[Corticosteroid-induced paranoid psychosis: case report and review of the literature]. / Paranoïde psychose geïnduceerd door corticosteroïden: gevalsbeschrijving en literatuuroverzicht.

BACKGROUND: Our study focuses on a 30-year-old man who was hospitalised against his will because of his agitated psychotic state. His symptoms were indicative of a paranoid psychotic disorder resulting from the use of corticosteroids. We considered it important to report this case because corticosteroids have been widely prescribed since about 1950 to treat a broad spectrum of somatic illnesses and because there have been many reports of both mild and acute psychiatric side-effects. AIM: To obtain answers to the following questions: what is the incidence of steroid-induced psychotic symptoms? Do patients with a psychiatric history run a greater risk of developing a steroid-induced psychosis? What are the most important risk factors and how can we prevent the development of steroid-induced psychotic symptoms? METHOD: After discussing the case, we studied the literature systematically using Medline. RESULTS: Up till now, very little reliable evidence has been available relating to steroidinduced psychosis. Therefore there has been a lack of information about the incidence of psychotic symptoms caused by steroids, about the risks involved when the patient has a psychiatric history and about the preventive measures that can be taken. CONCLUSIONS: The most important risk factor seems to be the dose. Thus, if a patient requires treatment with steroid, it seems advisable to prescribe the lowest possible dose.

[Comorbid anxiety disorders and alcohol-related disorders in a population of bipolar I disorder: investigation in a Flemish population]. / Comorbide angststoornissen en stoornissen in alcoholgebruik bij bipolaire I-stoornis; onderzoek in een Vlaamse populatie.

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.

[Personality traits of patients who have recovered completely from depression]. / Persoonlijkheidskenmerken bij patiënten die volledig hersteld zijn van een depressieve stoornis.

BACKGROUND: The psychobiological model of personality developed by Cloninger includes four dimensions of temperament and three dimensions of character. Studies have indicated that the personality dimensions of patients with depression differ from those of control subjects without depression. AIM: To assess whether the personality traits of persons who have experienced one or more depressive episodes in the past and have made full recovery differ from the personality traits of persons who have never suffered from depression. METHOD: The personality dimensions for 40 persons in remission but with a previous history of depression and for 49 healthy controls were determined by means of a Dutch version of the Temperament and Character Inventory (tci) questionnaire. results Compared to the control subjects, patients in remission showed a significant increase on the temperament scale Harm Avoidance and a statistically significant decrease on the character scale Self-Directedness. The increase also applied to all subscales of Harm Avoidance and the decrease applied to four of the five subscales of Self-Directedness. CONCLUSION: Compared to healthy control subjects, patients in remission showed a distinctly different personality profile. None of these differences can therefore be regarded merely as a transient phenomenon during a depressive episode ('state effect'). However, it cannot be concluded from the current study whether the altered personality profile is a consequence of having had a depression or whether it is a 'scarring effect' of a pre-existing vulnerability factor.

[Psychiatric disorders in velo-cardio-facial syndrome]. / Psychiatrische problemen bij het velocardiofaciaal syndroom.

Velo-cardio-facial syndrome (vcfs) is a congenital disorder with a markedly variable clinical expression. The majority of those affected have cognitive-behavioural symptoms and psychiatric problems. Most of the somatic characteristics can be treated effectively. The quality of life of patients with vcfs is therefore determined largely by cognitive and behavioural symptoms, including the increased risk of psychiatric disorders. On the basis of a case-study featuring a 41-year-old vcfs patient and by reviewing the literature we describe the psychiatric disorders that can occur in conjunction with this syndrome.

[Stress and depression: clinical, neurobiological and genetical perspectives]. / Stress en depressie: klinisch, neurobiologisch en genetisch perspectief.

