[The current psychometric state of risk assessment scales for adults in the Netherlands]. / Psychometrische stand van zaken van risicotaxatie-instrumenten voor volwassenen in Nederland.

BACKGROUND: Although Dutch forensic psychiatry is making increasing use of structural risk assessment scales, the controversy about the value and usefulness of these instruments continues unabated. AIM: To provide an overview of the psychometric qualities of the instruments used most often in the Netherlands for risk assessment in adults. METHOD: Dutch data about the Historical, Clinical, and Risk Management (HCR-20), the Sexual Violence Risk-20 (SVR-20), the Psychopathy Checklist-Revised (PCL-R) and two Dutch instruments, the 'Historische, Klinische en Toekomstige Risico-indicatoren-30' (HKT-30) and the 'Forensisch Psychiatrische Profielen' (FP-40) were reviewed. In addition, data relating to the unstructured clinical judgement were studied. RESULTS: The inter-rater reliability values of the instruments discussed were in general satisfactory, but the internal consistency was often unsatisfactory. Except in some studies, the predictive validity was in general reasonable. CONCLUSION: At present, caution is called for with regard to the assessment of the risk of recividism when this is based purely on risk assessment scales or purely on the unstructured judgement. Perhaps it is simply not possible to predict recividism more accurately. Until there are some new developments in this area, it seems advisable to combine as many data as possible about a person under investigation derived from assessment scales and clinical judgement and to compare the outcome with the conclusions of the other professionals.

[A bifid uvula in a patient with schizophrenia as a sign of 22q11 deletion syndrome]. / Een uvula bifida bij een patiënte met schizofrenie als teken van het 22q11-deletiesyndroom.

A bifid uvula and nasal speech were observed in a 25-year-old woman who was referred because of psychotic complaints. Fluorescence in situ hybridisation (FISH) research for the 22q11 deletion was carried out and the deletion was found. The 22q11-deletion syndrome (22q11DS) is characterised by somatic abnormalities including cardiovascular defects, velopharyngeal anomalies and typical facial characteristics. There is an increasing interest in the cognitive and psychiatric consequences of 22q11DS. There is a high prevalence of learning disabilities and the delayed development of language and speech. Mild mental retardation or borderline intellectual functioning is often reported. A broad range of psychiatric symptoms have been reported; a consistent finding is the development of a psychosis in a considerable proportion of 22q11DS patients from early adulthood onwards. It is important to consider the possibility of 22q11DS in psychiatric patients, as then early intervention strategies for later psychopathological abnormalities are possible, as well as the provision of genetic counselling.