The effects of trazodone on subjective and objective sleep parameters were compared to those of placebo in a double-blind design in seven patients who developed insomnia during treatment with the selective and reversible MAO-A inhibitor, brofaromine. Trazodone significantly increased deep sleep and altered the architecture of sleep in these patients. Subjectively, patients reported a better and deeper sleep. No negative interactions between brofaromine and trazodone were observed and side-effects were minimal. A low dose of trazodone may be a safe and effective agent in the treatment of MAO-I induced insomnia.

A case in which a 26 year old patient with undifferentiated schizophrenia, showing abnormal oral, lingual and jaw movements suggestive of tardive dyskinesia during a dose reduction of risperidone, is presented. A second case, relating to a 39 year old married woman diagnosed as having a DSM-IV schizophreniform disorder is also presented. These two cases are discussed in relation to the existing literature.

We report on the case of a 38-year-old Malay housewife diagnosed with conversion disorder. It was believed that ‘evil spirits’ caused her symptoms. The patient was eventually treated by the Main Puteri, a Malay shamanistic healing ceremony, after previous treatments failed. The patient improved on the third day of the performance, which was attributed to the departure of the spirits from her body. This case documents the potential benefits of indigenous psychotherapy.

Acute lithium intoxication is potentially lethal. Compared to conventional lithium preparations, sustained-release lithium formulations present specific problems for medical practice in the case of overdose. We report a case of intoxication with 8000 mg of sustained-release lithium carbonate preparation (Teralithe 400 LP®). Twenty-five hours after the ingestion, the patient was still asymptomatic, despite a serum level in the toxic range. After comparison of this case with reports found in the Medline database, we consider the clinical management of such cases.

It is proposed that patients with panic disorder have a defect in fear-relevant episodic memory, and their panic attacks arise from automaticity in recollecting fear-relevant emotional-autonomic cluster. The cluster as a component of fear appears to have been dissociated from cognitive structure (episodic or informative memory trace) or from ‘information structure’.

A special method was created for testing this hypothesis where 30 panic disorder patients, 12 healthy controls, and 32 patients with other psychiatric diagnoses were asked to recall and describe a fearful experience. None of the patients in the panic disorder group could recall any fearful event or episode in their past. All but one subject among healthy controls and all the subjects in the non-panic group could recall one or more fearful event or episode. Possible theoretical implications of these results are discussed in the context of some classical concepts.

A high frequency of sexual dysfunction occurs in treated and untreated patients with schizophrenia. Unfortunately, no effective therapy for this problem is currently available. We present a case of a 26-year-old patient with paranoid schizophrenia, who suffered from lack of desire and erection, and was successfully treated with sildenafil citrate (Viagra). This case illustrates the complex character of sexual dysfunction in male schizophrenic patients.

The atypical antipsychotic drug olanzapine has been proposed for treatment of dopaminergic psychosis in Parkinson's disease (PD). We report on a 68-year-old patient who developed a severe akinetic-rigid extrapyramidal syndrome, accompanied by additional paranoid symptoms, following olanzapine treatment of optic hallucinosis in PD. Olanzapine may also induce clinically relevant extrapyramidal side effects in PD patients.

We report on a patient with schizoaffective disorder who was on combination therapy of lithium, carbamazepine, and the neuroleptic trifluperidol. He experienced a lobar pneumonia and developed an acute and persistent cerebellar deterioration which was most likely due to lithium toxicity, while the serum lithium level was within the therapeutic range. The combination of lithium, carbamazepine, and neuroleptics is common, and is generally considered to be safe. The reported case suggests that this regimen might increase the risk of intoxication with potentially disabling side-effects.

From December 1–31, 1997, the Department of Psychiatry and Psychotherapy in co-operation with the Department of Information Technology, University of Tübingen, Germany, organised the first virtual congress on psychiatry in the Internet. The congress was aimed at facilitating exchange of results of psychiatric studies and ideas and at stimulating discussion among interested colleagues. Almost 100 participants from 17 countries on four continents took part in this event. Sixteen contributions were presented and discussed. The problems and opportunities of this medium in the organisation and running of congresses are presented and discussed. The experience gained in this congress suggests that the Internet will find increasing use as a medium for medical congresses within the next few years.

An overview of the existing European trainee organizations is not easy to give. The historical tendencies as described in the first part have currently brought about many initiatives. In the second part of this article, a description of the two main European trainee organizations is given.