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[The effectiveness of compulsory treatment for substance use disorder]. [强制治疗药物使用障碍的有效性]。
Q4 Medicine Pub Date : 2024-01-01
A Neven, M P W Dik, H A de Haan, A Batalla

Background: In a minority of patients with substance use disorders, there is both unwillingness to treat and serious harm or damage to the patient or society. In these situations, compulsory treatment may be considered. However, it is unclear whether compulsory care is effective in reduction of substance use.

Aim: To describe the literature on the effect of compulsory care (in criminal or civil law settings) on substance use in adult patients with substance use disorders.

Method: Literature review, including 17 articles through PRISMA analysis. The risk of bias was severe to critical in most studies.

Results: Compulsory treatment was imposed in 16 studies (similar to a ‘voorwaardelijke strafrechtelijke machtiging’ in the Netherlands), in one study also from the youth protection system and one from the civil law framework. In seven studies there were no significant differences in substance use between compulsory and voluntary treatment, in two studies outcomes were better in the compulsory group and in four studies outcomes were better in the voluntarily treated group. Four studies did not compare the two groups or did not describe significance.

Conclusion: The 17 included studies found varying outcomes regarding the effectiveness of compulsory treatment for substance use disorder, with a considerable risk of bias, ranging from methodological shortcomings to selective reporting of results. This makes it impossible to draw unequivocal conclusions about the effectiveness of compulsory care in achieving long-term abstinence or reducing substance use.

背景:在少数药物滥用障碍患者中,既有不愿治疗的,也有对患者或社会造成严重伤害或损害的。在这种情况下,可以考虑强制治疗。目的:描述有关强制治疗(在刑法或民法环境下)对药物使用障碍成年患者药物使用的影响的文献:方法:文献综述,通过 PRISMA 分析纳入 17 篇文章。大多数研究的偏倚风险为严重至极度偏倚:16项研究(类似于荷兰的 "voorwaardelijke strafrechtelijke machtiging’)实施了强制治疗,1项研究来自青少年保护系统,1项研究来自民法框架。在七项研究中,强制治疗和自愿治疗在药物使用方面没有明显差异,在两项研究中,强制治疗组的疗效更好,在四项研究中,自愿治疗组的疗效更好。有四项研究未对两组进行比较或未说明显著性:纳入的 17 项研究发现,强制治疗药物使用障碍的效果各不相同,存在相当大的偏差风险,包括方法上的缺陷和对结果的选择性报告。因此,无法就强制治疗在实现长期戒断或减少药物使用方面的有效性得出明确的结论。
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引用次数: 0
[Recurrent depressive disorder associated with an atypical CADASIL syndrome]. [与非典型 CADASIL 综合征相关的复发性抑郁障碍]。
Q4 Medicine Pub Date : 2024-01-01
K Ernes, S Huysmans, A Govaerts, F-L De Winter

A 55-year-old man with recurrent depressive episodes, with onset at age 45, was admitted to hospital after a suicide attempt. Due to a recent stroke as well as a family history of stroke and depression, CADASIL (prevalence of 2-5 per 100.000) was considered as a possible diagnosis. Although depression is common in CADASIL, the initial presentation is not typically comprised of recurrent depressions. Brain MRI, however, did not show the characteristic white matter lesions in the anterior temporal lobe. Genetic analysis revealed a cysteine-sparing mutation (Arg61Trp) in the NOTCH3 gene. Recently, several such mutations have been associated with CADASIL presenting with an atypical phenotype including a lower prevalence of recurrent stroke. This suggests that the prevalence of CADASIL may be higher than estimated in depressed patients. This case demonstrates the importance of considering CADASIL as a possible etiology of depression as this has consequences for prognosis, treatment and genetic counseling.

一名 55 岁的男子反复抑郁发作,45 岁时发病,自杀未遂后入院。由于最近发生过中风,而且有中风和抑郁症家族史,因此考虑将 CADASIL(发病率为 2-5/10 万)作为可能的诊断依据。虽然抑郁症在 CADASIL 中很常见,但最初的表现通常不是反复抑郁。然而,脑部核磁共振成像并未在颞叶前部显示出特征性的白质病变。基因分析显示,NOTCH3 基因中存在一个半胱氨酸保留突变(Arg61Trp)。最近,有几例此类突变与 CADASIL 相关,表现为非典型表型,包括较低的复发性中风发病率。这表明,在抑郁症患者中,CADASIL 的发病率可能比估计的要高。本病例表明,将 CADASIL 视为抑郁症的可能病因非常重要,因为这会对预后、治疗和遗传咨询产生影响。
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引用次数: 0
[Patient-related stressful experiences in psychiatry residency]. [精神病学住院实习中与患者相关的压力体验]。
Q4 Medicine Pub Date : 2024-01-01
A Hendrickx, T Pattyn, P Sienaert

Background: Residents in psychiatry can be confronted with patient-related stressful experiences which can be impactful. Guidelines for dealing with these are lacking.

