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Background: Studies of hypothalamic-pituitary-adrenal (HPA) axis function in chronic fatigue syndrome (CFS) point to hypofunction, although there are negative reports. Suggested mechanisms include a reduced hypothalamic or supra-hypothalamic stimulus to the HPA axis and enhanced sensitivity to the negative feedback of glucocorticoids. The aim of the current study was to investigate HPA axis function in CFS with the dexamethasone/corticotropin-releasing factor (Dex/CRF) test, in analogy with research in affective disorders., Method: Thirty-four well-characterized female CFS patients and 25 healthy control subjects participated in the low-dose Dex/CRF test. Current major depressive episode was an exclusion criterion. History of early-life stress (ELS) was assessed with the Structured Trauma Interview., Results: Salivary cortisol responses after 0.5 mg Dex were lower in CFS patients than in controls (before 100 microg CRF, p=0.038; after 100 microg CRF, p=0.015). A secondary analysis revealed an influence of early-life stress and of oestrogen intake. After removal of the 10 participants who were taking an oral oestrogen, patients without a history of ELS showed lower cortisol responses than patients with ELS and controls (before CRF, p=0.005; after CRF, p=0.008)., Conclusions: CFS is globally associated with reduced cortisol responses in the combined low-dose Dex/CRF test, but this effect is only clearly present in CFS patients without a history of ELS. This study provides further support for an enhanced glucocorticoid negative feedback and/or a reduced central HPA axis drive in CFS. Furthermore, it demonstrates that ELS is an important variable to consider in CFS research.

Background: Psychomotor disturbances have been described repeatedly over many centuries. More recently, Sobin and Sackeim [Sobin, C., Sackeim, H.A., 1997. Psychomotor symptoms of depression. Am. J. Psychiatry. 154, 4-17.] discussed the relevance of psychomotor symptoms in depression in an extensive review. Since their report, new pathophysiological, diagnostic and therapeutic findings have been published. In the current review of the recent literature, we aim to argue the importance of psychomotor symptoms in depression and propose directions for future research., Method: A review of all the relevant reports on this topic, published between 1996 and 2006, was conducted., Results: Several assessment methods demonstrate the diagnostic and pathophysiological significance of psychomotor symptoms. Antidepressants show differential effects on psychomotor performance and findings concerning the symptoms' predictive capacity for clinical response are contradictory. Numerous imaging studies as well as studies on the neurotransmitter systems and the HPA-axis contribute to the elucidation of the neurobiological processes underlying impaired psychomotor functioning in depression., Conclusions: Psychomotor disturbances are of great diagnostic significance for the depressive subtype of melancholia. To enhance the conceptualisation of the construct 'psychomotor' a standardised battery for their assessment is recommended. As to the symptoms' predictive therapeutic power, to date research into functional outcome and studies applying objective experimental assessment methods are lacking. Moreover, the reported pathophysiological importance of dopamine for 'retarded depression' still warrants translation to the daily practice.

Major depressive disorder (MDD) is characterized by disturbances of mood and affect, but also by a distinct pattern of psychomotor and cognitive deficits such as motor retardation and impaired executive functioning. An important aspect of executive functioning is performance monitoring, i.e., a continuous checking whether intended action goals have been reached and whether correction of the applied strategy is necessary. A well-known marker for action monitoring is the error negativity (Ne) or error-related negativity (ERN), an event-related potential (ERP) component generated in the anterior cingulate cortex (ACC) following erroneous responses. To date, Ne/ERN amplitudes have been investigated in moderately depressed patients only. The present study is the first to investigate action monitoring in severely depressed patients (mean Hamilton score=28.4). In addition, the patients' psychomotor performance was assessed to see whether there is a relationship between action monitoring and psychomotor retardation. Behavioural and ERP measurements were obtained during performance on a speeded two-choice reaction task in 26 patients with MDD and 25 healthy, matched controls. Psychomotor performance measures were speed of simple movements in various psychomotor tasks and the score on the Salpêtrière retardation rating scale (SRRS). Relative to the controls, the patients' behavioural results revealed a similar, but slower performance pattern. Overall between-group differences were demonstrated for the error positivity (Pe) amplitudes, but not for the Ne/ERN amplitudes. However, correlations of the Ne/ERN amplitude with several psychomotor variables were strong. In the depressed patients taking benzodiazepines an additional attenuation of Ne/ERN amplitudes was observed. Only severely depressed patients manifesting retardation showed impeded action monitoring. The correlations between action monitoring and psychomotor performance indicate that in MDD these two processes are highly interdependent, both being deregulated. Moreover, the same network of brain regions is likely to be implicated in both processes.

