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The reliability of a measure is a prerequisite for its validity. The measurement of the interrater reliability (IRR) of the 115-item AMDP System, filled out by 68 raters from several Centers for a single videotaped patient, raises two unusual aspects in IRR. First of all, a matrix of correlation coefficients between raters for such a number of individuals and items does not give a global visualization of differences in rating patterns. The authors apply the Q-technique of factor analysis (FA) or inverse FA in order to solve this problem. Second, the usual measures of IRR do not apply to single cases. In testing the adequacy of FA multivariate indexes as a measure of IRR (factor scores, Mahalanobis distances), the authors demonstrate a bias consisting of the influence of the mean item score on these indexes and they put forward an original modification of the classical FA program. They report a simulation of scores and the real patient CRO in order to demonstrate the adequacy of their modified FA as a measure of IRR in single cases.

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As far back as the second century, Ptolemy reported the apparent immobility of wheel radius at a certain speed. The psychophysical laws of this flicker fusion phenomenon related to the frequency of the light stimulus were established in 1834-1835 by the Englishman Talbot and by the Belgian Plateau, whose thesis in Liège is described as a landmark in the field. CFF is more a measurement of cortical arousal than of visual functions. In psychophysiology, CFF underwent periods of success and oblivion, at the mercy of researcher's enthusiasm or disappointment. At the turn of this century, Pierre Janet measured CFF in the laboratory of physiology of the Salpêtrière Hospital and demonstrated its decrease 'in hysteria, in states of depression, of lowered tension'. All reviewers of CFF literature have overlooked these observations, reported by Henri Piéron in the 'Melanges dedicated to Monsieur Pierre Janet'. When CFF falls into disgrace, it is because of the variability of its results, due to differences in apparatus and designs of the trials as well as the great number and the intrication of the variables which modify CFF thresholds, among them the nonsensory variables. When CFF is reappraised, as it has been the case in psychopharmacology in recent years, the reason is that it represents a brief, easy and economical measure of vigilance which, under certain conditions, seems to be also reliable, valid and sensitive. In the present monograph, the first in French on CFF, the authors try to analyze the most important contributions of the literature from the standpoint of the most relevant variables: characteristics of the stimulus (light intensity, wave form, wavelength, light-dark-ratio, diameter of the flickering point), test procedure (light vs. dark adaptation, visual angle, continuous vs. discontinuous presentation, monocular vs. binocular vision), influence of various physiological or psychological conditions (pupillary diameter, age, training, IQ; anxiety, depression, motivation etc.). The authors summarize the prerequisite for CFF to measure vigilance or aging in psychopharmacological research. The present Monograph is dedicated to the authors' 'Maîtres', who recently became Emeritus Professors, namely the ophthalmologist Roger Weekers, the pioneer of the clinical application of CFF in Belgium, and the psychiatrist Jean Bobon, who pioneered clinical psychopharmacology in Belgium.

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The ninth revision of the WHO International Classification of Diseases (ICD-9) has come into effect on January 1, 1979. A fully-compatible German adaptation of its psychiatric part and a pseudo-compatible American one, the DSM-III, have been published in 1980. There exists a French translation of ICD-9 by the WHO, but no real adaptation to French-speaking psychiatry. Improvements of the psychiatric section of ICD-9 over the previous revision are described: incorporated glossary, priority to semeiology, additional codes for etiology, increased number of categories of depression (distinction between unipolar vs. bipolar, distinction between stress vs. adjustment reactions etc.), drug dependence and child psychiatry. For the first time, a classification of impairments, disabilities, and handicaps is added to the ICD. The author explains major divergences between ICD-9 and French psychiatry e.g. dementias under Psychoses, non-psychotic endogenous depressions under Affective Psychoses. He thereby justifies his few modifications to ICD-9 with respect to terminology and fifth-digit coding.

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Nineteen hospitalised male alcoholic addicts, as an average 38 years old, were given i.m. tiapride (Tiapridal at the mean dose of 400 mg three times daily during the first four days of weaning and 300 mg orally during the following ten days. The weaning was sudden ;not any psychotropic drug, with the exception of barbiturates, was associated to the therapy during the two weeks trial period. More particularly neither sedating neuroleptics nor vitamins have been administered. The essential aim of our study was to quantify the subjective evolution of the patients' well-being and mood during the weaning period under tiapride. We expressed the total self-evaluation with the 100 mm line, the self-evaluation of the mood with two lists of antinymous adjectives BfS and BfS' according to Zerssen and the self-analysis of anxiety according to Cattell. Our study confirmed the rapidity of action of tiapride as well as its efficiency and harmlessness at the dose of 300-400 mg per day. The drug seems to be better tolerated than the usual neuroleptics and to involve smaller potential risks of substitutive drug addiction than the anxiolytic drugs or paraldehyde.

