[Thinking inside the box: improving the lifestyle of inpatients with severe mental illness]. / Thinking inside the box: leefstijl­verbetering bij mensen met een ernstige psychiatrische aandoening in de kliniek.

BACKGROUND: An unhealthy lifestyle plays an important role in the substantially reduced life-expectancy of inpatients with severe mental illness (SMI). However, there is a lack of evidence on the long-term effectiveness and implementation of lifestyle improvements in inpatient mental healthcare.
AIM: Increasing knowledge and understanding of (the implementation of) lifestyle changes in inpatients with SMI in longer-term clinical care.
METHOD: Cross-sectional research followed by an observational study to evaluate a multidisciplinary lifestyle enhancing treatment (MULTI) for both changes in health-related outcomes after 18 months compared to treatment as usual (TAU), and the implementation barriers and facilitators.
RESULTS: Patients were very sedentary and less physically active compared to people without SMI. After 18 months, MULTI showed significant improvements in total physical activity, cardiometabolic risk factors, psychosocial functioning and mediation use, compared to TAU. Physical health did not improve in TAU. The implementation of MULTI was hampered by organisational factors and facilitated by positive attitudes of healthcare professionals and patients towards MULTI and their own role in it.
CONCLUSION: Using a multidisciplinary integrated approach, it is possible to improve the lifestyle, and thus the health status, of SMI inpatients, within the current context of routine mental healthcare.

[Risk factors for tardive movement disorders in schizophrenia]. / Risicofactoren van tardieve bewegingsstoornissen bij schizofrenie.

BACKGROUND: Tardive movement disorders are common among patients with schizophrenia. Risk factors for movement disorders are of the utmost importance in the context of preventive strategies. AIM: To achieve clearer classification of movement disorders in schizophrenia, to identify the risk factors involved and thereby develop strategies to prevent movement disorders. METHOD: We searched PubMed for prospective studies which had been performed in homogeneous target populations with schizophrenia and which contained well-defined definitions of the movement disorders. From these we selected studies in which risk factors were repeatedly identified. RESULTS: Tardive dyskinesia is well documented. Risk factors for developing tardive dyskinesia are use of antipsychotics, particularly those belonging to the first generation, 'not belonging to the Caucasian race', early extrapyramidal symptoms and older age. So far, there is very little conclusive evidence regarding the genetics of tardive movement disorders. CONCLUSION: With regard to tardive dyskinesia, not belonging to the Caucasian race and old age are two risk factors that can be quickly determined for the purpose of prevention. In this case it leads to the choice of medication with a low D2 affinity. Furthermore, it is advisable, after commencing treatment with an antipsychotic drug, to evaluate on a regular basis if the patient is showing (early) signs of TD. If TD does occur, there is a choice between medication with a low D-2 affinity or clozapine.

[Severe treatment-resistant tardive dystonia: is deep brain stimulation a treatment option]. / Ernstige, therapieresistente tardieve dyskinesie: is diepe hersenstimulatie een behandeloptie?

BACKGROUND: Severe tardive dyskinesia or dystonia (TD) are side-effects of dopamine-blocking agents, most of which are antipsychotics. A small subgroup of patients develop a severe debilitating treatment-resistant form of TD. AIM: To assess the effects and side-effects of deep brain stimulation (DBS) in this subgroup of TD patients. METHOD: We searched PubMed and Embase using the search terms 'tardive' and 'deep brain stimulation'. We found 19 articles containing data referring to 52 patients. Using the Burke Fahn Marsden Dystonia Rating Scale (BFMDRS), the Abnormal Involuntary Movement Scale (AIMS) and the Extrapyramidal Symptoms Rating Scale (ESRS) we calculated the average improvement in the patients' condition. RESULTS: On all the scales the improvement was statistically significant (p < 0.00001), the average improvement being 67% to 78%. In only 4% of the patients was there a deterioration in the psychiatric disorder. CONCLUSION: DBS seems to be an effective treatment for treatment-resistant TD and the side-effects seem to be limited. However, the evidence is limited because our conclusion is based on case-reports and on small-scale trials without randomisation or blinding.

[Risk factors for inactivity in patients in long-term care with severe mental illness]. / Risicofactoren voor inactiviteit bij patiënten met ernstige psychiatrische aandoeningen in de langdurige zorg.

