Severe fatigue and cognitive complaints are frequently reported after SARS-CoV-2 infection and may be accompanied by depressive symptoms and/or limitations in physical functioning. The long-term sequelae of COVID-19 may be influenced by biomedical, psychological, and social factors, the interplay of which is largely understudied over time. We aimed to investigate how the interplay of these factors contribute to the persistence of symptoms after COVID-19.

RECoVERED, a prospective cohort study in Amsterdam, the Netherlands, enrolled participants aged⩾16 years after SARS-CoV-2 diagnosis. We used a structural network analysis to assess relationships between biomedical (initial COVID-19 severity, inflammation markers), psychological (illness perceptions, coping, resilience), and social factors (loneliness, negative life events) and persistent symptoms 24 months after initial disease (severe fatigue, difficulty concentrating, depressive symptoms and limitations in physical functioning). Causal discovery, an explorative data-driven approach testing all possible associations and retaining the most likely model, was performed.

Data from 235/303 participants (77.6%) who completed the month 24 study visit were analysed. The structural model revealed associations between the putative factors and outcomes. The outcomes clustered together with severe fatigue as its central point. Loneliness, fear avoidance in response to symptoms, and illness perceptions were directly linked to the outcomes. Biological (inflammatory markers) and clinical (severity of initial illness) variables were connected to the outcomes only via psychological or social variables.

Our findings support a model where biomedical, psychological, and social factors contribute to the development of long-term sequelae of SARS-CoV-2 infection.

To evaluate the use of a single-lead electrocardiography (1L-ECG) device and digital cardiologist consultation platform in diagnosing arrhythmias among general practitioners (GPs).

Handheld 1L-ECG offers a user-friendly alternative to conventional 12-lead ECG in primary care. While GPs can safely rule out arrhythmias on 1L-ECG recordings, expert consultation is required to confirm suspected arrhythmias. Little is known about GPs’ experiences with both a 1L-ECG device and digital consultation platform for daily practice.

We used two distinct methods in this study. First, in an observational study, we collected and described all cases shared by GPs within a digital cardiologist consultation platform initiated by a local GP cooperative. This GP cooperative distributed KardiaMobile 1L-ECG devices among all affiliated GPs (n = 203) and invited them to this consultation platform. In the second part, we used an online questionnaire to evaluate the experiences of these GPs using the KardiaMobile and consultation platform.

In total, 98 (48%) GPs participated in this project, of whom 48 (49%) shared 156 cases. The expert panel was able to provide a definitive rhythm interpretation in 130 (83.3%) shared cases and answered in a median of 4 min (IQR: 2–18). GPs responding to the questionnaire (n = 43; 44%) thought the KardiaMobile was of added value for rhythm diagnostics in primary care (n = 42; 98%) and easy to use (n = 41; 95%). Most GPs (n = 36; 84%) valued the feedback from the cardiologists in the consultation platform. GPs experienced this project to have a positive impact on both the quality of care and diagnostic efficiency for patients with (suspected) cardiac arrhythmias. Although we lack a comprehensive picture of experienced impediments by GPs, solving technical issues was mentioned to be helpful for further implementation. More research is needed to explore reasons of GPs not motivated using these tools and to assess real-life clinical impact.

To evaluate the long-term functional outcomes in patients who received primary radiotherapy for tumour–node stage T2N0 glottic carcinoma, stratified for tumour extension.

A cross-sectional study was performed on patients who were treated with radiotherapy for T2N0 glottic carcinoma. Four questionnaires were used to measure different aspects of functional outcome. In addition, objective evaluation and perceptual analysis were performed.

Fourteen patients were included in this study. The median time between the start of radiotherapy and assessment was 42 months (range, 26–143 months). Patients reported high-level functioning, with low symptom scores and good swallowing function, and showed a median dysphonia grade of 1.5. The median Voice Handicap Index-30 score was 17.5.

Patients with T2N0 glottic carcinoma treated with radiotherapy had good long-term quality of life, with low symptom scores, good swallowing functioning and slightly elevated voice outcome parameters.

People with psychotic disorders receive mental healthcare services mainly for their psychiatric care needs. However, patients often experience multiple physical or social wellbeing-related care needs as well. This study aims to identify care needs, investigate their changes over time and examine their association with mental healthcare consumption and evidence-based pharmacotherapy.

