[Autism spectrum disorder and schizophrenia: a challenging differential diagnosis]. / Autismespectrumstoornis en schizofrenie: een uitdagende differentiaaldiagnose.

Autism spectrum disorder and psychotic disorders/schizophrenia are separate disorders in the DSM-5. Due to overlapping symptoms and increased frequency in comorbidity they can be a diagnostic and therapeutic challenge in clinical practice. Relevant literature regarding the correlation between these disorders is discussed and linked to a case-report. An increased prevalence of autism/autistic traits is observed within psychotic patients and vice versa. Common symptoms and risk-factors, but also differential factors, are described. Despite of several hypotheses concerning increased frequency in comorbidity, no clear explanation was found so far. Little is known concerning treatment in case of comorbidity. In this case-report there was significant amelioration after treatment with an atypical antipsychotic. Psycho-education and attention to structuring are also important elements of the treatment plan.

Real-World Treatment Patterns, Outcomes, Resource Utilization and Costs in Treatment-Resistant Major Depressive Disorder: PATTERN, a Retrospective Cohort Study in Belgium.

OBJECTIVE: Treatment-resistant depression (TRD), a subgroup of major depressive disorder (MDD) that does not adequately respond to treatment, has a substantial impact on the quality of life of patients and is associated with higher medical and mental health care costs. This study aimed to report real-world treatment patterns, outcomes, resource utilization, and costs in the management of TRD by psychiatrists in Belgium. METHODS: We conducted a retrospective, non-interventional cohort study of patients ≥ 18 years, with diagnosed MDD who are treatment-resistant, defined as not responding to two different antidepressant treatments in the current moderate to severe major depressive episode (MDE). Data obtained from medical records of patients included patient health state (MDE, response, remission, and recovery) and resource use (number of consultations and emergency room visits, non-drug and drug interventions, and hospitalizations). RESULTS: One hundred and twenty-five patients were enrolled in nine sites, with an average observation period of 34 months. During the MDE, 89.7% of patients were treated with selective serotonin reuptake inhibitors, 63.2% with serotonin-norepinephrine reuptake inhibitors, and 60.8% with anti-psychotics. Twenty-four percent of patients did not respond to any treatment; 76% responded, of whom 61% experienced a relapse; 28% of patients reached recovery, of whom 31.4% experienced recurrence. The average yearly direct cost of a TRD patient is €9012, mainly driven by hospitalization in the MDE. The observed absenteeism relates to a high indirect cost, representing 70% of the total MDE cost. CONCLUSION: TRD is associated with a high unmet need and economic burden for patients and society, with highest costs in the MDE health state driven by absenteeism.

Real-world evidence from a European cohort study of patients with treatment resistant depression: Healthcare resource utilization.

BACKGROUND: Treatment resistant depression (TRD) is diagnosed when patients experiencing a major depressive episode fail to respond to ≥2 treatments. Along with substantial indirect costs, patients with TRD have higher healthcare resource utilization (HCRU) than other patients with depression. However, research on the economic impact of this HCRU, and differences according to response to treatment, is lacking. METHODS: This multicenter, observational study documented HCRU among patients with TRD in European clinical practice initiating new antidepressant treatments. Data regarding access to outpatient consultations and other healthcare resources for the first 6 months, collected using a questionnaire, were analyzed qualitatively according to response and remission status. The economic impact of HCRU, estimated using European costing data, was analyzed quantitatively. RESULTS: Among 411 patients, average HCRU was higher in non-responders, attending five times more general practitioner (GP) consultations and spending longer in hospital (1.7 versus 1.1 days) than responders. Greater differences were observed according to remission status, with non-remitters attending seven times more GP consultations and spending approximately three times longer in hospital (1.7 versus 0.6 days) than remitters. Consequently, the estimated economic impacts of non-responders and non-remitters were significantly greater than those of responders and remitters, respectively. LIMITATIONS: Key limitations are small cohort size, absence of control groups and generalizability to different healthcare systems. CONCLUSION: Patients with TRD, particularly those not achieving remission, have considerable HCRU, with associated economic impact. The costs of unmet TRD treatment needs are thus substantial, and treatment success is fundamental to reduce individual needs and societal costs.

Real-world evidence from a European cohort study of patients with treatment resistant depression: Treatment patterns and clinical outcomes.

