Tijdschrift voor psychiatrie最新文献

Background: Flexible assertive community treatment (FACT) teams are widespread in the Netherlands and abroad. Despite the presence of a model description and model fidelity scale, it is unclear how and why these have been developed in recent years and to what consequence.

Aim: The main research question investigated in this dissertation relates to better understanding the development of FACT in the past and present, taking into account model fidelity and quality improvement.

Method: A multi-perspective reflection on quality improvement in FACT teams as part of networks of care for People with severe mental illness using multiple research methods.

Results: Research shows the need for a comprehensive, multidimensional approach to mental health care of people with severe mental health problems, where FACT teams play a vital role within integrated networks, fostering recovery, collaboration, and continuous quality improvement.

Conclusion: The FACT model is currently not future-proof and requires revision. FACT teams need to adopt the model and adapt it locally using the newly created model fidelity scale. The thesis underscores the need for ongoing research and adaptation to ensure that the FACT model effectively meets the evolving needs of individuals with severe mental illness within integrated networks of care.

Background: Consultation from child and adolescent psychiatry (CAP) to primary and secondary mental health care providers offers a promising means of ensuring appropriate and timely care for youth with mental health problems. The possibility of (advisory) consultation can enhance the competencies of primary and secondary mental health care professionals, reduce (unnecessary) referrals to CAP, and thus improve continuity of care.

Aim: Evaluate the consultation and advice team (CAT) within a CAP institution, to gain insight into its processes and the experiences of both consultees and consulters.

Method: Thematic analysis was conducted on 9 semi-structured interviews with consultees and consulters and 5 observations of CAT meetings. Additionally, a descriptive analysis was conducted on data from 21 consultation forms.

Results: The CAT was perceived as valuable by both consultees and consulters. Consultees felt more competent following consultation, while consulters were satisfied with CAT’s work process. Analysis of the consultation forms indicated that only one youth was referred to CAP after CAT consultation.

Conclusion: The CAT appears to be a promising approach for bridging the gap between CAP and primary and secondary youth mental health care. This evaluation provides practical insights for further developing this form of consultation within CAP.

Background: Brexanolone (Zulresso) and zuranolone (Zurzuvae) are two synthetic neuroactive steroids that were approved by the U.S. Food and Drug Administration in March 2019 (as an intravenous treatment) and August 2023 (as an oral treatment) respectively, for the treatment of postpartum depression. To date, these products are not available in Belgium and The Netherlands.

Aim: To evaluate the effectiveness and side effects of brexanolone and zuranolone in the treatment of postpartum depression through the evaluation of previous double-blind placebo-controlled trials.

Method: A clinically oriented literature study.

Results: Brexanolone and zuranolone are effective in the treatment of postpartum depression with a clinically significant rapid response compared to placebo. The main reported side effects are dizziness, somnolence, and sedation.

Conclusion: Placebo-controlled studies support the effectiveness of treatment with brexanolone and zuranolone in postpartum depression, showing a rapid and statistically significant improvement in mood symptoms. However, the place of neurosteroids in practice is still unclear and needs to be clarified by future research and clinical experience.

The effects of gastric bypass on the efficacy of methylphenidate remain underexplored. Existing postoperative reports predominantly describe either unchanged or diminished efficacy, with only one prior case report documenting intoxication. We describe the case of a female patient exhibiting clinical signs of methylphenidate intoxication several weeks after a Roux-en-Y gastric bypass, followed by a similar reaction to a low dose of lisdexamfetamine. This is followed by a summary of postoperative changes reported in the literature regarding the effectiveness of methylphenidate and lisdexamfetamine, alongside an exploration of potential mechanisms for altered methylphenidate efficacy. As these changes remain incompletely understood, it is advised to closely monitor patients restarting methylphenidate or lisdexamfetamine post-gastric bypass for up to six months.

Background: Psychotic depression (PD) is a severe disease with a lifetime prevalence between 0.35 and 1%. The guidelines recommend combination therapy with an antidepressant and an antipsychotic, whereas in non-psychotic depression (NPD) an antidepressant is advised as monotherapy.

Aim: To determine whether there is a difference in relapse rates between PD and NPD, and which treatment is associated with the lowest relapse rate.

Methods: A systematic literature search across 6 databases (PubMed, Web of Science, Scopus, Embase, Cochrane, and CINAHL) and a meta-analysis were conducted to compare relapse rates between PD and NPD.

Results: Eight studies with a total of 468 patients and 147 relapse events were included in the meta-analysis. No statistically significant difference could be demonstrated in relapse rates between PD and NPD. The difference in relapse rates in PD between various treatments was not statistically analyzed, but qualitatively described. There was a wide variation in treatment methods and a broad range of relapse rates.

Conclusions: Based on our findings, there is no statistically significant difference in relapse rates between patients with PD and NPD. However, caution is warranted with this conclusion, as the meta-analysis is based on a limited number of studies with high variability in the outcome measure. It seems important to continue acute treatment after response or remission, but which treatment modality best prevents relapse remains unclear.

Background: When people have suicidal thoughts, risk assessment is usually conducted using the CASE approach.

Aim: To evaluate this approach.

Method: Reviewing research on ways to detect, predict, and understand suicidality.

Results: Risk assessment misses about half of suicides and yields many false positives. Simple techniques may help detect suicidality more often. The narrative interview appears effective in identifying the forces that might drive someone to attempt suicide.

Conclusion: A shift from risk- to action-oriented assessment seems warranted.