Normal, dust-obscured galaxies in the epoch of reionization.

Over the past decades, rest-frame ultraviolet (UV) observations have provided large samples of UV luminous galaxies at redshift (z) greater than 6 (refs. 1-3), during the so-called epoch of reionization. While a few of these UV-identified galaxies revealed substantial dust reservoirs4-7, very heavily dust-obscured sources at these early times have remained elusive. They are limited to a rare population of extreme starburst galaxies8-12 and companions of rare quasars13,14. These studies conclude that the contribution of dust-obscured galaxies to the cosmic star formation rate density at z > 6 is sub-dominant. Recent ALMA and Spitzer observations have identified a more abundant, less extreme population of obscured galaxies at z = 3-6 (refs. 15,16). However, this population has not been confirmed in the reionization epoch so far. Here, we report the discovery of two dust-obscured star-forming galaxies at z = 6.6813 ± 0.0005 and z = 7.3521 ± 0.0005. These objects are not detected in existing rest-frame UV data and were discovered only through their far-infrared [C II] lines and dust continuum emission as companions to typical UV-luminous galaxies at the same redshift. The two galaxies exhibit lower infrared luminosities and star-formation rates than extreme starbursts, in line with typical star-forming galaxies at z ≈ 7. This population of heavily dust-obscured galaxies appears to contribute 10-25% to the z > 6 cosmic star formation rate density.

[Frontotemporal dementia diagnoses within the psychiatric practice: pitfalls and practical tools]. / Diagnostiek van frontotemporale dementie in de psychiatrische praktijk: handvatten en valkuilen.

BACKGROUND: The behavioural variant of frontotemporal dementia (bvFTD) strongly resembles primary psychiatric disorders. Furthermore, a bvFTD mimic may occur, without neurodegenerative aetiology. AIM: To offer psychiatrist clinical tools for making or ruling out a bvFTD diagnosis. METHOD: To present the results of the first prospective cohort study on bvFTD patients and primary psychiatric patients. Results are discussed within the context of the international literature. RESULTS: Frontotemporal atrophy on imaging confirms a suspected bvFTD diagnosis. Merely fulfilling the bvFTD clinical criteria, with or without frontotemporal hypometabolism on functional imaging, may also result from primary psychiatric disorders or the bvFTD-phenocopy syndrome. A high level of stereotypy, hyperorality, a low level of depressive symptoms, impaired social cognition or absent insight increases the probability of bvFTD. Biomarker or genetic tests and follow-up are recommended. CONCLUSIONS A bvFTD diagnosis should be made multidisciplinary. Without the confirmation of atrophy or genetics, great reserve in making the diagnosis is in place and careful analyses for psychiatric aetiologies is advised.

[Proactive cognitive psychiatry while aging]. / Proactieve cognitieve psychiatrie bij het ouder worden.

BACKGROUND: COGNITIVE SYMPTOMS ARE COMMONLY REPORTED IN PATIENTS WITH UNIPOLAR OR BIPOLAR MOOD DISORDER. THE PREVALENCE OF COGNITIVE SYMPTOMS INCREASES WITH AGEING. THE PRESENCE AND EXTENT OF COGNITIVE SYMPTOMS HAS A DIRECT NEGATIVE IMPACT ON RECOVERY OF THE PSYCHIATRIC ILLNESS AND QUALITY OF LIFE.
AIM: IMPROVING OUTCOME OF OLDER PATIENTS WITH A UNIPOLAR OR BIPOLAR MOOD DISORDER.
METHOD: REVIEW OF AVAILABLE INTERVENTIONS TO IMPROVE COGNITIVE FUNCTIONING DIRECT OR INDIRECT.
RESULTS: STRATEGY TRAINING, TRAINING OF COGNITIVE FUNCTIONS AND PHYSICAL EXERCISE HAVE SHOWN TO BE EFFECTIVE TO IMPROVE COGNITIVE FUNCTIONING AND ITS POSSIBLE ADVANTAGES FOR PSYCHIATRIC POPULATIONS ARE CURRENTLY STUDIED IN THE NETHERLANDS. TREATMENT OF COMORBID INSOMNIA BY COGNITIVE BEHAVIORAL THERAPY MAY IMPROVE COGNITIVE FUNCTIONING INDIRECTLY BY DISCONTINUATION OF SLEEP MEDICATION, IMPROVEMENT OF SLEEP AND MOOD RELATED COGNITIVE SYMPTOMS.
CONCLUSION: A PROACTIVE APPROACH, INCLUDING SCREENING AND TREATMENT OF COGNITIVE SYMPTOMS BEFORE IMPAIRMENT OCCURS, IS WARRANTED TO OPTIMIZE OUTCOME OF THE AGEING PSYCHIATRIC PATIENT. TIJDSCHRIFT VOOR PSYCHIATRIE 63(2021)2, 120-124.

