[Profiling patients with early onset psychosis in Flanders]. / Profielschets van de minderjarige patiënt met psychose in een Vlaams kader.

BACKGROUND: Little is known about patients with early onset psychosis (EOP) because of the low prevalence and separation of mental health care for adolescents and adults. AIM: To describe characteristics of patients with EOP, their global functioning and their journey concerning healthcare, education, employment status, living situation and wellbeing in the years following onset of psychosis. METHOD: Data about demography, symptoms, treatment and functioning were collected from electronic patient records for 31 patients with EOP. Fourteen of these patients completed a questionnaire after discharge from inpatient treatment in ZNA University Child and Youth Psychiatry in Antwerp (UKJA) regarding after care, education, work and living conditions and wellbeing. RESULTS: Most patients developed severe psychotic symptoms before the age of 16 that required prolonged intensive psychiatric treatment. They showed multiple risk factors associated with psychosis. Following inpatient treatment most patients received special needs education and a majority transitioned into adult psychiatric care. Parents were the main source of social support for patients. CONCLUSION: During recovery access to support in different domains of life is needed. If we want to offer adequate care for each patient the organization of mental healthcare and assistance needs to be improved.

[What are possible applications of virtual reality for forensic psychiatry?] / Mogelijke toepassingen van virtual reality voor de forensische psychiatrie.

BACKGROUND: Virtual reality (VR) has been on the rise in recent years due to the better quality and accessibility of VR glasses and software. Despite the fact that VR is being used more often in psychiatric care, little is known about the possible applications of VR in forensic psychiatry. AIM: To investigate which possible VR-applications already exist that can also be used in forensic psychiatry and what the possible risks are. METHOD: Scientific literature was consulted in PubMed, Web of Knowledge, Embase en Cochrane Library to search for immersive VR-applications for aggression, motivation and the most prevalent psychopathologies in forensic psychiatry. RESULTS: Several relevant VR-applications were found that can be used in the diagnosis or treatment of forensic psychiatric patients. Despite the limited number of empirical studies, several authors emphasize the potential benefits of VR for this target group. CONCLUSION: Due to the low number of studies of good quality on the use of VR in psychiatric care, it is currently not yet possible to draw clear conclusions about efficiency, deployability and specific applications. However, there is enough potential within forensic psychiatry to integrate VR into various parts of the care process, such as treatment, diagnosis and risk assessment.

[Potential of participatory action research for clients, professionals and researchers in mental healthcare]. / Het potentieel van participatief actieonderzoek voor cliënt, praktijk en onderzoek in de ggz; onderbouwing en praktijkvoorbeeld.

BACKGROUND: In participatory action research (par), researchers, practitioners and the community engage in a research process together. This research approach has the potential to assist in bridging the research-practice gap by starting from practice needs and using joint expertise and experiences to enrich scientific knowledge, optimise clinical practice and empower stakeholders from different backgrounds.
AIM: To discuss the potential benefits of par for clients, professionals and researchers in the field of mental healthcare.
METHOD: Starting from the literature on par, fundamental characteristics and benefits of this research approach in the field of mental healthcare are described and illustrated with an example from practice.
RESULTS: par in mental healthcare can contribute to enriching prepositional and practical knowledge, facilitate positive social change in care delivery, empower all stakeholders, and ultimately make a significant contribution to the integration of research and practice.
CONCLUSION: par is valuable for clients, professionals and researchers in a variety of projects in mental healthcare.

Can psychiatric childhood disorders be due to inborn errors of metabolism?

Many patients who visit a centre for hereditary metabolic diseases remarkably also suffer from a child psychiatric disorder. Those child psychiatric disorders may be the first sign or manifestation of an underlying metabolic disorder. Lack of knowledge of metabolic disorders in child psychiatry may lead to diagnoses being missed. Patients therefore are also at risk for not accessing efficacious treatment and proper counselling. To search the literature for the co-occurrence of child psychiatric disorders, such as ADHD, autism, psychosis, learning disorders and eating disorders and metabolic disorders. A search of the literature was conducted by performing a broad search on PubMed, using the terms "ADHD and metabolic disorders", "autism and metabolic disorders", "psychosis and metabolic disorders", "learning disorders and metabolic disorders", and "eating disorders and metabolic disorders". Based on inclusion criteria (concerning a clear psychiatric disorder and concerning a metabolic disorder) 4441 titles and 249 abstracts were screened and resulted in 71 relevant articles. This thorough literature search provides child and adolescent psychiatrists with an overview of metabolic disorders associated with child psychiatric symptoms, their main characteristics and recommendations for further investigations.

