[The expanded suicide attempt in depressive patients and its sequelae. The forensic and therapeutic considerations in 3 case reports]. / Der erweiterte Suizidversuch bei depressiven Patienten und seine Folgen. Forensische und therapeutische Uberlegungen anhand dreier Kasuistiken.

Despite of the frequency of depressive disorders among the population, forensic aspects of depression are rare and usually focussed on suicidal behaviour, especially the so-called homicide-suicide (homicide followed by suicide). Today therapeutic strategies are seen in the first stage of dealing with depressed homicide-suicide attempters. Apart from the question of guilt with regard to the homicidal act, the question of recurrence of depression and the danger of a possibly repeated homicidal-suicidal behaviour are discussed in the light of three clinical cases.

Paroxetine as antidepressant in combined antidepressant-neuroleptic therapy in delusional depression: observation of clinical use.

The combination of antidepressive and antipsychotic (neuroleptic) medication is often used in the psychopharmacological treatment of delusional depression. In most studies of the treatment of delusional depression, tricyclic antidepressants have been used, and very little has been written about experience with SSRIs such as fluvoxamine, fluoxetine, or paroxetine. This paper therefore presents the preliminary findings of an open clinical study in which 14 delusional depressed inpatients, consecutively admitted to our Depression Unit, were given paroxetine combined with either zotepine or haloperidol. It was possible to observe a significantly impressive decline in the HAMD (24-item version) total score, of so-called delusional items (HAMD subscore of items 2, 17, 18, 20, 23, 24) and of the subscore of remaining HAMD items over 21 treatment days. There were no unusual side-effects.

[Follow-up of Werlhof disease after onset of treatment with maprotiline]. / Verlauf eines Morbus Werlhof nach Therapiebeginn mit Maprotilin.

Whereas leucocytopenia is reported to be a relatively frequent side-effect of treatment with tricyclic and tetracyclic antidepressants and atypical neuroleptic agents, isolated thrombocytopenias are rare. To our knowledge there are no reports of thrombocytopenia in connection with the tetracyclic antidepressant maprotiline. This report describes the case of a 53-year-old female patient with neurotic depression and an initially unsuspected chronic idiopathic thrombocytopenic purpura (ITP). Following previous treatment with an angiotensin-converting enzyme inhibitor, cilazapril, and an estrogen derivative, the patient developed an episode of the ITP after beginning treatment with maprotiline. The possible aetiology and the course of the illness are discussed.

Paroxetine in the treatment of inpatients with non-delusional endogenous or neurotic depression.

The clinical course of 35 depressed inpatients (19 women, 16 men; 19 endogenous, 16 neurotic depression (ICD-9 diagnoses); mean age 46.7 years) who were treated with paroxetine 20 mg/d was observed over 21 days using the Hamilton Depression Scale (HAMD). For both types of depression there was a significant decrease from day 1 to day 21 in the mean HAMD total score and in a subscore of cognitive and somatic items. The mean value of the HAMD suicide item increased in 3 cases and decreased in 25.