Showing papers in "Tijdschrift voor psychiatrie in 2010"

The therapeutic value of physical exercise for people with schizophrenia

Abstract: Background Only about 25% of people with schizophrenia follow the public health recommendations for a minimum of 150 minutes per week of moderate physical exercise. In their leisure time people diagnosed with schizophrenia take considerably less exercise than their healthy counterparts. Aim To collect scientific evidence of movement-related interventions in patients with schizophrenia. Method PubMed, PEDro, CINAHL, PsychINFO and Sport Discus were searched for the period from 2003 up to April 2009 for reports of randomised controlled trials (RCTs) on the basis of the search terms ‘schizophrenia', ‘exercise' and ‘physical activity'. Relevant literature was also traced by means of the reference lists for selected articles. Results Eight RCTs were selected. Physical exercise was reported to bring about significant improvements in cardiovascular and metabolic parameters and in psychiatric symptomatology. A physical exercise also has social advantages; it helps patients to cope with stress and improves their quality of life. Conclusion Physical exercise as part of psychomotor therapy should play an important role within the multidisciplinary treatment of schizophrenia. More research is needed into the effect of physical activity on cognitive functioning.

[Modafinil in psychiatric disorders: the promising state reconsidered].

Abstract: Background For more than two decades psychiatrists have known about and have promoted modafinil, a very promising stimulant that boosts wakefulness in cases of narcolepsy and also enhances cognitive functions. At present, however, we must conclude that modafinil is hardly ever used to treat illness other than narcolepsy. Aim To review current attitudes and practice with regard to the use and efficacy of modafinil in the treatment of psychiatric disorders. Method Relevant placebo-controlled studies were retrieved via PubMed (Medline) and Web of Science. Results Modafinil is used experimentally to treat ADHD, mood disorders, schizophrenia and substance-dependence. Compared to placebo, modafinil achieves positive but mainly variable results on different clinical and cognitive measures. It achieves results very rapidly, within a week, but over a period of time the results stabilise. Conclusion Modafinil is particularly successful in the treatment of ADHD, depression and cocaine-dependency on measures of attention and hyperactivity, fatigue and cocaine-use respectively. There is a need for further placebo-controlled trials with longer follow-up periods and larger sample size in order to ensure the safety of the product and to refine its area of efficacy.

[Myocarditis and cardiomyopathy: underestimated complications resulting from clozapine therapy].

Abstract: Background Treatment with clozapine can affect the heart, leading to serious complications such as myocarditis and cardiomyopathy. When in their early stages both illnesses are difficult to diagnose; this can have serious consequences. Recent analyses of clozapine data suggest that particularly myocarditis is possibly more common than has been assumed hitherto. Aim To determine the frequency of these complications and to find out what diagnostic tests are available and whether it is necessary or possible to adjust current guidelines on these complications. Method The relevant literature was consulted via PubMed, Embase Psychiatry and Psycinfo on the basis of the keywords 'clozapine' and 'myocarditis', 'cardiomyopathy' and 'heart failure'. Results Studies showed that the incidence of myocarditis varied from 0.015 to 1.3%. Cardiomyopathy was the subject of fewer studies, one study reported an incidence of 0.022%. More than 50% of the cases of myocarditis developed during the first few weeks of treatment, the average time being about 15 days. For an early diagnosis it is important to monitor the patient's symptoms carefully, especially during the first four weeks following the start of medication. Monitoring should include laboratory tests and electrocardiography. Echocardiography and MRI can be useful additions to the diagnostic process. Conclusions Early diagnosis of myocarditis is important because it is a serious condition. Timely recognition of subclinical myocarditis could possibly prevent later complications such as cardiomyopathy. Clinical guidelines are proposed on the basis of the literature.

[Neurofeedback and attention deficit hyperactivity disorder: what is it and is it working?].

