[Acute psychiatric symptomatology in Wegener's granulomatosis]. / Acute psychiatrische symptomatologie bij Wegener-granulomatosis.

A 69-year-old man presented with a manic episode but in fact was found to be suffering from Wegener's granulomatosis, a systemic disease that can attack the central nervous system. This case study demonstrates that in rare cases acute psychiatric symptoms can develop in a patient suffering from Wegener's granulomatosis, that need to be treated in the proper way. The purpose of the discussion is twofold: to draw attention to the rarity of the case and to stress the need for a multidisciplinary approach to systematic diseases.

Mode of action of the triazolobenzodiazepines in the treatment of panic attacks: a hypothesis.

Alprazolam (Xanax) or 8-chloro-1-methyl-6-phenyl-4H-S-triazolobenzodiazepine is a potent drug for the treatment of anxiety disorders. The chemical structure differs from the classical benzodiazepines by incorporation of the triazoloring. Due to the triazolo ring, the drug can have additional modes of action than the normal benzodiazepines. The triazolobenzodiazepines are potent inhibitors of the platelet-activating factor. This factor is a potent stimulator of the corticotropin-releasing hormone. This hormone has an effect on the hypothalamo-pituitary-adrenal axis but the corticotropin-releasing hormone is also known to be a stimulator of the locus coeruleus. The corticotropin-releasing hormone in patients with panic attacks is elevated. This could be a result of the hyperactive metabolism which is observed by positron emission tomographic (PET) studies of the right parahippocampal area.

Etiopathogenesis of reflex sympathetic dystrophy: a review and biopsychosocial hypothesis.

Reflex sympathetic dystrophy (RSD) is an enigmatic condition. Many clinicians, however, believe that psychological factors could contribute to the onset and persistence of the syndrome. In this article we critically review the evidence from psychometric and psychodynamic/biographical studies that suggests a role for such factors. An etiopathogenetic hypothesis based on the authors' clinical experience and the foregoing literature also encompasses elements of stress-coping theory, cognitive-behavioral views on chronic pain, and the psychobiological approach to sympathetic nervous system dysfunction. Implications of this model for future psychological research and the therapeutic treatment of RSD are discussed.

[Late-life depression and subcortical ischemic white matter lesions]. / Ouderdomsdepressies en subcorticale ischemische hersenschade.

Late-life depression and cerebral ischemic white matter lesions. Interest in cerebrovascular disease as a risk factor for depression in the elderly has grown in the last few years. Some authors recently have proposed the concept of a 'vascular depression'. In this paper, which presents a selective review of the literature, it is argued that 'vascular depression' is not a nosological entity. However, it has been shown that cerebral white matter lesions, identified using Magnetic Resonance Imaging (MRI) and thought to represent ischemic damage, are related to depression in the elderly. In particular, there is a correlation with late-onset depression. Moreover, these white matter lesions in depressed elderly adults are associated with cognitive impairment, and probably also with a relatively poor response to treatment.

Aptitude of psychiatric nurses: conceptual considerations and measurement difficulties.

Patient allocation is common practice in psychiatric nursing. This study investigates nurse aptitude, a sub-concept of competence, to validate and refine patient allocation. The focus is on operationalizing aptitude for daily management purposes. Aptitude varies in function of the tasks to be performed and the therapeutic relationship of each psychiatric nurse with her individual patients. Time, job context, socio-cultural context and semantic frame of reference have also to be taken into account when operationalizing aptitude. Self and peer opinions are a basis for aptitude measurement as patient care and its management are shared among a small team of nurses. A meticulous idio-graphic analysis is necessary. These constraints generate several measurement difficulties that are to be dealt with without too many unrealistic assumptions. The research design enabled reliable aggregation of peer 'on' and 'from' opinions. These allowed confrontation of opinions and identification of bias in these. Stepwise explorative experimentation led to gauging and calibrating a specific aptitude questionnaire to the context of psychiatric nursing. The final version is now being applied in practice in 14 wards of 11 hospitals in Flanders.