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Biomedical subjects

W M Verhoeven

Publications and source records attributed to W M Verhoeven.

At least 19 recordsLinked to original sources
PubMed2004

Alexithymia in Noonan syndrome.

Although Noonan syndrome is quite prevalent, there is a general paucity in the description of psychological and psychiatric aspects. In the present paper a 19-year-old female patient with Noonan syndrome is described who presented with anxiety symptoms. Mutation analysis in PTPN11, the NS1 gene on chromosome 12q24, showed no abnormalities. A diagnosis of panic disorder without agoraphobia was established. Treatment with citalopram resulted in a gradual decline of anxiety symptoms. The psychological profile was characterized by a prominent alexithymia. The main conclusion is that patients with Noonan syndrome might have deficits in emotional adaptative functions. It is hypothesized that alexithymia is a key feature of the behavioural phenotype.

Abnormalities, Multiple↗
PubMed2001

Two steps forward, one step back; paradigmatic changes in psychiatry.

The initial scientification of psychiatry after the European discovery of psychotropic drugs via psychopharmacology and biological psychiatry has gradually ended in an impasse. As a result of at least four developments, psychiatry is re-orientating in a more dimensional and functional direction in order to adapt to the progress in the neurosciences. Rigid adherence to nosological systems should be replaced by a careful observation and description of psychopathology as well as a search for relevant psychological dysfunctions and their putative pathophysiological basis. Psychotropics have to be developed that do not suppress symptoms but promote potentially intact functions. Emphasis should be given to the brain mechanisms that are involved in habit formation and chronicity. Modern genetics will drive the discipline towards early intervention and prevention and will elucidate the relations between genetic disorders and the behavioural phenotype. The basis, however, remains clinical observation, dynamically reshaped by neuroscience.

Antipsychotic Agents↗
PubMed2001

Citalopram in mentally retarded patients with depression: a long-term clinical investigation.

The effect of citalopram was investigated in 20 mentally retarded patients suffering from a depressive disorder characterized by alterations in the domains of affectivity, motivation, motor activity and vital signs. The study followed a baseline-controlled open design. Citalopram was started in a daily dosage of 20 mg that was kept unchanged for 6 weeks. Thereafter dosage was adjusted to maximally 60 mg per day. Treatment effects were assessed according to the Clinical Global Improvement Scale (CGIS) after at least 6 months. In 12 of the 20 patients a moderate to marked improvement in all domains was observed upon treatment with 20-40 mg citalopram daily. Treatment for one year in the effective dose prevented recurrence of depressive symptomatology. Concomitant use of sedative anticonvulsants reduced responsiveness to treatment. No interactions were observed. It is concluded that citalopram is a well-tolerated, safe and effective antidepressant in mentally retarded subjects with depressive disorders.

Adult↗
PubMed2000

Prader-Willi psychiatric syndrome and Velo-Cardio-Facial psychiatric syndrome.

Prader-Willi psychiatric syndrome and Velo-Cardio-Facial psychiatric syndrome: Similar to the studies on behavioural phenotypes, it is suggested to more rigorously promote the investigation of psychopathological phenotypes. The psychopathological profile in patients with Prader-Willi Syndrome (PWS) or Velo-Cardio-Facial Syndrome (VCFS) appears to be not classifiable within the current nosological systems. On a descriptive level, PWS-psychotic states show similarities with the cycloid psychoses, but VCFS psychosis does not. It is therefore advocated to adopt the notion of a brain-structure phenotype as well as that of a syndrome-specific psychiatric disorder.

Adult↗
PubMed1999

Stress and self-injurious behavior; hormonal and serotonergic parameters in mentally retarded subjects.

Self-injurious behavior (SIB) and stereotyped behavior (SB) are major challenges for professionals in the field of mental retardation. From animal experiments it has become obvious that these behavioral disturbances are not purposeless but may emerge secondary to restrictive environment and may serve de-arousing objectives. In mentally retarded subjects, several hypotheses have been formulated concerning the pathogenesis of SIB, particularly about the involvement of serotonin and beta-endorphin, which are supported by beneficial treatment effects of the opiate antagonist naltrexone and serotonin modulating compounds, respectively. The present study was designed to investigate basal levels of stress-hormonal and serotonergic parameters as well as plasma levels of amino-acids and the beta-carboline norharman in a group of 64 mentally retarded subjects with SB and/or SIB. Allocation to three different groups comprising 17 retarded controls, 26 subjects with mainly SIB and 21 subjects with mainly SB, was originally performed using the scores on the factors Irritability, Stereotypic Behaviour and Hyperactivity of the Aberrant Behavioral Checklist. Because of the overlapping nature of the behavioral parameters, subjects were subsequently divided into three maximally contrasting groups, viz. predominantly SIB, predominantly SB and retarded controls, each comprising 11 subjects. With respect to beta-endorphin, no differences were found either between both the original and maximally contrasting groups or in comparison to nonretarded controls. As compared to retarded controls, a tendency to lower values for total cortisol and cortisol binding globulin appeared to be present in the SIB group, whereas in the SB group a tendency toward higher levels of the major serotonin metabolite 5-HIAA was found. In the contrasting SB group, a trend toward decreased total cortisol level was observed as compared to the retarded control group. In addition, significantly lower values for norharman and tryptophan were demonstrated in the total group of mentally retarded subjects as compared to non-retarded controls. The results of the present study, yielding co-existent disturbances in stress-hormonal and monoaminergic mechanisms as well as in the metabolism of norharman, are in line with the hypothesis that mentally retarded subjects are at risk for the development of stress-related behavioral disorders such as SIB and SB.