Long-term neurocognitive functioning after electroconvulsive therapy in patients with late-life depression.

OBJECTIVE: There is ongoing concern about the possible negative impact of ECT on neurocognitive functioning in older patients. In this study, we aimed to characterize the long-term cognitive effects of ECT in patients with late-life depression, using an extensive neuropsychological battery. METHODS: A total of 110 patients aged 55 years and older with unipolar depression, referred for ECT were included. The neuropsychological test battery was assessed prior to ECT and 6 months after the last ECT session. RESULTS: There were no statistically significant group-level changes from baseline to 6 months post-ECT in any of the neuropsychological measurements. Individual differences in cognitive performance were detected using the Reliable Change Index. CONCLUSION: Patients with late-life depression do not show deleterious cognitive effects 6 months following an ECT index course, although there are considerable differences at an individual level. Clinicians should not hesitate to prescribe ECT in older patients, as most of these patients will tolerate the treatment course and a small group will even experience a cognitive enhancement. However, clinicians should be aware that a small group of patients can experience cognitive side-effects. Further study is needed to predict which patients have a higher risk of developing cognitive side-effects.

[Older patients with a bipolar disorder, a distinctive group]. / Ouderen met een bipolaire stoornis: achtergronden van speciale aanbevelingen in richtlijn.

BACKGROUND: The number of older adults with bipolar disorders is growing and warrants a specific approach. Recommendations, as in the current guideline, are mostly based on research in samples with younger patients or from the United States, as best available evidence.
AIM: To raise awareness of the limitations of the current guidelines for older adults with bipolar disorder.
METHOD: We present a selection of Dutch studies on older adults with bipolar disorder and compared these findings with research done in younger patients or older patients from the United States.
RESULTS: Psychiatric comorbidity is relatively rare, somatic comorbidity is more frequent as is medication use. Cognition is impaired, but stable after 5 years of follow-up. Social functioning is associated with cognition. Less than half of the older adults with bipolar disorders reported unmet needs, mostly on company and daily activities.
CONCLUSION: Dutch research on older adults with bipolar disorder confirms the differences with younger patients with bipolar disorder and their American peers. Recommendations can't be extrapolated to older adults with bipolar disorders. More research is needed to provide evidence based guidelines for this special population.

[The importance of neuropsychological assessment for forensic psychiatric evaluations of defendants]. / De betekenis van neuropsychologisch onderzoek voor de rapportage pro Justitia.

BACKGROUND: In criminal law, increased interest is being shown in brain disorders, cognitive impairment and neuroimaging, particularly in connection with pre-trial reports. In a number of cases the contribution made by neuropsychology to the forensic diagnosis is considerable, and there is a need for further clarification.
AIM: To clarify the relevance of the neuropsychological assessment of suspects and to explore the implications for forensic psychiatry.
METHOD: We discuss recent literature and present a characteristic case selected from the Dutch jurisdiction.
RESULTS: On the basis of neuropsychological assessment it is possible to obtain insight into the relation between brain disorders and criminal behaviour. The case that we present shows that the court may consider the influence of cognitive impairment on behavior to be very important.
CONCLUSION: Neurocognitive disorders can make an important contribution to psychiatric assessments of defendants. In the forensic practice a combined diagnostic approach consisting of psychiatric evaluation, neurological assessment of behaviour, imaging techniques and neuropsychological assessment, is clearly preferable.

[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.

[Key points for the treatment of the elderly with bipolar disorder]. / Aandachtspunten voor de behandeling van ouderen met een bipolaire stoornis.

BACKGROUND: There is a lack of research into the treatment of the elderly with bipolar disorder. The Dutch guidelines for the treatment of older persons with bipolar disorder are based primarily on research relating to younger adults. AIM: To define key points for the treatment of bipolar disorder in later life. METHOD: The working group on the elderly of the Dutch Foundation for Bipolar Disorder defined key points in several consensus meetings based on clinical experience and research literature. RESULTS: Recommendations were drawn up for the treatment of the elderly with bipolar disorder relating to somatic comorbidity, pharmacotherapy, cognitive dysfunctions and psychosocial support. CONCLUSIONS: In general the Dutch Guidelines for the treatment of Bipolar Disorder are applicable for the elderly, provided the key points are taken into consideration.

