[Psychiatrist's language]. / Psychiatertaal 2.0.

BACKGROUND: Clear and unambiguous description of psychiatric symptoms is a prerequisite for a personalized and reliable mental state examination. AIM: To draw attention to the correct use of psychiatric language. METHOD: Description of persistent linguistic errors and relevant but too little used terms, and a new Dutch translation for some psychopathological terms. RESULTS: The following linguistic errors are presented: ‘concentration’ as if it means the sustaining of attention; ‘compulsive behaviour’ that is not really compulsive; ‘no diagnosis’ while no disorder is diagnosed; ‘no psychopathology’ as if the patient has no science of psychopathology; ‘to impress as’ for characteristic that are not impressive; ‘mild’ while psychiatric disorders are never mild; ‘inhibition’ as if we can observe that subjective phenomenon; ‘signs’ for symptoms that do not appear to us at all; ‘weather and climate’ for affect and mood, while the mood generally changes somewhat faster than he climate. Attention is drawn for the terms chronognosia, overvalued idea, sensory hyporeactivity and disorders of self-awareness. New Dutch translations for dysmorphic disorder, délire de négation, and paranoic are explained. CONCLUSION: Psychiatrists, watch your language!

[Psychiatric diagnosis: personalised by definition]. / Psychiatrische diagnostiek: per definitie gepersonaliseerd.

BACKGROUND: Personalised psychiatry requires a psychiatric diagnosis which aims to determine the causes of the mental disorder and the context within which it has developed, including the factors of most importance for the choice of an appropriate treatment. AIM: To show that psychiatric diagnosis is personalised by definition. METHOD: Description of the differences between psychiatric classification and psychiatric diagnosis, including a discussion of symptom network diagnosis and diagnosis of meaningful connections. RESULTS: It appears from references from classical and recent psychiatric textbooks and from the recent Dutch Guideline for psychiatric evaluation that psychiatric diagnosis, different from classification, has always been aimed at determining both biological and psychosocial etiological and pathogenic factors and factors influencing the course and the treatment of the disorder. CONCLUSION: A personalised approach in psychiatry may lead to a direly necessary reappraisal of psychiatric diagnosis that is not limited to the classification of symptoms, but that aims specifically towards explaning and understanding mental illness.

[The DSM: background and translation]. / De DSM: achtergrond en vertaling.

BACKGROUND: The DSM-I (1952) and DSM-II (1968) were based on the etiological concepts prevailing at the time and, as a result, the inter-rater reliability was inadequate. The DSM-III (1980) developed from the need to increase the reliability of the classifications. Undeniably, the attempt to increase the reliability reduced the validity of some of the classifications. The importance of the DSM-III and successive editions should not be overestimated. The DSM is not a 'bible of psychiatric diagnostics', but is merely a classification system. Successive editions of the dsm have had a major influence on the language of psychiatry. This means that the Dutch translation needs to be of a high standard. AIM: To discuss the problems involved in translating the DSM-5 into Dutch. METHOD: By way of illustration, a number of problems are presented which arose with the translation into Dutch of the American terms for psychiatric disorders in the DSM-III and -IV. In some places this has led to the use of unusual, unfamiliar words and phrases. The translators of the DSM-5 face similar and new dilemmas. RESULTS: The examples demonstrate how important it is to keep as close as possible to the American terminology. In the Dutch version of DSM-5 the translation in many places remains closer to the American original. This means giving careful attention to different shades of meaning, which in turn can give rise to classification problems. CONCLUSION: The translation of the DSM-5 into Dutch is important. The translation of the title 'Diagnostic and Statistical Manual of Mental Disorders (DSM-5)' as 'Handbook voor de classificatie van psychische stoornissen - DSM-5' demonstrates clearly that the dsm-5 is certainly not a 'diagnostic bible'.

[Is there adequate discussion between psychiatrists and their patients regarding patients' sexual problems?]. / Het bespreken van seksuele problemen door psychiaters en aiossen.

BACKGROUND: Sexual problems arise frequently among psychiatric patients, either as a symptom of psychiatric disorders or as a side effect of psychotropic medication. However, it is questionable whether in daily practice psychiatrists and trainee psychiatrists give enough attention to patients' sexual problems. GOAL: To investigate how much attention psychiatrists and trainees give to patients' sexual problems and to discover what factors influence the amount of attention they give. METHODS: All psychiatrists and trainees working at two academic psychiatric centres and three mental health institutes in the province of North Holland were asked to complete an online questionnaire about the discussion of sexual problems. RESULTS: 164 psychiatrists and trainee psychiatrists completed the questionnaire (response rate 44%). About 50% of the respondents stated that they spent less than five minutes per week discussing sexual problems with their patients. When prescribing antidepressants and antipsychotics, psychiatrists and trainees often failed to inform patients about sexual side effects (33% in the case of antidepressants and 50% for antipsychotics). CONCLUSIONS: The investigation reveals that psychiatrists and trainees give little attention to sexuality problems of patients. The main reason for this seems to be feelings of shame and incompetence. Lack of time was not identified as a significant factor. We believe that the situation will improve considerably if psychiatrists and trainees involved in training programmes and supervisory activities give more attention to sexual problems.

