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Unlabelled: Alzheimer's disease (AD) is a major healthcare challenge due to the increasing longevity of the population. Clinically prominent neuropsychological and neurological impairments, together with behavioral disorders characterize Alzheimer's disease (AD). In the past, behavioural and emotional disturbances received less attention than cognitive symptoms in studies of dementia. The association between cognitive and behavioural symptoms is complicated by the fact that such association could also occur with different patterns during depressive episode without dementia. Because Alzheimer's disease (AD) tends to be under diagnosed, there is an increasing need for accurate neuropsychological screening tools that are easy to administer by psychiatrists. The aim of the present study was to validate, in French, a sensitive and specific screening battery (B2C) designed to improve the discrimination between patients with AD, patients with depression, and healthy elderly subjects., Population and Method: The B2C was administered to 123 ambulatory subjects (mean age 76.4 2.3 years): divided in three groups of subjects. AD subjects were included (n=49) with a Mini-Mental Status Examination (MMSE) score of between 18 and 26, and a confirmed diagnosis (DSM IV) of mild to moderate AD. Subjects were not included if they were receiving treatment with an acetylcholinesterase inhibitor. The depressive group comprised elderly subjects (n=27) with at least two DSM IV criteria for a major depressive episode including the depressive mood criterion and a score of more than 17 on the Montgomery-Asberg Depression Rating Scale (MADRS). The healthy control group (n=47) comprised age-matched subjects with no neurological or psychiatric pathology. The B2C consists of four individual tasks derived from classical neuropsychological tests. Tasks were presented in the following order: temporal orientation test (knowledge of month, date, year, day of the week and time of day), 5 word test (task is originally derived from the Enhanced Cued Recall test), clock drawing test (In this widely used test, the subject had to draw a clock with all the numbers and then draw the clock hands at twenty minutes to four), and the semantic verbal fluency test (the subject was asked to generate as many words as possible from a given category in a fixed time period of 60 seconds). During the pre-study investigator meeting, the test procedure was adapted to ensure uniformity of practice in all centres. The B2C was administered one week to one month after the study inclusion date by a psychologist blinded to the patient groups and who had not participated in the subject's inclusion. Multivariate analysis was performed using a forced model of all four tests. Due to the nature of the dependent variable (AD vs controls and depressive vs control), the chosen discrimination model was a binary logistical regression model. Explanatory variables were limited to the variables of the test battery, and the dependent variable was the subject's status (AD, depressive or control)., Results: The mean results for each test are presented in Table II. The time taken to perform the tests was significantly higher (p=0.0001) for the AD group (11.2 minutes) when compared with both the control (7.6 minutes) and depressive group (8.2 minutes). In each of the four subtests, the AD subjects were significantly more impaired than the two other groups. Multivariate analysis was performed using a forced model of all four tests which provided correct classification of a high percentage of subjects (88.5%). The analysis followed a normal distribution and demonstrated that the AD patients were significantly impaired in all four tests of the B2C compared with controls. Depressive, elderly subjects were only impaired in verbal fluency. Multivariate analysis showed that, compared with controls, patients with mild AD were significantly impaired for all four tests. Response operating characteristics (ROC) analysis of the B2C showed: 93.8% sensitivity and 85% specificity for discriminating AD from control patients (table III), and 63% sensitivity and 96% specificity for discriminating AD from depressive patients (table IV)., Discussion: The main objective of this study was to demonstrate that the Short Cognitive Evaluation Battery developed in the French language is able to discriminate between patients suffering from AD and healthy elderly subjects. The results clearly demonstrate that AD patients were significantly impaired in all four tests of the B2C compared with the control group. The present study also supports the use of the screening battery for discriminating between AD and depressive subjects. The SCEB was less discriminatory for AD versus depressive patients than for AD versus controls. This could be due to the limited size of the depressive group. The verbal fluency test was the most sensitive for discriminating between AD and depression but this was at the expense of specificity. Other brief screening tests have already been developed in English speaking countries, In French language, the B2C appears to be a highly sensitive and specific tool for discriminating between patients with mild AD and healthy elderly individuals. Furthermore, in combination with clinical evaluation, the B2C could improve the specificity of the difficult discrimination between mild AD and depression. The next step of the validation process will include concurrent validity study and inclusion of a higher number of subjects with depressive symptoms.

