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Wanneer verslavende middelen overmatig gebruikt worden en de betreffende persoon het middel blijft gebruiken ondanks dat dit problemen oplevert, is er sprake van een middelgerelateerde stoornis. Ondanks de grote omvang voltrekt deze problematiek zich grotendeels onzichtbaar. Het heeft echter vele negatieve gevolgen op de fysieke en psychische gezondheid, de omgeving (waaronder familie, vrienden, werk) en de samenleving. Bij het ontstaan en voortbestaan van middelgerelateerde stoornissen spelen genetische en omgevingsfactoren een rol. Deze stoornissen hebben in veel gevallen gevolgen voor de mondgezondheid, de zelfzorg en behandelbaarheid. Mondzorgverleners kunnen een belangrijke rol spelen bij het signaleren van deze problematiek, stimuleren tot het zoeken van professionele hulp en een essentiële stap zijn in de behandeling en het herstel., When addictive substances are used excessively and a person continues to use them despite the fact this causes problems, this is called substance use disorder. Despite the large scale of the problem, it occurs largely invisibly. However, it has many negative consequences for physical and psychological health, the surroundings (including family, friends, work) and society. Genetic and environmental factors play a role in the origin and continuation of substance use disorders. In many cases, these disorders affect oral health, personal care and treatability. Oral healthcare professionals can play an important role in identifying substance use disorders, in encouraging those with problematic substance use to seek professional help and as an essential step in treatment and recovery.

Psychiatric disorders are associated with a more severe course of COVID-19. COVID-19 can also lead to psychiatric symptoms.To gain insight into vulnerabilities and protective factors for the course of COVID-19 in a Dutch (neuro)psychiatric population.Patients were divided into three groups: patients with pre-existent mental disorders without and with new (neuro)psychiatric symptoms (NPS) during COVID-19 and patients without pre-existent mental disorders who developed de novo NPS during COVID-19. We summarize the characteristics of each group and compare the subgroups with inferential statistics.186 patients were included in the case register. Patients with NPS showed a more severe course of COVID-19. Mortality in patients with NPS was higher in patients with pre-existent mental disorders compared to patients without pre-existent mental disorders. The most frequently reported de novo psychiatric symptoms during COVID-19 were delirium (46-70%), anxiety (53-54%) and insomnia (18-42%).NPS might be an expression of a more severe COVID-19 episode. In patients who developed NPS during COVID-19 we found evidence for a higher mortality risk in patients with pre-existent mental disorders. Extra vigilance for neuropsychiatric symptoms during COVID-19 is warranted.

Against the treatment gap and the long delays in seeking treatment for mental health problems, primary care psychology (PCP) was added to reimbursed outpatient mental health services in the Belgian healthcare system.To describe the characteristics of patients treated within the measure of reimbursement of PCP.A total of 350 patients participated in an online survey at the start of their PCP treatment within one of the 31 mental healthcare networks in Belgium. Besides sociodemographic characteristics, they were questioned about their mental disorders, suicidality, service use, and delays in seeking treatment.Almost 90% of all patients screened positive for a lifetime and 12-month DSM-5 mental disorder, mostly anxiety and depressive disorders. Over 1/3 were experiencing suicidal thoughts and/or behaviors (STB) in the last 12 months. For 49.1% of patients, PCP was the first treatment ever. The median delay in seeking treatment was 6 years.PCP in Belgium serves mostly a clinical population with high proportions of lifetime and 12-month mental disorders and STB, and many of them have been in mental health treatment before. These findings raise the question whether PCP fits the needs for the patients that are treated.

