[Does ECT raise the risk of a recurrent stroke?] / Vormt ECT een risico op een recidief van cerebrovasculair accident?

BACKGROUND: As the guidelines and evidence for the use of electroconvulsive therapy (ECT) in patients with a recent or past history of stroke are unclear, ECT tends to be avoided in this population. AIM: To give a systematic review the literature on the risk and incidence of cerebrovascular accidents after ECT in these patients. METHOD: A systematic literature search was performed according to the PRISMA guidelines in PubMed and in the Cochrane Library. Publications in which ECT was applied in patients with a history of stroke were included by using specific MeSH terms. RESULTS: The following 19 articles met the criteria for review: 1 wide-scale prospective study, 1 small-scale prospective study with a control group, 3 small-scale retrospective studies, and 14 case reports. In the vast longitudinal Danish study, ECT was not associated with an elevated risk of recurrent stroke. Similarly, none of the other studies found the risk to be raised. CONCLUSION: Despite the limited number of prospective studies and the methodological discrepancies in the reports, ECT does not seem to be associated with an elevated risk of recurrent stroke. This review supports the safe use of ECT in patients with a recent or past history of stroke, if prior neurologic and cardiovascular assessments are being performed, as well as monitoring during the treatment.

[Reaction on 'Conversion disorder: for the neurologist, the psychiatrist or both?'] / Reactie op 'Conversiestoornis: voor de neuroloog, de psychiater of allebei?'.

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Impact of childhood trauma on course of panic disorder: contribution of clinical and personality characteristics.

OBJECTIVE: To investigate the impact of childhood trauma on the clinical course of panic disorder and possible contributing factors. METHOD: Longitudinal data of 539 participants with a current panic disorder were collected from the Netherlands Study of Depression and Anxiety (NESDA). Childhood trauma was assessed with a structured interview and clinical course after 2 years with a DSM-IV-based diagnostic interview and the Life Chart Interview. RESULTS: At baseline, 54.5% reported childhood trauma, but this was not predictive of persistence of panic disorder. Emotional neglect and psychological abuse were associated with higher occurrence of anxiety disorders other than panic disorder (social phobia) and with higher chronicity of general anxiety symptoms (anxiety attacks or episodes and avoidance). Baseline clinical features (duration and severity of anxiety and depressive symptoms) and personality traits (neuroticism and extraversion) accounted for roughly 30-60% of the total effect of childhood trauma on chronicity of anxiety symptoms and on occurrence of other anxiety disorders. CONCLUSION: After two years, childhood trauma is associated with chronicity of anxiety symptoms and occurrence of social phobia, rather than persistence of panic disorder. These relationships are partially accounted for by duration and severity of anxiety and depressive symptoms, and neuroticism and extraversion.

[Structural changes in DSM-5: the beginning of a transformation?]. / Structurele wijzigingen in de DSM-5: begin van een hervorming?

BACKGROUND: The dsm-5 received both praise and criticism following its publication in May 2013. Some blamed the dsm classification system for the unsatisfactory diagnostic system within psychiatry. Over the last 30 years or so there have been no major breakthroughs in our field and there has been no reduction in the number of mental health problems in Western society. It is time for a change; the question is whether DSM-5 will succeed in bringing about this change. AIM: To update and analyse the structural, diagnosis-independent changes that have been incorporated in DSM-5. METHOD: We discuss the changes. RESULTS: The most important structural, diagnosis-independent changes include: 1. the separate classification of disorders that begin in childhood from those that begin in adolescence has been abolished; 2. the multi-axial system has disappeared; 3. the approach has become more dimensional, which allows for the assessment of the severity of a disorder. CONCLUSION: In the DSM-5 there are clear signs that a transformation of our psychiatric assessment system has begun; this can only be seen as a positive development, but is probably just the tip of the iceberg. Further changes are likely to occur, some in the near future, others in the long term.

[Antidepressants and the risk of bleeding]. / Antidepressiva en risico op bloedingen: een literatuuroverzicht.

BACKGROUND: By blocking the serotonin transporter system antidepressants can, in theory, result in bleedings. However, we do not yet know how great the risk of bleeding is and what the clinical implications are. AIM: To assess how great the risk of bleeding is and what the clinical implications are. METHOD: Using keywords 'antidepressants' and 'bleeding' we searched the relevant literature up to March 2011 to find out what the risk of bleeding were for users of antidepressants. RESULTS: 34 studies met our selection criteria. Most studies reported upper gastrointestinal bleeding and hemorrhagic cerebrovascular accidents (CVA). Antidepressants with high serotonin affinity can slightly increase the risk of upper gastrointestinal bleeding. Antidepressants do not increase the risk for hemorrhagic CVA. Very little information is available about other types of bleeding. CONCLUSION: Our systematic review of the literature shows that antidepressants are relatively safe as far as bleeding is concerned. Precautions can be taken in the case of high risk patients.