The high-standard sport practice requires an optimum functioning level of the individual in all its physiological systems as a whole. If the physical program training progressed much these last years, the techniques of mental preparations are still very heterogeneous and are not based on any validated procedures, based only on individual practices. Nevertheless, the majority of athletes and trainers stress the major importance of "mental" in the realization of performances. One of the obstacles in the mental training of the athletes is the difficulty in finding tools making it possible to evaluate and measure the psychic state of the individual and its mode of coping and adjustment, apart from any psychopathology. Few studies have been carried out on applicability of the personality questionnaires derived from the current dimensional models in these populations. Our study aimed to describe the personality of the members of the french junior team of road cycling, using the Temperament and Character Inventory (TCI) developed by Cloninger to explore the seven dimensions of his psychobiologic model of personality. In this model, four dimensions are temperament factors, and three are character factors. The three main dimensions of temperament are Novelty Seeking (NS), ie the tendency towards excitement in response to novel or rewarding stimuli, Harm Avoidance (HA) hypothesized to represent the tendency to respond intensely to signals of adverse stimuli, and Reward Dependence reflecting the tendency to respond intensely to signals of reward and to maintain behavior previously associated with reward. These personality traits are hypothetically related to underlying neurotransmitter systems (especially NS to dopaminergic function and HA to serotonergic function). The two main dimensions of character are Self-Directedness (SD) and Cooperativeness (C), measuring maturity traits respectively concerning individual and social adaptation. In this study, we used a computerized version of the TCI in a sample of 18 racing cyclists, ie all the members of the french junior national team. Their results were compared to those of 26 male, young, community subjects, derived from the french normative validation sample of the TCI. Mean comparisons were performed with the Mann-Whitney test, with Bonferroni correction for multiple comparisons. A significant difference between subjects and controls was obtained for Reward Dependence (p<0.0001), attachment RD3 (p<0.0001), and dependence RD4 (p<0.0025). No significant difference appeared between both groups for the other temperament or character dimensions. Based on temperamental Cloninger typology, the type "passionate" appeared to be the most frequent in this sample (55.6%). These results suggested that the TCI can be easily and usefully used in athletes, and that the personality profile of young competitive cyclists is not abnormal except a high level of reward dependence. Numerous applications can be derived from this use: the development of specific and personalized mental training, the screening and prevention of psychological vulnerability.

The consumption of antidepressant seems to be in France higher than in comparable countries, as well as the overall consumption of healthcare and medications. In Western countries, in recent years, the use of antidepressants has regularly increased, mainly due to the use of serotoninergic antidepressants. In France, in a week, the prevalence of antidepressant use in the overall population increased from 1.7% in 1992 to 3% in 1995. This survey addressed the overall population in the form of a representative sample focusing on subjects who indicated, at the time they were consulted, that they were taking an antidepressant. The study aimed to determine the circumstances of prescription: prescriber file, reason for prescription, type of medication prescribed, match between the prescription and the product indications stated in the marketing authorization, prescription duration and reason for discontinuing treatment. Methodology - The first stage consisted in forwarding a letter to a panel of 44 000 subjects aged 15 years or more and representative of the French population. The aim was to achieve a cross-sectional description of the population taking antidepressants. The response rate was 82% (36 036 subjects). The subjects who stated that they were taking an antidepressant were re-contacted by telephone by an interviewer trained in the use of the Composite International Diagnostic Interview - lifetime (CIDI), exploring depression and anxiety diseases with a view to potential diagnosis as per DSM criteria. Longitudinal follow-up over 8 months from the initial screening was evaluated using a monthly questionnaire on the time course of antidepressant consumption. Results - Out of 20 000 households, comprising 44 000 people aged over 15 years, 1 333 people were taking an antidepressant or had taken one in the previous 4 weeks. The sex ratio of the antidepressant consumers was 3 women to 1 man, amplifying the known sex ratio with respect to depressive disorders. The mean age of the subjects taking an antidepressant at time t was 51 years. Lifestyle and socioprofessional category did not seem to influence antidepressant consumption. Somatic comorbidity was present in 60% of antidepressant consumers. Among the consumers of antidepressants at time t, 45% were taking a selective serotonin reuptake inhibitor (SSRI). The two products most widely prescribed in that class were fluoxetine (30% of the subjects taking an antidepressant at time t) and paroxetine (10% of the subjects taking an antidepressant at time t). The other SSRIs accounted for the remaining 5%. Thirty-nine percent of the consumers were taking a tricyclic antidepressant: clomipramine in 16% of cases, amitriptyline in 14%, and other tricyclic antidepressants in 9%. Lastly, 20% of the consumers were taking an antidepressant that was neither an SSRI nor a tricyclic antidepressant. Only 4% of the patients were concomitantly taking 2 antidepressants: single-agent therapy is in line with the recommendations of the various expert groups. In the survey, 9 antidepressant prescriptions out of 10 were written by an open-care practitioner, and 1 out of 10 by a hospital physician. For 60% of the subjects, the antidepressant treatment was prescribed by a general practitioner. General practitioners prescribe less tricyclic antidepressants and more SSRIs than specialists. The main reason for prescription reported by the patient was depression (57% of cases); followed by a state of anxiety or stress (15% of cases). In 10% of cases, the consumer stated that the reason for treatment was not psychological. Sixty-two percent of subjects presented with, or had presented with, a mood disorder as per M-CIDI (major depression, mood disorder, or a combination of the two) and 14% an isolated anxiety disorder. Twenty-five percent of the subjects on antidepressants did not fulfill all the M-CIDI criteria for any diagnosis. Among the people receiving antidepressants, 54% had a CIDI diagnosis in strict compliance with the marketing authorization indications for the product considered. One quarter (25%) presented with a diagnosis of a characterized psychiatric disease, outside of the marketing authorization indications for the product taken. This finding reflects misuse or use on the basis of published data not incorporated in the marketing authorization. The dosages were in line with those stated in the marketing authorization for the disease considered in almost 99% of cases for the subjects on paroxetine and fluoxetine, but for only 22% of cases for the subjects on tricyclic antidepressants. Tricyclic antidepressants would therefore appear to be frequently inappropriately in terms of proportions that would be ineffective: half of the subjects on clomipramine were taking a dose less than or equal to one third of the minimum recommended dose. Conclusion - This survey shows that the point-prevalence of antidepressants in the global population in France is about 3.5%. Women consume more antidepressants than men. SSRIs are the most widely prescribed antidepressants. The survey findings point out the discrepancies between official indications, such as the ones issued by the regulatory authorities, and the physicians' prescribing practices.

