Consultation-Liaison psychiatric service delivery: results from a European study.

The reported findings of the European Consultation-Liaison Workgroup (ECLW) Collaborative Study describe consultation-liaison service delivery by 56 services from 11 European countries aggregated on a C-L service level. During the period of 1 year (1991), the participants applied a standardized, reliability tested method of patient data collection, and data were collected describing pertinent characteristics of the hospital, the C-L service, and the participating consultants. The consultation rate of 1% (median; 1.

European consultation-liaison services and their user populations: the European Consultation-Liaison Workgroup Collaborative Study.

The authors identified variations in the characteristics of patients referred to 56 consultation-liaison (C-L) services in 11 European countries. The authors found differences in the types of patients referred to the services, and there were significant differences between countries. The first difference lays in whether services saw patients for deliberate self-harm and for substance abuse.

European Consultation-Liaison Psychiatric Services: the ECLW Collaborative Study.

Objective: To describe the patterns of organization of consultation-liaison (C-L) services in 11 European countries in relation to hospital characteristics and national approaches to C-L psychiatry.

Method: Cross-sectional survey.

Results: Services can best be described in terms of their size and seniority of their staff and whether or not they are multidisciplinary.

Mirtazapine: efficacy and tolerability in comparison with fluoxetine in patients with moderate to severe major depressive disorder. Mirtazapine-Fluoxetine Study Group.

Objective: To compare the efficacy and tolerability of mirtazapine and fluoxetine in depressed inpatients and outpatients.

Method: Patients with a major depressive episode (DSM-III-R), a baseline score of > or=21 on the 17-item Hamilton Rating Scale for Depression (HAM-D), and > or=2 on HAM-D Item 1 (depressed mood) were randomly assigned to a 6-week treatment with either mirtazapine (N=66, 15-60 mg/day) or fluoxetine (N=67, 20-40 mg/day). The upper limit of the mirtazapine dose range was above the dose range approved in the United States (15-45 mg/day).

Efficacy and tolerability of reboxetine compared with imipramine in a double-blind study in patients suffering from major depressive offsodes.

A 6-week, randomised, double-blind, multicentre study in 256 patients with a DSM-III-R diagnosis of major depression was carried out to compare the selective noradrenaline reuptake inhibitor (NARI), reboxetine, with the reference standard tricyclic antidepressant, imipramine. The efficacy of reboxetine, as measured by the extent of improvement of Hamilton Depression Rating Scale. Montgomery and Asberg Depression Rating Scale and the Clinical Global Impression Scale, was similar to that of imipramine.

Mirtazapine is more effective than trazodone: a double-blind controlled study in hospitalized patients with major depression.

Two hundred hospitalized patients with DSM-III diagnosis of moderate to severe major depressive episode were randomized to receive mirtazapine or trazodone for 6 weeks in a double-blind trial. The dosages were 24-72 mg/day for mirtazapine and 150-450 mg/day for trazodone. The improvement on all depression rating scales used was generally greater for mirtazapine, with statistically significant differences over trazodone in the Hamilton Psychiatric Rating Scale for Depression total score and two subscores (the Bech melancholia factor and retardation factor), the Brief Psychiatric Rating Scale total score, the General Psychiatric Impression Global Assessment Scale, the Beck score and responder rates.

Zopiclone in the treatment of insomnia in depressed patients.

During the early treatment of a major depressive episode with amitryptiline, insomnia was treated in 81 patients in a double-blind comparative trial comparing zopiclone and flunitrazepam. The study showed no major differences in the efficacy profile and showed better tolerability for zopiclone than for flunitrazepam.

Clinical Features and Drug Treatment of Psychodermatological Disorders.

The skin is intricately involved with emotional and behavioural problems, both in a causative and a reactive way. This can lead to the development of psychodermatological disorders. In addition to its primary role of tactile receptivity, the skin reacts directly to emotional stimuli.

Sleep disorders and depression: the 'chicken and egg' situation.

The question of whether sleep disorders are part of the clinical picture of depression or of its aetiology remains unanswered. Still, clinical observation in general, polysomnographic studies and the observed antidepressant effect of sleep deprivation, clearly indicate the intimate relationship between sleep disturbances and depression.

Congenital malformations caused by psychotropic drugs in pregnancy.

After a description of the harmful effects of psychotropic drugs as well as of the moments of vulnerability to any teratogenic effect, this paper reviews prospective, retrospective and epidemiological studies of the teratogenic effects of anticonvulsants (phenytoin, valproic acid, carbamazepine and barbiturates), lithium, anti-psychotics, benzodiazepines and anti-depressive agents. It is found that the results of these studies are not unequivocal. Only lithium and valproic acid are shown to be teratogenic.

Psychodermatology: an overview.

As the skin is an organ that has a primary function in tactile receptivity and reacts directly upon emotional stimuli, dermatological practice involves a psychosomatic dimension. It is, however, the high visibility of dermatoses and their easy accessibility which make the skin a direct target for behavioural problems. Furthermore, self-destructive tendencies and hypochondriacal features often express themselves through dermatological symptoms: dermatitis artefacta and skin hypochondriasis are among the specific psychocutaneous disorders discussed here.

