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[Pharmacotherapeutic treatment in an adolescent with bipolar disorders]. [青少年双相情感障碍的药物治疗]。
Q4 Medicine Pub Date : 2025-01-01
L Van de Steen

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.

双相情感障碍(BD)常见于儿童和青少年,但这一群体的药物治疗面临重大挑战。临床医生常常难以找到合适的治疗指南,因为目前的指南主要针对成人,对于儿童和青少年双相障碍的急性和维持治疗的具体建议要么不足,要么完全没有。这一差距部分是由于缺乏针对这一年龄组的针对性研究,导致从业人员依赖临床经验和对成人进行的研究。我描述了一个14岁的双相障碍1型女孩的治疗案例,她接受了心理治疗和精神药物治疗。阿立哌唑、奥氮平和锂的联合治疗被证明对该患者有效,但指南中缺乏该方案的正式证据。这强调了进一步研究和制定儿童和青少年BPSS药物治疗最新指南的必要性。
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引用次数: 0
[Organ donation after euthanasia]. [安乐死后的器官捐赠]。
Q4 Medicine Pub Date : 2025-01-01
W N K A van Mook, N M van Dijk, W C de Jongh, R C Oude Voshaar, R M Marijnissen, J A M Bollen, J A Godschalx-Dekker

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.

背景:在荷兰,病人在接受安乐死后可以捐献器官。在安乐死(ODE)后器官捐赠的许多情况下,组织以及肝脏、心脏、肾脏、肺和胰腺都可以捐赠。荷兰移植基金会(NTS)在安乐死后器官捐赠的国家指南中描述了ODE的程序。在因精神障碍而遭受痛苦的情况下,荷兰精神病学协会的指导方针是指向性的。最近,伊拉斯谟管委会建议由另一名当地精神病医生进行评估。目的:论证目前关于安乐死和器官捐赠的指导方针为提供谨慎和认真的护理提供了充分的基础。方法:探讨安乐死与器官捐献的背景、实践及相关评估指南。结果:通过遵循现行的安乐死法典、荷兰精神病学协会指南和NTS ODE指南,将安乐死和捐赠过程分开,保证了评估的谨慎性。结论:在患有精神疾病的情况下,目前通过涉及第二名独立精神科医生来保证额外的谨慎。由当地精神科医生进行的结构性额外评估可能会扰乱安乐死和器官捐赠的评估程序,使精神病患者与躯体疾病患者相比受到污名化,并给患者带来不必要的负担。
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引用次数: 0
[Underexposed consequences of assisted death on psychiatric grounds for mental health care]. [在精神卫生保健方面,以精神病学为理由协助死亡的后果曝光不足]。
Q4 Medicine Pub Date : 2025-01-01
S M P van Veen, M M Palm, E Elzinga, L J S Schweren, A T F Beekman

Background: Medical Assistance in Dying (MAID) on psychiatric grounds is a subject of increasing relevance to Dutch mental health care. In addition to different advantages, there are disadvantages.

Aim: To highlight some consequences of MAID on psychiatric grounds and to offer solutions to mitigate these.

Method: Based on an experience story, we highlight some relevant consequences.

Results: Various relevant themes emerge. Firstly, patients can experience pressure to choose MAID. Secondly, psychiatric disorders and suicidality in particular are dynamic and difficult to predict, which conflicts with the static nature of the MAID law. Thirdly, the possibility of MAID is an additional argument to keep the quality of mental health care sufficient, even with increasing scarcity. Finally, we have to stop talking about ‘exhausted treatment options’.

Conclusion: By recognising and minimising the disadvantages of MAID on psychiatric grounds, we create space for a practice where safety and accessibility are in balance.

背景:基于精神病学理由的临终医疗援助(MAID)是与荷兰精神卫生保健日益相关的主题。除了不同的优点,也有缺点。目的:强调MAID在精神病学方面的一些后果,并提供减轻这些后果的解决方案。方法:基于一个经验故事,我们强调了一些相关的结果。结果:出现了各种相关主题。首先,患者会感受到选择MAID的压力。其次,精神障碍和自杀是动态的,难以预测,这与MAID法的静态性质相冲突。第三,即使在日益稀缺的情况下,MAID的可能性是保持精神卫生保健质量充足的另一个论据。最后,我们必须停止谈论“用尽”的治疗方案。结论:通过认识和最小化MAID在精神病学方面的缺点,我们为安全和可达性平衡的实践创造了空间。
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引用次数: 0
[Promoting citizenship and supporting recovery in severe mental illness]. [促进公民意识和支持严重精神疾病的康复]。
Q4 Medicine Pub Date : 2025-01-01
J van Weeghel, Ph A E G Delespaul, F Bovenberg, C L Mulder

Background: The problems of people with a (serious) mental illness are rarely limited to mental health care.

