[Neuropsychiatric associations in Belgium: from foundation to separation (1869-2008)]. / Neuropsychiatrische verenigingen in België: van ontstaan tot splitsing (1869-2008).

Background Professional associations have traditionally been important to the specialization process and identity of medical specialists. Psychiatry and neurology share common origins in the 19th century and subsequently went through a major evolution. However, relatively little is known about the role of neuropsychiatric associations. Aim To provide a concise historical overview of the Belgian neuropsychiatric associations and understand the factors that mattered in their formation and dissolution. Method Descriptive research based on oral testimonies, archival material, journals of the concerned associations and secondary literature. Results In 1869, the then ‘alienists’ founded the first Belgian psychiatric association. Subsequently, three fault lines – professional associations versus scientific associations, regional versus national associations, neurological versus psychiatric associations – led to the current neurological and psychiatric associations in Belgium. Conclusion Over time, the neuropsychiatric associations have helped define the identity of neurology and psychiatry. On the other hand, the associations themselves have been subject to both substantive factors, i.e. the evolution of the discipline, and non-substantive factors. The latter are specific to Belgium and concern linguistic struggles and a historically created split between scientific associations and professional associations.

[Neurological soft signs in patients with obsessive compulsive disorder]. / Onopvallende neurologische stoornissen bij patiënten met obsessieve-compulsieve stoornis.

Background Obsessive-compulsive disorder (OCD) is a psychiatric condition with a lifetime prevalence of 2-3% and was long classified as an anxiety disorder but has been considered a separate condition since DSM-5. An imbalance between cortical and subcortical structures seems to be at the pathophysiological basis of the disorder. AIM: To review the presence, diagnostic and therapeutic importance of neurological soft signs (NSS), as a sign of network dysfunction in obsessive-compulsive disorder. METHOD: Literature review regarding the occurrence of NSS in OCD. PubMed, Ovid Medline and PsycArticles were consulted for this purpose with the advanced search (((OCD) AND (neurological soft signs)) OR (obsessive compulsive disorder)) AND (neurological soft signs). RESULTS: Our literature search yielded 27 articles that showed a higher NSS score in a patient group with OCD than in healthy controls. First-degree relatives achieve an NSS score intermediate between the two groups. NSS are also found in other psychiatric syndromes e.g., NSS score is higher in patients with schizophrenia or comorbid psychotic problems compared to the OCD patient group. CONCLUSION: These findings show the importance of neurological examination and documentation of abnormalities in OCD patients, for now the applicability of these neurological signs remains limited in diagnostics and treatment of OCD.

[Virtual reality in diagnosis and treatment of obsessive-compulsive disorder]. / Virtual reality bij diagnostiek en behandeling van obsessieve-compulsieve stoornis.

BACKGROUND: OCD has an estimated lifetime prevalence of 2,3%, and is accompanied by several emotional, social and work impairments. Virtual reality is increasingly used in the context of mental health treatment and has recently been proposed as a possible tool for assessment and intervention in OCD. AIM: To review the existing literature to investigate the role of virtual reality in the diagnosis/severity measurement and treatment of OCD. METHOD: Systematic literature review using PubMed, Embase and PsycInfo databases. RESULTS: We found 10 studies, of which 6 on diagnosis/severity measurement and 4 on treatment of OCD. Virtual reality can be a valuable objective tool in the diagnostic process of OCD. In addition, the anxiety level and the obsessive and compulsive symptoms decreased significantly in participants in virtual reality exposure therapy. CONCLUSION: Further clinical studies with adequate power and design are needed to determine whether virtual reality offers an added value over clinical tools in terms of diagnosis and severity measurement, and whether virtual reality ERP is superior or at least equivalent to in vivo ERP.

[Obsessive-compulsive symptoms as a side effect of infliximab - a case report]. / Obsessieve-compulsieve symptomen als bijwerking van infliximab; een gevalsbeschrijving.

