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CNS-involvement in Coxiella burnetii infection is rare. Severe cerebellar symptoms with incomplete restitution were observed in 3 patients who developed Q-fever pneumonia associated with a long-term prophylaxis with lithium for manic-depressive disorder. Several pathophysiological mechanisms for these complications are discussed and a specific toxic-infectious interaction is suggested.

81 remitted patients with bipolar affective disorder were examined 20 months after the last discharge from hospital, for personality disorders and other personality deviations, which could be important for their way of coping. There was a high frequency of narcissistic, histrionic and borderline traits and, especially in the bipolar schizoaffective subgroup, of schizoid and related traits. Patients with few former episodes seemed to be "syntonic". Bipolar patients with a longer duration of illness showed an increasing resignative and subdepressive change of feelings and attitudes, whereas the schizoaffective patients in the long term showed a hypomanic alteration. The personality changes of bipolar patients occur during the "free intervals" and are mediated by social interaction, whereas the alteration of some bipolar schizo-affective seems to be caused directly by their illness.

The additional determination of lithium in erythrocytes may serve to estimate the course of treatment individually more detailed than by serum values only, but not as a predictor of clinical response.

In 34 patients suffering from delusional parasitosis the relevance of an accurate differential diagnosis with respect to pharmacological treatment was investigated. Under a psychopharmacological therapy of the delusion's additional psychiatric symptomatology in 17 patients (50%) a full remission and in other 5 patients an improvement of the delusional symptoms was observed. The unexpected high recovery-rate is explained by the fact that all of the patients with additional depression showed a reduction also of the delusional symptomatology after a treatment with antidepressants. In contrast to that, patients with organic brain syndromes underlying the delusions had a significant worse outcome, which seems to be caused by the considerable lack of effective psychopharmacological treatment of such states. The results indicate that an accurate psychiatric differential diagnosis is of great importance for the psychopharmacological therapy of patients suffering from delusional parasitosis. In this context the Viennese decision-tree for delusional syndromes is discussed.

The authors have attempted by means of a statistical survey to quantify changes in the course and, in particular the phase-related and non-phase-related form of cyclothymic phases during long-term lithium treatment.

Noxiptilin (Elronon) proved to be a good bipolar thymoleptic agent in the clinical test at 3 special clinics. Its stimulating effect on the psychomotor function is more pronounced than its sedative action. Therefore, in cases with the anxious, agitated depressive syndrome the additional therapy with a neuroleptic agent or a sedative tranquilizer may be favourable. N. is well tolerated even at a higher age. The side effects are the same as those of other known thymoleptics.

The authors report clinical experience from therapy with Orap-Janssen and Orap-Richter from 1968 to 1974. Excellent tolerance makes Orap particularly suitable for long-term maintenance therapy in schizophrenic psychoses. The evaluation is based on observations in 91 patients.

In two cases of chronic endogenous depression changes of mood and drive have been investigated over a period of 26 days by self rating scales "ESTA". After a single dose of 250 microgramm TRH a small antidepressive effect and a clear shift of the syndrome in the direction of a mixed state could be demonstrated thus suggesting an increased desintegration of the mood-drive-system.