Pseudologia fantastica, also known as mythomania or pathological lying, is a psychiatric phenomenon that has been recognised for over a hundred years. By analysing two case studies and by searching the literature for relevant articles we aim to define the concept clearly and to ascertain whether pseudologia fantastica should be considered as a symptom of a psychiatric disorder or whether it should be considered as a separate entity.

Background: Patients with schizophrenia display catatonia, psychomotor retardation, neurological soft signs (NSS) and neurological hard signs. There is considerable confusion about these psychomotor symptoms., Aim: To discuss the symptoms with the help of the existing literature., Method: Relevant articles were retrieved from Medline. results These psychomotor symptoms are intrinsic features of the illness and cannot be regarded as mere side effects of treatment with antipsychotics. The symptoms seem to become progressively worse in the course of the illness and are associated with a poor prognosis. In contrast to cognitive symptoms, psychomotor symptoms are associated with positive symptoms. The various psychomotor symptoms are associated with the same brain structures and may themselves be interlinked., Conclusion: There is therefore considerable evidence to support the existence of a cluster of psychomotor symptoms, in addition to positive, negative and cognitive symptoms.

In Flanders since the 1970's, considerable changes have been made in the content of training courses for psychiatrists. There have been changes in the amount and nature of the knowledge that trainees have to acquire; trainees have had to learn new skills and break with traditional attitudes. All these changes can be attributed to developments in the profession itself, e.g. a more scientific approach, medicalisation and evidence-based clinical practice. Nevertheless, the main focus is still on personal development. The master-apprentice model persists as the principal training method. In the near future there will be further changes in the content and format of the training given to psychiatrists who have recently obtained their Master's qualification.

Corticotropin-releasing factor-binding protein (CRF-BP) regulates the availability of free CRF and is a functional candidate gene for affective disorders. Previous research showed an association between polymorphisms in the CRF-BP gene and recurrent major depression (MDD) in a Swedish sample. The purpose of the current study was to re-evaluate the previous findings in an extended Swedish sample and in an independent Belgian sample of patients with recurrent MDD and in control samples. In total, 317 patients and 696 control individuals were included. Five single nucleotide polymorphisms (SNPs) and a deletion polymorphism in the CRF-BP gene were genotyped and the haplotype block structure of the gene was assessed. In the extended Swedish population, there was a trend towards an association between two SNPs and MDD. The subsequent gender analysis showed significant associations of three SNPs (CRF-BPs2 T; CRF-BPs11 T and CRF-BPs12 C) and haplotype G_T_C_T_C with MDD in Swedish males. However, these findings did not withstand correction for multiple testing and there were no significant SNP or haplotype associations in the Belgian MDD sample. In conclusion, this study does not provide confirmatory evidence for a role of the CRF-BP gene in the vulnerability for MDD in general. The association between genetic CRF-BP variants and MDD may be sexually dimorphic, but this issue requires further investigation in a larger sample.

