Biological depression research can boast of a number of significant achievements over the past 35 years. Yet, in spite of those achievements, the field is in danger of desiccation. Five reasons are discussed herein: 1) short-comings of the DSM-based depression classification; 2) the ever increasing number of, generally poorly validated, diagnostic categories; 3) desubjectivation of psychiatric diagnosing; 4) the lack of a dimensional (better: functional) component in diagnosing depression; and 5) horizontalism, ie the absence of attempts to group symptoms “vertically” according to their diagnostic weight. The issues are in need of urgent scientific attention, lest biological depression research will stagnate and ultimately whither. We have indicated ways to approach the issues.

A study sample of 88 patients suffering from delusional beliefs was examined from first admission to follow-up. From the time of index admission, global functioning differs when distributed in accordance with ICD-10 categories. Patients with the discharge diagnoses affective disorder and acute and transient psychotic disorder have similar and optimistic perspective. The most pessimistic perspectives apply to patients with schizophrenia and an intermedium, but a rather pessimistic position also applies to patients with persistent delusional disorder. According to the discharge diagnosis following first admission, the score of global assessment functioning (GAF) at follow-up (8 years) is: schizophrenia 37; affective disorder 73; persistent delusional disorder 47; and acute and transient psychotic disorder 70. Generally, short-term outcome bears close resemblance to that of middle-term observation. During the observation period, 13 patients died. Amongst the surviving 75 patients, diagnosis at follow-up differed from that given at first-admission discharge, in eight cases using ICD-10 and in ten cases using DSM-III-R. Therefore, the use of ICD-10 as well as DSM-III-R enables clinicians to estimate a high stability (89%) diagnostic category with minimal delay.

In this cross-sectional study we have investigated the attitudes and feelings toward the mentally ill among the residents of two Central European regions which are at considerably different stages of development in moving toward community-based care, to see if we could connect differing patterns of attitudes in the two regions to the varying levels of development of psychiatric care. By using the telephone survey method, representative samples of interviewees were presented with two complexes of questions, measuring the social distance of the interviewee to the mentally ill and his/her feelings toward the mentally ill. Social rejection and feelings of the people toward the mentally ill in both regions were similar in the direction they took, however not so much in the intensity. The population of the community care area showed a slightly stronger rejection. But factor analysis clearly suggests a more rational and sophisticated position toward the patients in this population. The people living in the custodially-oriented catchment area, on the other hand, showed a more vague pattern in their attitudes.

Psychoanalytical, behavioural and cognitive theories assume a continuous process in the development of self-acceptance as an important psychological variable by parent-child interaction during childhood and adolescence. The objective of the present study was to investigate the relationships between perceived parental rearing behaviour and self-acceptance in psychiatric inpatients. The results of extreme group comparisons pointed to the reciprocal discriminative power of parental rearing factors and self-acceptance scores, supporting the hypothesis of a continuous process in the development of self-acceptance and mood traits. Perceived parental rearing predicted aspects of psychopathology in adulthood. The effects of maternal and paternal behaviour appeared to be gender-specific. Alternative interpretations of these findings are discussed.

Chronic illness in a child requires successful organisational and emotional adjustment of the child and the family. The way in which the child and the family adapt to the illness will affect their psychological well-being and their quality of life. This review summarizes recent research findings on the relationship between illness factors, individual and family functioning, coping strategies and psychosocial adjustment. The findings are presented within the framework of three complementary theoretical models: the family developmental approach; the psychosocial typology of illnesses; and the process model of stress and coping. These models are useful for a better understanding of the complex interactions between illness, family and coping and offer to the professionals engaged in the care of chronically sick children, guidelines for assessment and the development of intervention programs. The review starts with examining the impact of chronic illness on the psychosocial adjustment of the sick child, his/her siblings and parents. Then psychosocial Stressors and risk factors in terms of illness and family related characteristics are discussed. Coping resources and strategies are presented which have been shown to be related to child and parental adjustment; and finally, successful intervention programs are described.

Little consensus exists on the risk of benzodiazepine (BZD) dependence. We investigated how often BZD dependence and related concepts have been defined in the literature on BZD effects in humans. In addition, the definitions of BZD dependence were compared in order to assess the similarity of contents. From a total of 250 papers (published between 1988 and 1991) 51 provided 126 dependence-related definitions. Six studies referred to the DSM definitions and one to the WHO definition. The obsolete concept of addiction was frequently defined (n=13), with little consensus about its meaning. Psychological and physical dependence were defined fairly often (n=29), also with low levels of consensus. We conclude that the discussion on the risk of BZD dependence would be well-served by attempting to improve consensus first. This may lead to more meaningful data on the incidence, prevalence and relevant co-factors of BZD dependence. An outline for criteria for benzodiazepine dependence is presented.

Midazolam is a short acting benzodiazepine that has been used for electroconvulsive therapy (ECT) anesthesia. The purpose of this study was to determine whether midazolam used for this purpose would impair the antidepressive efficacy of ECT. In a double-blind random-assignment study midazolam was compared to methohexital on the antidepressive efficacy of bilateral ECT as measured by the reduction in the Montgomery Asberg Depression Rating Scale (MADRS) scores and seizure duration. Sixteen DSM-III-R major depressive disorder patients with melancholia were included. Midazolam and methohexital did not differ in their effects on the MADRS score or seizure duration; no correlation was found between seizure duration and outcome of depression for either group. Our preliminary findings do not support the claim that benzodiazepines should not be used during bilateral ECT.

Psychological and physical signs traditionally considered as indicators of conversion disorder had never been confirmed through empirical data. Nineteen of these signs were sought in 40 patients with proved neurological disorder and in 15 patients with conversion disorder. All neurological patients but one showed at least one of these signs and most presented several signs. All the signs but one were as frequent in neurological patients as in patients with conversion disorder. These signs are lacking specificity. Even when several signs are present, this finding has no diagnostic specificity.