[Neuro-endocrine correlates of burnout]. / Neuro-endocriene correlaten van burn-out.

BACKGROUND: The symptoms of burnout are similar to those of depression on the one hand and chronic fatigue syndrome on the other hand. However, the neuro-endocrine correlates of these two syndromes are the opposite, the former being a hyperfunction of the hypothalamic-hypophysial-cortical axis (HPA) and the latter being a hypofunction of the hpa-axis. AIM: To find out, via a systematic review of the literature, whether burnout is associated with either a hyperfunction or a hypofunction of the HPA-axis. METHOD: We searched PubMed using the following search terms: 'burnout syndrome and burnout', 'adrenocorticotropic hormone', 'corticotropin releasing factor', 'hypothalamic pituitary adrenal axis' and 'cortisol'. We retrieved 16 original articles en one meta-analysis were included in the study. RESULTS: Functional stress testing showed hypersuppression of the HPA-axis after dexamethasone. Basal cortisol values were found to be less conclusive, although a meta-analysis pointed to a negative association between burnout and cortisol. We did not find any studies that were carried out with the help of physiological, physical or psychological stress factors in burnout. CONCLUSION: Burnout is associated primarily with a hypofunction of the HPA-axis, which is a neuro-endocrine characteristic of exhaustion, rather than of depression. However, further studies involving functional stress testing are needed in order to map the neuro-endocrine profile fully and to clarify the link with the deregulation of the immune system.

[Antipsychotic agents in the treatment of somatoform disorders; a review]. / Gebruik van antipsychotica bij somatoforme stoornissen; een literatuuroverzicht.

BACKGROUND: Antipsychotics are regularly prescribed in the treatment of somatoform disorders. Up till now there has not been any systematic review of the literature on this subject. AIM: To provide a review of the literature on the use of antipsychotic agents in patients with somatoform disorders. METHOD: Publications listed in PubMed database were retrieved and studied. The search terms used were the somatoform disorders and functional disorders in combination with 'antipsychotic agent' and all individual antipsychotics. RESULTS: L-sulpiride was effective in the treatment of functional dyspepsia in four randomised, controlled trials (rcts). There is only limited evidence for the effectiveness of flupentixolmelitracen in the treatment of functional dyspepsia and of amisulprid in the treatment of glossodynia. The other studies report the ineffectiveness of antipsychotics (in the treatment of body dysmorphic disorder) or they are methodologically poor studies which do suggest a slight positive effect (in fibromyalgia and in hypochondria). CONCLUSION: Recommendations about the effectiveness of antipsychotics in the treatment of somatoform disorders need to be differentiated according to the type of subcategory. There have been very few RCTs and typical antipsychotics have been studied more than atypical antipsychotics. Antipsychotics have proved effective in the treatment of functional dyspepsia.

Emotional processing in panic disorder and its subtypes: An fMRI study using emotional faces.

BACKGROUND: Inconsistent findings regarding the pathophysiology of panic disorder (PD) could result from clinical heterogeneity. Identifying subtypes could enhance insights into the neurobiological substrates of PD. METHODS: An emotional faces fMRI paradigm was used in a group of PD patients (n = 73) and healthy controls (n = 58). The overall PD group was further divided into three previously identified subtypes: a cognitive-autonomic (n = 22), an autonomic (n = 16) and an aspecific (n = 35) subtype. Differences in brain activity levels in response to emotional facial expressions between groups were examined for six regions of interests, namely the amygdala, ventromedial prefrontal cortex, anterior cingulate, fusiform gyrus, lingual gyrus and insula. RESULTS: PD patients showed lower activity in the rostral anterior cingulate in response to angry faces than healthy controls, which was mainly driven by the autonomic subtype. No significant differences were found in other brain regions when comparing PD patients with controls or when comparing across PD subtypes. LIMITATIONS: Sample sizes in subgroups were relatively small CONCLUSIONS: The role of the rostral anterior cingulate cortex for emotional processes critical in panic disorder is highlighted by this study and provides, albeit preliminary, evidence for the use of a subtype approach to advance our neurobiological insights in PD considering its involvement in the appraisal of autonomic viscero-sensory symptoms.