The study investigated whether four specified drugs would show similar patterns on tests considered to measure sedation. In addition, their drug-effect patterns on sedation and memory performance were compared to determine whether the sedative effects could be differentiated from the memory effects. Two double-blind, placebo-controlled, crossover studies, each with 16 healthy volunteers, were performed, one testing lorazepam (2.5 mg) and mirtazapine (15 mg) and the other olanzapine (10 mg) and haloperidol (2.5 mg). Subjective sedation was assessed by means of visual analogue scales (VAS) and objective sedation using a simple-reaction-time (SRT) task and a choice-reaction-time (CRT) task, code substitution (symbol digit substitution test (SDST)) and the peak velocity of saccadic eye movements (SEM). A verbal memory test (VMT) was administered to evaluate memory capacity. Apart from haloperidol, all drugs proved to impair performance on all five sedation indices. Contrary to the VAS, the objective measures yielded different response profiles. Two types of drug-effect patterns emerged: one for greater impairments in response speed (SRT, SEM) and one for greater impairments in information processing (CRT, SDST). Lorazepam and olanzapine impeded memory performance, whereas mirtazapine did not. With the use of standardized scores it proved possible to differentiate between the size of the effects of the drugs on the sedation and memory tests. To accurately assess the level and nature of sedation and to differentiate sedation from memory impairments different types of sedation measures are required. Besides studying the subjective effects, it is recommended to also test psychomotor responses and information processing speed.

Ampakines act as positive allosteric modulators of AMPA-type glutamate receptors and facilitate hippocampal long-term potentiation (LTP), a mechanism associated with memory storage and consolidation. The present study investigated the acute effects of farampator, 1-(benzofurazan-5-ylcarbonyl) piperidine, on memory and information processes in healthy elderly volunteers. A double-blind, placebo-controlled, randomized, cross-over study was performed in 16 healthy, elderly volunteers (eight male, eight female; mean age 66.1, SD 4.5 years). All subjects received farampator (500 mg) and placebo. Testing took place 1 h after drug intake, which was around Tmax for farampator. Subjects performed tasks assessing episodic memory (wordlist learning and picture memory), working and short-term memory (N-back, symbol recall) and motor learning (maze task, pursuit rotor). Information processing was assessed with a tangled lines task, the symbol digit substitution test (SDST) and the continuous trail making test (CTMT). Farampator (500 mg) unequivocally improved short-term memory but appeared to impair episodic memory. Furthermore, it tended to decrease the number of switching errors in the CTMT. Drug-induced side effects (SEs) included headache, somnolence and nausea. Subjects with SEs had significantly higher plasma levels of farampator than subjects without SEs. Additional analyses revealed that in the farampator condition the group without SEs showed a significantly superior memory performance relative to the group with SEs. The positive results on short-term memory and the favorable trends in the trail making test (CTMT) are interesting in view of the development of ampakines in the treatment of Alzheimer's disease and schizophrenia.

To study action monitoring in anorexia nervosa, behavioral and EEG measures were obtained in underweight anorexia nervosa patients (n=17) and matched healthy controls (n=19) while performing a speeded choice-reaction task. Our main measures of interest were questionnaire outcomes, reaction times, error rates, and the error-related negativity ERP component. Questionnaire and behavioral results indicated increased perfectionism in patients with anorexia nervosa. In line with their perfectionism and controlled response style patients made significantly less errors than controls. However, when controlling for this difference in error rates, the EEG results demonstrated a reduced error-related negativity in the patient group. These seemingly contradictory outcomes of improved performance and reduced error monitoring are discussed in relation with indications of anterior cingulate cortex hypoactivity in anorexia nervosa patients.