Adult↗
PubMed1999

Brain correlates of memory dysfunction in alcoholic Korsakoff's syndrome.

OBJECTIVES: To investigate the relation between anterograde amnesia and atrophy of brain structures involved in memory processing in alcoholic Korsakoff's syndrome. METHODS: The volume of brain structures involved in memory processing was measured with MRI from 13 subjects with Korsakoff's syndrome, 13 subjects with chronic alcoholism without Korsakoff's syndrome, and 13 control subjects. The brain structures analysed were the hippocampus, the parahippocampal gyrus, the mamillary bodies, the third ventricle, and the thalamus. Brain volumes were correlated with the delayed recall of a verbal learning test. RESULTS: Compared with subjects with chronic alcoholism and control subjects, subjects with Korsakoff's syndrome had a reduced volume of the hippocampus, the mamillary bodies, and the thalamus, and enlargement of the third ventricle. The impairment of delayed recall correlated with the volume of the third ventricle (r=-0.55, p=0.05) in the Korsakoff group. CONCLUSIONS: Anterograde amnesia in alcoholic Korsakoff's syndrome is associated with atrophy of the nuclei in the midline of the thalamus, but not with atrophy of the mamillary bodies, the hippocampus, or the parahippocampal gyrus.

Alcoholism↗
PubMed1998

[Frontotemporal dementia in a young woman with apparent schizophrenia].

In a woman aged 35 who for the last 5 years had been suffering from conduct disorders, especially kleptomania, compulsive cleaning behaviour and affective neglect of her children, psychodiagnostic examination initially suggested a delusional disorder. In view of the gradual aggravation of bizarre behaviour, the diagnosis 'schizophrenic psychosis of the hebephrenic type' was made; supplementary examination revealed no abnormalities. Finally, in view of the ununderstood and progressive behavioural changes, the diagnosis was reconsidered; on the basis of clinical findings, SPECT examination and results of repeated CT of the brain, the diagnosis of 'frontotemporal dementia, type Pick' was made.

Adult↗
PubMed1998

Prader-Willi syndrome and cycloid psychoses.

The psychiatric symptomatology of people with Prader-Willi syndrome (PWS) has mainly been described in case reports and some large-scale descriptive studies. Unfortunately, there is still no systematic description of all the psychiatric symptoms which accompany this chromosomal error. Symptoms of mood disorder and anxiety dominate the picture of PWS, although some reports also mention psychotic symptoms with variations in prevalence of between 15% and 60%. The present paper presents six case reports of adult male subjects with a diagnosis of PWS and psychiatric symptoms who fulfill the criteria for cycloid psychosis (ICD-10 F.23.0). This psychotic disorder requires a specific psychopharmacological approach with mood stabilizing agents, particularly Lithium. It is concluded that subjects with PWS may be especially vulnerable to the development of cycloid psychosis, which suggests the existence of a specific 'psychopathological phenotype'.

Adult↗
PubMed1996

The effect of buspirone on challenging behaviour in mentally retarded patients: an open prospective multiple-case study.

During the past few decades, suggestive evidence has been accumulated that abnormalities in serotonin neurotransmission are involved in the pathogenesis of aggressive behaviour disorders and impulsivity. Support for this idea can be derived from clinical studies using 5-HT1 agonistic compounds and serotonergic antidepressants. In the present study, the efficacy of the 5-HT1a agonist buspirone was investigated in eight patients with mental retardation and severe, long-lasting challenging behaviour, characterized by aggressive outbursts, self-injurious behaviour and impulsivity. The findings demonstrate that buspirone, in a daily dosage varying between 20 and 50 mg, may be effective in reducing this type of behavioural disturbance and associated with an improvement in sociability. It is hypothesized that the responsiveness to buspirone treatment may be the result of a de-arousing phenomenon, mediated via corticosteroid dependent stress homeostatic mechanisms.

Adult↗
PubMed1995

Dimensional classification and behavioral pharmacology of personality disorders; a review and hypothesis.