BACKGROUND: Treatment resistant depression (TRD) characterizes a subgroup of 10-30% of patients with major depressive disorder, and is associated with considerable morbidity and mortality. A consensus treatment for TRD does not exist, which often leads to wide variations in treatment strategies. Real-world studies on treatment patterns and outcomes in TRD patients in Europe are lacking and could help elucidate current treatment strategies and their efficacy. METHODS: This non-interventional cohort study of patients with TRD (defined as treatment failure on ≥2 oral antidepressants given at adequate dose and duration) with moderate to severe depression collected real-world data on treatment patterns and outcomes in several European countries. Patients were started on a new treatment for depression according to routine clinical practice. RESULTS: Among 411 patients enrolled, after 6 months, only 16.7% achieved remission and 73.5% showed no response. At Month 12, while 19.2% achieved remission and 69.2% showed no response, 33.3% of those in remission at Month 6 were no longer in remission. Pharmacological treatments employed were heterogenous; 54 different drugs were recorded at baseline, and the top 5 treatment types according to drug classes accounted for 40.0% of patients. Even though remission rates were very low, at Month 12, 60.0% of patients had not changed treatment since enrolment. CONCLUSIONS: The heterogeneity of treatments highlights a lack of consensus. Moreover, despite low response rates, patients often remained on treatments for substantial periods of time. These data further support existence of an unmet treatment need for TRD patients in Europe.

Real-world evidence from a European cohort study of patients with treatment resistant depression: Baseline patient characteristics.

BACKGROUND: Treatment resistant depression (TRD; failure to respond to ≥2 treatments) affects ~20% of patients with major depressive disorder (MDD). Real-world data could help describe patient characteristics and TRD disease burden, to assess the unmet needs of TRD patients in Europe. METHODS: This observational study collected data from adults with moderate to severe TRD initiating a new treatment for depression, according to local standards of care. At baseline, socio-demographic characteristics, medical history, prior and current treatments were recorded. Disease severity, health-related quality of life (HRQoL), functionality and productivity were assessed. RESULTS: Overall, 411 eligible patients were enrolled across seven European countries. Mean (standard deviation [SD]) patient age was 51.0 (10.8) years; 62.3% were female. Long-term sick leave was reported by 19.0% of patients; 30.2% were unemployed. The mean (SD) duration of the current episode was 2.6 (3.9) years. At baseline, mean (SD) HRQoL scores for EuroQoL 5-dimension 5-level (UK tariff) and EQ-Visual Analog Scale were 0.41 (0.25) and 41.1 (18.7), respectively. The Work Productivity and Activity Impairment questionnaire demonstrated mean (SD) absenteeism of 57.0% (44.9%) and presenteeism of 54.7% (29.5%); mean (SD) overall work impairment was 60.5% (29.9%). LIMITATIONS: Key limitations are small cohort size, absence of a control group and generalizability to countries with different healthcare models. CONCLUSIONS: TRD patients had a high disease burden, low HRQoL and reduced function and productivity, with a substantial proportion unable to work. This demonstrates an unmet treatment need in TRD patients that, if addressed, could reduce the heavy personal and societal burden.

[Psychiatric disorders in people with intellectual disability or borderline intellectual disability: an introduction]. / Psychiatrische stoornissen bij mensen met een lichte verstandelijke beperking of zwakbegaafdheid; een inleiding.

BACKGROUND: Psychiatric disorders are also prevalent in people with intellectual disability and borderline intellectual disability.
AIM: To provide an introduction of the organisation of care and its development for people with intellectual disability and borderline intellectual disability.
METHOD: A description of specific concerns in prevalence, presentation, diagnosis, and a short summary of (the evolution) of care in the Netherlands and Belgium.
RESULTS: Compared to the end of last century there is more attention for the needs of this group. The provided care is also more professional.
CONCLUSION: Although not always easy in practice, good care for people with intellectual disability and borderline intellectual disability, and comorbid psychiatric problems, requires more cooperation and the use of shared knowledge and expertise.

[Practical guidelines for prescribing psychotropic medication to people with intellectual disability]. / Voorschrijven van psychofarmaca bij mensen met een verstandelijke beperking: handvatten voor de praktijk.

BACKGROUND: In people with intellectual disability (id) prescription of psychotropic drugs is often chronic and outside licensed indications.
AIM: To provide practical strategies for prescribing psychotropic drugs in people with id.
METHOD: We reviewed the literature and existing guidelines to summarize recommendations for prescribing psychotropic drugs in people with id.
RESULTS: The Diagnostic Manual - Intellectual Disability is a useful tool to facilitate diagnosis of mental disorders in people with id. Challenging behaviour in the absence of a psychiatric disorder is not a licensed indication for prescribing psychotropic drugs. Because of increased vulnerability for side effects in people with id, it is crucial to carry out a risk-benefit analysis before prescribing psychotropic drugs. In line with existing guidelines, we recommend monitoring of treatment and adverse effects with standardized scales adapted for id.
CONCLUSION: A careful decision-making process regarding initiation and continuation is essential to prevent insufficient as well as excessive pharmacotherapy in people with id.

