Tijdschrift voor psychiatrie最新文献

Background: In recent years, developments have been made in various research domains, from treatments with (es)ketamine to large-scale genome-wide association studies (GWAS).

Aim: To map some of the most promising scientific developments, that may have an impact on clinical practice in psychiatry or are already doing so.

Method: We summarized recent developments in the field of epidemiology, artificial intelligence (AI) and genetics, supported by and illustrated with recent relevant scientific literature.

Results: Triangulation of data and innovative trial designs, such as n=1 trials and platform trials, carry the potential to contribute to more reliable results and developments in precision psychiatry. AI has various possibilities for daily practice: from searching for evidence to applying therapeutic interventions via chatbots. GWAS enable individual genetic risk profile generation with ever-growing precision.

Conclusion: Multifaceted developments in psychiatric research are projected to render clinical psychiatry more efficient and treatment options more personalized. Bolstering (international) collaborations and co-creating with experts by experience are indispensable elements in determining the scientific course in the field for the years ahead.

Background: Obsessive-compulsive disorder (OCD) in youth ≤ 18 years is frequently associated with family accommodation. However, the current literature lacks scientific evidence specifically examining this association.

Aim: To clarify the association between family accommodation and OCD symptoms and to define the role of family therapy in the treatment of OCD in youth ≤ 18 years.

Method: A meta-analysis and systematic review focused on the relationship between family accommodation and OCD symptoms in youth ≤ 18 years.

Results: Fourteen studies were included, encompassing a total of 1,263 youth aged ≤ 18years with OCD. A significant association was found with a moderate effect size of r = 0.45 (95% CI: 0.35-0.54; p < 0.001). This association was identified exclusively in the domain of cleaning/contamination. Family accommodation decreased significantly following family therapy, and this reduction was significantly correlated with a decrease in OCD symptoms.

Conclusion: Family therapy focused on family accommodation appears to hold a critical role in the treatment of OCD. This approach can enhance parental alignment to sustain a more structured and boundary-setting parenting style. Future research should explore the impact of (empathetic) boundary-setting on OCD-symptoms, as well as the influence of the broader social context.

Background: In recent decades, the frequency of assigning co-morbid psychiatric diagnoses has risen markedly. This trend imposes a significant burden on patients and contribute to structural inefficiencies in mental healthcare.

Aim: To present a case for re-evaluating the current conceptualization of psychiatric comorbidity.

Method: A critical analysis of the DSM’s prevailing framework for comorbidity, alongside a discussion of potential alternative models.

Results: Comorbidity in psychiatry is, to a significant extent, a consequence of too narrow formulated diagnostic criteria. This may obscure the inherent interconnectivity of mental disorders and hinder recognition of healthy psychological functioning. Employing Ockham’s razor and hierarchical decision-making rules offers pathways to a more integrated diagnostic perspective. Conceptualizing the psyche as a complex adaptive network further strengthens the rationale for such an approach.

Conclusion: The accumulation of comorbid psychiatric diagnoses may be clinically counterproductive. Conceptualizing psychopathology within a hierarchical framework offers a viable alternative.

Background: The reforms within the Flemish bachelor’s nursing education have led to the elimination of specialization tracks, including psychiatry. This has created uncertainty about the preparation of nurses for work in mental health care, partly due to vague definitions and overlap between the terms ‘psychiatric nursing’ and ‘mental health nursing’.

Aim: To gain insight into how Flemish healthcare organizations recruit nurses following the elimination of the psychiatric specialization.

Method: Content analysis of job advertisements from the largest centralized official job database in Flanders, using terms ‘mental health care nurse’ and ‘psychiatric nurse’ without additional filter criteria.

Results: A total of 204 relevant job advertisements were identified. The majority of job postings (54.3%) were from psychiatric and general hospitals. 20.6% of vacancies were open to both nurses and other care profiles. Only three job postings (1.5%) explicitly used the job title ‘mental health nurse’.

Conclusion: The analysis shows a discrepancy between the evolution towards mental health nursing and job titles used in advertisements. Specialized nursing education remains essential for addressing complex mental health care needs. The ‘new’ mental health nursing can provide a base for high-quality and future-proof healthcare education programs, while preserving valuable historical elements of psychiatric nursing.

Background: In the current health care landscape, efforts are being made to identify the best treatment setting for ‘stable clozapine users’ when they no longer require intensive multidisciplinary outpatient treatment, such as a FACT team. Knowledge about their prognosis is essential for this.

Aim: The aim of this research is to gain insight into treatment that stable clozapine users receive within a specially established clozapine outpatient clinic. This understanding will help formulate recommendations regarding the organization of care for this group.

Method: A retrospective analysis of medical records and data was conducted on a group of patients defined as ‘stable clozapine users’ who were being treated at the clozapine outpatient clinic.