BACKGROUND: Inactivity is a major problem in long-stay patients with severe mental illness. Very little research has been done into the variables that can predict and explain this inactivity. AIM: To find associations between inactivity and the variables (psychiatric, pharmacological, lifestyle and comorbidity) of patients with severe mental health illness.methods A cross-sectional study was performed at "Zon en Schild", a centre for mental health care in Amersfoort in the Netherlands. The study included 100 long-stay psychiatric patients hospitalized throughout the period February 2011 till July 2011. All of these patients were being treated with antipsychotics and were long-term inpatients at a psychiatric clinic. At the out-patient clinic of "Zon en Schild"; they were screened for inactivity via a subscale of the Nurses"; Observation Scale for Inpatient Evaluation (NOSIE-30). Data were collected and analysed by means of a validated questionnaire, physical examination and patient records. Simple and multiple regression analyses were performed in order to find associated factors associated with inactivity. RESULTS: We found that 31.3% of the variance predicted by the multiple regression analysis model for inactivity was associated with the variables parkinsonism, negative symptoms, metabolic syndrome, diabetes, body-mass index (BMI), first-generation antipsychotics and combination of first- and second-generation antipsychotics. Age (ß=0.235, p=0.04) and a combination therapy involving traditional and atypical antipsychotics (ß=0.317, p=0.04) were significantly associated with inactivity. CONCLUSION: Age and the combination of first- and second-generation antipsychotics were associated with inactivity. Cross-sectional studies do not demonstrate any causal links, but can generate a hypothesis. One possible hypothesis for the surprising link between inactivity and the combination of traditional and atypical antipsychotics is that the combination of antipsychotics promotes and fosters inactivity.key words clinical, epidemiology, inactivity, long-term care, schizophrenia.

Movement disorders are associated with schizotypy in unaffected siblings of patients with non-affective psychosis.

BACKGROUND: Movement disorders and schizotypy are both prevalent in unaffected siblings of patients with schizophrenia and both are associated with the risk of developing psychosis or schizophrenia. However, to date there has been no research into the association between these two vulnerability factors in persons with an increased genetic risk profile. We hypothesized that unaffected siblings of patients with non-affective psychosis have more movement disorders and schizotypy than healthy controls and that these co-occur. METHOD: In a cross-sectional design we assessed the prevalence and inter-relationship of movement disorders and schizotypy in 115 unaffected siblings (mean age 27 years, 44% males) and 100 healthy controls (mean age 26 years, 51% males). Movement disorders were measured with the Abnormal Involuntary Movement Scale (AIMS), the Unified Parkinson Disease Rating Scale (UPDRS), the Barnes Akathisia Rating Scale (BARS), and one separate item for dystonia. Schizotypy was assessed with the Structured Interview for Schizotypy--Revised (SIS-R). RESULTS: There were significant differences in the prevalence of movement disorders in unaffected siblings versus healthy controls (10% v. 1%, p<0.01) but not in the prevalence of schizotypy. Unaffected siblings with a movement disorder displayed significantly more positive and total schizotypy (p=0.02 and 0.03 respectively) than those without. In addition, dyskinesia correlated with positive schizotypy (r=0.51, p=0.02). CONCLUSIONS: The association between movement disorders (dyskinesia in particular) with positive and total schizotypy in unaffected siblings suggests that certain vulnerability factors for psychosis or schizophrenia cluster in a subgroup of subjects with an increased genetic risk of developing the disease.

[The influence of cannabis on the course of bipolar disorder: a longitudinal analysis]. / De invloed van cannabis op het ziektebeloopvan de bipolaire stoornis; een longitudinale analyse.

BACKGROUND: Research shows that the use of cannabis has a negative impact on the onset and outcome of schizophrenia, but little is known about possible effects on mood disorders. AIM: To study the influence of cannabis use on clinical and social treatment outcomes in patients with bipolar disorders who had been treated for a period of 12 months. METHOD: 3459 bipolar patients were enrolled in an observational study. The influence of cannabis on various clinical and social treatment outcomes was examined over a period of one year. In addition, tests were applied in order to find out whether third, mediating variables had effects on possible associations between cannabis use and treatment outcomes. RESULTS: During 12 months of treatment cannabis users showed less compliance and higher levels of illness severity, mania and psychosis than did non-users. In addition, cannabis users were less satisfied with their lives and had less chance of forming relationships than non-users. There was little evidence that associations between cannabis use and treatment outcomes were mediated by third variables. CONCLUSION: Cannabis use clearly had an independent impact on clinical treatment outcomes in patients with bipolar disorder, but the impact on social outcomes was only modest.

