Acta psychiatrica Belgica最新文献

The results of a psycho-epidemiologic field study are presented. Lifetime and point prevalence rates of eight DSM-III (Diagnostic and Statistical Manual of Mental Disorders) diagnostic categories (generalized anxiety, phobia, panic, obsession-compulsion, major depression/dysthymia, mania, the somatization syndrome and alcohol abuse and dependence) are estimated on the basis of the DISSI (Diagnostic Interview Schedule, Screening Interview). The subjects, 25 to 45 year old adults (N = 240) were randomly selected from local registers. The point prevalence rates are 16.6% for anxiety disorders, followed by affective disorders (12.8%) and by the somatization syndrome (8.9%) and alcohol abuse and dependence (8.5%). Psychosocial correlates of the diagnostic categories are examined and the findings are compared to other field studies using comparable diagnostic tools.

In a double-blind randomized placebo-controlled cross-over design trial, the effects of a 4 week fluvoxamine versus a 4 week placebo treatment regimen on panic symptomatology were studied. Fluvoxamine seems to have specific antipanic properties, as a significant decrease in the number of panic attacks was observed. Other components of the disorder, like free-floating anxiety and avoidance behavior were not influenced during the short 4 week treatment period.

Psychiatric care or the care of the mentally ill is very ancient. However, psychiatry is only getting a part of medicine from the end of the XVIIIth Century on. Flemish psychiatric care means care for mental disturbed people in our Flemish countries; also we attend to the influences between opinions from stranger and Flemish physicians, philosophers and humanists. In the Middle Ages popular medicine, "healers" and priests interfere with the practice of the rare contemporary physicians and surgeons. Pilgrimage was the meeting-place for popular medicine, medical and religious acting. In Antwerp, Brugge, Ghent, the first hospices, hospitals and asylums arose. Geel got very well known as a unique centre of family care for crazy people. Mental disease was known as phrenesis (madness), melancholia, mania, epilepsy, rabies. In this period the possibilities of healing remained extremely limited. The Renaissance period was one of Humanism and Reform. The humanists developed a new image of humans. More, Erasmus and Vives were most critical against medieval philosophy and charged the medieval irrational thinking. Vives influenced medical, psychological and psychiatric thinking of his Flemish contemporaries. Also we can talk about the rise of Flemish humanistic medicine. For the Renaissance doctor the concept of passions of the soul as constituting disease states, treatable by opposite passions, set the stage for the consideration of affective disorders themselves as species of madness, whereas previously, madness was seen as a disorder of reason. Halfway the XVIIth Century arose what can be seen as the first biological revolution. The discovery by Harvey of the circulation in a closed system meant a sudden revolution of the Galenic scheme and introduced new ways for the physiology. The Flemish doctor J. B. van Helmont spent a long time to the reform of the medical art. His system was a prefiguration of actual functional affections, symptomatic drug therapy and talk therapy. The XVIIIth Century or "siècle des lumières", is characterised by the rapid development of the human sciences. Well-known are the medical school of Halle (Germany) and that of Leiden (Netherlands). The German Stahl was inspired by the van Helmont's system and first he plead for a healthy mental hygiene. The Dutchman Boerhaave studied on the nervous system and analysed the psychic affections in a psychosomatic perspective. With his publication of "Man a machine" the Frenchman La Mettrie was at the base of a new experimental and scientific medical research.(ABSTRACT TRUNCATED AT 400 WORDS)

The elaboration of a-theoretical comprehensive classifications has become a main concern of American psychiatry. European psychiatrists are frequently reluctant to join this consensus-based endeavour. Their nosological approaches have largely been guided by the theoretical distinction between genuine mental diseases and quantitative psychic deviations: Jasper' warning that the dismemberment of the latter leads astray incited them to concentrate mainly on the classification of the former. Thus, European psychiatrists developed several concepts of functional psychoses which differ in regard to the subdivision of these disorders and their delimitation from mere quantitative deviations. The American classifications have partially abandoned or distorted traditional european views. In order to examine the reliance of their concepts the European schools should more systematically provide operational diagnostic criteria and submit them to polydiagnostic validation-studies.

Many pharmacological agents have been proposed for the treatment of drinking problems. However, there are many pitfalls in the assessment of the clinical interest of those drugs. In this paper, we propose a new classification of drugs of interest for treating alcohol abuse and related problems. We also review the major clinical studies about those pharmacological agents and discuss some peculiar aspects of those trials think to be important to develop better strategies for the evaluation of pharmacotherapy of alcoholism.

Based on our experience of the ethnopsychiatric consultation directed by Tobie Nathan in Paris, we try to define the adaptations of the therapeutic setting necessary, according to him, in a transcultural situation, and by whom we can be inspired (work-group, participation of a translator, mobilisation of the traditional etiological interpretations). Then, we study the clinical case of a young Algerian girl living in Belgium. We analyze her acute delirious psychosis following the conceptions of Tobie Nathan: the particular situation of migrant children would be a proneness for the splitting of the ego. At least we show how important is in the psychotherapy the restitution of the original cultural framework.

We are still far from a global understanding of the schizophrenic processes. A quick overall view of the concept modifications is to be considered simultaneously with the evolution of the psychiatrical institutions and the psychiatrical new knowledges. Will the schizophrenical vulnerability concept help us? Nobody knows. A comprehension of the pathological process is due to the fact that we know little about the psychical functioning prior to the affection development. Nothing tells us it is so "normal". The act that this process appears during the adolescence when new desires and projects emerge makes wonder if the processes elaborated during the latency period could have prepared the subject to this reorganization of his personality.

In a retrospective study, the sleep EEG profiles and the neuroendocrine variables of 44 delusional and 44 non-delusional depressive matched for age, sex, and polarity were compared. Some classical biological disturbances in depressives patients (increase of awake duration, diminished REM latency, hypercortisolism, blunted TSH response) seemed to be more pronounced in the psychotic depressed group; nevertheless, they could be attributable to a greater severity. However, shortened REM latency seemed to be more specific to the psychotic subtype of depression.

Summarizing the most interesting data obtained in schizophrenia by the genetic, morphological and psychopharmacological studies, the authors try to take stock of the two main physiopathological process involved in this disorder, as to say, modifications in the limbic structures anatomy and chemical disturbances in different neurotransmitter system.

According to information processing theory, attention deficits appear to be a nuclear disorder in schizophrenia which the study has been renewed with the development of neurophysiology technique. The originality of our research was to study in a same subject Event-Related-Potentials in three different conditions: passive and active auditory oddball paradigm for Mismatch Negativity (MMN) and P 300, and a simple reaction time task with warming stimulus for the Contingent Negative Variation (CNV). The study was carried out among 20 schizophrenic subjects (paranoid subtype with acute exacerbation, DSM-III-R) and 20 healthy volunteers. Patients differed from controls as the following: a lower amplitude of N1-P2 components of the auditive evoked potentials, a lower amplitude of MMN (absent in 20% of the psychotic subjects), a lower amplitude and a longer latency of P300, and a lower amplitude of CNV. These results suggest a fundamental dysfunction of information processing which involves the early stages of automatic and voluntary attentional cognitive processes in schizophrenia.