Background. A randomized controlled clinical trial compared three treatments for major depression in primary care. Ninety-one patients were randomized to receive either problem-solving, or amitriptyline with standard clinical management, or drug placebo with standard clinical management. This paper examines the possible predictive value of a range of demographic clinical and personality variables in determining outcome.

Methods. To examine the interaction between treatment group and predictor variables, analyses of co-variants were carried out for two outcome measures: the Hamilton Rating Scale for Depression and the Beck Depression Inventory. Predictor variables were also entered into a stepwise forward logistic regression in which patients were categorized as recovered or not recovered.

Results. None of the predictor variables examined interacted with treatment to predict outcome. Patients with a longer duration of illness, chronic social difficulties, or definite, as opposed to probable, major depression had a poorer outcome at the end of treatment, irrespective of treatment group.

Conclusions. The findings in this study do not enable clear guidelines to be given as to which patients with major depression in primary care might benefit from either a psychological or pharmacological treatment.

Background. Tardive dyskinesia (TD) is a therapy-resistant adverse effect of neuroleptics. Although the exact pathophysiology of TD is unknown, oxygen radicals have been speculated to play a role in TD based on several lines of evidence. Superoxide dismutase (SOD) is a key enzyme which scavenges oxygen radicals. The authors investigated the association between erythrocyte SOD activity and TD.

Methods. Erythrocyte SOD activities were measured, blinded as to the presence or absence of TD, in 30 patients with schizophrenia who had been on typical neuroleptics for more than 10 years. TD severity was independently assessed, using the abnormal involuntary movement scale (AIMS), by two raters.

Results. There was a significant decrease in erythrocyte SOD activity in the definite TD group (N=10) as compared with the no TD (N=8) and questionable TD (N=12) groups. Erythrocyte Cu,Zn-SOD activities correlated with AIMS scores.

Conclusions. Patients with TD had low SOD activities as compared to those without TD. As a causal link between SOD activity and TD was not established in this study, larger prospective studies are warranted to determine whether patients with low SOD activity are susceptible to neuroleptic-induced TD.

Background. The treatment of Tourette's syndrome (TS) is often unsatisfactory. However, there is some evidence that transdermal nicotine patch (TNP) application may improve tics of non-smoking TS patients who are refractory to haloperidol treatment.

Methods. In this open study we applied two 10 mg TNP for 2 consecutive days to four TS patients whose symptoms were not controlled by haloperidol and to a never-medicated TS patient, all of whom are non-smokers. The Yale Global Tic Severity Scale (YGTSS) and a quantified video-taped micro-structured analysis of tics (head-shake tics, eye-blinks, vocal tics, facial grimace and other body tics) were both carried out to assess the change after the application of TNP.

Results. TNP application significantly reduced the YGTSS by an average of 50%, with no reported side-effects, for up to 4 weeks but not 16 weeks, as compared with TNP-free period. Consistent with these results, the total counts of tics also showed a significant decrease for up to 4 weeks after the TNP application.

Conclusion. TNP application differentially affected individually quantified tics, which may suggest a differential role of nicotinic receptors in the generation of different tics.

Background. Gilles de la Tourette's syndrome (GTS) is a familial neuropsychiatric disorder characterized by tics and obsessive–compulsive behaviours (OCB). Previous HMPAO SPET studies of subjects with GTS have shown hypoperfusion of striatal and frontal areas. Studies of patients with primary obsessive–compulsive disorder have shown, in contrast, hyperperfusion of similar areas.

Methods. Twenty subjects from five families affected by GTS, including individuals with OCB but no tics, were examined using HMPAO SPET.

Results. There were abnormalities of regional cerebral perfusion in individuals with GTS, OCB and tics. Hypoperfusion was in striatal, frontal and temporal areas. There was no hyperperfusion.

Conclusions. Regional cerebral blood flow patterns in individuals with OCB in families affected by GTS are comparable to their relatives with GTS and differ from individuals with primary OCD in the absence of a family history of tic disorders.

With the support of the European Union Biomed programme, a database is being assembled on all known health surveys and general population epidemiological studies in Europe that have a mental health component. This database may be consulted free of charge. Workers who have conducted, or are conducting, relevant studies are invited to send information to be incorporated in the database. The contact person is: Catherine Polge, Equipe ‘Vieillissement cognitif’, CRLS, Val d'Aurelle, F 34298 Montpellier Cedex 5, France. Tel 33 04 67 61 30 28. E-mail: catherine.polge@dicdoc.inserm.fr.

Unless positive responses are verified at a second stage of data collection, a questionnaire-based survey has limited ability to assess change in caseness in a longitudinal study of a condition of low prevalence, assuming imperfect validity of the survey instrument.