This paper examines the general view of the culture of alcohol consumption in the African continent. Unlike in some European countries where alcohol use is part of the daily life of the people or is used, especially during meals, in Africa, generally, alcohol is used mostly during rituals, marriage ceremonies, clan/family festivities. During rituals, intoxicating power of alcohol is associated, sometimes with the supernatural power of the gods. Alcohol is also given as gifts during bride price ceremony. Statistical data confirm that majority of alcohol users in this continent are Christians and non-religious people. Lower proportion of alcohol consumption is seen in the Muslim community in relation to the Christians. Even though, some use alcohol as daily drink, generally intoxication (except during rituals) is considered a sin. The most especially used beverage is the native alcohol (obtained as a distillation product of sap of tree, mostly parm). The level of native distillation techniques determines the alcohol content in the various native alcoholic beverages. Alcohol content in the distillation product might vary between 30-70%. Some proportion of African communities use the tree sap without distillation. In recent times, most African communities have lost the power of control over the sale and use of alcoholic beverages, and this subsequently led to increase alcohol problems, including chronic alcoholism, especially among children. In conclusion, as a result the gradual fading of cultural norms, alcohol use nowadays, in African communities, generally, is open to the general population, regardless of age.

Spice shops, selling ethnobotanical plants like Salvia divinorum, Mitragina speciosa, Amanita muscaria and others, have become very numerous in Romania, first of all because they are legal, second of all because more and more young people are tempted to experiment new sensations. These plants can cause different psychiatric illnesses and associating theme with alcohol or drugs can also be fatal.

Our objective was to present the case of a 25 year old male patient consulted at emergency service, and admitted in our department, presenting psychomotor agitation, anxiety and the specific elements of a psychotic episode, delusions and hallucinations, after smoking a cigarette with sage and night-shade.

The symptomatology remitted rapidly, after approximately 12 hours, revealing the complications of psychoactive substance use.

Insight presents patient's awareness of several attributes: recognizing that she/he is suffering from a mental illness, that the symptoms are pathological, that he/she needs treatment and that the cause or the source of their symptoms is an illness. Poor insight is linked to poorer treatment adherence, poorer clinical outcome and with social dysfunction. Greater insight is often associated with dysphoria and lower self esteem. The acceptance of the fact that one suffer from schizophrenia depends on the meanings of schizophrenia for the person. We study insight and level of self esteem in patients with schizophrenia. The study is done at Psychiatric Clinic, University of Nish. Thirty patients, 16 males and 14 females, average age of 38.6 years, with diagnosis of schizophrenia are included in the study. For determing insight we use The Beck Cognitive Insight Scale (BCIS) - a self report instrument that focuses on self reflectivenes about unusual experiences, capacity to correct erroneous judgment and certainty about mistaken judgments. It is 15-item, 4 point Likert scale with two sets of items. The Rosenberg Self Esteem Scale (SEC) is used to measure self-esteem. It is 10-item, 4 point Likert scale. Scores range from 10 to 40 with higher scores indicating higher self-esteem. Our results show mean value on BCIS 1.74, and 27.6 on SEC. Intellectual insight is the first step in patient's awareness of mental illness and it is accompanied with lower scores on the self eseem scale.

Le trouble obsessionnel-compulsif est une affection grave et difficile à traiter. Plusieurs études récentes ont montré une efficacité de certains antidépresseurs, particulièrement sérotoninergiques. Cependant, certains travaux plaident également pour un rôle des voies noradrénergiques. Nous discutons ici l'essai d'un nouvel antidépresseur, le milnacipran, à action noradrénergique et sérotoninergique, chez une patiente atteinte d'un trouble obsessionnel-compulsif rebelle. Le rôle possible de la médication dans la très nette amélioration de la symptomatologie obsessionnelle et dépressive est discuté.

The relationship of depression and alcoholism has given rise to a large number of studies with alcoholic patients screened for depression but only little information is available on the comparison of depressed patients with and without co-existing alcoholism, indicating similarities in symptom patterns but lower intensity of depression in alcoholic depressives. One thousand two hundred and thirty-one subjects were evaluated for inclusion in an open multicentre trial for one year long treatment with tianeptine, a new antidepressant. Patients had to fulfill DSM III criteria for major depression single episode, recurrent (without melancholia or psychotic features) or dysthymic disorder. Upon inclusion, 23% of those depressed patients also had a DSM III diagnosis of alcohol abuse or dependence. Results confirm the overall lower intensity of depression in the alcoholic-depressed subgroup with a symptom pattern corresponding more to retarded depression in the pure depression subgroup. On the contrary, alcoholic depressives had a higher rate of precipitating life-events and more social difficulties than non-alcoholic depressives. No differences were found regarding duration of the actual illness episode, medical and psychiatric history.

