Tijdschrift voor psychiatrie最新文献

In this paper we discuss the case of a 52-year-old man who consulted the emergency department because of confusion. Based on anamnesis, clinical presentation, various technical investigations and recovery after discontinuation of disulfiram, the diagnosis of disulfiram encephalopathy is made. This is a less common but serious complication of a frequently used therapy and underscores the importance of early recognition and careful but also controlled prescription of disulfiram. We describe the pathophysiology behind this complication and reflect on some important numbers.

Background: In recent decades, gas extraction in Groningen has led to a lot of material and immaterial damage, including much psychological suffering, which was ignored by policymakers for years. With the publication of the report of the Parliamentary Inquiry into Natural Gas Extraction in Groningen, this is recognized and suggestions are made to repair the damage caused in the broadest sense.

Aim: Description of current and expected psychological consequences, and research and treatment to be conducted focused on this specific regional phenomenon.

Method: Describing the Groningen situation based on various sources, and identifying current and expected mental consequences based on currently available data and scientific literature.

Results: Psychological consequences are largely known and identified, but not yet quantified. It is most important for the well-being of inhabitants that the government takes its care task seriously and supports victims in a practical sense. Subsequently, a targeted treatment offer must be developed.

Conclusion: The knowledge available within psychiatry and psychology about the development and treatment of psychological complaints should play a role in researching and improving the well-being and the mental health of those affected by the gas extraction problem, now and in the future.

Background: Although there is clear evidence that therapeutic drug monitoring (TDM) has beneficial effects for patients treated with tricyclic antidepressants, it is generally not recommended for second-generation antidepressants (SGA). However, it has been suggested that methodological shortcomings might influence the results in TDM studies with SGA.

Aim: A qualitative assessment of randomized controlled trials (RCTs) that specifically investigated drug concentration-effect relationships of SGA in patients with major depressive disorder (MDD) to analyze the potential benefit of TDM during treatment with these agents.

Method: A literature search, using the PubMed, Embase, and Cochrane CENTRAL databases, was conducted for RCTs. A research protocol was used to make a quality assessment.

Results: A total of 15 studies were included. Evidence for the existence of a drug concentration-effect relationship during the administration of SGA in adult patients with MDD is virtually non-existent. The argument that methodological shortcomings might influence the results in TDM studies with SGA is weak.

Conclusion: There is little evidence that methodological shortcomings of studies would influence the results in TDM studies with SGA. This does not mean that TDM during treatment with SGA cannot be useful in specific situations.

Background: Part of the people who radicalize suffer from psychiatric symptoms and some of the people who resort to extremist violence have previously been in contact with mental health services. The question is how psychopathological characteristics can influence radicalization and what mental health professionals can do about this.

Aim: Provide insight into the interaction between psychopathology, radicalization, extremism and how mental health professionals can integrate vulnerabilities into treatment.

Method: Description of relevant literature.

Results: Although there are no direct links between psychopathology, radicalization and extremism, psychopathological characteristics can play a role in people’s susceptibility to extremist ideologies and movements. Disorder-specific vulnerabilities and matching risk management interventions have been described in the literature.

Conclusion: Mental health care providers could take these vulnerabilities into account in their treatment. There are also treatment options in forensic mental health care for people convicted of terrorist acts.

Recently, a patient was admitted to our department, who reported personality disorder symptoms and a cannabis use disorder. Additionally, a delusional disorder, aggression regulation issues and PTSD were classified. After employing CBT for substance use, the Hero Without Violence module and EMDR, the treatment was completed. Integrated treatment in this patient proved successful regarding the PTSD, aggression regulation problems and SUD. With the described case, the authors hope to provide a clear description of the possibilities of integrated treatment for a patient with complex problems.

