Tijdschrift voor psychiatrie最新文献

Background: This scoping review focuses on the occurrence of tachyphylaxis, defined as reduced responsiveness upon reinitiating a previously effective medication. This phenomenon is previously documented in antidepressants and mood stabilizers.

Aim: To explore the frequency, treatment strategies, and predictability of tachyphylaxis across all psychotropic medications.

Method: The review adheres to PRISMA-ScR guidelines, employing a PubMed search to identify relevant articles.

Results: A total of 22 articles were included: eleven on mood stabilizers (lithium carbonate), eight on antidepressants (SSRIs and TCAs), and three on antipsychotics (aripiprazole, clozapine, olanzapine, paliperidone, quetiapine, and risperidone). No literature on benzodiazepines was found. The incidence varied (8.3-40.2% for antidepressants, 10.8-43.2% for mood stabilizers), with limited evidence for antipsychotics. Some articles discussed potential mechanisms of action, treatment strategies, and risk factors.

Conclusion: Tachyphylaxis was predominantly reported in mood stabilizers and antidepressants. Indications of tachyphylaxis were noted in antipsychotics, except for clozapine. Clear conclusions were hindered by insufficient methodological research. The scarcity of literature emphasizes the need for further investigation into the prevalence, pathophysiology, and risk factors of tachyphylaxis. Until more clarity emerges, clinicians should consider the risk of tachyphylaxis when discontinuing and restarting mood stabilizers and antidepressants.

In this case report we describe a pregnant woman with newly developed auditory hallucinations, initially seen by a psychiatrist of the psychiatric emergency service. The day after assessment , the patient developed epileptic seizures and was referred to the hospital. After additional blood and liquor tests and an MRI scan, an autoimmune encephalitis was diagnosed. She was treated with prednisolone and immunoglobulins. She made a full recovery and gave birth to a healthy son at term. In this article we describe the diagnostic considerations, the course and treatment, the importance of being alert to a somatic cause of psychiatric symptoms and of multidisciplinary collaboration.

Background: People with severe mental illness frequently experience difficulties in other life domains, such as physical health conditions, comorbid substance abuse, unstable housing or structural poverty. The interaction between these difficulties creates a complex care need that often goes unmet. In addition, they regularly come into contact with the legal system and police, through penal as well as protective measures.

Aim: To gain insight into the vision of actors from the judiciary and police into complex mental health care needs and judicial protective measures.

Method: Qualitative semi-structured interviews were conducted with 15 actors from the judiciary system and police.

Results: Participants see the interaction of difficulties in different life domains as complex. They are critical of the provision of care for this population. Participants are very open towards intersectoral collaboration, but confidentiality and a lack of structural partnerships hinders this. Involuntary admission and legal guardianship are generally considered meaningful protective measures.

Conclusion: In line with the vision of the mental health services, actors from the police and justice system consider the interaction between difficulties in different life domains as complex. They see a need for intensive, long-term and assertive care and a wide range of assisted living forms where integrated care is offered to people with complex mental health care needs. Judicial actors and police are willing to play a role in this. Further research into and development of accessible and, where necessary assertive, intersectoral care is necessary.

Background: Chinese migrants in the Netherlands have a higher prevalence of psychological complaints and on average report lower levels of happiness compared to the native Dutch. Meanwhile, they utilise mental health services less often. Which factors play a role in this is not fully clear.

Aim: To provide an overview of the factors that influence help-seeking behaviour among the Chinese population concerning Western mental health services.

Method: We conducted a systematic literature review in Embase, MEDLINE, PreMEDLINE and PsycINFO, following the Prisma guidelines. We included original studies on factors that influence the help-seeking behaviour of immigrant Chinese individuals regarding Western mental health care.

Results: We included 14 studies, among which 10 quantitative, three qualitative, and one mixed-method study. These were univocal about several cultural, practical, and demographic factors that influence the help-seeking behaviour of Chinese with mental problems in Western countries, although especially the demographic factors we found showed substantial differences among studies.

Conclusion: The Chinese population in the Netherlands shows a number of common factors that delay access to Western mental health services, with often more severe symptoms compared to non-Chinese individuals. Given the identified practical factors, in addition to making mental health care more accessible, maintaining an open, individual and cultural sensitive approach remains of cardinal importance.

A 29-year-old man developed priapism following the (re)administration of zuclopentixol. In the previous days, a significant amount of alcohol was consumed, presumably in combination with amphetamine and cannabis. Priapism is a rare but serious side effect of various psychoactive medications and recreational drugs, leading to permanent loss of erectile function if not treated in time. In this case the side effect was discovered in a late stage, at which curative treatment was no longer viable. A clear guideline for choosing an alternative antipsychotic agent is currently lacking, but an antipsychotic with low alfa-adrenergic affinity seems preferable. To prevent erectile disfunction following priapism, awareness of its severity is essential, for both doctor and patient.

