PATIENT’S AND GENERAL PRACTITIONER\u27S PERSPECTIVES REGARDING DISTURBED EATING

Objectives: We wanted to investigate the patient’s expectations on the general practitioner’s (GP) responsibilities in screening and follow up of disturbed eating behaviour. Then, we looked for remediation for some of the mentioned shortcomings in family medicine. We also examined if online aid (offered by the non-profit organisation "Eetexpert.be") is already known and used. Subjects and methods: Anonymous patient questionnaires were gathered at 4 treatment centres for eating disorders or were collected with help of the Flemish patients organisation for eating disorders (Vlaamse Vereniging Anorexia Nervosa en Boulimia Nervosa). Later, online enquiries were sent to Flemish GPs. Results: Out of 123 patients responding to the questionnaire, 44 found their GP to have had an important supportive role in their healing process. Active listening and targeted referral were among the most appreciated interventions by those patients. 71 GPs replied the online enquiry. Only 1 out of 5 knew about the free online assistance of "Eetexpert.be". Responders suggested several additional barriers to care. Conclusions: In Flanders there is a contrast between expectations and needs of patients on one hand compared to the services provided by GPs on the other. Reassuringly, all responding physicians were open to more education and support regarding eating disorder treatment

SUCCESSFUL ECT TREATMENT AFTER RELAPSE DURING VNS THERAPY

We present a case of a patient with severe treatment resistant depression who relapsed while being treated with vagus nerve stimulation. We describe that he was safely treated with unilateral ECT concomitantly with the VNS

COMBATIVE HF-rTMS TREATMENT, FOR A BIPOLAR I PATIENT, FOLLOWING UNSUCCESSFUL ECT

We aimed to Examine the safety and effectiveness of HF-rTMS in a treatment-refractory bipolar I patient in a mixed affective episode. Our case illustrates that “combative” HF-rTMS therapy could be a safe and valid treatment alternative for refractory bipolar I patients in mixed episode, not successfully treated with ECT

Intensive rTMS applications in difficult to treat psychiatric patients: some cases

Despite adherence to treatment guidelines, some patients are resistant to several psychopharmacological interventions. Guidelines to overcome treatment resistance are scarce and new treatment modalities are needed. When confronted with psychopharmacological failure, repetitive transcranial magnetic stimulation (rTMS) therapy can be considered. In these case series a combative high frequency (HF)-rTMS protocol with frequent stimulations at suprathreshold intensity was applied for treatment-resistant depression (TRD), schizoaffective- and bipolar I disorder, mixed episode. Besides effectiveness, tolerability was closely monitored. All three patients, suffering from different psychiatric conditions were experiencing limited to excellent clinical improvement without serious side effect or adverse events. These very preliminary results suggest, along with research using comparable intensive stimulation parameters for treatment-resistant depression, that 'aggressively' targeting the left DLPFC is well tolerated and safe. Our clinical results suggest a possible beneficial treatment strategy of HF-rTMS protocols following unsuccessful. Larger sham-controlled studies are needed to substantiate our results

Mobile crisis team in the brussels region: facts and figures

Background: A reformation of psychiatry was set up in Belgium with the establishment of mobile crisis teams. Subjects and methods: We performed a retrospective analysis of the patients referred to the mobile team "Pharos" in the period between December 2013 and December 2018. Results: The number of patients is growing over the years and the most common referral reasons are suicidal thoughts and depressive mood. We have a high percentage of inclusions, maybe because the main referrers are GPs. Alcohol withdrawal at home is feasable and safe. Conclusion: Many psychiatric crisis situations can be managed at home with support of mobile teams, but further research is needed to provide evidence on outcome and cost effectiveness

Neuropsychiatric symptoms in mild cognitive impairment and dementia due to AD : relation with disease stage and cognitive deficits

Background: The interaction between neuropsychiatric symptoms, mild cognitive impairment (MCI), and dementia is complex and remains to be elucidated. An additive or multiplicative effect of neuropsychiatric symptoms such as apathy or depression on cognitive decline has been suggested. Unraveling these interactions may allow the development of better prevention and treatment strategies. In the absence of available treatments for neurodegeneration, a timely and adequate identification of neuropsychiatric symptom changes in cognitive decline is highly relevant and can help identify treatment targets. Methods: An existing memory clinic-based research database of 476 individuals with MCI and 978 individuals with dementia due to Alzheimer's disease (AD) was reanalyzed. Neuropsychiatric symptoms were assessed in a prospective fashion using a battery of neuropsychiatric assessment scales: Middelheim Frontality Score, Behavioral Pathology in Alzheimer's Disease Rating Scale (Behave-AD), Cohen-Mansfield Agitation Inventory, Cornell Scale for Depression in Dementia (CSDD), and Geriatric Depression Scale (30 items). We subtyped subjects suffering from dementia as mild, moderate, or severe according to their Mini-Mental State Examination (MMSE) score and compared neuropsychiatric scores across these groups. A group of 126 subjects suffering from AD with a significant cerebrovascular component was examined separately as well. We compared the prevalence, nature, and severity of neuropsychiatric symptoms between subgroups of patients with MCI and dementia due to AD in a cross-sectional analysis. Results: Affective and sleep-related symptoms are common in MCI and remain constant in prevalence and severity across dementia groups. Depressive symptoms as assessed by the CSDD further increase in severe dementia. Most other neuropsychiatric symptoms (such as agitation and activity disturbances) progress in parallel with severity of cognitive decline. There are no significant differences in neuropsychiatric symptoms when comparing "pure " AD to AD with a significant vascular component. Conclusion: Neuropsychiatric symptoms such as frontal lobe symptoms, psychosis, agitation, aggression, and activity disturbances increase as dementia progresses. Affective symptoms such as anxiety and depressive symptoms, however, are more frequent in MCI than mild dementia but otherwise remain stable throughout the cognitive spectrum, except for an increase in CSDD score in severe dementia. There is no difference in neuropsychiatric symptoms when comparing mixed dementia (defined here as AD + significant cerebrovascular disease) to pure AD