[Personality traits in adults with autism spectrum disorders measured by means of the Temperament and Character Inventory]. / Persoonlijkheidsaspecten bij volwassenen met autismespectrumstoornissen gemeten met de 'Temperament and Character Inventory' (TCI).

BACKGROUND: There is growing interest in autism spectrum disorders (asd) in adulthood. Someone can be diagnosed with ASD, but the diagnosis tells us very little about the patient’s temperament, character and personality. Comparatively little is known about the personality traits of persons with ASD. AIM: To map personality traits of persons with asd. METHOD: The Temperament and Character Inventory (tci) was administered to a group of 68 men diagnosed with asd at the Lucertis Sarr expertise centre for Autism and at the Department of Psychiatry, Erasmus mc, Rotterdam, the Netherlands. The control group, specified in the instructions for the tci, consisted of a group of 447 men from the general population. RESULTS: Compared to the control group, men with asd scored higher on the scale Harm Avoidance, but lower on Sociability, Novelty Seeking, Reward Dependence, Self-directedness, and Cooperativeness. CONCLUSION: The score pattern found in men with asd is consistent with the clinical picture of asd and corresponds to earlier results of research done in Sweden. In our study we argue that negatively interpreted temperament and character traits can often be interpreted in a positive way.

Drug-free patients with major depression show an increased electrophysiological response to valid and invalid feedback.

BACKGROUND: Depressed patients are biased in their response to negative information. They have been found to show a maladaptive behavioral and aberrant electrophysiological response to negative feedback. The aim of this study was to investigate the behavioral and electrophysiological response to feedback validity in drug-free depressed patients. METHOD: Fifteen drug-free in-patients with unipolar major depression disorder (MDD) and 30 demographically matched controls performed a time-estimation task in which they received valid and invalid (i.e. related and unrelated to performance) positive and negative feedback. The number of behavioral adjustments to the feedback and the feedback-related negativity (FRN) were measured. RESULTS: Patients made fewer correct adjustments after valid negative feedback than controls, and their FRNs were larger. Neither patients nor controls adjusted their time estimates following invalid negative feedback. CONCLUSIONS: The FRN results suggest that depressed drug-free in-patients have an atypical rostral anterior cingulate response to feedback that is independent of feedback validity. Their behavioral response to invalid negative feedback, however, is not impaired. This study confirms the notion that the behavioral responses of depressed individuals to negative feedback are context dependent.

Treatment adherence therapy in people with psychotic disorders: randomised controlled trial.

BACKGROUND: Interventions to improve adherence to treatment in people with psychotic disorders have produced inconclusive results. We developed a new treatment, treatment adherence therapy (TAT), whose intervention modules are tailored to the reasons for an individual's non-adherence. AIMS: To examine the effectiveness of TAT with regard to service engagement and medication adherence in out-patients with psychotic disorders who engage poorly. METHOD: Randomised controlled study of TAT v. treatment as usual (TAU) in 109 out-patients. Most outcome measurements were performed by masked assessors. We used intention-to-treat multivariate analyses (Dutch Trial Registry: NTR1159). RESULTS: Treatment adherence therapy v. TAU significantly benefited service engagement (Cohen's d = 0.48) and medication adherence (Cohen's d = 0.43). Results remained significant at 6-month follow-up for medication adherence. Near-significant effects were also found regarding involuntary readmissions (1.9% v. 11.8%, P = 0.053). Symptoms and quality of life did not improve. CONCLUSIONS: Treatment adherence therapy helps improve engagement and adherence, and may prevent involuntary admission.

Cardiovascular variability during treatment with haloperidol, olanzapine or risperidone in recent-onset schizophrenia.

This study aimed to investigate the effects of treatment with haloperidol, olanzapine and risperidone on cardiovascular variability in patients with recent-onset schizophrenia by means of spectral analysis. Unmedicated patients (n = 18) had a higher mean heart rate and a tendency for a lower high-frequency power of heart rate variability than healthy control subjects (n = 57), indicating a decreased cardiac vagal control in unmedicated patients with schizophrenia. Patients treated with haloperidol (n = 10) showed significantly lower low-frequency power of heart rate and systolic blood pressure variability compared with olanzapine-treated patients, suggesting that haloperidol attenuated sympathetic functioning. On the contrary, olanzapine-treated patients (n = 10) showed the highest power in the low-frequency range of heart rate and systolic blood pressure variability, suggesting an increased sympathetic cardiac functioning. No significant effects of risperidone (n = 13) were found. None of the antipsychotic agents differed in their parasympathetic cardiovascular effects. We conclude that young, unmedicated patients with schizophrenia differed from controls in their parasympathetic functioning, but the antipsychotic agents haloperidol, risperidone and olanzapine induced only minor cardiovascular side effects.