Aim: Questioning residents in psychiatry about patient-related stressful adversities, their impact and resources to contribute to the existing literature.

Method: Qualitative study through semi-structured interviews of six psychiatry residents, followed by data-analysis using thematic analysis.

Results: Reported patient-related stressful experiences were suicide, verbal and imminent physical aggression, questioning expertise, concerns about legal consequences, powerlessness and expectations. Cognitive and physical impact was experienced with symptoms similar to acute stress disorder. The most important resource is social support.

Conclusion: In this study new patient related stressful experiences are reported that have not previously been described in the literature. Since estimating the impact of a patient related stressful experience proves difficult, it seems appropriate that the environment of the resident offers active support and further development of residents’ skills is stimulated.

背景:精神病学住院医师可能会面临与患者相关的压力体验,这些体验可能会产生影响。目的:询问精神病学住院医师与患者相关的压力逆境、其影响和资源,为现有文献做出贡献:方法:通过对六名精神科住院医师进行半结构式访谈进行定性研究,然后使用主题分析法进行数据分析:所报告的与患者相关的压力体验包括自杀、言语攻击和即将发生的肢体攻击、对专业知识的质疑、对法律后果的担忧、无力感和期望。对认知和身体的影响与急性应激障碍的症状相似。最重要的资源是社会支持:本研究报告了与患者相关的新的压力体验,这些体验在以前的文献中从未描述过。由于难以估计与患者相关的压力体验所造成的影响,因此似乎应该由住院医师所处的环境提供积极的支持,并促进住院医师技能的进一步发展。
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引用次数: 0
[Levenseindezorg en ggz: naar meer conceptuele helderheid]. [临终关怀与心理健康:使概念更加清晰]。
Q4 Medicine Pub Date : 2024-01-01
L Moureau
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引用次数: 0
[Intensive exposure treatment for obsessive compulsive disorder in old age.] [老年强迫症强化暴露疗法]
Q4 Medicine Pub Date : 2024-01-01
M G Guineau, R C Oude Voshaar, G-J Hendriks

The absence of treatment studies for obsessive compulsive disorder (OCD) in older adults and the fact that OCD typically starts at a young age and often follows a chronic, fluctuating course quickly leads to therapeutic nihilism for older adults with OCD. In this case report, we present a 72-year-old man with OCD symptoms from the age of 35, who has only been treated with medication and psychotherapy for a recurrent depressive disorder. After a short, intensive exposure and response prevention treatment (four days in two weeks), the OCD symptoms and the depressive symptoms were fully in remission and all medications (venlafaxine, olanzapine, depakine) were discontinued. Treatment gains were maintained with persistent remission until 18 months follow up. This case report shows that a comorbid depressive disorder may lead to undertreatment of OCD. It also shows that long standing OCD can be successfully treated in older adults.

由于缺乏针对老年人强迫症(OCD)的治疗研究,而且强迫症通常从年轻时就开始发作,病程通常呈慢性、波动性,这很快导致了对患有强迫症的老年人的治疗虚无主义。在本病例报告中,我们介绍了一位 72 岁的男性患者,他从 35 岁开始就有强迫症症状,只是因为反复出现抑郁障碍而接受过药物和心理治疗。经过短期强化暴露和反应预防治疗(两周内四天)后,强迫症状和抑郁症状完全缓解,并停用了所有药物(文拉法辛、奥氮平、地帕金)。治疗效果持续缓解,直至 18 个月的随访。本病例报告表明,合并抑郁障碍可能会导致强迫症治疗不足。它还表明,长期存在的强迫症可以在老年人中得到成功治疗。
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引用次数: 0
[The value of re-evaluation and thorough family history taking for the diagnostic work-up of chorea]. [重新评估和全面采集家族病史对诊断舞蹈症的价值]。
Q4 Medicine Pub Date : 2024-01-01
J J Luykx, E van Duijn, B Geerdinck, E Burgers, H P H Kremer, R Veenhuizen

The differential diagnosis of chorea encompasses a broad range of disorders. In psychiatry, tardive dyskinesia may be difficult to discern from other causes, particularly when the family history is negative. A 59-year-old man with an unclear medical history had been using risperidone for over a decade when we first saw him. He presented with severe dyskinesia in all extremities. The family history for neuropsychiatric disorders was negative. We interpreted the movement disorder as tardive dyskinesia, but later he turned out to suffer from Huntington’s disease. To improve diagnostic accuracy, we should have more frequently re-evaluated the differential diagnosis and our family history should have been more thorough. We outline the diagnostic considerations in patients presenting with chorea. Finally, we highlight the value of diagnostic re-evaluation and thorough family history taking to optimize diagnostic accuracy in neuropsychiatry.

