Biomedical subjects
P N van Harten
Publications and source records attributed to P N van Harten.
[Survey among readers of the Tijdschrift voor Psychiatrie].
BACKGROUND: The editorial board has defined the objectives of this journal as follows: to provide its readers with refreshing information, to report the results of scientific research and to build bridges between research and everyday practice. AIM: To find out what readers want and whether they support the board's objectives, and to use this information in planning the contents of future issues of the journal. METHOD: All readers were invited to complete a questionnaire either on paper or via the website. RESULTS: Questionnaires were completed by 255 readers (response rate 5.7%). The average rating on a 5-point Likert scale was 3.8. Thematic issues and issues devoted to book reviews were given a high rating. There seems to be a demandfor evidence-based medicine, the inclusion of scientific results reported in other journals and practice-based articles. No significant differences were found between the views expressed by readers who had previously submitted an article for publication and those who had not, nor between Flemish readers and Dutch readers. The website was not visited very often. CONCLUSION: The Tijdschrift voor Psychiatrie is greatly appreciated by its readers. They are largely in agreement with the objectives formulated by the editorial board. Thematic issues are highly rated and many subjects are mentioned by the readers for future issues. The low response to the survey can affect its representativity. The editorial board will take readers' wishes into consideration when selecting material for future issues of the journal.
[The meaning of cold chills in patients with fever in the emergency facility].
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[Drug-induced akathisia].
Akathisia (restlessness and characteristic movements of the legs) is one of the most disagreeable extrapyramidal side effects and often causes non-compliance. Dopamine blocking agents such as antipsychotics and antiemetics, may induce akathisia. Particular care must be taken to distinguish akathisia from psychotic agitation and restless legs. The prevalence of akathisia in patients using classical antipsychotics is 20-30% and for users of clozapine, olanzapine and quetiapine (atypical antipsychotics) it is lower. Risk factors are a high dosage of antipsychotics, akathisia in a previous treatment, and diabetes mellitus. The treatment of akathisia starts, if possible, with the antipsychotic being withdrawn or the dose administered being lowered. Another treatment possibility is switching to clozapine, olanzapine or quetiapine, or adding a beta-blocking agent, an anticholinergic or mianserin.
Addition of risperidone to clozapine therapy in chronically psychotic inpatients.
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[Fewer X-rays, while maintaining quality of care using clinical protocols for physical diagnosis of ankle injuries].
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Tardive dyskinesia is associated with impaired retrieval from long-term memory: the Curaçao Extrapyramidal Syndromes Study: IV.
Tardive dyskinesia may be associated with cognitive dysfunction. It is not clear whether this dysfunction occurs in the form of a global or specific cognitive deficit. A cross-sectional study was conducted in a well-defined catchment area (Curaçao, The Netherlands Antilles). All schizophrenic inpatients who had been taking neuroleptic medication for at least 3months and who were younger than 65years were included (n=53). Tardive dyskinesia was assessed with the Abnormal Involuntary Movement Scale. The neuropsychological assessment comprised tests of memory, executive function, and speed of information processing. Of the six cognitive measures, only delayed recall was significantly associated with orofacial dyskinesia. Limb-truncal dyskinesia was not associated with any of the cognitive measures. The pattern of memory impairment is consistent with there being a frontal-subcortical disturbance in orofacial dyskinesia. The results underscore the importance of using specific cognitive test procedures in the search for the cognitive correlates of dyskinesia.
Acute dystonia induced by drug treatment.
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Tardive dystonia.