Rationale: Impaired psychomotor function has been shown to be associated with clinical and functional outcome in schizophrenia. However, few studies have investigated the short-term effects of antipsychotics on the cognitive and psychomotor functions of this patient group. Because many confounding factors tend to influence the test results in patient research, this study investigates the drugs' effects in healthy volunteers., Objectives: The short-term effects of haloperidol (2.5 mg), olanzapine (10 mg), and paroxetine (20 mg) on psychomotor function in 15 healthy volunteers are compared with placebo and each other., Methods: In a crossover design, the subjects completed a battery of psychomotor tasks assessing psychomotor speed, sensorimotor accuracy, visuospatial monitoring, and speed of information processing. In addition, peak velocity of saccadic eye movements and subscales of the visual analog scales were analyzed as the objective and subjective measures for sedation, respectively. Finally, the verbal memory test was used to assess the drugs' effects on memory., Results: Apart from affecting the pursuit task where visuospatial monitoring, sensorimotor speed, and sensorimotor accuracy are measured simultaneously, haloperidol has been proven to be not associated with sedative nor with impairing effects on psychomotor function or verbal memory. In contrast, olanzapine had significant sedative effects. Moreover, the subjects displayed a significant impairment on all measures of psychomotor function and verbal memory, which was not attributable to the drug's sedative effects. After administration of paroxetine, no effects were found, with the exception of a single improvement in eye movement velocity., Conclusions: Short-term administration of olanzapine, and not of haloperidol, impedes several aspects of psychomotor function and verbal memory in healthy volunteers.

After performing an exploratory factor analysis, Berrios & Luque (1995) identified three subcategories in the Cotard's syndrome: Cotard type I, Cotard type II and Cotard type psychotic depression. The article, which is based on two case studies and an examination of the relevant literature since 1995, explores whether there are different treatment strategies for Cotard type I and the Cotard type psychotic depression. For the Cotard type psychotic depression, electroconvulsive therapy proves to be an effective method of treatment. For Cotard type I, antipsychotic therapy seems to be sufficient.

Humans need to monitor their actions continuously to detect errors as fast as possible and to adjust their performance to prevent future errors. This process of action monitoring can be investigated by measuring the error-related negativity (ERN), an ERP component elicited immediately after an error. In the current study, we investigated action monitoring after administration of the classic antipsychotic haloperidol (2.5 mg), the atypical antipsychotic olanzapine (10 mg), and the antidepressant paroxetine (20 mg), a selective serotonin reuptake inhibitor. Healthy volunteers (N = 14) were administered the three compounds and placebo in a randomized, double-blind, single-dose, four-way cross-over design. All participants performed a speeded two-choice reaction task, while event-related potentials and behavioral measurements were obtained. Both haloperidol and olanzapine significantly reduced ERN amplitudes. After paroxetine, the ERN was not different from placebo. N2 congruency effects were not affected by treatment condition. Only olanzapine demonstrated behavioral effects, namely a slowing of responses, an increase in error rates, and the absence of performance adjustments. The attenuated ERNs after the dopamine antagonist haloperidol are in line with the presumed role of dopamine in action monitoring. Haloperidol is thought to block dopaminergic signaling, thus reducing ERN amplitudes. On the other hand, the effects of olanzapine are mainly caused by its sedative side effects, leading to a decline in motivation and appraisal of errors. Finally, the absence of any effects after paroxetine suggests that serotonin transmission does not play a direct role in regulating mechanisms related to action monitoring.

Background: Hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis is a prominent neurobiological finding during a major depressive episode, reflecting a state dependent factor. An issue under investigation is whether the dysfunction of the HPA axis has also a role to play as a state-independent or trait factor for major depressive disorder (MDD). In relation to this, it is important to examine HPA axis function in patients who are clinically remitted from depression., Methods: Twenty-three remitted outpatients with recurrent MDD and 23 age- and gender-matched control individuals without a history of MDD participated in the sensitive combined dexamethasone/corticotropin-releasing factor (DEX/CRF) test., Results: Free salivary cortisol responses were not significantly different between the two groups, although three patients (13%) displayed extremely elevated cortisol responses after CRF., Limitations: Limited sample size. All but one patient were under treatment with an antidepressant., Conclusions: This study shows no evidence for a disturbed DEX/CRF test as a state-independent factor in recurrent MDD on a group level. However, MDD is a complex and heterogenic disorder. Probably, there is a subgroup of patients who show a disturbed DEX/CRF test due to an inherited and/or acquired predisposition or as a biological scar after previous depressive episodes.

