[Minocycline for schizophrenia: a brief overview]. / Minocycline bij schizofrenie: een beknopt overzicht.

BACKGROUND: The tetracyclic antibiotic minocycline appears to have positive results when added to the the treatment prescribed for persistent symptoms of schizophrenia. AIM: To provide an overview of the literature on minocycline and schizophrenia. METHOD: PubMed, up to September 2013, was scanned for articles relating to minocycline and schizophrenia. RESULTS: We found seven case reports with regard to the use of minocycline as an additive in the treatment of persistent schizophrenia. Furthermore, an open-label study and two randomised placebo-controlled studies regarding this addition were published. Using minocycline may add to the improvement of negative symptoms and cognition in patients with schizophrenia. CONCLUSION: It is concluded, albeit somewhat cautiously, that minocycline may be helpful in treating negative and cognitive symptoms in schizophrenia.

[Treatment of clozapine-induced tachycardia with propranolol complicated by psoriasis]. / Behandeling van clozapinegeïnduceerde tachycardie met propranolol gecompliceerd door psoriasis.

A 25-year-old male developed sinus tachycardia after given clozapine for treatment-resistant psychosis in schizophrenia. The tachycardia was treated successfully with propranolol for several weeks. The patient developed skin eruptions, later diagnosed as psoriasis. Propranolol is known to be capable of causing, evoking or aggravating psoriasis. Several other drugs commonly used in psychiatric practice are also known to cause psoriasis. Doctors need to be aware to the possible side effects of such drugs because they can jeopardise the patient's wellbeing and reduce the efficacy of psychiatric treatment.

[Psychiatric diagnosis by telephone?]. / Psychiatrische diagnostiek via de telefoon?

BACKGROUND: The fact that more and more interviews are being conducted on the phone suggests that phone interviews are just as valid as face-to-face interviews. AIM: To discuss the literature on the assessment of psychiatric patients with depressive disorder when there is no personal contact between psychiatrists and patient. METHOD: We searched the literature using PubMed and the snowball method so that we could make comparisons between face-to-face interviews and phone interviews. We only consulted the literature that dealt with the diagnosis of depressive symptoms. RESULTS: Some advantages are to be gained from diagnosis by telephone, but in the case of psychiatric diagnoses there are considerable disadvantages. The absence of visual cues is a major impediment to accurate diagnosis. CONCLUSION: Psychiatrists need to come face-to-face with their patients. The face-to-face interview is still 'the gold standard' for making diagnoses in psychiatry.

Substantial skin disorders in psychiatric illness coincide with diabetes and addiction.

BACKGROUND: Dermatological diseases in psychiatric patients are common; however, epidemiological data on this subject are scarce and to our knowledge integral studies of dermatological disease in psychiatric inpatients are not available yet. AIM: The aim of this study was to describe the incidence of dermatological problems in psychiatric inpatients. METHOD: This study evaluates the consultations for new dermatological problems by inpatients of a general psychiatric hospital of over 700 beds during a 6-month period. RESULTS: A total of 255 patients consulted their physician because of a new dermatological problem. Diagnoses (n=360) included skin infections (32%), accidents (7%), decubitus ulcers (7%), complications of medical treatment (3%), auto mutilation (1%) and neoplasms of the skin (1%). Patients with skin infections were likely to have diabetes [odds ratio (OR)=3.6; 95% confidence interval (CI): 1.56-8.40]. Patients with decubitus ulcers were likely to have an addiction problem (OR=6.4; 95% CI: 1.46-28.00). Dermatitis was associated with affective disorder (OR=2.5; 95% CI: 1.12-5.43) but not with psychosis (OR=0.5; 95% CI: 0.23-0.90). Only a poor correlation existed between the length of hospital stay and skin problems. CONCLUSIONS: Dermatological problems are common in hospitalized psychiatric patients. Patients with diabetes mellitus are at high risk for skin infections. There are significant relationships between the psychiatric and the dermatological diagnoses. The length of the admission to a psychiatric hospital does not seem to play a major role in skin diseases.

