[Multiple sclerosis and bipolar disorder: an overlap between soma and psyche]. / Multiple sclerose en bipolaire stoornis: overlap tussen soma en psyche.

This clinical vignette describes a 29-year-old woman who had her first neurological manifestations of multiple sclerosis (MS) on the same day as a second lifetime manic episode as part of a bipolar I disorder. The patient was stable for eight years before this episode. An MRI-scan conducted during admission showed multiple demyelinating lesions in the frontal cortex, which might have influenced the development and course of the manic episode. Her manic symptoms went into remission during the same time as her neurological symptoms. This clinical vignette with literature review is an illustration of the interesting, yet still unknown relationship between MS and affective disorders, where one might be influenced by the other but also have a common pathophysiology. This highlights that the dividing line between neurology and psychiatry, whose pathophysiology often takes place in the same organ, is often arbitrary.

[Mission statements of Dutch mental health institutions; the quality of communication with stakeholders]. / Mission statements van Nederlandse ggz-instellingen; de kwaliteit van communicatie met belanghebbenden.

BACKGROUND: As a result of recent reforms in Dutch health care, healthcare providers are having to operate more and more like commercial organisations and adopt some of the rules prevailing in the profit sector. Because missions statements can be an efficient means of useful communication with internal and external stakeholders they can make a useful contribution to the way healthcare institutions are managed and to their status and reputation. Research shows that in view of this the quality of the messages conveyed via mission statements is important. AIM: To ascertain which stakeholders are mentioned in the mission statements of Dutch mental healthcare providers and to quantify the quality of the messages conveyed to them via mission statements. METHOD: We examined the mission statements of 34 mental health providers to find out which stakeholders were included. The message conveyed to the stakeholders was quantified by means of a validated measuring instrument devised specifically for this purpose. RESULTS: Patients were referred to in all mission statements and the quality of the messages conveyed was of higher quality than the messages conveyed to other stakeholders. Other important stakeholders on whom the institutions depended were referred to much less frequently and the quality of sections of text referring to them was definitely inferior. CONCLUSION: Mission statements frequently serve as management tool for Dutch mental healthcare providers. The potential benefits that these statements could bestow on the providers are not being fully exploited because the standard of communication with several internal and external stakeholders is of poor quality.

[Sexsomnia during treatment with a selective serotonin reuptake inhibitor]. / Sekssomnia tijdens behandeling met een selectieve serotonineheropnameremmer.

Sexsomnia is a parasomnia characterised by sexual behaviour. A 30-year-old man, with no history of parasomnias or related precipitating factors, developed sexual behaviour during sleep after three weeks of treatment with escitalopram 10 mg daily. The parasomnia disappeared on the sixth day after the escitalopram had been stopped. The temporal relationship between the use of this selective serotonin reuptake inhibitor and the occurrence of the parasomnia suggests a causal relationship, possibly related to increased serotonergic neurotransmission in the raphe nucleus.

[Unipolar depression suddenly switches to hypomania in a patient who has just started taking venlafaxine]. / Acute stemmingsomslag naar hypomanie bij een patiënte met een unipolaire depressie direct na starten van venlafaxine.

A woman with a recurrent episode of a depression that hitherto had been unipolar developed a hypomania the day after her treatment with paroxetine 20 mg/day was switched to venlafaxine 75 mg/day. The hypomanic symptoms subsided gradually as the dosage was reduced and the patient thereafter remained in a euthymic state while on venlafaxine at a dose of 18.75 mg/day. Three possible explanations are discussed for the patient's response: there was a pharmacokinetic interaction between paroxetine and venlafaxine, the patient had an idiosyncratic reaction to venlafaxine or venlafaxine inhibited the re-uptake of norepinephrin.