[Changes in regulations regarding fitness to drive in psychiatric disorders in The Netherlands, 2010-2019]. / Veranderingen in regels over rijgeschiktheid bij psychiatrische stoornissen in Nederland, 2010-2019.

BACKGROUND: In the last decade, regulations regarding the fitness to drive in The Netherlands have been changed extensively. AIM: To describe the changes in the regulations, and to evaluate the consequences for daily practice. METHOD: Overview of changes in the regulations concerning the fitness to drive as published in the Dutch legislation announcements in the past 10 years. RESULTS: Important changes have been implemented regarding the regulations on fitness to drive in patients with affective disorders, psychotic disorders, dementia, ADHD and pervasive developmental disorders. CONCLUSION: Compared to 2010, the regulations concerning the fitness to drive in psychiatric disorders are less rigid, more balanced, and more evidence based. Therefore, it has become easier to inform and advise the patient on this topic.

[Takotsubo cardiomyopathy as a complication of electroconvulsive therapy]. / Takotsubo-cardiomyopathie als complicatie van elektroconvulsietherapie.

Takotsubo cardiomyopathy is an acute, stress-induced, reversible cardiac syndrome and can occur as a rare complication in electroconvulsive therapy. We give further details of this complication by referring to the case of a 67-year-old female patient. In addition, we give a brief description of the background of the syndrome. If this syndrome is suspected, the patient should immediately be referred for cardiac diagnostic tests to rule out myocardial infarction. There is no absolute contra-indication to ECT for a patient who has experienced Takotsubo cardiomyopathy. However, to start ECT treatment again it is recommended that this should be performed in a general hospital and in combination with beta-blockers.

[Fitness to drive in psychiatric patients; a review of the literature and consequences for daily practice]. / Rijgeschiktheid bij psychiatrische aandoeningen; literatuuroverzicht en consequenties voor de praktijk.

BACKGROUND: A question that often arises in daily practice is whether a psychiatric patient should be considered as still fit to drive. AIM: To describe the Dutch regulations concerning psychiatric patients' fitness to drive and to evaluate the scientific basis of these regulations. METHOD: Information about the current regulations was collected and summarised and the specialist literature was reviewed. RESULTS: The regulations in the Netherlands are rather strict and as a result persons with a psychiatric illness can sometimes have their driving license withdrawn for a long period. The literature that was reviewed reveals that there is much uncertainty concerning the relationship between psychiatric illness and its effects on fitness to drive. CONCLUSION: The specialist literature indicates that some of the Dutch regulations are unfair and too rigid. In this article the consequences for daily practice are considered and a plea is made for more research and for laws and regulations that have a more solid basis.

[Spontaneous bilateral rupture of the Achilles tendon in an elderly woman undergoing prednisone pulse therapy with a history of polymyalgia rheumatica]. / Spontane bilaterale achillespeesruptuur bij een oudere vrouw met prednisonstootkuren en in de voorgeschiedenis polymyalgia rheumatica.

An 83-year-old woman presented at the neurology out-patient clinic with acute bilateral weakness of the calf muscles that had lasted for a few weeks. Ultrasound and MRI evaluation of the Achilles tendons revealed bilateral ruptures. Possible predisposing factors included treatment with prednisone pulse therapy for obstructive pulmonary disease and prior polymyalgia rheumatica. Surgical reconstruction of the tendons resulted in a major clinical improvement. Rupture of the Achilles tendons can occur spontaneously, and sometimes bilaterally. A predisposing factor is present in nearly every case of spontaneous bilateral rupture of the Achilles tendons. As in spontaneous unilateral ruptures, the most frequently described predisposing factor is the use of corticosteroids or quinolones.