The growing populations of the elderly is frequently regarded as a homogeneous entity. In this retrospective study 140 patients above 60 years, first admitted to a psychiatric hospital, were screened for individual psychiatric symptoms. This was done according to the D.S.M.-III-R criteria and with the european ADMP-IV scoring system.

As expected dementia and related disorders are characteristic of the “older” categories, depressieve disorders were seen more frequently in the “younger” categories. Screening the elderly for psychiatric symptoms also shows differentiation within the group of the older patients.

Symptoms related to dementia increase in frequency, also increasing are e.g. visual hallucinations. A decrease was found for hypochondriasis and phobia. So, the group patients above 60 years is clearly heterogeneous.

In an introduction the evolution of a neuropsychological and neuropsychiatrie approach in the two last decades is discussed. The role of the basal ganglia, the thalamus and their cortical connections in aphasia is discussed. This review is given as a paradigm to demonstrate a neuropsychiatrie approach of psychiatric disorders. The role of corticosubcortical relations in depression is discussed.

Several lines of evidence suggest that there may be abnormal brain serotonin metabolism in habitually biolent and impulsive offenders. These personality disorders are usually connected with early onset, male limited type 2 alcoholism in which one central feature is the abnormal tendency to behave aggressively and impulsively under the influence of alcohol repeatedly. Low CSF 5-HIAA has been found to correlate with familial alcoholism tendencies; paternal alcoholism. Both this and with it the tendency to abnormal oral glucose tolerance test (tendency to low blood glucose nadir) predict the new violent and impulsive crimes under the influence of alcohol. Also peripheral measures such as platelet MAO, abnormal tryptophan/LNAA ratio in plasma, whole blood serotonin, blood platelet uptake of serotonin, platelet 3H-IMI dinging (Bmax), abnormal prolactin and Cortisol secretion in fenfluramine challenge, and possibly daily urinary free Cortisol secretion correlate with impulsive aggressive behavior.

In this article the value of the tyramine conjugation test (TCT) as a predictor of the response to antidepressive medication is reviewed. The TCT seems of little discomfort for the patient, is easy to perform and is suggested to have a high sensitivity and specificity. In addition, there are indications that a decreased tyamine conjugation could be a traitmarker for the vulnerability of depression. Hypotheses concerning the, as yet unclear etiology of the decreased tyramine are reviewed.

Deze aflevering gaat over een probleem van naamgeving. Door de recente trends op het gebied van de indicatiestelling van psychofarmaca worden we meer en meer in de war gebracht. Uit het verloop van dit verhaal zult u wel zien waarom en de vraag is of u de redactie van advies wilt en kunt dienen.

In de meeste farmacologische textboeken worden de psychofarmaca ingedeeld naar de klinische werking, zoais u weet, en drie hoofdgroepen worden onder-scheiden: de psychoanaleptica, de psycholeptica en de psychodysleptica. Hier zullen we ons beperken tot de eerste twee groepen. Tot de belangrijkste typen farmaca van de eerste groep worden de antidepressiva en soms de lithiumzouten gerekend en tot de tweede groep behoren de ataractica (zoals de ben-zodiazepinen) en de antipsychotica. Hoe verhoudt zieh zo'n indeling ten opzichte van andere farmaco-therapeutische indelingen in de geneeskunde: worden eiders farmaca gerubrieeerd volgens de klinische indicaties of volgens de primaire aangrijpingspunten c.q. chemische karakteristie-ken? Soms volgt de indeling het werkingsprineipe, dan weer het ziektebeeld of symptoom, waarbij het middel het meest wordt toegepast.