This study combined annually obtained routine outcome monitoring (ROM) data with care consumption data of people with a long-term psychotic illness receiving treatment in four Dutch mental healthcare institutes between 2012 and 2016. Existing treatment algorithms were used to determine psychiatric, physical and social wellbeing-related care needs based on self-report questionnaires, semi-structured interviews and physical parameters. Care consumption was measured in hours of outpatient mental healthcare consumption per year. Generalised estimating equation models were used to calculate odds ratios of care needs and their associations with time, mental healthcare consumption and medication use.

Participants (n = 2054) had on average 7.4 care needs per measurement and received 25.4 h of care per year. Physical care needs are most prevalent and persistent and people with more care needs receive more mental healthcare. Care needs for psychotic symptoms and most social wellbeing-related care needs decreased, whereas the chance of being overweight significantly increased with subsequent years of care. Several positive associations were found between care needs and mental healthcare consumption as well as positive relations between care needs and evidence-based pharmacotherapy.

This longitudinal study present a novel approach in identifying care needs and their association with mental healthcare consumption and pharmacotherapy. Identification of care needs in this way based on ROM can assist daily clinical practice. A recovery-oriented view and a well-coordinated collaboration between clinicians and general practitioners together with shared decisions about which care needs to treat, can improve treatment delivery. Special attention is required for improving physical health in psychosis care which, despite appropriate pharmacotherapy and increasing care consumption, remains troublesome.

Cognitive deficits may be characteristic for only a subgroup of first-episode psychosis (FEP) and the link with clinical and functional outcomes is less profound than previously thought. This study aimed to identify cognitive subgroups in a large sample of FEP using a clustering approach with healthy controls as a reference group, subsequently linking cognitive subgroups to clinical and functional outcomes.

204 FEP patients were included. Hierarchical cluster analysis was performed using baseline brief assessment of cognition in schizophrenia (BACS). Cognitive subgroups were compared to 40 controls and linked to longitudinal clinical and functional outcomes (PANSS, GAF, self-reported WHODAS 2.0) up to 12-month follow-up.

Three distinct cognitive clusters emerged: relative to controls, we found one cluster with preserved cognition (n = 76), one moderately impaired cluster (n = 74) and one severely impaired cluster (n = 54). Patients with severely impaired cognition had more severe clinical symptoms at baseline, 6- and 12-month follow-up as compared to patients with preserved cognition. General functioning (GAF) in the severely impaired cluster was significantly lower than in those with preserved cognition at baseline and showed trend-level effects at 6- and 12-month follow-up. No significant differences in self-reported functional outcome (WHODAS 2.0) were present.

Current results demonstrate the existence of three distinct cognitive subgroups, corresponding with clinical outcome at baseline, 6- and 12-month follow-up. Importantly, the cognitively preserved subgroup was larger than the severely impaired group. Early identification of discrete cognitive profiles can offer valuable information about the clinical outcome but may not be relevant in predicting self-reported functional outcomes.

Epidemiological studies indicate that individuals with one type of mental disorder have an increased risk of subsequently developing other types of mental disorders. This study aimed to undertake a comprehensive analysis of pair-wise lifetime comorbidity across a range of common mental disorders based on a diverse range of population-based surveys.

The WHO World Mental Health (WMH) surveys assessed 145 990 adult respondents from 27 countries. Based on retrospectively-reported age-of-onset for 24 DSM-IV mental disorders, associations were examined between all 548 logically possible temporally-ordered disorder pairs. Overall and time-dependent hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards models. Absolute risks were estimated using the product-limit method. Estimates were generated separately for men and women.

Each prior lifetime mental disorder was associated with an increased risk of subsequent first onset of each other disorder. The median HR was 12.1 (mean = 14.4; range 5.2–110.8, interquartile range = 6.0–19.4). The HRs were most prominent between closely-related mental disorder types and in the first 1–2 years after the onset of the prior disorder. Although HRs declined with time since prior disorder, significantly elevated risk of subsequent comorbidity persisted for at least 15 years. Appreciable absolute risks of secondary disorders were found over time for many pairs.

Survey data from a range of sites confirms that comorbidity between mental disorders is common. Understanding the risks of temporally secondary disorders may help design practical programs for primary prevention of secondary disorders.

Intermittent explosive disorder (IED) is characterised by impulsive anger attacks that vary greatly across individuals in severity and consequence. Understanding IED subtypes has been limited by lack of large, general population datasets including assessment of IED. Using the 17-country World Mental Health surveys dataset, this study examined whether behavioural subtypes of IED are associated with differing patterns of comorbidity, suicidality and functional impairment.