Major depressive disorder (mdd) can be elicited by various kinds of stress, such as negative life events, chronic stress and experiences of abuse early in life. These stressors interact with personality traits and with a genetic predisposition to depression, thereby bringing about mdd. Therefore, the neurobiology of depression cannot be separated from the neurobiology of stress system. A substantial number of publications have in fact demonstrated that mdd patients show abnormalities of the hypothalamic-pituitary-adrenal (hpa) axis, which is a key element of the stress response. Such disturbances are exacerbated by chronic stress, early experiences of abuse and even prenatal exposure to stress. On the other hand, genetic variations can play a role in the hpa axis dysfunction and in vulnerability to depression. Evidence is emerging that certain genes are directly involved in the functioning of the hpa axis. Other genetic factors, not directly related to the hpa axis, are probably relevant as well, the best known example being the serotonin transporter gene.

[Emergency psychiatry in Belgium; a challenge for the mental health services]. / Urgentiepsychiatrie in België; een uitdaging voor de geestelijke gezondheidszorg.

In Belgium emergency psychiatry is a discipline that has developed only recently, following two federal pilot projects, one in 1993 and one in 2002. At present there are 10 subsidised psychiatric emergency rooms (pers) in Belgium, serving about 13,000 patients annually. Many of those seeking help are 'revolving-door' patients, but the pers also serve patients who have had no prior contact with the mental health care service. The disorders that are encountered most often have to do with substance abuse (about 30%) and mood disorders (17%). More than 4 in 10 patients were admitted to a psychiatric clinic after being referred to a per. Research suggests that the link to continuous care may reduce the 'revolving-door' phenomenon.

Meta-analyses of genetic studies on major depressive disorder.

The genetic basis of major depressive disorder (MDD) has been investigated extensively, but the identification of MDD genes has been hampered by conflicting results from underpowered studies. We review all MDD case-control genetic association studies published before June 2007 and perform meta-analyses for polymorphisms that had been investigated in at least three studies. The study selection and data extraction were performed in duplicate by two independent investigators. The 183 papers that met our criteria studied 393 polymorphisms in 102 genes. Twenty-two polymorphisms (6%) were investigated in at least three studies. Seven polymorphisms had been evaluated in previous meta-analyses, 5 of these had new data available. Hence, we performed meta-analyses for 20 polymorphisms in 18 genes. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Statistically significant associations were found for the APOE varepsilon2 (OR, 0.51), GNB3 825T (OR, 1.38), MTHFR 677T (OR, 1.20), SLC6A4 44 bp Ins/Del S (OR, 1.11) alleles and the SLC6A3 40 bpVNTR 9/10 genotype (OR, 2.06). To date, there is statistically significant evidence for six MDD susceptibility genes (APOE, DRD4, GNB3, MTHFR, SLC6A3 and SLC6A4).

Combined dexamethasone/corticotropin-releasing factor test in chronic fatigue syndrome.

BACKGROUND: Studies of hypothalamic-pituitary-adrenal (HPA) axis function in chronic fatigue syndrome (CFS) point to hypofunction, although there are negative reports. Suggested mechanisms include a reduced hypothalamic or supra-hypothalamic stimulus to the HPA axis and enhanced sensitivity to the negative feedback of glucocorticoids. The aim of the current study was to investigate HPA axis function in CFS with the dexamethasone/corticotropin-releasing factor (Dex/CRF) test, in analogy with research in affective disorders. METHOD: Thirty-four well-characterized female CFS patients and 25 healthy control subjects participated in the low-dose Dex/CRF test. Current major depressive episode was an exclusion criterion. History of early-life stress (ELS) was assessed with the Structured Trauma Interview. RESULTS: Salivary cortisol responses after 0.5 mg Dex were lower in CFS patients than in controls (before 100 microg CRF, p=0.038; after 100 microg CRF, p=0.015). A secondary analysis revealed an influence of early-life stress and of oestrogen intake. After removal of the 10 participants who were taking an oral oestrogen, patients without a history of ELS showed lower cortisol responses than patients with ELS and controls (before CRF, p=0.005; after CRF, p=0.008). CONCLUSIONS: CFS is globally associated with reduced cortisol responses in the combined low-dose Dex/CRF test, but this effect is only clearly present in CFS patients without a history of ELS. This study provides further support for an enhanced glucocorticoid negative feedback and/or a reduced central HPA axis drive in CFS. Furthermore, it demonstrates that ELS is an important variable to consider in CFS research.