Plasma activity of prolyl endopeptidase in relation to psychopathology during immunotherapy with IFN-alpha in patients with renal cell carcinoma.

Abnormal activity in peripheral blood of the cytosolic enzyme prolyl endopeptidase (PEP, EC 3.4.21.26, post prolyl cleaving enzyme, prolyl oligopeptidase) has been found in patients with a variety of psychiatric disorders, most consistently in mood disorders. Mood disturbance is a well-known side effect of immunotherapy with interferon-alpha (IFN-alpha). Earlier, we documented a decrease in serum PEP activity in the first 4 weeks of treatment with IFN-alpha. In 24 patients (16 men, 8 women, median age 60.5 years, range 47-72 years) with metastatic renal cell carcinoma (RCC), psychiatric assessment and blood sampling were performed before and at 4 and 8 weeks and at 6 months after initiation of treatment with IFN-alpha. No episodes of depression were observed, and the sum score and the scores on the subscales for depression and hostility of the Symptom Check List-90 (SCL-90) did not change during follow-up, whereas the anxiety scores were somewhat lower at 4 and 8 weeks compared with baseline. No change in plasma PEP activity and no relationships between change in psychiatric parameters and change in plasma PEP activity were found. As more subtle relationships between PEP activity and psychiatric status could have easily been obscured, a role for PEP in the pathophysiology of IFN-alpha-induced mood disturbance can neither be confirmed nor excluded.

[Recognition of autism spectrum disorders in adults]. / Herkenning van autismespectrumstoornissen bij volwassenen.

Autism spectrum disorder was diagnosed in three adults. The first patient, a married man aged 41, was referred to a psychiatrist with 'impending burn-out'. The second was a 32-year-old male student with schizophrenia and a depressive disorder who was referred to a centre for autism because a friend of his mother's knew someone with Asperger's syndrome. The third patient was a 25-year-old woman with a 'fixation on food' who was referred by her general practitioner to a psychiatrist for evaluation of longstanding use of antidepressant medication. Autism used to be thought of as a condition of childhood. Only recently has the diagnosis and treatment of autism spectrum disorders become the focus of attention in adult psychiatry. It is made all the more difficult as during development into adulthood, the expression of disorders of reciprocal social interaction, communication, imagination and repetitive stereotypical thinking and actions, change.

[Psychiatric and neuropsychological characterization of a group of adults referred to a university outpatient clinic for ADHD]. / Psychiatrische en neuropsychologische kenmerken van een groep volwassenen verwezen naar een academische polikliniek voor ADHD.

BACKGROUND: Attention-deficit hyperactivity disorder (ADHD) has always been classified as a psychiatric disorder of childhood. Very little research has been done into the nature of adult ADHD. AIM: To obtain insight into the clinical profile of a group of adults referred to an outpatient clinic for diagnostic assessment of ADHD. METHOD: A group of 225 adults diagnosed with ADHD were studied and compared with 101 adults who had been referred to the same outpatient clinic but had been given a different diagnosis. All referred patients were diagnosed according to dsm-iv criteria for ADHD and underwent neuropsychological tests. RESULTS: The diagnosis of ADHD was confirmed in 69% of the patients. In the ADHD group 72% were male and the average age was 32. Half of these patients had a co-morbid disorder. The 2 groups did not differ in psychopathology but the ADHD group used nicotine and alcohol more frequently. Neuropsychological tests revealed more signs of subjective distractibility in the non-ADHD group, whereas in the objective tests it was the ADHD group who gave a poorer performance. CONCLUSION: This study describes the clinical profile of a group of adults referred to an outpatient clinic for ADHD. The ADHD group differed from the non-ADHD group in a number of demographical, psychiatric and neuropsychological parameters.

[The psychopathology of Karl Jaspers: then and now]. / De psychopathologie van Karl Jaspers: toen en nu.

The book entitled 'Allgemeine Psychopathologie' by the German psychiatrist-philosopher Karl Jaspers, first published in 1913, has had a lasting influence on the way in which psychiatry defines subjective psychiatric symptoms--phenomena. His psychopathology of meaningful connections, however, which purports to provide an empathic 'understanding' of the causes of mental disorders, is more controversial, particularly now that neurobiology claims it can explain all material causes. This article presents an enthusiastic summary of Jaspers' original work and culminates with a plea for a re-appraisal and revaluation of Jaspers phenomenology and methodological dualism. Jaspers' view on this subject is particularly important in our days of DSM-criteria, neuro-imaging and molecular biology.

