[Electroconvulsive therapy in the Netherlands: the practice in 2015 compared to that in 2008]. / Elektroconvulsietherapie in Nederland: de praktijk in 2015 vergeleken met die in 2008.

BACKGROUND: The most recent information about the use of ECT in the Netherlands dates from 2008. An update version of the guideline for the use of ECT in the Netherlands was issued in 2010. AIM: To obtain insight into the practice of ECT in the Netherlands five years after implementation of the guideline. METHOD: Our study is based on a questionnaire about the use of ECT by psychiatrists in all Dutch institutions (n=33). Questions concerned the use and availability of ECT as well as the implementation of the updated guideline; they also served as a check on the expertise and training of ECT-psychiatrists. RESULTS: All institutions responded. The total number of ECT-sessions performed in 2015 was 15,633, a 16% increase compared to 2008. In 2015 more institutions were using 7x24 ECT and more had an ECT-nurse available. Nearly all psychiatrists were acquainted at the time with the revised guideline of 2010 and nearly 50% of them had adjusted the way they practised ECT. However, just under 40% of psychiatrists did not have the correct knowledge about some technical details regarding ECT. CONCLUSION: The revised guideline on ECT and its implementation have most likely improved the practice of ECT in the Netherlands.

[Apathetic geriatric patient benefits from methylphenidate]. / Apathische kwetsbare oudere heeft baat bij methylfenidaat.

Two independent, home-dwelling geriatric patients presented with apathy at a general practice in the Netherlands and were seen by an elderly care physician after (non-)medical interventions had failed. Both patients were treated with low-dose methylphenidate. During treatment, apathy symptoms decreased and the patients became more active. Apathy is a frequent symptom of several neuropsychiatric diseases, depression and somatic conditions. Its incidence varies from 1.3% in healthy elderly people to more than 50% in the elderly with depression or dementia. In this clinical lesson we present these two cases and discuss considerations for treatment of apathy with methylphenidate.

[Music as an uninvited guest: the auditive variant of the Charles Bonnet syndrome]. / Muziek als ongenode gast: de auditieve variant van syndroom van Charles Bonnet.

Visually handicapped patients can be tormented by complex visual hallucinations (Charles Bonnet syndrome). Likewise, deaf patients and patients with impaired hearing can be plagued by auditory hallucinations, mostly involving music. Our article focuses on three female patients who suffered from musical hallucinations. In one of these patients the hallucinations ceased when her hearing was restored. In the second patient the hallucinations ceased when carbamazepine was prescribed. Quetiapine reduced the musical hallucinations in the third patient. The differential diagnoses and therapeutic options are discussed.

[Palliative care in a psychiatric-somatic care unit]. / Palliatieve zorg op een psychiatrisch-medische unit.

Patients with severe psychiatric and somatic disorders may require admission to a combined psychiatric-somatic care unit. These units provide specialised psychiatric and somatic care as well as palliative care. This is illustrated by two case reports. A 51-year-old man with a malignant brain tumour was admitted to our psychiatric-somatic care unit after threatening his wife and children. He was aggressive and confused. Seizures were suspected and palliative care was needed. Within a few weeks his condition deteriorated. He died 1 day after terminal sedation had been initiated. A 78-year-old woman was admitted to receive daily electroconvulsive treatment (ECT) for depression with catatonia. The ECT had to be interrupted repeatedly due to comorbid infections and complications. She died 3 days after palliative care was initiated.

[Psychoses and epilepsy. A case study]. / Psychosen en epilepsie.

Over the last few decades much research has been done into the raised level of psychiatric comorbidity in epilepsy. On the basis of a case study of a patient suffering from post-ictal psychoses we explain the psychiatric differential diagnosis within the framework of epilepsy and we investigate the frequent psychiatric side-effects of anticonvulsants. It is concluded that the links between epilepsy and psychiatric symptoms are complex and that the neuropsychiatry of epilepsy is concerned with syndromes that are unique and do notfit into modern psychiatric classification systems.

[Repeated suicide attempts: a need for continued care]. / Recidiverende suïcidepogers: hulp blijven aanbieden.

Prevention of deliberate self-harm, especially suicide attempts, remains difficult and this puts a great burden on the family as well as on the health-care professionals. The risk of a subsequent suicide attempt or a successful suicide is high while the behaviour is often met with antipathy, a feeling of helplessness and anger. This is in conflict with the needs of the patient; every suicide attempt requires the health-care professionals involved to exhibit a emphatic, patient and serious attitude, even when patients refuse to cooperate, are restless, aggressive or unwilling to communicate. Prevention of the suicidal behaviour can only be achieved this way.

[Perinatal asphyxia as incorrect explanation for mental retardation]. / 'Perinatale asfyxie' als onterechte verklaring voor mentale retardatie.

Three women, aged 21, 34 and 32 and with a family history of mental retardation said to be caused by perinatal asphyxia, each gave birth to a child with mental retardation. A chromosomal translocation, fragile X syndrome, and myotonic dystrophy could be diagnosed, respectively. In retrospect, the diagnosis of perinatal asphyxia in the family history had been too readily accepted. In reality the mental retardation was caused by a genetic disorder. Physicians are used to making a diagnosis, and when a diagnosis is not (yet) possible, they try to establish a working diagnosis or differential diagnosis. Too often such a working diagnosis becomes, through time, a definite diagnosis.

No evidence for paternal mtDNA transmission to offspring or extra-embryonic tissues after ICSI.

There is a risk that ICSI may increase the transmission of mtDNA diseases to children born after this technique. Knowledge of the fate and transmission of paternal mitochondrial DNA is important since mutations in mitochondrial DNA have been described in oligozoospermic males. We have used an adaptation of solid phase mini-sequencing to exclude the presence of levels of paternal mtDNA >0.001% in ICSI families. This method is more sensitive than those used in previous studies and is sufficient to detect the likely paternal contribution (approximately 0.1-0.5% from simple calculations of expected dilution during fertilization). Using this method, we were able to detect concentrations as low as 0.001% paternal mtDNA in a maternal mtDNA background. No paternal mtDNA was detected in the embryonic (blood or buccal swabs) tissue of children born after ICSI nor in extra-embryonic tissue (placenta or umbilical cord). In conclusion, we did not detect paternal mtDNA in blood, buccal swabs, placenta or umbilical cord of children born after ICSI. We have found no evidence that ICSI increases the risk of paternal transmission of mtDNA and hence of mtDNA disorders.