The European Study of the Epidemiology of Mental Disorders (ESEMeD/MHEDEA 2000) is a new cross-sectional study investigating the prevalence and the associated factors of mental disorders, as well as their effect on health-related quality of life and the use of services in six European countries. This paper describes the rationale, methods and the plan for the analysis of the project. A total of 22,000 individuals representative of the non-institutionalized population aged 18 and over from Belgium, France, Germany, Italy, the Netherlands and Spain are being interviewed in their homes. Trained interviewers use a computer-assisted personal interview (CAPI) including the most recent version of the Composite International Diagnostic Interview (CIDI, 2000), a well-established epidemiological survey for assessing mental disorders. This is the first international study using the standardized up-to-date methodology for epidemiological assessment. Sizeable differences in prevalence, impact and level of need that is met by the health services are expected. The analysis of these differences should facilitate the monitoring of ongoing mental health reform initiatives in Europe and provide new research hypotheses.

Many hypotheses have been made to explain the high rate of benzodiazepine consumption in France, including a general cultural and/or familial tendency to use certain types of psychotropic drugs. This study explored the association between lifetime medication use by parents and their children. Two hundred and twenty-one young patients (158 boys and 63 girls) consulting at a child and adolescent psychiatry department, six to 16 years of age (mean = 9.7 years), were screened for lifetime use of psychotropic drugs using a structured interview. Parents were asked about their own consumption, as well as their children's. Lifetime consumption rates (at least once) were 22.2% in boys and 20.6% in girls, and 19.6% in children less than 11 years old. Higher rates were found in patients with emotional disorders (anxiety disorders and depression). In parents, 45.1% of mothers and 24.1% of fathers reported using medications at least once. A significant association was found between child and parental medication use: 34.1% of children had positive lifetime consumption when their mothers also used medications at least once versus only 13.6% in other children (odds ratio = 3.31 [1.68-6.50]; P = 0.001). The most significant association was found between medication use by girls and their mothers (odds ratio = 12.1 [2.38-61.5]; P = 0.003). These data point to the existence of a family pattern of psychotropic drug consumption, especially in females.

Studies of the prevalence of depression and anxiety disorders have shown that there is a high prevalence of comorbidity of these 2 disorders. The resulting disability and burden affect not only the individual in terms of decreased productivity, but the level of health care utilization is also increased. The objective of this article is to look at the epidemiology, disability, and global burden of depression and anxiety across the different nations of the world. This article will concentrate on the results from the Cross-National Collaborative Group. The transcultural trends in prevalence and disability presented here must be viewed in the light of the limitations of the study, such as methodology and population sampling, uniformity in the method of clinical assessment, and the collection and processing of data. New studies of depression and anxiety among different cultures are currently in progress in the form of the European Study of Epidemiology on Mental Disorders (ESEMeD), which is closely linked to the World Health Organization (WHO) World Mental Health 2000 initiative. The methodology for ESEMeD is similar to that of the WHO World Mental Health 2000 study, which will facilitate comparisons between the results for Europe and the rest of the world. Results of these studies are awaited with anticipation.

Objective: To provide primary care physicians with a better understanding of transcultural issues in depression and anxiety., Participants: The 4 members of the International Consensus Group on Depression and Anxiety were James C. Ballenger (chair), Jonathan R. T. Davidson, Yves Lecrubier, and David J. Nutt. Five faculty invited by the chair also participated: Laurence J. Kirmayer, Jean-Pierre Lepine, Keh-Ming Lin, Osamu Tajima, and Yutaka Ono., Evidence: The consensus statement is based on the 5 review articles that are published in this supplement and the scientific literature relevant to the issues reviewed in these articles., Consensus Process: Group meetings were held over a 2-day period. On day 1, the group discussed the review articles, and the chair identified key issues for further debate. On day 2, the group discussed these issues to arrive at a consensus view. After the group meetings, the consensus statement was drafted by the chair and approved by all attendees., Conclusion: The consensus statement underlines the prevalence of depression and anxiety disorders across all cultures and nations while recognizing that cultural differences exist in symptom presentation and prevalence estimates. In all countries, the recognition of depression by clinicians in the primary care setting is low (generally less than 50%), and the consensus group recommends a 2-step process to aid the recognition and diagnosis of depression. In line with the low recognition of depression and anxiety disorders is the finding that only a small proportion of patients with depression or anxiety are receiving appropriate treatments for their condition. Biological diversity across ethnic groups may account for the differential sensitivity of some groups to psychotropic medication, but this area requires further investigation.

We explored the psychometric features of the French Temperament and Character Inventory (TCI) in a 602-subject community sample (263 men and 339 women), representative of the French population. The factor structures of the temperament and character dimensions, explored separately, were in agreement with the hypothesized constructs, except for the scales Novelty Seeking NS1 (exploratory excitability), Persistence, and Self-Directedness SD4 (self-acceptance). The internal consistency of the main dimensions was good (Cronbach alpha coefficients between 0.68 and 0.82), but weak for Persistence (0.49). The mean scores of the temperament dimensions were notably different from those published in other normative data - especially lower for Novelty Seeking (16.4+/-5.6) and higher for Harm Avoidance (16.1+/-7.2) when compared with US data - suggesting cross-cultural differences in personality assessment, and the necessity to use specific normative values with each translated instrument.

