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POSTTRAUMATIC STRESS DISORDER (PTSD) IS HIGHLY PREVALENT IN PATIENTS WITH ACQUIRED BRAIN INJURY. EYE MOVEMENT DESENSITIZATION AND REPROCESSING (EMDR) IS AN EFFECTIVE TREATMENT FOR POSTTRAUMATIC STRESS SYMPTOMS. HOWEVER, SCIENTIFIC RESEARCH ON APPLICABILITY AND EFFECTIVENESS OF EMDR IN ACQUIRED BRAIN INJURY, AND MORE SPECIFICALLY IN PATIENTS WITH APHASIA, IS SCARCE. WE DESCRIBE THE TREATMENT OF POSTTRAUMATIC STRESS SYMPTOMS WITH EMDR IN A PATIENT WITH APHASIA AFTER ACQUIRED BRAIN INJURY. WE ADJUSTED EMDR STANDARD PROTOCOL. THERAPY WAS RELATIVELY SHORT, THE SPOUSE WAS INVOLVED IN THE TREATMENT, AND RESULTS WERE POSITIVE. FINDINGS SHOW THE POSSIBILITIES FOR EMDR IN PATIENTS WITH APHASIA AND ENCOURAGE FURTHER INVESTIGATION INTO THE APPLICATION OF EMDR IN THIS POPULATION.

Background: Psychiatric disorders are associated with a more severe course of COVID-19. COVID-19 can also lead to psychiatric symptoms., Aim: To gain insight into vulnerabilities and protective factors for the course of COVID-19 in a Dutch (neuro)psychiatric population., Method: Patients were divided into three groups: patients with pre-existent mental disorders without and with new (neuro)psychiatric symptoms (NPS) during COVID-19 and patients without pre-existent mental disorders who developed de novo NPS during COVID-19. We summarize the characteristics of each group and compare the subgroups with inferential statistics., Results: 186 patients were included in the case register. Patients with NPS showed a more severe course of COVID-19. Mortality in patients with NPS was higher in patients with pre-existent mental disorders compared to patients without pre-existent mental disorders. The most frequently reported de novo psychiatric symptoms during COVID-19 were delirium (46-70%), anxiety (53-54%) and insomnia (18-42%)., Conclusion: NPS might be an expression of a more severe COVID-19 episode. In patients who developed NPS during COVID-19 we found evidence for a higher mortality risk in patients with pre-existent mental disorders. Extra vigilance for neuropsychiatric symptoms during COVID-19 is warranted.

Background: A variable ptosis may point towards serious neurological disorders and is presented to general practitioners, ophthalmologists and neurologists., Case Description: Two patients presented at the neurology outpatient clinic with a ptosis confined to awakening from sleep. There were no other neurological complaints and neurological examination was normal. The diagnosis 'awakening ptosis' was made., Conclusion: Awakening ptosis is a benign, but rare disorder. The exact pathophysiology remains unclear. In the case of a classic clinical picture of awakening ptosis, additional examinations are not indicated.

Background: In some Dutch mental health care organisations specific neuropsychiatric departments have been developed for patients with brain injury., Aim: To identify the characteristics of patients with brain injury who form a specific population in mental health care and to determine whether such patients require either specialised care or a special type of care., Method: A cross-sectional analysis of typical brain injury inpatients was performed. We noted the age and gender of these patients and recorded any previous periods of inpatient care. We listed patients’ impairments, the diagnoses they had been given and the treatment they had received. This inventory formed the basis of our conclusions., Results: The typical clinical patient with brain injury in this setting was a male of 51 years or older, most probably affected by a stroke or traumatic brain injury, admitted for a period of 6 months, many years after the incident. He was mostly referred from home or hospital by a physician and was expected to return home again. A combination of cognitive and psychiatric impairments was often found. Physically the patient had no or only mild disabilities, but societal participation was low and many cognitive-affective disorders were seen. Treatment was relatively infrequent and mostly directed at daily activities. The most frequent diagnosis was & lquo;cognitive deficits not otherwise specified’. Irritability, agitation, apathy and depression were frequent symptoms., Conclusion: This inventory suggests that brain injury patients in a mental health care setting need special care which is not available in other health care settings.

Objective: To gain insight into how the acute care of critically ill children at general hospitals is organised, whether staff is sufficiently trained and whether the necessary materials and medications are present., Design: Questionnaire combined with a site visit., Method: Questionnaires were sent to all primarily involved specialists (emergency room specialists and paediatricians), and to the auxiliary anaesthetists and intensivists involved, at the nine general hospitals in Southeast Netherlands. Two researchers performed standardised interviews with the lead paediatricians on site and checked for materials and medication present in the emergency and paediatric departments., Results: Of the 195 questionnaires sent, 97 (49.7%) were deemed suitable for analysis. The response from the primary specialists involved (77.6%) was more than twice that of the auxiliary specialists (31.9%). At 7 hospitals, verbal agreements on the organisation of acute care were maintained, 1 hospital had a written protocol, and 2 hospitals had a task force addressing this topic. One out of 5 respondents was unaware of the verbal agreements and 1 out of 3 mistakenly assumed that a protocol existed. Two out of 3 primary specialists involved were certified for Advanced Paediatric Life Support (APLS); 1 out of 13 of the auxiliary specialists had such a certificate. Scenario training was being conducted at 8 hospitals. A paediatric resuscitation cart was available at both the emergency and paediatric departments of 8 hospitals, 3 of which were fully stocked at both departments. Laryngeal mask airways and PEEP-valves (Positive End Expiratory Pressure) were lacking at 6 of the 9 hospitals. The medication stock was complete at all the hospitals., Conclusion: The organisation of and training for the acute care of critically ill children and presence of materials - the aspects we investigated - need attention at all general hospitals evaluated. It appeared that many specialists are not APLS certified and written protocols concerning organisation and training were lacking. The establishment of a task force responsible for the acute care of children is one measure that could result in rapid improvement. Another measure could be the introduction of a standardised list of inventory needed for acute care.

Background: There is a dearth of knowledge and understanding concerning hoarding by children and adolescents. Psychiatrists need to know more about the phenomenon of hoarding since it can be a marker of psychopathology and it sometimes is symptomatic of a psychiatric disorder., Aim: To review hoarding from an epidemiological and psychopathological perspective and to discuss it in relation to the developmental aspect of the first object acquisition: the transitional object., Method: We conducted a literature search in PubMed, Medline, PsycINFO and the Cochranedatabase using primarily the search term ‘hoarding', but also in combination with the terms: primates, child, adolescent, psych*, klepto*, transitional object, obsessive-compulsive disorder, collecting and attachment., Results: Both animals and humans engage frequently in collecting and hoarding. Up to 60% of normally functioning children and adolescents are involved in collecting. A strong emotional attachment to possessions may be a response to an attachment problem. Hoarding combined with psychopathology is seen in persons of all ages but the prevalence rates for children and adults are unknown., Conclusion: Hoarding is a worrisome type of behaviour which must be regarded as an indication of serious comorbid psychopathology. It can occur either as a symptom of an existing disorder or as a separate disorder. Finally we recommend that hoarding be included in the diagnostic criteria of the dsm and icd.