[Risk factors and development course of conduct disorder in girls; a review]. / Gedragsstoornissen bij meisjes: een overzicht van risicofactoren en ontwikkelingsverloop.

BACKGROUND: So far there have been relatively few studies of conduct disorder in girls. It is very important that professionals engaged in preventing and treating this disorder have a sound knowledge of the risk factors involved and of the developmental course of the disorder. AIM: To provide an overview of what is known about the risk factors and about the way in which conduct disorder develops in girls. METHOD: We searched the Eric, PubMed and Medline databases for articles on conduct disorder in girls. We reviewed 41 studies and we summarised the results. RESULTS: Several risk factors contribute to the development of conduct disorder in girls. Just like boys, girls too can display the life-course-persistent pathway of antisocial behavior. Such girls are often associated with serious risk factors. Those with serious forms of antisocial behaviour have an increased risk of experiencing adjustment problems in later life. CONCLUSION: Future research in this area will have to concentrate on the creation of adequate prevention and treatment programs.

[Prevalence of the use of psychoactive medication to treat young persons with autism spectrum disorder in the province of Antwerp, Belgium]. / Gebruik van psychoactieve medicatie bij kinderen en jongeren met autisme-spectrumstoornis in de provincie Antwerpen.

BACKGROUND: Very little information is available concerning the prevalence of the use of medication for treatment of individuals with autism spectrum disorder (ASD), particularly in European countries. Earlier studies have shown that a large number of patients with ASD use at least one psychoactive drug and that the numbers are increasing. Even in the nineties, studies suggested that the frequent use of psychoactive medication was widespread, although at the time there were only limited grounds for this assumption. AIM: To assess the prevalence with which psychoactive medication and complementary and alternative medicine (CAM) are being used for treating young people with ASD, and also to investigate relations between medication use and a number of individual characteristics that are included in the Behavioral Model of Health Service Use. METHOD: The study sample (0-17 years) in the province of Antwerp, Belgium, was recruited by various means. We used a questionnaire that had been previously used in North American studies and that had to be completed by the parents of the young persons involved in the study. RESULTS: We included data from 263 questionnaires. In our sample 42.6% of the young persons used one or more one psychoactive drug. More than 12.2% used more than one drug. The most frequently used psychoactive drugs were ADHD-medication (31.6%) and antipsychotics (16.7%). About 14% used at least one CAM. We found a positive relationship between the use of medication and psychiatric comorbidity and/or epilepsy, the severity of autism and the parents' living conditions. CONCLUSION: We found a relatively low use of antipsychotics, antidepressants, mood stabilisers and sedatives, the prevalence being lower that that reported in North American studies. Our findings appear to be in accordance with current clinical guidelines.

[Case report: The child- and adolescent psychiatric phenotype of a brother and sister with 16p11.2 microduplication]. / Het kinder- en jeugdpsychiatrische fenotype bij een broer en zus met de 16p11.2-microduplicatie.

16p11.2 microduplication is linked with a vulnerability for a range of psychiatric and somatic problems, with variable expression and penetration rate. We discuss the phenotypical expression of this microduplication with the case of a brother and sister. Both subjects went through child psychiatric diagnostics and treatment, where a varying degree of developmental delay and symptoms that match an attention deficit/hyperactivity disorder were observed in combination with short stature and low body mass index.

[Reform of the Belgian mental health care system for children and adolescents]. / Een kentering in de ggz voor kinderen en jongeren in België.

BACKGROUND: The Belgian child and adolescent mental health care system is in the process of being substantially reformed and re-shaped. AIM: To outline recent reforms in Belgian child and adolescent mental health care. METHOD: To provide an overview of the recent literature on service delivery and on the organisation of the Belgian mental health care system for children and adolescents. RESULTS: On the basis of various studies a National Plan for Child and Adolescent Mental Health was drawn up and recently approved. CONCLUSION: According to this National Plan additional measures will be taken to help children and young people with mental health problems. Networking will play an increasingly important role in the new organisational configuration of the new mental health policy.