[Two subjects, each with a brain lesion and each prone to criminal behaviour: a plea for the involvement of a behavioural neurologist in the forensic psychiatric evaluation of such cases]. / Twee verdachten met hersenletsel en crimineel gedrag. De bijdrage van de neuroloog aan forensisch psychiatrische diagnostiek.

Interest in the neurobiology of criminal behaviour is increasing. Recent research emphasises the important role played by the frontal lobe in the processing of emotional and social information and in the controlling of behaviour. Damage to specific frontal structures in the brain may therefore lead to antisocial and criminal behaviour. On the basis of the case histories of two suspects with brain lesions, the impact of such damage on the forensic psychiatric diagnosis is discussed. A plea is made for the more frequent involvement of a neurologist in the diagnostic evaluation usually undertaken by the forensic psychiatrist.

Cognitive functioning in elderly patients with early onset bipolar disorder.

BACKGROUND: Very little is known about the long term cognitive sequelae of bipolar disorder. AIM: To investigate neuropsychological functioning in older euthymic persons with early onset bipolar disorder. METHOD: Fifteen older patients (age >60) with an early onset (<50 years) bipolar-I disorder in a euthymic mood were tested using a comprehensive neuropsychological test battery. Neuropsychological functioning was compared with that of a sex, age and education-matched group of 15 comparison subjects without mood disorders or memory complaints. RESULTS: Bipolar subjects scored lower than comparison subjects on selective attention, verbal memory, verbal fluency and mental effort tests. CONCLUSIONS: The findings suggest that euthymic bipolar patients are impaired across a range of cognitive domains. This could represent a trait-like cognitive disability related to the disease, as the impairments are comparable with those found in younger bipolar patients.

[Late-onset schizophrenia: is it a dementia nonpraecox? Review article with advice on differential diagnosis]. / Laat-ontstane schizofrenie: een dementia non-praecox?

BACKGROUND: For many years now researchers have been discussing whether late-onset schizophrenia (LOS) is in fact a separate subgroup of schizophrenia. They also want to find out whether LOS has a neurodegenerative aetiology and is a progressive illness. AIM: To obtain insight into the clinical aspects, aetiological factors and the course of late-onset schizophrenia. In addition, advice is given about better ways of diagnosing LOS in clinical practice and about differentiating LOS from dementia. METHOD: The literature was searched via Medline and the Cochrane Library on the basis of the key words '(very) late-onset schizophrenia' and 'paraphrenia' combined with 'course', 'outcome', 'cognition', 'decline', 'white matter hyperintensities', 'MRI', and 'neuropsychological', 'postmortem' and cerebrospinal fluid'. The period studied was from 1960 to November 2004. RESULTS: Clinical parameters andfunctional and structural brain research point to differences from and similarities to the early form of schizophrenia (EOS). In cases of 'very-late-onset schizophrenia-like psychosis' (VLOS) the clinical differences vis-à-vis EOS are even more marked. It is not known to what extent neurodegenerative factors play a role. There is no clear consensus about the course of (V)LOS either. CONCLUSION: In view of the aetiologial and physiopathological factors it is still not clear whether (V)LOS can be differentiated from EOS on a neurobiological basis. There is insufficient proof about the extent to which (V)LOS is a dementia nonpraecox with neurodegenerative aetiology. To achieve clear differentiation between the various forms of dementia it is essential that the clinical diagnosis of LOS is supported as strongly as possible and is evaluated continually.

[The development of psychotic symptoms in later life: late-onset schizophrenia or frontotemporal dementia? A case study]. / Het ontstaan van psychotische verschijnselen op latere leeftijd. Laat onstane schizofrenie of froontotemporale dementia?

The diagnosis of psychotic disorders that develop later in life is complicated, as can be seen from the case of a 65-year-old woman. Initially she was admitted to hospital for psychotic depression, but after some time doubts arose regarding the diagnosis. The most striking symptoms were bizarre delusions with acoustic, haptic and gustatory hallucinations. In addition, she showed behavioral and personality changes. It is difficult to establish whether a patient has late-onset schizophrenia or frontotemporal dementia. The similarities and differences between the symptoms of these two disorders are discussed and advice is given to assist with clinicians with diagnosis in the future.