High numbers of mobilized CD34+ cells collected in AML in first remission are associated with high relapse risk irrespective of treatment with autologous peripheral blood SCT or autologous BMT.

The faster hematopoietic recovery after autologous peripheral blood SCT (APBSCT) in patients with AML may be offset by an increased relapse risk as compared with autologous BMT (ABMT). The EORTC and GIMEMA Leukemia Groups conducted a trial (AML-10) in which they compared, as second randomization, APBSCT and ABMT in first CR patients without an HLA compatible donor. A total of 292 patients were randomized. The 5-year DFS rate was 41% in the APBSCT arm and 46% in the ABMT arm with a hazard ratio (HR) of 1.17; 95% confidence interval=0.85-1.59; P=0.34. The 5-year cumulative relapse incidence was 56% vs 49% (P=0.26), and the 5-year OS 50% and 55% (P=0.6) in the APBSCT and ABMT groups, respectively. APBSCT was associated with significantly faster recovery of neutrophils and platelets, shorter duration of hospitalization, reduced need of transfusion packed RBC and less days of intravenous antibiotics. In both treatment groups, higher numbers of mobilized CD34+ cells were associated with a significantly higher relapse risk irrespective of the treatment given after the mobilization. Randomization between APBSCT and ABMT did not result in significantly different outcomes in terms of DFS, OS and relapse incidence.

Platelet serotonin, monoamine oxidase activity, and [3H]paroxetine binding related to impulsive suicide attempts and borderline personality disorder.

BACKGROUND: The aim of the present study was to examine the relationship between suicidal behavior and impulsiveness, and more generally borderline personality disorder on the one hand, and platelet indicators of central serotonergic function on the other. METHODS: After a suicide attempt platelet serotonergic measures were obtained from 144 patients with at least one previous attempt. A major DSM-III-R Axis I diagnosis and the use of antidepressants were reasons for exclusion. RESULTS: Platelet monoamine oxidase (MAO) activity was negatively correlated with the personality traits "multi-impulsive behavior" and "disinhibition." In accordance, platelet MAO activity was also lower in patients with less-planned suicide attempts. Platelet serotonin (5-HT) and recidivism were positively correlated with borderline personality disorder, in particular chronic feelings of emptiness. Platelet 5-HT was lower in patients with alcohol abuse. The maximum number of binding sites (Bmax) for paroxetine binding was positively correlated with "sensation seeking." CONCLUSIONS: These findings support the hypothesis that serotonergic involvement in impulsive suicidal behavior is mediated by the relationship between serotonergic function and impulsiveness as personality trait. Other borderline personality traits relevant to recurrent suicidal behavior, in particular chronic feelings of emptiness, appear also related to serotonergic measures.

Paroxetine treatment of premature ejaculation: a double-blind, randomized, placebo-controlled study.

Seventeen male outpatients with premature ejaculation were randomly assigned to treatment with paroxetine (N = 8) or placebo (N = 9). After a first week dose of 20 mg/day, the paroxetine regimen was increased to 40 mg/day for 5 weeks. Patients and their female partners were interviewed separately. Patients treated with paroxetine had significantly greater clinical improvement than the patients given placebo.

Reduction by paroxetine of suicidal behavior in patients with repeated suicide attempts but not major depression.

OBJECTIVE: Suicidal behavior has been associated with reduced central serotonergic function. Because selective serotonin reuptake inhibitors (SSRIs) enhance serotonergic function, the authors studied the efficacy of an SSRI, paroxetine, in the prevention of recurrent suicidal behavior. METHOD: They conducted a 1-year double-blind study comparing paroxetine (40 mg/day) and placebo in 91 patients who had recently attempted suicide for at least a second time. None of the patients had experienced a major depressive episode or had any other major DSM-III-R axis I diagnoses. At least one cluster B personality disorder was present in 74 patients. RESULTS: With adjustment for the number of previous suicide attempts, paroxetine showed significant efficacy in the prevention of recurrent suicidal behavior. Among the patients who had attempted suicide fewer than five times, 12 (36%) in the placebo group (N = 33) and five (17%) in the paroxetine group (N = 30) made a subsequent suicide attempt. Paroxetine was also significantly more effective in patients who met fewer than 15 criteria for cluster B personality disorders than in those who met more than 15 criteria. Overall, paroxetine was not significantly different from placebo in its effect on depressive mood, hopelessness, and anger. However, the data suggest that paroxetine may have some temporary effect in reducing anger. CONCLUSIONS: This study indicates that enhancing serotonergic function with an SSRI may reduce suicidal behavior in a subgroup of patients who have attempted suicide more than once but who do not suffer from major depression.