There are regional differences in the Netherlands in the numbers of emergency compulsory admissions (Inbewaringstelling: IBS). We looked at three 24/7 facilities to investigate the relationships between patient and consultation characteristics on the one hand, and numbers of emergency compulsory admissions on the other, against the background of the level of urbanisation.We compared emergency consultations in 18-64 year olds in Apeldoorn, Amsterdam and Rotterdam between 2012 and 2016 in terms of socio-demographic, procedural and clinical characteristics, and in terms of outcome. We used the Severity of Psychiatric Illness Scale (SPI) to determine disorder severity.Apeldoorn had as many consultations per 100,000 inhabitants as the highly urbanised city of Rotterdam. GPs there referred 68% of patients, compared with 25% in Amsterdam and 50% in Rotterdam. In Apeldoorn, 17% of the patients were psychotic, compared with 35% in the other regions. In addition, 66% of the patients there had a low SPI score, compared with 40% in the large cities. Amsterdam and Rotterdam had 3.5 times higher risk of emergency compulsory admissions as Apeldoorn. After adjustment for socio-demographic, procedural and clinical characteristics, this difference with Apeldoorn was 1.5 for Amsterdam and 2.6 for Rotterdam. SPI score and psychotic disorder were found to be the most important predictors of IBS admission.Differences in consultation numbers, referral patterns and the location of consultations indicate that there are regional differences in the position of the 24/7 facility in the mental health care system. The numbers of emergency compulsory emissions were related in part to the level of urbanisation and the associated epidemiological differences but probably also to differences in the position of the crisis facility in the mental health care system. Differences in admission numbers were primarily linked to differences in diagnostic characteristics and disorder severity and, to a lesser extent, to referral patterns and socio-demographic characteristics. However, these variables did not explain all the observed inter-regional differences.

In addition to impediments to social and social functioning, people with severe mental illness also experience the negative consequences of prejudice and stigmatization. Stigmatization also occurs in mental health care, including addiction care.To describe the occurrence and manifestations of stigmatization by care providers, from the perspective of clients and care providers.Digital surveys among clients of the panel Psychisch Gezien (n = 628) and among care providers (n = 471).More than half (54%) of the panel members had experienced stigmatization by mental health care providers in the past two years. They experienced this mainly through a distant attitude (22%) and the language used by care providers (20%). Two-fifths (40%) of the care providers indicated that stigmatization occured regularly or often in their own team. Both clients and counselors emphasized the importance of normalizing mental health problems, reluctant use of psychiatric labels and recovery-oriented work to reduce stigma.Stigmatization by mental health care providers is manifested in many ways, making it a complex and ambiguous problem. Although there is nolsquo;one size fits allrsquo; solution, normalization of mental problems is an important starting point.

Backgroundnbsp; Mental capacity, the criterion used today to determine who can make decisions independently, is under pressure from the United Nations Convention on the Rights of Persons with Disabilities. Aimnbsp; To outline the prevailing view, the view of the UN Convention and a middle ground. To formulate steps to apply the spirit of the UN Convention today. Methodnbsp; Essay starting from the most relevant international human rights sources within the United Nations and the Council of Europe, supplemented by secondary literature on these sources. Resultsnbsp; The UN Convention abandons mental capacity as the criterion to determine whether a patient can make decisions autonomously. At the same time, it rejects any form of coercion applied directly or indirectly because of mental illness. Conclusionnbsp; The UN Convention does not offer a clear alternative, so the future is uncertain. Nevertheless, the important principles of the UN Convention should not be forgotten; they can already be implemented today by being aware of the role of human rights in mental health care, by placing the quality of decision-making at the center and by making less and more conscious use of coercion.

Background Geriatric psychiatry is still a relatively young field, but it has made itself indispensable in recent years. This article examines specific features of psychopathology in older adults. Aim To examine what makes older adultslsquo;differentrsquo; compared to younger cohorts. Method Non-systematic literature search. Results Older adults are characterized by a large inter-individual variability, sometimes specific clinical presentation of psychopathology and/or multi-morbidity, including polypharmacy, which results in a specific integrated care with attention to age-specific adjustments in the treatment. Conclusion Psychopathology in older adults requires specialist expertise and multidisciplinary collaboration. In order to optimally treat older adults, ageism must also be tackled thoroughly.

Background Mental illness is more common and has a less favorable course in people with a low socioeconomic position (SEP). Aim To clarify the concept of SEP and what mechanisms underlie socioeconomic differences in mental illness. Method Review of theoretical and empirical scientific research. Results For determining socioeconomic differences in mental illness, it matters whether one looks at educational level, occupational level, or income. Mechanisms of social causation and social selection play a role. Among other mechanisms, SEP contributes to mental illness through exposure to stressors, unfavorable living conditions, unhealthy behaviors, and social exclusion. Conversely, mental health problems can negatively influence SEP. Conclusion Researchers and practitioners should be aware that SEP is more than a background characteristic of a patient or a statistical control variable; over the life course there is a complex interaction between SEP and both the etiology and course of mental illness.