Abstract: BACKGROUND Neurofeedback (nf) is a method of treatment that is being used increasingly in the Netherlands, particularly in psychological practices. Many psychiatric and somatic symptoms are currently being treated with the help of nf. In particular, nf is being used more and more to treat attention deficit hyperactivity disorder (adhd). Despite its growing popularity, nf is still a relatively unknown treatment method in psychiatric practices. AIM: To investigate the scientific evidence for treating adhd with nf. METHOD: We searched the literature for reports on controlled trials that investigated the effectiveness of nf on adhd. results Six controlled trials were located. The studies reported that nf had a positive effect on adhd, but all the studies were marred by methodological shortcomings. CONCLUSION: On the basis of currently available research results, no firm conclusion can be drawn about the effectiveness of treating adhd by means of nf. In view of the fact that nf is being used more and more as a method of treatment, there is an urgent need for scientific research in this field to be well planned and carefully executed.

[Antipsychotics and metabolic abnormalities in children and adolescents: a review of the literature and some recommendations].

Abstract: Background Adult patients with schizophrenia and bipolar disorder have an increased risk of developing the metabolic syndrome. This is due to their psychiatric illness and to the use of antipsychotic drugs. Children and adolescents are being treated more and more with antipsychotics. The risk of metabolic abnormalities in this age group remains unclear. Aim To investigate the relationship between psychotic disorders in childhood and metabolic abnormalities and to study the influence of the use of both typical and atypical antipsychotics on this relationship. Method The PubMed database was searched for relevant articles published between 2000 and June 2009. Results So far, research into the relationship between psychiatric disorders and metabolic abnormalities in children and adolescents has been inadequate. The normal values and meaning of the components of the metabolic syndrome in children and adolescents have not yet been firmly established. Children and adolescents who use antipsychotics run a significantly higher risk of weight gain. The younger the child, the greater the risk. There are no data about the risk of developing diabetes mellitus type 2. The influence of typical antipsychotics on these conditions has not been investigated. Conclusion The risk of significant weight gain due to the use of atypical antipsychotics is greater in younger children. The 'metabolic syndrome' concept is not applicable to children and adolescents. Very little is known about metabolic risks in the long term. Caution is called for in the prescription of antipsychotics for children and adolescents and further research is needed.

[Does ADHD medication stop working after 2-3 years? On the surprising, but little-known follow-up of the MTA study].

Abstract: The large Multimodal Treatment Study of Children with ADHD (MTA) has become widely known especially because in the treatment phase intensive medication management appeared to be superior (on some outcome-measures) to other treatment modalities. The second followup, 22 months after the end of the treatment phase, shows several surprising and controversial results. For example, the advantage of having partaken in the intensive medication algorithm has disappeared and continued stimulant treatment is a marker not of beneficial outcome, but of deterioration (higher symptom scores). The balance of advantages and disadvantages of longterm stimulant treatment appears to be considerably less favourable than previously thought. A reconsideration of several widely held views on stimulant treatment would seem in order. However, in The Netherlands the results of the second follow-up do not seem to draw the amount of attention and publicity the previous findings did. A possible reason for this is that they contradict prevailing ideas on ADHD. The goal of this article is to draw attention to the most important findings and clinical implications of the second follow-up. At the same time the article illustrates the extent to which the dissemination of scientific knowledge is a social process.

Routine outcome monitoring voor patiënten met ernstige psychiatrische aandoeningen; een consensusdocument

