[The knowledge of resident doctors on diagnostics, etiology and treatment of Wernicke encephalopathy]. / De kennis van a(n)iossen over diagnostiek, etiologie en behandeling van wernicke-encefalopathie.

BACKGROUND: Wernicke encephalopathy (we) is a severe, acute neuropsychiatric disorder caused by a deficiency in thiamine. There have been indications that we is undertreated, which can lead to the Korsakoff syndrome, delirium or death. Treatment according to protocol is simple and effective. The knowledge of physicians about we has not been researched before.
AIM: To test the knowledge of resident doctors on diagnosis, etiology and treatment of we.
METHOD: The knowledge of 70 resident doctors in different medical specialties was examined through two clinical cases: the first with we due to hyperemesis gravidarum and the second due to alcohol abuse. Both open and multiple-choice questions were asked. Cues of the classical triad of we (cognitive disorder, eye movement disorder and gait disorder) were given accumulatively.
RESULTS: The classical triad of we was not recognized by 73% of the resident doctors in the case of hyperemesis gravidarum and they missed we in the case of alcohol abuse. Many of the resident doctors were not able to name the thiamin deficiency, the triad of we, more than three causes of we or the correct treatment with thiamine sufficiently. 67% of resident doctors indicated that their knowledge of we was insufficient and 76% expressed a need for more information about we.
CONCLUSION: The knowledge of resident doctors about the diagnostics, etiology and management of we is insufficient. Moreover, the resident doctors evaluate their knowledge about we to be insufficient. Medical school and postgraduate specialization have to focus more on this common and severe syndrome, which can appear in different medical areas.

[Symptoms of lithium toxicity at therapeutic levels]. / Klachten van lithiumintoxicatie bij een therapeutische spiegel.

A 60-year-old woman was admitted to the medical psychiatric unit with neurological and psychiatric symptoms. She was being treated with a maintenance dose of lithium for bipolar I disorder. Lithium toxicity and manic state were both considered. However, serum lithium levels appeared to be non-toxic. During hospital admission, her symptoms worsened and many diagnostic tests were performed. Lithium toxicity was considered again and lithium was discontinued, despite therapeutic blood levels. The neuro-psychiatric symptoms subsequently disappeared and the patient improved without residual symptoms. When neuro-psychiatric symptoms occur without elevated lithium levels, the possibility of chronic lithium toxicity should still be considered. More caution is required when risk factors are present, such as: old age, interacting medication, reduced renal function, dehydration and fever. Finally, electroencephalography can contribute to the diagnosis of chronic lithium toxicity.

[A patient diagnosed with conversion disorder who did not respond to therapy]. / Een patiënte met de diagnose conversiestoornis die niet verbeterde.

A 61-year-old woman with a conversion disorder (functional neurological symptom disorder) was referred by her neurologist to the outpatient psychiatric clinic for medically unexplained somatic symptoms. She did not respond well to our treatment, which we initially related to a comorbid mood disorder. Eventually, a progression of both motor and cognitive symptoms were found to be consistent with corticobasal degeneration, a rare neurodegenerative disorder. This case report illustrates the importance of a revised neurological examination when a patient with conversion disorder does not improve.

EEG alpha power as an intermediate measure between brain-derived neurotrophic factor Val66Met and depression severity in patients with major depressive disorder.

Major depressive disorder has a large impact on patients and society and is projected to be the second greatest global burden of disease by 2020. The brain-derived neurotrophic factor (BDNF) gene is considered to be one of the important factors in the etiology of major depressive disorder. In a recent study, alpha power was found to mediate between BDNF Met and subclinical depressed mood. The current study looked at a population of patients with major depressive disorder (N = 107) to examine the association between the BDNF Val66Met polymorphism, resting state EEG alpha power, and depression severity. For this purpose, repeated-measures analysis of variance, partial correlation, and multiple linear models were used. Results indicated a negative association between parietal-occipital alpha power in the eyes open resting state and depression severity. In addition, Met/Met patients showed lower global absolute alpha power in the eyes closed condition compared with Val-carriers. These findings are in accordance with the previously uncovered pathway between BDNF Val66Met, resting state EEG alpha power, and depression severity. Additional research is needed for the clarification of this tentative pathway and its implication in personalized treatment of major depressive disorder.

DBH -1021C>T and COMT Val108/158Met genotype are not associated with the P300 ERP in an auditory oddball task.

OBJECTIVE: The amplitude and latency of the P300 may be associated by variations in dopaminergic genes. The current study was conducted to determine whether functional variants of the catechol-O-methyltransferase (COMT) and dopamine beta-hydroxylase (DBH) gene were associated with P300 amplitude and latency in an auditory oddball task. METHODS: The P300 ERP was assessed by a two-tone auditory oddball paradigm in a large sample of 320 healthy volunteers. The Val108/158Met polymorphism (rs4680) of the COMT gene and the -1021C>T polymorphism (rs1611115) of the DBH gene were genotyped. P300 amplitude and latency were compared across genotype groups using analysis of variance. RESULTS: There were no differences in demographic characteristics in subjects for genotypic subgroups. No genotype associations were observed for the P300 amplitude and latency on frontal, central and parietal electrode positions. CONCLUSIONS: COMT Val108/158Met and DBH -1021C>T polymorphisms do not show evidence of association with characteristics of the P300 ERP in an auditory oddball paradigm in healthy volunteers. SIGNIFICANCE: We failed to find evidence for the association between dopaminergic enzymatic polymorphisms and the P300 ERP in healthy volunteers, in the largest study undertaken to date.

[Unexplained physical symptoms successfully treated by symptom-based psychotherapy]. / Onverklaarde lichamelijke klachten succesvol behandeld: symptoomgerichte psychotherapie.

A 43-year-old woman suffered severe weight loss due to unexplained vomiting. No physical cause was detected. She was treated with hypnotherapy, cognitive therapy and a gradual increase in food with the help of a dietician. The vomiting stopped and the patient was able to eat again. For patients with unexplained physical symptoms, it is often difficult to understand that a psychological component is involved. This psychological component should not be emphasized. It is more important to tell the patient that there is no explanation for their problem, but that there is a possible treatment: psychotherapy.