[Comorbid anxiety disorders and alcohol-related disorders in a population of bipolar I disorder: investigation in a Flemish population]. / Comorbide angststoornissen en stoornissen in alcoholgebruik bij bipolaire I-stoornis; onderzoek in een Vlaamse populatie.

BACKGROUND: Bipolar I disorder (bp i) is a very debilitating psychiatric disorder which is frequently associated with comorbid psychiatric and somatic disorders. Many studies in other countries show strongly elevated prevalences of anxiety disorders and alcohol-related disorders in the bp i population, but so far no data on this topic are available with regard to the Flemish population. AIM: To determine the prevalence of anxiety disorders and alcohol-related disorders in a Flemish population of bp i outpatients in remission and to find out whether comorbidity of these disorders is linked to the onset of the disorder at a younger age. METHOD: Sixty-nine bp i patients in remission were given structured interviews at home and the results were compared with the Belgian prevalence reported in the European Study of the Epidemiology of Mental Disorders (esemed) project. results Both the prevalence of the alcohol-related disorders (15 of 69 patients or 21.7%) and the prevalence of anxiety disorders (17 patients or 24.6%) were elevated compared to the general population (8.1 and 13.2% respectively). Among the anxiety disorders the prevalence was elevated for panic disorder, social phobia and post-traumatic stress disorder. No significant association was found between the comorbidity and the patient's age at the onset of the illness. CONCLUSION: The prevalence of anxiety disorders and alcohol-related disorders in an outpatient population of Flemish patients with bp i in remission is elevated.

[Aripiprazole and acute dystonia]. / Aripiprazol en acute dystonie.

The case of a patient who developed acute dystonia during treatment with aripiprazole prompted us to review the literature for reports on similar cases. From the literature we conclude that aripiprazole has a favourable profile as far as extrapyramidal side effects are concerned. However, the reports on extrapyramidal side effects in the literature may be incomplete. It is therefore still important that such cases are reported within the framework of post-marketing surveillance.

Differential electrophysiological correlates of panic disorder in non-pulsatile tinnitus.

AIMS: The prevalence of panic disorder (PD) reportedly is up to fivefold higher in people with tinnitus than it is in the general population. The brain networks in the two conditions overlap but the pathophysiological link remains unclear. In this study the electrophysiological brain activity is investigated in adults with non-pulsatile tinnitus with and without concurrent PD. METHODS: Resting-state EEGs of 16 participants with non-pulsatile tinnitus and PD were compared with those of 16 peers with non-pulsatile tinnitus without PD and as many healthy controls. The sLORETA technique was used to identify group-specific electrophysiological frequencies in the brain and to approximate the brain regions where differences occurred. The influence of distress was investigated and functional connectivity charted using the Region-of-Interest (ROI) approach (amygdala, anterior cingulate cortex (ACC), insula, precuneus). RESULTS: The comorbid group showed significantly diminished theta activity (p < 0.05) in the precuneus (BA7) compared to the tinnitus group without PD as well as in another region of the precuneus (BA31) as compared to the controls. Higher levels of distress influenced results in the tinnitus group without PD, while in those with PD a diminished connectivity was observed between the dorsal ACC and the other three ROIs as contrasted to the controls. CONCLUSIONS: Adults with non-pulsatile tinnitus and concurrent PD show differential brain activity patterns to tinnitus only sufferers and healthy controls. Higher levels of distress may modulate brain activity in the absence of PD. Screening for distress is recommended in both clinical and research settings.

[Psychopathology in female carriers of the fragile X mutation]. / Psychopathologie bij draagsters van de fragiele-X-mutatie.

Fragile X syndrome is, after Down's syndrome, the most common form of mental retardation. Women are potential carriers and can have the defective gene on one of their two X chromosomes without developing the complete syndrome. In this paper we examine which psychiatric disturbances may appear or develop in women because they are carriers of the fragile X mutation. Carriers have been found to have a higher frequency of anxiety disorders, affective disorders and schizotypal features.

[Benzodiazepines in the treatment of catatonia]. / Benzodiazepinen bij de behandeling van katatonie.

A patient who developed acute catatonia during benzodiazepine withdrawal is discussed. The case prompted us to review the literature on the role of benzodiazepines in the treatment of acute catatonia. Only retrospective and open studies were found which indicate that benzodiazepines do have a beneficial effect. Lorazepam is the most widely studied benzodiazepine and at present is the best treatment option. In the specific case of acute catatonia brought on by benzodiazepine withdrawal the recommended dosage is the same as for acute catatonia caused by something other than benzodiazepine withdrawal.