration as well as the dosage of clozapine monotherapy were reported adequate in only one trial. Plasma clozapine levels were assessed in only three trials. Main side-effects reported were hypersalivation, sedation, diarrhea, nausea, hyperprolactinaemia. The outcome favored clozapine augmentation with sulpiride, lamotrigine and E-EPA. Lithium was shown to benefit only schizoaffective patients. However, the methodological shortcomings of trials analyzed limit the impact of evidence provided.

Nicotine has been proposed to provide anxiety relief, oral gratification and self-medication of psychotic symptoms in psychiatric patients. In order to investigate the relations between psychopathology and tobacco use we measured the concentration of cotinine, the major metabolite of nicotine, in the saliva of psychiatric patients and healthy volunteers. In a sample of 42 schizophrenic patients we correlated smoking status, cotinine levels, symptom profiles (PANSS), and neuroleptic side effects (Simpson–Angus). Despite reporting the same amount of cigarettes consumed per day the saliva concentration of cotinine was significantly higher in patients with schizophrenia than in the controls. There were no significant differences in clinical characteristics between smoking and non-smoking schizophrenic patients, but smokers tended to be on higher drug doses. High cotinine concentrations correlated significantly with the negative symptoms Passive withdrawal and Social avoidance. The results indicate that the schizophrenic patients smoke cigarettes more intensely than other patients and healthy subjects. The correlation between high cotinine levels and negative symptomatology may reflect an attempt by schizophrenic patients to overcome the emotional withdrawal and thus the results may lend support to a self-medication hypothesis.

There is ample evidence for a distorted presentation of the mentally ill in the media. However, only little is known about its impact on attitudes towards people with mental disorders. Therefore, we investigated the relationship between watching TV and reading the newspaper on the one hand, and the desire for social distance towards people with schizophrenia on the other. In 2001, a representative population survey was conducted in Germany, using a fully structured personal interview. We found that the desire for social distance towards people with schizophrenia increases almost continuously with the amount of TV consumption. The association between reading the newspaper and social distance is less pronounced and depends on the type of newspaper people read. Since, obviously, there is a relationship between media consumption and attitudes towards people with schizophrenia, inaccurate and one-sided messages about mental disorders should be replaced by accurate and more balanced messages.

Selective Serotonin Reuptake Inhibitors (SSRIs) have been accused of causing bleeding problems as a side effect. Theories about the mechanism are still being discussed. We report a case, presenting bleeding problems, during sertraline treatment. The SSRIs are widely used to treat depression and many other psychiatric disorders. Their lower severity of side effects and being markedly safer in overdose are some of the reasons of their preference as primary choice in most of the cases. Besides their common side effects like, agitation, headache, insomnia, weight gain or loss, and sexual dysfunction, SSRIs also have been suspected of increasing the risk of bleeding. A population-based cohort study supported the hypothesis of an increased risk of upper gastrointestinal bleeding during the use of SSRIs, and they also indicated that this effect is potentiated with concurrent use of NSAIDs or low-dose aspirin. We would like to report our recent experience with one patient who was on sertraline, 50mg/day.

Exposure to earthquakes has been associated with psychological distress and in particular the development of post-traumatic stress disorder (PTSD). Earthquake-related psychological distress can be longstanding. The present study involved 157 Greek survivors of the 1999 Parnitha earthquake assessed approximately 4 years after the earthquake. Assessments were based on the Traumatic Stress Symptom Checklist (TSSC). Using stringent calibrations for the estimation of symptom presence 25% of the survivors endorsed at least 5 and 12% at least 10 TSSC symptoms. Approximately 22% of the survivors reported subjective distress and 15% impaired adjustment due to their symptoms. Intensity of fear during the earthquake and participation in rescue operations related to greater post-earthquake psychological distress. The results suggest that the psychological consequences of earthquakes can be serious and long-standing even when the magnitude of the earthquake is moderate. Psychological treatments that have been proven to reduce fear and PTSD symptoms need to be made available to the survivors. Such treatments may also increase the survivors' psychological preparedness and emotional resilience in view of future earthquakes.

Attachment styles as well as personality traits in adolescents and adults have been found to be associated with their health outcomes and with their personality pathology. In this cross-sectional exploratory study, we study the relationship between attachment styles that derive from our data employing the items of Feeney et al. (1994) self-report attachment style questionnaire (ASQ), and personality traits given by the junior version of Cloninger et al. (1993) self-report temperament and character inventory (TCI), in a sample of 426 adolescents (54% females) from a general population. The secure attachment style was correlated significantly negatively with the personality trait harm avoidance (HA), but significantly positively with the personality traits novelty seeking (NS), reward dependence (RD), cooperativeness (CO) and self-transcendence (ST). The preoccupied (anxious/ambivalent) attachment style was correlated significantly positively with HA and NS, but significantly negatively with self-directedness (SD). The fearful-avoidant category was correlated significantly negatively with NS. Our five-factor solution of the attachment styles and their relation to the TCI point towards a need for a modification of the two-axis, four-category attachment model of Bartholomew (1990) and Bartholomew and Horowitz (1991), with their category dismissing-avoidant replaced by the two categories defined here as dismissing relations (correlated significantly negatively with CO) and dismissing others (correlated significantly negatively with RD and significantly positively with SD).

Data on admissions of schizophrenia- and schizoaffective disorder patients to Tel-Aviv’s seven public psychiatric hospitals during 11 consecutive years were obtained along with relevant meteorological information. Mean monthly admission rates were significantly higher during the summer (for schizophrenia patients) and fall (for schizoaffective patients). Schizophrenia patients’ mean monthly admission rates correlated with mean maximal monthly environmental temperature (R =0.35, N =132 months, P <0.001). The present study may indicate that persistent high environmental temperature may be a contributing factor for psychotic exacerbation in schizophrenia patients and their consequent admission to mental hospitals.