Tijdschrift voor psychiatrie最新文献

Background: In contemporary practice, psychiatrists are expected to navigate the complexity of biopsychosocial factors across various life stages. This necessitates a nuanced, stage-specific approach to patient assessment and intervention.

Aim: To provide a conceptual framework for integrating developmental stage considerations within both psychiatric training and clinical practice.

Method: Through a literature review of Erik Erikson’s theoretical contributions and international applications of his developmental model, a connection is made with the current curriculum and everyday practice.

Results: Erikson outlines eight developmental stages, based on both biological and social factors. Each stage is characterized by specific developmental tasks within that life phase, contributing to successful development CONCLUSION: Erikson’s developmental theory offers rich inspiration for today’s psychiatric education and practice, particularly in light of the renewed appreciation of life course and transitional psychiatry. Additionally, the conceptualization of developmental stages provides valuable tools in the pursuit of a multifaceted approach to diagnosis.

Background: Parents’ and children’s mental health problems can be associated. Family-focused care is of importance for meeting the needs of families in which both parents and children experience mental health problems.

Aim: To learn about existing initiatives for family-focused mental health care for children and adults, and to identify their facilitators and barriers.

Method: Via the nl-ggz (Dutch Mental Health Care) Association and LinkedIn, mental health professionals were asked to complete a questionnaire about family-focused care for parents and children. Professionals (N = 41) answered questions about collaboration initiatives within and between organisations for child and adolescent mental health and for adult mental health. Their answers were analysed and categorised using thematic analysis.

Results: The majority of participants indicated that family-focused collaboration occurred in the form of family interventions and ‘child or parent checks’. Important barriers for more intensive family-focused collaboration were funding problems and bureaucracy, while a family-focused view during treatment and in the approach of the organisation were important facilitators. Barriers and facilitators mentioned by services in which structural collaboration took place, did not seem to differ from those mentioned for other services in which no or little collaboration took place.

Conclusion: In the majority of the services, the health care system still mostly focuses on individuals, albeit with initiatives to improve collaboration. This does not seem to be due to lack of knowledge of barriers and facilitators for successful family-focused care but due to a lack of implementing that knowledge in a sustainable way. A transformation seems to be required in which family-focused care is not only available for families with certain (serious) problems but for all families in order to decide what care would be suitable.

Background: The professional literature places considerable emphasis on the content of treatments, yet relatively little attention is given to their conclusion. When should a treatment be terminated, and how? In practice, there are few guidelines for ending treatment, particularly in the case of long-term interventions that may no longer significantly contribute to further improvement. A careful conclusion is, however, an essential component of any treatment. Due to a lack of attention to the termination process, treatments may continue longer than necessary, resulting in higher costs. Consequently, patients on waiting lists experience delays in accessing care.

Aim: To describe and evaluate a method by which long-term treatments can be systematically assessed and, when appropriate, brought to a conclusion.

Method: A description of the multidisciplinary ‘outtake afternoon’ at the TOPGGz depression outpatient clinic of GGZ inGeest, the use of an outtake form, and the results of this approach.

Results: A total of 65 patients were reviewed, with an average treatment duration of 79 weeks. In just over half of the cases (54%), the evaluation prompted the initiation of a discharge trajectory. Of the patients for whom such a trajectory was initiated, 50% were formally discharged from the outpatient clinic within three months. In addition, relevant problems and dilemmas could be clearly articulated, and clinicians reported feeling supported in their decision-making and actions through this approach.

Conclusion: Periodic, systematic evaluation of long-term treatments can facilitate their timely and appropriate conclusion.

Background: In practice, it is assumed that because of the psychopathology and the coercive context, obtaining informed consent from forensic psychiatric patients for retrospective file research, without direct reward, is difficult and could result in selection bias. However, this has not been studied before.

Aim: To explore the willingness of forensic psychiatric patients to give informed consent for retrospective file research.

