[Interstitial pneumonia and venlafaxine use]. / Interstitiële pneumonie bij venlafaxine-gebruik.

We describe a 71-year-old woman who developed interstitial pneumonia within a complex somatic state. Diagnostic clearance suggested venlafaxine-induced interstitial pneumonia. In the literature, we found 13 cases of venlafaxine-induced interstitial pneumonia. Case reports were also described for other antidepressants. Based on these case reports, there is consensus in the literature that antidepressants may in rare cases give rise to (sub)acute or chronic interstitial pneumonia. Although a rare side effect, it seems important to be aware of this as a psychiatrist.

Melancholie bij ouderen in tijden van COVID-19.

Melancholy in the elderly in times of COVID-19.

[Neurosyphilis: a historical disease with current relevance]. / Neurosyfilis: een historische ziekte met actueel belang.

In the last few years, an increasing worldwide incidence in syphilis has been reported, mostly in the United States and Western Europe. Neurosyphilis is characterized by a wide differential diagnosis, which too often causes the disease to remain undetected for a long time. We report a case of a male patient with manic psychotic symptoms, in whom neurosyphilis was identified after elaborate diagnostic investigations. We give an overview of the disease process and correlations with psychiatric symptoms, diagnostics, screening and treatment.

[Neuro-endocrine correlates of burnout]. / Neuro-endocriene correlaten van burn-out.

BACKGROUND: The symptoms of burnout are similar to those of depression on the one hand and chronic fatigue syndrome on the other hand. However, the neuro-endocrine correlates of these two syndromes are the opposite, the former being a hyperfunction of the hypothalamic-hypophysial-cortical axis (HPA) and the latter being a hypofunction of the hpa-axis. AIM: To find out, via a systematic review of the literature, whether burnout is associated with either a hyperfunction or a hypofunction of the HPA-axis. METHOD: We searched PubMed using the following search terms: 'burnout syndrome and burnout', 'adrenocorticotropic hormone', 'corticotropin releasing factor', 'hypothalamic pituitary adrenal axis' and 'cortisol'. We retrieved 16 original articles en one meta-analysis were included in the study. RESULTS: Functional stress testing showed hypersuppression of the HPA-axis after dexamethasone. Basal cortisol values were found to be less conclusive, although a meta-analysis pointed to a negative association between burnout and cortisol. We did not find any studies that were carried out with the help of physiological, physical or psychological stress factors in burnout. CONCLUSION: Burnout is associated primarily with a hypofunction of the HPA-axis, which is a neuro-endocrine characteristic of exhaustion, rather than of depression. However, further studies involving functional stress testing are needed in order to map the neuro-endocrine profile fully and to clarify the link with the deregulation of the immune system.

Psychiatric complications of drug treatment of Parkinson's disease.

Drug-induced psychiatric conditions are a common and severe problem in the treatment of patients with Parkinson's disease. Psychotic symptoms are the most frequent reason for nursing home placement of patients with Parkinson's disease. The psychotic symptoms seem to present themselves in a continuum where alterations in dreaming patterns often precede visual hallucinations, which often progress into delusional syndromes and, finally, into confusional organic syndromes. When evaluating a patient on dopaminergic treatment, it is important to inquire systematically about abnormal sleep related phenomena, for these are important clues in the early detection of psychotic symptoms. The pathogenesis of the psychotic symptoms is not yet fully understood but complex adaptations of various neurotransmitter systems seem to be involved. In the treatment of these drug-induced psychotic symptoms, the atypical antipsychotic drug clozapine plays an important role. Drug-induced mania, hypersexuality and anxiety, although less frequent than the psychotic symptoms, also occur as a complication of dopaminergic treatment. Depressive symptoms, although common in Parkinson's disease, are less likely to occur as a side effect of the drug treatment.