[(Too) long in tbs? A study on patients receiving forensic psychiatric tbs-treatment for 15 years or longer]. / (Te) lang in tbs? Een onderzoek naar patiënten die meer dan 15 jaar in tbs-behandeling zijn.

BACKGROUND: In 2013 in the Netherlands about 100 forensic psychiatric patients were treated in tbs-hospitals for 15 years or more.
AIM: To investigate the variables that characterise patients who have been receiving forensic psychiatric treatment (tbs) for 15 years or more, and to obtain insight in which actions might be helpful to facilitate discharge or transfer of such patients to other (mental health care) facilities, according to their caregivers and experts.
METHOD: The group of long-term tbs-patients (n = 97) was compared with regard to diagnostic characteristics, 'basic historical risks' (as assessed by risk assessment instruments), and behaviour  to three other groups of forensic patients: a. a group who had received treatment for 5 to 10 years, b. a group of patients who had been recently discharged, and c. a group of long-stay tbs-patients.
RESULTS: Long-term tbs-patients relatively often had been sex offenders (50% compared to about 20% of recently discharged tbs-patients), and had been admitted in a tbs-hospital at a relatively young age (on average they had been five years younger on admission). The professional clinicians of the long-term tbs-patients considered that the psychopathology of the long term tbs-patients was more severe than the psychopathology of the average tbs-patient. The clinicians also indicated that the long-term tbs-patients all need long-term supervision; however, they considered that only a minority of these patients (17%) required a maximum level of security and very restricted possibilities for temporary leave.
CONCLUSION: Patient related factors and organisational factors within the tbs-hospital and the general mental health care system seem to play a role in the lengthy period of tbs-treatment of the long-term tbs-patients. According to tbs-clinicians, these patients require prolonged and intensive supervision which the general mental health care system is often not equipped to deliver.

Antitumor activity, induction of cross-resistance, and nephrotoxicity of a new platinum analogue, cis-1,1-diaminomethylcyclohexaneplatinum(II) sulfate, and of cis-diamminedichloroplatinum(II) in an immunocytoma model in the LOU/M rat.

A newly synthesized platinum analogue, cis-1,1-diaminomethylcyclohexaneplatinum(II) sulfate (TNO-6), was compared with cis-diamminedichloroplatinum(II) (cis-DDP) for antitumor activity and nephrotoxicity. Antitumor activity was determined in an IgM immunocytoma model in the LOU/M rat. Tumor cells were inoculated on the left flank, and therapy was started when a tumor diameter of 10 to 30 mm was reached. At the start of the therapy, the primary tumor had already metastasized to the draining lymph node and liver. Both platinum compounds, dissolved in 5% glucose water, induced an almost complete tumor regression within 10 to 14 days (average, 84% tumor load reduction) and prolonged survival, compared to that of nontreated animals. The antitumor activity induced by repeated i.p. administration of cis-DDP and TNO-6 reached its maximum at a dose of 1.0 mg/kg body weight (twice a week for 7 weeks). This treatment regimen resulted in a highest tolerable dose for cis-DDP of 1.0 mg/kg and for TNO-6 of 2.0 mg/kg. However, when rats were treated with a 2.0-mg/kg dose of TNO-6, no increase in antitumor activity was obtained. For both platinum compounds, tumor recurrence occurred in almost all animals within 2 to 7 days after the maximum tumor load reduction. Tumors that recurred were found to be cross-resistant to both platinum compounds tested but were sensitive to treatment with doxorubicin (Adriamycin). With regard to toxicity, repeated administration of TNO-6 (1.0 mg/kg twice a week for 7 weeks) induced less decrease of body weight than did cis-DDP. For TNO-6, even in the highest dose investigated (2.0 mg/kg twice a week for 7 weeks), no nephrotoxicity was observed on histological examination of kidney and blood urea and creatinine values, whereas for cis-DDP nephrotoxicity was still present in the lowest dose investigated (0.5 mg/kg). From the comparison of the antitumor activity and nephrotoxicity of TNO-6 and cis-DDP, administered i.p. in 5% glucose solution, it is concluded that both drugs have comparable antitumor activity and potency. In contrast to the effects of cis-DDP, no nephrotoxicity was observed with TNO-6; thus, TNO-6 might be a good alternative to cis-DDP in avoiding nephrotoxicity during platinum therapy.