Tijdschrift voor psychiatrie最新文献

Background: Outpatient forensic treatment is generally more focused on diminishing transgressive behavior, rather than the treatment of a specific disorder. However, the indications for prescribing psychotropic medication are usually a specific disorder. Although guidelines are used a large portion of psychopharmacological prescription is off-label.

Aim: To explore the extent of off-label prescribing. The study aimed to address three main questions: What is the percentage of off-label prescribing? Which part of off-label prescribing is based on guidelines and formularies? What is the frequency of pharmacist consultation before prescribing off-label medication?

Method: Data for the study were collected by 17 psychiatrists working in the thirteen forensic outpatient clinics of de Waag. The study focused on a sample of 202 adult patients, who were treated between October 2022 and May 2023.

Results: 72.0% of 350 prescriptions were prescribed off-label. From these 72.0%, 51.4% was based on guidelines and formularies and 20.6% not. In 84,7% off the off-label prescription not based on guidelines and formularies a pharmacist wasn’t consulted.

Conclusion: This study confirms the high percentage of off-label prescriptions in the forensic psychiatry. However, more than 70% was based on guidelines and formularies.

We describe a patient who developed lip necrosis and a nasal septal defect after excessively nasal abuse of cocaine. Necrosis of the lip can be caused by local vasoconstriction of the vessels of the skin, by the anesthetic effects of cocaine, by local irritation and inflammation and by the effects of adulterants. The patient was unable to stop using cocaine on her own and was compulsorily admitted. The surgical reconstruction of the lip was planned, but not performed because of the constant use of cocaine.

Background: In this article we provide norm scores for the I.ROC, an instrument for measuring recovery. Normative data from the general population are presented in the form of two common metrics: percentile rank (PR-)scores and T-scores. The pros and cons of both metrics are discussed and their relationship is considered.

Method: The literature on the psychometric characteristics of the I.ROC is summarized. Data from a large sample from the Dutch general population were used to calculate T- and PR-scores. Two approaches for converting raw scores into T-scores were compared: a simple linear conversion and a conversion based on the curvilinear relationship of raw scores with normalized (rankit) T-scores.

Results: The frequency distribution of raw scores on the I.ROC was approximately normal and a linear formula was sufficient for most raw scores. Only for very low scores did we find substantial differences between linear and normalized T-scores. A crosswalk table and figure are provided to convert raw scores to T-scores and PR-scores.

Conclusion: The I.ROC appears to be an instrument well aligned with a comprehensive recovery paradigm. Employment of common metrics (T-scores and PR-scores) is recommended for a clear presentation of results to both the client and professional. For occasional conversion of raw scores to T-scores, a straightforward linear formula suffices; for scoring software, a more precise and sophisticated curvilinear formula for normalized T-scores is advised.

Informed consent is a requirement for medical research. Obtaining consent can be complex in patients with severe psychiatric disorders, often leading to their exclusion from study participation. Here, we discuss a case involving a patient with clozapine-resistant schizophrenia, highlighting the different perspectives of caregivers and physician-researchers, with an emphasis on decision-making capacity. The case illustrates the complexity of informed consent in this population, including the challenges in assessing decision-making capacity, ethical dilemmas, and potential improvements.
We conclude that improving existing standardized assessment tools, promoting inclusive approaches to research participation, and supporting patient representation in decision-making processes can contribute to the quality and integrity of medical research involving individuals with the most severe forms of psychiatric disorders.

Background Patients with psychotic disorders have a higher risk of physical illnesses on account of genetic predisposition, poorer access to healthcare, medication use, environmental factors and lifestyle. Because healthy lifestyle behaviour is established at young age, it is important to signal problems in good time. A lifestyle screening might be useful in this respect. Aim To describe the lifestyle characteristics of patients in a mental health clinic for young adults (age: 18-28 years) with early psychotic disorder based on parts of the instrument ‘Lifestyle-in-the-picture’ compared to healthy controls. We also discuss experiences of lifestyle coaches in applying ‘Lifestyle-in-the-picture’. Method Lifestyle characteristics and lifestyle behaviour of 90 patients with a psychotic disorder and 137 young adults from the general population were compared quantitatively. Additionally, interviews were held with lifestyle coaches as to the use of the instrument ‘Lifestyle-in-the-picture’. Results The young adult patients had considerably poorer results on lifestyle aspects than controls: increased body mass index (BMI 53% versus 18%), smoking, addiction and unhealthy eating and activity patterns. They were more dissatisfied with their physical and mental health. According to the lifestyle coaches, the ‘Lifestyle-in-the-picture’ instrument was a good starting point to work on improvement with patients since the instrument provided insight in the healthy and unhealthy aspects of their lifestyle and gave directions to set goals. Conclusions Young adults with a psychotic disorder have an unhealthy lifestyle and also more risk factors compared to controls. Lifestyle screening programmes are important to discuss health risks in time and which steps for improvement can be taken. The step from insight to actual more healthy behaviour is challenging.

Background: In the care of patients with persevering (‘treatment-resistant’) persistant physical symptoms (PPS), problems are common. With this study, we want to identify starting points for improvement of care, including suggestions for the role of mental health care.

Aim: Using the profile for persevering PPS we will estimate the prevalence, describe characteristics of this patient group and map problems encountered in their care.

Method: Online survey in general practitioners (GPs).

Results: The response rate to the survey was 12.8%. The mean estimated prevalence of persevering PPS in general practice was 0.7% (corresponding to an estimated 122,500 patients throughout the Netherlands). Many patients encountered iatrogenic harm, experience societal problems and limitations in mobility and ADL independence. Although there was a general increased use of health care in these patients, some also avoided care or were under-treated. In the persistence of symptoms, patient-related factors played a role (like insisting on further somatic diagnostic tests, lack of motivation for PPS-specific treatment), but health-care related factors, like rejection for care or a lack of regional treatment options for patients with PPS, also had a causal role.

Conclusion: Almost every GP experiences problems in the care for patients with persevering PPS. Mental health care professionals can support the GP better, by optimizing options for consultation and referral.

Background: Given the growing focus on deprescribing, it is crucial to thoroughly evaluate our benzodiazepine prescribing practices considering the potential risks.

Aim: To investigate the prevalence and predictors of benzodiazepine prescriptions during psychiatric hospitalization and as discharge medication.

Method: This retrospective electronic patient file study included psychiatric admissions at the UMC Utrecht between 12/01/01 and 21/04/01. Descriptive statistics were used to evaluate prevalence of benzodiazepine prescriptions in youth and adults. Multivariate regression analyses were performed to predict factors associated with benzodiazepine prescriptions and dosage.

Results: In total, we analyzed data from 856 admissions of youth and 4002 admissions of adults. 36.0% of the youth were prescribed benzodiazepines during admission and 14.8% at discharge. Associated factors were age (OR: 1.38) and bipolar disorder (OR: 3.98). In adults, 69.7% were prescribed benzodiazepines during admission and 37.6% at discharge. Associated factors were length of hospital stay (OR: 1.01) and anxiety disorders (OR: 2.53). Male sex, age (resp. higher and lower), and a longer length of stay predicted benzodiazepine dosages for both youth (B = 3.48; 95% CI: 0.83-0.07) and adults (B = 2.17; 95% CI: -0.04-0.05).

Conclusion: Benzodiazepines are frequently prescribed during inpatient stays and at discharge in youth and adults, offering opportunities for deprescribing.