Objectives: In schizophrenia, stereotypy is observed, a symptom characterized by repetitive, functionless motor behaviour. Whereas cognitive dysfunctioning is known to remain stable throughout the illness, less is known about the course of the motor symptoms. The Zeigeversuch [Mittenecker, E., 1953. Perseveration und Persönlichkeit: 1. Teil: experimentelle Untersuchungen. Z. Exp. Angew. Psychol. 1, 5-31], which entails the generation of a random sequence of button presses, was claimed to capture stereotypy. We used a newly designed computerized version of the Zeigeversuch, the Stereotypy Test Apparatus (STA) to evaluate the evolution of STA performance through the course of the illness., Methods: To assess stereotyped and perseverative behaviour, 58 schizophrenic inpatients and 48 healthy controls performed the STA and the Wisconsin Card Sorting Test (WCST), respectively, as well as several other traditional neuropsychological tests and the Symbol Digit Substitution Test (SDST) on a writing digitizer., Results: The STA correlated only weakly with the WCST and SDST measures but not with the cognitive or motor slowing on the SDST, nor with the other cognitive measures. Stereotyped and perseverative idiosyncrasies both seem to increase in the course of the illness, in contrast with other cognitive dysfunctions. However, whereas perseveration is already present in the early stages of the illness, stereotyped behaviour only manifests itself in the later stages of schizophrenia. Failure of cognitive inhibition may result in an activation of prepotent stereotyped responses captured by the STA.

Objectives: A vast amount of studies demonstrates the presence of psychomotor slowing in schizophrenia. The objective of the present study was to investigate whether this overall psychomotor slowing can be divided into distinct processes that differentially affect cognitive functioning in schizophrenia., Methods: The pen-tip movements of 30 schizophrenic inpatients and 30 matched controls were digitally recorded during performance of the Symbol Digit Substitution Test (SDST) and analysed to differentiate matching time and writing time, representing the cognitive and sensorimotor component of slowing, respectively. In addition, the results were compared to each other and to the scores of traditional neuropsychological tests that assess domains such as memory and attention., Results: Both matching time and writing time were longer in the schizophrenic patients relative to the controls but did not correlate. Only matching time correlated significantly with the conventional neuropsychological test results., Conclusions: Although schizophrenic patients display both sensorimotor and cognitive slowing, the two processes are unrelated. Furthermore, only the cognitive component was associated with most of the cognitive deficits as measured by traditional neuropsychological tests.

Background: Clinical experience shows that feelings of hopelessness quite often arise in patients with schizophrenia., Aim: To describe these feelings of hopelessness, obtain insight into interrelated factors, distinguish hopelessness from depression, study the influence of hopelessness on suicidal behaviour andfind out how feelings of hopelessness can influence the treatment that is provided., Method: We searched the literature via MEDLINE and PsyCINFO using the key words 'schizophrenia', 'hopelessness', 'demoralization', and 'disappointment'., Results: Demoralization is a broader term than hopelessness and is used quite often. Positive correlations arefound between hopelessness and: (1) awareness of illness; (2) engulfment; and (3) depressive symptoms. Negative correlations are found between hopelessness and: (1) cognitive disorders; and (2) an avoidant coping style. Hopelessness and demoralisation cannot be equalled with depression. Hopelessness clearly heightens suicidal tendencies. Feelings of hopelessness in a patient suffering from schizophrenia signal that closer attention should be given to that patient., Conclusion: Feelings of hopelessness in patients with schizophrenia are not necessarily a sign of pathology but may point to existential suffering. This needs to be recognised by those dealing with persons sufferingfrom schizophrenia,