[Measuring client satisfaction in youth mental health care: qualitative methods and satisfaction questionnaires]. / Meten van gebruikersoordeel in de jeugd-ggz; kwalitatieve methoden en tevredenheidsvragenlijsten.

BACKGROUND: Quality youth care and decisions about youth care should ideally be based on a combination of empirical data, the clinical judgment of health professionals and the views and preferences of clients. Additionally, the treatment provided needs to fit in with the client's social and cultural background. Clients' views about their treatment are often collected via satisfaction measurements and particularly via satisfaction questionnaires. AIM: To make a critical analysis of the factors that determine both client satisfaction and the content of the satisfaction questionnaires used as a measurement method in youth care. METHOD: We made a selective study of the relevant literature. RESULTS: Our results show that client satisfaction is not an indicator of the effectiveness of treatment and that the degree of client satisfaction varies according to the client's outlook and perspective. Apparently, there are many disadvantages of using questionnaires as a measurement method. CONCLUSION: For the collection of a young person's views, qualitative methods seem to be more effective than questionnaires.

[Early-onset eating disorders: a review of the literature]. / Vroeg ontstane eetstoornissen: literatuuroverzicht.

BACKGROUND: The incidence of anorexia nervosa (AN) in adolescents has increased significantly in recent years. In several studies and in the media it has been suggested that AN has recently become more prevalent in the pre-adolescence. In view of the impact that an eating disorder can have on a child, it is important to diagnose and start treating the illness as early as possible. AIM: To review the literature on the characteristics and susceptibilities of patients with eating disorders because this information can be important for early diagnosis, prevention and identification of susceptibilities to early-onset eating disorders. METHOD: We searched the literature for articles relating to early-onset eating disorders. We based our search on PubMed and on related relevant articles listed in the references. We selected 34 relevant articles published between 1987 and 2014. RESULTS: The literature lists characteristics and susceptibilities at various levels. Many types of factors are involved; examples of 'biological' factors are prior streptococcal infection, previous consultations with GP and a patients medical history; psychological factors include comorbidity, temperament, a particular personality profile, maturation-anxiety; environmental factors such as family history, family functioning and/or stressful events can play a role in the development of eating disorders. CONCLUSION The literature indicates that the early development of AN in children is related to a complex combination of etiological factors. However, there is a need for more research into this group of patients.

[Hallucinations and obsessive behaviour in an infant with autism spectrum disorder: diagnostic problems]. / Hallucinaties en dwangmatig gedrag bij een kleuter met autismespectrum-stoornis: een diagnostisch vraagstuk.

Regular non-medical treatment of a 6-year-old female patient with autism spectrum disorder failed due to comorbid compulsions and hallucinations. Differential diagnosis included obsessive-compulsive disorder and psychosis. The patient's young age complicated accurate diagnosis and management. In this case we opted for a diagnostic follow-up, resulting in treatment with a selective serotonin reuptake inhibitor because of the patient's frequent compulsions. This reduced the symptoms significantly.

[Quetiapine in the treatment of the Gilles de la Tourette syndrome. A case study]. / Quetiapine bij de behandeling van het gilles-de-la-tourettesyndroom.

In this article we describe the clinical response of an 8-year-old boy with the Gilles de la Tourette syndrome (GTS) when treated with quetiapine. Upon admission for observation he received a trial course of quetiapine, to which he responded favourably. We searched the Medline and Psycinfo databases for information about the recommended dose of quetiapine for children with GTS. From the 12 case-studies and one open-label trial that we found, we conclude that the maximum dose of quetiapine for children with GTS is 200 mg. Data concerning the safety of quetiapine when administered to children are limited and contradictory.

Lower baseline plasma cortisol and prolactin together with increased body temperature and higher mCPP-induced cortisol responses in men with pedophilia.

