[Priapism associated to zuclopentixol and the choice for an alternative]. / Priapisme bij gebruik van zuclopentixol en de keuze voor een alternatief.

A 29-year-old man developed priapism following the (re)administration of zuclopentixol. In the previous days, a significant amount of alcohol was consumed, presumably in combination with amphetamine and cannabis. Priapism is a rare but serious side effect of various psychoactive medications and recreational drugs, leading to permanent loss of erectile function if not treated in time. In this case the side effect was discovered in a late stage, at which curative treatment was no longer viable. A clear guideline for choosing an alternative antipsychotic agent is currently lacking, but an antipsychotic with low alfa-adrenergic affinity seems preferable. To prevent erectile disfunction following priapism, awareness of its severity is essential, for both doctor and patient.

[Treatment program for psychological work-related complaints: employees with or without a job in sick leave]. / Behandelprogramma voor psychische arbeidsgerelateerde klachten: werk­nemers in dienstverband versus UWV-vangnetters.

BACKGROUND: In the Netherlands, unemployed people in sick leave, can get sickness payment from the Employee Insurance Agency (UWV), so called 'vangnetters' (users of a safety net). They participated in a day-care program for people with psychological work-related complaints together with people in sick leave who were employed by an employer who were referred to a university psychiatric center (UCP).
AIM: Comparison of both groups on initial complaints and treatment outcome.
METHOD: A retrospective explorative study (during an 11-years period) comparing start and follow-up measurements by using questionnaires.
RESULTS: The UWV group (n = 111) differed from the UCP group (n = 254) at the start of the program: longer sickness leave, more severe initial complaints and a few other coping strategies. One year after finishing the program, 61% of the UWV group and 83% of the UCP group were in paid employment. People who were not in paid employment after a year already had more initial complaints compared to people who were back at work. The length of sickness leave was not a limiting factor for reintegration in work.
CONCLUSION: Differences in initial symptoms and coping strategies did not really lead to differences in perspective of reintegration in work. Cooperation with the UWV for employed as well as unemployed people in sick leave led to good treatment results.

Adult Manifestation of Milder Forms of Autism Spectrum Disorder; Autistic and Non-autistic Psychopathology.

We compared the presence of autistic and comorbid psychopathology and functional impairments in young adults who received a clinical diagnosis of Pervasive Developmental Disorders Not Otherwise Specified or Asperger's Disorder during childhood to that of a referred comparison group. While the Autism Spectrum Disorder group on average scored higher on a dimensional ASD self- and other-report measure than clinical controls, the majority did not exceed the ASD cutoff according to the Autism Diagnostic Observation Schedule. Part of the individuals with an ASD diagnosis in their youth no longer show behaviors that underscribe a clinical ASD diagnosis in adulthood, but have subtle difficulties in social functioning and a vulnerability for a range of other psychiatric disorders.

Predictive validity of self-report questionnaires in the assessment of autism spectrum disorders in adults.

While various screening instruments for autism spectrum disorders are widely used in diagnostic assessments, their psychometric properties have not been simultaneously evaluated in the outpatient setting where these instruments are used most. In this study, we tested the Ritvo Autism Asperger Diagnostic Scale-Revised and two short versions of the Autism-Spectrum Quotient, the AQ-28 and AQ-10, in 210 patients referred for autism spectrum disorder assessment and in 63 controls. Of the 210 patients, 139 received an autism spectrum disorder diagnosis and 71 received another psychiatric diagnosis. The positive predictive values indicate that these tests correctly identified autism spectrum disorder patients in almost 80% of the referred cases. However, the negative predictive values suggest that only half of the referred patients without autism spectrum disorder were correctly identified. The sensitivity and specificity of each of these instruments were much lower than the values reported in the literature. In this study, the sensitivity of the Ritvo Autism Asperger Diagnostic Scale-Revised was the highest (73%), and the Autism-Spectrum Quotient short forms had the highest specificity (70% and 72%). Based on the similar area under the curve values, there is no clear preference for any of the three instruments. None of these instruments have sufficient validity to reliably predict a diagnosis of autism spectrum disorder in outpatient settings.

Cocaine as a risk factor for neuroleptic-induced acute dystonia.

BACKGROUND: A prospective study was conducted to test the hypothesis that cocaine use is a risk factor for neuroleptic-induced acute dystonia (NIAD). METHOD: The study sample consisted of a high-risk group for NIAD, males aged 17-45 years who had received high-potency neuroleptics within 24 hours of admission and had not used neuroleptics in the month prior to admission. Patients were excluded if they suffered from a neurodegenerative disorder or were exposed to anticholinergics, benzodiazepines, promethazine, carbamazepine, phenytoin, or levodopa during the study. Twenty-nine patients--9 cocaine users and 20 nonusers--entered the study, which lasted 2 years. Patients were followed for 7 days. RESULTS: Cocaine-using psychiatric patients developed significantly more NIAD than did nonusers (relative risk = 4.4, 95% CI = 1.4 to 13.9). CONCLUSION: Cocaine use is a major risk factor for NIAD and should be added to the list of well-known risk factors. The authors strongly suggest that cocaine-using psychiatric patients who are started on a regimen of neuroleptics should also be administered an anticholinergic for at least 7 days to prevent NIAD.

[acute dystonias in combined abuse of cocaine and neuroleptics]. / Acute dystonieën bij gecombineerd gebruik van cocaïne en neuroleptica.

A 25-year-old mildly retarded black cocaine user was hospitalized 15 times in 10 years for recurrent maniform psychosis. During the last intake he developed severe dystonia following zuclopenthixol 50 mg and droperidol 10 mg i.m. In view of current knowledge regarding the pathophysiology of acute neuroleptic induced dystonias, this suggests that cocaine may be a risk factor for development of acute dystonia. However, only a few studies with small numbers of patients and/or poor design have been reported. Therefore the conclusion cannot be drawn that an anticholinergic should be added to neuroleptics in patients with cocaine abuse.

Intestinal bacterial translocation in experimentally burned mice with wounds colonized by Pseudomonas aeruginosa.

Translocation of micro-organisms from the gastrointestinal tract may play a role in the pathogenesis of septic complications in severely burned patients. We therefore investigated the influence of burn wound infection with Pseudomonas aeruginosa on translocation in experimentally burned mice. The P. aeruginosa disseminated in 15% of the animals on the second day and in 20% of the animals on the third day postburn in the Pseudomonas-seeded group. Wound colonization with P. aeruginosa, compared with a control group, led to an increased incidence of translocation of Escherichia coli from the GI tract to the spleen (p < 0.005), liver (p < 0.03), lungs (p < 0.005), and peritoneal cavity (p < 0.03) on the second day postburn but not on the third day postburn. On both the second and third days, the number of viable E. coli in the organs in the Pseudomonas-seeded group exceeded that in the organs in the control group. In this model translocation of E. coli from the GI tract played a more important role than did hematogeneous dissemination of P. aeruginosa from the burn wound.