Showing papers in "Tijdschrift voor psychiatrie in 2020"

De ptss Checklist voor dsm-5 (pcl-5) voor rom: Een vergelijking van de responsiviteit met de Outcome Questionnaire (oq-45) en praktische bruikbaarheid

Abstract: BACKGROUND The PTSD Checklist for the DSM-5 (PCL-5) may be a suitable addition for routine outcome monitoring (ROM) for patients with PTSD AIM: To determine whether the PCL-5 is worth the extra effort that administration requires from the patient METHOD: Pretest and retest measurement results of the PCL-5 and the OQ-45 were compared head-to-head in 464 patients from the Sinai Center of Arkin RESULTS: The correlations between scores on the instruments were high and analysis of variance for repeated measurements revealed no difference in responsiveness Comparison of Cohen's d (049 vs 043) and Delta T (50 vs 44), indicated a slightly better responsiveness of the PCL-5 and also the proportion of recovered patients was greater according to the PCL-5 compared to the OQ-SD CONCLUSION: At first glance, the PCL-5 and the OQ-SD were equally sensitive to detect change during treatment However, the PCL-5 provided more detailed information about the nature and severity of symptomatology in an individual patient and with the PCL-5 we were slightly better able to demonstrate clinical significant change than with the OQ-SD We recommend to add the PCL-5 to ROM for patients with PTSD

FACT als onderdeel van wijkgerichte zorg in het (zorg)netwerk

Abstract: Achtergrond Wijkgerichte zorg voor mensen met ernstige psychische aandoeningen (epa) vraagt toenemend om een verregaande samenwerking tussen verschillende domeinen. Deze samenwerking zal telkens uniek en lokaal vormgegeven moeten worden en zal tegelijkertijd afgestemd moeten zijn op generieke, landelijk gestelde doelen. Doel Aanbieden van nieuwe inzichten over het samenwerken in en tussen het sociale en ggz-domein. Methode Reflecteren op de ontwikkelingen in het sociaal domein en specialistische ggz, gebruikmakend vanrelevante literatuur en recente ervaringen in binnen- en buitenland. Resultaten Men kan integrale zorg beter mogelijk maken door flexibele assertive community treatment(fact)-teams in netwerken te laten samenwerken met wmo-partners (o.a. door het delen van financiele en/of personele middelen). In dit proces ontwikkelen netwerken voor epa-zorg zich over verschillende fasen waarin nieuwe samenwerkingsverbanden gerealiseerd worden. De modelgetrouwheidsschaal voor fact-teams werd aangepast om dat proces beter mogelijk te maken. Conclusies Het fact-model met de bijbehorende modelgetrouwheidsschaal is klaar voor een toekomst met verschillende variaties van lokale samenwerkingsverbanden. Het is de verantwoordelijkheid van de lokale teams om goede ambulante zorg voor mensen met epa te borgen.

[Ketamine as an anesthetic, analgesic and anti-depressant]

Abstract: ACHTERGROND Therapieresistentie komt voor bij ongeveer 30% van de patienten met een depressie. Er is dan ook grote behoefte aan nieuwe behandelmogelijkheden. Ketamine, oorspronkelijk ontwikkeld als anestheticum, wordt onderzocht en incidenteel reeds toegepast bij patienten met een therapieresistente depressieve stoornis. DOEL Kritische beschouwing over het huidige gebruik van ketamine als antidepressivum. METHODE Literatuuronderzoek. RESULTATEN Een kortdurend antidepressief effect van ketamine is aangetoond. Veel minder is bekend over het in stand houden van dit effect, de potentiele risico’s van herhaalde toediening, en de effectiefste toedieningsmethoden en behandelschema’s. CONCLUSIE Aanvullend onderzoek naar ketamine als antidepressivum blijft noodzakelijk. Eventuele (offlabel-) behandeling dient in de tussentijd alleen onder voorbehoud van zorgvuldige patientselectie en strikte monitoring te worden toegepast. BACKGROUND Treatment-resistance occurs in about 30% of patients with depression. Therefore, there is an urgent need to identify new treatment strategies. Ketamine, originally developed as an anesthetic, is studied and applied as treatment for patients with treatment-resistant depression. AIM A critical review of the current use of ketamine as an antidepressant. METHOD Literature study. RESULTS Ketamine is a proven effective acute antidepressant. However, limited information is available about maintenance of effect of ketamine, potential risks of repeated administration, and different routes of administration and treatment schedules. CONCLUSION Additional research on ketamine as an antidepressant is needed. Meanwhile, (off-label) treatment should only be applied after careful patient selection and under close monitoring.

