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Background: When patients with cardiovascular disorders undergo electroconvulsive therapy (ect) they sometimes have to be treated for tachycardia and high blood pressure., Aim: To describe the effects of beta-blockers on seizure duration and cardiovascular variables in patients undergoing ect., Method: Search for studies in Medline, with the keywords 'beta-adrenergic blocking agents' and 'electroconvulsive therapy'. Only articles based on randomised placebo-controlled investigations were included. results The search strategy produced 21 articles. These were assessed by all authors. Esmolol was the drug administered in most of the trials. Since seizure duration can influence the therapeutic effect of ect it is advisable to use bilateral electrode placement in patients with cardiovascular risk factors and to administer esmolol prior to seizure induction., Conclusion: The beta-blocker of choice for use during ect seems to be esmolol; it can shorten seizure duration, although the effect is probably dose-dependent. Esmolol is also the drug of choice in ect sessions for patients without cardiovascular risk factors but who develop prolonged hypertension or tachycardia. A possible alternative is labetalol, but its longer half-life is a disadvantage, particularly if it is administered in a high dose. So far, experience with landiolol is limited, but its short half-life, greater cardioselectivity and higher potency mean that it could be a promising alternative.

Background: There is still uncertainty regarding the best treatment optionfor depressed inpatients and the best strategy to follow if patient response is insufficient., Aim: To compare the efficacy of imipramine and fluvoxamine in depressed inpatients who subsequently received lithium supplement in case of poor response., Method: After a drug-free period and four days of placebo use, patients were randomised either to imipramine or to fluvoxamine (phase 1); the antidepressant dosage was fixed according to a predetermined plasma level. The efficacy of the antidepressant was evaluated four weeks after the predetermined plasma level had been attained. If patient response was inadequate, the antidepressant was augmented with lithium (phase 2). Patient response to the lithium addition was evaluated three weeks after an adequate lithium level had been attained., Results: The study involved 138 inpatients. At the end of phase 1, imipramine was found to be superior tofluvoxamine according to the Clinical Global Impression of Improvement. Remission was achieved by 6 (23%) patients on imipramine and by 10 (15%) patients on fluvoxamine; this difference was not statistically significant. At the end of phase 2, 41 (9%) patients on imipramine and 27 (40%) patients on fluvoxamine achieved remission, this significant difference demonstrating the superiority of the imipramine strategy., Conclusion: Imipramine with subsequent lithium addition is superior to a similar strategy with fluvoxamine.

A woman aged 56 had been treated at the age of 23 for a psychotic depression with vital characteristics in the context of a bipolar disorder. The treatment included electroconvulsive therapy (ECT). From the age of 47, she suffered relapses; drug treatment proved inadequate. For the last 3 years, ECT was administered, which resulted in a good condition. ECT is an effective treatment in patients with depression resistant to medication. However, in spite of continuation pharmacotherapy, the proportion of patients relapsing within 6 months after successful ECT is large. For these patients, continuation ECT may be an efficacious method.

Two women, aged 51 and 65 years, with tricyclic-resistant depression (DSM-III-R) were treated with lithium addition. This is a valuable therapeutic alternative. Interactions and side effects should be closely monitored. Treatment response is possible in a short period of time (1 week), but recovery after lithium addition may also take a few weeks. It is not yet clear which patients will respond to lithium addition and in what way, and which will not. It is advisable to use lithium addition with adequate plasma lithium levels.

The clinical presentation and the relation with malignancy of acute febrile neutrophilic dermatosis in 7 patients are described. The syndrome is characterised by fever, neutrophilic granulocytosis, painful erythematous plaques and typical histology consisting of a dense dermal infiltrate of mature neutrophils. The idiopathic form (80% of reported patients) usually follows a viral infection. The secondary form (20% of reported patients) is associated with a malignancy, which in the large majority (85%) is a hematologic disorder (this was the case in 3 of the 7 patients); the course of the syndrome may then be serious. The secondary form of the disease may be associated with an exacerbation of a preexistent malignancy, as was seen in 2 of the 3 patients. If the syndrome runs a serious course the treatment consists of corticosteroid administration.