There is some evidence that hormonal and serotonergic alterations may play a role in the pathophysiology of paraphilias. The aims of the present study were to examine: 1) baseline plasma cortisol, plasma prolactin, and body temperature; and 2) cortisol, prolactin, body temperature, as well as behavioral responses to meta-chlorophenylpiperazine (mCPP) and placebo in pedophiles and normal men. Pedophiles showed significantly lower baseline plasma cortisol and prolactin concentrations and a higher body temperature than normal volunteers. The mCPP-induced cortisol responses were significantly greater in pedophiles than in normal volunteers. In normal volunteers, mCPP-induced a hyperthermic response, whereas in pedophiles no such response was observed. mCPP induced different behavioral responses in pedophiles than in normal men. In pedophiles, but not in normal men, mCPP increased the sensations "feeling dizzy, " "restless," and "strange" and decreased the sensation "feeling hungry". The results suggest that there are several serotonergic disturbances in pedophiles. It is hypothesized that the results are compatible with a decreased activity of the serotonergic presynaptic neuron and a 5-HT2 postsynaptic receptor hyperresponsivity.

Lower serum activity of prolyl endopeptidase in anorexia and bulimia nervosa.

The aim of this study was to examine whether anorexia and bulimia nervosa are accompanied by lower serum activity of prolyl endopeptidase (PEP;EC 3.4.21.26; post-proline cleaving enzyme), a cytosolic endopeptidase which cleaves peptide bonds on the carboxyl side of proline in proteins of relatively small molecular mass. Substrates of PEP are, amongst others, neuroactive peptides, such as arginine vasopressin, luteinizing hormone-releasing hormone, thyrotropin releasing hormone,alpha-melanocyte secreting hormone, substance P, oxytocin, bradykinin, neurotensin and angiotensin (Ag) I and II. Serum PEP activity was measured in the serum of 18 normal women, 21 anorexia nervosa and 21 bulimia nervosa women by means of a fluoremetric method. The Bulimic Investigatory Test, Edinburgh (BITE), the Eating Disorder Inventory (EDI) and the Hamilton Depression Rating Scale (HDRS) were scored. Serum PEP activity was significantly lower in patients with bulimia nervosa and anorexia nervosa, irrespective of the restricted or binging subtype, than in normal controls. There were significant and inverse correlations between serum PEP activity and the HDRS and BITE. In anorectic patients, but not in normal or bulimic patients, there was a significant correlation between serum PEP and body mass index. In bulimic patients, but not in normal or anorectic patients, there was a significant correlation between serum PEP and duration of illness. It is concluded that lowered serum PEP activity takes part in the pathophysiology of anorexia and bulimia nervosa. It is hypothesized that a combined dysregulation of PEP and neuroactive peptides, which are substrates of PEP, could be an integral component of eating disorders.

Neuroendocrine and immune aspects of fibromyalgia.

Fibromyalgia is a form of non-articular rheumatism characterised by long term (>3 months) and widespread musculoskeletal aching, stiffness and pressure hyperalgesia at characteristic soft tissue sites, called soft tissue tender points. The biophysiology of fibromyalgia, however, has remained elusive and the treatment remains mainly empirical. This article reviews the neuroendocrine-immune pathophysiology of fibromyalgia. There is no major evidence that fibromyalgia is accompanied by activation of the inflammatory response system, by immune activation or by an inflammatory process. There is some evidence that fibromyalgia is accompanied by some signs of immunosuppression, suggesting that immunomodifying drugs could have potential in the treatment of fibromyalgia. Recent trials with cytokines, such as interferon-alpha, have been undertaken in patients with fibromyalgia. Immunotherapy with these agents, however, may induce symptoms reminiscent of fibromyalgia and depression in a considerable number of patients. Lowered serum activity of prolyl endopeptidase (PEP), a cytosolic endopeptidase that cleaves peptide bonds on the carboxyl side of proline in proteins of relatively small molecular mass, may play a role in the biophysiology of fibromyalgia through diminished inactivation of algesic and depression-related peptides, e.g. substance P. Trials with PEP agonists could be worthwhile in fibromyalgia. The muscle energy depletion hypothesis of fibromyalgia is supported by findings that this condition is accompanied by lowered plasma levels of branched chain amino acids (BCAAs), i.e. valine, leucine and isoleucine. Since there is evidence that BCAA supplementation decreases muscle catabolism and has ergogenic values, a supplemental trial with BCAAs in fibromyalgia appears to be justified.

Pedophilia is accompanied by increased plasma concentrations of catecholamines, in particular epinephrine.