[Regional differences in compulsory treatment in mental health care in the Netherlands during 2013-2017].

Abstract: BACKGROUND Compulsory treatment in mental health care has continuously increased for years. Registration of court ordered compulsory psychiatric care is based upon counts of legal authorisations. These counts do not refer to number of individual persons involved. AIM: To report the number age-specific prevalence of coercion in psychiatric care, number of persons involved, age distribution and regional differences. METHOD: Analysis of the number of requests for compulsory care and population size according to the age groups for the years 2013-2017. We used direct age standardisation at the level of jurisdiction regions. RESULTS: The annual number of unique persons for whom compulsory care was requested was 28% less than the number of requested court orders. The annual increase in compulsory care was 3%. Per specific treatment order the increase during 2013-2017 was 12% for emergency compulsory admissions, 8% for hospital admissions, 10% for extended hospital admissions and 43% for community treatment order. CONCLUSION: The number of persons for whom compulsory mental care is requested increased on average by 3% each year. Greatest increase was observed for age groups 25-44 years and 80 years and older. After age-standardisation substantial differences remain between jurisdiction regions.

Psychedelics in the treatment of substance use disorders and psychosis

Abstract: After psychedelics were banned in 1968, the flourishing research on the use of psychedelics in patients with a mental disorder stopped abruptly. Recently, we see a renaissance of this research. AIM: To present an overview of what is known about the treatment of addiction and psychosis with psychedelics. METHOD: Literature study based on Medline en PubMed publications till December 2019. RESULTS: Studies on the effectiveness of psychedelics in the treatment of addiction and psychosis is still very limited in size and methodological quality. Nevertheless, most studies show positive effects of both classical and atypical psychedelics in a variety of addictions on motivation, craving, reduced consumption, and abstinence often following a single dose and with long-lasting benefits (3-24 months). Use of ketamine in patients with a psychosis stabilized on an antipsychotic might reduce negative symptoms. CONCLUSION: Before psychedelics can be used in standard clinical practice for the treatment of patients with an addiction or a psychosis, larger and methodologically better studies are needed. The use of psychedelics also creates an opportunity to better understand the shared underlying pathology of many different mental disorders.

[Delirium as the only symptom of COVID-19 pneumonia in the elderly]

Abstract: Early descriptions about the presentation of COVID-19 focused primarily on respiratory symptoms. However, we now know that COVID-19 can also present with one or more atypical symptom(s). With this case-report we want to draw attention to atypical presentations of COVID-19 that can occur in psychiatric practice, especially in the elderly. We report the case of an elderly woman with an atypical presentation of a COVID-19 pneumonia, namely without the often mentioned respiratory symptoms, gastrointestinal symptoms or fever, but with acute confusion. It is important to swiftly consider the possibility of a COVID-19 infection in (elderly) patients who present with delirium, as missing an infection can have important negative consequences, both for the treatment of the patient and for further spread within the (hospital) environment.

[The predictive value of mild intellectual disability/ borderline intellectual functioning and ptsd for treatment results in severely mentally Ill patients].