Background: A new line of research into psychomotor retardation in patients with a major depressive disorder began about ten years ago. The purpose of the research was twofold: to obtain a clearer understanding of psychomotor retardation in patients with a major depressive disorder and to assess the importance of psychomotor retardation for the diagnosis and treatment., Aim: To present an overview of the results of these studies in which psychomotor retardation of these patients was investigated., Method: The patients had to perform visuomotor tasks involving pen movements. The psychomotor retardation was measured by recording their pen movements objectively and accurately by means of a computer and digitiser., Results: Patients with major depressive disorder showed pronounced psychomotor retardation in the visuomotor tasks. The psychomotor retardation appeared to be of both a cognitive and motor nature. The treatment study which examined the effect of fluoxetine on psychomotor retardation revealed that the cognitive retardation disappeared but the motor retardation remained. It was particularly the more retarded patient who responded well to fluoxetine. The research that compared the psychomotor retardation in various subtypes of depression revealed that patients with major depressive disorder showed pronounced retardation but dysthymic patients did not show any retardation. Psychomotor retardation was more severe in patients with major depressive disorder with melancholic features., Conclusion: Psychomotor retardation can play an important role in the diagnosis and treatment of depressive disorders.

A patient who developed acute catatonia during benzodiazepine withdrawal is discussed. The case prompted us to review the literature on the role of benzodiazepines in the treatment of acute catatonia. Only retrospective and open studies were found which indicate that benzodiazepines do have a beneficial effect. Lorazepam is the most widely studied benzodiazepine and at present is the best treatment option. In the specific case of acute catatonia brought on by benzodiazepine withdrawal the recommended dosage is the same as for acute catatonia caused by something other than benzodiazepine withdrawal.

Rationale: The central cholinergic system is implicated in cognitive functioning. The dysfunction of this system is expressed in many diseases like Alzheimer's disease, dementia of Lewy body, Parkinson's disease and vascular dementia. In recent animal studies, it was found that selective cholinergic modulation affects visuospatial processes even more than memory function., Objective: In the current study, we tried to replicate those findings. In order to investigate the acute effects of cholinergic drugs on memory and visuospatial functions, a selective anticholinergic drug, biperiden, was compared to a selective acetylcholinesterase-inhibiting drug, rivastigmine, in healthy elderly subjects., Methods: A double-blind, placebo-controlled, randomised, cross-over study was performed in 16 healthy, elderly volunteers (eight men, eight women; mean age 66.1, SD 4.46 years). All subjects received biperiden (2 mg), rivastigmine (3 mg) and placebo with an interval of 7 days between them. Testing took place 1 h after drug intake (which was around Tmax for both drugs). Subjects were presented with tests for episodic memory (wordlist and picture memory), working memory tasks (N-back, symbol recall) and motor learning (maze task, pursuit rotor). Visuospatial abilities were assessed by tests with high visual scanning components (tangled lines and Symbol Digit Substitution Test)., Results: Episodic memory was impaired by biperiden. Rivastigmine impaired recognition parts of the episodic memory performance. Working memory was non-significantly impaired by biperiden and not affected by rivastigmine. Motor learning as well as visuospatial processes were impaired by biperiden and improved by rivastigmine., Conclusions: These results implicate acetylcholine as a modulator not only of memory but also of visuospatial abilities.

Purpose: Evidence indicates that classical antipsychotics may aggravate non-malignant and malignant catatonia (MC). Atypical antipsychotics are less likely to cause movement disorders than classical antipsychotics and they are being frequently prescribed in disorders that can be associated with catatonia. Therefore, the important question that arises is whether atypical antipsychotics have a role to play in the treatment of catatonia., Materials and Methods: A Medline search was performed to locate papers on the use of atypical antipsychotics in catatonia published between 1970 and 31st December 2004., Results: The literature on the use of atypical antipsychotics in catatonia consists of case reports and retrospective studies. In most cases of non-MC a reduction of the catatonic symptoms is reported upon treatment with atypical antipsychotics. Cases of MC relate mainly to the neuroleptic malignant syndrome (NMS), which is considered as an iatrogenic stuporous variant of MC caused by antipsychotics., Conclusion: There are indications that atypical antipsychotics may be useful in non-MC. As a consequence, one should not only focus on the possible extrapyramidal and autonomic side effects of these drugs, but also on the possible beneficial effects on certain brain functions and on the catatonic symptomatology. However, randomized controlled trials are needed to evaluate the effect of these drugs, and caution is advisable, since cases of NMS have been linked to treatment with atypical antipsychotics. There is no evidence to prescribe atypical antipsychotics in MC.

