[Electroconvulsive Therapy (ECT) in Neuroleptic Malignant Syndrome (NMS) on an Intensive Care Unit (ICU)]. / Elektrokonvulsivtherapie (EKT) bei malignem neuroleptischen Syndrom (MNS) auf Intensivstation.

A 57-year-old female patient with unclear somnolence was admitted to an Intermediate Care Unit (IMC) by an emergency physician. Several psychotropic drugs were on the medication list (quetiapine 450 mg/d, paroxetine 40 mg/d and perphenazine 12 mg/d), due to depression with psychotic features. As the patient's state deteriorated on day 3, she was intubated and transferred to Intensive Care Unit (ICU), where a malignant hyperthermia (MH) was assumed. The ICU's call to the MH hotline did not give a hint to consider a neuroleptic malignant syndrome (NMS) neither to consider electroconvulsive therapy (ECT). It was not until day 9 that a psychiatric consultation was undertaken, under the suspected diagnosis of NMS. On the same day ECT was performed, followed by a rapid remission of all clinical features and laboratory findings. Early consideration and application of ECT treatment for NMS on an ICU is life-saving.

[MMSE for survival prognostics in dementia]. / MMST zur Uberlebensprognostik bei Demenz.

OBJECTIVE: Evaluation of the predictive power of the Mini-Mental State Examination (MMSE) for survival analyses of dementia patients. METHODS: In an 8-year follow-up study for 145 dementia outpatients the survival and relative death risks (hazard ratios) were calculated with Kaplan Meier and Cox-regression analyses. RESULTS: Following Cox-regression the relative death risk increases by 36.2 % per severity level of dementia (mild / moderate / severe), p = 0.023. Per single MMSE point lost, the relative death risk rises by 4.1 % (p = 0.005). Kaplan Meier analysis supports the result. CONCLUSIONS: MMSE scores may in fact be used for dementia survival prognoses in counseling family and professional caregivers of dementia patients, but also for socioeconomic management of the increasing dementia burden for society.

[Do German World War II victims fulfill PTSD-criteria?]. / Erfüllen kriegstraumatisierte, gerontopsychiatrische Patienten PTSD-Kriterien?

OBJECTIVE: Long-term psychiatric consequences of World War II are currently a main medical and political topic in Germany. METHODS: This retrospective study examined 33 psychogeriatric cases. RESULT: PTSD-criteria following ICD-10 were fulfilled in every case. All patients had a delayed subtype of PTSD with a latency of 14-60 years between trauma and onset of disorder. No case of chronic PTSD was found. In 26 cases a depression was diagnosed. CONCLUSIONS: Long latencies for PTSD are a typical feature in psychogeriatrics, possibly due to the situation in post-war-Germany probably even more in the Soviet occupied zone, the later German Democratic Republic (GDR). In the GDR it was not at all a public topic to speak about Russian violence (political taboo). The depressive and psychotic comorbidity of psychogeriatric PTSD-patients should be examined more specifically in future studies.

Quetiapine indication shift in the elderly: diagnosis and dosage in 208 psychogeriatric patients from 2000 to 2006.

RATIONALE: Quetiapine was approved in Germany as an atypical antipsychotic for treatment of schizophrenia in 2000, followed by the approval as an antipsychotic for treatment of bipolar mania in 2003. The approval of quetiapine for treatment of bipolar depression is expected. We hypothesized that the psychogeriatric prescription pattern for quetiapine shifts from the psychotic to the affective spectrum. METHODS: Retrospectively we screened discharge reports of all geriatric inpatients of the psychiatric department of the Ruhr-University of Bochum in the period from January 2001 until March 2006 and identified 208 individual patients aged over 60 years, who had received quetiapine as final medication. Age, gender, daily drug dose, year of treatment and diagnosis (according to ICD-10) were recorded and analyzed. RESULTS: Over the six-year time span, the proportion of affective disorders (F3) as indication for quetiapine in the elderly increased, whereas the proportion of dementia (F0) as indication for quetiapine decreased significantly. The proportion of schizophrenic disorders (F2) treated with quetiapine did not change significantly. DISCUSSION: Since the decision of the German Federal Court in 2002 'off label' use goes to the expenses of the prescriber. So the decrease of quetiapine in dementia is probably due to its 'off label' status in dementia. The psychogeriatric indication shift for quetiapine towards affective disorders could be the consequence of good clinical experiences with the drug and growing evidence for its antidepressant effect. CONCLUSION: In addition to controlled pharmacological trials prospective clinical research is needed to evaluate the prescription attitudes of clinicians.