[A new, more comprehensive role model for the psychiatrist; the need to adapt and personalise psychiatric concepts and actions]. / De rol van de psychiater; medisch, contextueel én persoonsgericht denken en handelen in de psychiatrie.

BACKGROUND: More and more criticism is being levelled at the traditional cornerstones of psychiatric treatment such as medication, diagnostics and the specific effectiveness of treatment models. On the other hand, however, increasing attention is being given to other 'non-specific' factors such as the quality of the working alliance, the value of feedback and the personality and character of the therapist. In addition, there is an ever-increasing demand on the part of the public who want a more prominent role in the treatment process for relatives and family members. AIM: To respond to these societal developments by delineating a new and more comprehensive role for the psychiatrist. METHOD: The authors analyse how the need for new roles is connected with the fact that psychiatrists and the general public have different conceptual frameworks and tend to use different conversational styles and vocabulary. RESULTS: According to the authors, the psychiatrist should be able to fulfill several roles in the treatment process. The traditional psychiatric 'jargon' is inadequate for expressing the specific value of the differing roles and conceptual frameworks of psychiatrists and members of the public. CONCLUSION: When opting for a specific role and type of language, the psychiatrist should be guided by what is most likely to lead to fruitful cooperation with the patient and his or her relatives. In discussing treatment plans with the patient the psychiatrist must learn to use more comprehensive and flexible language.

Effects of TENS and methylphenidate in tuberculous meningo-encephalitis.

PRIMARY OBJECTIVE: Beneficial effects of transcutaneous electrical nerve stimulation (TENS) on cognition and behaviour were observed in a child with probable Herpes Simplex Encephalitis. Based on these positive findings, it was examined in the present case study whether a child who had been diagnosed to suffer from tuberculous meningitis would benefit from TENS. Furthermore, as aggression and overactive behaviour were also prominent clinical symptoms, the effects of methylphenidate were investigated. METHODS AND PROCEDURES: Neuropsychological tests were used to assess attention/concentration and visuospatial and visuoconstructive memory. Behaviour, including the level of activity during 24 hours, was assessed by one observation scale and actigraphy. EXPERIMENTAL INTERVENTIONS: TENS and methylphenidate. MAIN OUTCOMES AND RESULTS: TENS particularly improved overall affective behaviour. Methylphenidate appeared to have the opposite effect on cognition and hardly any effect on patient's behaviour. CONCLUSIONS: TENS might improve the patient's behavioural functioning. Pros and cons for treatment effects are discussed.

Phosphorylation state of red and white muscle in tilapia during graded hypoxia: an in vivo (31)P-NMR study.

The aim of this study was to measure the energetic consequences of hypoxia in different types of skeletal muscle within a single tilapia species (n = 5). To that aim, 81.0 MHz (31)P-nuclear magnetic resonance (NMR) spectra were collected, alternately, from three surface coils placed adjacent to the tissues of interest (dorsal white muscle, ventral white muscle, and lateral red muscle) during a graded hypoxia load over 6 h followed by a 5-h recovery period. The fish were contained in a flow cell, enabling us full control of the oxygen content of the bathing medium. The intracellular pH and the concentrations of ATP, phosphocreatine (PCr), and P(i) were determined from the NMR spectra. For normoxia, biochemical differences for [gamma-ATP], [PCr], and [sugar phosphates] (SP) were observed between all three locations, especially between the red and white muscle. During hypoxia stress, loss of phosphorylated compounds (PCr+P(i)+SP) was observed at all locations but was the most severe in red muscle. When the aerobic (respirometry) and anaerobic ((31)P-NMR) ATP production via an energy balance are compared, flexible metabolic depression is demonstrated during anaerobioses. It is concluded that control of the aerobic and anaerobic component of metabolism during metabolic depression is independent of each other.

[Type I tricho-rhino-phalangeal syndrome]. / Het tricho-rhino-falangeaal syndroom, type I.

A two-year-old boy and his mother with the Tricho-Rhino-Phalangeal syndrome type I were studied. The mother showed the complete triad of the syndrome with fine, sparse, slow-growing hair, pear-shaped nose and abnormal fingers. Cone-shaped epiphyses of the phalanges of the hands and shortening of the mesophalanges and of the first and fifth metacarpals were observed radiographically. With the exception of the extreme shortening of several phalanges and metacarpals the above mentioned symptoms were also present in the son.