Skin disorders in chronic psychiatric illness.

BACKGROUND: Chronic psychiatric patients are prone to develop skin diseases. However, epidemiological data are scarce. OBJECTIVE: To describe the prevalence of skin complaints and dermatological disorders in residential psychiatric patients. METHODS: Ninety-one randomly chosen patients of the residential wards of a general psychiatric hospital completed a short, structured interview concerning skin disease and underwent a physical examination of the skin. RESULTS: Of the examined patients, 69% reported symptoms of skin disease in the month prior to the interview and 77% had skin disorders at physical examination. In 34 (37%) patients, skin disorders were diagnosed, which were not mentioned in the interview. Patients with diabetes had infectious skin disease more often than their fellow patients [odds ratio (OR) 10.9; 95% confidence interval (CI): 2.40-49.75]. Moreover, overweight patients had infectious skin disease more often (OR 7.4; 95% CI: 1.38-39.3). Women reported more skin complaints (OR 6.4: 95% CI: 1.67-24.2), and also had skin problems other than infection, tumours or dermatitis more frequently (OR 3.7; 95% CI: 1.34-10.14). Clozapine use was associated with benign neoplasms of the skin. The nature of this association remains unclear and merits further investigation. CONCLUSIONS: Many chronic psychiatric patients have skin problems. Clinical examination of the skin is important to discover these problems. Patients with diabetes mellitus are particularly at risk for skin infections. Because of their relationship with overweight and diabetes mellitus, atypical antipsychotics may be partly responsible for these serious complications. Only a few other relationships between psychiatric medication and specific skin problems were found.

[Mental and physical health problems of, and the use of healthcare by, Afghan, Iranian and Somali asylum seekers and refugees]. / Psychische en lichamelijke gezondheidsproblemen van en gebruik van zorg door Afghaanse, Iraanse en Somalische asielzoekers en vluchtelingen.

OBJECTIVE: To estimate the prevalence rates of mental and physical health problems and the use of healthcare services among adult asylum seekers and recognised refugees from Afghanistan, Iran and Somalia in the Netherlands. DESIGN: Cross-sectional study. METHOD: Asylum seekers were approached in 14 reception centres and refugees were interviewed in 3 municipalities (Arnhem, Leiden and Zaanstad). Respondents were interviewed in their own language and asked questions pertaining to: general health, chronic complaints, symptoms of post-traumatic stress disorder (PTSD), symptoms of depression/ anxiety, the use of healthcare services (general practitioner, medical specialists, hospitalisation, mental-health services, medication) and background variables. RESULTS: A total of 232 asylum seekers and 178 refugees participated (response rates of89% and 59%, respectively). Of these, 142 (61%) and 99 (56%), respectively were males and the average age was 34.4 (SD: 11.o) and 40.3 (SD: 13.3) years, respectively. Compared to refugees, asylum seekers more often considered their health to be poor (42% and 59%, respectively), had more symptoms of depression/anxiety (39% and 68%, respectively), and had more symptoms of PTSD (11% and 28%, respectively). No differences were found between refugees and asylum seekers in the self-reported use of healthcare services. CONCLUSION: This study showed that asylum seekers have more health problems than refugees, but that there are no differences in the self-reported use of healthcare services. More research is needed to answer the question ifasylum seekers have sufficient access to the healthcare system.

[Movement disorders in clinical research]. / Bewegingsstoornissen meten bij klinisch onderzoek.

Measuring (extrapyramidal) psychotic disorders often is a highly relevant part of clinical research into the course and treatment of movement disorders. Traditionally these disorders have always been assessed on the basis of a well-known set of rating scales. The limitations and shortcomings of these scales are discussed in the article. It is argued that a new standard instrument needs to be developed for the measurement of movement disorders. The SADIMOD can be regarded as a good starting point for the development of such an instrument.