This paper provides an overview of the phenomenology, epidemiology, and treatment of tardive dystonia. Tardive dystonia is one of the extrapyramidal syndromes that starts after long-term use of dopamine receptor antagonists. The diagnosis is based on the presence of chronic dystonia, defined as a syndrome of sustained muscle contractions, frequently causing twisting and repetitive movements or abnormal postures. Furthermore, dystonia must develop either during or within 3 months of a course of antipsychotic treatment, and other causes such as Wilson's disease, acute dystonia, or a conversion reaction must be ruled out. Tardive dystonia occurs in about 3 percent of patients on long-term antipsychotic treatment. Some probable risk factors for tardive dystonia are younger age, male, and the presence of tardive dyskinesia. The treatment of tardive dystonia starts with an evaluation of the need for using the causative drug. If antipsychotics must be continued, a switch to an atypical antipsychotic, particularly clozapine, may be helpful. If the dystonia is relatively localized, botulinum toxin is an effective but not well-known treatment possibility. If tardive dystonia is more extensive, either dopamine-depleting drugs or high dosages of anticholinergics can be tried.
[For how long should antipsychotic medication be continued after the first psychotic episode in schizophrenics?].
Four patients, two women aged 24 and 62 years and two men aged 25 and 24, respectively, were admitted because of psychosis. A Dutch consensus paper advises treating patients with a first episode of schizophrenia or schizophreniform disorder with neuroleptics for two years as secondary prophylaxis. However, this advice should be tailored to the individual patient's characteristics. Thus, the first patient was given prophylactic medication for five years because she had many schizophrenic symptoms and a positive family history. In the second patient, the diagnosis was much less certain and, because of her advanced age, the risk of developing tardive dyskinesia was considerable. Prophylaxis was given for three months only. The third patient used drugs and did not really want to be treated. In the fourth patient the affective symptoms could not be interpreted for certain as part of a basic schizophrenic defect. In addition, he would be seriously handicapped professionally if he developed tardive dyskinesia. In his case, two years of secondary prophylaxis was advised.
Lack of relation between culture and anorexia nervosa--results of an incidence study on Curaçao.
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Intermittent neuroleptic treatment and risk for tardive dyskinesia: Curaçao Extrapyramidal Syndromes Study III.
OBJECTIVE: The authors examined the association between three lifetime medication variables (cumulative amount of neuroleptics, number of interruptions in neuroleptic treatment, cumulative amount of anticholinergics) and the occurrence and severity of tardive dyskinesia. METHOD: The study was conducted in the only psychiatric hospital of a well-defined catchment area (the Netherlands Antilles). For all patients who had a history of taking neuroleptics for at least 3 months and were currently using neuroleptics (N = 133, mean age = 51.5 years), the presence and severity of tardive dyskinesia were measured with the Abnormal Involuntary Movement Scale. RESULTS: Of the three lifetime medication variables, only the number of neuroleptic interruptions was significantly related to tardive dyskinesia. The risk of tardive dyskinesia was three times as great for patients with more than two neuroleptic interruptions as for patients with two or fewer interruptions. CONCLUSIONS: This finding supports the schizophrenia protocol of long-term neuroleptic treatment rather than targeted or intermittent neuroleptic treatment.
Cocaine as a risk factor for neuroleptic-induced acute dystonia.
BACKGROUND: A prospective study was conducted to test the hypothesis that cocaine use is a risk factor for neuroleptic-induced acute dystonia (NIAD). METHOD: The study sample consisted of a high-risk group for NIAD, males aged 17-45 years who had received high-potency neuroleptics within 24 hours of admission and had not used neuroleptics in the month prior to admission. Patients were excluded if they suffered from a neurodegenerative disorder or were exposed to anticholinergics, benzodiazepines, promethazine, carbamazepine, phenytoin, or levodopa during the study. Twenty-nine patients--9 cocaine users and 20 nonusers--entered the study, which lasted 2 years. Patients were followed for 7 days. RESULTS: Cocaine-using psychiatric patients developed significantly more NIAD than did nonusers (relative risk = 4.4, 95% CI = 1.4 to 13.9). CONCLUSION: Cocaine use is a major risk factor for NIAD and should be added to the list of well-known risk factors. The authors strongly suggest that cocaine-using psychiatric patients who are started on a regimen of neuroleptics should also be administered an anticholinergic for at least 7 days to prevent NIAD.
