For all controlled studies that bear upon the analgesic-effect of antidepressants, a meta-analysis was conducted to get an estimation of the effect size and to get a sight on the possible modes of action. For this purpose both content and methodological variables were coded for each study. The mean size of the analgesic effect is 0.63. This means that the average patient getting an antidepressant has less pain than 74% of the patients getting a placebo. However because of selective drop-out and the use of psychometri-cally inadequate pain scales, this may be an over-estimation. Real analgesic qualities of antidepressive agents seem to offer the most plausible explanation for the effect, but the importance of serotonin reuptake blocking is not confirmed. A main objection, however, is that in all studies the depression variable was insufficiently controlled at inclusion. Because both the estimation of the effect size as the explanation of the effect are confounded with methodological doubts, it is concluded that further studies need to be done to overcome these difficulties.

With the introduction of major tranquillizers more than three decades ago symptom rating scales were soon accepted as the method of evaluating their clinical effects. The Mini-compendium is a collection of rating scales for measuring outcome of antianxiety drugs, antidepressants, antimanics, and anti-psychotics. The scales have been selected by their “cash values”, i.e. the scales most frequently used for the respective dimensions. These scales have been further developed in terms of strict item definitions. The simple sum of the individual scale items has been considered as a sufficient statistic if they fulfilled latent structure analysis of shared phenomenology.

In this article the value of the tyramine conjugation test (TCT) as a predictor of the response to antidepressive medication is reviewed. The TCT seems of little discomfort for the patient, is easy to perform and is suggested to have a high sensitivity and specificity. In addition, there are indications that a decreased tyamine conjugation could be a traitmarker for the vulnerability of depression. Hypotheses concerning the, as yet unclear etiology of the decreased tyramine are reviewed.

R,S-Oxazepam and R,S-temazepam can be separated in their enantiomers by means of a chiral AGP column. The corresponding R- and S-glucuronide conjugates can be separated on a normal reversed-phase C18 column. Man conjugates the S-enantiomer of oxazepam and temazepam both better than the R-enantiomer. The urinary recovery of the glucuronides following either R,S,-oxazepam or R,S-temazepam almost amounts to 100% of the dose administered.

The present review deals with preventive and treatment strategies for sleep and wake disorders, and the other problems of shift workers. Management must take into account the direction, speed and other parameters of the rotation schedule. Good sleep-wake hygiene may alleviate the problems. Further, additional napping may compensate – at least partially – for sleep deprivation and fatigue. Hypnotics must be avoided as much as possible. Finally, new techniques for manipulation of circadian rhythms are discussed: light, melatonin and benzodiazepines.

A preclinical evaluation is presented of the serotonin 5-HT2 antagonists ritanserin and risperidone. Whereas ritanserin is a relative selective 5-HT2 antagonist, risperidone is a potent 5-HT2 and catecholamine antagonist. The pharmacological differences between both drugs are also observed in the drug discrimination test procedure. Using DOM, d-amphetamine and cocaine. Ritanserin was found active in animal models of anxiety using natural aversive stimuli; and in animal models of depression. Clear differences were observed between ritanserin and the benzodiazepines and between ritanserin and the tricyclic antidepressants. Risperidone was active in animal models of psychosis. Risperidone has, as opposed to classical neuroleptics such as haloperidol, less risks of inducing a dopamine D2 overblockade. Clinically, ritanserin is described as a thymostenic agent.

Risperidone is an antipsychotic with therapeutic effects on both the positive and negative symptoms of schizophrenia and with a reduced risk of extrapyramidal side-effects.

Violent behaviour between inpatients and wardpersonnel is seen from a relational viewpoint. The reactions of the staff show a strong similarity with regressive transferences from the patients. Limit-setting as a method should be employed to contain the individuel behaviour of the patient as also so further the social climate on the ward. The method of limit-setting involves the reality testing of the patient, the transference reactions between patient and staff, clarity in decision-making and regulations, and architectural arrangements. These four levels of influence are separately discussed.

Deze aflevering gaat over een probleem van naamgeving. Door de recente trends op het gebied van de indicatiestelling van psychofarmaca worden we meer en meer in de war gebracht. Uit het verloop van dit verhaal zult u wel zien waarom en de vraag is of u de redactie van advies wilt en kunt dienen.

In de meeste farmacologische textboeken worden de psychofarmaca ingedeeld naar de klinische werking, zoais u weet, en drie hoofdgroepen worden onder-scheiden: de psychoanaleptica, de psycholeptica en de psychodysleptica. Hier zullen we ons beperken tot de eerste twee groepen. Tot de belangrijkste typen farmaca van de eerste groep worden de antidepressiva en soms de lithiumzouten gerekend en tot de tweede groep behoren de ataractica (zoals de ben-zodiazepinen) en de antipsychotica. Hoe verhoudt zieh zo'n indeling ten opzichte van andere farmaco-therapeutische indelingen in de geneeskunde: worden eiders farmaca gerubrieeerd volgens de klinische indicaties of volgens de primaire aangrijpingspunten c.q. chemische karakteristie-ken? Soms volgt de indeling het werkingsprineipe, dan weer het ziektebeeld of symptoom, waarbij het middel het meest wordt toegepast.

In deze rubriek zal worden ingegaan op recente observaties betreffende de psychofarmakologie in de breedst mogelijke zin. Vaak zullen zaken uit de Literatuur worden behandeld. De gekozen onderwerpen dienen altijd klinische relevantie te hebben. Ook zal deze rubriek gaan over gewoontes die in psychofarmakologische behandeling of in onderzoek zijn geslopen die volgens de auteur lang niet altijd logisch zijn. Soms zal deze rubriek een oproep bevatten om te reageren op een bijdrage gepubliceerd in dit of in een ander tijdschrift. Ook zal de lezer worden aangemoedigd hier zijn eigen ervaringen mee te delen. Het is niet de bedoeling in deze rubriek onderzoeken uitvoerig te rapporteren. Daarvoor staan andere pagina's van de Acta Neuropsychiatrica voor u open.