Aim: Exploring whether citizenship can be a guiding concept for providing care to this group.

Method: Reflection based on relevant literature and healthcare practices.

Results: Citizenship brings the social backgrounds and consequences of mental health problems into focus, and connects people with and without such problems. In addition to the relations are rights, roles and resources of great importance. A process of subjectivation of citizenship is underway, which offers perspectives for our target group. Human rights guarantee that everyone is a citizen. Conversely, citizenship provides the institutional framework to implement human rights. Recovery and citizenship are each other’s terms.

Conclusion: Promoting citizenship is a joint task for mental health care, social domain and government.

背景:患有(严重)精神疾病的人的问题很少局限于精神保健。目的:探讨公民身份是否可以作为护理这一群体的指导理念。方法:结合相关文献和医疗实践进行反思。结果:公民身份使人们关注心理健康问题的社会背景和后果,并将有和没有心理健康问题的人联系起来。除了关系之外,权利、角色和资源也非常重要。公民身份主体化的过程正在进行中,这为我们的目标群体提供了视角。人权保障人人都是公民。相反,公民身份为落实人权提供了制度框架。恢复和公民身份是彼此的术语。结论:促进公民权是精神卫生、社会和政府的共同任务。
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引用次数: 0
[Recurrent fugues, also consider epilepsy]. [反复发作的赋格,也可考虑癫痫]。
Q4 Medicine Pub Date : 2025-01-01
J Broekmeulen, J Schulkens, C de Leeuw, E I Hoff

We discuss an interesting case of a 65-year-old man with multiple dissociative episodes which previously had been assessed as fugues. After evaluation in the memory clinic these episodes appeared to be generalized epileptic seizures, with an electro-encephalographic diagnosis of non-convulsive status epilepticus. Throughout this case, the different features that characterize an epileptic versus a psychiatric etiology are being discussed as well as other differential diagnostic considerations. A non-convulsive status epilepticus is a treatable disease which can being missed often. With this case, we intend to create awareness and clues to recognize this disease.

我们讨论一个有趣的情况下,一个65岁的男子多次分离发作,以前被评估为赋格。在记忆诊所评估后,这些发作表现为全身性癫痫发作,脑电图诊断为非惊厥性癫痫持续状态。在本病例中,我们讨论了癫痫与精神病因的不同特征,以及其他鉴别诊断考虑。非惊厥性癫痫持续状态是一种可治疗的疾病,可经常被忽略。通过这种情况,我们打算提高认识和线索,以识别这种疾病。
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引用次数: 0
[Herwaardering van klinische intuïtie]. [重新评估临床直觉]。
Q4 Medicine Pub Date : 2025-01-01
H L Van
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引用次数: 0
[Compulsory care for a mental incompetent pregnant woman: a case-report]. [一例精神不健全孕妇的强制护理:个案报告]。
Q4 Medicine Pub Date : 2025-01-01
B Schreuders, L Saleh, A-M den Hertog-de Visser, S Morsink, A G M G J Mulders, K M Koorengevel

The compulsory Mental Healthcare Act (Dutch: Wvggz) provides, in exceptional cases, a legal framework for the implementation of psychiatric and somatic treatment without the patients consent. We describe a pregnant patient with a psychotic disorder who was compulsorily admitted to a psychiatric ward and treated with antipsychotic medication. She was unable to give informed consent regarding obstetric care. The care authorization did provide a legal framework for compulsory obstetric care to prevent serious harm for herself and/or her unborn child. A good relationship of trust, frequent counseling and the presence of an acquaintance ensured that the patient agreed with a caesarean section when this became necessary. This case describes how the Wvggz can provide psychiatric and obstetric care for a pregnant patient with a severe psychiatric disorder as well as the importance of continuing to look for options for voluntary care in a multidisciplinary manner.

强制性《精神保健法》(荷兰语:Wvggz)在特殊情况下规定了在未经患者同意的情况下实施精神和躯体治疗的法律框架。我们描述了一个患有精神病的孕妇,她被强制送入精神科病房并接受抗精神病药物治疗。她无法就产科护理作出知情同意。护理授权确实为强制性产科护理提供了法律框架,以防止对她本人和/或未出生的孩子造成严重伤害。良好的信任关系、频繁的咨询和熟人的在场确保了病人在必要时同意剖腹产。本案例描述了Wvggz如何为患有严重精神障碍的怀孕患者提供精神病学和产科护理,以及继续以多学科方式寻找自愿护理选择的重要性。
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引用次数: 0
[Erotomania as a symptom of pathological grief]. [情欲狂是病理性悲伤的症状]。
Q4 Medicine Pub Date : 2025-01-01
F Janssens, F Auwerkerken