Abstract: BACKGROUND: Routine outcome monitoring (rom) means the assessment of the patient's condition on a routine basis using instruments. So far there is no consensus about which instruments should be used for rom with severely mentally ill patients (rom-smi). AIM: To reach a consensus about instruments for rom-smi in the Netherlands and Belgium and to create possibilities for comparison of rom data. METHOD: This article discusses the consensus document of the National Remission Working Group for rom in patients with smi and covers the following topics: reasons for rom-smi, domains for rom-smi and appropriate instruments, logistics and analyses of the data. results Patients with smi have problems in several domains. These can be assessed by collecting information about psychiatric symptoms, addiction, somatic problems, general functioning, needs, quality of life and care satisfaction. Potential instruments for rom-smi are short, valid, reliable and assess several domains, taking the patient's perspective into account, and have been used in national and international research. The working group advises institutions to choose from a limited set of instruments. After the scores have been aggregated and standardised, comparisons can be drawn. rom-smi data can be interpreted more meaningfully, if outcome data are supplemented with data regarding patient characteristics and the treatment interventions already applied. CONCLUSION: It should be possible to reach a consensus about instruments for romsmi and the way in which they should be used. The use of identical instruments will lead to improvements in mental health care and create possibilities for comparison (benchmarking) and research

Olanzapine in the treatment of adolescents with anorexia nervosa

Abstract: This article, which was triggered by a case study of a 15-year-old female patient, gives an overview of the literature on the use of olanzapine as an adjunctive treatment for anorexia nervosa in adolescents. On the basis of studies performed so far (two small double-blind placebo-controlled studies, two open-label trials, one retrospective study, a number of case studies that included adolescents, and four series of case studies on adolescents alone), the short-term results of using olanzapine were promising. However, careful monitoring is needed.

Vrouwen, schizofrenie en oestrogeen; neurobiologische hypothesen en interventiestudies

Abstract: BACKGROUND: Gender differences play a role in the origin and course of schizophrenia. It has been hypothesised that the gonadal hormone, oestrogen, may possibly perform a protective function in the development of certain forms of schizophrenia. AIM: To review neurobiological hypotheses concerning the role of oestrogen in the development and course of schizophrenia. METHOD: The relevant literature was consulted with the help of PubMed, textbooks and bibliographic references; the search terms used were 'oestrogen', 'schizophrenia', 'gender', 'epigenetics', 'psychosis', 'women' and 'brain'. There were no restrictions with regards to the time-period. RESULTS: Neuro-imaging, animal experiments and hormone-therapy studies showed several effects of oestrogen in the field of epigenetics, morphology of the brain, interaction with neurotransmitters and neuroprotection. CONCLUSION: Oestrogen is an important link in a complex of factors that clearly play a role in the varying development of schizophrenia in men and women. So far, however, there is insufficient evidence to support the existence of a specific mechanism that would explain why oestrogen may perform a protective function in schizophrenia.

[Omega-3 and omega-6 fatty acids in the treatment of children and adolescents with ADHD].

Abstract: UNLABELLED Background There is a growing trend towards the use of alternative forms of treatment for attention deficit hyperactivity disorder (adhd), such as the food supplements omega-3 and omega-6 fatty acids. AIM To study biochemical aspects, important hypotheses regarding the role of these fatty acids in brain development, the mode of operation and research results concerning the effectiveness of treating adhd with these supplements. METHOD A Medline search was performed using the Mesh-term 'fatty acids' and the search terms 'omega-3 and omega-6 fatty acids' and 'attention deficit hyperactivity disorder'. results Some rct's (randomised controlled trails) involving children with adhd didn't show any improvement after treatment with omega-3 and omega-6 fatty acids. Some other rct's, however, did show a reduction in adhd symptoms and learning difficulties, but the children concerned had not been officially diagnosed with adhd. A recent rct showed a substantial reduction in adhd symptoms in children with the inattentive type of adhd and in children with adhd and comorbid problems. CONCLUSION There are indications that there is a theoretical rationale for the effectiveness of fatty acids in the treatment of adhd; research is ongoing. At the moment, however, treatment of adhd with omega-3 and omega-6 fatty acids is not recommended because it does not qualify as being evidence-based.

[Sleep disturbances in Smith-Magenis syndrome: treatment with melatonin and beta-adrenergic antagonists].

Abstract: Smith-Magenis syndrome is a generic disorder, characterised by physical, neurological and behavioural features and caused by a 17p11.2 deletion. Patients with this syndrome typically display an inversion of the sleep-wake cycle. In this article we describe clinical developments in a two-year-old girl with Smith-Magenis syndrome whose sleep problems were successfully treated with melatonin and beta-adrenergic blockers. We also mention relevant data obtained in our literature search.

