Tijdschrift voor psychiatrie最新文献

Background: Mental health care has improved considerably over the past decades, maar there are also still too many people who do not get better or too late.

Results: In order to further improve psychological treatments, we can do several things. We can do more research on mechanisms of change, develop interventions that are scalable (for use in low- and middle-income countries), and we can personalize treatments with innovative machine learning techniques and ‘individual patient data’ (network) meta-analyses. We should not develop new general therapies, because they are typically not better than the ones that already existed. We should develop new therapies for more complex problems, like chronic conditions and comorbid disorders. We should also think of sequential treatments because many patients do not respond after the first treatment.

Conclusion: If we could make all these improvements, we could much faster provide treatments to patients to which they respond, we could reduce drop-out and make mental health care much more efficient.

Background: The care for service users with severe mental illness is evolving. In this, feedback is indispensable for improving quality. At four locations for long-term inpatient treatment in Amsterdam, triadic mirror meetings have been implemented, in which service users and family give feedback on received care in a group discussion. To evaluate this method, we conducted a qualitative study.

Aim: To investigate the experiences of service users, family and healthcare professionals who participated in the mirror meetings.

Method: Service users, family and healthcare professionals participated in a semi-structured interview about their experiences with the mirror meeting. The interviews were analyzed thematically.

Results: The experiences of service users, family and healthcare professionals with mirror meetings in the triad were positive: they mentioned an increase in understanding of everyone’s perspective and a sense of equality, connection and shared learning. Service users and family also mentioned obstacles, such as insufficient preparation and lack of time.

Conclusion: Triadic mirror meetings with service users and family are a useful method in long-term clinical care to collect feedback and improve the quality of care in an atmosphere of joint learning.

Background: Climate change is a pressing issue, with significant effects also in Europe. In particular younger generations will face negative consequences of climate change, including impact on mental health. Therefore, climate change is relevant to psychiatrists.

Aim: In this article, we explain how climate change leads to mental health problems and what psychiatrists can do.

Method: Overview based on a recent European position paper on the consequences of climate change for mental health and recent literature RESULTS: Climate change leads to mental health problems on multiple levels: through direct consequences of disasters (for example, traumatization), as well as the effects of heat on mental health and adverse effects on social and societal determinants of mental health. These effects are most likely greatest in non-Western countries, where resources are limited. Additionally, there are mental complaints due to an increase in climate anxiety, especially among young people.

Conclusion: We call on the field of psychiatry to increase and share interdisciplinary knowledge and take actions to prepare for the consequences of climate change. Actions are needed at multiple levels including preparing direct patient care for effects of climate change (e.g., preparing for heatwaves), reducing further climate change (moving towards sustainable health care systems), and by influencing the public debate.

Electroconvulsive therapy (ECT) is among the most effective treatments for severe depression. However, there is a lack of research regarding its safety and efficacy in patients with deep brain stimulation (DBS). While the available clinical data does not indicate safety concerns, clinicians are often cautious due to theoretical risks and manufacturer warnings. However with a growing number of patients receiving DBS, the group that could benefit from ECT is expanding. In this report, we present the first two cases in the Netherlands in which ECT was administered to patients with DBS. Our findings suggest that ECT can be safely and effectively administered when the DBS system is switched off during ECT-stimulus. Clinically, this means that these patients should not be excluded from ECT but instead referred to specialized centers for evaluation and care.

Background: In relationships where partner violence occurs, the agreement between partners about the violence is often low. This can have various causes and implications.

Aim: To investigate what partners in outpatient forensic treatment for intimate partner violence report about the occurring violence and if indications for psychopathology are related to differences in reporting.

Method: Seventy couples, of which the man had entered intimate partner violence treatment, completed questionnaires about the severity and frequency of different types of violence by themselves and their partners and psychopathology.

Results: There was poor to moderate agreement between intimate partner violence reports of women and men. Women reported more violence than their partners attributed to them, men less. There was more agreement about violence by women than about violence by men. In addition, some indications of psychopathology appear to be moderately or weakly positively correlated with differences in reporting.

Conclusion: It’s valuable to gather information from both partners regarding any violence involved and to explore how differences in their accounts might impact (both the content and approach of) the treatment.