Oral risperidone with lorazepam versus oral zuclopenthixol with lorazepam in the treatment of acute psychosis in emergency psychiatry: a prospective, comparative, open-label study.

Acutely psychotic patients presenting as psychiatric emergencies with aggression or agitation are often administered conventional antipsychotics intramuscularly. However, patients view intramuscular administration as coercive, and conventional antipsychotics are often associated with adverse events. In this open study, consecutive adult patients presenting with an acute exacerbation of schizophrenia or other psychotic disorder were assigned to oral risperidone 2-6 mg/day (n = 48) or oral zuclopenthixol 20-50 mg/day (n = 27) for 7-14 days. Lorazepam (either oral or intramuscular) was administered to both groups as needed. Patients were assessed regularly until day 14 or discharge. Mean Positive And Negative Syndrome Scale (PANSS) aggression scores (sum of item scores on excitement, poor impulse control, hostility and uncooperativeness) decreased steadily and similarly in both groups; the mean changes from baseline were statistically significant at days 10 and 14 and at study end-point. The mean decrease at study end-point in the PANSS component score for hostility was statistically significant in the risperidone group, but not in the zuclopenthixol group. Social Dysfunction and Aggression Scale aggression scores and Clinical Global Impression scores decreased significantly and similarly in both groups. Overall, 18.7% of patients showed minor extrapyramidal symptoms during the study, but only 16.7% of risperidone-treated patients, compared to 59.3% of zuclopenthixol-treated patients, received anti-parkinsonian medication (p < 0.001). Lorazepam was administered to all of the patients assigned to risperidone and to 89% of those assigned to zuclopenthixol. Oral risperidone plus lorazepam is a convenient, effective and well-tolerated alternative to conventional antipsychotics for the treatment of acute psychosis in emergency psychiatry.

Self-rating inventory for posttraumatic stress disorder: review of the psychometric properties of a new brief Dutch screening instrument.

The Self-rating Inventory for Posttraumatic Stress Disorder of 22 items was developed for use with populations without identified traumatic experiences. The inventory has been used extensively in survey research in The Netherlands. This paper examines the psychometric properties. In four different groups (trauma and psychiatric patients, elderly Dutch subjects, former peacekeepers, and medical students) internal consistency, test-retest reliability, concurrent and discriminant validity, and sensitivity and specificity are analyzed. The inventory showed good internal consistency, test-retest reliability, concurrent and discriminant validity, and high sensitivity and specificity. It appears to be valuable for survey research on posttraumatic stress in nonselected populations. As a screening device, high sensitivity for PTSD symptoms is evident even when the traumatic event has not been defined.

Posttraumatic stress symptoms in refugees: assessments with the Harvard Trauma Questionnaire and the Hopkins symptom Checklist-25 in different languages.

The original versions of the Harvard Trauma Questionnaire and Hopkins Symptoms Checklist-25 were written and subsequently validated in the Cambodian, Laotian, and Vietnamese languages. For use in a Dutch treatment center, with refugee patients mostly speaking other languages, additional translations were made. The objective of this study was examination of the psychometric properties of some of these new translations, i.e., the Arabic, Farsi, Serbo-Croatian, Russian, and English bilingual adaptations. It is concluded that the psychometric properties of both tests are adequate across those different cultures and are, in general, applicable to measure symptoms of depression, anxiety, and posttraumatic stress disorder.

A cross-national study of posttraumatic stress disorder in Dutch-Australian immigrants.

