Tijdschrift voor psychiatrie最新文献

Background: Although cognitive impairments occur in approximately 70% of individuals with a psychotic spectrum disorder (PSS) and have a substantial impact on daily functioning, they are often underrecognized in clinical practice. Due to their limited specificity, they are not included in the DSM classification criteria. Historically, cognitive deficits were already central to the concept of dementia praecox.

Aim: To provide an overview of the literature on cognition in psychosis.

Method: This article summarizes the existing literature on cognition in PSS.

Results: Patients with PSS generally score lower than the general population across nearly all cognitive domains, although no specific cognitive deficit is unique to PSS, and variability between patients is considerable. The article further discusses the prevalence and course of cognitive dysfunction, as well as findings from neuroimaging and genetic studies. After a first psychotic episode, it is recommended to screen cognitive functioning, for instance using the MATRICS battery. Pharmacological treatment typically shows only modest positive effects on cognitive impairment. In contrast, cognitive remediation (CR) – aimed at improving or compensating cognitive functions through strategies and training – has shown beneficial effects. Although clinical guidelines recommend CR, its availability in practice remains limited.

Conclusion: Integrating systematic cognitive screening and CR into treatment may contribute to improved functioning and quality of life...

In patients with longstanding nutritional problems and gastrointestinal symptoms, underweight or with significant weight loss, mostly without an identifiable somatic cause, a diagnostic dilemma arises. There is considerable symptomatic overlap between anorexia nervosa (AN), avoidant/restrictive food intake disorder (ARFID), and somatic symptom disorder (SSD) in such cases, which can lead to divergent clinical interpretations, delayed interventions, and lack of therapeutical direction. We describe a 49-year-old patient who had been treated for several years by gastroenterologists for nausea, vomiting, and weight loss. Extensive diagnostics revealed no abnormalities, and pharmacotherapy had little effect. After several second opinions, both somatic and psychiatric, her symptoms were classified as SSS, and the patient began psychotherapeutic treatment. Although the DSM-5 allows for classification, there is a lack of consensus regarding the nature of this clinical presentation and appropriate treatment strategies. We identify factors that may help differentiate between the above-mentioned classifications, though further research into underlying mechanisms remains essential. Current healthcare structures often fail to meet the complex needs of these patients. Moreover, the somatic features of this condition lead to exclusion from treatment programs. We advocate for cross-domain diagnostics and integrated care, in which biological, psychological and social aspects are regarded as equally essential components.

We discuss a case involving a 75-year-old man with Parkinson’s disease (PD) who experienced a psychotic duplication phenomenon. This resembled Capgras syndrome, a misidentification delusion characterized by the false belief that a familiar person has been replaced by a double. However, our patient did not exhibit a delusion but rather a hallucination in which he simultaneously perceived his partner in two locations. He consistently engaged with the hallucinatory experience of his partner, whom he saw duplicated at the table, without awareness of the inaccuracy of this perception. Therefore, this may be better classified as a psychotic duplication experience, or reduplicative paramnesia. A similar phenomenon has been described twice previously in Lewy body dementia, where the distinction between delusion and hallucination was also unclear. Throughout the course of Parkinson’s disease, diverse neuropsychiatric symptoms can occur, including variants of reduplication and misidentification. Distinguishing these phenomena in our case was challenging, and we discuss the underlying mechanisms.

Background: For women with a known psychiatric disorder, the perinatal period carries an increased risk of mental health relapse. Drawing up and using a signal plan for pregnancy and the postpartum period (SPPP) can be an important intervention.

Aim: Pregnant women with a mental health diagnosis have an increased risk of relapse and are at risk for the development of postpartum psychopathology. During this period a pregnancy relapse prevention plan (PRPP) can be made that describes the risks, symptoms of relapse and related interventions. The main goal of this study is to describe the lived experiences of women with a mental health diagnosis with making and using the PRPP.

Method: A qualitative study to examine the experiences of women with a mental health diagnosis with making and using the PRPP. Participants were recruited from an outpatient clinic within a ‘Psychiatry and Pregnancy’ mental health institute in the Netherlands. Twelve women with a mental health diagnosis who gave birth participated in this study. Data were collected by individual semi structured interviews supported by a topic list.

Results: Four categories/themes of findings emerged from the data; referral and starting up, making and advantage of the PRPP, care after childbirth, using the PRPP, and cooperation.

Conclusion: The pregnancy relapse prevention plan provide pregnant women overview, predictability and tranquillity on all aspects according to the pregnancy, childbirth and the postpartum period. The support and the recognition were appreciated. The signal function of the plan was described as an added value. The involvement of the partner and caretakers were essential.