Background In psychiatric research there has been an increasing interest for sex- and genderspecific aspects in clinical presentation, outcome, and treatment of psychiatric disorders. Scientific studies on psychopathology pay more and more attention to the biological differences and differences in exposure to environmental risk factors between women and men. Aim To give a review on sex- and genderspecific aspects on psychiatric diagnostics and treatment. Method Review of most recent literature. Results The translation of this newly generated knowledge into clinical practice is still lagging behind. An important next step is to integrate this knowledge into clinical guidelines, and in teaching and training programs. Conclusion The development of sex-gender sensitive diagnostic instruments and outcome measures may contribute to personalized healthcare. These are essential steps on the way to sex-gender sensitive mental health care which will ultimately benefit the individual patient.

Backgroundnbsp; Prejudice, stigma and discrimination against people with mental health problems are largely responsible for their limited social participation. Joining the globalised wokeness movement could reduce the tendency of social injustice. Aimnbsp; To explore the reasons why people with mental health problems experience difficulties to integrate into the wokeness debate and to suggest possible solutions. Resultsnbsp; Intersectionality, persons with mental health problems often being part of different vulnerable minority groups, stress and public stigma, are the main reasons of the limited level of advocacy for this target group. Conclusionnbsp; The struggle against social injustice that mental vulnerable persons are victims of, remains unequal even in times of wokeness. A strategic, non-patronising cooperation between psychiatrists, patients, family members and interest groups in the media and in the public and political forum, could make it possible to join the international wokeness movement.

Backgroundnbsp; Psychiatry and psychology have struggled since their earliest development with the question whether psychopathology manifests itself identically around the world, and whether a disorder can be better understood from a biological or a socio-cultural perspective. Aimnbsp; To describe the culture and psychopathology debate based on recent developments in ICD and DSM, illustrated with depression and PTSD. Methodnbsp; Clinical experience, previous publications in other languages, and a recent PubMed search on culture and psychopathology. Resultsnbsp; There is some consensus in worldwide studies on the universal manifestation of these two disorders. On the other hand, there is broad criticism due to three forms of bias: poor construct validity, looping effects and category truncation. DSM has developed concepts and tools that can enhance cultural competence in practice and in research. Conclusionnbsp; Researchers and practitioners should develop phenomenological skills to describe and incorporate the local expression of psychological problems into practice. And take into account the three forms of bias mentioned.

BACKGROUND: There is limited knowledge of the predictive validity of risk factors and protective factors for recidivism in forensic psychiatric patients with an autism spectrum disorder (ASD). AIM: To examine risk factors, protective factors and the predictive value of these factors in relation to recidivism for forensic psychiatric patients with ASD compared to patients without ASD. METHOD: For 69 patients, including 32 patients with ASD, the risk factors and protective factors were measured at the start and end of treatment. Of these 69 patients recidivism was examined for 23 patients, including 10 patients with ASD. Furthermore, the predictive validity of these measurements in relation to recidivism was explored. RESULTS: The positive changes on risk and protective factors at the end of treatment did not differ significantly between both groups, except for the external protective factor, on which patients with ASD scored less favourable. We used a follow-up period of 2.5 to 4 years. Only 1 out of 10 ASS-patient showed recidivism compared to 7 out of 13 in the non-ASD-group. The scores on the risk assessment instruments at the start of treatment showed a significant predictive validity for recidivism, the scores at the of the end treatment did not. Structured clinical judgment of recidivism showed no significant predictive validity at the start as well as the end of treatment. CONCLUSION: Despite the small sample, the results give rise to further research about risk factors and protective factors for recidivism, and the usability of risk-assessment for forensic patients with ASD.

