[Neuropsychiatric manifestations of COVID-19 in intensive care unit patients]. / Neuropsychiatrische verschijnselen bij patiënten met COVID-19 op de ic.

It has become clear that COVID-19 can lead to neuropsychiatric complications. In this article, three cases are discussed that illustrate how neuropsychiatric complications can manifest within the COVID-19 disease course. Patients are at risk to develop a severe, hyperactive delirium, which is often accompanied by anxiety and sometimes neurological symptoms. The treatment of the neuropsychiatric complications is characterized by unusually high doses of antipsychotics and sedatives. Timely psychiatric consultation is advised for adequate recognition and effective treatment of delirium and other neuropsychiatric symptoms.

Psychiatric co-morbidity is highly prevalent in idiopathic cervical dystonia and significantly influences health-related quality of life: Results of a controlled study.

INTRODUCTION: The aim of this study was to systematically investigate the prevalence of psychiatric disorders and factors influencing health-related quality of life (HR-QoL) in cervical dystonia (CD) patients, in the context of objective dystonia motor severity. METHODS: We studied 50 CD patients and 50 matched healthy controls. Psychiatric assessment included the MINI-PLUS interview and quantitative questionnaires. Dystonia motor severity (based on video evaluation), pain and disability were determined with the TWSTRS rating scale. In addition, severity of tremor and jerks was evaluated with the 7-point CGI-S scale. HR-QoL was determined with the RAND-36 item Health Survey and predictors of HR-QoL were assessed using multiple regression analysis. RESULTS: In CD patients, the MINI-PLUS revealed a significantly higher prevalence of psychiatric disorders (64% vs. 28%, p = 0.001), with substantially more depression (32% vs. 14%) and anxiety disorders (42% vs. 8%). This was confirmed by the quantitative rating scales. Disease characteristics did not differ between patients with and without a psychiatric diagnosis. HR-QoL in dystonia patients was significantly lowered. The most important predictors of HR-QoL appeared severity of depressive symptoms, pain and disability, but not severity of motor symptoms. CONCLUSION: Psychiatric co-morbidity is highly prevalent and is an important predictor of HR-QoL in CD patients, rather than dystonia motor severity. Our findings support the theory of a shared neurobiology for motor and non-motor features and highlight the need for systematic research into psychiatric disorders in dystonia. Adequate treatment of psychiatric symptoms could significantly contribute to better overall quality of life of CD patients.

[Pharmacological treatment of negative symptoms in schizophrenia; research and practice]. / Medicamenteuze interventie bij negatieve symptomen bij patiënten met schizofrenie.

BACKGROUND: Negative symptoms in patients with schizophrenia predict a worse social outcome. The treatment options for negative symptoms are extremely limited. Various treatment strategies have been studied in which several types of medication were added to antipsychotics in order to alleviate negative symptoms. AIM: To review the types of medication that have been used to supplement antipsychotic treatment in order to alleviate negative symptoms in patients with schizophrenia. METHOD: By means of PubMed we were able to perform a systematic review of all randomised controlled trials and relevant meta-analyses published up to and including May 2009. RESULTS: The pharmacological mechanisms that were studied in connection with the treatment of negative symptoms were as follows: the modulation of the glutamate system, the modulation of the serotonergic system, the histaminergic system and the dopaminergic system and the influencing by means of antioxidants and hormones. Despite all the methodological problems the modulation of the glutamate system and the blocking of serotonin 5-HT-3/2a receptors may be able to bring about a limited reduction of negative symptoms. The therapeutic results of the pharmacological treatments studied which may be effective is only moderate. CONCLUSION: For the time being the pharmacological addition strategies do not lead us to recommend their use in current clinical practice but they can certainly serve as a basis for further research. medication, negative symptoms, schizophrenia.