Tijdschrift voor psychiatrie最新文献

Background: Autism spectrum disorders (ASD) in juvenile sex offenders present a unique challenge in forensic child and adolescent psychiatry. Specific characteristics of ASD, such as deficits in social cognition and obsessions, may theoretically contribute to sexually inappropriate behavior (SIB), however this has been scarcely studied in adolescents. Research on normative sexual development in adolescents with ASD shows no significant differences compared to neurotypical peers.

Aim: To synthesize the available evidence of the relationship between ASD, SIB and sexual offending in adolescents.

Method: A systematic search was conducted across multiple databases, yielding 16 relevant studies.

Results: There is evidence suggesting a higher prevalence of ASD among juvenile sexual offenders and preference for specific sexual offenses. Few specific therapeutic approaches have been identified for this group. Although there is some consensus regarding the use of cognitive behavioral therapy (CBT) and multisystemic therapy (MST), there is limited evidence supporting pharmacological interventions. Research into prevention and risk factors is limited.

Conclusion: There is a need for further research into the prevalence, prevention, the role of parental knowledge, family dynamics, and how specific developmental skills in ASD may contribute to the emergence of problematic sexual behavior. No specific treatment strategy is currently favored for this population. We highlight several factors that warrant further investigation regarding the relationship between ASD and SIB or sexual delinquency.

Background: Since 2020, the Compulsory Mental Healthcare Act (Wvggz) has been in effect in the Netherlands. This law provides the option for ‘compulsory care’ for individuals experiencing severe harm as a result of a mental disorder. A new element introduced by this law is the ‘external referral’ (externe aanwijzing). This allows anyone to raise concerns about a citizen’s mental condition and report it. This can lead to an external referral of a medical director (GD), initiated by the public prosecutor. The GD is responsible for determining whether care is needed in the context of a care authorization or ‘zorgmachtiging’ (ZM).

Aim: To analyse the process of the ‘externe aanwijzing’ within Antes.

Methods: This observational study is conducted at Antes, an institution for mental healthcare, where 128 externe aanwijzingen were analyzed during the period of 2020-2021.

Results: The majority (60%) of the analyzed externe aanwijzingen resulted in a positive recommendation for a ZM by the GD. Externe aanwijzingen through a forensic route more frequently led to a ZM (68%) compared to those through the municipality (39%). Nearly all patients with a ZM received active treatment.

Conclusion: Individuals with a forensic externe aanwijzing more commonly receive a ZM directly as a result of this process. The externe aanwijzing proves to be a valuable means of engaging individuals averse to care, including voluntarily. This study provides insights into the process of externe aanwijzingen and care authorizations within Antes.

Background: Precision psychiatry is an emerging field focusing on individualized approaches to mental health care, aiming to reduce uncertainty regarding prognosis and treatment response.

Aim: To identify challenges that hinder the implementation of precision psychiatry and to propose directions for future research.

Method: A narrative review of challenges within the field of precision psychiatry.

Results: Significant emphasis has been placed on technical innovation for data-driven predictive models of treatment outcomes. However, the complex and dynamic nature of mental health presents major challenges for successful implementation. Research in representative populations, relevant outcome definitions, and integration of contextual and behavioral factors is essential. Furthermore, validation and implementation currently remain understudied.

Conclusion: A shift is needed from retrospective research based on linear and static disease concepts to prospective research that considers the impact of contextual factors and the dynamic and complex nature of mental health.

Background: In the Netherlands, acute care for psychiatric emergencies is primarily provided at mental health crisis centres. In cases where there is insufficient capacity or when an evaluation of acute physical symptoms by first responders deems it necessary, patients are directed to the emergency ward. However, information on the role of the emergency ward is required to organize an efficient care chain.

Method: To better understand the role of the emergency ward within the emergency psychiatric services, a quantitative analysis of data recorded on psychiatric emergencies from 2018 to 2020 at the largest emergency ward in Amsterdam was conducted, along with a qualitative study on the experiences of healthcare professionals.

Results: On average, 53 patients were admitted monthly to the emergency ward, with 44% (n = 131) displaying both acute psychiatric and physical comorbidity. Within this group, 69% (n = 90) exhibited self-injurious behaviour. Additionally, 9% (n = 26) of patients were admitted due to insufficient capacity at mental health crisis centres. Detailed analysis revealed that this group included cases of drug-induced psychosis (12%; n = 3) and substance-use related psychiatric emergencies (23%; n = 6). Interviews conducted for the qualitative analysis indicated that a prolonged length of stay in the emergency ward and limited admission capacity were viewed as significant factors affecting the efficiency of emergency psychiatric services.

Conclusions: The findings suggest that the actual function of the emergency ward differs from its presumed primary role as a facility for acute physical care within the psychiatric services. A possible solution to reduce patient movements and the risk of overlooking somatic needs in psychiatric patients, is to centralize both the mental health crisis centre and the hospital emergency ward in one location.

Background: In May 2024, the Belgian federal parliament approved new legislation focused on task differentiation and the introduction of a care ladder within the nursing profession. This law recognizes nursing as an autonomous and interprofessional discipline and introduces new professional roles such as the basic nurse, the nurse responsible for general care (VVAZ), the nurse specialist, and the nurse researcher.