The prevalence of mental illness has remained stable in recent decades, yet the use of psychotropic drugs has increased. This trend suggests that psychotropic drugs are being prescribed with an unnecessary frequency. Internationally, there is growing attention for deprescribing.To investigate what experiences and needs patients and their loved ones/relatives have with regard to deprescribing of psychotropics.An online questionnaire was distributed among members of the MIND mental health care panel, which consists of (former) patients with a psychiatric disorder and their loved ones.A total of 564 respondents took part in this survey. Most patients have phased out/stopped their psychotropic drugs (83.8%). This was usually done at the initiative of the patient (66.7%), in consultation with the practitioner (72.9%). The practitioner only took the initiative to deprescribe in 15.1% of the cases. In 68.6% tapering was not discussed at the start of psychotropic drug use. Patients did not experience willingness from practitioners in deprescribing, and would like to discuss deprescribing more often (79.5%).There is an undeniable demand among patients and near ones for more emphasis on deprescribing of psychotropic drugs. We advise to include this topic in the shared decision making process.

A substantial number of mental health care patients have a migration background. It is not clear whether they are given the right sort of care.To investigate the differences in care needs between patients from western countries and non-western first- and second-generation migrants with severe mental illness (SMI).In a cross-sectional study the Camberwell Assessment of Needs was filled in by 914 patients and also by their mental health professionals. We looked at differences in needs in general and specifically at care needs that were met and that were not met for patients of western origin and first-and second generation non-western migrants. These differences were analysed based on care areas:lsquo;activities of daily livingrsquo;,lsquo;mental healthrsquo;,lsquo;rehabilitationrsquo; andlsquo;servicesrsquo;.According to both patients and mental health workers, there were more needs for care with patients in the first and (to a lesser degree) the second generation of non-western migrants. The number of unmet needs is particularly higher for the domains 'mental health' and 'services' experienced by patients with a first generation migration background. Furthermore, for the first generation, mental health care workers mentioned more unmet needs in the rehabilitation domain. Further professionals proved to be uninformed significantly more often about the needs of patients with a migration background, that specifically does concern the items intimate relationships and sexuality.Patients with SMI and a non-western migration history have more (unmet) needs for care than western patients with SMI. * BOTH FIRST AUTHORS.

Flexible assertive community treatment (FACT) teams are widespread in the Netherlands. Despite the presence of a model description and model fidelity scale, it is unclear what FACT workers actually do daily.Examination of the daily activities of FACT workers on weekdays in relation to the intended activities from the theoretical FACT framework.Repeated momentary activity assessments were made among all employed staff (n = 54) of four FACT teams from three different organizations using the experience sampling method (ESM) yielding multiple reports on each workday for one week. 936 reports were analyzed with SPSS, providing a picture of the daily activities of FACT workers.Overall, employees spent 30% of their time with clients, 30% in consultation (4% with network partners), 20% on administration and 20% in travel time and personal activities (30-30-20-20).The actual time spent by FACT workers with clients does not match the expected production standards. Contact with relatives and network partners lags far behind the desired figures required for modern network-oriented care. The ESM-based results are different from actual methodologies and require careful interpretation. Applying ESM in FACT teams promises to support a quality development dialogue.

In the Netherlands, mental health care consumption is characterized by a strong social gradient, in contrast to specialist medical care.A more detailed analysis of this social gradient in relation to type of care, diagnosis and cost parameters.Analysis of national costs data and socio-economic data at 4-digit postal code level.Mental health care had a strong socio-economic gradient, with a 25% to 350% difference in both healthcare consumption and treated prevalence between the least and most deprived areas. Increasing area socioeconomic deprivation was associated with an increase in complex care compared to non-complex care, in inpatient treatment compared to outpatient treatment, and treatment of severe mental disorder compared to less severe problems. The social gradient was not predictive of municipal variation in the degree of - on average weak - association between mental health care and social care.Mental problems and social problems are intrinsically connected, but the association between mental healthcare and social care is limited and very heterogeneous.