Update of the multidisciplinary guidelines for anxiety and depression

Abstract: The multidisciplinary guidelines for depression, panic disorder and post-traumatic stress disorder have been revised. They incorporate some important changes: algorithms are now based on the severity of the disorders, a 'stepped-care' approach is promoted, so-called basic interventions are required for each algorithm and so-called first-step interventions are advocated for mild disorders. Antidepressants are no longer indicated for mild disorders.

[A multi-centre study of the reliability, validity and sensitivity to change of the honos65+ in psychiatry for older persons].

Abstract: BACKGROUND Within the mental health care services for older persons there is a growing need for insight into and evaluation of the results of clinical treatment. The Health of the Nations Outcome Scales 65+ (honos65+) is a promising instrument for the assessment of mental, social and physical health in older persons, but it is not yet known whether it is valid for older persons in the Netherlands. AIM To assess the reliability, validity and sensibility to change of the honos65+ when applied to older persons with psychiatric disorders. METHOD The bio-psycho-social level of functioning of clients aged 60 and over (n=168) receiving mental health care was assessed by means of existing and validated measuring instruments and the results were compared with those obtained with the honos65+. Three months later the population sample was re-assessed in order to test the extent to which the honos65+ was sensitive to change. RESULTS The reliability and validity of the honos65+ could be ascertained for 168 clients aged 60 and over. After three months 116 clients were re-assessed so that the sensitivity of the honos65+ to change could be noted. CONCLUSION The honos65+ is a reliable and valid instrument for assessing clients with affective disorders such as depression and anxiety and for detecting changes in clients’ problems and functioning. No conclusions could be reached regarding the reliability and validity of the honos65+ when used for clients with other psychiatric disorders because the clinical subgroups were too small for patterns to be detected.

[Routine Outcome Monitoring for patients with severe mental illness: a consensus document].

Abstract: BACKGROUND: Routine outcome monitoring (ROM) means the assessment of the patient's condition on a routine basis using instruments. So far there is no consensus about which instruments should be used for ROM with severely mentally ill patients (ROM-SMI). AIM: To reach a consensus about instruments for ROM-SMI in the Netherlands and Belgium and to create possibilities for comparison of ROM data. METHOD: This article discusses the consensus document of the National Remission Working Group for ROM in patients with SMI and covers the following topics: reasons for ROM-SMI, domains for ROM-SMI and appropriate instruments, logistics and analyses of the data. RESULTS: Patients with SMI have problems in several domains. These can be assessed by collecting information about psychiatric symptoms, addiction, somatic problems, general functioning, needs, quality of life and care satis/action. Potential instruments for ROM-SMI are short, valid, reliable and assess several domains, taking the patient's perspective into account, and have been used in national and international research. The working group advises institutions to choose from a limited set of instruments. After the scores have been aggregated and standardised, comparisons can be drawn, ROM-SMI data can be interpreted more meaningfully, if outcome data are supplemented with data regarding patient characteristics and the treatment interventions already applied. CONCLUSION: It should be possible to reach a consensus about instruments for ROM-SMI and the way in which they should be used. The use of identical instruments will lead to improvements in mental health care and aeate possibilities/or comparison (benchmarking) and research.

[Pre-trial psychiatric reports on Antillean suspected offenders in the Netherlands and on the Dutch Antilles].

