Tijdschrift voor psychiatrie最新文献

Background: Psychiatric stigma is a destructive and complex social phenomenon that hinders patients with a mental vulnerability from participating and seeking help.

Aim: Exploring possible arguments for a decreasing negative impact of stigma in healthcare, in the media, and among young people.

Method: Discussion of relevant literature and initiatives.

Results: Integrated somatic-psychological healthcare, providing accurate information about mental health issues and advice on empathetic connection to journalists, and the use of social media by young people are successful strategies to address stigma.

Conclusion: Although the negative impact of stigma is still palpable and requires vigilance, there are positive signs of reduced influence that may give rise to hope.

In this case report we describe the search for treatment of early onset schizophrenia, in a 16-year-old patient, who did not respond to treatment. Possible causes explaining the non-response were presence of a secondary cause of the psychotic episode, non-compliance, treatment resistance and an increased metabolization of the medication. The challenges in finding an appropriate treatment plan are analyzed. The main focus lies on the complex interplay between several causes of treatment resistance, dealing with non-compliance and aggression towards patients and carers. Lastly, we regret the absence of clear guidelines for use of pharmacogenetics in Belgium.

Background: Suicide attempts have a profound emotional impact on both individuals and society as a whole.

Aim: To delve into the factors that have an influence on the transition from suicidal ideation to attempt and the preventive strategies impeding this transition.

Method: Between October 1, 2022 and March 7, 2023 we interviewed 27 adults (23 women, four men, mean age 33 years) who attempted suicide within the past 12 months.

Results: Despite the heterogeneity of the suicidal process, suicidal thoughts predominately emerged during adolescence (Mdn = 15; M = 17.8). In most participants, planning and preparatory actions occurred long before the attempt, with a median of six years prior to the attempt for the selection of the method. All volitional moderators were observed, although pain sensitivity in particular varied among participants. Access to lethal means and planning emerged as important moderators in the suicidal process. Asking the survivors what could have helped to prevent their attempts, most participants mentioned that they felt their suicidality was not taken seriously enough.

Conclusion: We discussed the significance of planning in the suicidal process, challenges in conceptualizing planning and impulsivity, and individual differences in pain sensitivity. Based on the findings, we underscore the critical need for restricting access to means, giving greater consideration to preparatory actions within the suicidal process, and fostering open dialogues about suicidality.

Background: Treatment of individuals who have committed sexual offenses (ISOs) is an important part of the prevention of sexual violence and is usually implemented with cognitive behavioural therapy.

Aim: To review other psychotherapeutic treatment methods are explored.

Method: A systematic literature search was conducted in two databases and further supplemented with articles from reference lists.

Results: A total of thirteen articles were identified which covered treatments from experiential therapy, schema therapy, psychodynamic therapy and integrative psychotherapy.

Conclusion: The included articles emphasize the importance of affect regulation, traumatherapy, a thorough case conceptualization and increasing self-awareness. However, there is an important need of more recidivism research on the psychotherapeutic treatment of ISOs.

Background: Many patients with depressive disorder do not recover after psychotherapy. It is unclear for how long treatment should be continued unchanged for patients showing limited progress.

Aim: Examine whether early non-response is a predictor of treatment outcome in patients with moderate to severe depression and when the predictive value is highest.

Method: Per-protocol analyses were performed with 252 moderately to severely depressed patients. Participants were randomly assigned to 16 sessions of either short-term psychodynamic supportive psychotherapy (SPSP) or cognitive behavioural therapy (CBT). The predictive value of early non-response (< 20% reduction of symptoms of the Inventory of Depressive Symptomatology) at week 1, 2, and 4 for treatment non-response at week 8 (< 50% reduction of symptoms) was evaluated with logistic regression.

Results: Early non-response was a moderate to strong predictor of final non-response in week 8. The predictive value was highest in week 4 (odds ratio: 12.1; p < 0,001; AUC: 0.78). Most early non-responders remained non-responder after treatment (84% of non-responders in week 1 to 93% of non-responders in week 4).

Conclusion: Early non-response indicates little chance of treatment response and may indicate that changes in depression management should be considered earlier than conventionally thought.

Background: In recent years, radicalisation has become an important concern. The radicalisation process is characterised by an ideological shift away from mainstream societal views and an increasing willingness to engage in violence. Psychopathology is considered an individual factor that may influence this process.

Aim: To explore what is currently known about the prevalence of schizophrenia spectrum or other psychotic disorders (SSOPD) in the context of radicalisation and aim to identify any individual or process-related characteristics associated with this combination.

Method: Scoping literature review.

Results: Nineteen articles were included. The reported prevalence of SSOPD among radicalised individuals varied widely (3.8-75%). This variation can be partly explained by differences in methodology, sample selection, and definitions of key concepts. Higher prevalence rates were reported within the subgroup of lone actors. Regarding the radicalization process in individuals with a SSOPD, two distinct trajectories are described. One study suggests a less traumatic background in radicalised youth with a SSOPD compared to those without a diagnosis.

Conclusion: SSOPD may play a relevant role, particularly in individuals at risk of lone actor violence. Accurate psychiatric diagnosis is crucial in the prevention and management of radicalisation. Further research using standardised methods and longitudinal designs is needed to better understand the complex relationship between SSOPD and radicalisation.

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.

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.