[Phenibut: harmless dietary supplement or dangerous drug?] / Phenibut: onschuldig voedingssupplement of gevaarlijk roesmiddel?

In clinical practice, more and more alarming signals are picked up concerning addiction and withdrawal after the use of Phenibut. Phenibut is a psychotropic agent that acts on gaba receptors. Phenibut is freely available online as a dietary supplement, but appears to have potent and potentially harmful psychotropic effects. We describe the case of a 19-year-old man with social anxiety who self-medicated by using Phenibut, which he subsequently got addicted to. We outline the dangers linked to the use of Phenibut and offer suggestions for treatment.

[Oculogyric crisis as an isolated extrapyramidal symptom of auto-intoxication with risperidone]. / Oculogyre crisis als enige extrapiramidaal symptoom bij auto-intoxicatie met risperidon.

A 19-year-old female was seen at the emergency department following an auto-intoxication. An oculogyric crisis (ogc) was observed, in the absence of other extrapyramidal symptoms (eps). In a second anamnesis, patient indicated that she had taken risperidone 3 mg (an atypical antipsychotic). This particular case description of an isolated ogc shows that care providers should be attentive to the occurrence of ogc, even if the most frequent eps are absent. This case also emphasizes the importance of a complete history in order to efficiently and timely guide the care provider to the correct diagnosis.

[Psychosis in a patient with Prader-Willi syndrome]. / Psychose bij een patiënt met het syndroom van Prader-Willi.

Prader-Willi syndrome (pws) is a genetic disorder characterised by specific physical and behavioural abnormalities. Recent studies indicate that patients suffering from this syndrome have an increased risk of psychiatric disorders, including psychosis. We describe the development and the psychiatric condition of a 31-year-old patient with pws who had a first psychotic episode at age 14 and subsequently experienced a highly variable course of recovery and relapse.

[Rapid tranquillisation for agitated patients with psychostimulant intoxication]. / Acute ingrijpmedicatie bij de geagiteerde patiënt met intoxicatie met psychostimulantia.

BACKGROUND: Because psychostimulant intoxication can lead to serious health risks for the patient, it is often necessary to ensure that the patient receives both adequate medical surveillance and rapid tranquillisation.
AIM: To find out whether there is scientific evidence that psychopharmacological intervention helps patients with psychostimulant intoxication to manage aggression and agitation.
METHOD: We searched the literature systematically.
RESULTS: Our study showed that intravenous droperidol worked faster and was more effective than intravenous lorazepam in inducing sedation in patients intoxicated with psychostimulants. In other studies the number of patients intoxicated with psychostimulants was too small or the patient population was not described in sufficient detail for any meaningful conclusions to be drawn.
CONCLUSION: So far, research has been so limited that it has not yet provided convincing evidence about the best medication to use in the treatment of aggressive patients intoxicated with psychostimulants.

Perspectives on the eligibility criteria for euthanasia for mental suffering caused by psychiatric disorder under the Belgian Euthanasia Law: A qualitative interview study among mental healthcare workers.

INTRODUCTION: Euthanasia in adults with psychiatric conditions (APC) is allowed in Belgium and impacts a variety of workers in this field, including psychiatrists, psychiatric nurses, psychologists, and support "buddies". This study examines their perspectives on the appropriateness of the current legal criteria for, and practice of, euthanasia in the context of psychiatry, and their suggestions to properly implement or amend these criteria. METHODS: Semi-structured interviews were conducted with 30 Dutch-speaking mental healthcare workers who had at least one experience with an APC requesting euthanasia, in Flanders and Brussels (Belgium), between August 2019 and August 2020. Interview transcripts were analyzed through qualitative content analysis. FINDINGS: Our study shows that, for these mental healthcare workers, only one of the legal eligibility criteria to assess euthanasia requests by APC (i.e., unbearable suffering) is rather straightforward to interpret. In addition, there was a lack of consensus on what aspects of the Euthanasia Law should be modified and in what way. CONCLUSIONS: Many mental healthcare workers do not well understand or misinterpret the legal criteria for euthanasia involving APC. Criteria are sometimes defined so narrowly that euthanasia requests by APC are generally deemed ineligible or, alternatively, are stretched to allow for inclusion of cases that go beyond what the Law intended. Our study indicates the need for an authoritative professional code of conduct offering clear advice for Belgian euthanasia practice in the context of psychiatry. It is also recommended that future trainings are standardized, supported by the most important professional associations in the field, and freely available to all who are confronted with euthanasia requests from APC or who offer support to APC who consider euthanasia.