In Sweden, a psychiatry reform, aimed at improving the living conditions of the psychiatrically disabled, came into force in 1995. The aim of the present study was to evaluate the impact of the reform by investigating quality of life and standard of living 2 years later in a randomly selected group of people with longstanding psychiatric disability. Self-ratings and interviews were conducted in a study group and a control group. The study group consisted of 19 women and 18 men (mean age 46.1 years) diagnosed with neurosis, schizophrenia or affective disorder. The control group consisted of 19 women and 17 men (mean age 48.7 years). Self-rated quality of life was significantly poorer in the study group (P < 0.0001, unpaired t-test), and so was housing (P < 0.001, test of similar proportions in independent samples). We found no significant positive correlation between subjective quality of life and standard of living in either group but a significant negative correlation in the control group (P < 0.05; r = 0.40, Pearson correlation coefficient). The results suggest that, in 1997, people with longstanding psychiatric disability still had poorer quality of life than the general population. This may be due to factors other than outward standard of living.

Abstinent alcoholics often denycraving for alcohol but still show a high level of relapse. The eyeblink response to startling noise was used as an indicator of the emotional response to alcohol-related, positive, negative and neutral visual stimuli in abstinent alcoholics, social drinkers and rarelydrinking controls. The cognitive evaluation of the stimuli was assessed byratings of subjective craving, valence and arousal. The startle response of the alcoholics to alcohol-related stimuli was significantlyinhibited despite an aversive overt stimulus-evaluation. These findings indicate that alcohol-related stimuli mayhave appetitive incentive salience for alcoholics in spite of verbal reports of craving and valence to the opposite.

Studies suggest a greater reliance on visual information for maintaining balance in anxious subjects. Nevertheless, links between this supposed preferred visual processing and spatial orientation have not yet been evaluated. Two groups of subjects differing in their level of trait anxiety were formed. Equipped with a head-mounted visual display, they learned a virtual corridor using passive translation but active rotation, both with normal and with two different conflicting sensory conditions. After two visual navigation trials in the corridor, they were blindfolded and asked to reproduce the same trajectory from memory. In addition, subjects drew a map of the remembered corridor. Anxious subjects were comparable to non-anxious subjects when asked to reproduce the trajectory from memory, but exhibited a deficit when drawing a map of the corridor they were in. The results do not support the hypothesis that anxious subjects use preferentially one type of sensory cue over another for spatial orientation, but instead manifest difficulties in constructing more global representations of space.

The increasing evidence that bipolar and unipolar affective disorders have different biological etiologies and courses of illness has been associated with an intensifying interest in specific treatment regimens for both disorders during the last decade. In this context, the question arose whether antidepressants exert similar efficacy in the acute treatment of bipolar compared to unipolar depression. Although the clinical impression does not indicate substantial differences in the efficacy of antidepressants between these groups of patients, empirical databases concerning this topic are rare. The present study compared the efficacy of antidepressants in 50 unipolar and 50 bipolar depressed inpatients (ICD-9 criteria) under naturalistic treatment conditions. Both groups of patients were mahed for age, gender and duration of illness. Clinical assessments of status at the time of admission and at discharge were used to rate response to antidepressant treatment. Analyses of the data revealed that both groups of patients needed the same time for treatment response and did not show any significant differences in ouome measures at discharge. These findings do not concur with the hypothesis formulated by some experts in the field of affective disorders that antidepressants are less effective in the acute treatment of bipolar depressed patients compared to unipolar depressed patients.

Given the limited knowledge on the long-term outcome of adolescents who receive electroconvulsive therapy (ECT), the study aimed to follow-up adolescents treated with ECT for severe mood disorder. Eleven subjects treated during adolescence with bilateral ECT for psychotic depression (n = 6) or mania (n = 5), and ten psychiatric controls matched for sex, age, school level, and clinical diagnosis, completed at least 1 year after treatment a clinical and social evaluation. Mean duration between time of index episode and time of follow-up evaluation was 5.2 years (range 2–9 years). At follow-up: (1) all patients except two in the control group received a diagnosis of bipolar disorder. (2) Fifteen patients had had more than one episode of mood disorder. (3) The two groups did not differ in social functioning nor school achievement. (4) Impact on school achievement was related to the severity of the mood disorder rather than ECT treatment. The results suggest that adolescents given ECT for bipolar disorder, depressed or manic, do not differ in subsequent school and social functioning from carefully matched controls.

The increasing cost of pharmaceuticals in the Czech Republic has led to restrictions on the prescription of more expensive atypical antipsychotics. The aim of the study was to compare the costs and outcomes of using risperidone versus classical neuroleptics in treatment of schizophrenia in order to see if there was any cost advantage in restricting use of more recent antipsychotics. Sixty-seven patients (39 women) with a mean age of 34.6 years (S.D. = 9.74) suffering from schizophrenia or schizoaffective disorder were treated with risperidone while 67 patients (39 women) with the same diagnoses with a mean age of 35.7 years (S.D. = 9.91) received standard neuroleptics. Yearly direct medical costs and outcomes (indicated by the average Global Assessment of Functioning score) were assessed retrospectively in an open, intent-to-treat study by abstracting psychiatric outpatient charts. The outcomes were not significantly different between the treatment groups while the risperidone treatment was significantly more expensive than the therapy with standard neuroleptics. This result which appears to be inconsistent with the literature was caused by the cheap labor force in the Czech Republic. The difference between the followed treatments in the direct costs will probably become insignificant in the future when the country’s economy will be more developed.

The A allele of the 5-HT2A gene (–1438A/G polymorphism) has been associated with anorexia nervosa in four studies, but not in three others. One possibility to explain such a discrepancy is that the A allele acts as a modifying rather than a vulnerability allele. To test this hypothesis, we increased our initial sample of 102 trios [Mol. Psychiatry 7 (2002) 90] with 43 new patients with anorexia nervosa and 98 healthy controls. In addition to confirming the absence of association on the global sample of 145 patients, we found that patients with the A allele had a significantly later age at onset of the disease (P = 0.032). Furthermore, the A allele was also transmitted with an older age at onset (P = 0.023) using a quantitative-trait TDT approach. The A allele may thus act as a modifying factor (delaying onset), potentially explaining variations of allele frequency across samples, in which differences in average age at onset are not only possible, but also expected. Taking into account vulnerability genes, but also genes modifying the expression of the disorder, will help to disentangle the complexity of the etiological factors involved in anorexia nervosa.

The Kleine–Levin syndrome (KLS) is characterized by periodic, sudden-onset episodes of hypersomnia, compulsive hyperphagia, and behavioral–emotional symptoms, lasting from a few days to a few weeks, with complete remission in the intercritical periods. We report on efficacy of lithium treatment in a highly recurring form of the disorder in a 17-year-old male adolescent. The decreasing severity of the disorder paralleled the progressive increase of lithium dosage, up to 0.9 mEq l–1. Implications regarding the pharmacological treatment of this neglected disorder are discussed.