IED was assessed using the Composite International Diagnostic Interview in the World Mental Health surveys (n = 45 266). Five behavioural subtypes were created based on type of anger attack. Logistic regression assessed association of these subtypes with lifetime comorbidity, lifetime suicidality and 12-month functional impairment.

The lifetime prevalence of IED in all countries was 0.8% (s.e.: 0.0). The two subtypes involving anger attacks that harmed people (‘hurt people only’ and ‘destroy property and hurt people’), collectively comprising 73% of those with IED, were characterised by high rates of externalising comorbid disorders. The remaining three subtypes involving anger attacks that destroyed property only, destroyed property and threatened people, and threatened people only, were characterised by higher rates of internalising than externalising comorbid disorders. Suicidal behaviour did not vary across the five behavioural subtypes but was higher among those with (v. those without) comorbid disorders, and among those who perpetrated more violent assaults.

The most common IED behavioural subtypes in these general population samples are associated with high rates of externalising disorders. This contrasts with the findings from clinical studies of IED, which observe a preponderance of internalising disorder comorbidity. This disparity in findings across population and clinical studies, together with the marked heterogeneity that characterises the diagnostic entity of IED, suggests that it is a disorder that requires much greater research.

John Farquhar Fulton was an American neurophysiologist and historian, who pioneered psychosurgery based on animal experiments. Together with psychologist Carlyle Jacobsen, Fulton presented the results of bilateral frontal lobe ablation in chimpanzees. This study prompted neurologist Egas Moniz and neurologist Walter Freeman to perform similar brain surgery on human subjects.

To present the scientific papers of John Farquhar Fulton on psychosurgery.

To review available literature and to show evidence that John Farquhar Fulton made a significant contribution to the development of psychosurgery.

A biography and research papers are presented and discussed.

Fulton and Jacobsen experimented with ‘delayed response tasks’ in chimpanzees. The aim was to test the animal's capability to memorize the correct location of the food. They found that after sequential ablations of the left and right frontal association cortices these memory tasks became significantly difficult for the monkeys to perform. The researchers saw parallel conclusions in clinical cases of human frontal lobe damage.

An investigation into the role of the limbic system is one of the crowning achievements of John Farquhar Fulton, as this has influenced even today's thinking about the role of the limbic system. We should thank Fulton for his pioneering work as modern psychosurgery has gradually evolved from irreversible ablation to reversible stimulation techniques, including deep brain stimulation.

The authors have not supplied their declaration of competing interest.

High rates of psychiatric comorbidity are subject of debate: to what extent do they depend on classification choices such as diagnostic thresholds?

To investigate the influence of different thresholds on rates of comorbidity between major depressive disorder (MDD) and generalized anxiety disorder (GAD).

Point prevalence of comorbidity between MDD and GAD was measured in 74,092 subjects from the general population according to DSM-IV-TR criteria. Comorbidity rates were compared for different thresholds by varying the number of necessary criteria from ≥ 1 to all 9 symptoms for MDD, and from ≥ 1 to all 7 symptoms for GAD.

According to DSM-thresholds, 0.86% had MDD only, 2.96% GAD only and 1.14% both MDD and GAD (Odds Ratio [OR] 42.6). Lower thresholds for MDD led to higher rates of comorbidity (1.44% for ≥ 4 of 9 MDD-symptoms, OR 34.4), whereas lower thresholds for GAD hardly influenced comorbidity (1.16% for ≥ 3 of 7 GAD-symptoms, OR 38.8). Specific patterns in the distribution of symptoms within the population explained this finding: 37.3% of subjects with core criteria of MDD and GAD reported subthreshold MDD symptoms, whereas only 7.6% reported subthreshold GAD symptoms.

Lower thresholds for MDD increased comorbidity with GAD, but not vice versa, owing to specific symptom patterns in the population. Generally, comorbidity rates result from both empirical symptom distributions and classification choices and cannot be reduced to either of these exclusively. This insight invites further research into the formation of disease concepts that allow for reliable predictions and targeted therapeutic interventions.

The authors have not supplied their declaration of competing interest.

José Manuel Rodriguez Delgado (1915–2011), a Spanish physiologist, was among the first scientist to perform electric brain stimulation in both animals and humans. His work on brain-stimulation research during the 1960s and 1970s was innovative but also controversial.

To present the scientific papers of Jose Delgado on psychosurgery.

To review available literature and to show evidence that Jose Delgado made a significant contribution to the development of psychosurgery.

A biography and private papers are presented and discussed followed by a literature review.