Introduction: Few studies using objective and sensitive measuring techniques have investigated whether psychomotor retardation (PR), an important symptom of a major depressive disorder (MDD), is also present in dysthymic patients. In this study, the following questions were addressed: (1) is PR also prevalent in dysthymia? (2) If so, is the PR cognitive or motor in nature? And (3) does the nature and degree of the PR in patients with dysthymia differ from the PR in MDD patients found in earlier studies?, Methods: PR was measured by comparing the, digitally recorded, fine motor performance of 20 unmedicated dysthymic inpatients (mean age: 33) and 32 controls on copying and drawing tasks. In addition, the performance of the dysthymic patients was compared to the performance results of 32 unmedicated MDD inpatients collected in an earlier study., Results: The dysthymic patients were not slower than the controls in performing the fine motor tasks: neither initiation time (IT) nor movement time (MT) were prolonged. As expected, the MDD patients did show significantly longer ITs and MTs in all tasks compared to the controls. On the clinical Salpetriere Retardation Rating Scale (SRRS), the dysthymic patients had high scores on mainly subjective cognitive items like concentration and memory complaints., Limitations: The dysthymic patients had significantly less severe forms of depression compared to the MDD patients. As dysthymia, by definition, is a less severe form of depression we could not examine whether PR would manifest itself in severely depressed dysthymic patients, as is the case in certain MDD patients., Conclusion: In this study, no objective evidence was found for PR in dysthymic patients during fine motor tasks. PR may be used to differentiate between dysthymia and MDD.

Rationale: Action monitoring has been studied extensively by means of measuring the error-related negativity (ERN). The ERN is an event-related potential (ERP) elicited immediately after an erroneous response and is thought to originate in the anterior cingulate cortex (ACC). Although the ACC has a central role in the brain, only a few studies have been performed to investigate directly the effects of drugs on action monitoring. A recent theory argues that the mesencephalic dopamine system carries an error signal to the ACC, where it generates the ERN., Methods: ERPs and behavioral measurements were obtained from 12 healthy volunteers performing an Eriksen Flankers task. On each of the 4 test days, the stimulant D-amphetamine, the sedative lorazepam, the antidepressant mirtazapine, or a placebo was orally administered in a double-blind, four-way crossover design., Results: The indirect dopamine agonist amphetamine led to a strong enlargement of ERN amplitudes without affecting reaction times. Lorazepam and mirtazapine both showed slowing of responses, but only lorazepam led to reduced ERN amplitudes., Conclusions: Administration of amphetamine leads to stimulated action monitoring, reflected in increased ERN amplitudes. This result provides evidence for dopaminergic involvement in action monitoring and is in line with differences in ERN amplitude found in neuropsychiatric disorders also suggesting dopaminergic involvement. The different effects for lorazepam and mirtazapine are probably caused by the neurobiological characteristics of these two types of sedation. Action monitoring is suppressed after administration of lorazepam, because the GABAergic pathways directly inhibit ACC functioning, whereas the histaminergic pathways of mirtazapine do not innervate the ACC directly.

