Tijdschrift voor psychiatrie最新文献

Background: In psychologic and psychiatric research, methodological standards are used to develop an evidence-base for clinical practice. Each method forms ‘evidence’ based on specific methodological assumptions. The choice for a method defines what counts as ‘evidence; thus shaping the organization of clinical practice.

Method: In this paper, we discuss qualitative analyses of three patient-participants in ‘gold standard’ psychotherapy research, who stood out in the sample for their explicit engagement with the questionnaires.

Results: These ‘rich cases’ illustrate how to methodological assumptions can lead to loss of valuable clinical information, which jeopardizes the representativeness and utility of the evidence-base.

Conclusion: By excluding people from analyzes in advance or during the study, or by losing them ‘in the mean’, we lose the opportunity to offer those people an empirically supported treatment. Therefore, if we want to work evidence-based, we also have to collect evidence for the non-evident.

Background: It is difficult to qualify patients with substance-related and addictive disorders for the Dutch Compulsory Care Act (Wvggz) AIM: Investigating factors that influence rejections of substance-related and addictive disorders as mental disorders in the Wvggz RESULTS: Substance-related and addictive disorders are assessed differently as mental disorder than other psychiatric disorders under both the old Dutch Special Admissions Act (Bopz) and the Wvggz. It is often not made clear whether the assessment is made from the medical-psychiatric or legal domain.

Conclusion: To qualify patients with substance-related and addictive disorders for the Wvggz, a medical-psychiatric classification and/or diagnosis must be converted into the required legal terms in as structured a manner as possible. It is also undesirable for a law and therefore the court to determine whether there is a mental disorder. This belongs to the medical-psychiatric domain.

Background: Disciplinary law is regulated differently in Belgium than in the Netherlands. The Belgian Order of Physicians is responsible for the disciplinary supervision of physicians. The order is an institution with legal personality and has a three-tiered structure, two of which have judicial authority, namely the ten provincial councils and the two appeal councils. The third structure, the national council, has normative authority with the task of drafting the Code of Medical Ethics.

Aim: To describe disciplinary law in Belgium.

Method: To provide an overview of the main characteristics and to outline some current developments.

Results: The provincial council initially handles complaints behind closed doors, and the complainant can appeal to the appeal council through a public procedure. The Code of Medical Ethics does not have legally binding force but is regularly updated, taking into account both international and national relevant legislation. The domain of medical practice has become more extensive in recent decades and is increasingly regulated by law with new control bodies. The Order of Physicians retains its deontological powers but must take into account the legal powers of these new bodies.

Conclusion: Both the Order of Physicians and the political authorities agree that the 1967 law (Royal Decree No. 79) needs to be revised and updated, but no submitted bill has succeeded in doing so to date. Key concepts for revision are: multidisciplinary structure, more openness and transparency.

Background: Non-invasive brain stimulation, such as repetitive transcranial magnetic stimulation (rTMS), is increasingly used in the treatment of neurological diseases and psychiatric disorders. Where rTMS is already an accepted treatment option for depression, in the Netherlands/Belgium, no consensus exist on the application of rTMS for (obsessive-compulsive disorder (OCD). People with OCD who do not respond enough to exposure therapy and serotonergic antidepressants are in great need for treatment alternatives.

Aim: Consensus statement on the application of rTMS as treatment for OCD METHOD: Evaluation of the current literature on the efficacy of rTMS for OCD, mainly based on recent meta-analysis, by a broad group of experts in the field of rTMS, OCD and treatment guidelines.

Results: rTMS is a potentially effective treatment for OCD with a medium effect size (g ≈ 0,5). Based on the current literature it is not yet clear which rTMS protocol is the most effective.

Conclusion: based on the evidence for rTMS in OCD, and the non-invasive nature of the treatment modality, rTMS can considered in cases with OCD who do not respond enough to exposure therapy and serotonergic antidepressants, prior to the start of more invasive treatment alternatives, such as deep brain stimulation or lesion surgery.

Background The prevalence of smoking among patients with psychiatric disorders is 3-4 times higher than the general population. However, smoking is still permitted in many psychiatric clinics. The National Prevention Agreement (2018) mandates that all psychiatric wards be smoke-free by 2025. The UMC Utrecht clinics have been smoke-free since November 2020. Aim To examine healthcare workers’ attitudes before and after implementing the smoke-free policy. Method In an observational study with quantitative data analysis, data were collected in one center from healthcare workers in psychiatry departments with surveys. We collected demographic information, smoking status, attitudes towards the smoke-free policy, and its impact on patients and care. Incidents of aggression were prospectively recorded and reported in the MAP (aggression incidents in patient care). Results Out of 172 healthcare workers invited to participate, 30% (n = 52) completed the pre-implementation survey, and 20% (n = 34) completed the post-implementation survey. Prior to implementation, 62% (n = 32/52) of healthcare workers had a positive attitude towards the smoke-free policy, which increased to 77% (n = 26/34) post-implementation. Expectations of increased aggression incidents were reported by 62% (n = 32/52) during the pre-implementation phase. The number of aggression incidents was 46 in the one-year period before implementation (November 2019 – February 2020) and 45 incidents after implementation (November 2020 – February 2021). Conclusion This study supports the implementation of a smoke-free policy in psychiatric clinics due to the lack of a significant increase in aggression incidents. Healthcare workers perceived this outcome and observed quicker granting of ‘green’ freedoms.

Suicidality is prevalent in mental healthcare settings. A small subset of patients exhibiting severe, chronic suicidal tendencies place a significant demand on healthcare services. Existing guidelines offer insufficient guidance, and crisis interventions often yield counterproductive results. This culminates in a pattern of securing and controlling, lacking adequate prospects for recovery and potentially causing harm to the patient. In order to develop a more effective treatment approach, an autonomy promoting policy (APP) has been formulated by the authors. In this article the background and dilemma’s surrounding the APP will be described based on a fictional patient case, and describes how the guide helps in these situations.

Background: The law regulating the forced or protective admission of the mentally ill person in Belgium is 34 years old. The parliament recently agreed on an extensive legislative amendment to better adapt the law to the changing mental health care system and society.

Aim: Outlining the epidemiological, clinical and legal developments regarding forced admissions in Belgium.

Method: Analysis of epidemiological data, evolutions in clinical practice and the previous and new legislative framework.

Results: The incidence of forced admission in Flanders rised, with large provincial differences. Care for involuntarily admitted patients has evolved significantly in recent years, including the establishment of High and Intensive Care Units. The amended law allows a more thorough clinical evaluation before forced admission. More diversification and customization of protective measures become possible.

Conclusion: The new law addresses a number of problems with the previous legislative framework. A number of points for improvement remain, which will hopefully be picked up by policy makers in further initiatives.