Olanzapine is a second-generation antipsychotic, which is also used as a mood stabilizer. We report a case of a 33-year-old psychiatric patient, with bipolar affective disorder, who developed anaphylaxis as a late reaction to olanzapine. This case report shows the possibility, although rare, of a severe late anaphylactic reaction to olanzapine.

BACKGROUND Up to 100% relapse rate after successful electroconvulsive therapy (ECT) poses a challenge for patients and psychiatrists. The aim of the study was to evaluate the outcome of patients affected by major depression after the successful course of acute ECT. METHODS 84 patients recruited in a randomized double blind multicenter study designed to investigate the optimal stimulation placement in acute ECT had a follow up under naturalistic conditions between the 5th and 7th month. Outcome, maintenance therapy and patients; attitude were evaluated with semi structured questionnaires by patients and the study raters. RESULTS 82.14% (68/84) questionnaires of the patients and 83.3% (70/84) of the rater were returned. 98% of the patients had at least one antidepressant; only in 23% (20/68) lithium was prescribed. 35% (7/20) of the patients with lithium and 57% (16/28) without lithium had a relapse within the first 6 months (OR 0.6) in a median of 2.5 months. Only one institution offered maintenance ECT in 8.3% (7/84) patients. For 52.2% of the patients ECT was a helpful treatment an 49.3% would recommend the therapy to their relatives. The vast majority (59.4%) wishes a better information about the ECT and 21.4% feel frightening about the therapy. CONCLUSIONS The results show a high relapse rate and highlight the meaning of maintenance medication especially for a lithium combination therapy, as stated before. In regard to the subjective sensation the patients claim a better education about the ECT and anyway one of four patients feel frightening about the therapy.

Psychotherapy (PT) and electroconvulsive therapy (ECT) apparently indicate the dichotomy of body and soul. This article deals with the different categories of PT and describes ECT as a powerful and important somatotherapeutic strategy. Finally, some aspects of metaphysics as the philosophy of mind are reported, supporting the view of bridging and solving the dichotomy of these two clinical indispensable therapeutic strategies.

An adequate treatment of depressive disorders often necessitates a combination of several antidepressants. For the prevention of undesirable side-effects or drug interactions, therapeutic drug monitoring (TDM) is a safe and efficient procedure. We document 4 cases of combinations of fluoxetine with clomipramine or moclobemide and escitalopram.

ZusammenfassungMit dem Thema Psychotherapie (PT) und Elektrokonvulsionstherapie (EKT) begibt man sich unweigerlich in das Spannungsfeld von Leib und Seele. Im ersten Abschnitt wird die Psychotherapie in ihrer Vielfalt beschrieben. Anschließend wird die EKT in ihren Grundzügen dargestellt. Die Skizzierung von Metaebenen im Anschluss, wie z.B. die der Neurophilosophie, soll dem Leser die Möglichkeit bieten, die Interaktionsdynamik dieser Therapiestrategien zu verstehen und selbst zu gestalten („Jedes Erkennen ist Tun und jedes Tun ist Erkennen”).

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The electroconvulsive therapy (ECT) consensus paper has been produced by the Austrian Task Force for Special Psychiatric Treatment Modalities of the Austrian Society of Psychiatry and Psychotherapy in collaboration with all psychiatric units of Austria prescribing ECT. It is intended as a theoretical and practical clinical guide to the good administration of ECT. There has been high evidence that ECT is an effective treatment in severe and medication refractory depression. In schizophrenia, schizoaffective disorder and mania, ECT efficiency is less studied but well documented in treatment resistance. Relating to severe catatonia, ECT can be lifesaving. ECT has side effects; also transient especial memory impairments are of importance. The stimulation technique during treatment series should be optimized and marked psychotropic medication avoided thus reducing incidence, frequency and severity of memory disturbances. ECT displays a high safety profile and does not cause morphological damages. Considering anesthesiological and internal aspects, there are no absolute contraindications. Mortality is defined through the risk of anesthesia itself amounting 1 : 30.000. For indications and administration of ECT, a professionally well-trained staff is indispensable. ECT exhibits selective and specific mechanisms of action; thus certain neurobiological changes occur in defined brain areas depending on the complexity of current's configuration, the electrode placement and number of ECT series. In cases of compulsory detention and patient's incapability of giving consent, ECT is regulated by the Austrian Detaining Low section 3 from 1990.

We report the case of a 22-year-old woman with a diagnosis of mixed bipolar affective mood disorder (ICD-10 F 31.6), who has suffered a carbamazepine intoxication after addition of olanzapine. The withdrawal of the antipsychotic led to a normalisation of the increased carbamazepine serum levels, the intoxication symptoms subsided simultaneously. Because of the severe psychopathological state of the patient and the positive anamnestic experiences olanzapine was prescribed while therapeutic drug monitoring was performed; again an increase in carbamazepine serum concentration was observed but within the steady state limits and without clinical symptoms.

Objective: Therapeutic drug monitoring (TDM) of the new generation antidepressants is subject of controversial discussion. Nonetheless, TDM may safeguard against drug-drug interactions, can be used to control compliance and is valuable in the investigation of overdose. Method: The aim of this prospective study was to investigate serum levels of trazodone when prescribed as monotherapy or when used in combination with the selective serotonin reuptake inhibitors citalopram and fluoxetine in a simultaneous assay using high-performance liquid chromatography (HPLC). Over a 1-year period, we studied 97 patients (63 females) with depressive syndrome who were subdivided into 3 main diagnostic groups. Fifty-two patients were smokers, the mean age was 39.9 years and the mean weight was 72.4 kg; 40 patients were taking trazodone alone, 41 trazodone in combination with citalopram and 16 patients trazodone in combination with fluoxetine. Results: The use of citalopram and fluoxetine in combination with trazodone had no significant impact on trazodone serum levels, and the same was true for differences in body weight and smoking behavior. On the other hand, age and sex had a significant influence on the pharmacokinetic pattern of trazodone, causing higher concentrations in females and in older patients. Since the polypharmacy investigated did not change the serum levels of trazodone, we assume that there is no metabolic interaction between trazodone and citalopram and trazodone and fluoxetine. We observed none of the adverse effects which might have been expected, including dizziness, severe headache, daytime sedation, fatigue or the serotonin syndrome even in a mild form. Conclusion: A "double-tracked" antidepressive treatment using trazodone and the SSRIs citalopram and fluoxetine is associated with a wide safety margin.

This report presents the simultaneous pattern of cerebral blood flow and cerebral glucose metabolism in two patients with a major depressive disorder who were undergoing continuation ECT. The regional cerebral blood flow and regional cerebral metabolic rate of these patients were imaged using double isotope 18F-FDG and 99mTc-HMPAO single-photon emission computed tomography before acute ECT and after the completion of continuation ECT; bilateral electrode placement (11 and 12 sessions, respectively) was chosen for the acute treatment course whereas unilateral placement was the method chosen during the continuation phase (6 and 7 sessions, respectively). Baseline SPECT scans of our patients, who continued to receive treatment with medication, were normal as compared with controls; however, scans at the end of continuation ECT revealed decreased uptake activities of both isotopes in prefrontal regions on both sides, which might be associated with the therapeutic impact and efficacy. These results are consistent with previous brain imaging studies of acute ECT. Furthermore, marked changes in both basal ganglia regions were found. The pattern of the isotope uptake ratios did not show any similarities to neurodegenerative processes, which might confirm the high safety profile of ECT also during the continuation phase of treatment.