Background: Coercion in Dutch mental health care has continuously increased since the Special Admissions to Psychiatric Hospitals Act (Bopz) came into force in 1994. With the introduction of the Conditional Authorization in 2004, the increase in involuntary admissions was slowed down and outpatient compulsory treatment increased. The new Compulsory Mental Healthcare Act in the Netherlands (Wvggz) has been in force since 2020 and aims to reduce involuntary admissions.

Aim: Description of trends in compulsory mental healthcare based on decisions under the BOPZ and its successors, the Wvggz and the Care and Compulsion Act (Wzd).

Method: Annual data 2003-2023 from the national Council for the Judiciary (Rvdr) on authorizations (legal detentions) were analysed with linear regression.

Results: The Rvdr-data show a steady increase of compulsory admissions until 2020. From 2020 onwards, the trend appears to have been halted.

Conclusion: The Rvdr data show an interruption of the previously observed increasing trend. The actual number of involuntary admissions unknown due to al lack of a national register.

Background: Since 2013, deep brain stimulation (DBS) has been reimbursed in the Netherlands as a proven effective treatment for treatment-resistant obsessive-compulsive disorder (OCD). Nevertheless, DBS is still rarely applied, and a national Dutch treatment protocol is lacking.

Aim: To prepare a nationwide multidisciplinary treatment protocol for the application of DBS in the treatment of treatment-resistant OCD.

Method: Formulation of recommendations for the execution and application of DBS in OCD regarding indication, implantation, optimization of stimulation parameters, and consolidation of long-term effects, based on literature research and consensus among experts represented in the multidisciplinary Dutch DBS in Psychiatry working group.

Results: Following indication, DBS electrodes are bilaterally implanted in white matter tracts in the anterior limb of the internal capsule. In previously highly treatment-resistant patients with severe OCD, this leads to an average 66% response rate after optimization of stimulation parameters. Placebo-controlled effects are significant (Hedges’ g = 0.9). The main reported side effects are transient hypomanic symptoms, fatigue, and subjective cognitive complaints. Perioperative complications are rare. Positive effects remain stable during years of follow-up. DBS is cost-effective and leads to increased quality of life and functional recovery. Nevertheless, DBS is applied infrequently relative to the estimated number of patients with treatment-resistant OCD.

Conclusion: By adhering to the described recommendations regarding indication, implantation, optimization, and consolidation, DBS is an effective and safe treatment option for treatment-resistant OCD. A nationwide multidisciplinary treatment protocol can contribute to the implementation of DBS with more and earlier referrals, allowing more patients to benefit from this treatment more quickly.

Background: The Dutch national psychiatry curriculum stresses the importance of professionalism in residency programs. It introduces professional identity and professional virtues as important aspects of the professional role of the psychiatrist.

Aim: To provide a theoretical basis for the notions of professional identity formation and professional virtues.

Method: Conceptual analysis on the basis of philosophical and medical education literature.

Results: Professional identity formation can be understood as a process of psychological development of the individual and a process of socialization within the profession. Professional virtues show how professional identity manifests itself in professional activities directed towards realizing an important societal good.

Conclusion: Focus on professional identity formation and professional virtues enriches the residency program without necessarily adding extra requirements. It provides inspiration and soul to professionalism and reveals what it is ultimately about.

Background: In the Compulsory Mental Health Care Act (Wvggz) family members and representatives have a more central position. However, in clinical practice there is a lack of collaboration.

Aim: Giving an overview of the relevant legal texts and analyzing possible reasons for the lack of collaboration.

Method: Discussion of relevant legal texts and publications.

Results: The aim of the Compulsory Mental Health Care Act is to enhance the patients’ rights and rights of their family. In clinical practice it is difficult to find a good collaboration. One problem is that patients’ competence may fluctuate over time. And also confidentiality is seen as an important barrier. Family members also experience tension by fulfilling different roles, especially when they are representative.

Conclusion: Although the Compulsory Mental Health Care Act gives a clear framework for collaboration with family members, the application is complex in clinical practice. The formal possibilities can only be applied, when relations with both patients and their family members are built in trust.