Tijdschrift voor psychiatrie最新文献

Background: E-health and e-communities, such as PsychoseNet.nl, can play a central role in creating a sustainable public mental health care system. These platforms combine information sharing, peer support, and accessible help services, with the goal of promoting empowerment and recovery.

Aim: To explore the impact of the recovery-supportive chat function of PsychoseNet.nl as an accessible tool for individuals with mental health vulnerabilities, and to examine its potential role within the broader mental health care ecosystem.

Method: An analysis of the recovery-supportive chat function, using conversation reports, user and staff evaluations, and a description of implementation and supervision processes. The approach is recovery- and development-oriented.

Results: Between 2020 and 2024, the chat grew from 100 to 1,300 conversations per month. Visitors find the chat highly meaningful and useful. The ‘5x trajectory’ offers more in-depth support. The chat serves as a bridge to mental health care, an alternative during waitlists, and a low-threshold advice or self-help channel.

Conclusion: The recovery-oriented chat of PsychoseNet.nl provides a valuable addition to traditional mental health care by offering anonymous, accessible, and empowerment-enhancing support. A chat function focused on recovery and relational connection within an online community represents an innovative public mental health intervention. Further expansion and integration into other e-communities and mental health care models could contribute to a sustainable and accessible public mental health care system.

Background: The revised Dutch Multidisciplinary Guideline for Depression recommends liothyronine augmentation to selective serotonin reuptake inhibitors (SSRIs) as one of several third-line treatment options for moderate to severe depression, the others being lithium and atypical antipsychotics. The guideline refers to two network meta-analyses demonstrating efficacy.

Aim: To evaluate the evidence for efficacy of augmentation to SSRIs in depression.

Method: A PubMed and Cochrane Central search was conducted for controlled trials investigating added to an SSRI.

Results: Seven studies were identified, three assessing augmentation and four examining co-initiation. Among the augmentation studies, only one was placebo-controlled and found no significant effect. Of the two active-controlled trials, one open-label study suggested better efficacy than lithium, while the other did not specify whether or was used (dose suggested) and showed similar efficacy to other augmentation options. The co-initiation trials reported conflicting results, ranging from better outcomes with to no difference or trend toward worse outcomes.

Conclusion: The efficacy of augmentation to an SSRI is not yet sufficiently established. Network meta-analyses are based primarily on active-controlled studies. Given the potential role of a long-term, placebo-controlled trial is needed to clarify the effectiveness of augmentation to an SSRI.

Background: Diagnosis of late onset neuropsychiatric symptoms can be very challenging. Age-related variability in the clinical presentation of highly prevalent psychiatric conditions may be linked with cognitive and somatic disease or psychosocial adjustments.

Aim: To discuss traditional and innovative diagnostic tools such as novel biomarkers, and to describe future developments that might improve the diagnostic accuracy benefitting also the treatment of late onset neuropsychiatric symptoms.

Method: We conducted a literature search and combined this with a critical reflection on current practice inspired by the clinical experience of the authors.

Results: We describe a step-by-step approach to the differential diagnosis of late-onset psychiatric disorders versus neurodegenerative disorders. We also describe a three-step diagnostic process that illustrates how biomarkers can be efficiently used in the diagnosis of neurocognitive disorders.

Conclusion: Recent research has improved the early diagnosis of neurocognitive disorders in patients presenting with late onset psychiatric symptoms. Concurrently, recent studies on the curative treatment of neurodegeneration offer promising preliminary findings.

Background: Those engaged with mental health problems are confronted with the existence of DSM categories and ‘diagnoses’. This situation is the result of a development spanning two centuries.

Aim: To properly understand the current situation, knowledge of the historical developments that led to the idea of capturing behavioral deviations in ‘diagnoses’ is essential.

Method: We describe the development of diagnostic concepts from the early 19th century to the present, in the form of a narrative review.

Results: During the 19th century, a conceptual framework was formulated to describe behavior and syndromes. Based on longitudinal observations, the 20th century came to regard the distinction between mood and psychotic disorders as fundamental. The clinical elaboration of behavioral psychology led to behavior therapy and to the definition of the group of anxiety disorders. The 1960s–1970s saw the necessity to standardize diagnostic concepts, which led to the publication of the DSM-III.

