Success rate of thyroid remnant ablation for differentiated thyroid cancer based on 5550 MBq post-therapy scan.

BACKGROUND: Success rate of thyroid remnant ablation in patients with low-risk differentiated thyroid cancer (DTC) is commonly based on measurement of serum thyroglobulin levels and 185 MBq (5 mCi) diagnostic 131I scanning or neck ultrasound, performed 6-9 months after ablation. In the present study, we report the rates of successful 131I ablation based on a 5550 MBq (150 mCi) post-therapy scan performed 6-9 months after ablation. METHODS: Retrospective cohort study of 77 adult patients with DTC, stage T1-T3, N0 or N1, M0, demonstrating thyroid remnant uptake one week after a 2775 MBq (75 mCi) ablation dose. Six to nine months later, all patients received a 5550 MBq dose of 131I, followed by a post- therapy scan after one week. Complete thyroid ablation was defined as no thyroid remnant uptake and a thyroglobulin level < 0.2 µg/l after thyroid hormone withdrawal. RESULTS: Thyroid ablation was complete in 20 patients (26%). Forty-eight patients (62%) demonstrated persistent remnant uptake. This was associated with thyroglobulin levels > 0.2 µg/l in 24/48, and positive thyroglobulin antibodies in 4/48 patients. CONCLUSION: Thyroid remnant ablation success assessed by 5550 MBq post-therapy scanning was much lower than reported in studies evaluating ablation success based on 185 MBq diagnostic 131I scanning or neck ultrasound. The latter techniques may be too inaccurate to detect thyroid remnants and thus may not be sufficiently reliable to predict long-term disease outcome.

3D shapes of aryl(dihydro)naphthothiophenes: a comprehensive and structural study.

Convenient access to new aryl(dihydro)naphthothiophenes is described using a common ß-chloroacrolein derivative. Our strategy is based on the construction of a condensed thiophene ring prior to a Suzuki-Miyaura coupling and allowed installing various substituents at the molecular platform. The overall shapes of these architectures were confirmed by X-ray analyses and were in good agreement with theoretical calculations. It has been established that the relative orientation between all fragments that composed molecules within this series is strongly related to both steric and electronic factors. Contribution of these key parameters revealed to be crucial to rationalize attempts to prepare fluorenone and fluorene derivatives from aryl(dihydro)naphthothiophene platforms.

[Ethical advice regarding the relationship between psychiatrists and the pharmaceutical industry]. / Deontologisch advies inzake de omgang van psychiaters met de farmaceutische industrie.

BACKGROUND: The pharmaceutical industry is an important partner in mental health care. AIM: To provide ethical advice that will help psychiatrists build a balanced relationship with the pharmaceutical industry. METHOD: In this article we present the current advisory principles that have been developed by the Flemish Psychiatric Association (Vlaamse Vereniging voor Psychiatrie; VVP). RESULTS: Not only do we give general advice that is relevant for all psychiatrists, but we also give advice that is applicable specifically to the psychiatrist-researcher, teachers and psychiatric trainees. Finally, we explain more fully how the VVP, as an organisation, deals with these issues. CONCLUSION: It is important that the psychiatrists and the pharmaceutical industry deal with each other in a balanced and constructive manner, thereby stimulating progress in the field of psychiatry. For this purpose the VVP has formulated a number of ethical principles which, in our view, define the way in which psychiatrists should deal with the pharmaceutical industry.

[Sexuality in eating-disorder patients]. / Seksualiteit bij vrouwelijke patiënten met een eetstoornis.

BACKGROUND: A link is suspected between eating disorders and dysfunctional sexuality. The grounds for this link are thought to be clinical, biological and psychological. AIM: To find out from the literature what is known about sexuality in patients with eating disorders, to identify differences related to subtypes of the disorders and to ascertain whether sexuality can play a role in the diagnosis and treatment of various types of eating disorders. METHOD: We studied the research literature with the help of PubMed. RESULTS: Patients with eating disorders are more likely to have sexual problems; these include reduced libido, reduced sexual activity and sexual dissatisfaction. The distorted body image leads to the avoidance of sexual activity. Anorexia patients are more negative about sexuality and have a greater loss of libido than do bulimia patients, who experiment more with sex. CONCLUSION: Patients with eating disorders experience sexual dysfunction, but there are clear differences between the various eating-disorder subtypes. It is advisable that, in the future, sexuality should be included in the outcome of research in eating disorders. This step will help researchers to evaluate the effect that treatment can have on the outcome of the eating disorder.