Abstract: BACKGROUND The registered criminality among Antilleans living in the Netherlands is much higher than among Antilleans living on the Dutch Antilles (113 offences and 11 offences respectively, per year per 1000 persons, p<0.001). AIM To compare the prevalence of psychiatric disturbances among Antillean suspected offenders in the Netherlands (n=989) and on the Dutch Antilles (n=199) between 2000 and 2006. METHOD A careful study was made of pre-trial psychiatric reports on Antillean suspected offenders (referred to as suspects) in the Netherlands and of comparable reports on Antillean suspects on the Dutch Antilles. RESULTS There was no significant difference in the prevalence of mental disorders among Antillean suspects in the Netherlands (22.3%) and on the Dutch Antilles (20.3%). Abuse of drugs and cannabis was more prevalent on the Dutch Antilles where treatment for addiction is less frequently available than in the Netherlands. Mental retardation was ascertained more often among Antilleans in the Netherlands (22.4%) than among Antilleans on the Dutch Antilles (15.1%). Antillean suspects on the Dutch Antilles were more often found to be fully responsible for their actions than were Antillean suspects in the Netherlands (65.3% versus 19.1%, p<0.001) There was no significant difference in the frequency of ‘strongly diminished responsibility' and ‘a total lack of responsibility'. CONCLUSION On the basis of the pre-trail assessments there seems to be little difference in the prevalence of mental disorders in Antillean suspects in the Netherlands and on the Dutch Antilles.

[Dose-escalation of SSRIS in major depressive disorder. Should not be recommended in current guidelines].

Abstract: summary background In cases where patients with unipolar depression do not respond to a standard dose of selective serotonin reuptake inhibitors ( ssris ), treatment guidelines often recommend a higher dose. A systematic review of the literature revealed uncertainty about the efficacy of dose escalation and pointed to methodological weaknesses in earlier research. aim To review current practice and results concerning dose-escalation of ssris . method We made a summary of previously published English articles that systematically reviewed previous ssri-dose-escalation studies in depressed patients and present the results of a recent double-blind randomised dose-escalation study of paroxetine. By means of a 123I-β- cit-spect study in a subgroup of the patients in the recent dose-escalation study it was possible to measure the amount of paroxetine bound to serotonin transporters. This provided combined clinical and pharmacological outcomes. results The study with paroxetine provided clinical evidence that dose-escalation of paroxetine in depression was not effective and that adverse effects increased. The occupancy of the serotonin-transporters did not increase significantly after dose-escalation, despite increases in paroxetine serum levels. conclusion Dose-escalation of ssris for patients with unipolar depression who did not respond to a standard dose, does not improve response or the chance of remission. The pharmacological explanation for this is that the occupancy of the serotonin-transporters does not increase following dose-escalation.

The current psychometric state of risk assessment scales for adults in the Netherlands

Abstract: Background Although Dutch forensic psychiatry is making increasing use of structural risk assessment scales, the controversy about the value and usefulness of these instruments continues unabated. aim To provide an overview of the psychometric qualities of the instruments used most often in the Netherlands for risk assessment in adults. Method Dutch data about the Historical, Clinical, and Risk Management (hcr-20), the Sexual Violence Risk-20 (svr-20), the Psychopathy Checklist-Revised (pcl-r) and two Dutch instruments, the ‘Historische, Klinische en Toekomstige Risico-indicatoren-30’ (hkt-30) and the ‘Forensisch Psychiatrische Profielen’ (fp-40) were reviewed. In addition, data relating to the unstructured clinical judgment were studied. Results The inter-rater reliability values of the instruments discussed were in general satisfactory, but the internal consistency was often unsatisfactory. Except in some studies, the predictive validity was in general reasonable. Conclusion At present, caution is called for with regard to the assessment of the risk of recidivism when this is based purely on risk assessment scales or purely on the unstructured judgment. Perhaps it is simply not possible to predict recidivism more accurately. Until there are some new developments in this area, it seems advisable to combine as many data as possible about a person under investigation derived from assessment scales and clinical judgment and to compare the outcome with the conclusions of the other professionals. Language: nl

[Attitudes to the seeking of psychiatric help from mental health care professionals and actually seeking help: differences in Europe].

