Glycosylated hemoglobin as a screening test for hyperglycemia in antipsychotic-treated patients: A follow-up study

Purpose: To assess the point prevalence of undetected prediabetes (preDM) and diabetes mellitus (DM) in patients treated with antipsychotics and to compare metabolic parameters between patients with normoglycemia (NG), preDM, and DM. Furthermore, conversion rates for preDM and DM were determined in a 1-year follow-up.Patients and methods: In a naturalistic cohort of 169 patients, fasting glucose (FG) and hemoglobin A1c (HbA1c) criteria were applied at baseline and at follow-up after 1 year. A distinction was made between baseline patients diagnosed according to FG (B-FG) and those diagnosed according to HbA1c (B-HbA1c). Conversion rates in the 1-year follow-up were compared between B-FG and B-HbA1c.Results: At baseline, preDM and DM were present in 39% and 8%, respectively. As compared to patients with NG, metabolic syndrome was significantly more prevalent in patients with preDM (62% vs 31%). Although the majority of patients were identified by the FG criterion, HbA1c contributed significantly, especially to the number of patients diagnosed with preDM (32%). Regarding the patients with preDM, conversion rates to NG were much higher in the B-FG group than in the B-HbA1c group (72% vs 18%). In patients diagnosed with DM, conversion rates were found for B-FG only.Conclusion: PreDM and DM are highly prevalent in psychiatric patients treated with antipsychotic drugs. HbA1c was shown to be a more stable parameter in identifying psychiatric patients with (an increased risk for) DM, and it should therefore be included in future screening instruments

Compulsory treatment in patients' homes in the Netherlands: What do mental health professionals think of this?

Background: Compulsory treatment in patients' homes (CTH) will be introduced in the new Dutch mental health legislation. The aim of this study is to identify the opinions of mental health workers in the Netherlands on compulsory community treatment (CCT), and particularly on compulsory treatment in the patients' home. Methods: This is a mixed methods study, comprising a semi-structured interview and a survey. Forty mental health workers took part in the semi-structured interview about CCT and 20 of them, working in outpatient services, also completed a questionnaire about CTH. Descriptive analyses were performed of indicated (dis) advantages and problems of CCT and of mean scores on the CTH questionnaire. Results: Overall, the mental health workers seemed to have positive opinions on CCT. With respect to CTH, all mean scores were in the middle of the range, possibly indicating tha

Metabool syndroom bij de behandeling met clozapine

Abstract Metabolic syndrome during clozapine treatment Objective: To assess the prevalence of metabolic syndrome in inpatients with psychotic disorders treated with clozapine for at least one year. Design: Chronically admitted patients were screened on the use of clozapine and the presence of metabolic side effects. Methods: The Third Adult Treatment Panel was used tot assess metabolic syndrome. In addition, patient variables, dosage and plasma concentration of clozapine were recorded. Results: Included were 62 patients with a most prevalent diagnosis of schizophrenia. Mean duration of treatment with clozapine was 9.2 years. Metabolic syndrome was present in 60% of the patients and more frequent in cases with comedication of mood stabilizers. Conclusion: Metabolic syndrome is highly prevalent among patients treated with clozapine for psychotic disorders. Additional factors in the emergence of metabolic syndrome are: unhealthy life style, inactivity and comedication

Physician assistant voor de somatische zorg binnen de ggz

https://www.napa.nl/2019/02/opinieartikel-in-de-psychiater-over-pa-binnen-ggz

Diagnosis in psychiatry; a piece of cake?

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Working memory in schizophrenia: A systematic study of specific modalities and processes

Item does not contain fulltextAlthough many researchers agree that working memory (WM) impairments are a core symptom of schizophrenia, it remains unclear how the disturbances on specific WM components relate to one another. In this study, we presented a Delayed-Matching-To-Sample task to 24 schizophrenia patients and 24 healthy controls, matched on demographical variables. Verbal and visuospatial WM performance was investigated with pseudowords and Chinese characters as stimuli, respectively. Processing demands (maintenance and manipulation, measured with delay and mental rotation) were low or high. Reaction time and accuracy were recorded. All experimental factors had significant effects. In general, patients were slower and less accurate than controls. Patients were especially slower on verbal tasks but they were not less accurate. Accuracy differences did not increase when either maintenance or manipulation demands increased alone but they did when both maintenance and manipulation demands increased simultaneously. These findings indicate that performance impairment in patients was non-specific and that no specific deficit of any WM component was observed