Abstract: BACKGROUND Little is known about the influence of mild intellectual disability/borderline intellectual functioning (mid/biF) or posttraumatic stress disorder (ptsd) on treatment results in severely mentally ill (smi). AIM: To investigate whether screeners determining mid/biF or ptsd are associated with less favorable treatment outcome in smi. METHOD: The screener for intelligence and learning disabilities (scil) was used to screen for mid/biF. The trauma screening questionnaire (tsq) was used to detect ptsd. Outcomes of these screeners were associated with repeated measures on the health of the nation outcome scales (HoNOS) in 628 smi at the Mental Care Centre of Oost Brabant. RESULTS: In 628 patients one or more HoNOS was acquired. In 352 (56%) patients a scil was acquired, in 334 (53%) patients a tsq. The largest improvement was observed in patients not meeting the criteria for mid/biF and/or ptsd. Less improvement was observed in patients with ptsd and a suspected iq between 70-85, estimated with the scil. No significant change on the HoNOS was observed in patients with an estimated iq below 70. CONCLUSION: Routine screening for mid/biF and ptsd symptoms is important for early recognition of the disorder, resulting in providing better treatment interventions for patients with mid/biF and ptsd.

Psychedelica bij de behandeling van depressie, angst en obsessieve-compulsieve stoornis

Abstract: There is a need for new, effective treatments for patients with (treatment-resistant) depressive disorders, anxiety disorders and obsessive-compulsive disorder (ocd). At the same time, there is renewed interest in psychedelics for the treatment of psychiatric disorders. AIM: To provide an overview of results from past and current research into psychedelics in the treatment of depression, anxiety disorders and ocd. METHOD: Literature search in Medline and PubMed databases, supplemented with cross-references and results from recent studies. RESULTS: There is a considerable evidence base for the atypical psychedelic ketamine. Ketamine has a rapid, beneficial effect on depression and suicidality; longer-term effects are less clear. Research into classical psychedelics for the treatment of depression and anxiety disorders is currently limited to a few small (open label) studies, although positive outcomes are reported even after a single administration, with potentially longer lasting benefits. Studies must be repeated in larger and more diverse groups of patients. CONCLUSION: Further research into efficacy, therapeutic mechanisms and intervention models is very worthwhile; for the benefit of patients, but also to provide a deeper insight into the psychotherapeutic and neurobiological mechanisms that play a role in (the treatment of) common mental disorders.

[Decrease of depression and outcome in treatment of anxiety disorders - an observational study of ROM data].

Abstract: Achtergrond: De meeste ggz-instellingen in Nederland werken met stoornisspecifieke zorgprogramma’s. Indien er sprake is van comorbiditeit, wat eerder regel is dan uitzondering in de specialistische ggz (sggz), blijkt er onvoldoende evidentie te bestaan als het gaat om het kiezen van de focus van behandeling. Doel: Inzicht krijgen in de prevalentie van comorbiditeit met depressie bij patienten met angststoornissen volgens de dsm-iv-classificatie (angststoornissen inclusief de dwangstoornissen en de posttraumatische stressstoornis). Tevens nagaan of er een verschil is in behandeleffect bij een protocollaire angstbehandeling tussen patienten met een (of meerdere) angststoornissen zonder of met een comorbide depressie. Methode: Retrospectieve studie met gegevens uit routine outcome monitoring over de periode 2012-2017. In deze periode identificeerden we 127 patienten van wie rom-data en diagnostische criteria beschikbaar waren. Diagnostiek en dsm-classificatie vonden plaats met een klinisch interview. De behandeling werd uitgevoerd conform de Multidisciplinaire richtlijn Angststoornissen en elke 12 weken systematisch gemonitord met zelfrapportagelijsten, waaronder de Inventory of Depressive Symptomatology (ids) en de Beck Anxiety Inventory (BAI). Resultaten: Bij 46,5% van de onderzochte patienten was er een comorbide depressieve stoornis aanwezig. De behandeleffecten bij patienten met of zonder comorbide depressie verschilden niet van elkaar. Als opvallende bevinding werd gevonden dat de mate van vermindering van de depressieve klachten (gemeten met de ids) voorspellend bleek te zijn voor de mate van vermindering van de angstklachten (gemeten met de BAI): een sterkere vermindering van de stemmingsklachten bleek een gunstiger beloop van het effect van de protocollaire angstbehandeling te voorspellen. Conclusie: Bij iets minder dan de helft van de patienten in het zorgprogramma angststoornissen was sprake van een comorbide depressieve stoornis. Traag of niet afnemen van de depressieve symptomen lijkt geassocieerd met een slechter behandelresultaat op de angstklachten.