Cognitive theories of social phobia have largely been inspired by the information-processing models of anxiety. They propose that cognitive biases can, at least partially, explain the etiology and maintenance of this disorder. A specific bias, conceived as a tendency to preferentially process socially-threatening information, has been proposed. This bias is thought to intervene in cognitive processes such as attention, memory and interpretation. Research paradigms adopted from experimental cognitive psychology and social psychology have been used to investigate these hypotheses. The existence of a bias in the allocation of attentional resources and the interpretation of information seems to be confirmed. A memory bias in terms of better retrieval for threat-relevant information appears to depend on specific encoding activities.

This paper investigates the prevalence of symptoms and various diagnostic criteria of DSM-IV social phobia in a French national representative population of 12,873 subjects, aged 15 or more. Respondents filled out a mailed questionnaire based on the social phobia section of the Munich-Composite International Diagnostic Interview (M-CIDI) in the year 1996. Response rate was 80.5%. Sixty-seven point one percent of the sample acknowledge having at least once in their lifetime a strong fear of one or more of the six prototypical social fear situations that are used as the CIDI social phobia stem items. However, only a few fulfilled all DSM-IV diagnostic criteria for social phobia. Depending on the type of diagnostic algorithms used and the stringency in which these criteria are applied, the resulting prevalence varied between 1.9 and 7.3%. These findings provide some further evidence about the considerable effects of varying diagnostic criteria and thresholds on prevalence rates for social phobia, explaining why most recent surveys have reported considerably higher rates of social phobia than those in the early 1980s.

Aims: To describe the psychiatric indications of neuroleptics (especially the relative share of schizophrenic and other psychotic disorders) and the usage patterns of these drugs (dose, duration, coprescriptions)., Methods: A one-day national cross-sectional survey in a random sample of 723 French psychiatrists was carried out in 1996. Each psychiatrist was asked to complete a standardized questionnaire for the first three patients seen the day of the survey to whom at least one neuroleptic was prescribed (initiated or renewed)., Results: One thousand seven hundred and fifty-four questionnaires were returned. Three quarters of the patients (74%) were psychotic (664 with schizophrenia, and 636 other psychosis), 19. 3% were depressive and 6.7% had other psychiatric disorders. Phenothiazines were the most often prescribed (40.8%), followed by butyrophenones (22.5%), benzamides (15.8%), other neuroleptics (14. 8%) and thioxanthenes (6.1%). Among schizophrenic subjects, an average number of 1.54 (95% CI: 1.50-1.60) neuroleptics were prescribed per patient, compared with 1.4 (95% CI: 1.32-1.41) and 1. 2 (95% CI: 1.14-1.23) in other psychotic and depressive subjects, respectively. Regardless of the indication, non-neuroleptic psychotropic drugs were coprescribed in 75.4%, mainly benzodiazepines (75.7%). Adjuvant drugs used in prevention or treatment of side-effects were coprescribed in 46.7%, mostly anticholinergic antiparkinsonians (86.1%)., Conclusions: Neuroleptics are mainly prescribed for psychotic disorders and especially schizophrenia. However, current recommendations are not always followed.

Clinicians are familiar with the life and psychological difficulties of incest victims, but their observations often are refuted as being retrospective and unsystematic. We aimed to ascertain similarities and differences between incestuous rape and nonincestuous rape. One hundred and two victims consulting a French forensic center were interviewed in a systematic follow-up study over 6 months using structured interview schedules. Stepwise logistic regression analysis adjusted for age, gender, and characteristics of the trauma showed that posttraumatic stress disorder, dissociative disorders, agoraphobia, and low self-esteem were overrepresented in the incest-rape group compared to the nonincest-rape group.

This study explored the relative impact of general medical conditions and psychopathology on the current and lifetime use of anxiolytic and/or hypnotic drugs by general hospital inpatients. One hundred and five consecutive patients, admitted to an internal medicine department, were assessed by a structured interview about current and lifetime use of anxiolytic and/or hypnotic drugs, and with somatic and psychopathology scales. Eighty percent of patients reported using anxiolytics and/or hypnotics at least once in a lifetime, 62.9% in the last year, 55.2% in the last 3 months, and 42.9% in the last week. Correlations were found between drug use and current levels of anxiety and depression, but not somatic pathology. Psychological suffering appeared to be a major determinant for anxiolytic and/or hypnotic use by patients with general medical conditions. Consumption rates were higher than in the general population, but there was no direct link between somatic morbidity and drug use.

This study aimed to investigate the psychological disorders following rape as well as the course of Post-Traumatic Stress Disorder (PTSD), and to determine clinical factors predictive of chronic PTSD. Seventy-three rape victims were observed in a systematic follow-up study over 1 year following rape using structured interview schedules. The frequency of PTSD was massive. The early disorders predicting PTSD 1 year after rape included somatoform and dissociative disorders, agoraphobia and specific phobias as well as depressive and gender identity disorders and alcohol abuse. Through stepwise logistic regressions, the following were found to be good models of prediction of chronic PTSD 1 year after rape: for the characteristics of the traumas, intrafamily rape, being physically assaulted outside rape, and added physical violence during rape; for the early psychological and behavioural attitudes, low self-esteem, permanent feelings of emptiness and running away; and for early mental disorders, agoraphobia and depressive disorders. Finally, among all these predictive factors, added physical violence during rape, low self-esteem, permanent feelings of emptiness and agoraphobia were shown to constitute a strong model of predictors. People presenting features such as the predictive factors of chronic PTSD found in the study should be asked about a history of rape and symptoms of PTSD.