Hardly any research has been conducted into systematic symptom monitoring in palliative care for patients with a psychiatric disorder.To gain insight into the usefulness of the Utrecht Symptom Diary (USD) and the symptom burden of patients with a psychiatric disorder in the palliative phase.A pragmatic retrospective study using completed USDs by patients (USD-P) and/or caregivers (USD-Z) at the palliative unit and three clinical departments of geriatric psychiatry of GGz Centraal, from October 2011 to January 2018. Analysis was performed using completed USDs, from 3 months to 14 days before death andle; 14 days before death. The first measurement was used in both periods. Primary outcomes: prevalence of symptoms (scoregt; 0) and clinical relevance of symptoms (scoregt; 3).50 USDrsquo;s from 38 patients were included, 9 USD-Ps and 41 USD-Zs were analysed. Self-reporting was usually not possible due to psychotic experiences, forms of denial, difficulty with concentration, weakness or fatique. Fatigue and loss of appetite were the most common in USD-Ps and USD-Zs. Fatigue reached most often clinically relevant intensity in USD-Ps and USD-Zs.If the patient cannot fill in the USD-P, the USD-Z can be an alternative to systematically monitor symptoms. Application of the USD-Z requires good observation and awareness of differences in interpretation between healthcare providers and patients in a target group that has difficulty in expressing complaints clearly. Psychical symptoms are reported more often as clinically relevant than psychological symptoms. Fatigue is the most frequently and most unequivocally scored by patients and healthcare providers in terms of presence and clinically relevant intensity.

Childhood mental health problems are partly influence by genetic factors with heritability estimates varying between 40% and 90%.We provide examples of genetic research focusing on explaining the continuity of symptoms and the association between parental traits and offspring psychopathology.We summarize two recently publish review papers RESULTS: There are significant genetic correlations between childhood and adult mental disorders. Genetic factors also explain part of the associations between parental traits and offspring psychopathology, because parents and children share 50% of their genetic material.The role of genetic factors is not restricted to influencing the risk to develop a mental disorder. They also play a role in persistence of symptoms and the associations with the environment.

Insights from psychiatric genetics research and large international psychiatric genetics consortia are promising but still remain outside the realm of clinical practice.brAIM: To provide an overview of developments in the field of psychiatric genetics; and to offer guidance for health professionals how to assess and manage clinical implications of these developments.brMETHOD: In this review, we address: recent developments in psychiatric genetics, with a focus on polygenic risk scores (PRS); ethical dilemmas associated with clinical application of PRS; and basic principles of genetic counseling for psychiatric disorders.brRESULTS: PRS are not yet ready for implementation in clinical practice because of limited predictive value and poor generalizability. In addition, it is still unclear how genetic risk and PRS can be communicated clearly to patients and families.brCONCLUSION: Advances in psychiatric genetics and increased availability of genetic risk scores may lead to questions from patients and families coping with psychiatric illness. These questions may be best addressed using psychiatric genetic counseling techniques. We recommend that psychiatrists have some basic knowledge of psychiatric genetics and know how to refer their patients to a clinical geneticist. Implementing a psychiatric genetics theme in training and education may be helpful.br.

The importance of genetics in psychiatry has been a topic of ongoing debate. The futile search for candidate genes underlying psychiatric disorders in the decades before 2007 resulted in overall disappointment. Since then, however, researchers and clinicians have witnessed the discovery of a plethora of common and rare genetic variants associated with psychiatric disorders.brAIM: To relate the history of general genetics to the history of psychiatric genetics, underlining how.brMETHOD: Literature research.brRESULTS: The anatomical and physiological phases of this history have shaped the field of psychiatric genetics. We describe pivotal discoveries that have facilitated the uncovering, reading and writing of DNA. We then discuss several milestone discoveries in the field of psychiatric genetics. We end with an outlook on where the field of psychiatric genetics may be heading in the decades to come, arguing that alsquo;clinical phasersquo; of psychiatric genetics may be ahead of us.brCONCLUSION: The research with a focus on polygenic risk scores (PRS) could be translated into clinical practice in the coming years and we expect more attention to the question of how genetic variants cause psychiatric disorders. We look to future developments with some optimism.br.

Genetic research has made continuous progress in the past years, as a results of the rapidly growing sample sizes and development of novel analytical tools.brAIM: To present the latest developments in research into the genetic overlap and differences between psychiatric disorders.brMETHOD: Description of findings from recent literature.brRESULTS: First of all, psychiatric disorders differ in their heritability, and consequently impact of environmental factors. Second, some disorders show high concordance in direction of genetic effects, while other disorders have rather different effects. Using these genetic (dis)similarities, subgroups of psychiatric disorders can also be defined.brCONCLUSION: Genetic research is developing at rapid pace, and much more will be learned about the genetic overlap and differences between psychiatric disorders in the next years. The big promise -and challenge- will be to integrate genetic research with research of environmental factors, other biological measures and more detailed phenotypic information.br.