Plasma epinephrine and norepinephrine concentrations were measured in pedophiles and normal men both in placebo conditions and after administration of meta-chlorophenylpiperazine (mCPP), a post-synaptic 5-HT2 receptor agonist. The plasma concentrations of catecholamines, in particular epinephrine, were significantly increased in pedophiles. It is concluded that pedophiles may have an increased activity of the sympathoadrenal system.

Cytokines in de obsessief compulsieve stoornis en in anorexia nervosa: een overzicht.

The alterations in the inflammatory response system (IRS) appear to be quite different between OCD and anorexia nervosa and are also different from the changes observed in major depression. In anorexia nervosa, there is some evidence for increased production of monocytic cytokines, i.e. tumor necrosis factor-α (TNFα) and interleukin-6 (IL-6), and decreased production of Th-1 like cytokines, i.e. IL-2 and IFNγ. In the same patients there are also signs of immunosuppression, e.g. lowered numbers of CD4 and CD8 T cells and increased production of transforming growth factor-beta (TGFß). The increased production of monocytic cytokines may be the consequence of the hyponutritional status of those patients. The diminished production of the Th-1 like cytokines may be the consequence of at least four different factors: 1) the deficiency in nutritional factors; 2) neuroendocrine disorders, such as increased Cortisol production; 3) the increased TGFß production; and 4) lower serum dipeptidyl peptidase activity. In OCD no consistent or specific alterations in the IRS are observed. There is no evidence that IRS activation may play a role in the pathophysiology of OCD and anorexia nervosa.

The prolonged P(300) latency in recently detoxified alcohol-dependent patients is related to activation of the inflammatory response system.

The aims of this study were to examine the late components of the auditory event-related potentials (AERPs), i.e. N(100), P(200) and P(300), in recently detoxified alcohol-dependent patients compared to normal controls and to investigate whether there is a relationship between alterations in these AERPs and signs of activation of the inflammatory response system (IRS). The study subjects consisted of 14 healthy volunteers and 14 recently detoxified alcohol-dependent patients. All subjects performed a two-tone auditory discrimination task, using a standard "oddball" paradigm. The alcohol-dependent patients had their blood sampled to examine IRS markers, such as erythrocyte sedimentation rate (ESR), serum copper concentrations and the number of leukocytes. The P(300) latency was significantly greater in recently detoxified alcohol-dependent patients than in normal controls. There were significant correlations between the P(300) latency and the ESR (r = 0.84, p = 0.009), serum copper concentrations (r = 0.73, p = 0.01) and number of monocytes (r = 0.71, p = 0.006). It is concluded that the P(300) latency is prolonged in detoxified, chronic alcohol-dependent patients and is positively related to indicators of IRS activation. It is hypothesized that activation of the IRS may play a role in the delayed P(300) latency in recently detoxified, alcohol-dependent patients.

Lowered serum dipeptidyl peptidase IV activity in patients with anorexia and bulimia nervosa.

The aim of this study was to examine whether anorexia nervosa and bulimia nervosa are accompanied by lower serum activity of dipeptidyl peptidase IV (DPP IV, EC 3.4.14.5), a membrane-bound serine protease that catalyses the cleavage of dipeptides from the amino-terminus of oligo- and polypeptides. Substrates of DPP IV are, amongst others, neuroactive eptides, such as substance P, growth hormone releasing hormone, neuropeptide Y, and peptide YY. DPP IV activity was measured in the serum of 21 women with anorexia nervosa, 21 women with bulimia nervosa and 18 normal women. Serum DPP IV activity was significantly lower in patients with anorexia nervosa and bulimia nervosa than in the normal controls. In the total study group, there were significant and inverse relationships between serum DPP IV activity and the total scores on the Bulimic Investigatory Test, Edinburgh, the Eating Disorder Inventory (EDI) and the Hamilton Depression Rating Scale. In the total study group no significant correlations between DPP IV and age, body weight or body mass index could be found. It is concluded that lowered serum DPP IV activity takes part in the pathophysiology of anorexia and bulimia nervosa. It is hypothesised that a combined dysregulation of DPP IV and neuroactive peptides, which are substrates of DPP IV, e.g. neuropeptide Y and peptide YY, could be an integral component of eating disorders.