Conclusion: The existing formal classification systems have brought a certain order to the description of behavioral disorders and mental problems. However, the choices made in the process are not value-free. The current diagnostic categories have limited prognostic value and fail to include the role of personal meaning in the emergence of symptoms.

Background: Young adults with mental health problems need age-appropriate support as they move into adulthood. Few studies focus on specific therapeutic interventions for this group within a residential context. Little is known about the experiences of test discharge in the treatment process. A test discharge is a temporary discharge followed by a readmission.

Aim: To investigate how young adults experience a test discharge. Based on these findings, the use of test discharge as a therapeutic intervention can be optimised. At a later stage, the perspectives of mental health professionals and significant others will also be explored.

Method: A qualitative explorative study was designed. Ten semi-structured interviews were conducted with a heterogeneous group of young adults living in a Flemish (semi-residential) young adult unit.

Results: A test discharge was initially perceived as an alienating, suspenseful and frightening event. Afterwards, young adults experienced the test discharge as supportive for their personal development. It provided them with realistic feedback about themselves and enabled them to identify and adjust their own existing responses or patterns.

Conclusion: During a test discharge, young adults face practical and emotional challenges. Targeted and tailored counselling, aiming to strengthen their autonomy and (self-)confidence, is crucial.

Background: Over the past decades, public and professional attention for burnout has grown significantly. Despite widespread use, burnout lacks a uniform scientific and medical definition. The Netherlands is currently one of the few countries where burnout is recognized as a formal diagnosis by occupational health care providers and general practitioners. In psychiatry, however, the term is rarely used, although symptoms can be severe and disabling.

Aim: To critically assess whether burnout is best understood as a disease, a symptom, or a social construct. I explores its scientific foundations, diagnostic challenges, overlap with psychiatric conditions, and societal and healthcare context.

Method: A narrative analysis of the historical and societal evolution of the term burnout, the overlap with conditions like depression and anxiety, and current diagnostic and treatment practices in the Netherlands. Burnout is also discussed within the broader framework of stress dysregulation.

Results: Burnout shows considerable conceptual and clinical overlap with depression, anxiety, and other stress-related conditions. Diagnostic criteria are inconsistent and lack scientific validation. The growing unregulated market of burnout interventions reflects the absence of a clear medical classification and increases the risk of under- or overtreatment. Burnout may better be seen as a spectrum of overload (from mild stress-related symptoms to severe dysregulation with overlap with depression) than a distinct medical condition.

Conclusion: Burnout is a serious and disabling condition but scientifically remains vague and poorly defined. A nuanced approach is needed that focuses on stress dysregulation and considers both medical and social aspects. Renewed interdisciplinary scientific efforts are essential to better understand burnout and ensure appropriate care.

Background: The Compulsory Mental Health Care Act in the Netherlands (CMHCA) came into effect in 2020. Mental health nurse practitioners have since been allowed to be ‘responsible clinician’ However, there seems to be diversity in the implementation of the role in practice.

Aim: To investigate the state of affairs regarding the role of the mental health nurse practitioners as ‘responsible clinician’ within the CMHCA and reflecting on this topic.

Method: Legislative texts, guidelines and professional associations have been consulted. The quality and professional statutes of eighteen large mental health institutions in the Netherlands were also studied, using the search terms ‘responsible clinician’, ‘Compulsory Mental Health Care Act’, ‘nurse practitioner’, ‘CMHCA’.

Results: The CMHCA leaves room for precise interpretation of the role of responsible clinician. In more than half of the quality and professional statutes examined (N=10), the role of responsible clinician is not specified. The other statutes (N = 8) include various frameworks for the role of a mental health nurse practitioner as responsible clinician.

Conclusion: The role of the nurse practitioner as responsible clinician is not clearly described in the statutes and guidelines reviewed. The CMHCA leaves room for how to fulfill this. We recommend a broad field consultation to arrive at clearer advice about which discipline is responsible clinician in which situation.