Results: A total of 62 patients were treated at the clozapine outpatient clinic; 60 were included in our study. Of these, 77% required more treatment than initially estimated, indicating an underestimation of their care needs. Intensive treatment was provided to 60% of the patients, and 33% of them experienced a one-time or repeated escalation of care. Additionally, 15% of the patients were admitted to a hospital at least once. Notably, 23% of the patients were (re)referred to a FACT team.

Conclusion: The findings indicate that stable clozapine users remain vulnerable, and most patients will require intensive treatment again at some point. To prevent discontinuity of treatment, we recommend keeping stabilized patients with psychosis under treatment in specialized mental health care teams, rather than referring them back to primary care.

Fahr’s disease is a rare neurodegenerative disorder characterized by symmetrical calcifications of the basal ganglia. Fahr’s disease is categorized as a neurodegenerative condition due to the pathophysiological effects of calcification. The condition can be associated with a range of neuropsychiatric, motor, and cognitive symptoms. We report a 38-year-old man with mania with psychotic features. Neurological examination showed a bilateral tremor in the hands. Imaging revealed calcifications in the basal ganglia, consistent with Fahr’s disease. He was successfully treated with olanzapine and lithium, but developed extrapyramidal symptoms, which responded well to procyclidine. The risk of extrapyramidal symptoms and neuroleptic malignant syndrome is increased in Fahr’s disease, necessitating cautious use of antipsychotic medications. The complex symptomatology and incomplete penetrance of Fahr’s disease may contribute to underdiagnosis. This case highlights the value of brain imaging in cases of severe atypical psychiatric symptoms.

Background: Currently, consensus on the use of medication for ADHD during pregnancy and lactation is lacking, complicating treatment decisions for fertile patients with ADHD.

Aim: To describe approaches present in guidelines, literature, and local practices of hospital psychiatrists concerning counseling ADHD-patients on pregnancy.

Method: From March to September 2024, a literature search was complemented by a questionnaire. Twelve hospital psychiatrists were questioned about how they advised patients with ADHD about pregnancy. We collected information on the use of medication, comorbidity, best practices and non-pharmacotherapeutic interventions.

Results: Most hospital psychiatrists advised against stimulants during pregnancy. Alternatives were bupropion, non-medicinal interventions, antidepressants and antipsychotics. Most hospital psychiatrists advised against the use of stimulants or bupropion during lactation. Some hospitals used shared-decision making.

Conclusion: The advice given to women with ADHD about pregnancy differs between psychiatrists. The description of their practices and considerations provided valuable insights for psychiatrists. Further research should follow on (non)medicinal alternatives for stimulants and the development of multidisciplinary guidelines.

Background: Experiencing a patient’s suicide can have a considerable emotional and behavioral impact on psychiatrists. Knowledge about good aftercare for them is still lacking.

Aim: To gain more insight into the impact of suicide on psychiatrists and into improvement of their recovery.

Method: An exploratory qualitative descriptive study using semi-structured interviews conducted with five psychiatrists working at a large Dutch mental health institution.

Results: Five themes were distinguished: emotional impact, stacking and workload, taking responsibility, feelings of being held accountable and perceived support. Suicides made a profound emotional impression on all psychiatrists. Experienced emotions varied in nature and duration. Due to the accumulation of incidents and workload, the psychiatrists experienced little room for recovery. They felt a great responsibility to provide good aftercare for family and colleagues as well as to manage formal matters properly. They also felt that they are held accountable. Emotional support from colleagues was experienced as very valuable. Practical support was missed.

Conclusion: For the mental well-being of psychiatrists, it is important for them to receive both emotional and practical support in the aftermath of a patient’s suicide. This requires a joint approach from fellow practitioners as well as policy makers. Training is indispensable in this regard.

: Postural orthostatic tachycardia syndrome (POTS) is a potentially disabling disorder of the autonomic nervous system. In addition to the characteristic tachycardia in verticalization, this syndrome is accompanied by a range of other complaints such as brain fog, dizziness, cognitive dysregulation , sleeping problems, fatigue and gastrointestinal disorders. Due to the unfamiliarity with this syndrome, the somatic symptom pattern is often misinterpreted as anxiety or mood symptoms with referral to psychiatry. When during psychiatric evaluation POTS diagnosis is missed, the patient is denied adequate cardiological treatment and iatrogenic damage can occur through psychiatric or psychological treatment. Since POTS can also occur after COVID infection, this syndrome will increasingly appear in the psychiatrist's differential diagnosis due to rising prevalence.: We describe a 24-year-old woman who had been treated unsuccessfully for 13 years in mental health care for anxiety complaints and development stagnation, during which she also experienced dizziness, palpitations, and other physical complaints. The cardiologist diagnosed and treated POTS, after which her symptoms decreased significantly.