Kleine-Levin syndrome is a rare self-limited disorder which usually affects adolescent males and is characterized by episodic hypersomnia, increased appetite, and behavioral/psychiatric disturbances. Individuals are normal between the attacks.

The case of an adolescent boy is presented who suffered from recurrent sleepiness, hyperphagia, and behavioral disturbances such as rocking, punching and pacing, and was originally misdiagnosed as suffering from encephalitis. Before the diagnosis of Kleine-Levin was given, the patient underwent unnecessary investigations and treatment which, in turn, complicated his clinical condition both physically as well as psychologically. In the course of five years he had four such episodes which appeared to have progressively milder manifestations. Between episodes he was normal.

It is important that the diagnosis is suspected early, especially in adolescent males who present with recurrent episodes of somnolence, increased appetite, and abnormal behavior, since it most often represents a benign and self-limited entity and does not warrant extensive investigations or treatment. It is also important to distinguish this syndrome from more serious organic and psychiatric diseases with more serious prognoses. The differential diagnosis of this syndrome is discussed and a review of the literature is presented including evidence and hypotheses regarding its pathophysiology.

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.

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.

Spontaneous remarks to the author concerning the experience of brief depressive episodes prompted an enquiry into the experience of these in the general population. The finding that a high proportion of subjects admitting to the experience of recurring brief depression, that the episodes were generally of less than 24 hours' duration, suggests that allowance should be made for such very brief episodes in future enquiry of the topic, as these would not be recognised by the criteria for recurrent brief depression in the ICD and DSM definitions. There was no association of duration of episode with either age or gender. There did not appear to be an association of episode duration with possible precipitants of stress, climatic conditions, season of year or dietary factors.

This study examines the relationship between duration of untreated psychosis (DUP) and long-term symptomatic and social outcome in 205 patients with schizophrenia, whose parents are member of a consumer organisation. We found only a tendency that longer DUP was related to negative symptoms, but no relation to other outcome domains. The results of this study do not support antipsychotic intervention at the earliest sign of psychosis in order to ‘protect the brain’.

Clinical trials of new antidepressants usually compare a new drug to a reference antidepressant and to a placebo. The placebo is intended to validate the trial in the case of a no-difference outcome, i.e., it helps in assessing equivalence. The aim of the present paper is to test whether placebo has indeed helped establish equivalence of effect in comparative trials of new antidepressants. We carried out an example of sample size determination first in a trial to show a difference between the new and control drug, and second in a trial to assess equivalence between two competing drugs. Finally, we retrospectively calculated the maximum difference accepted as equivalence of effect in published trials of new antidepressants. Assuming a response rate to antidepressants of 70%, 294 subjects for each treatment group are needed to show a 10% difference between two antidepressant drugs and more than 1,300 to assess equivalence at a 5% level of δ, the maximum difference acceptable as equivalence of effect. The level of δ in published trials of new antidepressants ranges between 12 and 43%, suggesting they cannot claim to demonstrate equivalence of effect. Therefore, the presence of a placebo arm for comparison didn’t help establish whether both drugs really worked the same way. Comparative trials of new antidepressants should adopt a two-arm design, a suitable number of patients and a high standard in the experimental design in order to minimise possible control-event rate variation.

Several scales have been used to diagnose and evaluate depression in schizophrenia. However, the association between different depression scales and between depression scales and negative symptoms has not been studied adequately. Sixty-four consecutively admitted schizophrenic patients to Eginition Hospital, Department of Psychiatry, Athens, were assessed on the following scales: the Calgary Depression Scale for Schizophrenia (CDSS), the Hamilton Depression Rating Scale (HDRS), the Expanded Brief Psychiatric Rating Scale-Depression subscale (EBPRS-D), the Positive and Negative Syndrome Scale-Depression subscale (PANSS-D) and the Negative Symptoms subscale (PANSS-N). The depression scales were found to be highly intercorrelated with the exception of the comparison between the EBPRS-D and the PANSS-D. Out of the four depression scales studied, only CDSS and EBPRS-D can discriminate between depression and a PANSS-Negative Symptoms subscale score or negative item scores.

Torture has been a widespread experience in the twentieth century. Acute and chronic psychological sequelae are common among victims of torture. To our knowledge, there are few reports about eating disorders as a psychological sequela of torture. We report a female patient who developed an eating disorder following torture. A case of weight loss from food avoidance and vomiting in a young adult Turkish torture victim is described, and possible etiological factors discussed.