Abstract: BACKGROUND Little is known about attitudes to seeking help from mental health care professionals. AIM To investigate these attitudes and their correlates, and find out whether these attitudes are associated with the use of care services. METHOD Data were derived from the European Study of Epidemiology of Mental Disorders, a survey that is representative of the adult population of six countries (n = 8,796). RESULTS Almost a third of respondents were of the opinion that professional help was worse than or equivalent to no help at all, in relation to serious psychiatric problems. Females, respondents under the age of 65, with a higher income, living in Spain or Italy, with a mood disorder, and those who had previously sought mental health care, more often stated that they would seek professional help if beset by a serious mental health problem. All these groups, except for the younger than 65, also reported more often that they would feel comfortable discussing mental health problems with a professional or that they were receiving this kind of help. All these attitudes were associated with an increased chance that persons would use professional help if beset by mental health problems. CONCLUSION Definite steps need to be taken to increase the visibility and credibility of the mental health services.

Eye movement desensitisation and reprocessing (EMDR) as a treatment for phantom limb pain

Abstract: A 68-year-old man, who had had phantom limb pain in his leg and foot for 27 years, was referred for EMDR treatment. This case study shows that after 10 sessions of EMDR the pain intensity had diminished from 10 to 1 (on a scale of 10). Further sessions, consisting mainly of discussions, focused on consolidation of the result, namely on finding a new physical and mental balance and on strengthening self-confidence in the new situation.

[Apathy: from symptom to syndrome].

Abstract: Background Apathy is a major behavioural problem in dementia and other neuropsychiatric diseases. Aim To provide an overview of the development of the concept of apathy and its importance for clinical practice. Method The article is based on a review of the literature. Results There is evidence that apathy should be regarded as a syndrome rather than a symptom. Apathy is a construct that has several aspects and can occur across a range of diseases.It can occur as part of depressive disorders or cognitive deterioration or it can occur independently. Recently, diagnostic criteria for the diagnosis of the apathy syndrome have been formulated on the basis of an international consensus. Conclusion The diagnostic criteria that have been formulated recently will make it much easier to validate measuring instruments and research into the epidemiology, aetiology, pathophysiology and treatment of apathy.

Antipsychotic agents and stimulants: A judicious combination?

Abstract: A 31-year-old male, diagnosed with schizophrenia and receiving maintenance treatment with olanzapine, was prescribed methylphenidate for comorbid attention deficit hyperactivity disorder (adhd). The adhd symptoms diminished and there were hardly any side-effects. No increase in psychotic symptoms occurred. The patient used far fewer amphetamines and benzodiazepines. In theory, stimulants and antipsychotics produce opposite effects. Relevant literature on the subject is discussed.

[Comorbid anxiety disorders and alcohol-related disorders in a population of bipolar I disorder: investigation in a Flemish population].

Abstract: BACKGROUND Bipolar I disorder (bp i) is a very debilitating psychiatric disorder which is frequently associated with comorbid psychiatric and somatic disorders. Many studies in other countries show strongly elevated prevalences of anxiety disorders and alcohol-related disorders in the bp i population, but so far no data on this topic are available with regard to the Flemish population. AIM To determine the prevalence of anxiety disorders and alcohol-related disorders in a Flemish population of bp i outpatients in remission and to find out whether comorbidity of these disorders is linked to the onset of the disorder at a younger age. METHOD Sixty-nine bp i patients in remission were given structured interviews at home and the results were compared with the Belgian prevalence reported in the European Study of the Epidemiology of Mental Disorders (esemed) project. results Both the prevalence of the alcohol-related disorders (15 of 69 patients or 21.7%) and the prevalence of anxiety disorders (17 patients or 24.6%) were elevated compared to the general population (8.1 and 13.2% respectively). Among the anxiety disorders the prevalence was elevated for panic disorder, social phobia and post-traumatic stress disorder. No significant association was found between the comorbidity and the patient's age at the onset of the illness. CONCLUSION The prevalence of anxiety disorders and alcohol-related disorders in an outpatient population of Flemish patients with bp i in remission is elevated.

