PSYCHIATRIE

CENTRUM PSYCHIATRIE

ARTIKELS

ABSTRACT 1

Het fossa posterior-meningeoom: een zwarte zwaan.

Snauwaert PH, Vervaet J, Geerts PJ, et al. Tijdschrift voor Geneeskunde, 2019, 75, 750-756

INTRODUCTION/BACKGROUND De levensverwachting is de laatste 100 jaar met 40 jaar toegenomen. Ouder worden betekent meer kans op dementie en een toename van leeftijdsgebonden tumoren. Meningeomen zijn langzaam groeiende tumoren. Hun kliniek hangt af van de grootte en de locatie in de hersenen. Wanneer ze zich bevinden in een neurologisch „stille zone”, blijven ze lang asymptomatisch. Het vroegtijdig herkennen van gedragsveranderingen veroorzaakt door een hersentumor blijft moeilijk. Vaak wordt er eerst, zeker in de aanwezigheid van psychosociale stressoren, gedacht aan een psychiatrisch ziektebeeld. Nadien wordt dit vaak weinig in vraag gesteld. De term „zwarte zwaan” wordt als metafoor gebruikt om een ziektebeeld te beschrijven dat niemand had voorspeld, waar geen aanwijzingen voor waren en waarvan de diagnose achteraf wel bijgesteld kan worden. In dit artikel wordt de ziektegeschiedenis besproken van een 81-jarige vrouw met een initiële aanmelding wegens depressieve klachten die al twee jaar last blijkt te hebben van hoofdpijn, duizeligheid en sinds drie maanden een gedragsverandering onder de vorm van apathie. Na beeldvorming en de vaststelling van een fossa posterior-meningeoom wordt de diagnose van een depressie bijgesteld. Bij apathie, een blanco psychiatrische voorgeschiedenis, gedragsveranderingen en een leeftijd boven 50 jaar moet structurele beeldvorming worden overwogen om organiciteit uit te sluiten.

ABSTRACT 2

Late-onset manic episode after bariatric surgery.

Dries D, Geerts PJ

International Journal of Psychiatry, 2019, 4(1), 1-3

INTRODUCTION/BACKGROUND A manic episode is a clearly recognizable period with an abnormally and persistently elevated, expansive or irritable mood, with an abnormal and persistently increased targeted activity of energy, present for a week and during the biggest part of the day. The episode usually fits within a bipolar disorder, in which also depressive episodes occur. These episodes often precede the manic phase. When a first manic episode occurs at a later age without any personal history, a somatic cause must always be excluded. Late-onset mania is associated with increased somatic comorbidity in patients aged 50 years and older. In this case report we present a patient with a late-onset (occurring after the age of 50) manic episode, occurring 3 months after a gastric bypass operation. Bariatric surgical outcomes are associated with medical and psychological complications, like neuropsychiatric disorders. In the screening before surgery, it has been generally found that 66% have at least one axis I diagnosis. A comprehensive presurgical approach with different disciplines and including psychiatric evaluation was developed by the National Institute of Health. There is no definitive guideline for post bariatric psychiatry evaluation, despite high post-surgical prevalence of psychiatric complications.

CONCLUSION The manic episode usually fits within a bipolar disorder, and is an invalidating psychiatric disorder. In a de novo presentation after the age of 50 years, it is called a late onset mania. Given no clearly identifiable underlying somatic factor in our case, secondary mania was excluded. The family burden and postoperative psychosocial stress, which affects oxidative and inflammatory pathways, are etiologically important to conclude to a primary manic episode, with a patient with genetic vulnerability for bipolarity. Nonetheless, primary and secondary mania can be considered as a continuum, and complex pathways are involved in both. The clinical distinction between primary and secondary mania is more important than the difference in pathogenesis, since the cause can and must always be treated in secondary mania. This applies even more in an elderly patient population. It is therefore important to be attentive to prodromi or subtle symptoms of manic or psychiatric problems in the post operative phase, also in patients without known psychiatric problems after screening and without preoperative complications. Extra vigilance is also recommended in the following weeks and months after bariatric surgery, as this case shows and provides a long-term follow-up. Further investigation should be done to suggest guidelines regarding follow-up. The cornerstone of treatment of a late onset manic episode remains first of all to exclude or treat underlying causes. Further treatment does not differ from the early onset mania.

ABSTRACT 3

Oculogyre crisis als enige extrapiramidaal symptoom bij auto-intoxicatie met risperidone.

