[A case-report on catatonia: a prevalent but under-recognised psychiatric illness]. / Katatonie: een veelvoorkomend, maar weinig herkend ziektebeeld.

We describe the case of a 63-year-old female patient with schizoaffective disorder who spent more than two months in two different psychiatric wards because of an unrecognised psychiatric illness. Ultimately, the patient was referred to the psychiatric ward of the university hospital where she was treated for catatonia with electroconvulsive therapy (ect). Three treatments with ect led to a full recovery of the patient.

[Cognitive dysfunction in bipolar disorder: determinants and functional outcome]. / Cognitieve stoornissen bij patiënten met een bipolaire stoornis: determinanten en consequenties.

BACKGROUND: Research into the nature and extent of cognitive dysfunction in patients suffering from bipolar disorder has increased greatly over the last 10 years because the dysfunction is known to persist even if the mood symptoms are in remission and can influence a patient's psychosocial functioning. AIM: To provide an overview of 1) the nature and extent of cognitive dysfunction in bipolar patients; 2) clinically relevant factors such as illness characteristics, comorbidity and psychotropic/psychoactive drugs and 3) the consequences of cognitive dysfunction. METHOD: We searched the literature in PubMed using the following search terms: bipolar disorder, neuropsychological, cognitive functioning, cognition, functional outcome, determinants, psychotropic/psychoactive drugs. RESULTS: Attentional deficits, memory lapses and aberrant executive functioning occur in both manic and depressive episodes, and may persist even in absence of mood symptoms. The precise cause of cognitive dysfunction is unknown. Persistent cognitive dysfunction frequently interferes with daily functioning. CONCLUSION: Since the treatment of bipolar patients is nowadays directed towards complete recovery rather than symptomatic remission, it is important to take into account the possibility that these patients are also suffering from cognitive dysfunction.

A 2-year naturalistic study on cognitive functioning in bipolar disorder.

OBJECTIVE: Cognitive alterations in bipolar disorder may reflect genetic influence. However, to what degree mood, medication, thyroid function and other factors impact on longitudinal cognitive functioning remains unclear. METHOD: A group of patients with bipolar (spectrum) disorder (n = 76) underwent two monthly cognitive assessments over a 2-year period in a prospective, repeated measures design. Regression models were used to investigate associations with predictors, corrected for multiple testing. RESULTS: Patients with bipolar disorder performed worse than healthy controls (n = 61) on all cognitive domains tested. Effect sizes were small, with a maximum of -0.36 for sustained attention. However, cognitive performance varied substantially over the 2-year follow-up, co-varying with subjective cognitive complaints and impacting on functioning. Alterations in sustained attention and motor speed were the only impairments that were invariant over time. Predictors had very limited explanatory power on temporal variation in cognition. Use of second-generation antipsychotics was associated with the largest negative effects on cognition, which were evident in the areas of motor speed and basic information processing (-0.35 < ß < -0.5). CONCLUSION: Cognitive function in bipolar disorder varies significantly over time, largely independent of clinical factors. The temporal stability of sustained attention is the exception, suggesting it may represent a possible candidate intermediary phenotype.

Meta-analyses of cognitive functioning in euthymic bipolar patients and their first-degree relatives.

BACKGROUND: Previous work suggests that impairments in executive function and verbal memory in particular may persist in euthymic bipolar patients and serve as an indicator of genetic risk (endophenotype). METHOD: A systematic review of the literature was undertaken. Effects sizes were extracted from selected papers and pooled using meta-analytical techniques. RESULTS: In bipolar patients, large effect sizes (d>0.8) were noted for executive functions (working memory, executive control, fluency) and verbal memory. Medium effect sizes (0.5

Lithium induced cognitive side-effects in bipolar disorder: a qualitative analysis and implications for daily practice.

Qualitative analysis of the literature on cognitive side-effects of lithium in patients with a bipolar disorder identified four of 17 studies that fulfilled criteria of adequate methodological quality. Analysis of these four studies showed that lithium had a negative effect on memory and speed of information processing, often without subjective complaints or awareness of mental slowness. The consequences of these findings for daily practice are discussed, in particular with respect to driving performance. When neurocognitive complaints or deficits are present, lithium plasma level, thyroid functions and degree of mood disturbance should be assessed. In cases where all these parameters are within normal limits and neurocognitive complaints still persist, dose reduction of lithium, thyroid hormone addition, prescription of a slow release preparation or replacement of lithium by another moodstabiliser should be considered. Guidelines are suggested with respect to further neuropsychological screening.

Cadmium, zinc, lead, and copper in livers and kidneys of cattle in the neighbourhood of zinc refineries.

Cattle in the Kempen area (in the province North-Brabant, the Netherlands) were investigated for cadmium, lead, zinc, and copper in livers and kidneys. The animals originated from farms located within a 20 km radius around several zinc refinery plants. The local soil is polluted with zinc and cadmium because of a thermal refining process used in the past.Mean cadmium organ concentrations were 2.5 times, and mean lead organ concentrations were 1.5 times higher than the concentrations found in controls. Copper levels tended to be decreased, but zinc levels did not differ from controls.The observed cadmium and lead organ concentrations did not indicate intoxication of the animals, but 22% of the kidneys and 3% of the livers investigated trespassed the maximum tolerance limit of cadmium with regard to human consumption.Continuous control of cadmium organ contents in organs from slaughtercattle kept in cadmium-polluted areas is recommended.

Aminopyrine N-demethylation by rats with liver cirrhosis. Evidence for the intact cell hypothesis. A morphometric-functional study.

The intact cell hypothesis states that a reduced number of intrinsically normal hepatocytes, together with hemodynamic alterations, explains decreased drug metabolism in cirrhosis. We explored this hypothesis by comparing results of the aminopyrine breath test with in vitro measurements of aminopyrine N-demethylation and morphometrically determined liver cell volume in a rat model of cirrhosis. Aminopyrine N-demethylation in vivo (ABT-k) was 0.98 +/- 0.10/h (mean +/- SD) in controls. The cirrhotic rats were separated into those with normal (NCR) and those with abnormal ABT-k (PCR). Microsomal aminopyrine N-demethylase averaged 2.08 +/- 0.77 and 2.09 +/- 0.54 mumol/min in controls and NCRs, respectively; it was reduced to 1.00 +/- 0.81 mumol/min (p less than 0.02) in PCRs. Morphometrically determined hepatocellular volume was 18.8 +/- 2.8, 17.1 +/- 1.9, and 11.6 +/- 6.1 ml in controls, NCRs, and PCRs, respectively, PCRs being lower than controls (p less than 0.01) and NCRs (p less than 0.05). When N-demethylase and cytochrome P450 were related to hepatocellular volume (in milliliters), no significant difference between the three groups was apparent. We conclude that reduced aminopyrine N-demethylation in progressed cirrhosis is mainly due to a loss of liver cell volume. The function per liver cell volume remains constant, however, thus favoring the intact cell hypothesis for the handling of slowly metabolized compounds such as aminopyrine.