Controles bij de behandeling met lithium: de richtlijn en de klinische praktijk

Abstract: achtergrond Lithium kan bijwerkingen hebben op de schildklier en de nieren. Om dit te controleren dienen de spiegels van lithium, creatinine en thyroïdstimulerend hormoon (tsh) regelmatig gecontroleerd te worden. doel Onderzoeken bij zowel psychiaters als huisartsen of zij de controles van lithiumspiegel, creatinineen tsh-waarde twee keer per jaar verrichten conform de Richtlijn bipolaire stoornissen van de Nederlandse Vereniging voor Psychiatrie (2001). methode Het onderzoek werd uitgevoerd op basis van de gegevens die het klinisch-chemisch laboratorium had over lithiumcontroles van 2004 in huisartsenpraktijken en de ggz in de regio Apeldoorn, een regio met ongeveer 250.000 inwoners. resultaten Ruim 11% van de psychiaters en bijna een kwart van de huisartsen controleerde de lithiumspiegels niet zo frequent als werd geadviseerd door de richtlijn uit 2001. De huisartsen controleerden significant minder vaak dan de psychiaters. Creatinineen tsh-waarden werden zowel door de huisartsen als door de psychiaters minder vaak gecontroleerd dan de richtlijn aangeeft, creatinine respectievelijk bij 65,8 en 61,2% en tsh bij 68,3 en 58%. conclusie Onze aanbeveling is om een waarschuwingssysteem in te stellen vanuit het laboratorium dat de arts informeert wanneer een patiënt een controle heeft gemist. Een andere overweging is om lithium alleen door psychiaters voor te laten schrijven en niet door huisartsen.

Attituden aangaande zoeken van professionele hulp voor psychische problemen en werkelijk hulpzoekgedrag: verschillen in Europa.

Abstract: BACKGROUND: Little is known about attitudes to seeking help from mental health care professionals. AIM: To investigate these attitudes and their correlates, and find out whether these attitudes are associated with the use of care services. METHOD: Data were derived from the European Study of Epidemiology of Mental Disorders, a survey that is representative of the adult population of six countries (n = 8,796). RESULTS: Almost a third of respondents were of the opinion that professional help was worse than or equivalent to no help at all, in relation to serious psychiatric problems. Females, respondents under the age of 65, with a higher income, living in Spain or Italy, with a mood disorder, and those who had previously sought mental health care, more often stated that they would seek professional help if beset by a serious mental health problem. All these groups, except for the younger than 65, also reported more often that they would feel comfortable discussing mental health problems with a professional or that they were receiving this kind of help. All these attitudes were associated with an increased chance that persons would use professional help if beset by mental health problems. CONCLUSION: Definite steps need to be taken to increase the visibility and credibility of the mental health services

De diagnostiek van comorbiditeit bij patiënten met een autismespectrumstoornis

Abstract: achtergrond: Het is dikwijls lastig om te bepalen of er naast een autismespectrumstoornis (ASS) sprake is van psychiatrische comorbiditeit of dat het geobserveerde gedrag voldoende wordt beschreven door de diagnose ASS. doel: Aangeven wanneer men moet denken aan mogelijke comorbide stoornissen bij kinderen en volwassenen met ASS. Hierbij ligt de focus op de drie meest voorkomende comorbide stoornissen bij zowel kinderen als volwassenen met ass, namelijk depressie, angst en ADHD. methode: Bespreken van de beschikbare literatuur en klinische ervaring. resultaten: Bij de diagnostiek van ass en comorbide stoornissen is het belangrijk om een gedegen ontwikkelingsanamnese te hebben. Deze ontwikkelingsanamnese kan tevens dienen als zogenaamd uitgangspunt van het gedrag van de client. Veranderingen in het gedragspatroon ten opzichte van vroeger zijn dikwijls indicatief voor de aanwezigheid van een comorbide stoornis. conclusie: Aangezien ASS een levenslange stoornis is en er in de verschillende levensfases comorbiditeit aanwezig kan zijn die ook behandeling of begeleiding behoeft, zal het diagnostische proces niet stoppen bij het vaststellen van ASS.