Background: The quality of Dutch mental healthcare is under pressure due to staff shortages and an increasing demand for care. To improve the quality of care, four outpatient mental healthcare institutions formed a learning network in 2022 for anxiety, mood and trauma en stressor related disorders. Within this network, data on treatment processes and outcomes were shared and systematically compared. This facilitated the identification of best practices and provided insights to optimize workflows, ensuring treatments are delivered more efficiently and effectively.

Method: An observational cohort study was conducted across four mental healthcare institutions. Data on treatment efficiency and outcomes were collected using electronic patient record (EPR) and routine outcome monitoring (ROM).

Results: Treatment efficiency (treatment duration), and treatment outcomes (symptomatic recovery) were analyzed across all four institutions. While effect sizes (Cohen’s d) varied between institutions, all effects were large to very large. However, substantial practice variation in treatment efficiency was observed, indicating potential areas for improvement.

Conclusion: A learning network appears to make a valuable contribution to improving the quality of outpatient mental healthcare. Collaboration rather than competition has provided important insights into more efficient and effective treatment processes through systematic data comparison. Further improvements in the outpatient treatment of anxiety, mood, and trauma- en stressor-related disorders should primarily focus on enhancing treatment efficiency. Methods such as chat-based contact and routine outcome monitoring during treatment (within-treatment response) may play a key role in this process.

Background: Adolescents admitted to psychiatric High Intensive Care (HIC) units typically transition to HIC-Adults upon turning 18 years. Little is known about how adolescents, parents, and healthcare providers experience this transition.

Aim: To gain insight into the experiences of adolescents, parents, and healthcare providers regarding HIC care during the transitional age (here: 16-23 years).

Method: Demographic and clinical data were extracted from patient records. Nine adolescents and ten parents were interviewed. Transcripts were analyzed using inductive thematic analysis. Seventeen healthcare providers participated in two focus groups.

Results: The adolescents admitted between April 2020 and December 2023 on either HIC-Youth or HIC-Adult (N = 280), were mostly female (69%), living at home (78%) and admitted due to suicidality (54%). Four key themes were identified: placement and ward climate, autonomy and parental involvement, staff interactions, and attention to transition. Adolescents and parents reported absence of tailored care during the transition. Healthcare providers recognized differences between units but were unaware of the impact.

Conclusion: Adolescents on HIC-units suffer from complex issues, and central components are autonomy, safety and developmental age. Although attention to transitional care is increasing, greater awareness of the pivotal role of a HIC unit in the transition is needed.

Background: In the Netherlands, it is possible for patients to donate organs after having received euthanasia. In many cases of organ donation after euthanasia (ODE), tissues, as well as the liver, heart, kidneys, lungs, and pancreas, can be donated. The procedure for ODE is described in the national guideline for organ donation after euthanasia by the Dutch Transplant Foundation (NTS). In case of suffering due to a psychiatric disorder, the guideline of the Dutch Psychiatric Association is directional. Recently, the Erasmus MC suggested an assessment by an additional local psychiatrist.

Aim: To argue that current guidelines on euthanasia and organ donation offer a sufficient foundation for providing careful and conscientious care.

Method: Discussion of the background and practice of euthanasia and organ donation and the guidelines relevant for assessment.

Results: By following the current Euthanasia Code, the Dutch Psychiatric Association guideline and the NTS ODE guideline, the euthanasia and donation processes are separated and the carefulness of the assessment is guaranteed.

Conclusion: In case of suffering from a psychiatric disorder, extra caution is currently guaranteed by involving a second independent psychiatrist. An structural additional assessment by a local psychiatrist can disrupt both the euthanasia and organ donation assessment procedures, stigmatize psychiatric patients compared to those suffering from somatic disorders, and is unnecessarily burdensome for the patient.

Bipolar disorder (BD) frequently occurs in children and adolescents, but pharmacological treatment in this group presents significant challenges. Clinicians often struggle to find appropriate treatment guidelines due to the primary focus of current guidelines on adults, leaving specific recommendations for the acute and maintenance treatment of BD in children and adolescents either insufficient or entirely absent. This gap is partly due to the lack of targeted studies in this age group, leading practitioners to rely on clinical experience and studies conducted in adults. I describe a case of the treatment of a 14-year-old girl with BD type 1, who received both psychotherapy and psychopharmacotherapy. The combination of aripiprazole, olanzapine, and lithium proved effective for this patient, but formal evidence for this regimen is lacking in the guidelines. This underscores the need for further research and the development of updated guidelines for the pharmacological treatment of BPSS in children and adolescents.