Motor Disturbance in ASD: A Pilot Study Showing Hypokinetic Behavior?

Data supporting theoretical models linking autism spectrum disorders (ASD) to motor disturbance are inconclusive. In the present study, children and adolescents with ASD (n = 44) were compared with a matched group of typically developing individuals (n = 49) on both instrumental and observational assessments of motor abnormalities. No group differences were found in the instrumental data. However, more bradykinetic motor behavior was found using an observational scale in the ASD groups. More rigid motor behavior was found in the adolescents with ASD but not in the children. Individuals with ASD show significantly more hypokinetic behavior, which may not be strictly dopaminergic in origin, but may reflect a weak central coherency in neuronal networks related to the motor system in which developmental changes are present.

[Reduction of prolonged QTc-interval related risks in treatment with neuropharmacological drugs. Recommendations for clinical practice]. / Het verminderen van aan QTc-tijdverlenging gerelateerde risico's bij psychofarmacagebruik. Adviezen voor de praktijk.

A prolonged QTc-interval may cause potentially life-threatening arrhythmias. Almost all drugs used in psychiatric practice are able to prolong the QTc-interval. There are some indications that clinicians are not sufficiently aware of the risks of QTc-interval prolongation in clinical practice. By drawing up a list of risk factors associated with prolonged QTc-interval and by correcting for these factors as far as possible, one should be able to reduce the overall risk of potentially lethal arrhythmias and administer more appropriate pharmacological treatment.

Instrument measurement of lingual force variability reflects tardive tongue dyskinesia.

Tardive tongue dyskinesia is often under-diagnosed or misdiagnosed. Instrument measurement of lingual force variability may be a valid and reliable method for assessing tardive tongue dyskinesia. Instrument measurement of lingual force variability was compared to the clinical level of tardive tongue dyskinesia and total body dyskinesia as measured by the Abnormal Involuntary Movement Scale (AIMS) in 35 subjects: 23 patients with a psychiatric disorder using antipsychotics, of which 11 were with and 12 were without tardive tongue dyskinesia, and 12 age- and gender-matched healthy controls. Lingual force variability correlated with tardive tongue dyskinesia (Spearman r = 0.56; p < 0.01) and with total dyskinesia (r = 0.47; p = 0.02); there was no association with age, antipsychotic dose, or psychiatric diagnosis. Instrument test-retest reliability corresponded with an ICC of 0.85 p < 0.0001. Instrument measurement of lingual force variability is a valid and reliable method for assessing tardive tongue dyskinesia.

Incidence and persistence of tardive dyskinesia and extrapyramidal symptoms in schizophrenia.

Although it has been suggested that second-generation antipsychotics (SGA) may reduce the rate of prevalent tardive dyskinesia (TD), little is known about the incidence and outcome of TD in those exposed exclusively to SGA. The incidence and subsequent persistence of TD and extrapyramidal symptoms (EPS) was calculated in a cohort of patients with schizophrenia treated predominantly with SGA. This cohort of more than 10,000 patients with schizophrenia was seen six times over a period of two years. Dichotomous measures of EPS and TD were used to calculate the yearly incidence rates of TD and EPS as well as their subsequent cumulative persistence rate in a subset of 9104 and 6285 patients at risk for TD and EPS, respectively. Of 9104 individuals who did not present with TD at baseline, 138 developed TD, yielding a TD incidence rate of 0.74% (95% CI: 0.62, 0.87) and a subsequent cumulative persistence rate of 80%. Of 6285 individuals without EPS at baseline, 464 developed EPS yielding an incidence rate of 3.7% (95% CI: 3.4, 4.0) and a subsequent cumulative persistence rate of 82%. Incidence rates of TD and EPS may be low in the SGA era. However, once emerged, these disorders prove persistent, suggesting strong moderators effects of underlying predisposing factors.