Acta psychiatrica Belgica最新文献

This report illustrates the difficult differential diagnosis between severe hysteria and psychosis in a young adult in crisis, and the need to elucidate the existing structure underlying the therapeutic approach. Alice's history will be the subject to a theoretic-clinic discussion. It allows to bring out important concepts to support an hypothesis of a neurotic decompensation.

The efficacy and tolerability of moclobemide and sertraline were compared in a 13 week trial on 55 depressive patients. Patients were diagnosed according to DSM-III-R criteria using SCID (Structured Clinical Interview for DSM-III-R). The study group was composed of 48 patients with major depression and 7 with minor depression. Patients were randomized in two drug groups and raters were blind to the drugs patients used. HDRS and CGI were used to assess the change in depressive symptoms. Twenty seven patients received moclobemide and 28 patients received sertraline. The dose of moclobemide used was 300-600 mg/day and that of sertraline was 50-200 mg/day. At the end of 13 weeks mean drop in HDRS for the overall group was 14.78 and the response rate calculated as percentage of patients showing a 50% drop in HDRS score was 77.8. The response rate was 76.5% for moclobemide and 78.5% for sertraline. The difference was not significant. The side effects were assessed by using UKU Side Effects Rating Scale. The most three observed side effects were dry mouth, headache and insomnia.

It is hypothesized that infantile autism could represent a defensive position with variable clinical characteristics whose expressions are notably influenced by the environment. We examined a group of ten children under the age of three who were followed up on home care. Our research focused on a double-blind correlation test between two types of data: the diagnostic on the one hand and the child video recording observation on the other hand. Certain objectivable autistic states were found in two children for which the initial diagnosis of autism were in a first time ruled out (according to DSM-III-R and French Classification). This confirms the polymorphism of children autistic states.

The authors report about the catamnestic study of 919 schizophrenic women who gave birth to a child after their first schizophrenic episode, 112 (12.2%) of the patients suffered a new psychotic breakdown in connection with generation process. The overwhelming majority, 109 (11.9%) decompensated during the post partum periode (within 6 months after parturition). In a significantly lesser degree, 3 (0.32%) of the cases, the psychotic episode occurred during pregnancy (in the first trimester). The authors emphasize the importance of careful pharmacological and psychotherapeutical management of pregnant schizophrenic women.

During an ongoing study on potential neurochemical and neuroendocrine predictors of recovery after ECT, it was observed that depressed patients with unfavorable response to ECT, improved consequently with antidepressants alone or in combination and in some cases with the addition of neuroleptics or lithium salts. 13 female depressed patients with melancholia (DSM-III criteria), who had proven resistant to electroconvulsive therapy (ECT) and showed marked improvement with subsequent psychopharmacologic regimens, are described. In not less than 2 months after the last ECT, remission was achieved with a heterocyclic antidepressant (HCA) alone (3 patients) combined infusion of chlorimipramine and maprotiline (3 patients) combined HCAs-antipsychotics (4 patients) and HCAs in combination with lithium (3 patients). It is worth noting that certain depressed patients improved markedly with drugs which had poor results at the same doses before ECT. Confirmation of these observations by prospective studies would provide novel therapeutic capabilities and clues about the mode of action of this controversial treatment.

Several authors have suggested that anbedonia, autonomy and interpersonal dependency could characterize personality of subjects prone to depression. We have studied in a group of 117 healthy subjects the Pearson correlation coefficients between two anbedonia scales (Physical Anbedonia Scale or PAS, Fawcett Clark Pleasure Capacity Scale-Physical Pleasure or FCPCS-PP) and the three sub-scales of the Interpersonal Dependency Inventory (IDI) (two rating dependency and one rating autonomy). The results have shown a significant correlation between the PAS and the autonomy sub-scale of the IDI. Anbedonia and autonomy could characterized a particular profile of personality.

After discussing the term "anthropologist doctor", the author describes the hard job of the psychiatrist in the penitentiary in Lantin. From the historical account of the penitentiary anthropology service, he establishes that this service has never had the necessary financial means to create and run laboratories of penitentiary anthropology, especially after the law for social defence was voted and enforced. He fears that, for want of money, the creation now of observation and treatment services would reduce the time one could spend working with prisoners in psychiatric wards. He deals briefly with the condition of psychopaths and drug-addicts in prisons.

The author presents a study comparing psychopathic personality and drug addiction with regard to diagnosis, aethiopathogenia and treatment. Two third of drug addicts have associated personality disorders related to psychopathic disorders. Treatment on Therapeutic Communities provides a good alternative to both treatments in out patients or in open care units. The results obtained support the value of such a system in discussions about the taking over of patients in Social Defense Institutes and in jails.

Different levels of possible psychiatrist's mediations in Belgian legal procedures are detailed and a functional analysis of the first July 1964 Social Protection Law is proposed. The role of each participant is defined and commented. This is followed by a review of the recognized psychiatric pathology in a daily practice with confined patients in a social protection hospital. Finally, comparisons between DSM III-R diagnoses of confined patients and patients hospitalized in a local psychiatric hospital underlines the differences between these two institutions.

The cognitive-behavioral profession provides a theoretical model to understand the drug-compliance problem in schizophrenia and to enhance its therapeutic approach. The main components of this approach include continuous behavioral analysis, enhancement of therapeutic alliance, psychoeducation of the patient and significant others, perceptual and attitudinal strategies, behavioral strategies and cognitive restructuring.