[Compulsive buying or oniomania: an overview].

Abstract: Achtergrond - Mensen met koopverslaving ervaren een permanente drang om te kopen, ongeacht hun financiele middelen. De aandacht voor koopverslaving is pas de laatste decennia toegenomen. Omdat overmatig kopen als kenmerk van diverse aandoeningen met enige regelmaat voorkomt in de klinische praktijk, dringt zich de vraag op of het een verschijnsel van deze tijd is of dat het gezien moet worden als symptoom van een psychiatrische stoornis, dan wel als eigenstandig psychiatrisch syndroom. Doel - Inzicht verkrijgen in ongecontroleerd kopen. Methode - Een literatuuronderzoek in Medline, PubMed en Psycinfo in de periode van 1966 tot augustus 2008. Resultaten - Ongecontroleerd kopen is een betrekkelijk onbekend en beperkt gedefinieerd verschijnsel ondanks het frequente voorkomen en een hoge comorbiditeit. Het toont zich als een chronisch, repetitief gedrag, komt meer bij vrouwen voor en dient te worden ondergebracht bij de 'stoornis in de impulsbeheersing nao'. Geboden etiologische modellen bieden onvoldoende houvast en een gedragstherapeutische behandeling lijkt tot dusver het meest succesvol. Conclusie - Ongecontroleerd kopen moet beschouwd worden vanuit een neurowetenschappelijk perspectief. Nader onderzoek dient naast een neuropsychiatrische focus een contextueel psychologisch/gedragsanalytisch accent te hebben, waarin onderwerpen zoals inhibitie, zelfcontrole en regelgeleid gedrag centraal staan.

Hallucinations and vivid dreams by use of metoprolol

Abstract: A 71-year-old man had had visual hallucinations and vivid dreams for two years after starting to take metoprolol. When metoprolol was replaced by atenolol the patient's symptoms disappeared within five days. Side-effects of beta-blockers on the central nervous system are relatively uncommon. The mechanisms underlying these side-effects are not fully understood. Lipophilic beta-blockers can cross the blood-brain barrier, whereas hydrophilic beta-blockers cannot. Doctors need to be alerted to the varying side-effects of specific beta-blockers.

The neurobiology of antisocial behaviour

Abstract: Background Neuro-imaging is being used increasingly to provide explanations for antisocial behaviour. Aim To make a neurobiological contribution to the diagnosis of many types of antisocial behaviour. Method The literature was searched using PubMed and combinations of the keywords 'psychopathy', 'antisocial', 'neurobiology' and 'neuro-anatomy' for the period 1990-2009. Results Impairments in the prefrontal cortex, amygdala, hippocampus, superior temporal gyrus, corpus callosum and anterior cingulate cortex provide a possible explanation for a large number of the symptoms associated with antisocial behaviour. The concept of psychopathy is connected mainly with impairments in a prefrontal-temporal-limbic system. CONCLUSION Combinations of deficiencies in the associated brain areas and malfunctioning of the communication between the various brain structures seem to play a more important role than deficiencies in the separate brain structures.

[Clients using the youth mental health services in The Hague are not an ethnic reflection of the youth of that city; bias not by social economic status but by ethnic origin].

Abstract: BACKGROUND: Young people who are born outside the Netherlands (or have at least one parent born outside the Netherlands) make less use of the mental health services than one might expect. AIM: To find out whether the under-use of these services is related to the average income or to the ethnic composition of the districts concerned. METHOD: The relationship between average income, ethnic composition and the percentage of youth treated per district was analysed on the basis of postal codes. RESULTS: The ethnic composition of the district was related to the percentage of young persons using the mental health services, but the average income was not. CONCLUSION: On the basis of district variables, the under-use of the youth mental health services was found to be an ethnic or cultural problem, not a poverty problem.