Tijdschrift voor psychiatrie最新文献

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: 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: Mental health care is under great pressure; the current system is bursting at the seams with waiting times and cutbacks against the backdrop of major societal transformations.

Aim: From the chaos of the present, this essay attempts to sketch a perspective on the future of psychiatry.

Method: Using the theory of major transformations and systems change this essay zooms out to a complex systemic perspective to try to paint a picture of psychiatry in 10 years’ time.

Results: Several theories of major systemic change suggest that healthcare is moving from the current medical model to human-centered care from an ecosystem that is organized around the person. There are already new initiatives that seem to be making a start in this direction. Nevertheless, the future is difficult to predict and time will tell where we will be in 10 years’ time.

Conclusion: The major transformation in healthcare is moving in the direction of human-centered care in which hope and possibilities present themselves for a healthier society.

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.

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.

Backgrund: Psychiatric disorders in older adults are underdiagnosed and undertreated, despite their high prevalence and significant impact on medical care utilisation. Given demographic developments and the limited number of specialised psychiatrists, an age-based mental health care division is not sustainable for the future. Which solutions are future-proof?

Aim: To describe solutions for a future-proof psychiatry for older adults.

Method: Literature review and consideration.

Results: Future-proof care requires a strategic positioning of old age psychiatrists, focusing on their specific expertise at the intersection of psychiatry and somatics, neurocognitive disorders, the psychosocial characteristics of the third and fourth stages of life, and end-of-life care. This includes an effective role in early detection and consultation in general practice, guidance during transitions in the psychosocial context of individuals, transitions from vitality to physical frailty in mental health care, and within the somatic care chain involving general hospitals and long-term care facilities.

Conclusion: For future-proof care, strategic positioning of the old age psychiatrist is desirable, as well as investments in research, education, network-based care, and digital technology to flexibly respond to the evolving care demands.

Background: Despite major progress in women’s emancipation, women remain underrepresented in the highest academic positions.

Aim: To 1. determine the percentage of female psychiatry professors affiliated with a university medical center (UMC), 2. analyze the increase in female psychiatry professors over the years relative to the number of female psychiatrists, and 3. provide a prognosis for future trends.

Method: For this descriptive study we utilized data from the Dutch Association of Psychiatry and the Dutch UMC, and research questions were answered with descriptive analyses, correlation tests with a Pearson correlation coefficient and group comparisons with a two-tailed t-test. Results were presented graphically.

Results: Out of 40 psychiatry professors in UMC, 14 were women (35%) and 26 were men (65%). A cautious forecast suggested this will rise to 43% by 2030. The average age at appointment for male professors was 46.3 years (SD 5.4), compared to 49 years (SD 5.6) for female professors (p = 0.17).

Conclusion: Over the past two years, the percentage of female psychiatry professors has increased significantly by 11%. Despite the increase, this percentage remains low compared to the 54% of female psychiatrists in 2024 and does not keep pace with the growing number of female psychiatrists. We advocate for policies that promote diversity and inclusion, as these lead to higher quality research and does justice to our diverse patient population.

Background: In 2017, the World Psychiatric Association-Lancet Psychiatry Commission on the future of psychiatry identified several priority areas for the next decade. Six major domains were distinguished, namely the patient and his treatment, psychiatry and healthcare systems, psychiatry and society, the future of mental health legislation, digital psychiatry and training the psychiatrist of the future. This essay examines the state of affairs in Belgium seven years after the publication of the above-mentioned document.

Method: Testing the situation in Belgium based on scientific literature and policy documents, and on experience and opinion of the authors.

Results: Psychiatry training and research are slow to keep up with demographic changes such as aging and cultural diversity. There is also a stark lack of capacity and competencies in clinical practice. The reforms within Belgian mental health care have received international appreciation in recent years. However, multi-stage care is still not getting off the ground. There is also insufficient capacity for outpatient care for patients with serious psychiatric disorders. In addition to the law on compulsory admission, the law on patient rights was renewed. Digital psychiatric care has hardly been rolled out. Finally, the training and education for the future psychiatrist is still based too much on knowledge transfer and not enough on the acquisition of skills.

Conclusion: The World Health Organization and Europe praise the Belgian reforms regarding the socialization of healthcare. However, compared to future expectations for our field, a lot still needs to be done.