[Sleep: the basis of a healthy lifestyle]. / Slaap: de basis voor een gezonde leefstijl.

BACKGROUND: The use of sleep as modifiable lifestyle factor is not yet self-evident in psychiatry.
AIM: To increase knowledge about sleep as health-affecting factor.
METHOD: Description of normal sleep, effects of disturbed sleep and lifestyle advice to promote healthy sleep.
RESULTS: Disturbed sleep negatively impacts physical and mental health. Targeted lifestyle advice can improve sleep and bring about positive effects in multiple areas.
CONCLUSION: From preventive and treatment perspectives, interventions optimizing sleep in psychiatric care seem promising.

Poor Sleep and Its Relation to Impulsivity in Patients with Antisocial or Borderline Personality Disorders.

Studies investigating sleep and personality disorders consistently demonstrate a relation between personality disorders characterized by behavioral disinhibition and/or emotional dysregulation (traditionally termed cluster B personality disorders) and poor sleep. This finding is in line with previous studies associating insomnia with impulsive behavior, since this is a core characteristic of both antisocial and borderline personality disorder. The current study investigates a group (n = 112) of forensic psychiatric inpatients with antisocial or borderline personality disorder or traits thereof. Subjective sleep characteristics and impulsivity were assessed with the Pittsburgh Sleep Quality Index, the Sleep Diagnosis List, and the Barratt Impulsiveness Scale, respectively. More than half of the patients (53.6%) report poor sleep quality and 22.3% appears to suffer from severe chronic insomnia. Both poor sleep quality and chronic insomnia are significantly associated with self-reported impulsivity, in particular with attentional impulsiveness. This association was not significantly influenced by comorbid disorders. Actively treating sleep problems in these patients may not only improve sleep quality, mental health, and physical well-being, but may also have impact on impulsivity-related health risks by increasing self-control.

Observational and experimental studies on sleep duration and aggression: A systematic review and meta-analysis.

Short sleep duration has been linked to higher levels of aggression. To synthetize all available research on this association, a systematic review and meta-analysis was performed. We included observational and experimental studies, using various measures of sleep duration and aggression. Eighty eligible papers were identified, describing 82 studies comprising a total number of 76.761 participants. Meta-analysis of results was possible for 60 studies. Pooled observational results on the association between sleep duration and aggression showed a correlation estimate of -0.16 (95%CI -0.19, -0.12; I2 = 83.9%) and an odds ratio estimate of 1.83 (95%CI 1.47, 2.28; I2 = 0.0%). For experimental studies, the pooled Standardized Mean Difference after manipulation of sleep duration was -0.37 (95%CI -0.80, 0.05; I2 = 89.05%) for controlled designs and -0.34 (95%CI -0.54, -0.14; I2 = 89.05%) for pre-post designs. Effect estimates were stronger for individuals with psychological vulnerabilities and younger persons. Exclusion of studies with low methodological quality strengthened the effect estimate in experimental but not in observational studies. To conclude, short sleep duration is associated with higher levels of aggression, with observational research strongly supporting the association and experimental studies providing mixed results. More well-designed prospective and experimental studies are needed to establish causality and optimize treatment, especially for individuals with psychological vulnerabilities.

Poor sleep quality at baseline is associated with increased aggression over one year in forensic psychiatric patients.

OBJECTIVE: In forensic psychiatric patients, sleep problems as well as impulsivity and aggression are highly prevalent, yet studies on their association over time are lacking. This study investigates the association between sleep quality and changes in impulsivity and aggression in forensic psychiatric patients over one year. METHODS: Data were drawn from an ongoing prospective observational study in adult forensic psychiatric patients admitted to a forensic treatment facility between October 2006 and January 2018. Validated self-reports and observational instruments were used to assess sleep quality, impulsivity and aggression upon admission to the hospital and after one year. Linear regression analyses were performed to examine the association between sleep quality, impulsivity and aggression. All models were adjusted for baseline values of outcome measures, demographic features and general psychopathology. RESULTS: Data from 83 men (age 37.7 ± 11.7 years) with completed consecutive measurements were analyzed. Poor sleep quality was associated with increased self-reported aggression (ß = 1.08; 95% CI, 0.38-1.78). This association was positively confounded by general psychopathology, indicating that sleep quality is specifically related to self-reported aggression instead of being part of general psychopathology (adjusted ß = 1.18; 95% CI, 0.39-1.97). Poor sleep quality was not associated with changes in self-reported impulsivity, clinician-rated impulsivity or clinician-rated hostility in this population. CONCLUSION: Poor sleep quality was associated with an increase in self-reported aggression over one year in male forensic psychiatric patients. Early evaluation and treatment of sleep problems in (forensic) psychiatric patients may play an important role in reducing the risk of aggressive behavior.

