Clinical efficacy, safety and tolerability of quetiapine in the treatment of 23 hospitalized psychotic adolescents were evaluated retrospectively. Twelve patients were changed to quetiapine from another antipsychotic medication during their hospital stay. In these patients, CGI-S improved from 4.75+/-0.87 to 2.92+/-0.67 (observation period 3.7+/-1.6 months). The most common adverse events were transient tachycardia and sedation. Mild EPS occurred only in one patient under quetiapine monotherapy. Transaminase increases more than threefold above norm were observed in two patients. fT4 values were slightly below the norm in 67% of the cases. In 11 patients, quetiapine was initiated using a rapid titration schedule with high dosages in the acute phase. Receiving a mean maximum daily dose of 927+/-300 mg, CGI-S improved from 6.00+/-0.63 to 3.18+/-1.25 (observation period 2.9+/-1.8 months). Severe adverse events did not occur. Besides applying lorazepam temporarily in nine of the 11 patients, antipsychotic co-medication was not necessary in this group. In line with other studies, quetiapine may be considered as an effective treatment for adolescents with a severe psychotic disorder showing a favourable side-effect profile. Our preliminary data suggest that a rapid initiation with high doses could be a promising approach in acute psychotic adolescents.

Some of W.R. Bion's specific ideas can further the understanding of the classic Balint group technique. The group leader supports a 'container-contained' process, preventing the group from attacking or criticizing the presenter. 'Projective identification' helps the group to understand what has been presented. Meaningless impressions, feelings, emotions, and simple facts are transferred to the group, such as still unthinkable bizarre 'beta-elements' to be transformed by the 'alpha-function' to the now thinkable 'alpha-elements'.Abstaining from the group process, the presenter is protected from re-projections of feelings and emotions. The Balint group technique makes sense to promote the 'digestion' of bizarre beta-element-like aspects into alpha-elements, enabling the presenter to 'think his or her own thoughts' instead of projected one, giving the chance to change into a response model instead of a reacting one. ' Mental growth' occurs when feelings and thoughts can be tolerated at a higher level.

One possible side effect of selective serotonin re-uptake inhibitors (SSRI) is the exacerbation of nervous tics in a 12-year-old boy treated with tiapride following prescription of paroxetine for a depressive syndrome. Potential causal factors include residual cholinergic activity of paroxetine, the observably increased drive under paroxetine, metabolic properties, and protein binding. The problem of side effects under selective serotonin re-uptake inhibitors, as well as the issues of co-morbidity and co-medication in the treatment of nervous tics and Tourette's Syndrome are discussed.

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ZusammenfassungAnhand eines komplexen Fallberichts aus der Balintgruppe wird das Konzept der parasitären Beziehung nach Bion aufgegriffen, bei welcher Denken und Entwicklung zerstört werden und eine Alpha-Funktion zur Transformation gemachter Erfahrungen nicht mehr zur Verfügung steht. Ausgehend von der Überlegung, dass eine parasitäre Beziehung gar keine übliche Arzt-Patienten-Beziehung mehr darstellt, wird ein aktives Leiterverhalten beschrieben, um die über Spiegelungsphänomene in der Gruppe verloren gegangene Alpha-Funktion zu ersetzen und die parasitäre Verstrickung aufzulösen.