[In- and out-of-hospital emergency psychiatry: what is the best approach?] / Acute psychiatrie binnen en buiten het ziekenhuis.

A range of clinical syndromes may present with psychiatric symptoms, both in and out of hospital settings. In such situations agitation, suicidality, communication difficulties and legal aspects often play a role, making diagnosis and treatment a challenge. Based on several case studies, we illustrate how the recently-published Dutch open access source 'Acute Psychiatry' (www.acutepsychiatrie.com) can be of help in acute psychiatric presentations both within and outside psychiatric hospitals.

Educational achievement in psychiatric patients and their siblings: a register-based study in 30 000 individuals in The Netherlands.

BACKGROUND: Poor educational achievement is associated with a range of psychiatric disorders. Several studies suggest that this underperformance is due to cognitive deficits that commence before disease onset and reflect a genetic risk for this disorder. However, the specificity and the familial contribution of this cognitive deficit are not clear. We analysed lifetime educational achievement of psychiatric patients diagnosed with schizophrenia, bipolar or depressive disorder and their unaffected siblings. METHOD: In a register-based case-control study, 1561 patients with schizophrenia, 813 patients with bipolar disorder, 8112 patients with depression, and their siblings were each matched with eight population controls. Patients, siblings and controls were compared on the highest educational stream they completed. RESULTS: Lower educational achievement was present in schizophrenia patients from primary school onwards [completing primary school: odds ratio (OR) 0.69; completing secondary school: OR 0.69; completing academic education: OR 0.46], compared to patients with bipolar disorder or depression. Siblings of schizophrenia, bipolar or depressed patients showed no underachievement at primary or secondary school, but siblings of schizophrenia patients as well as siblings of depressed patients were less successful in their educational achievement after secondary school (completing academic education, schizophrenia siblings: OR 0.90; depressive disorder siblings: OR 0.91). CONCLUSIONS: Educational underachievement from primary school onwards is specifically related to schizophrenia and not to bipolar disorder or depression. Moreover, it appears to be a harbinger of the illness, since it is not found in their siblings. These results add to evidence that early cognitive deficits are a distinct feature of the schizophrenia phenotype.

Cigarette smoking and cannabis use are equally strongly associated with psychotic-like experiences: a cross-sectional study in 1929 young adults.

BACKGROUND: Cannabis use is associated with increased risk for psychotic-like experiences (PLEs) and psychotic disorders. It remains unclear whether this relationship is causal or due to confounding. METHOD: A total of 1929 young adults aged 18-30 years participated in a nationwide internet-based survey in The Netherlands and gave information on demographics, substance use and parental psychiatric illness and completed the Community Assessment of Psychic Experiences (CAPE). RESULTS: Cigarette smoking and cannabis use were equally strongly associated with the frequency of PLEs in a fully adjusted model (ß = 0.098 and 0.079 respectively, p < 0.05). Cannabis use was associated with distress from PLEs in a model adjusted for an elaborate set of confounders excluding smoking (ß = 0.082, p < 0.05). However, when cigarette smoking was included in the model, cannabis use was not a significant predictor of distress from PLEs. Cigarette smoking remained associated with distress from PLEs in a fully adjusted model (ß = 0.107, p < 0.001). CONCLUSIONS: Smoking is an equally strong independent predictor of frequency of PLEs as monthly cannabis use. Our results suggest that the association between moderate cannabis use and PLEs is confounded by cigarette smoking.

Cannabis use as an indicator of risk for mental health problems in adolescents: a population-based study at secondary schools.

BACKGROUND: Although the association between cannabis use and a wide range of psychiatric symptoms is fairly well established, it is not clear whether cannabis use is also a risk factor for general mental health problems at secondary school. Method A total of 10 324 secondary school children aged 11-16 years, participating in an ongoing Public Health Service School Survey, gave information on demographics, substance use, school factors and stressful life events and completed the Strengths and Difficulties Questionnaire (SDQ). RESULTS: Cannabis use in the past month was associated with a clinically relevant score on the SDQ [unadjusted odds ratio (OR) 4.46, 95% confidence interval (CI) 3.46-5.76]. Other risk factors associated with poor psychosocial functioning were: a low level of education, alcohol use, cigarette smoking, hard drug use, frequent truancy, an unfavourable school evaluation, feeling unsafe at school, being victimized, frequent absence due to illness, a mentally ill parent, molestation by a parent, financial problems and feeling distressed by an adverse event. In a full model adjusting for these risk factors, cannabis was not significantly associated with mental health problems, although an association at trend level was apparent. Of these risk factors, regular alcohol use, cigarette smoking, hard drug use, frequent truancy, an unfavourable school evaluation and frequent absence due to illness were also associated with cannabis use. CONCLUSIONS: The association between cannabis use and poor psychosocial functioning in adolescence is due, at least in part, to confounding by other risk factors. Thus, cannabis use can best be viewed as an indicator of risk for mental health problems in adolescence.