The relationship between social phobia and alcoholism is complex. Alcohol problems typically develop secondary to social phobia, with patients reporting that they find alcohol helpful in coping with the symptoms of anxiety. However, excessive alcohol consumption may actually precipitate anxiety symptoms, and thus a vicious circle of anxiety and alcoholism is established. The clinician must consider the possibility of comorbidity in patients presenting with either alcoholism or social phobia. Only when both components of the condition are adequately assessed and treated can the cycle of social phobia and alcohol abuse be broken.

Objective: This study aimed to determine whether the General Health Questionnaire, a simple psychological screening instrument, could be useful to non-specialists in screening for psychologically traumatized rape victims., Study Design: 285 rape victims (mean age 22.5, men 8%) attending consecutively a Consultation for Victims of Psychological Trauma at the University Hospital in Tours, France, were assessed through the Structured Interview for Post-Traumatic Stress Disorder (SI-PTSD), and the French 28-item version of the self-rated General Health Questionnaire (GHQ-28)., Results: 70% had Post-Traumatic Stress Disorder (PTSD) and 72% a GHQ-28 overthreshold score. The principal component analysis of the GHQ-28 ratings yielded a 4-factor solution: social dysfunction, feeling of foreshortened future type of depression, somatoform complaints and hyperalertness anxiety. GHQ-28 reliability and validity in screening for PTSD were studied through computation of Cronbach's alpha coefficient (0.95), sensitivity (88%) and positive predictive value (86%). CONCCLUSION: Using the GHQ-28 is valid and appropriate for practical use.

We wrote a Basic program for Macintosh and IBM-compatible computers in order to administer the 226 questions of the French Temperament and Character Inventory (TCI) automatically, and to obtain a personality profile instantaneously. Validity was assessed by comparing the results of 32 psychiatric inpatients who used this program and the paper-and-pencil form of the TCI over an interval of 4.8 days on average. No acceptability problem was met with the computerized version. Correlation coefficients between computer and paper-and-pencil scores varied from 0.78 to 0.91 for temperament dimensions, and from 0.71 to 0.82 for character dimensions. The mean scores of the two versions were not significantly different. These results suggest that a computerized version of the TCI can be a reliable and acceptable instrument for the assessment of personality dimensions in psychiatric patients.

In a recent issue of the Harvard Review of Psychiatry, results from the Stirling County Study showed that the prevalence and incidence rates of depression were similar in men and women when "gender-fair" criteria were used and help-seeking was not required. We attempted to replicate these findings by applying the criteria for depression from the Stirling County Study to two national and six international epidemiologic surveys conducted in the 1980s and 1990s. Depression was defined as dysphoric mood and disturbances of sleep, appetite, and energy, with at least a mild degree of impairment. The rates of depression were computed using this algorithm with data from the US Epidemiologic Catchment Area Study, conducted in the 1980s, the US National Comorbidity Survey, conducted in the 1990s, and independent community surveys from Canada, Puerto Rico, France, Taiwan, Korea, and New Zealand. For the US studies, these rates were recalculated after persons seeking treatment were removed from the analyses, where such data were available. Using Stirling County Study criteria, the lifetime prevalence rate of depression remains approximately twice as high in women as in men cross-nationally, except in Puerto Rico. Excluding help-seeking as a criterion and controlling for birth cohort do not change the findings. The Stirling County findings on absence of a sex difference in rates of depression using "gender-fair" criteria may be due to methodological variance in the collection of data, sample size, or the social and/or genetic uniqueness of the Atlantic Canadian community.

Background: Epidemiological data on panic disorder from community studies from 10 countries around the world are presented to determine the consistency of findings across diverse cultures., Method: Data from independently conducted community surveys from 10 countries (the United States, Canada, Puerto Rico, France, West Germany, Italy, Lebanon, Taiwan, Korea, and New Zealand), using the Diagnostic Interview Schedule and DSM-III criteria and including over 40,000 subjects, were analyzed with appropriate standardization for age and sex differences among subjects from different countries., Results: The lifetime prevalence rates for panic disorder ranged from 1.4 per 100 in Edmonton, Alberta, to 2.9 per 100 in Florence, Italy, with the exception of that in Taiwan, 0.4 per 100, where rates for most psychiatric disorders are low. Mean age at first onset was usually in early to middle adulthood. The rates were higher in female than male subjects in all countries. Panic disorder was associated with an increased risk of agoraphobia and major depression in all countries., Conclusions: Panic disorder is relatively consistent, with a few exceptions, in rates and patterns across different countries. It is unclear why the rates of panic and other psychiatric disorders are lower in Taiwan.

Objective: To estimate the rates and patterns of major depression and bipolar disorder based on cross-national epidemiologic surveys., Design and Setting: Population-based epidemiologic studies using similar methods from 10 countries: the United States, Canada, Puerto Rico, France, West Germany, Italy, Lebanon, Taiwan, Korea, and New Zealand., Participants: Approximately 38000 community subjects., Outcome Measures: Rates, demographics, and age at onset of major depression and bipolar disorder. Symptom profiles, comorbidity, and marital status with major depression., Results: The lifetime rates for major depression vary widely across countries, ranging from 1.5 cases per 100 adults in the sample in Taiwan to 19.0 cases per 100 adults in Beirut. The annual rates ranged from 0.8 cases per 100 adults in Taiwan to 5.8 cases per 100 adults in New Zealand. The mean age at onset shows less variation (range, 24.8-34.8 years). In every country, the rates of major depression were higher for women than men. By contrast, the lifetime rates of bipolar disorder are more consistent across countries (0.3/100 in Taiwan to 1.5/100 in New Zealand); the sex ratios are nearly equal; and the age at first onset is earlier (average, 6 years) than the onset of major depression. Insomnia and loss of energy occurred in most persons with major depression at each site. Persons with major depression were also at increased risk for comorbidity with substance abuse and anxiety disorders at all sites. Persons who were separated or divorced had significantly higher rates of major depression than married persons in most of the countries, and the risk was somewhat greater for divorced or separated men than women in most countries., Conclusions: There are striking similarities across countries in patterns of major depression and of bipolar disorder. The differences in rates for major depression across countries suggest that cultural differences or different risk factors affect the expression of the disorder.