Van Renterghem L, Titeca K, Geerts PJ, et al. Tijdschrift voor Psychiatrie, 2019, 61 (9), 649-653

INTRODUCTION/BACKGROUND Een 19-jarige patiënte bezocht de spoedgevallendienst met een auto-intoxicatie, waarop zich een oculogyre crisis (ogc) zonder andere extrapiramidale symptomen (eps) voordeed. Patiënte had risperidon 3 mg (een antipsychoticum van de tweede generatie) ingenomen; deze informatie verschafte ze ons echter pas bij een tweede bevraging. Deze bijzondere gevalsbeschrijving van een geïsoleerd voorkomende ogc toont aan dat hulpverleners aandachtig dienen te blijven voor het voorkomen van ogc, ook wanneer de frequentst voorkomende eps niet aanwezig zijn. In tweede instantie benadrukt deze casus het belang van een volledige anamnese om de hulpverlener zo vlot mogelijk naar de correcte diagnose te leiden.

ABSTRACT 4

Electroconvulsive therapy in a patient with multiple cerebreal cavernous malformations.

Boonen I, Titeca K, Geerts PJ, et al. Journal of ECT (Electroconclusive Therapy), 2020, Published Ahead of Print, DOI: 10.1097/YCT.0000000000000654

Er is geen abstract beschikbaar.

PRESENTATIES/ CONGRESSEN

ABSTRACT 1

Electroconvulsive therapy in a patient with multiple cerebral cavernous hemangioma and prior epilepsy surgery: a case-report and literature overview.

3th Bi-Annual meeting of the dutch, german and Belgian ECT workgroups Boonen I, Titeca K, Geerts PJ March 2019, Leuven, België

INTRODUCTION/BACKGROUND A 60-year-old Caucasian female with refractory depression and multiple cerebral cavernous hemangioma (of which one in the brainstem) was treated in our hospital with electroconvulsive therapy (ECT). In her medical history she underwent epilepsy surgery caused by a hemangioma left frontotemporal. Anesthetics used were etomidate, succinylcholine and nicardipine. Diclofenac and ondansetron were given because of complaints of headache and nausea. Each procedure of ECT went safely and without complications. Nortriptyline and lithium carbonate were started during the second half of treatment with ECT as a maintenance treatment. Blood pressure did not reach values higher than 150 mmHg systolic nor higher than 102 mmHg diastolic. Maximum heart rate was 145 beats per minute. She underwent 18 treatments so far and the frequency is gradually decreasing. Electroconvulsive therapy raises the blood pressure and heart rate just after the administration of the electrical pulse. Cavernous hemangioma are malformations of blood vessels in which blood flow is low. The main risk in cavernous hemangioma is bleeding luckily these lesions are less prone for high blood pressure than other vascular malformations like aneurysms. Multiple case reports are published in which ECT was administered safely. We provide a brief summary of the literature and conclude that despite the possible complication of hemorrhage on its own, ECT can be safely administered to patients with cavernous hemangioma with standard of care before, during and after the procedure. Stringent blood pressure regulation and neurological follow-up off course remain advisable.

ABSTRACT 2

A comparative study of screening instruments for alcohol use disorders in elderly hospitalized patients.

European Alliance for Personalised Medicine (EAPM) Congress Leterme E, Vandenbulcke M, Geerts PJ June 2019, Rotterdam, Nederland

OBJECTIVE Alcohol use disorders constitute an important health risk in the elderly. Accordingly, an important challenge in general hospitals is to identify subjects with an increased risk of alcohol use disorder. By comparing three screening instruments, we aimed to determine the most user-friendly yet valid tool for use in patients above 64 years hospitalized in a general hospital.

MATERIALS/METHODS We screened and interviewed all patients above 64 years of age admitted to AZ Groeninge hospital on a census day.

Exclusion criteria were dementia, aphasia, a foreign language, refusing consent and terminal illness. The Modified Single Alcohol Screening Questionnaire (M-SASQ), Alcohol Use Disorders Identification Test (AUDIT) and AUDIT alcohol Consumption questions (AUDIT-C) were used. The MINI-international Neuropsychiatric Interview Plus (M.I.N.I.-Plus) was chosen as golden standard diagnostic test.

RESULTS In total 229 patients were included. The prevalence of alcohol dependence and abuse was low (respectively 1.7% (n = 4) and 1.3% (n = 3)). When screening for alcohol dependence, sensitivity reached maximum (100%) for AUDIT-C and M-SASQ, whereas, AUDIT was associated with one false negative result (sensitivity 75%). For alcohol abuse there were no false negatives (sensitivity 100%). Specificity was 82% (CI 95% 77–87%) for AUDIT-C, 85% (CI 95% 80–89%) for M-SASQ and 96% (CI 95% 92–99%) for AUDIT.

CONCLUSION M-SASQ seems to be a valid and simple screening instrument to detect alcohol use disorders in elderly hospitalized patients. AUDIT was more specific but is more timeconsuming.