The support needs of parents having a child with a chronic kidney disease: a focus group study.

BACKGROUND: Parents of children with a chronic kidney disease (CKD) have a crucial role in the management of their child's disease. The burden on parents is high: they are often exhausted, depressed and experience high levels of stress and a low quality of life, which could have a negative impact on their child's health outcomes. Support aiming at preventing and reducing parental stress is essential. Therefore, it is necessary to have insight in the problems and support needs among these parents. OBJECTIVE: Our aim is to describe parents' support needs regarding the problems they experience in having a child with CKD. METHODS: Five focus group interviews were conducted with parents of children: (i) with hereditary kidney disease, (ii) with nephrotic syndrome, (iii) with chronic kidney failure, (iv) using dialysis and (v) after renal transplantation. The children were treated at a paediatric nephrology unit in one university hospital in the Netherlands. The data were thematically analysed. RESULTS: Twenty-one parents participated in the focus groups. Parents need more information about their child's CKD and treatment options, and managing their own hobbies and work. Furthermore, parents need emotional support from their partner, family, friends, peers and healthcare professionals to help them cope with the disease of their child. Additionally, parents need practical support to hand over their care and support in transport, financial management and regarding their child at school. CONCLUSION: Needs regarding balancing their personal life are seldom prioritized by parents as the child's needs are considered more important. Therefore, it is important that healthcare professionals should not only attend to the abilities of parents concerning their child's disease management, but also focus on the parents' abilities in balancing their responsibilities as a caregiver with their own personal life.

The psychiatric expert witness.

The novice psychiatric expert witness undergoes intense scrutiny and enters an unfamiliar legal system. Caution must be taken to maintain professional integrity and avoid bias. Educating the court about matters pertaining to mental health is a critical function of the expert. Forming well-reasoned opinions that are communicated with clear language enhances this task. An expert who is both knowledgeable and well prepared will better serve the court, and is less likely to be intimidated by the adversarial process.

Heterogeneity of the psychoses: is there a neurodegenerative psychosis?

Whereas etiological heterogeneity of the various types of schizophrenia has been repeatedly proposed, relatively few attempts have been made to separate the component diseases. Using a strategy focusing on bimodal distributions within several relevant domains of schizophrenia, we demonstrate that currently available data on schizophrenia patients are consistent with the hypothesis that some of these patients have an ongoing neurodegenerative disease, whereas others do not. We review studies (longitudinal and cross-sectional) documenting progressive increases in ventricular size, accelerated loss of brain tissues, progressive delays in treatment response, and neurochemical (magnetic resonance spectroscopy) and neurophysiological (P300) indices, all of which are consistent with ongoing cerebral degeneration in a significant subgroup of schizophrenia patients. These lines of evidence converge on a conceptualization of schizophrenia as being composed of several etiologically distinct processes, with one subset of psychotic patients evidencing progressive brain degeneration. We conclude with a discussion of possible etiologies for this condition.

The atypical antipsychotic sertindole: a case series.

BACKGROUND: Psychotic disorders are often difficult to treat with traditional neuroleptics. Sertindole is a new atypical neuroleptic with a broader CNS receptor profile. METHOD: Ten patients diagnosed with either schizophrenia or schizoaffective disorder were treated with sertindole for 18 months and observed for changes in Clinical Global Impression scale scores. RESULTS: Nine patients experienced a reduction of symptoms after 12 months of treatment. Eight patients completed 18 months of treatment, all exhibiting overall improvement. Despite side effects of tiredness, weight gain, headache, nausea, and decreased ejaculatory volume, sertindole was generally well tolerated. CONCLUSION: Sertindole appears to be a useful treatment in psychotic disorders. It may present an advantage over traditional neuroleptics in the form of fewer extrapyramidal symptoms and improvement of negative symptoms.

Partial hospitalization: an update.

As a treatment modality for serious mental disorders, partial hospitalization has been proven to have therapeutic and economic advantages. However, it has relatively low utilization and poor third-party reimbursement compared to the more traditional outpatient and inpatient treatments. The authors provide a review and update of the definitions, historical development, models, staffing, and referral patterns of partial hospitalization. They comment on the role of the psychiatrist as a member of the multidisciplinary team in this treatment setting.

Emotional factors in oculogyric crisis.

Drug-induced oculogyric (OGC) is ordinarily discussed from a neuropharmacological point of view. It is usually controlled without difficulty by adjusting the dosage, changing the neuroleptic, or adding antiparkinson medications. When these traditional methods failed to control this symptom in the author's patient, it became clear other models must be considered. They included conversion and psychophysiological models. The psychophysiological model proved to be most useful. It was hypothesized that a tendency for OGC was drug-induced. When combined with an increased state of emotional arousal and/or a reduction in the ability of the neuromuscular system to compensate, the OGC would occur. The increased state of emotional arousal could result from either internal or external stress. Internal stresses occurred when there was diminished external stimuli to aid repression. Fatigue was the most obvious factor altering the ability of the neuromuscular system to compensate. The psychophysiological model provided a frame-work to formulate an effective treatment program to deal with the various contributing factors.