Abnormalities in corticotrophin (ACTH) and cortisol levels before and after corticotrophin-releasing hormone (CRH) stimulation have been reported in depressed bipolar patients. The ACTH and free cortisol response to the injection of 100 micrograms of synthetic human CRH and plasma cortisol-binding globulin (CBG) levels were measured in 42 lithium-treated patients suffering from RDC bipolar-I disorder in remission, and in 21 age- and sex-matched control subjects. A 1-year follow-up was conducted in order to assess any possible relationship between outcome and the hormonal response. Bipolar patients showed higher baseline and peak ACTH concentrations than controls. A lower net area under the ACTH concentration curve after CRH stimulation predicted depressive relapse within 6 months by multiple regression analysis. The CRH challenge test could be a potentially good predictor of depressive relapse in remitted bipolar patients.

To study the prescription criteria of Spanish psychiatrists treating children and adolescents. Methods: a survey was designed to record their first choice and complementary preferences for pharmacological, psychotherapeutic and psychoeducational interventions in five disorders: autism, depression, separation anxiety, obsessive compulsive and attentiondeficit/hyperactivity disorders. Results: One hundred and nine psychiatrists responded. No distinction was made between children and adolescents. Around 90% recommended all three types of intervention in the five disorders. Only 2-10% would use only one treatment. Antidepressants were the most frequently prescribed drugs (recommended by 58%), followed by anxiolytics (33%), antipsychotics (24%), stimulants (20%), beta-blockers (19%), mood stabilizers (10%) and alpha-adrenergics (4%). Cognitive-behavioral therapy was the most popular approach, recommended by 66%; a third of the interviewees recommended family, support, interpersonal and dynamic psychotherapy. Interestingly, respondents quite frequently prescribe drugs, drug combinations and psychotherapies whose efficacy has not been demonstrated in the disorders in question. Conclusions: The majority of Spanish psychiatrists preferred the combined treatments in all disorders. There seems to be a tendency towards excessive generalization of therapeutic results obtained in adults.