Tijdschrift voor psychiatrie最新文献

Background: Against the background of societal, technological and scientific developments, residency training programs anticipate changes in mental health care and its implications for the professional role of psychiatrists.

Aim: To sketch expected developments in (inter)national residency training programs in psychiatry the next ten years.

Method: Literature study and extrapolation of (inter)national plans regarding medical residency training programs.

Results: The next ten years we expect more emphasis on the following topics: a new balance between generalist and specialist medical competences and a shift towards more interdisciplinary learning, sustainable employability (‘lifelong learning’, psychological safety, professional balance), scientific education with a focus on translation and pluriformity, and international collaboration CONCLUSION: New (inter)national plans for residency programs in psychiatry aim to prepare psychiatrists to appropriately respond to the increasing societal demand for mental health care while keeping an eye on their own sustained employability.

Background: Opinions differ on the societal importance of mental health care (GGZ) and the direction it should take. Is there a need for prevention targeting high-risk health groups, should more attention be paid to precision psychiatry, or is the focus better placed on promoting a mentally healthy lifestyle or accessible care in disadvantaged neighborhoods?

Aim: To outline the social importance of mental health care from three perspectives: the biomedical-clinical approach, the moral-philosophical, social-critical perspective and an approach that emphasizes social inequality and disadvantage. Further I reflect on the possible importance of some innovations in mental health care for future general mental health.

Method: Literature review and consideration.

Results: Questions about the social importance of mental health care and the future direction of mental health care are typically viewed from a biomedical and clinical perspective, with the assumption that what benefits patients is also the most direct path to improved public mental health. However, other narratives also dominate the discussion, such as socio-critical approaches or perspectives emphasizing social inequality and marginalization.

Conclusion: Anyone who examines these approaches from a public health perspective must conclude that many innovations in mental health care are largely irrelevant to public mental health, despite their impact on the relationship between society and mental health care.

Background: About one hundred years prior to Capgras' description of the eponymous misidentification psychosis, this clinical picture had already been described by Schroeder van der Kolk. To this day, this publication has received unjustly little attention.

Aim: To highlight Schroeder van der Kolk's case report and to bridge past and present, with emphasis on psychiatric care.

Method: Analysis of the original case history alongside Capgras' three publications and presentation of a modernized adaptation.

Results: The pathogenetic factors emphasized by Capgras - alienation, heightened affective tension, paranoid hypervigilance, and unconscious Oedipal conflicts - are also discernible in the patient described by Schroeder van der Kolk. His treatment strategy probably shows more similarities with contemporary psychiatric practice than might be expected.

Conclusion: The original case report can serve as a source of inspiration for the refinement of clinical intuition, functioning as a paper-based consultation.

We describe the case of a 64-year-old woman who experienced a first psychotic episode following an increase in volume of a known arachnoid cyst in the posterior fossa. This was associated with anxiety and panic attacks as well as mild cognitive deficits. A cystoperitoneal shunt was placed three years earlier to treat headaches, poor balance and memory problems associated with the cyst. Increasing the flow rate through the shunt, followed by the initiation of an SSRI, resulted in remission of the psychotic and affective symptoms. This case illustrates the potential association between structural infratentorial lesions, such as arachnoid cysts, and neuropsychiatric symptoms, particularly psychosis. Given that decompression of the cyst was associated with a reduction in symptoms, this suggests a link between the onset of psychotic symptoms and cerebellar dysfunction.

Background: Posttraumatic stress disorder (PTSD) is associated with high rates of avoidant, dependent and obsessive-compulsive personality disorders (cluster C-PD). It is unknown whether concurrent treatment for PTSD and comorbid cluster C-PD leads to superior treatment effects, compared to standalone trauma-focused treatment.

Aim: To test the efficacy of adding 52-58 sessions of PD treatment (group schema therapy; GST) to 12-18 sessions of individual trauma-focused treatment (imagery rescripting; ImRs).

Method: 130 adult outpatients were randomized to receive either ImRs or ImRs+GST. The main outcome was PTSD severity one year after start of treatment (CAPS-5). Secondary outcomes were cluster C-PD, psychiatric symptoms, quality of life, functioning, treatment response, remission, and dropout.

Results: At 12 months, there were large decreases in PTSD severity (d = 2,4), PD symptoms and all other secondary outcomes. There were no significant differences between conditions.

Conclusion: Large effects were observed in both treatment arms. The results suggests that trauma focused treatment is the preferred primary treatment in patients presenting with PTSD and comorbid cluster C-PD, after which more intensive psychotherapy aimed at the personality disorder may be considered in the case of residual personality disorder symptoms.

Background: The medical profession such as that of a psychiatrist is a profession with three essential characteristics (specialist care, autonomy and formal recognition, and professional ethics). The 21st century is characterized by bureaucratization and marketization of healthcare. Medical sociologist Friedson described three forms of logic: the logic of the professional, the logic of bureaucracy and the logic of the market.

Aim: To test the position, autonomy and effectiveness of the psychiatrist from a historical perspective. To assess developments in Dutch and Belgian psychiatry and make a comparison.

Method: Two psychiatrists from Belgium and the Netherlands mention relevant developments. It is examined which form of logic is followed in these developments.

Results: The logic of the professional applies to quality and further training, but is threatened by some Boards of Directors and the position of the Dutch psychiatrist. The logic of bureaucracy dominates in the new legislation on compulsory healthcare in the Netherlands. Finally, the powerful health insurers illustrate the logic of the market.

Conclusion: The logics of bureaucracy and the market take the upper hand in the Netherlands, to the detriment of the logic of the professional. Extensive bureaucratization and the power of health insurers are not desirable developments for Belgium. Belgians should urgently consider the options for compulsory treatment and mandatory quality and further training.

Background: Recent reports from the psychiatric drug development space have been feeding the expectation of novel pharmacotherapies reaching the clinic over the next couple of years. In this context, advancement of novel compounds such as esketamine, KarXT, MDMA, daridorexant and psilocybine following decades of stagnation, is undoubtedly promising. However, complacency on the side of drug developers and psychiatrist should be considered premature.

Method: Discussion of literature, examples and backgrounds of drug development in psychiatry.

Results: After all, compared to neurology and oncology, psychiatry is lagging behind in terms of potential new drugs targeting truly novel mechanisms of action to treat psychiatric disorders. The current situation is conceptually related to 1) lacking an understanding of the pathophysiology of psychiatric disorders, 2) limited pharmacological characterization of novel drugs, 3) equating phenomenological diagnostic categories to diseases with a biological basis, and 4) the pharmaceutical industry aiming to introduce ‘blockbuster drugs’ to the market.

Conclusion: Altogether, psychiatric drug development is currently undergoing something of a renaissance, but relevant stakeholders seem unable to address the shortcomings and pitfalls of the current approach, risking psychiatric drug development to fall even further behind. Improving drug development in psychiatry is only possible if clinicians, researchers, drug developers and regulators join forces in a concerted effort to address these issues.