舞蹈症的鉴别诊断包括多种疾病。在精神病学中,迟发性运动障碍可能很难与其他病因相鉴别,尤其是在家族史呈阴性的情况下。一名病史不详的 59 岁男子在我们第一次见到他时,已经使用利培酮十多年了。他出现了严重的四肢运动障碍。他的神经精神疾病家族史呈阴性。我们将运动障碍解释为迟发性运动障碍,但后来发现他患有亨廷顿’病。为了提高诊断的准确性,我们本应更频繁地重新评估鉴别诊断,并更全面地了解家族史。我们概述了出现舞蹈症患者的诊断注意事项。最后,我们强调了重新评估诊断和全面采集家族史对于优化神经精神病学诊断准确性的价值。
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引用次数: 0
[Anorexia nervosa in contextueel perspectief]. [从上下文的角度来看神经性厌食症]。
Q4 Medicine Pub Date : 2024-01-01
A A van Elburg
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引用次数: 0
[A case of clozapine-induced myoclonic epilepsy]. [一例氯氮平诱发的肌阵挛性癫痫】。]
Q4 Medicine Pub Date : 2024-01-01
M M Koopmans, A B Koopmans, E van Beijeren, F M E Cox

Clozapine is effective in treatment-resistant schizophrenia. However, clozapine has its own (well-) known side effects. We describe a case of a patient who developed epileptic seizures after starting clozapine. First he had a tonic-clonic seizure and subsequently myoclonic seizures. It is relevant to recognize the epileptic origin of these events. If tapering the clozapine dosage is not possible, the myoclonic seizures are treatable with anti-epileptic drugs. We describe the case history of this patient, the differential diagnosis and the evidence of a correlation between myoclonic epilepsy and clozapine based on international literature.

氯氮平对难治性精神分裂症有效。然而,氯氮平有它自己的(众所周知的)副作用。我们描述了一个病例的病人谁开发癫痫发作后,开始氯氮平。他先是强直阵挛性发作,随后是肌阵挛性发作。认识到这些事件的癫痫起源是相关的。如果不能减少氯氮平的剂量,肌阵挛性发作可以用抗癫痫药物治疗。我们根据国际文献描述了该患者的病例史,鉴别诊断和肌阵挛性癫痫与氯氮平之间相关性的证据。
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引用次数: 0
[A methodological perspective on generalization, discrimination, and prejudices]. [从方法论角度看以偏概全、歧视和偏见]。
Q4 Medicine Pub Date : 2024-01-01
J Dirkx

Background: As a result of a common misunderstanding of the concepts of generalization, discrimination and prejudice, their methodological significance for a scientific psychiatry gets out of sight.

Aim: An attempt to rehabilitate these concepts METHOD: An explorative consideration based on actual trends in society and mental health care RESULTS: Examples are given of the one-sided framing of these concepts in society and psychiatric practice as well as of their positive contribution to a better understanding of psychiatric problems, to better diagnostics and, as a result, psychiatry as a scientific discipline.

Conclusion: It remains necessary to take a critical look at one’s own bias in the form of generalization, discrimination and prejudices. On the other hand, we also know the heuristic and methodological value of these concepts for psychiatry as a science. We should not only discriminate patients as unique individuals, but also generalize them to a variety of complex groups using biases that are subject to adjustment.

背景:由于对泛化、歧视和偏见概念的普遍误解,它们对科学精神病学的方法论意义被忽视了。目的:尝试恢复这些概念方法:基于社会和精神卫生保健的实际趋势的探索性考虑结果:给出了这些概念在社会和精神病学实践中的片面框架的例子,以及它们对更好地理解精神病学问题,更好地诊断和最终将精神病学作为一门科学学科的积极贡献。结论:我们仍然有必要以批判的眼光看待自己的偏见,即泛化、歧视和偏见。另一方面,我们也知道这些概念对于作为一门科学的精神病学的启发式和方法论价值。我们不仅应该将患者作为独特的个体加以区分,还应该使用可调整的偏见将其推广到各种复杂的群体。
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引用次数: 0
[Dialoog over een toekomstbestendige conceptualisering in de psychiatrie]. [关于面向未来的精神病学概念的对话]。
Q4 Medicine Pub Date : 2024-01-01
F Scheepers
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引用次数: 0
期刊
Tijdschrift voor psychiatrie
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