La Entrevista Neuropsiquiátrica Internacional Reducida (MINI) es una entrevista diagnóstica estructurada breve, desarrollada en formatos clínicos (MINI-CR) y autoevaluados (MINI-PR), para 17 trastomos psiquiátricos del eje I del Manual Diagnóstico y Estadístico (DSM) III-R. Este estudio, que investiga la validez de la MINI en relación con la Entrevista Clínica Estructurada para el DSM III-R - Pacientes (SCID-P), se realizó conjuntamente con un estudio similar, que investigaba la validez de la MINI en relación con la Entrevista Diagnóstica Internacional Compuesta (CIDI) para la Gasificatión Estadística International de las Enfermedades (CIE) 10. Ambos estudios examinaron también la fiabilidad interevaluador y test-retest de la MINI. Trescientos setenta sujetos (330 en Florida y 40 en París) participaron en la validatión de la MINI frente a la SCID- P. Trescientos ocho de ellos tenían al menos un trastorno psiquiátrico y 62 eran controles adultos no pacientes. Ochenta de los sujetos (40 en Florida y 40 en París) participaron tambien en el estudio paralelo de la validez de la MINI frente a la CIDI. Los 330 sujetos de Florida realizaron primero la versión autoevaluada de la MINI. La MINI-CR se administró a todos los sujetos (después de la MINI-PR en el caso de los sujetos de Florida), seguida por la SCID-P. La MINI-CR fue evaluada por dos entrevistadores para 42 sujetos en Florida y 42 en París (prueba de fiabilidad interevaluador) y fue administrada de nuevo por un tercer entrevistador a ciegas uno o dos días después de la evaluatión inicial (prueba de fiabilidad test-retest). En conjunto, los resultados apoyaron la validez y la fiabilidad de la MINI. Además, la administratión de la MINI-CR llevó la mitad de tiempo que la administratión de las secciones correspondientes de la SCID-P. Se debate la aplicación de entrevistas estructuradas breves en entornos clínicos y de investigación.

Les symptômes d’un groupe de schizophrènes ambulatoires ont été évalués de manière transversale. 95 patients ont été inclus dans une première étude et 87 d’entre eux réévalués un an après.

Les patients étaient considérés comme déprimés quand ils avaient : soit un score égal ou supérieur à 3 à une appréciation clinique globale de la dépression (de score maximum égal à 5), soit un score de 20 ou plus à la M.A.D.R.S.*.

La fréquence de la dépression était de 20 % environ selon les deux modes d’évaluation.

Les patients déprimés avaient aussi la symptomatologie psychiatrique d’ensemble la plus sévère comme en témoignaient leurs scores à la B.P.R.S.*, à l’échelle de schizophrénie extraite de la C.P.R.S.*, et à la check-list d’auto-évaluation S.C.L. 90*.

Les deux modes d’évaluation de la dépression ont paru mesurer deux aspects différents du syndrome : dans la première étude, 20 patients étaient déprimés selon le score clinique global, 20 également selon la M.A.D.R.S., mais 12 seulement selon les deux modes d’évaluation. Comparée au score global, la M.A.D.R.S. paraît retenir des patients dont la pathologie globale et dépressive est plus sévère. Les cliniciens ont hésité à juger cliniquement comme déprimés des malades déficitaires même lorsque leurs profils cliniques avaient par ailleurs une configuration franchement dépressive.

