Two different methods were compared in the assessment of depressive symptomatology improvement: live naturalistic (N) performed by the patient's therapist, and from videotape record of structured clinical interview (VSI) assessed by an independent rater out of five psychiatrists.

Sixty-one newly admitted depressed inpatients, with a Montgomery and Asberg Depression Rating Scale (MADRS) total score above 20, were assessed before antidepressant treatment (DO), after 10 days (D10) and 4 weeks of treatment (D28). Assessments were based on the MADRS and the Depression Retardation Rating Scale (DRRS) for both N and VSI methods, and on the SCL-90-R for self-rating.

With the MADRS, the N method was shown to be more sensitive to symptomatology change than the VSI method, but the VSI method was more correlated to self-assessment than the N method was. However, these results were not replicated on the DRRS, for which an underscoring with the VSI method was evidenced as compared to the N method.

As shown in other studies, the poorest agreement between the two methods was evidenced at DO, suggesting a “novelty effect” particularly with the VSI method. This “novelty effect” may be all the more pronounced if a personality disorder is associated to depression. Consequently, information concerning each patient before rating videotapes is needed, as well as investigations in the field of depression and personality disorders.

The greater change observed in MADRS with the N method as compared to the VSI method, may be due non-specific factors related mostly to therapist expectations by comparison to neutral raters. This hypothesis should be tested in the placebo group of a double-blind study, and, if confirmed, the use of VSI methods, by minimising non-specific factors of improvement due to therapist expectations, may decrease the placebo response in antidepressant drug trials.

There has been a growing interest in the quality of life (QoL) of the mentally ill, subsequently a number of instruments to measure QoL have been developed. One of the measures of QoL which has received considerable attention is the Lancashire QoL Profile (LQOLP). The present study investigated test-retest reliability and internal consistency in the Swedish translation of the LQOLP using a cross-sectional sample of 29 inpatients. The results showed that test-retest reliability of subjective life satisfaction in the nine life domains covered by the LQOLP was satisfactory in seven of the domains, and acceptable in two (social relations and religion). Test-retest reliability for total subjective satisfaction score, global well-being, and an interviewer rated QoL were all on a satisfactory level (r > 0.80). The internal consistency and homogeneity of the total subjective QoL scale and the nine life domain subscales was satisfactory except for the social relations scale, where it was somewhat low.

The purpose of this study was to evaluate the quality of life of heroin dependent patients before and 1 year after the start of methadone maintenance treatment. Subjects were patients (n = 102) requesting treatment in a public methadone maintenance programme in Geneva (Switzerland). This was a prospective follow-up study using a validated questionnaire (SQLP). The SQLP was well accepted by patients and staff. Validity of the questionnaire was reconfirmed in this population. Compared to previously studied populations, the quality of life of heroin dependent patients before start of treatment was poor. More than half the patients were still in treatment after 1 year and their quality of life had clearly improved, in most domains. Like many of their peers in the psychiatric field, the patients had high initial expectations. Expectations decreased significantly over time. It was found that the higher were the initial expectations, the poorer was the quality of life after 1 year. The quality of life of heroin abusers requesting treatment is mediocre, and improved considerably after 1 year of comprehensive methadone maintenance treatment. Quality of life evaluation is feasible in this population and can offer an additional evaluation of quality of substance abuse treatment.

Many countries have recently changed to the diagnostic system ICD-10. In Denmark a change from ICD-8 to ICD-10 was carried out in 1994. In the present study it was assessed whether the change in diagnostic system is responsible for a considerable increase in the number of registered drug abusers in the Danish mental hospitals, reported by the National Board of Health in Denmark from 1993 to 1994. Data is extracted from the Danish Psychiatric Case Register, which contains data on all psychiatric admissions in Denmark from 1970 to the present. The results show that it is not possible to follow the development of different kinds of drug abuse from ICD-8 to ICD-10. It is however, possible when setting the right conditions to make longitudinal investigations across the shift from ICD-8 and ICD-10 when estimating the total number of drug diagnoses. It is concluded that comparing data in different diagnostic systems even in different versions of the same system is demanding and that research based on such sources always must be carried out on the basis of a profound evaluation of the selection procedure, the registration principles and the diagnostic system itself. This is recommended not only in the fields of substance abuse but in all studies based on data from different diagnostic systems.

The use of a placebo control group in the evaluation of a new product is today considered by most as a necessary condition of experimental drug research. Placebo response is an essential consideration in all clinical trials. If not properly controlled, incorrect and dangerous conclusion may be inferred for a product efficacy and safety profile. However, the inclusion of a placebo group in clinical trials in neuropsychiatric research raises several ethical and scientific questions. Whereas in certain indications, such as suicidal patients and severe and psychotic depression, the use of a placebo is generally not accepted, it is difficult to assess drug efficacy. This article discusses the concept of placebo in clinical trials, the occurrence of adverse events after placebo treatment and the high response rate of placebo in neuropsychiatric clinical research. The experimental methodology to adequately control all the factors involved is also analysed and discussed.

The inter-rater reliability of the French versions of the MADRS and the DRRS was studied on the basis of 58 videotape records of structured standardised interviews of depressed inpatients under antidepressant treatment. Each patient was assessed by two trained raters, from the same videotape recording. The inter-rater reliability of total scores was high with both scales (intra-class correlation coefficients: 0.86 for MADRS and 0.77 for DRRS). However, the inter-rater reliability for individual items was higher and more homogeneous for the MADRS than for the DRRS. Finally, the structured interview in French appears to be relevant for the MADRS, but it should be improved for the DRRS.

This longitudinal study was performed to characterise frequently readmitted patients in a sample of 64 first-timers of inpatient care. Half of the 12 revolving door patients were psychotic at last discharge. The relative risk for diagnostic change in the Axis I group was nine times higher than in the personality disorder group.

The aim of this study was to test that deficit (D) schizophrenic patients as defined by Carpenter et al had a higher prevalence of family history of schizophrenia but less obstetric complications than non-deficit (ND) patients. A lower rate of obstetric complications but an excess of schizophrenic and a higher rate of alcoholism family antecedents in 18 D patients compared to 23 ND patients were found. These results could suggest that there is a different weight of genetic and early environmental factors in D and ND patients.

An open label trial was conducted to study the efficacy of zuclopenthixol decanoate, a D1/D2 antagonist, in the treatment of chronic (> 10 years) neuroleptic-resistant aggressive schizophrenia (n = 10) and psychotic oligophrenic patients (n = 6). A significant reduction was noted in the Brief Psychiatric Rating Scale score, especially in the clusters of hostility-suspiciousness and excitement. After many years of seclusion, ten of the 16 patients were transferred to an open psychiatric department and were allowed to visit their families.