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DSM-III borderline personality disorder defines a group of patients who are characterised by impulsivity and unpredictable behaviour, inappropriate aggression, intense and unstable relationships and are often associated with repeated suicidal behaviour. A substantial body of research has established an association between disturbance of serotonin and also dopamine and suicidal behaviour in depression. A similar relationship is also seen in studies of personality disorders which suggests the association is not specific to depression. A placebo controlled study of low dose flupenthixol has been shown to significantly reduce subsequent suicidal behaviour in patients with personality disorders without depression or schizophrenia. Evidence points to a biological basis for suicidal behaviour and borderline personality disorder and possibly of pharmacotherapy.

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. The improvement scores of the groups showed that mianserin has significant advantages when depressed mood, sleep disturbances and autonomic disregulations predominate the depressive anxiety state.

Dopamine D-1 and D-2 receptors can be labelled selectively by using 3H-SCH 23390 and 3H-Spiperone as ligands, respectively. Neuroleptics are divided into different groups according to their affinity for D-1 and D-2 receptors. Thioxanthenes have comparable affinities for D-1 and D-2 receptors. Phenothiazines have higher affinity for D-2 than for D-1 receptors. Butyrophenones, diphenylbutylpiperidines and substituted benzamides are almost selective inhibitors of D-2 receptors. The affinity of neuroleptics for several other receptor types is mentioned. The use of the receptor binding technique in diseased schizophrenics is discussed. In vivo receptor binding in vitro and ex vivo receptor autoradiography and PET scanning are discussed as alternative methods to evaluate neuroleptics, clinical outcome and treatment strategies.

The aim of this study is to evaluate the activity of flupentixol oral high concentration and to define the profile of the drug according to the administered dose. The trial includes 40 acute patients (21 schizophrenics, 13 manic patients and 6 other psychotics). The study was open, but the patients were treated at random either by haloperidol or by flupentixol. Both substances showed a strong antipsychotic and antimanic effect. The differences according to the administered doses were: a quicker onset of action for flupentixol in schizophrenic patients; a more pronounced activity of flupentixol in the same patients, as far as anxiety, depressive tendencies and defect symptoms are concerned. Extrapyramidal side effects are the most common ones amongst the two drugs.

The first thioxanthene derivative without the double bind up to now considered mandatory for the antipsychotic effect, teflutixol, was administered in a phase II pilot efficacy trial to acute or subacute psychotic inpatients (mean age 36,1) during at least 5 weeks at a dosage of 3 to 20 mg p.d. once a day. The patients were abruptly switched from a haloperidol baseline therapy, which was administered on an average for 3 weeks at 15 mg p.d. Preliminary results are reported for the first 11 patients on a purely clinical basis. Despite the limitations of a small sample and of a qualitative analysis of data, it is hypothesized that teflutixol is a potent and original neuroleptic drug combining at 6 mg p.d. or less potent antidelusional, hallucinolytic and antiautistic effects. Latency and duration of action approximate 2 days. At 6 mg and above appear side-effects of the desinhibiting type (anxious and/or aggressive mood, withdrawal, flaring up of delusions, insomnia, agitation) and extrapyramidal side-effects of the akathisia type. No adrenolytic, anticholinergic or toxic effects were prominent. The patient followed up for the longest period (6 months on 3 mg p.d.) has not relapsed and has normal liver functions.

The treatment of alcoholism still presents great problems because a number of factors have to be taken into consideration. Tranquilizers and chlormethiazol are only justified in the detoxication phase. For the subsequent after-care, depot neuroleptics are recommended because of the uniformly high plasma level. We gave clopentixol decanoate - 100 mg i.m. - in two-weekly intervals. The symptoms caused by ethylism were adequately overcome without side effects. Clopentixol decanoate creates the basis for successful psychotherapy: only when the mood situation is compensated and the internal unrest overcome can verbal therapy be successful.

The efficacy of i.m. cis(Z)-clopenthixol in aggressive, agitated and delusional patients is well established but it necessitates, as for all other parenteral neuroleptics, several injections daily. Zuclopenthixol acetate is the first injectable neuroleptic characterized simultaneously by a short latency of action (2-3 h) and by a long duration of action (2-3 days). Within the frame of a Belgian multicentre study of zuclopenthixol acetate and haloperidol, a group of French-speaking psychiatrists added the AMDP scales to the basic protocol. The results of this AMDP subsample of 20 Acetate vs. 13 Haloperidol patients do not allow the demonstration of statistically significant differences between both neuroleptics because of the smallness and unbalance of the sample, but they indicate that both antipsychotics are very active and that a comprehensive rating scale such as the AMDP gives a much better differentiated clinical picture of a new drug than the total scores of short, so-called "economical" rating scales.

A total of 95 schizophrenic or manic patients received zuclopenthixol (cis(Z)-clopenthixol) either intramuscularly or orally during a period of 2 to 4 weeks in mean daily doses of 25 mg (i.m.) or 75 mg (p.o.). They were rated with the CGI, VAS, MSS, BPRS, and AMDP scales. Zuclopenthixol proved to be a potent antimanic, anti-aggressive and antidelusional neuroleptic already from the second day of injection. Very few anticholinergic and extrapyramidal side effects as well as little somnolence were seen and the local tolerance was excellent. The 14-factor AMDP profile proved valid, sensitive to change and highly differentiated.

A new thioxanthene derivative, teflutixol (Lu 10-022) has been administered for 4 weeks to 21 patients [12 schizophrenics, 6 patients with obsessive, compulsive neurosis (OCN), 2 patients with affective psychosis (AP), and one patient with paranoic reactions (PR)]. The maximum daily dose varied between 0.5 mg and 4 mg administered once in the morning. Fifteen of the patients received 1 mg or less daily. Based upon weekly assessments by the BPRS as well as a global evaluation all 4 groups showed a clear amelioration of the scores, and for both the schizophrenics and the patients with OCN this was highly significant [student's t (p less than 0.001)].