Background: Psychiatrists generally make little use of lived experiences in addition to clinical and scientific knowledge, even while its use may make services more humane.

Aim: This study aims to explore psychiatrists’ lived experience perspectives and their considerations when integrating the personal into the professional domain.

Methods: As part of a qualitative participatory research approach, peer supervision sessions were followed for 2 years and additional interviews and a focus group were organised which were then analysed thematically.

Results: The participating psychiatrists had three main considerations for using their own experiences in clinical practice: personal, professional and clinical relevance. We identified 11 facilitating and 9 hindering factors in working with lived experiences related to clinical practice. In addition to the high workload and responsibility as a practitioner, a barrier is the lack of experience and recognition of this as a type of knowledge within the profession, including misconceptions about possible harmful effects. Facilitating factors included the opportunity to share with peers, a warm working relationship with patients and being able to create openness and destigmatisation among colleagues.

Conclusion: Psychiatrists appreciated the integration of lived experiences into the professional domain, even though still in its infancy. The peer supervision setting in this study was experienced as a safe space to share personal experiences with vulnerability and explore how they can harness lived experiences in the work context.

Background: In bipolar disorder (BD) preventive maintenance treatment is the rule, yet the scientific evidence supporting this is limited.

Aim: To argue the need for research into the gradual discontinuation of maintenance treatment for (BD).

Method: A narrative review of evidence regarding the effectiveness of maintenance treatment for (BD), supplemented by exploration of potential reasons behind the predominant reliance on pharmacological interventions.

Results: Evidence for maintenance treatment primarily focuses on clinical effectiveness, while individuals with bipolar disorder may prioritize other outcome measures. Much research on (BD) centers on neurobiological or genetic aspects.

Conclusion: A non-pharmacologic approach for longterm treatment in BD has been understudied. The desire of many individuals with bipolar disorder to managing their vulnerability with minimal (or no) medication necessitates thorough research on who, when, and how maintenance medication can be successfully tapered.

Background: Studies showed significant physical improvement after starting elexacaftor/tezacaftor/ivacaftor (ETI). However, some patients reported new mental health symptoms.

Aim: This study explores the impact of ETI on end-stage cystic fibrosis patients, focusing on mental health.

Method: A mixed-method study was conducted at the cystic fibrosis reference center, University Hospital Leuven (Belgium). Patients were eligible for ETI in a compassionate use program. Data collection included clinical records providing demographic, medical, and psychological data, and semi-structured interviews for qualitative insights.

Results: Post ETI-initiation, all 27 patients demonstrated physical improvement, of which 18 reported positive or no mental health changes and 9 negative changes. Clinical records revealed specific mental health issues, including increased depressive symptoms (n=7), anxiety (n=5), suicidal tendencies (n=4), emotion-regulation difficulties (n=4), and manic episodes (n=2). Semi-structured interviews with 15 patients identified three main themes and four subthemes: revitalizing health, emotional adaption (embracing hope, confronting shadows), and personal development (second lease of life, dealing with the unknown).

Conclusion: Despite remarkable improvements from ETI, 9/27 patients experienced new mental health symptoms, ranging from mild anxiety to suicide attempts. Our study underscores the importance of proactive psychological support and integrated psychiatric care during ETI-initiation.

Background: A substantial proportion of patients within regular Mental Health Services have a mild intellectual disability (MID) or borderline intellectual functioning (BIF). Previous research has shown that psychiatrists are ambivalent about their own knowledge and skills in providing care to these patients.

Aim: To gain insight into factors that play a role in how psychiatrists experience the provision of care to patients with MID/BIF and comorbid psychiatric disorders.

Methods: Exploratory qualitative research by semi-structured interviews with nine psychiatrists.

Results: The results can be divided into five themes; perception, recognition, interaction, cooperation and knowledge and skills. Inhibition and feelings of inadequacy were expressed throughout the themes. Prejudices came to the fore. Mental Health Services were already seen as playing a role in the care of patients with a MID/BIF and comorbid psychiatric conditions. Nonetheless we heared a desire for cooperation and referral options to Intellectual Disability Physicians or Services.

Conclusion: How psychiatrists experience the provision of care to patients with MID/BIF is influenced by psychological processes such as stigmatization and transference phenomena. These processes are primarily unconscious. Awareness of these processes and their role in the contact between psychiatrist and patients in this group is needed to improve their care.