The relationship between work and home characteristics and work engagement in medical residents

Contains fulltext : 175323.pdf (publisher's version ) (Open Access)Introduction: Work engagement is important for medical residents and the healthcare organizations they work for. However, relatively little is known about the specific predictors of work engagement in medical residents. Therefore, we examined the associations of work and home characteristics, and work-home interference with work engagement in male and female residents. Methods: This study was conducted on a nationwide sample of medical residents. In 2005, all Dutch medical residents (n = 5245) received a self-report questionnaire. Path analysis was used to examine the associations between the potential predictors and work engagement. Results: In total, 2115 (41.1%) residents completed the questionnaire. Job characteristics, home characteristics and work-home interference were associated with work engagement. Important positive contributing factors of work engagement were opportunities for job development, mental demands at work, positive work-home interference and positive home-work interference. Important negative contributing factors were emotional demands at work and negative home-work interference. The influence of these factors on work engagement was similar in male and female residents. Discussion: Opportunities for job development and having challenging work are of high relevance in enhancing work engagement. Furthermore, interventions that teach how to deal skilfully with emotional demands at work and home-work interference are expected to be the most effective interventions to enhance work engagement in medical residents.10 p

The contribution of work characteristics, home characteristics and gender to burnout in medical residents

Contains fulltext : 175906.pdf (publisher's version ) (Open Access)Burnout is highly prevalent in medical residents. In order to prevent or reduce burnout in medical residents, we should gain a better understanding of contributing and protective factors of burnout. Therefore we examined the associations of job demands and resources, home demands and resources, and work-home interferences with burnout in male and female medical residents. This study was conducted on a nation-wide sample of medical residents. In 2005, all Dutch medical residents (n = 5245) received a self-report questionnaire on burnout, job and home demands and resources and work-home interference. Path analysis was used to examine the associations between job and home characteristics and work-home interference and burnout in both males and females. In total, 2115 (41.1 %) residents completed the questionnaire. In both sexes emotional demands at work and the interference between work and home were important contributors to burnout, especially when work interferes with home life. Opportunities for job development appeared to be an important protective factor. Other contributing and protective factors were different for male and female residents. In females, social support from family or partner seemed protective against burnout. In males, social support from colleagues and participation in decision-making at work seemed important. Effectively handling emotional demands at work, dealing with the interference between work and home, and having opportunities for job development are the most essential factors which should be addressed. However it is important to take gender differences into consideration when implementing preventive or therapeutic interventions for burnout in medical residents.16 p

A man who wanted to commit suicide by hanging himself: an adverse effect of ciprofloxacin.

Item does not contain fulltextIn this case report, we describe a man who developed recurrent depression and suicidal ideation with a serious plan to commit suicide as definite adverse effect of ciprofloxacin, which had been prescribed for recurrent prostatitis

Cycloid psychoses in the psychosis spectrum: Evidence for biochemical differences with schizophrenia

Contains fulltext : 159096.pdf (publisher's version ) (Open Access)Cycloid psychoses (CP) differ from schizophrenia regarding symptom profile, course, and prognosis and over many decades they were thought to be a separate entity within the psychosis spectrum. As to schizophrenia, research into the pathophysiology has focused on dopamine, brain-derived neurotrophic factor, and glutamate signaling in which, concerning the latter, the N-methyl-d-aspartate receptor plays a crucial role. The present study aims to determine whether CP can biochemically be delineated from schizophrenia. Eighty patients referred for psychotic disorders were assessed with the Comprehensive Assessment of Symptoms and History, and (both at inclusion and after 6 weeks of antipsychotic treatment) with the Positive and Negative Syndrome Scale and Clinical Global Impression. From 58 completers, 33 patients were diagnosed with schizophrenia and ten with CP according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and Leonhard criteria, respectively. Fifteen patients were diagnosed with other disorders within the psychosis spectrum. At both time points, blood levels of the dopamine metabolite homovanillic acid, brain-derived neurotrophic factor, and amino acids related to glutamate neurotransmission were measured and compared with a matched control sample. Patients with CP showed a significantly better response to antipsychotic treatment as compared to patients with schizophrenia. In CP, glycine levels were elevated and tryptophan levels were lowered as compared to schizophrenia. Glutamate levels were increased in both patient groups as compared to controls. These results, showing marked differences in both treatment outcome and glutamate-related variable parameters, may point at better neuroplasticity in CP, necessitating demarcation of this subgroup within the psychosis spectrum.7 p