Method: A explorative pilot study in which patients from the resocialization units of FPC Mesdag were informed by the clinician responsible for their care about a retrospective file study into the position of trauma treatment in the treatment process. It was registered how many patients could have been informed, how many were informed, how many agreed to be approached by a researcher and how many gave informed consent.

Results: Of the 96 patients, 74% (n = 71) were informed. 32% (n = 23) agreed to be approached by a researcher. 31% (n = 22) gave informed consent.

Conclusion: The willingness of forensic psychiatric patients appears to be limited. The fact that a small group from a presumably very heterogeneous population gives informed consent provides a strong indication that asking for informed consent in retrospective file research could lead to selection bias. Also, the group that gives informed consent turns out to be too small to conduct thorough research.

Background: Reproductive hormones in women very likely play an important role in mood disorders. However, little is known about the impact of the menopausal transition on the course of bipolar disorder.

Aim: To get an overview of the impact of the menopausal transition on the course of bipolar disorder.

Method: Databases (PubMed, Embase and PsycInfo) were searched for relevant articles according to the PRISMA-2020 guidelines. Inclusion criteria were: (a) patients diagnosed with bipolar disorder; (b) clinical information about bipolar disorder and menopausal transition; (c) English-language articles; (d) retrospective and prospective studies.

Results: The ten included articles showed an increased risk for depressive episodes during the menopausal transition in women with bipolar disorder. Furthermore, the menopausal transition appears to be a potential trigger of bipolar disorder onset.

Conclusion: The menopausal transition seems to affect the course of bipolar disorder. Further research is required to clarify underlying mechanisms and make treatments available.

Background: The explosive growth after 1945 in the production and use of substances that act on the central nervous system. The possibilities for drug intervention on mood, cognition and behaviour became much greater. Meanwhile, the non-medical use of psychoactive substances also increased. Alcohol consumption tripled after 1960 and drug use increased.

Aim: Sketching the impact of these developments on the field of work of Dutch mental health care.

Method: Analysis of historiography of psychotropic drug use and its broader social context; supplemented with primary source material, mainly psychiatric medication narratives.

Results: The medication revolution in mental health care led to therapeutic optimism, but also to conflict. Patients struggled with the profound physical and emotional side effects of psychotropic drugs. They also experienced problems with dependency and discontinuation of medication. Within the counterculture of the 1960s and 1970s, psychiatric medication was seen as an oppression of the free individual. Practitioners struggled with patients’ lack of medication adherence and their self-medication with alcohol and drugs.

Conclusion: It is argued that the tension in the past and present of mental health care around the use of substances for the mind could possibly be alleviated in the future through the practice of autonomous medication management.

The compulsory Mental Healthcare Act (Dutch: Wvggz) provides, in exceptional cases, a legal framework for the implementation of psychiatric and somatic treatment without the patients consent. We describe a pregnant patient with a psychotic disorder who was compulsorily admitted to a psychiatric ward and treated with antipsychotic medication. She was unable to give informed consent regarding obstetric care. The care authorization did provide a legal framework for compulsory obstetric care to prevent serious harm for herself and/or her unborn child. A good relationship of trust, frequent counseling and the presence of an acquaintance ensured that the patient agreed with a caesarean section when this became necessary. This case describes how the Wvggz can provide psychiatric and obstetric care for a pregnant patient with a severe psychiatric disorder as well as the importance of continuing to look for options for voluntary care in a multidisciplinary manner.

We describe a 23-year-old woman with erotomania as a symptom of complicated grief. The delusional disorder emerged after a breakup with her partner, during a period of complicated grief following the unexpected loss of her twin brother. The delusion potentially functioned as a protection against a recurrent depressive disorder. Treatment usually consists of starting psychopharmaceuticals, however, often with limited results. Therefore, psychotherapeutic treatment is also important because an erotomanic delusion often arises from feelings of rejection, loneliness or worthlessness. Erotomania has been mentioned in texts and stories since ancient times. However, a case report on erotomania as a potential buffer against complex grief has not previously been described in the literature. We discuss the erotomania, contextualized in her life course and the existing literature.