[Thiamine deficiency caused by malnutrition: a rare cause?]. / Thiaminedeficiëntie veroorzaakt door malnutritie; een zeldzame oorzaak?

A 50-year-old man was admitted to our psychiatric clinic with symptoms of depression, comorbid neurological disturbances and cardiomyopathy. The condition was diagnosed as beriberi and Korsakov's syndrome, on the basis of thiamine deficiency. The patient's diet was unbalanced and restricted, but he was not an alcohol abuser. Thiamine suppletion led to a partial remission of symptoms. If a patient presents with depressive symptoms combined with neurological disturbances or heart irregularities, the Wernicke-Korsakov syndrome should be ruled out, even if the patient does not abuse alcohol. If in doubt, always opt for thiamine suppletion.

[The beginning psychiatric training syndrome in the year 2007. Myth or reality?]. / Het 'beginning psychiatric training syndrome' anno 2007. Mythe of realiteit?

The beginning psychiatric training syndrome is a controversial, but imaginative nosological concept. This short paper provides a concise overview of the relevant literature on beginning psychiatric training syndrome, and presents the results of a pilot study regarding health problems among 35 residents in the Netherlands. On the basis of the two analyses, it is concluded that, as a rule, health problems among this group of doctors tend not to evolve into states of psychopathology in the restricted sense. Nonetheless, it is advisable to monitor such health problems with a view to their prevention.

Familial spastic paraplegia: evidence for a fourth locus.

Autosomal dominant familial spastic paraparesis (AD-FSP) is a genetically heterogeneous disorder of the central nervous system characterized by a progressive spasticity of the legs. One gene causing AD-FSP (FSP1) has recently been mapped to chromosome 14q, another gene (FSP2) to chromosome 2p, and a third gene (FSP3) to chromosome 15q. We now report a large Dutch family with AD-FSP without linkage to any of these chromosomes, providing evidence for a fourth locus (FSP4).

Pleomorphic adenoma of the vulva: a review illustrated by a clinical case.

The pleomorphic adenoma of the vulva is an extremely scarce diagnosis. This form of neoplasm is more frequently observed in other topographic sites of the human body. Treatment modalities largely derive from experiences with the pleomorphic adenoma located in these other sites. As a result of similarity with other tumors and scarcity of the neoplasm, the diagnosis of pleomorphic adenoma of the vulva is easily missed in daily routine practice. Recurrences of this neoplasm are frequently observed with an estimated incidence of malignant transformation of 25%. Addressing this previously mentioned issue, an extensive surgical excision and long-term follow-up is advocated. This report is illustrated by the case of a 66-year-old woman who was admitted to our hospital with a pleomorphic adenoma of the vulva, diagnosed by pathologic assessments following surgical excision. As a result of the rarity of this diagnosis, characteristics and treatment of extravulvar in addition to vulvar localizations of the pleomorphic adenoma are reviewed.

Provocation of transient lower esophageal sphincter relaxations during continuous gastric distension.

BACKGROUND: Transient lower esophageal sphincter relaxations (TLESRs) are triggered by gastric distension. The aim of the study was to investigate TLESRs during controlled prolonged gastric distensions using the barostat technique. METHODS: Twelve healthy volunteers (4 M, 8 F, age range 19-42 years) were studied under fasting conditions with combined esophageal manometry (Dentsleeve) and gastric barostat. Randomized isobaric distensions at 0 (control), 10, 12 and 14 mmHg were performed each period for 30 min with 30-min recovery periods in between. RESULTS: The frequency of TLESR was significantly (P < 0.05) higher during all distension periods compared to control periods (4.0 +/- 0.4 TLESR/30 min versus 2.6 +/- 0.4 TLESR/30 min). The frequency of TLESR in the first 15-min period of distension was significantly (P < 0.001) higher compared to the second 15-min period pointing to adaptation (2.7 +/- 0.3 TLESR/15 min versus 1.3 +/- 0.2 TLESR/15 min, respectively). The frequency of TLESR correlated significantly with intragastric pressure (r = 0.47; P < 0.01) and wall tension (r = 0.48; P < 0.01), but not with intragastric volume. TLESR characteristics such as duration were not related to pressure or wall tension. CONCLUSIONS: Acute gastric distension increases the frequency of TLESR but adaptation occurs rapidly. The frequency of TLESR during distension is related to pressure and wall tension rather than to intragastric volume.