[Patient with fetal alcohol spectrum disorder]. / Patiënte met foetale alcoholspectrumstoornis.

FETAL ALCOHOL SPECTRUM DISORDERS (FASDS) IS A CONDITION THAT IS PROBABLY OFTEN MISSED. THIS SYNDROME IS BASED ON FEATURES IN FOUR DOMAINS: 1. REDUCED HEIGHT AND WEIGHT GROWTH, 2. SPECIFIC FACIAL FEATURES, 3. PREDISPOSED CENTRAL NERVOUS SYSTEM ABNORMALITIES (INCLUDING MICROCEPHALY) OR FUNCTION (NEUROLOGICAL, PSYCHOLOGICAL AND/OR BEHAVIORAL PROBLEMS) AND 4. (SUSPECTED) PRENATAL ALCOHOL USE BY THE MOTHER. DUE TO PSYCHIATRIC AND BEHAVIORAL PROBLEMS PATIENTS MAY ALSO BE SEEN IN SPECIALIZED MENTAL HEALTH CARE. TO INCREASE THE CHANCE THAT THESE PATIENTS WILL RECEIVE AN APPROPRIATE AND EFFECTIVE TREATMENT, AWARENESS OF THIS SYNDROME IS ESSENTIAL. WE DESCRIBE THE CLINICAL PICTURE ON THE BASIS OF A CASE DESCRIPTION, PROVIDE RECENT LITERATURE AND FORMULATE RECOMMENDATIONS FOR CLINICAL PRACTICE.

Sex-specifics of ECT outcome.

OBJECTIVE: Electroconvulsive therapy (ECT) is the most effective treatment for patients with severe major depressive disorder (MDD). Given the known sex differences in MDD, improved knowledge may provide more sex-specific recommendations in clinical guidelines and improve outcome. In the present study we examine sex differences in ECT outcome and its predictors. METHODS: Clinical data from 20 independent sites participating in the Global ECT-MRI Research Collaboration (GEMRIC) were obtained for analysis, totaling 500 patients with MDD (58.6 % women) with a mean age of 54.8 years. Severity of depression before and after ECT was assessed with validated depression scales. Remission was defined as a HAM-D score of 7 points or below after ECT. Variables associated with remission were selected based on literature (i.e. depression severity at baseline, age, duration of index episode, and presence of psychotic symptoms). RESULTS: Remission rates of ECT were independent of sex, 48.0 % in women and 45.7 % in men (X2(1) = 0.2, p = 0.70). In the logistic regression analyses, a shorter index duration was identified as a sex-specific predictor for ECT outcome in women (X2(1) = 7.05, p = 0.01). The corresponding predictive margins did show overlapping confidence intervals for men and women. CONCLUSION: The evidence provided by our study suggests that ECT as a biological treatment for MDD is equally effective in women and men. A shorter duration of index episode was an additional sex- specific predictor for remission in women. Future research should establish whether the confidence intervals for the corresponding predictive margins are overlapping, as we find, or not.

[A patient with acute abdominal pain and vomiting due to the cannabinoid hyperemesis syndrome]. / Een patiënt met acute buikpijn en braken veroorzaakt door het cannabinoïd-hyperemesissyndroom.

An adolescent patient with acute abdominal pain and vomiting presented in the emergency room. Bathing in hot water relieved his symptoms. Physical examination, basic laboratory testing and imaging showed no abnormalities. The patient was diagnosed with cannabinoid hyperemesis syndrome, which is characterized by chronic cannabis use, recurrent episodes of intractable vomiting and compulsively hot showering or bathing to relieve the symptoms. Unfamiliarity with the syndrome can easily lead to unnecessary diagnostic testing and inappropriate treatment. The consulting psychiatrist could play a role in the diagnostic process and treatment. Furthermore, early recognition of this syndrome in the emergency room may lead to a proper addiction treatment program.