Nosological orientation in psychiatry has severely hampered the progress of research in biological psychiatry, especially in the case of personality disorders. Dimensional approaches have redefined the characteristics of these disorders and their possible pathogenetic factors. The significance of arousal and stress, so far relatively neglected in clinical research, and its important function in adaptive and coping strategies has to be included in the study of the behavioral pharmacology of personality disorders. Some preliminary clinical data are available suggesting the potential therapeutic use of serotonin modulating agents in the key symptomatology of certain personality disorders such as disturbed impulsive regulation and increased stress reactivity.

Adaptation, Psychological↗
PubMed1995

Cerebrospinal fluid 5-hydroxyindolacetic acid and aggression: a critical reappraisal of the clinical data.

Over the past 15 years several clinical studies have been published dealing with the hypothesis that disturbances in central serotonergic functioning could be related to outward directed aggression and impulsivity. Close reading of the 22 relevant reports, however, raises doubt about the unequivocality of the results across diagnostic boundaries and in comparison with normal controls. Only eight of the studies are methodologically acceptable and seem to support the hypothesis. Taking all data together, it is concluded that some relationship exists between decreased serotonin metabolism, as reflected by lowered cerebrospinal fluid 5-hydroxyindolacetic acid, and certain aspects of aggressive behavior in a subgroup of young, male, personality-disordered subjects with seriously deviant behavior.

Behavior↗
PubMed1994

Brofaromine in endogenous depression.

1. Recently, a new generation of monoamine oxidase (MAO) inhibitors has been developed which selectively and reversibly inhibit MAO-A activity. 2. One of these compounds, called brofaromine, has been administered in subjects suffering from endogenous depression, revealing antidepressive efficacy in a majority of them without inducing serious adverse events. 3. The results obtained so far suggest that brofaromine might be effective in endogenous depressed patients who failed to respond to tricyclic antidepressants.

Antidepressive Agents↗
PubMed1993

Inhibition of the pituitary-adrenal axis with dexamethasone and cortisol in depressed patients and healthy subjects: a dose-response study.

Different doses dexamethasone (0.25, 0.5, and 1 mg) or cortisol (30, 60, and 120 mg) were administered PO at 2230h to 39 depressed patients and 20 healthy subjects on nonsuccessive days. The inhibiting capacity of the two steroids on hypothalamo-pituitary axis (HPA) function was evaluated by measuring the plasma levels of cortisol, ACTH, and beta-endorphin at 0900h and 1530h each day following treatment. Baseline levels of the hormones were measured before starting treatment. A dose-dependent suppressive effect of both steroids on the plasma levels of cortisol, ACTH, and beta-endorphin was found both in patients and controls, except for the 0900h levels of cortisol after cortisol treatment. The effects were most profound in the morning. Differences between patients and controls were observed after cortisol treatment, but not dexamethasone, with respect to cortisol, ACTH, and beta-endorphin plasma levels in the morning. Cortisol treatment discriminated dexamethasone nonsuppressors from suppressors (patients and controls) and patients categorized as dexamethasone suppressors from controls in a way that dexamethasone treatment could not. The data favour the idea of impaired corticosteroid feedback beyond the pituitary level as part of HPA dysfunction.

Adrenocorticotropic Hormone↗
PubMed1993

Psychiatry and mental retardation: towards a behavioural pharmacological concept.

The rediscovery of psychiatric disorders in mentally retarded subjects has revealed the inadequacy of existing diagnostic and classification systems. The major reason for the limitations of the latter is that such systems have not been developed for application in subjects with substantial intellectual handicaps or other brain dysfunctions. Furthermore, the impact of the different aetiological brain factors is more or less neglected, and so are the specific interrelations between brain dysfunctions and psychiatric symptoms. For a better understanding of the behavioural disorders in mentally retarded subjects, the data from primate studies should be taken into consideration, especially where these suggest a relationship between developmental factors and brain dysfunction. Finally, a functional approach is advocated, linking biological and psychological dysfunctions, that could eventually lead to a so-called functional psychopharmacology.

Animals↗
PubMed1992

Bipolar illness, lithium prophylaxis, and pregnancy.

In advising bipolar patients wishing to become pregnant, Weinstein's guidelines were extended to seven stages: contraceptive measures; genetic counseling; discontinuing lithium in the first trimester or prescribing alternatives; ultrasound scanning for congenital anomalies, low lithium levels during pregnancy; discontinuing lithium at the end of pregnancy; starting immediately after birth, no breast feeding, observation of the neonate in the neonatal ward; and close observation of the patient in the follow-up year. Of the 15 bipolar patients, 11 gave birth to healthy children (five of them twice). Most patients knew nothing about the inheritance of bipolar illness. Four made no further attempt to become pregnant: two in view of a serious possibility of inheritance, the other two after a severe relapse. Three patients chose an alternative to lithium medication (carbamazepine and haloperidol). Postpartum, 27% of the patients who used medication relapsed and 60% of the patients who used none relapsed.

Adult↗