[Paranoia and Asperger syndrome]. / Paranoia en het aspergersyndroom.

Paranoia in patients diagnosed with Asperger syndrome in adulthood is discussed and illustrated with the help of a case study. Impaired mentalisation, characteristic for Asperger disorder, influences the way an individual experiences life, making him more vulnerable for the development of delusional beliefs.

[Khat-induced psychosis?]. / Khatgeïnduceerde psychose?

Khat is a drug endemic in East Africa, whose active ingredient has amphetamine-like effects. Khat might induce psychosis, but there is no consensus about this in the literature. Two cases of suspected khat-induced psychosis are presented. Treatment of choice appears to be discontinuation of khat use, possibly combined with treatment with an antipsychotic.

[Information about electroconvulsive therapy on the internet]. / Informatie over elektroconvulsietherapie op het internet.

This article aims to provide a quantitative and qualitative assessment of the information about electroconvulsive therapy that is currently available on the internet. We carried out a quantitative assessment by entering five search terms into eight (meta)search engines. We achieved our qualitative assessment by visiting the first twenty websites generated by each search on one of the search engines, in particular Google (www.google.com), and by scoring these websites with an adapted Sandvik-score. We conclude that the scored websites are technically sound but are incomplete as far as content is concerned.

Electroconvulsive therapy in Belgium: a nationwide survey on the practice of electroconvulsive therapy.

OBJECTIVE: To review and describe the practice of electroconvulsive therapy (ECT) in Belgium. METHODS: A 30-item questionnaire on the practice of ECT was sent to all institutions providing ECT. RESULTS: In 2003 ECT was offered in 32 hospitals. Although ECT hospitals are equally spread over three regions, there is a significant difference in the ECT utilization rate. There are no major regional differences in the practice of ECT. Fifty-three percent of the hospitals reported less than 10 treatment sessions per month. The major indication for ECT was depression (89.7%). Propofol was the anesthetic most commonly used (75%). Eleven departments (34.3%) used a sine wave device. Bitemporal electrode placement was the preferred option in 65.6% of all departments, and 37% of these used the combination of bitemporal electrode placement and a fixed high stimulus dose. Continuation ECT and outpatient ECT were rarely used. LIMITATIONS: This questionnaire study relies upon answers given by psychiatrists, and did not audit actual practices. CONCLUSIONS: Although ECT is widely available in Belgium, it remains underused and the practice of ECT is amenable for improvement. Guidelines should be implemented and continuing education is needed.

Toxicity of an in situ oil shale process water to rainbow trout and fathead minnows.

An in situ oil shale process water, designated Omega-9 water, was used in flow-through bioassays with fathead minnows, rainbow trout and rainbow trout eggs. Of the two fish species, rainbow trout were more sensitive to acute exposure to Omega-9 water with 96-hour LC50 dilutions of 0.51% and 0.41% in two independent determinations. In embryo-larval studies, the length of fry from eggs hatched and maintained in 0.16% process water was significantly less than that of eggs hatched in control water. A solution of the 13 major inorganic constituents of Omega-9 water, with a 96-hour LC50 of 0.56% for rainbow trout, showed that inorganics accounted for most of the acute toxicity of Omega-9 water.

Acute and embryo-larval toxicity of phenolic compounds to aquatic biota.

Because of the prevalence of phenolic compounds in various types of effluents, both acute and embryo-larval bioassays were performed on eight phenolic compounds with rainbow trout, fathead minnows and Daphnia pulicaria. In flow-through bioassays, the 96-hr LC50 values for rainbow trout and fathead minnows ranged from < 0.1 mg/L for hydroquinone to > 100 mg/L for resorcinol. Daphnia pulicaria was consistently the least sensitive species tested as measured in 48-hr bioassays, while fathead minnows and rainbow trout varied in their relative sensitivity to phenolics as measured in 96-hr tests. Fathead minnows were more sensitive to phenol at 25 degrees C than at 14 degrees C. In embryo-larval bioassays with phenol, fathead minnow growth was significantly reduced by 2.5 mg/L phenol, while rainbow trout growth was significantly reduced by 0.20 mg/L phenol. For both species the embryo-larval effects concentration was 1.1% of the 96-hr LC50. Another embryo-larval bioassay was attempted with p-benzoquinone, a highly toxic phenolic compound found in fossil fuel processing wastewaters, which was discontinued because the compound was rapidly degraded chemically or biologically in the headtank and aquaria.