[The importance of movement-directed interventions in the multidisciplinary treatment of binge eating disorder: an overview]. / Bewegingsgerichte interventies in de multidisciplinaire behandeling van eetbuistoornissen; een literatuuronderzoek.

BACKGROUND: More than three out of four persons with binge eating disorder do not get enough physical exercise. AIM: To collect scientific evidence of the effects and benefits that movement and physical exercise can have on persons with a binge eating disorder. METHOD: PubMed, PsychInfo, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Physiotherapy Evidence Database, the Dutch Journal of Psychiatry (Tijdschrift voor Psychiatrie), het Tijdschrift voor Vaktherapie and Actual Themata derived from psychomotor therapy were screened for the period January 1994 to August 2011. The methodological quality of the studies was determined on the basis of a checklist. Evidence for the effectiveness of the interventions was summarised by best-evidence synthesis. RESULTS: Eight studies met the inclusion and exclusion criteria. Strong evidence was found for: 1) significant weight-loss after movement interventions; 2) fewer symptoms of depression after a combination of both movement and cognitive behavioural therapy (CBT) than after CBT on its own. There was only limited evidence for 1) the fact that the combination of movement and CBT leads to less eating disorder pathology than does CBT alone; 2) the beneficial effects of yoga on weight-loss as well as on the reduction of eating disorder pathology.There are indications that walking can be helpful in reducing of eating disorder pathology. CONCLUSIONS: Activities involving movement and physical exercise deserve to play an important role in the multidisciplinary treatment of binge eating disorders.

[Stigmatisation of psychiatric patients by general practitioners and medical students: a review of the literature]. / Stigmatisering van psychiatrische patiënten door huisartsen en studenten geneeskunde: een literatuuronderzoek.

BACKGROUND: In clinical practice general practitioners (GPS) and society tend to stigmatise patients with psychiatric problems. AIM: To attempt to describe this stigmatisation by GPS and medical students on the basis of information given in the literature. METHOD: We searched the literature via PubMed using mesh terms: 'family practice', 'physicians', 'family', 'mental disorder', 'attitude' and 'psychiatry' and the word 'stigma'. In addition, literature was supplied by experts and articles were located by the snowball method. RESULTS: Stigmatisation constitutes a major obstacle in the psychiatric and somatic care that gps provide for patients with a psychiatric disorder. Although such patients have a higher somatic vulnerability as a result of their psychiatric problems, they receive fewer technical and exploratory investigations than other categories of patients. Medical students too have a negative attitude towards patients with a psychiatric disorder. More education and training could lead to less stigmatisation but the effect would probably be only temporary. Personal experience is the main factor that leads to greater empathy. CONCLUSION: The literature suggests that psychiatric patients are victims of self-inflicted stigmatisation and stigmatisation by society and doctors. This leads to social exclusion and poorer healthcare. By tackling the problem of stigmatisation we could greatly improve the quality of life and healthcare for this group of patients.

[Eating disorders on the internet. A review of the quality of Dutch websites]. / Eetstoornissen op het internet; een onderzoek naar de kwaliteit van Nederlandstalige websites.

BACKGROUND: The internet is an important medium for people looking for health-related information. Since increasing numbers of people are now using the internet, it follows that more and more people are using the net to locate health-related information and services. In recent years more research has been done into the quality of health websites. AIM: To study the quality of Dutch (-language) websites dealing with eating disorders and to produce a representative picture of the health information (in Dutch) available to the 'regular' internet user seeking information about eating disorders. METHOD: We searched Dutch websites dealing with eating disorders using the Belgian-Dutch version of the Google search engine. We traced, visited, explored and classified websites using a classification system based on findings in the literature. Then we examined the quality of these websites by means of a self-made Scoring form for the Quality of Websites about Eating disorders (SQWE). We also assessed quality using the discern questionnaire, an instrument that has proved useful in earlier research. RESULTS: Of the 141 websites that we located, 24 satisfied our selection criteria. "abbreviation" and discern showed the websites to be of variable quality. On the basis of the search terms we used, we did not find any pro anorexia nervosa or pro bulimia websites. CONCLUSION: The websites providing information in Dutch about eating disorders are of variable quality and, in accordance with previous research results, the site characteristics are not reliable predictors of the quality of the content. The SQWE and DISCERN instruments, however, do have the potential to distinguish between good quality and poor quality websites.