Background: Deinstitutionalization of care is an important trend in the mental healthcare landscape. However, due to the severity and chronicity of their condition, treating persons with a severe and persistent mental illness (SPMI) in community services is difficult. This puts them at risk of being the victim of therapeutic persistence in residential care: they are repeatedly exposed to the same treatment, without achieving the desired results. To counter this, the concept of oyster care was developed.

Aim: To explore the experiences of caregivers who work with patients with an SPMI, and how they integrate oyster care into their work based on these experiences.

Method: 12 caregivers working at a ward for patients with an SPMI participated in an individual, qualitative, semi-structured interview. The interviews were subjected to a thematic analysis.

Results: Caregivers indicated that they found working with SPMI patients challenging but experience job satisfaction at the same time. Regarding the concept of oyster care, it appeared this concept was mainly developed ‘bottom-up’, and that various tools and guidelines had already been distilled from good practices. From the results of this study, several recommendations could be made to improve the quality of care to patients with an SPMI.

Conclusion: At policy level, there are still several opportunities regarding oyster care. These opportunities mainly concern a more targeted organization of people and resources. This encompasses offering non-verbal therapies (music therapy, creative therapy, psychomotor therapy, etc.), expanding the presence of physicians on the ward, converting isolation rooms into seclusion areas, and providing sufficient trained staff so that care providers can take the time that patients with an SPMI need. Validating these opportunities could contribute to providing a higher quality of care that better meets the needs of patients who, because of complex mental suffering with resistance to standard treatments, find it difficult to find their place within (and outside) long-term mental healthcare. In addition, such initiatives could have a positive impact on the workload experienced by caregivers and, consequently, on staff retention, which is currently problematic at wards for patients with an SPMI.

Background: Terrorism and psychiatric diagnoses are socially intertwined.

Aim: To provide insight into the various ways in which psychiatric diagnoses and the concept of terrorism relate to each other and what this means for psychiatric practice.

Method: A reflection on this theme from the perspective of the security domain and that of psychiatry.

Results: Language use, applications of the concept of disorder and scientific research have an impact on society’s perception of terrorism. The role of the psychiatrist in the debate and the contribution of mental health issues on the path towards terrorism are obscured when only mutually exclusive extremes are discussed, such as ‘mad or bad’, ‘terrorist or psychiatric patient’.

Conclusion: Professionals in psychiatry are challenged in the public debate to constantly assess their role to safeguard both public safety and the interests of patients as (potential) terrorists.

Background: There is no recent data available on the prevalence of trauma, PTSD and complex PTSD in the Netherlands.

Aim: To determine the prevalence of trauma, DSM-5 PTSD, and ICD-11 PTSD and complex PTSD.

Method: A sample of 1,690 Dutch adults was recruited through the LISS panel between September and November, 2023. A subsample (n = 204) participated in a structured clinical interview.

Results: The estimated lifetime prevalence of DSM-5 PTSD was 11.1%, and 1.3% currently meets criteria for DSM-5 PTSD. The estimated current prevalence of ICD-11 PTSD was 1.3% and 1.6% for complex PTSD. Women, younger and middle-aged adults, and those with a non-Dutch cultural background were at elevated risk for developing PTSD. Approximately half of those with probable lifetime PTSD sought professional help, but only one-third received guideline treatment.

Conclusions: Potentially traumatic events, PTSD, and complex PTSD are unevenly distributed across the population. Despite the availability of evidence-based treatments, only a minority of affected individuals receive adequate care. These findings underscore the urgent need for targeted screening, preventive interventions, and public health campaigns aimed at increasing awareness about PTSD and treatment.

Background: Consultation is an efficient method to share expertise in health care without having to transfer the treatment to another provider.

Aim: To model the effects of a national consultation network for patients with persistent depression who are in treatment in specialized mental health care facilities in the Netherlands.

Method: Explorative impact analysis using national data on patients with depression as their primary diagnosis and using specialized mental health for longer than 2 years.

Results: All scenarios showed that the systematic use of consultation can provide health benefits to patients while saving costs. Economic gains consisted of both direct effects on health care costs and of effects on the ability of patients to work. In all scenarios consultation had substantial effects on the duration of treatment, which might favourably impact existing waiting times for patients.

Conclusion: Consultation is a dominant intervention as it saves costs, while improving health. It may have substantial effect on the currently unacceptable waiting lists for mental health care. The Netherlands Network Depression aims to develop a consultation network, improving the logistics, methods and accessibility of consultation.