Case management has been an integral part of psychiatric practice in the United States for over a decade and has generated a large body of literature. The application of case management principles to the care of people suffering from psychiatric disorders is becoming increasingly popular in the United Kingdom and Europe and literature is now beginning to be published. However, no definitive statements about the efficacy of case management have been made due to a range of conceptual and methodological problems. The present paper is a critical review of the case management outcome literature. Reported outcomes are reviewed in the context of study design and service characteristics. The authors conclude that case management practice can have at least some impact on patients' use of services (including marked decrease in in-patient bed days); satisfaction with services; engagement with services; and social networks and relationships when it is delivered as a direct, clinical service with high staff: patient ratios. A set of recommendations are suggested for the future practice and presentation of research into case management.

A review of the literature shows that the admission rates of new cases of schizophrenia vary with a factor of two to five in North American studies as well as in European studies. Furthermore, the tendency has been decreasing for the last 40–50 years in Europe. Eighteen studies specifically analyzing the development over the last 20 years are reviewed. The studies preponderantly show significant decreases most probably due to the reduction of the number of available psychiatric beds alongside the decentralization of psychiatry, and to decreasing virulence of schizophrenia. Alternatively, a diagnostic delay of schizophrenia can hardly explain the decrease.

5-methoxypsoralen (5-MOP) stimulates pineal melatonin secretion, and a decrease in dark phase melatonin levels has been described in major depression. As exogenous melatonin has shown synchronizer properties, authors hypothesized that giving 5-MOP would have antidepressant properties.

Twenty-six inpatients meeting the criteria of major depressive disorders were enrolled in a four-week, double blind trial of 5-MOP versus amitriptyline. Clinical improvement was identical in both treatment groups but biological changes were different in each group: 5-MOP patients showed an early nocturnal surge of melatonin levels that was maintained at the fourth treatment week, while melatonin levels remained unchanged in patients treated with amitriptyline.

The study aimed to describe coping strategies in a sample of key-relatives of schizophrenic patients, and to explore their relationships with the following variables: patients' and key-relatives' socio-demographic characteristics; patients' and key-relatives' clinical status; and key-relatives' subjective burden. Significant correlations were found between the scores on coercion items and those on Present State Examination (PSE-9) factors “disorganized syndrome” and “psychomotor poverty syndrome”. A long duration of illness was found to be associated with relatives' strategies characterized by positive communication and patient's social involvement. Coercion, avoidance and resignation coping strategies were significantly associated with the occurrence of anxiety and depressive symptoms in patients' key-relatives.

The cases of two borderline patients are presented, dexamethasone suppression test (DST) positive and refractory to many therapeutic interventions and treated successfully with high doses of amitriptyline (225 and 200 mg/day, respectively). During the therapeutic intervention, the psychopathological condition of the patients was evaluated using Hamilton's rating scale for depression and a constructed scale based on items 11, 12 and 13 (dysphoria, anger, sense of emptiness, boredom, anhedonia) of the diagnostic interview for borderline patients.

A thirty-eight year old woman, suffering from schizoaffective disorder for approximately 17 years, improved significantly with the association of clozapine (CPZ) and nimodipine.