Background: The results of previous studies on psychomotor retardation (PR) in elderly depressed patients are inconsistent. The purpose of this study was (1) to try and establish whether elderly depressed patients show PR, and (2) if so, which process (cognitive/motor or both) is mainly slowed?, Methods: Twelve elderly depressed patients and healthy controls (age: 70) were compared on figure copying tasks in which the cognitive task difficulty was manipulated., Results: Both initiation time (IT) and movement time (MT) were prolonged in the patient group. The effects of the cognitive manipulations were not larger in the patient group., Limitations: The sample size was small. Furthermore, patients were not medication free., Conclusions: A cognitive and a more pronounced motor retardation was found. Clinicians should be aware of this at least additive effect of aging and depression on PR in elderly patients.

Few studies examining psychomotor retardation (PR) in patients with major depressive disorder (MDD) included medication-free patients. The purpose of this study was (1) to examine whether unmedicated patients with MDD would exhibit PR, (2) to determine whether this retardation, if present, was more cognitive or motor in nature, and (3) to investigate whether any differences in PR could be established between melancholic and nonmelancholic depressed patients. Thirty-eight unmedicated inpatients with severe MDD (20 melancholic and 18 nonmelancholic patients) and 38 matched controls were compared on figure-copying tasks in which the cognitive task difficulty was manipulated. In addition, a simple motor task and the symbol digit substitution task (SDST) were administered. As a group, the patients were significantly slower performing all tasks and both initiation times (IT) and movement times (MT) were prolonged. However, when a distinction was made between the two subtypes, only the melancholic patients showed prolonged MTs compared to the controls. Furthermore, the melancholic patients differed significantly from the controls in IT in all tasks. The nonmelancholic patients had significantly longer ITs than the controls in two copying tasks. It can be concluded that there was clear cognitive and motor slowing in this group of unmedicated inpatients with MDD. The melancholic patients were more severely affected than the nonmelancholic patients and showed a slowing of cognitive as well as motor processes. Differences in psychomotor functioning between melancholic and nonmelancholic depressed patients could imply different underlying neurobiological disturbances in these subtypes of major depression.

Schizophrenia and depression have an overlap in symptomatology, namely a slowing in both motor and mental activities, denoted in depression as 'psychomotor retardation' and in schizophrenia as 'psychomotor poverty'. By means of a new technique that allows the measurement of psychomotor speed and the computerized analysis of writing movements recorded during the performance of the Digit Symbol Test, it indeed proved to be possible to observe a slowing in both disorders. In addition, a different structure of slowing in the two patient groups could be identified.

We report on our experience with autoinjection therapy in 72 patients with erectile dysfunction. We analysed factors that have an impact on the outcome of autoinjection therapy, and we focused on psychological, sexological and relational issues. In 53 (74%) patients an organic aetiological factor was found. Although with the aid of injection 82% of the men were able to achieve an erection adequate for penetration, only 39% continued treatment beyond one year. Lowest drop-out rates were encountered among patients with diabetes mellitus and men without organic aetiology (50% and 53% respectively). The most important reason for discontinuation was lack of acceptance of autoinjection therapy by the partner. Other reasons were prolonged erection, haematomas, ineffectiveness and fear of self-injection. Although autoinjection provides a safe and effective long-term method for the treatment of erectile dysfunction, the drop-out rate is strikingly high. Apparently, the acceptance of the partner is the most important determinant of the result of autoinjection therapy. Therefore, the partner should be involved in the counselling and treatment from the beginning.

To evaluate the psychological effect of implantation of an inflatable hydraulic penile prosthesis, a follow-up investigation was carried out among 25 patients who between November 1985 and March 1989 received such a prosthesis in the department of Urology at St. Radboud Hospital, and among their partners. The methods consisted of written questionnaires and personal interviews. The mean time between implantation and evaluation was 20 months. Implantation did not improve sexual or general partner relationship. However, the great majority of patients (84%) and their partners (75%) would decide again to have the prosthesis implanted. Some elements of dissatisfaction (concerning the limited length of the erect penis, difficult coital position, and failing ejaculation) were found, that draw attention to the necessity of improving information and psychosexual counselling.