L‘évaluation objective des comportements agressifs en milieu hospitalier fait actuellement l’objet d’un regain d’intérêt. Pour disposer d’un instrument permettant la quantification précise de l’agressivité, nous avons choisi d’adapter l’≪Overt Aggression Scale≫ (OAS) de Yudofsky dans notre unité de soins. Cette échelle est constituée de 2 volets. Le premier se compose de 4 catégories de comportements agressifs: agressivité verbale, agression physique envers autrui, agression physique envers soi-même et agression physique contre objets. Le second volet comporte les interventions du personnel soignant. L‘adaptation de l’OAS fut effectuée en 2 phases successives. Dans un premier temps, nous avons évalué sa maniabilité et sa sensibilité de détection en l’utilisant durant un mois dans notre unité (Tableau I). Ensuite, afin de tester sa fidélité, une série de comportements agressifs filmés furent cotés par 8 observateurs. L‘analyse de la concordance de leurs jugements, realisée avec le W de Kendall, a donné des coefficients très significatifs en général (P < 0,001 pour 25 des 30 coefficients calculés, Tableau II) et particulièrement pour l’agressivité spécifiquement ciblée dans chaque séquence filmée (P < 0,001 pour 11 des 12 coefficients spécifiques calculés, Tableau II). Les résultats recueillis lors de ces 2 phases de travail permettent de conclure que l’OAS adaptée semble être un instrument maniable, sensible (sensibilité de détection) et fidèle. Une étude ultérieure nous permettra de tester la reproductibilité, caractéristique essentielle à l’utilisation de l’OAS dans une perspective longitudinale.

The effect of the antidepressant agent, tianeptine, on the hypothalamo-pituitary-adrenal (HPA) axis was studied in adult male rats under basal and stressed conditions. Chronic treatment with tianeptine (10 mg/kg; 2 weeks; twice a day) induced a significant decrease of hypothalamic CRF (–12%) and pituitary ACTH concentrations (–21%), suggesting that tianeptine reduces the activity of hypothalamic CRF neurons and pituitary corticotrophs. The possible effect of tianeptine in the neuroendocrine response to stress was thus investigated. Rats were submitted to restraint stress for 30 min; under these conditions ACTH and corticosterone levels were considerably increased. A single injection of tianeptine was found to significantly reduce stress-evoked elevations of plasma ACTH and corticosterone. Time-course experiments, consisting of administering tianeptine 1–3 h before immobilization stress, revealed that the maximum inhibitory effect of tianeptine occurs about 2 h after injection of the antidepressant. Administration of various doses of tianeptine (from 2.5 to 20 mg/kg) showed that the effect of the drug was dose-dependent; the maximum effective dose being 10 mg/kg. Taken together, these data indicate that tianeptine may exert original ‘anti-stress’ activity.

This was a metabolic study of bulimia nervosa required to design short-term cognitive-behavioural therapy (CBT) beginning with a brief admission to a psychiatric ward. The treatment produced significant improvements in eating behaviour and results are compared with those of previously published studies. The comparisons do not suggest that brief admission at the onset of therapy might enhance its effectiveness. In other respects, increase in normal meal intake was found to correlate significantly with decrease in hinging. This supports the notion that appropriate food intake at meal times should be an important issue in CBT for bulimia nervosa.

The effect of treatment (28 days) with zopiclone, triazolam, flunitrazepam and placebo on sleep quality and daytime well-being was proven in a randomised, double-blind, parallel group, multicentre study in private practice. Results of an exploratory statistic of treatment efficacy in a subgroup of 1,291 patients suffering from insomnia are presented. Patients met the following criteria: insomnia lasting at least four weeks and the presence of at least two of the following: 1) sleep latency ≥ 45 minutes, 2) total sleep time ≤ 6 hours, and 3) nocturnal awakening ≥3 times. Treatment efficacy was assessed according to the following factors: either a shortening of sleep latency by at least 15 minutes, or prolongation of total sleep time by at least 20%, or reduction of the number of nocturnal awakenings to three or less and a refreshed feeling in the morning as well as no impairment in daytime well-being due to tiredness or anxiety. The total response rate was markedly higher with zopiclone (42.3%; p = 0.0003) than with placebo (29.0%). Triazolam (36.6%; p = 0.0905) and flunitrazepam (33.1%; p = 0.3401) were also more effective than the placebo, but they both tended to have a lower response rate than with zopiclone (p = 0.1199 and 0.0151, respectively). Total response was found to be essentially a reflection of the response of the socially important parameter of daytime well-being. These results suggest that zopiclone is more effective in the treatment of insomnia than either triazolam or flunitrazepam. Since the response of daytime well-being to therapy was generally poor, this parameter embodies the next main therapeutic challenge in the treatment of patients with insomnia.