A 35-year-old man with no psychiatric history develops compulsive complaints after the start of infliximab. Given the coincidence of initiating this drug and the occurrence of these psychological symptoms, the dose of infliximab is reduced, which resulted in a rapid decrease of the symptoms. The medicine infliximab is frequently prescribed for autoimmune disorders but in rare cases it can also cause major psychological side effects. This article aims to demonstrate the causal relationship between drug administration and the development of obsessive-compulsive symptoms. The literature could not provide an unambiguous explanation, but based on the above findings, it may be advisable to formulate clinical recommendations, in particular vigilance for the onset or worsening of anxiety or obsessive-compulsive symptoms and to seek psychiatric advice in time.

[Consensus statement on the application of rTMS in depression in the Netherlands and Belgium]. / Consensusverklaring voor de toepassing van rTMS bij depressie in Nederland en België.

BACKGROUND: Since 2017, repetitive transcranial magnetic stimulation (rTMS) has become eligible for reimbursement for the treatment of therapy-resistant depression in the Dutch healthcare system.
AIM: To initiate a guideline in the Netherlands and Belgium for the safe and effective application of rTMS for the treatment of depression.
METHOD: Based on literature review, existing guidelines and consensus among Dutch rTMS experts, recommendations were developed regarding the implementation of rTMS as a treatment of depression. All available evidence was weighed and discussed among all co-authors and recommendations were reached by consensus among the group.
RESULTS: rTMS targeting the dorsolateral prefrontal cortex (DLPFC) should be seen as a first choice in the treatment of depression using high-frequency rTMS (left) or, as an alternative, low-frequency rTMS (right). Stimulation protocols should use more than 1000 pulses per session for an average of 20-30 sessions, offered in 2-5 sessions per week. Contraindications for rTMS include epilepsy, intracranial presence of (magnetisable) metals, pacemaker and cochlear implant.
CONCLUSION: rTMS, performed by competent professionals is an effective and safe treatment for depression.

Deep brain stimulation for treatment-resistant major depressive disorder: a comparison of two targets and long-term follow-up.

We previously found that electrical stimulation in the anterior limb of the internal capsule/bed nucleus of the stria terminalis (IC/BST) alleviates depressive symptoms in severe treatment-resistant obsessive-compulsive disorder (OCD) patients. Here we tested the hypothesis that electrical stimulation in either IC/BST or in the inferior thalamic peduncle (ITP) effectively reduces depressive symptoms in treatment-resistant major depressive disorder (TRD). In a double-blind crossover design, the effects of electrical stimulation at both targets were compared in TRD patients. The 17-item Hamilton Depression Rating scale (HAM-D) was the primary outcome measure. During the first crossover, patients received IC/BST stimulation versus no stimulation in random order (2 × 1 weeks). During the second crossover (3 × 2 months), patients received IC/BST versus ITP versus no stimulation. Patients and evaluators were blinded for stimulation conditions. All patients (n=7) were followed up for at least 3 years (3-8 years) after implantation. Six patients completed the first crossover and five patients completed the second. During the first crossover, mean (s.d.) HAM-D scores were 21.5 (2.7) for no stimulation and 11.5 (8.8) for IC/BST stimulation. During the second crossover, HAM-D scores were 15.4 (7.5) for no stimulation, 7.6 (3.8) for IC/BST stimulation and 11.2 (7.5) for ITP stimulation. The final sample size was too small to statistically analyze this second crossover. At last follow-up, only one patient preferred ITP over IC/BST stimulation. Two patients, with a history of suicide attempts before implantation, committed suicide during the follow-up phases of this study. Our data indicate that, in the long term, both ITP and IC/BST stimulation may alleviate depressive symptoms in patients suffering from TRD.

[Deep brain stimulation in psychiatry]. / Diepe hersenstimulatie in de psychiatrie.