Aim: To explore the potential impact of this reform on the role of the psychiatrist within Belgian mental health care.

Method: Reflective essay.

Results: Within mental health care, the new legislation leads to a redistribution of tasks: nurses gain greater autonomy and responsibility, while psychiatrists can focus more on complex or acute situations. The reform aims to increase efficiency and better align care with patients’ needs.

Conclusion: While the reform offers opportunities for broader care integration, it also requires clear agreements and appropriate training. Especially in mental health care, where care is often complex and multidisciplinary, strong collaboration between physicians, nurses, and other professionals is essential to ensure high-quality care.

Background: Mental healthcare is undergoing a paradigm shift from traditional disorder-specific diagnostics toward a transdiagnostic framework for conceptualizing psychological distress. This framework facilitates an integrated understanding of underlying mechanisms that cut across conventional diagnostic boundaries.

Aim: To present a clinically applicable model of transdiagnostic clinical reasoning, elucidating its added value in routine practice and delineating its distinctions from disorder-focused approaches.

Method: A narrative synthesis of the literature was conducted to integrate current conceptual and empirical insights into a pragmatic framework for transdiagnostic case formulation and intervention planning.

Results: Psychopathological presentations frequently co-occur, reflecting shared etiological and maintaining mechanisms that may be biological, psychological, and contextual in origin. A set of functional process domains is delineated to illustrate the clinical utility of a holistic formulation framework in the assessment and treatment of complex, comorbid presentations. The model emphasizes the centrality of relational co-creation—collaborative engagement between service users, significant others, and mental health professionals—as a vehicle for tailored, person-centred care.

Conclusion: Transdiagnostic clinical reasoning can be readily applied in current clinical practice. By focusing on underlying processes from a cross-diagnostic perspective, it enables a more integrative, mechanism-oriented, and individualized response to psychological distress, capturing its inherent complexity and heterogeneity.

: Paroxysmal perceptual alteration (PPA) is a syndrome that may occur as an unknown side effect of antipsychotics. Patients can develop complaints of perceptual distortions when using antipsychotics, usually accompanied by severe tension and anxiety. I describe the case of a 32-year-old man who developed PPA in reaction to various antipsychotics. The complaints were severely disabling for him. Based on this case, the symptoms, prevalence, (differential) diagnosis, pathophysiological hypotheses and treatment of this unknown side effect are discussed. The aim of the discussion is to create awareness and provide tools to recognize PPA and treat it adequately.

Background: During the COVID-19 pandemic, clinicians observed an increase in young people with sudden-onset tics related to watching videos about tics and Tourette’s syndrome (TS) on TikTok. It was notable that the displayed symptoms did not fully align with descriptions from the DSM-5.

Aim: To examine the portrayal of tics and TS on TikTok: which messages are conveyed and how.

Method: Through a qualitative analysis of TikTok videos, we investigated how tics and TS are presented: what informational messages are conveyed, how creators experience having tics, and how these messages are communicated.

Results: Informational messages were largely accurate. However, disproportionate attention was given to sensational symptoms (cursing, aggression and complex tics). The experiences of creators with tics and TS were diverse and helped broaden the perspective on these conditions.

Conclusion: These videos create an unbalanced portrayal of tics and TS. For healthcare professionals, it is crucial to be aware of the influence of social media on the perception of tics and TS. There is a need for nuanced psychoeducation and for supporting patients in navigating online information. The involvement of individuals with lived experience is a valuable addition.

We describe the case of a 33-year-old man who was treated with atomoxetine for attention-deficit/hyperactivity disorder. During follow-up, the patient reported intermittent priapism as a side effect of this medication. It was decided to discontinue atomoxetine, after which the painful erections resolved spontaneously. The literature includes several cases describing atomoxetine-induced priapism in children and adolescents. This case, in which an adult male experienced priapism as a side effect of atomoxetine, highlights the importance of being vigilant for this potential complication when prescribing the drug, including in adult patients.

Background: The COVID-19 pandemic posed significant challenges for parents, due to the closure of childcare facilities and schools, the shift to working from home, and the loss of support services.

Aim: To examine the extent to which COVID-related stress (CRS) and caring for psychiatrically vulnerable children (PVC) influenced parental stress and the experience of psychological basic needs during the first COVID-19 lockdown.

Method: Parents of PVC (n = 203) and parents of non-PVC (n = 919) completed questionnaires assessing parental stress and psychological needs. Associations were examined using multiple regression analyses.

Results: Parents of PVC experienced higher parental stress, greater need frustration and lower need satisfaction. CRS increased these experiences for all parents; while caring for PVC specifically contributed to higher parental stress. Notably, an interaction effect between PVC and CRS was found in total parental stress: CRS had less impact on parental stress in families with PVC.

Conclusion: The findings underscore the need for (secondary) preventive support for all parents, and specific, accessible, and high-quality support for parents of PVC during pandemics. Moreover, targeted attention for parents both with or without PVC remains essential at policy and research levels.