[Are patients in randomised controlled trials of psychotherapy representative for clinical practice?]. / Zijn patiënten in gerandomiseerde gecontro- leerde onderzoeken over psychotherapie representatief voor de klinische praktijk?

BACKGROUND: In the debate about evidence-based psychotherapy it is often assumed that randomised controlled trials (RCT's) have a limited generalizable. Among the reasons for this assumption are the strict exclusion criteria which rule out patients with comorbidity or multiple diagnoses. AIM: To investigate whether these strict exclusion criteria do effect the generalizable of RCT's. METHOD: Narrative overview of the research literature on psychotherapy. RESULTS: We found that the exclusion criteria infact have less effect than expected on the generalizable. CONCLUSION: Most patients from clinical practice can indeed be included in a RCT. Recent RCT's also include many patients with comorbidity.

Body experience assessment in non-clinical male and female subjects.

INTRODUCTION: Body image is an important feature in the quality of life of clinical and non-clinical subjects. Therefore, the evaluation of different instruments for measuring body image is necessary. More and more attention is also given to the body image of males. This study addresses the body image of non-clinical males in comparison to females by using well-know questionnaires. METHOD: Four widely used questionnaires are evaluated: The Body Attitude Test, The Eating Disorder Inventory, The Body Shape Questionnaire and the Body Attitude Questionnaire. Psychometric properties of these questionnaires are investigated in 427 males and 389 female subjects. Normative values for a Flemish population are provided. RESULTS AND CONCLUSIONS: All questionnaires have good psychometric properties. To separate males from females all four questionnaires can be used. The four questionnaires are able to differentiate between individuals who are and who are not suffering from body image concerns.

Be kind to your eating disorder patients: the impact of positive and negative feedback on the explicit and implicit self-esteem of female patients with eating disorders.

OBJECTIVE: Lack of self-esteem may play an important role in the development of eating disorders (ED). This study investigated the differential impact of positive and negative feedback on implicit and explicit self-esteem in women with an ED (N=25) as compared to women without an ED (N=29). METHOD: False feedback (positive or negative) was given on participant's performance on a specifically developed intellectual test. Before and after the performance, explicit and implicit self-esteem was measured. RESULTS: On the explicit measure ED patients reacted congruently with the nature of the feedback. On the implicit measure only ED patients responded to the positive feedback with an improvement of self-esteem, with no effect for negative feedback. The control group was unaffected by either feedback. Furthermore, no correlation was observed between the explicit and implicit measures, a finding suggesting that these measurements tap different constructs. CONCLUSION: Positive feedback affects implicit self-esteem of female patients with eating disorders. The results underline the importance of positively approaching women with ED.

[Disclosure of conflicts of interest in the Tijdschrift voor Psychiatrie]. / Bekendmaking van strijdige belangen in het Tijdschrift voor Psychiatrie.

Between March 2000 and December 2008 authors disclosed conflicts of interest in 9% of articles in the Tijdschrift voor Psychiatrie. For the same period, in the articles dealing with pharmaceuticals, the percentage of articles containing disclosures of conflict of interest was considerably higher, namely 24%. The policy of the journal with regard to the disclosure of conflicts of interest has helped to promote transparency. Further efforts are needed to encourage authors to disclose conflicts of interest.

State anxiety and subjective well-being responses to acute bouts of aerobic exercise in patients with depressive and anxiety disorders.

OBJECTIVE: Acute aerobic exercise is associated with a reduction in state anxiety and an improvement in subjective well-being. The objective of the present study was to contrast the effects of aerobic exercise at self-selected intensity versus prescribed intensity on state anxiety and subjective well-being (negative affect, positive well-being and fatigue) in patients with depressive and/or anxiety disorders. In addition, the potential impact of heart rate feedback was assessed. METHODS: Nineteen men and 29 women performed three test conditions on a bicycle ergometer during 20 minutes: two tests at self-selected intensity; one with and another without heart rate feedback, and a third test at the prescribed intensity of 50% of the maximal heart rate reserve according to Karvonen. Tests were executed in random order. State anxiety and subjective well-being were evaluated using the state anxiety inventory and the subjective exercise experiences scale. RESULTS: After 20 minutes cycling, patients showed significantly decreased state anxiety and negative affect in the three conditions. The magnitude of the reduction did not differ significantly between the three conditions. Only cycling at self-selected intensity enhanced positive well-being. Cycling at 50% of the maximal heart rate reserve decreased fatigue, whereas cycling at self-selected intensity increased fatigue. CONCLUSIONS: The response in state anxiety and negative affect was unaffected by the type of aerobic exercise. Self-selected intensity influenced exercise-induced changes in positive well-being and fatigue in a positive and negative way, respectively.