Beloop van covid-19-infecties en impact op mentale gezondheid;opzet van een landelijk casusregister.

Abstract: Achtergrond: De Nederlandse Vereniging voor Psychiatrie (NVvP) heeft een casusregister opgezet om de (neuro-)psychiatrische gevolgen van covid-19-besmetting in kaart te brengen. Doel: Inzicht krijgen in zowel kwetsbaarheden als beschermende factoren voor het krijgen van een covid-19-besmetting en het beloop hiervan in een (neuro)psychiatrische populatie. Methode: We verzamelen informatie van zo veel mogelijk patienten met psychiatrische problematiek (zowel pre-existente psychiatrische problematiek als tijdens de infectie ontstane (neuro)psychiatrische klachten) en een covid-19-besmetting. De dataverzameling bestaat uit o.a. demografische gegevens, gegevens over de covid-19-besmetting en gegevens over de psychiatrische problematiek en de behandeling daarvan. Om een zo representatief mogelijk cohort te krijgen roepen wij alle ziekenhuizen, ggz-instellingen, verslavingszorg en andere zorginstellingen voor mensen met een psychiatrische aandoening in Nederland op om deel te nemen aan het CoviP-casusregister.

Protocol voor lichttherapie bij bipolaire stoornis

Abstract: BACKGROUND There is no national protocol for the use of light therapy in bipolar depression. AIM The chronotherapy collaboration group of the Foundation for Bipolar Disorders intended to write a protocol for light therapy in bipolar depressive episodes. METHOD Narrative review of several systematic reviews, two clinician’s guides and deliberation with the sub-commission Guidelines of the Dutch Ophthalmologic Society. RESULTS The following indication was established: depressive episode, with or without seasonal features, in bipolar I or II disorder, including subsyndromal (depressive) seasonal complaints. The list of relative contra-indications (pre-existent retinal illnesses, systemic illnesses with effect on the retina and use of photosensitive medication) was shortened. In this case the medical professional discusses the possibility of an ophthalmologic consultation with the patient. Use of a mood stabilizer/antimanic medication in order to prevent mania or a mixed episode is only necessary in a depressive episode in bipolar I, but not in bipolar II disorder. Standard treatment is 10.000 lux white light during 30 minutes in the morning. CONCLUSION There is sufficient evidence to propose light therapy in a bipolar depressive episode with or without seasonal features.

Een biologisch substraat voor psychische stoornissen : Gouden toekomst of gouden bergen?

Abstract: BACKGROUND The constructivist position is often used for psychiatric diseases, in contrast with the general medical view. In the medical view a biological substrate is decisive for a classification as ‘disease’, which is not the case in the constructivist position. AIM We investigate how both positions relate to each other in psychiatric diseases. METHOD Analysis based on a conceptual analysis of Ian Hacking’s book The Social Construction of What? (1999). RESULTS Different objects ought to be distinguished in a constructivist analysis of psychiatric diseases; the disease itself and the idea or concept of that disease. These different objects interact with each other. These interactions can be made explicit by distinguishing interactive kinds from indifferent kinds. Doing so makes it clear that even if a disease is not determined by a biological substrate, this does not imply that a biological substrate is something completely separate from that disease. CONCLUSION Hacking’s philosophy makes it possible to move beyond the opposition between the medical and the constructivist account of psychiatric diseases by combining both accounts.

Kwaliteitssystemen in de Nederlandse ggz hebben weinig impact op de praktijk van de zorg

