Tijdschrift voor psychiatrie最新文献

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: 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.

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: For some ten years now the term ‘confused persons’ has gained prominence in the Netherlands. Introduced by the police, it gathered attention due to rising numbers of police calls, to become entangled with broader sentiments of unsafety due to serious incidents with people with mental disorders. Mental health services have struggled with the term, since it is no diagnosis and it often leads to misunderstandings and controversies.

Aim: To explain 1. the origins of the term, 2. the numbers, 3. the impact on police, juicidal system and society, 4. possible explanations for misunderstood behaviour, and 5. leads for both health and safety services.

Method: Overview of recent sources and previous own research.

Results: It is important to differentiate across type and severity of behaviours, between people with (serious) social difficulties and people with severe mental disorders, so they are not needlessly medicalized (too much professional involvement), legalized (resulting in punishment) or normalized (too little professional involvement). More attention is needed for the ‘normal life’ of people that are faced with intensive and often restrictive professional services, so more differentiated housing, working and living becomes available. Last, for some people it is necessary to maintain (professional) surveillance and/or guidance for their entire lives, both from a safety and human perspective.

Conclusion: Confused or misunderstood behaviour is a broad concept that includes many causes with varying causes: from micro-organizational and collaboration problems to (macro) the social structure and culture in society. Focusing on a few well-defined groups, collaboration and system problems can be useful. The existing problems are not easy to solve and require sustainable investments in human willingness and expertise.

Background: Sexual behavior disorders in intellectual disability form several challenges, despite evolutions in treatment options and risk assessment. The use of antilibidinal pharmacotherapy in this population is controversial and research is inconclusive about the most appropriate treatment strategy.

Aim: To highlight pharmacotherapeutic management of sexual behavior disorders in intellectual disability, its medical and ethical considerations.

Method: A literature review to provide an overview of the available literature, which was elaborated based on clinical experience.

Results: We found a lack of scientific evidence on the efficacy of pharmacotherapy specifically for sexual behavior disorders in people with intellectual disabilities. The routine use of antilibidinal medication is contraindicated. Medical and ethical guidelines have been published as well as contraindications for initiating androgen deprivation therapy in the general population. The necessity of pharmacotherapy should be closely monitored and supplemented with psychotherapeutic care to cultivate the patient’s sexual skills, attitudes and knowledge. A distinction should be made between sexual behavior disorders of the ‘paraphilic type’ and of the ‘sexually maladjusted or naive type’.

Conclusion: Multidisciplinary evaluation, risk assessment and an individualized approach are the cornerstones of high-quality treatment of sexual behavior disorders in persons with intellectual disability.