A higher anxiolytic and hypnotic consumption has been evidenced in France by recent international and national surveys. In an effort to counteract this pattern French Health authorities have enforced limitation to the prescription of these drugs. Understanding the causes of this overuse needs a careful analysis of the pattern of use of this medicine but also of the associated morbidity factors. In the last ten years several studies have attempted to address these issues. In the general population there were 25 to 30% of occasional or regular users with between 5 and 7% chronic users making french anxiolytic users two to three time superior to most industrialised countries. This high level of consumption is not the privilege of anxiolytic since the same pattern of use is observed for all medicine. Studies in primary care, in medical inpatients and psychiatric inpatients show as expected that anxiolytic use increase with the psychiatric morbidity and also with somatic disorder. The main risk factors for anxiolytic use are female sex, old age and psychic and somatic morbidity. Age seems to play a major role in subjects over 65: 17% are chronic users. Multiple factors might play a role in benzodiazepine use as medical care system, physician type of practice, cultural specific aspects but no proper simple explanation is available to explain the mechanism of the french high anxiolytic use. Given the poor global recognition of mental disorder observed in most countries it is suggested to privilege primary care physician training in psychiatry to optimize psychotropic drug use.

The individualization of social phobia among other phobic disorders is very recent, although previous clinical descriptions can be found in the literature. The new classifications (DSM-III, DSM-IV and ICD-10) have provided operationalized criteria for this disorder, which have allowed researchers to conduct epidemiological studies. However, some diagnostic issues are not completely solved, namely, those with other boundary disorders. Cross-cultural prevalence and risk factors of social phobia are reviewed. Results of a French community study have found a lifetime prevalence rate of 2.1% in males and 5.4% in females. Comorbidity of social phobia with other anxiety disorders and major depression was high. Suicidal tendencies, family history and health services utilization were analyzed according to the lifetime comorbidity pattern of social phobia and depression.

Social phobia is individualized in international classifications only since 1980 with the DSM III, ten years after the publication by Marks of its phobic disorders classification. Nevertheless, many european authors, psychiatrists or psychologists, have raised the question of social anxiety as far back as the eighteenth century, with various points of view and appellations. The first report of an ereutophobia observation is due to Casper, in 1846, which described a serious social anxiety affecting a young man. Ereutophobia has been especially studied by Pitres and Regis, in 1807 and 1902, and by Claparede in a comprehensive review published in the same period. Janet has also proposed, in 1903, a classification of phobia including a section for social phobia. In 1910, Hartenberg has described several forms of social anxiety under the generic term of shyness (timidity, performance anxiety, personality disorders, etc.). Then, there is a relative silent period until 1960 even if the names of Kontaktneurosen or social neurosis are punctually mentioned in british and german literatures, and if Morita, in Japan, has taken an interest in social anxiety around 1930. The existence of social phobia as a valid syndrome A has been confirmed in the successive classifications since the DSM III. Several structured interview schedules or self-rating scales have been proposed for assessment of social phobia, such as Liebowitz or Davidson scales, but at present no one instrument has demonstrated superiority and the use of a battery of several scales is recommended. Moreover, some diagnostic issues are not yet completely solved, in particular concerning the validity of different subtypes of social phobia. To date, only the generalized type has been individualized in the classifications when circumscribed and performance types remain disputed. Delineation of social phobia with avoidant personality, shyness, performance and test anxiety, other phobic disorders and complications like alcoholism are discussed. Clinical, epidemiological and therapeutical implications of these questions are of importance from a theoretical but also practical point of view.

The validity of diagnosis in psychiatry remains controversial. The new international classifications of mental disorders and the use of diagnostic criteria have allowed a marked improvement in the diagnostic process but the validity of the clinical entities is far from being strongly established. Epidemiological approach is a way among others which can offer new insights to that problem. During the recent decade, several community surveys have been conducted using quite similar methods and designs, referring to the same classification systems and using structured diagnostic interviews. A systematic collection of clinical signs and symptoms has found that, in the community, as well as in clinical setting, anxiety and affective disorders are frequently comorbid in the same subject. The concept of comorbidity has different meanings in a clinical or epidemiological sense. Results from several community surveys underline the importance of this phenomenon in various countries whatever the specific prevalence of anxiety and affective disorders could be. The most recent large study, the National Comorbidity Survey, has been undergone partly to address many questions concerning the comorbidity patterns between affective, anxiety and substance use disorders, their risk factors and influence on morbidity and health seeking process. Comorbidity is high between major depression and all different anxiety disorders, and to a much larger extent with generalized anxiety disorder. The distinction between pur and comorbid disorders on one hand, primary and secondary disorders according to the sequence of age of onset in comorbid disorders on the other hand has been also underlined recently. Comorbidity between anxiety and affective disorders strongly argue for investigating the genetics as well as the psychosocial factors involved in this phenomenon. Within this methodological perspective, these studies may offer new answers to major problems encountered in clinical and psychopathological research and, by the way, improve current therapeutic strategies.