BACKGROUND: Deep brain stimulation (DBS) is now used regularly to treat therapy-refractory obsessive-compulsive disorders, and is being applied experimentally for refractory depression, Tourette syndrome, addiction, eating disorders, post-traumatic stress disorder, autism and schizophrenia. AIM: To review the effects and mechanisms of dbs and to consider the future opportunities for this type of treatment in psychiatry. METHOD: We reviewed the literature using PubMed. RESULTS:  DBS is effective and safe to use in the treatment of therapy-refractory OCD and has produced encouraging results in cases of refractory depression and Tourette syndrome. However, further investigations are needed with regard to the use of DBS for treating other psychiatric disorders. DBS influences brain networks that are relevant for a whole range of psychiatric symptoms. CONCLUSION:  DBS should always be considered as possible treatment for therapy-refractory OCD. DBS often leads to marked and rapid improvement in mood, anxiety, behaviour and other psychiatric symptoms, making it a promising intervention for a variety of refractory patient groups. The development of DBS for psychiatry will benefit from our increased knowledge about how specific brain networks relate to psychiatric dysfunctioning.

[Clotiapine in the treatment of acutely agitated patients: hardly any evidence]. / Clotiapine als acute ingrijpmedicatie: nauwelijks wetenschappelijke onderbouwing.

BACKGROUND: In Flemish emergency psychiatry, clotiapine is still one of the options available for the treatment of agitation. However, there is a lack of evidence concerning the efficacy of this practice.
AIM: To find out whether there is sufficient evidence to justify the continued use of clotiapine in the treatment of agitation.
METHOD: On searching the literature systematically, we identified controlled trials of clotiapine.
RESULTS: The efficacy and safety of clotiapine were studied in two randomised controlled trials. Clotiapine (administered intramuscularly) was compared with zuclopenthixol acetate and lorazepam. Clotiapine was found to be just as efficient as the control treatments, causing fewer anticholinergic side-effects than zuclopenthixol but more extrapyramidal side-effects than lorazepam. The study population comprised only 102 patients, 51 of whom were treated with clotiapine. Because the quality of the reported data was low, straightforward conclusions were difficult to draw.
CONCLUSION: Scientific evidence to support the use of clotiapine in the treatment of agitation ranges from meagre to practically non-existent. Since alternative treatment options are available, the contained use of clotiapine should be questioned.

Long-term electrical stimulation of bed nucleus of stria terminalis for obsessive-compulsive disorder.

We previously reported that bilateral electrical stimulation in the anterior limb of the internal capsule/bed nucleus of the stria terminalis (IC/BST) effectively reduces symptoms in severe treatment-resistant obsessive-compulsive disorder (OCD) patients. Here we used a linear mixed model to investigate the evolution of symptomatic and functional status of our patients (n=24) and examined if baseline variables could predict this evolution. Data were collected during routine, clinical psychiatric visits. Our analysis showed a long-term, sustained effect of electrical stimulation in the IC/BST. After a fast initial decline of OCD symptoms, these symptoms remain relatively stable. In addition, we found a strong ON/OFF effect of stimulation (e.g., due to battery depletion). Our data also show that it is not the surgical procedure but rather the electrical stimulation that drives the improvement in Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) scores. The Beck Depression Inventory (BDI) at baseline was the only predictor significantly related to the evolution of the Y-BOCS. A higher BDI at baseline seemed to be related to a smaller decrease of the Y-BOCS over time. In conclusion, electrical stimulation in the IC/BST has a fast and sustained effect on OCD and comorbid symptoms and functional status of patients.

EEG correlates of impaired self-other integration during joint-task performance in schizophrenia.