We describe a 23-year-old woman with erotomania as a symptom of complicated grief. The delusional disorder emerged after a breakup with her partner, during a period of complicated grief following the unexpected loss of her twin brother. The delusion potentially functioned as a protection against a recurrent depressive disorder. Treatment usually consists of starting psychopharmaceuticals, however, often with limited results. Therefore, psychotherapeutic treatment is also important because an erotomanic delusion often arises from feelings of rejection, loneliness or worthlessness. Erotomania has been mentioned in texts and stories since ancient times. However, a case report on erotomania as a potential buffer against complex grief has not previously been described in the literature. We discuss the erotomania, contextualized in her life course and the existing literature.

我们描述了一名23岁的女性,她有性欲狂,这是一种复杂悲伤的症状。在与伴侣分手后,她出现了这种妄想症,当时她意外失去了双胞胎兄弟,陷入了复杂的悲伤之中。这种错觉可能起到了预防复发性抑郁症的作用。治疗通常包括开始使用精神药物,然而,通常效果有限。因此,心理治疗也很重要,因为性欲妄想通常是由被拒绝、孤独或毫无价值的感觉引起的。自古以来,情色癖就在文本和故事中被提及。然而,一个案例报告的情色癖作为一个潜在的缓冲对抗复杂的悲伤以前没有在文献中描述。我们讨论的情欲狂,语境在她的生活历程和现有的文学。
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引用次数: 0
[The nurse practitioner as responsible clinician: opportunities and challenges]. 【护士作为负责任临床医生:机遇与挑战】。
Q4 Medicine Pub Date : 2025-01-01
M J van Til, J M C van Dam, D G Hollands, M B de Koning

Background: The Compulsory Mental Health Care Act in the Netherlands (CMHCA) came into effect in 2020. Mental health nurse practitioners have since been allowed to be ‘responsible clinician’ However, there seems to be diversity in the implementation of the role in practice.

Aim: To investigate the state of affairs regarding the role of the mental health nurse practitioners as ‘responsible clinician’ within the CMHCA and reflecting on this topic.

Method: Legislative texts, guidelines and professional associations have been consulted. The quality and professional statutes of eighteen large mental health institutions in the Netherlands were also studied, using the search terms ‘responsible clinician’, ‘Compulsory Mental Health Care Act’, ‘nurse practitioner’, ‘CMHCA’.

Results: The CMHCA leaves room for precise interpretation of the role of responsible clinician. In more than half of the quality and professional statutes examined (N=10), the role of responsible clinician is not specified. The other statutes (N = 8) include various frameworks for the role of a mental health nurse practitioner as responsible clinician.

Conclusion: The role of the nurse practitioner as responsible clinician is not clearly described in the statutes and guidelines reviewed. The CMHCA leaves room for how to fulfill this. We recommend a broad field consultation to arrive at clearer advice about which discipline is responsible clinician in which situation.

背景:荷兰《强制性精神卫生保健法》(CMHCA)于2020年生效。从那以后,精神健康护士从业人员被允许成为负责任的临床医生。然而,在实践中,角色的执行似乎存在多样性。目的:了解精神卫生执业护士作为“责任临床医生”的作用现状;在CMHCA内部并反思这个话题。方法:参考立法文本、指南和专业协会。还研究了荷兰18家大型精神卫生机构的质量和专业法规,使用搜索词&lsquo;负责任临床医生&lsquo; &lsquo;强制性精神卫生保健法&lsquo; &lsquo;执业护士&lsquo; ‘CMHCA&rsquo;。结果:CMHCA为责任临床医生的角色的精确解释留下了空间。在超过一半的质量和专业法规检查(N=10),负责任的临床医生的作用没有规定。其他法规(N = 8)包括关于精神卫生执业护士作为负责任临床医生的作用的各种框架。结论:执业护士作为负责任的临床医生的角色在法规和指南中没有明确描述。CMHCA为如何实现这一目标留下了空间。我们建议进行广泛的领域咨询,以获得更明确的建议,即在哪种情况下,哪个学科是负责任的临床医生。
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引用次数: 0
[Verplichte zorg bij een wilsonbekwame zwangere: maatwerk met respect voor mensenrechten]. [对有能力的孕妇的强制性照顾:尊重人权的定制工作]。
Q4 Medicine Pub Date : 2025-01-01
J A Godschalx-Dekker, W Duijst
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引用次数: 0
期刊
Tijdschrift voor psychiatrie
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