The Tridimensional Personality Questionnaire (TPQ) is a 100-item true-false self-questionnaire proposed by R. Cloninger and based on a three independent dimensions model of personality. These three dimensions, each with four sub-scales, are Novelty Seeking (NS), Harm Avoidance (HA) and Reward Dependence (RD). Recently, several groups have used the TPQ to study clinical samples, and other have reported normative data in the general population but, up to date, no result has been published on the French TPQ version. The aims of this study were therefore to assess the psychometric properties of this questionnaire and also to research an eventual relationship between dimensions of personality and anxiety and depression mood, measured by mood and anxiety scales in out-patients. A population of 165 subjects was included in this study and assessed with the TPQ. In this sample, 119 patients completed also the Hospital Anxiety and Depression (HAD) scale. The factor analysis with a Varimax rotation suggests three possible solutions with 3, 4 or 5 factors for the TPQ. These all three analysis indicate that the dimensions NS and HA load consistently unto the first two factors, and seem therefore two robust and independent dimensions. Contrastly, the RD dimension seems definitely heterogeneous, even if the RD2 sub-scale (persistence) is treated separately from the other as proposed by Cloninger. Analysis of correlations between TPQ dimensions and HAD sub-score show that only the HA dimension is related to anxiety sub-score (r = 0.34), depression subscore (r = 0.52) and total HAD score (r = 0.47).(ABSTRACT TRUNCATED AT 250 WORDS)

The main clinical factors involved in deciding the length of an antidepressant treatment are briefly reviewed in the framework of current classifications of affective disorders. History of previous episodes and the polarity of depressive illness have a major role in such a process. Current definitions of remission, relapse and recurrence are given. In the context of a single depressive episode, treatment must be continued for at least 4 months after the start of clinical improvement in order to prevent a relapse. In case of recurrent depressive episode, the indications of a long-term treatment must be discussed. Some issues unsettled as to the adequate dosage of such a treatment, as well as to the length of treatment in other types of depressive states.

The relationship of anxiety with cardiovascular function and symptoms has been of long historic interest, culminating in the recent emphasis given to the modulation of cardiovascular response in panic patients. Cognitive approaches postulate an interaction of physiological and psychological factors in the maintenance of panic disorder. Pharmacological approaches postulate a dysfunction of central alpha-adrenoceptors in panic and also in some cardio-vascular diseases. Ambulatory heart rate recordings confirm the presence of major cardiovascular changes during panic attacks in several studies. We have carried out a study in an unselected population being explored in an outpatient cardiology unit with 24 hours ambulatory heart rate recordings. Hundred and ninety-seven consecutive referrals for an ambulatory heart rate examination were assessed with the seven anxiety items of the Hospital Anxiety and Depression Scale (HAD-A). Fifty patients (26 males and 24 females), with an higher score than 8, were interviewed with the SADS-La. Sixty-two per cent of them fit DSM III-R criteria for panic disorder. Among these 50 interviewed patients, 19 (11 males and 8 females) were referred for organic heart disease and 31 (15 males and 16 females) were investigated only for functional symptomatology. The proportion of panickers was similar in patients referred either for functional or organic heart disease (63.2 vs 61.3; chi 2 = .02; p = .89). Nineteen patients (11 males and 8 females) had pathological ECG ambulatory recording results and 31 patients (15 males and 16 females) were classified as Holter (-). The proportion of panickers was found similar in these two subgroups of patients (63.2 vs 61.3; chi 2 = .02; p = .89).(ABSTRACT TRUNCATED AT 250 WORDS)

In an open-label pilot study, 35 outpatients with social phobia (DSM-III-R) received moclobemide for 12 weeks. The dosing range was 300-600 mg/day. Eighteen patients completed the study and 28 received at least 4 weeks of treatment. There was a consistent improvement in the efficacy parameters. Moclobemide was effective in both major components of social phobia (fear and avoidance). Moclobemide seems as effective as conventional irreversible monoamine oxidase inhibitors. Tolerability was good apart from one occurrence of grand mal seizure.

Both epidemiological and clinical studies have demonstrated a high prevalence of panic disorder among alcoholic patients. In contrast, little attention has been given to studying alcohol abuse and/or dependence in patients suffering from panic disorder. One hundred and fifty-five consecutive referrals for treatment for panic disorder were interviewed using a modified version of the Schedule for Affective Disorders and Schizophrenia--Lifetime Version, modified for the study of anxiety disorders. Thirty-two patients (20.7%) had a lifetime history of alcohol abuse and/or dependence. Although the lifetime comorbidity rate of either agoraphobia and/or social phobia seems without any influence on the risk of alcohol-related disorder, alcoholic patients suffering from panic disorder appear to be more likely to have a history of depression and other addictive disorders. The majority of patients with primary alcoholism were male, and those who became alcoholics after they developed panic disorder were more likely to be female. The comparison between patients with primary and secondary alcoholism did not indicate any difference in the comorbidity rate with other psychiatric disorders nor the severity of panic disorder.

