[Palliative care in a psychiatric-somatic care unit]. / Palliatieve zorg op een psychiatrisch-medische unit.

Patients with severe psychiatric and somatic disorders may require admission to a combined psychiatric-somatic care unit. These units provide specialised psychiatric and somatic care as well as palliative care. This is illustrated by two case reports. A 51-year-old man with a malignant brain tumour was admitted to our psychiatric-somatic care unit after threatening his wife and children. He was aggressive and confused. Seizures were suspected and palliative care was needed. Within a few weeks his condition deteriorated. He died 1 day after terminal sedation had been initiated. A 78-year-old woman was admitted to receive daily electroconvulsive treatment (ECT) for depression with catatonia. The ECT had to be interrupted repeatedly due to comorbid infections and complications. She died 3 days after palliative care was initiated.

[Neuroleptic malignant syndrome: a life-threatening complication that can be treated effectively]. / Maligne neurolepticasyndroom: een levensbedreigende complicatie, die goed te behandelen is.

Two patients with the neuroleptic malignant syndrome (NMS), a man aged 31 years and a woman aged 83 years, were referred for electroconvulsive therapy after 70 and 7 days, respectively. Both patients benefited from the treatment, but the patient who had had the syndrome longer had persistent contractures. NMS is potentially lethal. Diagnosis and treatment should be done as soon as possible to prevent mortality and complications. Admission to a general hospital and early consultation of NMS-experienced colleagues is strongly advised. Electroconvulsive therapy is indicated ifa trial course of lorazepam yields insufficient improvement.

[Pregnant and mentally incompetent]. / Gravida en wilsonbekwaam.

Two women, aged 31 and 36 years, under treatment for schizophrenia and psychotic episodes, respectively, became pregnant and decided to discontinue their medication. Thereupon the psychiatric disorder recurred and they refused--i.e. they were unable--to consent to a proposed treatment or investigation regarding their pregnancies. The necessary consent had to be obtained from a legal guardian. This was the husband in the first, urgent case. In the second case approval from the judge was obtained for the patient to be admitted against her will to protect her life and that of the foetus. In the Netherlands obstetric intervention to protect the life of the mother or her unborn child is legally regulated by the Wet Bijzondere Opnemingen in Psychiatrische Ziekenhuizen (Act on Compulsory Admissions to Psychiatric Hospitals) and the Wet op de Geneeskundige Behandelingsovereenkomst (Act on Agreement Concerning Medical Treatment).