Abstract: ACHTERGROND Kwaliteitssystemen zijn tegenwoordig een belangrijk en veelgebruikt middel om de kwaliteit van zorg in de ggz te volgen, transparant te maken en te verbeteren. Echter, er is weinig bekend over de impact van deze systemen op de praktijk van de zorg. DOEL De impact van kwaliteitssystemen bepalen en verklaren. METHODE Een combinatie van kwalitatieve (focusgroepen, documentanalyse en interviews) en kwantitatieve (vragenlijst, literatuuranalyse) dataverzameling en analyses vanuit verschillende theoretische inzichten. RESULTATEN Er zijn veel kwaliteitssystemen beschikbaar, terwijl de impact van deze systemen op de praktijk van de zorg beperkt is. Veel systemen zijn niet bekend en worden niet of inadequaat gebruikt. Het uitblijven van impact kan worden verklaard op grond van de rolonduidelijkheid en het wantrouwen in de sector. Dat bepaalde systemen wel worden gebruikt, kan grotendeels worden verklaard door de individuele voorkeuren van professionals. CONCLUSIE De huidige inzet van kwaliteitssystemen is erg inefficient. Er is een gebrek aan een gezamenlijke definitie van kwaliteit en de kwaliteitsinformatie uit de systemen is complex. Dit maakt sturing op de kwaliteit van zorg lastig. Daarnaast speelt er veel wantrouwen jegens de sector, waardoor systemen eerder worden ingezet voor controle dan voor kwaliteitsverbetering.

[Microdosing with psychedelics: what do we know?]

Abstract: The repeated use of small doses of psychedelics such as psilocybin and lsd over a period of time (microdosing, md) has gained popularity and scientific attention in recent years. Retrospective reports from users suggest clinical potential. AIM: To answer the question whether md with psychedelics could theoretically provide symptom relief for people with psychiatric disorders. METHOD: Investigate what the current evidence is about the effects of md with psychedelics on the behavioral level, psychological functioning and mental well-being. A search for relevant articles in PubMed and Medline databases (on January 10, 2020), which resulted in a total of 28 hits. After de-duplication, removal of irrelevant and addition of relevant articles, 23 articles were included. RESULTS: Most of the knowledge we have so far comes from uncontrolled online questionnaire studies in which users report retrospectively or keep diaries of the effects they experience during md. According to users, it leads to positive effects on mood, concentration, focus and productivity. Negative effects, including physical discomfort and increased fear, also seem to occur. The limited number of experimental studies in healthy people revealed that md has subtle effects on cognitive processes and brain connectivity. CONCLUSION: The findings of experimental studies in combination with the reports from users give cause for further investigation into the clinical potential of low-dose psychedelics in combating certain symptoms. More placebo-controlled studies are needed to provide clarity for who (age, diagnosis) md can be effective and for which (cognitive, emotional) processes.

[Recreative ecstasy use in the Netherlands: use characteristics, health risks and criminality].

Abstract: Ecstasy (MDMA) is used by approximately 370,000 Dutch people yearly, mainly young adults with a good education. AIM: To describe ecstasy-related negative health effects, health risks, use profiles and crime based on data from scientific literature and other publicly available sources. RESULTS: Ecstasy appears to cause little health damage during recreational use. Adverse health incidents, particularly hyperthermia, are observed, but are probably partly due to the use of ecstasy under (a combination of) unfavourable circumstances, such as: a warm environment, too little drinking, and considerable physical exertion (dancing). The estimated risk of serious ecstasy-related non-fatal accidents was 1 in 3,400 pills and 1 per 700 users. The number of fatal ecstasy-related incidents is estimated to be a maximum of 35 per year. Crime associated with the production and trade of ecstasy is worrying and, according to some authors, disruptive to society. CONCLUSION: On the basis of these results, we conclude that the use of ecstasy does involve health risks, but given the widespread use of ecstasy, the number of (fatal) incidents is relatively low. Better information about the conditions under which ecstasy can be used more safely will contribute to fewer incidents.

[Effectiveness of anti-stigma interventions regarding severe mental illness: a systematic literature review].

Abstract: Stigma is one of the greatest challenges facing people with severe mental illness (smi) and can have profound psychological, social and professional consequences. AIM: To systematically review the evidence of effectiveness of anti-stigma interventions (anti-stigma campaigns and specific interventions to reduce public stigma and self-stigma) for people with smi and to make recommendations for clinical practice. METHOD: A systematic literature search for individual studies and reviews concerning the efficacy of interventions that reduce stigma for people with smi. RESULTS: Anti-stigma interventions have small-to-medium effects. Although head-to-head comparisons do not show a clear advantage for educational or contact interventions, results suggest that the elements of contact, recovery and continuity (for public stigma) and psycho-education (for self-stigma) may yield the greatest effects. Due to the short follow-up period of most studies, there is limited evidence on the long-term effectiveness of these interventions. More specifically, it remains unknown whether these interventions lead to changes in actual behavior. CONCLUSION: Anti-stigma interventions have limited effects on knowledge, attitudes and behavior. Several methodological shortcomings, as well as short follow-up periods in most studies, preclude making firm conclusions.