The contrast between the great importance of psychiatric disorders and the fact that they are often not identified as thus in medical and surgical units has been emphasized during the last ten years. The prevalence of depression disorders in an hospitalised population of medical patients is generally estimated between 15% and 30%. It is admitted that one third to two third of theses cases are not diagnosed by non psychiatrist physicians. It is the reason why self questionnaires have been finalized in order to detect psychiatric troubles in medical populations. The General Health Questionnaire (GHQ), constructed by Goldberg, is surely the most internationality used, but no validation study has yet been undertaken in France. This study means the validation of a french version of GHQ-28 items, set on 46 diabetics (type 1 and type 2) selected in a week hospital. This validation is based on the comparison of the two principal scoring methods: "GHQ" (0,0,1,1); "CGHQ" (0,1,1,1 for negative items) and the determination of the best cut-off score in this specific population. The referring DSM III-R diagnoses were assessed by the Composite International Diagnostic Interview (CIDI; Robins et al., 1988), which is a highly structured psychiatric interview developed by the World Health Organisation. Sixteen patients out of the 46 diabetics showed criterions of depressive and/or anxious disorders, 6 of them presenting both. The analysis of the answers to the questionnaires was based upon the technic of the Relative Operating Characteristic (ROC) curves which takes all the sensitivity-specificity couples bound to each of the possible threshold-score into account.(ABSTRACT TRUNCATED AT 250 WORDS)

Everyday clinical and therapeutic practice relies on signs, variables or factors allowing to adjust strategies influencing the short and if possible long term evolution of mental disorders. The possible prediction of the future course of illness by such variables is debated. Actually in the present literature a confusion appears between several terms. Stricto sensu the predictive value of a test or of a diagnostic procedure supposes the assessment of a discriminative sensibility and specificity relative to a well established fact: the illness. The importance of some clinical and biological factors may be gauged by such means. More frequently risk factors are proposed. A risk factor represents a particular characteristic or condition associated to an increased probability of a specific disorder being present or developing ulteriorly. However, such factors are not necessarily causal factors. The search of prognostic factors also constitutes an important step in our understanding of pathological processes as well as of evolution.

The joint-rater and test-retest reliability study of two translated versions of the SADS-LA (Schedule for Affective Disorders and Schizophrenia--Lifetime version--modified for the study of anxiety disorders), one in French and the other in German, have been tested in family study settings, in a sample of patients and first-degree relatives. The test-retest reliability study demonstrated that identification of major affective disorders and schizophrenia was performed with sufficient reliability; however, diagnoses of subtypes of major disorders (e.g. bipolar II disorder) and identification of minor disorders was less reliable. The implications of these findings in phenotype identification during family studies in psychiatry are discussed.

This report examines the reliability, concordance, and long-term stability of the subtypes of schizophrenia defined by four major diagnostic systems (DSM-III, DSM-III-R, ICD-10, and Tsuang-Winokur criteria) and rated both for the first hospitalization and for a best estimate diagnosis reflecting lifetime evolution of symptomatology. Schizophrenics studied belonged to two samples of multiply affected families, namely a sample selected in France and a sample of non-metropolitan French identified in the island of La Réunion. ICD-10 and DSM-III-R show opposite stringency regarding subtyping of schizophrenia, with DSM-III-R having a narrow and ICD-10 a broader definition of specific subtypes. Long-term stability of each subtype was fairly good, stability being the highest for hebephrenics and only intermediate for paranoid and undifferentiated subtypes. Comparison of two different cultural and geographical regions reveals an overall similarity of subtype frequencies in familial schizophrenia. The implications of the results for the choice of diagnostic procedures in family studies of schizophrenia are discussed.

Saliva cortisol was measured at 11 p.m. in a sample of 74 psychiatric inpatients composed of 24 primary endogenous depressives, 40 secondary depressives and 20 nondepressives (DSM III and Saint-Louis criteria). Primary depressives had significantly higher 11 p.m. saliva cortisol levels than nondepressives (p less than 0.02) and secondary depressives (p less than 0.05). In contrast, there were no significant differences between secondary depressive and nondepressive saliva cortisol levels. A saliva cortisol cutoff limit of 3.45 nmol/l identified primary depressives with a sensitivity of 62.5% and with a specificity of 75% in the depressive group, and 90% in the nondepressive group. The measurement of saliva cortisol at 11 p.m. could be used alone as a reliable and practical index of hypothalamic-pituitary-adrenal axis activity in depression, especially in outpatients.

Twenty somatic symptoms are listed, that are often met in depressive states but that are presently neglected by clinicians and by the various depression rating scales. Thanks to the data provided by animal pharmacology and clinical studies, an attempt to correlate the clinical studies with the biochemical results is proposed between those symptoms and eventual monoaminergic dysfunctions. This study leads to a clinical observation scale. In the future, the authors envisage a multifactorial analysis of the data obtained by the use of the scale. Symptomatic groupings could help establish a new classification for depressive states. They could also guide the choice of the medication according to the monoaminergic dysfunctions that are pointed out.

Familial aggregation of anxiety disorders has repeatedly been reported: the estimated risk among the first degree relatives is of 15% to 18% compared to 3% in control groups. The most recent studies are focused on more homogeneous clinical subgroups. Thus, among agoraphobics first degree relatives, the risk is elevated not only for agoraphobia but also for panic attacks and other phobias. In families of panic attacks, the risk of panic attacks in the first degree relatives is specifically elevated. Thanks to the extremely fast development of genetic linkage and molecular genetics, progress is expected in the field of genetics and psychiatry. Linkage methods applied to anxiety disorders are discussed.