[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.

[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.

[The added value of somatic screening for psychiatric outpatients]. / De meerwaarde van een somatische screening op een polikliniek psychiatrie.

BACKGROUND: Somatic disorders occur more often in psychiatric patients than in the general population; some disorders are undiagnosed at the moment of referral. According to current guidelines, patients admitted to a psychiatric clinic should receive somatic screening. This recommendation, however, does not apply to outpatients. AIM: To assess the added value of screening for somatic disorders in patients newly referred to the outpatient department of a psychiatric clinic in the Netherlands. METHOD: In a pilot study, newly referred outpatients aged between 18-65 were screened on the basis of a letter of referral, a questionnaire, an interview, standard blood tests and, if deemed necessary, additional blood tests. The screening was considered to have particular benefits when the outcome influenced the patient's subsequent somatic and/or psychiatric treatment. RESULTS: One or more 'new aspects of somatic concern' were found in 62% of the study sample. Of the total of 162 found aspects, 64% were unknown at referral. In 34% of the patients the family doctor was contacted about subsequent treatment; in 2% of the patients a medical specialist was consulted and 10% was referred to a medical specialist. CONCLUSION: A standard form of somatic screening in a psychiatric outpatient unit definitely provides added value. Further research is needed in order to optimise the screening instruments and the practicality of using such instruments.