The inter-relationships of tardive dyskinesia, parkinsonism, akathisia and tardive dystonia: the Curaçao Extrapyramidal Syndromes Study II.
A study of the four extrapyramidal syndromes (EPS), tardive dyskinesia, parkinsonism, akathisia and tardive dystonia, was performed in the Netherlands Antilles, a well-defined catchment area with only one psychiatric hospital. The population under study (N = 194; mean age 53.1) was mainly Afro-Caribbean, and most patients were chronic. The severity of each EPS was measured with valid and reliable rating scales. The purpose was to study both the strength of the inter-relationships of EPS and the prevalence of combinations of EPS. The inter-relationships between the EPS were analyzed by means of logistic regression. The adjusted odds ratios between the various EPS revealed strong connections between the hyperkinetic syndromes (tardive dyskinesia, tardive dystonia and akathisia). Parkinsonism was found to be inversely related to tardive dyskinesia and to tardive dystonia. Almost 30% of the patients suffered from two or more EPS. The highest prevalence rates of combinations were: tardive dyskinesia combined with parkinsonism 12.9%, tardive dyskinesia combined with tardive dystonia 9.8%, and tardive dyskinesia combined with akathisia 5.2%. Our findings show a strong positive correlation between hyperkinetic forms of EPS. Furthermore, chronic psychiatric inpatients regularly suffer from combinations of EPS. Different treatment strategies are suggested for various combinations of EPS.
[Thorn apple poisoning].
A 20-year-old man presented with signs of thornapple intoxication: restlessness, disorientation, hallucinations, euphoria, and furthermore dry and red skin and symmetrical dilation of the pupils. Thornapple intoxication mimics atropine intoxication. Thorn apples (Datura stramonium) are seemingly becoming popular as a hallucinogenic drug. When the symptoms are mild gastric lavage leaving active charcoal in the stomach afterwards will suffice. In case of severe symptoms treatment with physostigmine is indicated.
The prevalence of tardive dystonia, tardive dyskinesia, parkinsonism and akathisia The Curaçao Extrapyramidal Syndromes Study: I.
A prevalence study of extrapyramidal syndromes was conducted among all psychiatric inpatients of the Netherlands Antilles (n = 194; mean age 53.1). The Netherlands Antilles are very suitable for epidemiological research as it is a well-defined catchment area with only one psychiatric hospital and a health care system based on western principles. In this mainly chronic population, the prevalence was measured of tardive dystonia, tardive dyskinesia, parkinsonism and akathisia using respectively the Fahn-Marsden rating scale, the Abnormal Involuntary Movement Scale, the Unified Parkinson Disease Rating Scale and the Barnes Akathisia Rating Scale. The prevalence numbers were for tardive dystonia 13.4%, tardive dyskinesia 39.7%, parkinsonism 36.1%, akathisia 9.3% and pseudoakathisia 12.9%. The most important conclusions were: (1) The prevalence of tardive dystonia was higher than reported in most other studies and (2) extrapyramidal syndromes are very common in this predominantly Negroid population, with three out of four patients suffering of one or more extrapyramidal syndromes.
[Alarming admission rates for schizophrenia in migrants from Surinam, the Netherlands Antilles and Morocco].
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[acute dystonias in combined abuse of cocaine and neuroleptics].
A 25-year-old mildly retarded black cocaine user was hospitalized 15 times in 10 years for recurrent maniform psychosis. During the last intake he developed severe dystonia following zuclopenthixol 50 mg and droperidol 10 mg i.m. In view of current knowledge regarding the pathophysiology of acute neuroleptic induced dystonias, this suggests that cocaine may be a risk factor for development of acute dystonia. However, only a few studies with small numbers of patients and/or poor design have been reported. Therefore the conclusion cannot be drawn that an anticholinergic should be added to neuroleptics in patients with cocaine abuse.