[Schizophrenia exists: yes / no / don't know]. / Schizofrenie bestaat: wel / niet / weet niet.

BACKGROUND: The suggestion that schizophrenia does not exist has let to a discussion in Dutch national newspapers. According to several contributors, the diagnosis schizophrenia can wrongly lead to stigmatisation and defeatism with regard to treatment and should therefore be replaced by the broader concept, psychosis. This view strengthens the argument that 'schizophrenia does not exist'. In reaction to this view it has been suggested that in some articles that schizophrenia is now believed to have a definite biological basis. AIM: To clarify the various arguments and concepts that are used. METHOD: The arguments for and against are reviewed from an ontological perspective. Ethical/political arguments and scientific arguments are handled separately and are set against each other. RESULTS: The ontological status of psychiatric disorders, including schizophrenia, are problematic, as has been shown in a recent study by Kendler. From the perspective of the medical scientific programme - namely, try to go from syndromes to anatomically defined diseases - it would appear that one party wants to abandon this programme, whereas the other party wants to continue it. CONCLUSION: Research over the last few decades has been unable to clarify the ontological status of schizophrenia.

[Omega-3 fatty acids in the treatment of affective disorders: an overview of the literature]. / Omega-3-vetzuren bij de behandeling van stemmingsstoornissen. Een literatuuroverzicht.

BACKGROUND: More and more interest is being shown in fish oil because it contains omega-3 fatty acids which may have beneficial effects in a wide range of somatic and psychiatric disorders. AIM: To search the literature for evidence of the effectiveness of omega-3 fatty acids in affective disorders. METHOD: We studied the literature with the help of Pubmed (1966-March 2006) using the keywords 'depression', 'affective disorder', 'bipolar disorder', 'seasonal affective disorder', 'postpartum depression', 'puerperal depression', 'fatty acids', 'eicosapentaenoic acid', 'arachidonic acid', 'docosahexaenoic acid' and 'fish oil'. We obtained additional information from the bibliographic references attached to the articles concerned. RESULTS: Epidemiological studies and studies on fatty acid concentrations suggest a link between omega-3 fatty acids and affective disorders, although some of the results are contradictory. Some clinical investigations found that treatment with omega-3 fatty acids did have a positive effect, but the number of test subjects was very limited and some investigations even produced negative results. CONCLUSION: There is insufficient clinical evidence to prove conclusively that treatment with omega-3 fatty acids has a beneficial effect on affective disorders.

[Dose reduction of conventional antipsychotics: does it reduce tardive dyskinesia?]. / Dosisreductie van klassieke antipsychotica: gunstig voor tardieve dyskinesie?

The first step in the treatment of tardive dyskinesia is to reduce the dose of antipsychotics. The view sometimes expressed in general practice is that, initially, dose reduction exacerbates tardive dyskinesia, which is an effect that can be explained on theoretical grounds. However, it is apparent from published scientific research that dose reduction of conventional antipsychotics tends to improve tardive dyskinesia rather than exacerbate it.

Lateralized neuropsychological functioning in depressive patients before and after drug therapy.

Several decades of research have led to different hypotheses about cognitive functioning in depression; one of the hypotheses states that there is altered functioning of the hemispheres during a depressive episode. Lateralization studies have found diminished neuropsychological functioning in depressive patients; especially right-hemisphere functions seem impaired. In our study we used conventional neuropsychological tests to study shifts in hemispheric functioning. Neuropsychological testing before and after therapy in 52 (for the most part therapy-resistant) depressives showed no substantial effects in lateralized functioning. None of the measures enabled prediction of response to treatment; however 17 different interaction variables were identified, five of which make an unique contribution.

Hypnotics as concurrent medication in depression. A placebo-controlled, double-blind comparison of flunitrazepam and lormetazepam in patients with major depression, treated with a (tri)cyclic antidepressant.

The addition of benzodiazepine hypnotics to a treatment with tricyclic antidepressants has received little systematic study. In a double-blind placebo-controlled design, the effects on mood and on sleep of two benzodiazepine hypnotics (lormetazepam and flunitrazepam) were studied in patients with major depression who were also treated with maprotiline or nortriptyline. After 4 weeks of combined treatment, lormetazepam resulted in a significantly greater decrease in the score on the Hamilton Depression Subscale than placebo, while there was a non-significant trend in favour of lormetazepam in comparison with flunitrazepam. With respect to sleep EEGs, lormetazepam resulted in a significantly greater suppression of REM sleep. The differences between lormetazepam and flunitrazepam may be partly explained by the shorter half-live of lormetazepam.

Monoamine oxidase inhibitors in resistant major depression. A double-blind comparison of brofaromine and tranylcypromine in patients resistant to tricyclic antidepressants.

In a double-blind study the selective monoamine oxidase-A inhibitor brofaromine was compared with the classical MAOI tranylcypromine in 39 patients with major depression resistant to treatment with tricyclic antidepressants. Concerning efficacy no significant differences were found. Ten out of 22 patients responded to brofaromine and 5 out of 17 patients to tranylcypromine. Adverse effects favoured brofaromine. Although orthostatic hypotension occurred in both groups, severe decrease in blood pressure and dizziness occurred significantly more with tranylcypromine. Both MAOIs caused a decrease in stage 4 and REM sleep and an increase in REM latency. In most patients receiving tranylcypromine REM sleep was completely abolished.

Reversible monoamine oxidase-A inhibitors in resistant major depression.

Monoamine oxidase (MAO) inhibitors (MAOIs) provide effective alternative therapy for those patients with major depression who do not respond to tricyclic antidepressants or such related compounds as the selective serotonin reuptake inhibitors. This article reviews studies on the efficacy of both the classical MAOIs and the new, selective monoamine oxidase-A (MAO-A) inhibitor brofaromine in patients with resistant major depression. Brofaromine appears to be as effective as the older MAOIs in these patients, but is better tolerated and safer to use. Brofaromine was also found to be better tolerated than lithium when added to treatment with the tetracyclic antidepressant maprotiline. More studies on the benefits of the new MAO-A inhibitors in resistant depression are indicated, not only with brofaromine but also with moclobemide, which to date has not been studied in this indication. Studies to determine their place in the overall treatment strategy of major depression are also needed.

[Elderly patients, classical monoamine oxidase inhibitors and intercurrent somatic diseases]. / Ouderen, klassieke monoamineoxidaseremmers en intercurrente somatische aandoeningen.

Three patients, a woman aged 70, a man aged 74 and a woman aged 78 years, all using tranylcypromine, a monoamine oxidase inhibitor (MAOI), to prevent the recurrence of severe depressive disorders, developed an intercurrent somatic disease. On admission to a general hospital, the first patient was initially refused her MAOI. The second patient was twice refused anaesthesia and the depression recurred twice when the MAOI was tapered off in connection with his operation. Both recovered after being given tranylcypromine. The third patient received tramadol from her surgeon and read in the directions for use that this drug should not be combined with a MAOI. After discontinuation of the MAOI the depression recurred, her medical condition deteriorated and she died. MAOIs are often a treatment of last resort. Discontinuation of an effective treatment and hence compromising the patient's psychiatric status increases the risk of medical and psychiatric complications and therefore should be avoided. Interdisciplinary consultation is essential in such cases.

A case of organic brain syndrome following head injury successfully treated with carbamazepine.

A case of organic brain syndrome occurring in relation to psychological stress 2 years after a severe head injury is described. Treatment with haloperidol resulted only in slight improvement. A dramatic improvement was achieved with carbamazepine.