Revision of autism spectrum disorder diagnosis in three women

Abstract: BACKGROUND Increasing attention has arisen for autism spectrum disorders (asd) in adults, especially women To ensure the specificity of the diagnostic process, careful consideration of the differential diagnosis is necessary, in order to optimise treatment AIM: To offer practical recommendations to increase the specificity of the diagnostic process for asd RESULTS: The asd diagnoses of the three women were reconsidered and eventually removed in favor of new diagnoses, which opened the door to more suitable therapeutic possibilities CONCLUSION: The asd diagnoses of the three women must always be considered During the diagnostic process, it must be considered whether there are distinctive symptoms of asd present that justify the need for an asd diagnosis, or whether the symptoms can be explained more suitably by another psychiatric disorder

Attention to psychiatry and pharmacotherapy during the COVID-19 pandemic

Abstract: ACHTERGROND De gevolgen van covid-19 zijn ongekend groot voor iedereen in Nederland. De verwachting is dat de coronacrisis negatieve invloed heeft op de geestelijke gezondheid van veel mensen met en zonder psychische kwetsbaarheid. De rol van hulpverleners in de psychiatrie is daarbij essentieel. Echter, op moment van schrijven is er weinig houvast aangaande wat psychiaters kunnen doen om de negatieve invloed van het coronavirus op psychische klachten te verminderen. Bovendien ontbreken richtlijnen voor het veilig en effectief voorschrijven van psychofarmaca, bijvoorbeeld als het gaat om interacties met experimentele covid-19-medicatie.

[Autism spectrum disorder diagnosis in young children: a clinical-ethical study on the experiences of parents and physicians].

Abstract: BACKGROUND After decades of research and clinical experience, autism spectrum disorder (ASD) turns out to be heterogeneous in every sense, including phenotype and etiology. How is this heterogeneous view translated in information that is useful and significant to parents and clinicians? AIM: To formulate recommendations with regard to clinical ASD care in young children. METHOD: We conducted in-depth interviews on how parents (11 mothers and 6 fathers of 11 children) and physicians (n = 16) view and experience a young child's ASD diagnosis. The interviews were analysed in Nvivo 11 according to the guidelines of interpretative phenomenological analysis. RESULTS: The interviewed parents and physicians addressed psycho-relational implications of an ASD diagnosis as much as treatment-oriented implications. Twelve months after their child got an ASD diagnosis, some disappointment regarding these implications led parents to a pragmatic understanding of an ASD diagnosis. CONCLUSION: Our results may be useful to both clinicians and policy makers with regard to clinical ASD care in young children. An ASD diagnosis in itself may be of limited help to parents and clinicians but can be of use if it is embedded in a request-oriented diagnostic process guided by a communication model of shared decision making and aimed at elaborating a treatment-oriented profile of the child.

Positive effects of psychoeducation on mental disorders in the Netherlands

Abstract: Mental Health First Aid (mhfa) is a psychoeducation program designed to recognize mental health problems in others, to approach and support them and to refer them to appropriate help AIM: To discuss the possible contribution that mhfa can make to the early detection, intervention and destigmatization of mental health problems in the Netherlands METHOD: Description of the characteristics, effectiveness and knowledge gaps of mhfa in the Dutch context based on literature and practice RESULTS: Positive experiences abroad suggest that mhfa can also contribute to early detection, intervention and destigmatization of mental disorders in the Netherlands Optimization of the program on the local context is important here CONCLUSION: Dutch evaluation- and effect studies are needed to determine whether the positive effects from international research also apply in the Netherlands, whether adults and young people receive early and adequate help thanks to mhfa, and how the stigma surrounding mental disorders can be further reduced