OBJECTIVE: Studying the rates of posttraumatic stress disorder (PTSD) in people who experienced World War II, but who have subsequently lived in different environments is a way of looking at the impact of recovery environment on PTSD. Immigrants had less support in terms of the social cohesion in their home country, but were not subjected to the same triggers of war-related intrusions. METHOD: Posttraumatic stress disorder was investigated in citizens from the Netherlands who emigrated to Australia in the post-World War II years (n = 251). Immigrants born between 1920 and 1930 (n = 171) were compared with a same-aged group living in Holland (n = 1461) for stressful war experiences and the extent of PTSD. RESULTS: Those who had been exposed to the most severe war stress were overrepresented in the immigrant group. Immigrants with current PTSD more often stated that motives for migration were threat of a third world war, disappointment with Dutch society and personal problems. We were unable to demonstrate specific effects of emigration on the prevalence of current PTSD. CONCLUSIONS: This study suggests that exposure to severe war stress promoted the need to emigrate. The comparable PTSD scores of the groups of war victims living in Australia and the Netherlands support the notion that extreme war stress may be considered the primary determining factor in the development of PTSD, and that actual post-war living circumstances are, in the long term, of subordinate importance.

Test-retest reliability of the self-rating inventory for posttraumatic stress disorder.

The Self-rating Inventory for Posttraumatic Stress Disorder is a 22-item self-report questionnaire to give a diagnosis for PTSD based on DSM-IV criteria. Originally, the questionnaire was standardized with trauma survivors and psychiatric patients. Here test-retest reliabilities with 90 medial students are reported for 15 (.79) and 19 days (.97). As expected, the stability was slightly less for 34 days (.60).

Test-retest reliability of the trauma and life events self-report inventory.

Three groups of first-year male and female medical students (total N = 90) completed the Trauma and Life Events Self-report Inventory twice. Test-retest reliability for the three different time periods was .82, .89, and .75, respectively.

[Psychiatric symptoms in refugees reported to the Psychiatric Center De Vonk]. / Psychiatrische symptomen bij vluchtelingen aangemeld bij het psychiatrisch centrum De Vonk.

OBJECTIVE: To determine traumatic experiences and psychological symptoms in refugees reported to the psychiatric centre De Vonk, and the relationship between biographical data, experiences of violence and post-traumatic stress symptoms on the one hand and the referral or admission policy on the other. DESIGN: Descriptive. SETTING: Centre '45, refugee unit De Vonk (department for the treatment of traumatized refugees and asylum seekers), Noordwijkerhout, the Netherlands. The psychiatric centre De Vonk comprises, apart from an outpatient clinic and a daytime clinic, a department created for the clinical treatment of refugees with symptoms related to traumatization. METHODS: The main biographical and background data were collected. The first interview was routinely preceded by the Harvard trauma questionnaire (HTQ) and the Hopkins symptom checklist (HSCL-25), if necessary with the aid of an interpreter. The HTQ measures experiences of violence and post-traumatic stress symptoms; the HSCL-25 comprises an anxiety scale and a depression scale. RESULTS: Biographical data were obtained from 232 patients and questionnaire data from 169 patients. The population was heterogeneous as regards region of origin, duration of the stay in the Netherlands, education and age. Serious forms of violence were reported, such as abuse, torture and war violence, and many symptoms of anxiety and depression were mentioned. The scores for posttraumatic stress symptoms exceeded the clinical reference values in 82% in the group examined. Of the referred patients, 37% were admitted to the clinic. CONCLUSION: In spite of the diversity of language, culture and education among the refugees/asylum seekers referred to De Vonk, it proved adequately possible in practice to use standardized psychological and psychiatric instruments in this group of patients. The symptom level of the patients referred was particularly high.

Reported physical health in resistance veterans from World War II.

Male Dutch Resistance veterans from World War II who reported on chronic diseases were compared with subjects from a population survey. Resistance veterans in general reported significantly more disease. Veterans with symptoms of posttraumatic stress disorder reported more disease than those who had none. Furthermore, 13 specific disease categories were more prevalent in the Resistance veterans than in the general population. In the Resistance veterans total number of reported diseases was significantly correlated with anxiety, depression, and posttraumatic stress disorder. In Resistance veterans weekly tobacco use was comparable to that of the control subjects, but alcohol consumption was significantly less.