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The author compares the advantages and disadvantages of psychiatric documentation and rating systems (the AMDP and MSIS systems), and of major multiphasic rating scales (the CPRS, IMPS, PSE, SCI and WPRS scales). He briefly describes the history and content of the AMDP System, formerly known as AMP. This standardized system of alemanic origin is presently adapted or being adapted in nine languages (Croatian, English, Esthonian, French, Italian, Japanese, Portugese, Russian and Spanish). Of the four forms, only the two forms designed for the quantitative assessment of pychopathological and somatic symptoms have been included in the first edition of the French adaptation (1978). Similarities and dissimilarities between the German system and its first French adaptation are discussed.

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Before the development of audiovisual techniques, it was impossible to avoid two time-related biases in drug evaluation: rating on different occasions, i.e. in different mood states as regards the rater (the so-called time-gap); knowledge by the rater of the sequence of his ratings. In order to make a time-blind evaluation possible, the author has worked out the following steps: tape-recording of the interviews, standardization of the interview, elimination of questions endangering a time-blind analysis, evaluation of the different interviews of the same patient on different rating sessions. The author summarizes his first three drug trials analyzed according to the time-blind procedure, and concludes that this procedure is a definite progress regarding the validity of drug research.

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The author complemented the AMDP-4 scale by some somatic items from the Liege psychiatric record, the code of Devroye, Pinchard and Timsit. He compares the frequency of the symptoms of the AMDP scale and the DPT code in 63 patients before treatment and their sensitivity to change after psychotropics in 49 patients. On the 27 DPT items added to the AMDP, 20 appear to be frequent and 6 are sensitive to therapeutic change. Two other modifications from the original AMDP scale are reported: the grouping of symptoms by system, and a standard interview aimed at limiting positive answers in relation to the interview. The author considers that the AMDP scale so modified is superior to other classical somatic scales, but deplores that functional symptoms are confused with psychopathological symptoms, neurological symptoms, toxic signs, general examination signs and even laboratory tests in the original scale.

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In the process of adapting the German AMDP Psychopathology Scale into French and of analyzing its interrater-reliability, free AMDP interviews were tape-recorded and played back. It became rapidly evident that such interviews are incompatible with a comprehensive and reliable evaluation of psychopathology: the collected information is incomplete and variable from one interviewer to the other and even from one interview to the other by the same interviewer, which is particularly invalidating in case of video ratings. The present semi-structured interview is based on 140 videotaped recordings of non-psychiatric patients, of depressives and psychotics. Formulation of questions is seldom imperative; their sequence is only suggested and may be modified according to the interviewer's style and to the patient's pathology. Have been avoided questions too dependent on setting (community, hospital) or likely to disclose the first-interview or retest nature of the recording, thus allowing time-blind evaluations. The mean duration of the interview is 28 mn (less than 30 mn in 70% of the cases) for 126 items.

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Eighteen inpatients suffering from a severe anxiety received in double-blind and crossover conditions iv and im injections of 10 mg diazepam, 5 mg lorazepam or saline t.i.d. during 5 days. The morning injections was made iv in a CCTV studio. Before injection and 20 mn after it, the patient filled out a 100 mm Visual Analogue Scale; his doctor-in-charge proceeded to a standard interview and to physiological measurements (tremor of hand, patellar reflexes, blood pressure, pulse rate). The videotaped interviews were randomly, i.e. time-blind, rated by two independent observers on 3 scales: the VAS, the Hamilton Anxiety Scale and an ad hoc Verbal and Non-Verbal Anxiety Scale (VNVA). The statistical analysis was completed by a logical analysis according to Lewis Carroll. The results demonstrate the superiority of lorazepam over diazepam on psychic anxiety, somatic anxiety, sleep and blood pressure, the only significant side-effect being drowsiness.

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

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The ZERSSEN Mood Scale or " Befindlichkeits-Skala " is the only self-rating scale that is altogether specific (adjectives on mood states essentially), actual and therefore sensitive (lack of adjectives on the habitual state, on personality traits), bipolar (possible detection of a manic or depressive shift), easy to administrate and analyze, existing under 2 statistically equivalent forms. Each BS and BS' form contains 28 pairs of antonymic everyday adjectives, whose French translation has been checked by back-translation. The subject has to cross if he feels right now " rather... ", " rather... " or " neither nor ". The French translation was tested on 100 depressed and 6 manic newly hospitalized patients, on 30 depressed patients in the course of a 6-week antidepressant trial, and on 46 academic and administrative members of the staff. Various calculations on the validity, reliability and sensitivity of the scale confirm the original German data. The product-moment correlation between BS and BS' (split-half reliability) reaches .89 in the control group, .79 in the newly hospitalized depressives and .93 to .96 in the anti-depressant trial, a p less than .001 in all three studies. The correlation does not reach a significant level in neurotic depressives, who are a mean 11 y. younger than psychotic depressives and score significantly lower than the latter. Age, sex and sequence of administration do not influence the means, the standard deviations and the correlation between BS and BS'. The original German studies and our original French ones give convergent results as for means and extreme scores of the main mood levels, with a cutting score for mania at 6 and for depression at 27 : (see article) Thanks to their high intercorrelation, the BS and BS' scales may be given independently, thus allowing a daily or even twice daily administration. The range of application of the ZERSSEN Mood Scale is not limited to psychiatry but includes numerous medical, surgical and psychological fields.

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