[rTMS for a patient with derealisation disorder; an experimental treatment]. / rTMS bij een patiënt met een derealisatie-stoornis; een experimentele behandeling.

We describe a 70 year old patient with a history of epilepsy, who developed a derealisation disorder after discontinuing the use of valproic acid. An experimental treatment with rTMS led to a remarkable decrease of his symptoms. We determined our target, the right ventrolateral prefrontal cortex (VLPFC), with the use of neuronavigation. During treatment no complications occurred, specifically no epileptic seizures.

['Home away from house': an example of a reduplicative paramnesia]. / Een patiënt die dacht dat zijn huis in een ander land stond; reduplicatieve paramnesie.

We describe a 78-year old male patient with Parkinson’s disease and without a past psychiatric history, who had hallucinations and a very particular form of a delusional misidentification syndrome. His belief that he was not at home and that his home was on a different location, even in another country, is a form of 'reduplicative paramnesia'. This delusion is seen more often in association with neurodegenerative disease, for example in Parkinson’s disease. We describe the characteristics of this delusion, provide possible explanations and delineate several therapeutic options.

[The Othello syndrome in Parkinson's disease: an example of a lesser-known delusion]. / Het othellosyndroom bij de ziekte van Parkinson; een voorbeeld van een minder bekende waan.

Delusions are fairly common features of Parkinson's disease. Some delusions are easily recognised, but others are less well-known and can be missed by health professionals. We describe the case of a female patient with Parkinson's disease who believed, erroneously, that her partner was being unfaithful; this type of delusion is also called the Othello syndrome. After psychoeducation and the start of clozapine, the delusion faded and the relationship became more peaceful.

[Less need for insulin, a surprising effect of phototherapy in insulin-dependent diabetes mellitus]. / Verminderde insulinebehoefte; een verrassend effect van lichttherapie bij insulineafhankelijke diabetes mellitus.

A 40-year-old woman with insulin-dependent diabetes mellitus was treated successfully with phototherapy for a seasonal affective disorder. Following sessions of phototherapy she developed hypoglycaemias and required less insulin. A review of the literature showed that melatonin has an inhibiting effect on insulin sensitivity. The melatonin secretion, which is suppressed by phototherapy, may cause an immediate decrease in the plasma glucose levels. This decrease may well be important for patients with insulin-resistant diabetes mellitus and seasonal affective disorder.