[Somatic disorders in outpatient psychiatry: the added value of a standard physical examination during the intake of outpatients]. / Somatiek in de ambulante psychiatrie: de toegevoegde waarde van een standaard lichamelijk onderzoek tijdens de ambulante intake.

BACKGROUND: It is well-known that psychiatric patients often suffer from severe somatic problems, such as diabetes mellitus and cardiovascular disease. Up till now, research has concentrated almost exclusively on the inpatient setting, but there is strong evidence that the correlation also exists in psychiatric patients who are outpatients. In the Netherlands there are, as yet, no clear recommendations regarding a standard form of somatic screening for the outpatient population. A pilot study performed by GGz Breburg has shown that somatic screening (without a physical examination) gave substantial additional value to treatment planning. AIM: To investigate the added value that a physical examination can provide when new psychiatric patients are screened for aspects of somatic concern (ASC). METHOD: Newly referred outpatients (n = 70) were screened somatically by means of a questionnaire and supplementary medical interview, and by laboratory tests and physical examination. If a somatic problem was found which had not been detected previously, the patient was referred back to to the general practitioner. RESULTS: At least one ASC was found in 81,4% of all patients. In 45,7% of all patients the asc had not been detected. 12% of all the newly discovered somatic problems were found exclusively via the physical examination. CONCLUSION: A physical examination provides substantial information and adds value to the somatic screening of psychiatric outpatients.

[Ending up in a wheelchair in a strange way]. / Op onduidelijke wijze in een rolstoel beland.

In this case-report we present a patient with a genetic disease which was first diagnosed in his eighties. The genetic disease is a rare neurologic disease, Kennedy's disease or spinobulbar muscular atrophy (SBMA). We also discuss the genetics of the disease and developments of future therapies.