[Frontal lobe epilepsy or a psychogenic disorder? The importance of taking a good patient history]. / Frontale epilepsie of een psychogene aandoening?

BACKGROUND: Frontal lobe epilepsy (FE) is a diagnosis which can be easily missed due to the variety in symptoms. The symptoms depend on the location of the epileptical activity in the frontal lobe. CASE DESCRIPTION: A 48-year-old man of Moroccan descent is diagnosed with frontal epilepsy, but this diagnosis is rejected based on the 24-hours EEG. Instead he is diagnosed with psychogenic non-epileptic seizures (PNES). Upon this diagnosis, he develops reactive depressive symptoms and he is referred to the psychiatrist. However, based on the clinical presentation the diagnosis PNES is overruled and replaced with frontal lobe epilepsy. The patient recovers when he is treated with valproic acid. CONCLUSION: The article describes the symptoms of FE and those of PNES. This case description demonstrates the difficulties and illustrates the importance of a good history when diagnosing FE.

Updated European Consensus Statement on diagnosis and treatment of adult ADHD.

Background Attention-deficit/hyperactivity disorder (ADHD) is among the most common psychiatric disorders of childhood that often persists into adulthood and old age. Yet ADHD is currently underdiagnosed and undertreated in many European countries, leading to chronicity of symptoms and impairment, due to lack of, or ineffective treatment, and higher costs of illness. Methods The European Network Adult ADHD and the Section for Neurodevelopmental Disorders Across the Lifespan (NDAL) of the European Psychiatric Association (EPA), aim to increase awareness and knowledge of adult ADHD in and outside Europe. This Updated European Consensus Statement aims to support clinicians with research evidence and clinical experience from 63 experts of European and other countries in which ADHD in adults is recognized and treated. Results Besides reviewing the latest research on prevalence, persistence, genetics and neurobiology of ADHD, three major questions are addressed: (1) What is the clinical picture of ADHD in adults? (2) How should ADHD be properly diagnosed in adults? (3) How should adult ADHDbe effectively treated? Conclusions ADHD often presents as a lifelong impairing condition. The stigma surrounding ADHD, mainly due to lack of knowledge, increases the suffering of patients. Education on the lifespan perspective, diagnostic assessment, and treatment of ADHD must increase for students of general and mental health, and for psychiatry professionals. Instruments for screening and diagnosis of ADHD in adults are available, as are effective evidence-based treatments for ADHD and its negative outcomes. More research is needed on gender differences, and in older adults with ADHD.

Manic episode, thyroid gland function and lithium.

This paper addresses the issue of (recurrent) mania in relation to an increased T4-value, whether or not influenced by lithium. Lithium has an anti-TSH-effect on the thyroid gland by inhibiting the intracellular enzyme adenylate cyclase. This might cause hypothyroidism. Moreover, lithium is also known to have a direct stabilizing effect on (behavioral manifestations) of dopamine receptor supersensitivity. The hypothesis regarding the relation between thyroid function and affective disturbances is that the altered thyroid function may cause a change in the availability of the central dopamine receptors. Dopamine is known to be able to cause a manic state. TSH and TRH are also involved in this mechanism. It is, therefore, very likely that an increased thyroid function, whether or not caused by discontinuation of lithium-therapy, could induce a (recurrent) mania.

Overt hepatic encephalopathy precipitated by zinc deficiency.

Encephalopathy in liver disease may be unresponsive to protein restriction, lactulose, and neomycin. Zinc supplements have been reported to improve psychometric performance in liver cirrhosis, but the importance of zinc deficiency in overt hepatic encephalopathy has not yet been clearly established. A patient with severe recurrent hepatic encephalopathy was studied to determine the relation between her signs of encephalopathy and zinc deficiency. The study included a period in which zinc deficiency was artificially induced by oral histidine. An episode of overt encephalopathy occurred that was identical to earlier episodes and responded to oral zinc. The study showed an association between encephalopathy and zinc deficiency by successive zinc depletion and supplementation regimens. Long-term zinc supplementation improved severe recurrent hepatic encephalopathy and therefore the quality of life.