The diagnosis, symptomatology, and epidemiology of seasonal affective disorder

The operational criteria for seasonal affective disorder (SAD) have undergone several changes since first proposed in 1984. SAD is currently included as a specifier of either bipolar or recurrent major depressive disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. The International Classification of Diseases, Tenth Edition has provisional diagnostic criteria for SAD. The most characteristic quality of SAD is that the symptoms usually present during winter and remit in the spring. Furthermore, the symptoms tend to remit when the patients are exposed to daylight or bright light therapy. The cognitive and emotional symptoms are as in other types of depression but the vegetative symptoms are the reverse of classic depressive vegetative symptoms, namely increased sleep and increased appetite. SAD is a common condition, but the exact prevalence rates vary between different studies and countries and is consistently found to be more common in women and in youth. SAD probably possibly occurs in children although not as commonly as in young adults. Some studies have found that certain ethnic groups who live at high northern latitudes may have adapted to the long arctic winter.     

Seizure types, epilepsy syndromes, etiology, and diagnosis

The clinical manifestation of epileptic seizures may vary widely from patient to patient, depending on the region of the brain involved. Over the centuries, many seizure classification systems have been used, and the current most widely used classification system is that of the International League Against Epilepsy (ILAE). The ILAE system divides seizures into those of partial onset and those of generalized onset, depending on whether the initial clinical manifestations indicate that one cortical region or both hemispheres are involved at the onset of the seizure. Partial seizures are then divided into simple partial seizures, in which a fully conscious state is retained, or complex partial seizures, in which consciousness is impaired. A more recent classification system based purely on symptom features and signs has been proposed, and this system may provide advantages for localization, and especially for surgical evaluation. Epilepsy is a condition characterized by recurrent unprovoked seizures. Epilepsy may be idiopathic, cryptogenic, or symptomatic. Idiopathic epilepsies are generally genetic, and while many such syndromes have been described, advances in molecular genetics will undoubtedly reveal many more syndromes in the near future. Cryptogenic epilepsies are those in which an underlying cause is suspected, but the etiology remains undetected. Epilepsies for which there is an underlying structural cause or major metabolic derangement are considered symptomatic. Common causes and diagnostic evaluation are described in this article.     

The etiology of schizophrenia as perceived by psychiatrists in Europe and the United States

This paper compares and contrasts statements made by American and European psychiatrists on the etiology of schizophrenia. In the U.S., leading figures in psychiatry hold increasingly to the view that the disorder is physiogenic at source—from which it seems to follow that the appropriate treatments should similarly focus on physiological and pharmacological therapies. In contrast, European psychiatrists seem to be divided in support for organic and psychodynamic explanations. Some European writers have pointedly warned against over-interpreting recent studies which seem to point to specific organic dysfunctions and deficits as schizophrenogenic. This paper was presented at the Second Annual Convention of the American Psychological Society, Dallas, Texas, June 7–10, 1990.     

The etiology of schizophrenia as perceived by psychiatrists in Europe and the United States

This paper compares and contrasts statements made by American and European psychiatrists on the etiology of schizophrenia. In the U.S., leading figures in psychiatry hold increasingly to the view that the disorder is physiogenic at source—from which it seems to follow that the appropriate treatments should similarly focus on physiological and pharmacological therapies. In contrast, European psychiatrists seem to be divided in support for organic and psychodynamic explanations. Some European writers have pointedly warned against over-interpreting recent studies which seem to point to specific organic dysfunctions and deficits as schizophrenogenic. This paper was presented at the Second Annual Convention of the American Psychological Society, Dallas, Texas, June 7–10, 1990.     

Suicide, schizophrenia, and schizoid-type psychosis: role of life events and childhood factors

The first objective was to identify the provoking events of suicide in patients with schizophrenia or schizoid-type disorder, and to assess the humiliation component of these events. The second objective was to verify if quality of care during childhood is a vulnerability factor for suicide in patients with schizophrenia or schizoid-type psychosis. Thirty-three cases of suicide with a diagnosis of schizophrenia or schizoid-type psychosis were compared with 34 living patients with a similar diagnosis. The psychological autopsy method was used. The assessments were made with the Structured Clinical Interview for the Diagnostic and Statistical Manual for Axis I mental disorders, the Life Events and Difficulties Schedule, and the Child Experiences and Child Abuse Interview. The suicide group (SG) experienced more often a recent severe event, usually of a humiliation nature, than the control group (CG). It also experienced more severe events associated with aggressive behavior or with psychiatric impairment. Contrary to expectations, the CG had worse scores than the SG for quality of care during childhood. In conclusion, suicide in schizophrenia is related both to environmental stress and to psychiatric impairment.