Localization of self-inflicted dermatological lesions: what do they tell the dermatologist?

The dissimulating attitude of factitious patients creates the need for objective clinical features which cannot be faked and which have a genuine value for the psychiatric diagnosis and prognosis. The psychiatric significance of the localization of self-inflicted dermatological lesions is investigated in four psychiatric areas: the type of life events preceding specific localizations, underlying psychiatric profiles that are characteristic for a given localization, differential response to treatment and psychiatric sequels.

Integration of medical and psychiatric management in self-mutilation.

The traditional management of factitious patients with self-inflicted injuries consists of medical/surgical treatment of the physical lesions, followed by psychiatric referral. The former is assigned to the dermatologist, the surgeon, or the primary care physician. More often than not, the subsequent psychiatric referral for treatment of the psychiatric disorder underlying and actually causing the self-mutilation fails because of self-mutilators' notorious resistance to psychiatric help.

Self-mutilation: diagnosis and practical treatment.

The management of self-inflicted lesions requires an understanding of the dynamics of the act of self-mutilation. The overview of practical techniques allows the non-psychiatrist physician to deal with self-inflicted disorders more effectively. The efficacy of behavioral and psychotherapeutic techniques is enhanced when combined with psychopharmaca.

Somatization of psychiatric illness in Mediterranean migrants in Belgium.

Mediterranean migrants with acute psychiatric problems show a predominance of dramatic somatization in their symptom patterns, when compared with Belgian patients with similar psychiatric problems and admitted after identical recruiting and referral procedures. D.S.

Management of self-mutilation. Confrontation and integration of psychotherapy and psychotropic drug treatment.

The management of diverse types of self-mutilation is discussed with a particular emphasis on the selective use of open confrontation of the dissimulating patient with the self-inflicted nature of the lesions. Integration of psychotherapy with psychotropic drug treatment in self-mutilating patients is a necessity.

Depression after surgery for breast cancer. Comparison of mastectomy and lumpectomy.

The impact of the loss of the breast in women undergoing surgical treatment for breast cancer is subordinated to the confrontation with the diagnosis of a malignancy in causing depression. The equal distribution of depression in mastectomy and in lumpectomy patients supports the hypothesis that it is the confrontation with the potentially lethal outcome of the diagnosis which is decisive in causing depression. The grief reaction following mastectomy has two components: a depressive reaction to the loss of the breast and an anticipatory grief for anticipation of the potentially lethal outcome.

An update of panic disorders. Somatization, biological markers and treatment outcome.

Psychiatric underdiagnosis of panic disorders is due to its particular somatization profiles. Cardial somatization is very common, but focal neurological symptoms and a pattern of gastro-intestinal complaints deserve more attention. Recent research into biological data is discussed, and the importance of psychological issues--childhood separation or sexual victimisation--and cognitive factors is stressed.

Training future dermatologists in psychodermatology.

The contents and design of a psychodermatology training programs (PTP) preparing future dermatologists to cope with the psychosomatic features of their practice are discussed. This program focuses on the psychosocial factors that may provoke, precipitate, and aggravate dermatoses. It singles out the secondary illness reaction which is the result of the particular somatopsychic consequences of the visibility of dermatoses, its repercussion on the patient's body image, and on his or her social and sexual life.

A Belgian multicentre study of fluvoxamine in depressive outpatients.

Fluvoxamine, a new antidepressant that specifically inhibits serotonin reuptake, was studied in 272 outpatients in a six-week multicentre trial in Belgium. On the Hamilton Depression Scale, the mean score dropped from 25.2 to 8 after six weeks (p less than 0.

Valproate as psychotropic agent. Interactions and adverse cerebral reactions.

Recent data stress the psychotropic actions of valproate in schizo-affective disorder. Four patients are reported presenting an altered state of consciousness and prominent EEG dysfunction following combined valproate/neuroleptic drug treatment. Similar cerebral reactions have been reported in anti-epileptic poly- and monotherapy, and the pathogenetic considerations are discussed.

Dermatitis artefacta.

Self-inflicted dermatoses mainly refer to psychiatric disturbances such as psychoses, mental retardation, and personality disorders. Diagnostic clues are found in the nature and the evolution of the lesions as well as in the ambivalent combination of dependency on doctors and hostility toward them revealed in the patient's medical history. Management of dermatitis artefacta patients means dealing with the complex emotional issue of a basic antagonism in the dermatologist-patient relationship.

Treatment of depressive anxiety states associated with psychosomatic symptoms. A double-blind multicentre clinical study: mianserin versus melitracen-flupentixol.

A four-week randomized multicentre study comparing mianserin and melitracen-flupentixol was conducted in 90 outpatients suffering from depressive anxiety states with a predominantly psychosomatic symptomatology. Both patient groups showed a favourable clinical response to treatment as well as a good tolerance. No significant differences were observed in the drop-out rates or in the incidence of side-effects, although drowsiness tended to develop more frequently during the first days of mianserin treatment.