[Psychoanalysis and cognitive behaviour therapy: in the past and in the future]. / Psychoanalyse en cognitieve gedragstherapie; terugblikken en vooruitzien.

Some recent developments in psychoanalysis and cognitive behaviour therapy are reviewed. This is followed by some thoughts and comments on the directions in which these two disciplines are likely to develop in the future.

[Addisonian crisis in patients with known adrenal insufficiency: the importance of early intervention]. / Addison-crisis bij patiënten bekend wegens bijnierschorsinsufficiëntie: het belang van vroegtijdig ingrijpen.

In patients known to have adrenal insufficiency, inadequate adjustment of the glucocorticoid dosage during intercurrent illness can be life threatening. We describe two patients with adrenal insufficiency who died after their glucocorticoid dosage was insufficiently increased during an episode of gastroenteritis and pneumonia, respectively. Another patient died after a few days of fever and vomiting of unknown origin, after a period of refusing her medication. To prevent unnecessary death from Addisonian crisis, we have developed a protocol. Patients with known adrenal insufficiency, as well as their relatives and general practitioners, should repeatedly receive verbal and written instructions on how to deal with physical and severe psychic stress. We teach the patients and their relatives how to use an emergency injection of hydrocortisone, and the patients can consult the on-call endocrinologist by telephone 24 hours a day.

[Increase in the percentage of female authors in the international psychiatric literature since 1970]. / Toename van het percentage vrouwelijke auteurs in de internationale psychiatrische vakliteratuur sinds 1970.

BACKGROUND: The participation of women in medicine and psychiatry is increasing. AIM: To find out whether this trend is also reflected in the international psychiatric literature. METHOD: We took steps to discover the gender of the first and the last author as listed below the title of 290 articles sampled at random from three leading psychiatric journals published between 1970 and 2007. results Women turned out to be underrepresented as the first or last author of these psychiatric articles; this conclusion was also found to apply to the first and last authors who were medical authors. Whereas the proportion of female first authors had increased significantly since 1970 and had reached almost 50% in 2007, there had been no such increase as far as last authors were concerned. CONCLUSION: In the psychiatric literature studied, the proportion of female first authors rose to almost 50%.

[Preliminary results of a focus-group-based research project on the problems of implementing evidence-based practice in Belgium (Flanders). Do psychiatrists differ from other health care practitioners?]. / Preliminaire bevindingen van focusgroeponderzoek over hinderpalen bij implementatie van evidence-based praktijkvoering in Vlaanderen. Zijn psychiaters anders dan andere zorgverleners?

BACKGROUND: The impact of evidence-based practice (EBP) has increased substantially in recent years. However, health care practitioners are experiencing difficulties in implementing EBP. AIM: The specific task was to find out what problems are encountered by Flemish (Belgian, Dutch-speaking) health care practitioners. method In order to explore this problem, we adopted a qualitative research strategy and set up 25 focus groups, 5 of which consisted solely of psychiatrists. results Psychiatrists shared with other health care disciplines some concerns about the characteristics of 'evidence' and about the influential role played by their 'partners' in the health care system, namely by government, commercial firms and patients. Psychiatrists perceived their discipline to be much more complex than other disciplines, particularly in areas such as research design, patients' problems, psychiatric diagnosis and therapeutic psychiatrist-patient relationships. The literature and the preliminary results of ongoing research revealed that other disciplines too are confronted with similar complexities. CONCLUSION: There seems to be no justification for ruling out the possibility of implementing EBP on the basis of discipline-related barriers.

Octreotide acetate in dominant cystoid macular dystrophy.

PURPOSE: Dominant cystoid macular degeneration (DCMD) is an autosomal dominant trait of cystoid macular edema with poor visual prognosis. Until now, no efficient treatments for DCMD have been reported. The authors evaluated a somatostatin-analogue (octreotide acetate) as treatment for DCMD. METHODS: The authors treated four patients with early DCMD by intramuscular longacting octreotide acetate, 20 mg every 4 weeks for 1 year. In addition to general ophthalmologic examination the authors performed fluorescein angiography (FA) before and after treatment. RESULTS: Seven out of eight eyes showed improvement on FA and stabilization of visual acuity. CONCLUSIONS: Somatostatin-analogues may reduce cystoid edema in DCMD and may thus prevent disease-related visual loss.