Delgado showed that with electrical brain stimulation one could evoke well-organized complex behavior in primates. A rhesus monkey was stimulated with an electrode implanted inside the red nucleus, followed by a complex sequence of events. After stimulation of an area three millimeters from the red nucleus, the rhesus monkey just yawned. Delgado also investigated the mechanisms of aggressive behavior in other animals. Stimulation of the caudate nucleus by remote control in a fighting bully resulted in sudden paralysis. In some human patients suffering from depression, euphoria was induced after stimulation of the septum.

Delgado pioneered the brain electrode implantation in order to electrically stimulate specific brain areas for treatment epilepsy and of different types of mental illness. He was severely criticized. His studies, however, paved the way for new modulation techniques such as the development of deep brain stimulation.

The authors have not supplied their declaration of competing interest.

Walter Jackson Freeman II was born the grandchild of William Williams Keen, one of world's most renowned surgeons from Philadelphia and the son of an otorhinolaryngist, which may have been contributed to his interest in medicine. Freeman started his medical career in a psychiatric hospital and over the years, he operated thousands of patients. He was a protagonist in American psychosurgery and therefore, he often has been referred as the “lobotomist”.

To present the scientific papers of Walter Jackson Freeman on psychosurgery.

To review available literature and to show evidence that Freeman made a significant though controversial contribution to the development of psychosurgery.

A biography is presented and discussed followed by a literature review.

In this whole career, “the lobotomist” operated more than 3500 patients and performed mainly operations on the frontal areas. However, he operated human brains without due regard for his patient's mental abilities and emotional well-being after their lobotomy. Despite his work was praised, there was also a lot of criticism on his methods.

Despite the dubious reputation, Freeman can be remembered as an ambitious doctor who made a significant contribution to the development of psychosurgery. However, unfortunately he crossed medical and legal boundaries.

The authors have not supplied their declaration of competing interest.

Othello syndrome is a psychotic disorder characterized by delusion of infidelity or jealousy. It predominantly occurs in the context of specific psychiatric or neurological disorders. Othello syndrome is associated with mental changes including excessive aggression, hostility, and irritability. Patients with Othello syndrome misinterpret the behaviour of the spouse or sexual partner to provide evidence for their false perception.

The purpose of this paper is to examine the phenomenon of Othello syndrome as a result of specific neurological diseases.

The study design was a retrospective case series of patients with Othello syndrome. We searched the electronic databases PubMed and Embase for review articles and original research using the search terms ‘Othello syndrome, Morbid Jealousy, Pathological Jealousy, Delusional Jealousy, Delusions and Infidelity, Delusions of Jealousy or Infidelity’.

In the present study of 95 case reports, the relationship between Othello syndrome and a neurological pathology was described. This syndrome was most commonly associated with neurodegenerative diseases (59%), followed by medication induced Othello syndrome (13.7%) and vascular dementia (8.4%). Lesions particularly in the right (dorsolateral) frontal lobes were associated with this syndrome.

This study demonstrates that Othello syndrome occurs most frequently in patients with right frontal lobe dysfunction. It is predominantly related with Lewy Body Disease and Alzheimer's disease. Clinicians should keep an “index of suspicion” regarding dementia when Othello syndrome presents in elderly persons.

The authors have not supplied their declaration of competing interest.

Charles Bonnet syndrome (CBS) is a disorder in older adults, and is characterized by a triad of recurrent vivid visual hallucinations, ocular pathology causing visual impairment due to lesions in central or peripheral visual pathways, and normal cognitive status. It is often misdiagnosed as a psychosis, early dementia or a drug related condition. Hypoxemia was anecdotally reported as a cause of CBS.

We present an older adult with CBS caused by severe obstructive sleep apnea syndrome.

To report a case study, describing treatment of obstructive sleep apnea syndrome as a cause of CBS.

A case study is presented and discussed.

An older male adult was admitted to hospital for persistent vivid visual hallucinations. There was no personal or family history of mental illness. Neurological examination was normal, except for visual impairment due to age related macular degeneration. The remainder of his physical examination was normal. Previous treatment with antipsychotics proved not to be effective. Severe hypoxemia (SaO2 79%) was diagnosed with overnight pulse oximetry and subsequent polysomnography revealed an obstructive sleep apnea syndrome. After three nights of nasal continuous positive airway pressure, the vivid hallucinations ceased.

Physicians need to understand the underlying causes and mechanisms of CBS. One should be aware of the importance of a full clinical examination and sleep apnea research in elderly persons with visual impairment.

The authors have not supplied their declaration of competing interest.