Deficits in a wide variety of social cognitive processes are well established in schizophrenia. However, research focusing on actual interacting individuals is surprisingly scarce. Problems in low-level processes such as self-other integration may importantly underlie often-reported higher-level deficits. The current study aimed at measuring possible disturbances in self-other integration in schizophrenia using both behavioral and event-related potential (ERP) measures. Sixteen healthy controls and fifteen schizophrenia patients performed a social Simon task in both a joint and an individual setting. Behaviorally, patients showed general slower reaction times, but comparable self-other integration as reflected in the social Simon effect. The ERP results for the healthy controls revealed increased no-go P3 amplitudes in the joint compared with the individual setting. Crucially, patients did not show this increase in no-go P3 amplitude. In line with previous research, the present ERP findings demonstrate that healthy volunteers needed more effort to inhibit their responses in the joint compared with the individual setting. Patients however, showed altered self-other integration when they had to withhold their responses while their co-actor had to act. These outcomes indicate that schizophrenia patients have deficits in low-level processes required for successful joint action.

Parsing the components of the psychomotor syndrome in schizophrenia.

OBJECTIVE: Catatonia, extrapyramidal signs, psychomotor slowing, and (motoric) neurological soft signs are well-known psychomotor symptoms in schizophrenia. This study aims at investigating the interrelations between these symptoms. In addition, associations between psychomotor symptoms, clinical symptoms, and cognitive functioning will be studied. METHOD: An extensive test battery containing psychomotor (Bush Francis Catatonia Rating Scale; St Hans Rating Scale; Salpêtrière Retardation Rating Scale; Neurological Evaluation Scale) and clinical (Positive and Negative Syndrome Scale; Calgary Depression Scale) rating scales as well as instrumental psychomotor tests (Line Copying Task; Finger Tapping Task) and cognitive tasks (Symbol Digit Substitution Test; Stroop Colour Word Test; Continuous Performance Test; Letter Number Sequencing) was administered to a sample of 124 patients with schizophrenia or schizoaffective disorder. RESULTS: Correlational analyses showed that two clusters emerge from our data: first, a psychomotor poverty cluster referring to the interrelations between catatonia, parkinsonism, psychomotor slowing, and negative symptoms; second, a cluster containing motoric neurological soft signs, which were found to be correlated with cognitive functioning. CONCLUSION: Psychomotor abnormalities are highly prevalent phenomena in schizophrenia that have to be considered as a heterogeneous construct. However, longitudinal and neurobiological research is needed to further explore the precise nature of the interrelations found in this study.

A prospective, multicentre, open-label study to evaluate the effectiveness of aripiprazole in the treatment of a broad range of patients with schizophrenia.

PURPOSE: The aim of this study is to evaluate the effectiveness of 12-week treatment with aripiprazole in a broad range of patients suffering from schizophrenia by using a variety of physicians, caregivers and patients scales. SUBJECTS AND METHODS: A total of 361 in- or outpatients who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for schizophrenia received open-label aripiprazole (10-30 mg per day) in this 12-week, prospective, multicentre, uncontrolled study. The primary endpoint was the Clinical Global Impression-Improvement (CGI-I) scale which measured effectiveness of study medication, including efficacy, safety and tolerability. A variety of physician-, patient- and caregiver-rated parameters were measured to gain a complete view of the effectiveness of aripiprazole. RESULTS: The effectiveness of aripiprazole treatment was demonstrated in a broad range of schizophrenia patients (CGI-I score of 3.0; 95% confidence interval: 2.8, 3.2: last observation carried forward [LOCF]) as the upper bound of the 95% CI was less than 4 (score of "no change"). Both patient and caregiver PGI-I scores (LOCF: 95% CI: 2.79, 3.09 and, 95% CI: 2.74, 3.17, respectively) corroborate this finding. Aripiprazole had a positive effect on disease severity by study end, as assessed by an increase of the (physician-rated) CGI-S scores, with 57.3% of patients having improved disease, one-third maintaining their condition (30.8%) and 11.3% with worsening symptoms (LOCF). The Investigator Assessment Questionnaire (IAQ) showed a great improvement (>50% of patients). Patients reported significantly improved quality of life and overall, 71% of patients and 67% of caregivers preferred aripiprazole to their previous antipsychotic medication (LOCF; P<0.0001 over time). CONCLUSION: Aripiprazole was effective in a broad range of patients with schizophrenia.