Because of rapid developments in genetic technology, more underlying genetic causes of psychiatric disorders can be detected which may contribute to better monitoring and treatment of co-morbidities than previously.Review of monogenetic causes of psychiatric disorders.Review of the literature.Research in people with monogenetic disorders will generate new knowledge and insights on psychopathology and cognitive function in general and pave the way to new treatment targets. In this article we discuss four monogenetic disorders that are relevant for clinical psychiatry and (educational) psychology: fragile X syndrome, tuberous sclerosis, Rett Syndrome, and Huntingtonrsquo;s disease.Given the multisystem nature of these genetic disorders, a well-coordinated, multidisciplinary approach by specialized expert centers is highly recommended.

The hypothesis that etiopathogeneses of psychiatric disorders are determined by interplay between genetic background and environmental factors, as well their interactions can increasingly be put to direct scientific test, based on a wave of methodological, technological and knowledge developments.brAIM: To provide insight into and to provide perspective on some important scientific developments and facilitate challenges in this area.brMETHOD: Narrative overview of the scientific literature and formulation of a concept and future perspective.brRESULTS: The overview points to concrete progress in the fields of genetic epidemiology, environmental analyses, gene-environment interactions and epigenetics in psychiatry. For example, recent studies have provided evidence for the existence of interactions and correlations between genetic and environmental factors, interdependence of risk-influencing effects of environmental factors, and translational neurobiological studies have identified biological processes that influence the impact of (or the response to) environmental influences on individuals mediate. These important steps to translate epidemiological research into testable biological hypotheses are facilitated by new techniques and the availability of large and relevant clinical and biological datasets.brCONCLUSION: Scientific progress on the interplay between genetic background and environmental factors enriches the conceptual framework of the etiopathogenesis of mental disorders and provides a future perspective in which we are likely to receive answers to a number of clinically relevant questions in the coming decade.br.

Electroconvulsive therapy (ect) is an uncommon treatment in children and adolescents. This could partially be explained by the fact that a large proportion of the (child and adolescent) psychiatrists have little knowledge on ect in youths. We describe a case of a 12-year-old boy with a severe depression refractory to pharmacotherapy and psychotherapy, in which ect treatment was successful, including six years follow-up. Additionally, this report represents the state of the art concerning the efficacy and safety of ect in youths.

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.

In January 2020 the Compulsory Mental Healthcare Act (Dutch: Wvggz) was implemented. The Wvggz details the rights of patients with mental illness who require compulsory care. The law aims, amongst others, to improve the legal rights of patients and those close to them, for example by enabling the possibility to draw up their own action plan (AP) or care card.To explore what health care professionals think of the possibilities for involvement by patients and those close to them, enabled by the Wvggz.A qualitative study in which health care professionals were interviewed about the possibilities for involvement by patients and those close to them. We used thematic analysis to study the data from the interviews.Health care professionals were positive about the idea to involve patients and those close to them, though they indicated that patients and those close to them were already involved before the law came into effect. The main difference was that their involvement was more documented, for instance patients can write their own AP or fill out a care card. Health care professionals mentioned that both the AP and the care card offer the possibility for patients and those close to them to express and realize their wishes. On the downside, not all patient groups were able to draw up their own plan of action. Furthermore, according to the health care professionals, both the action plan and care card could give patients the false impression that their wishes can always be acknowledged.Health care professionals mention that patients and those close to them were already involved before the law came into effect. However, the ways in which their involvement is arranged and documented are different.

Religious coping can be seen as a method which applies religious resources, including prayer, and trust and appeals to God, in order to deal with stressful situations.To gain insight into the associations between religious coping styles and mental health and to investigate whether the use of the coping styles differs between mental health care clients and non-mental health care clients with a Christian background.The sample consisted of 655 Dutch participants with a Christian worldview, aged 18 to 79 years (M = 42.6, SD = 14.2). 60.9% were female and 49.5% higher educated. Intra- and extramural clients in mental health care were involved. A cross-sectional, online survey was used, combined with an available client database.More use of the collaborative coping style was associated with less psychological complaints. More use of the (passive-)deferring and selfdirecting coping styles was associated with more psychological complaints. Christian mental health care clients used the collaborative and the deferring coping styles less often compared to Christian non-clients.The collaborative religious coping style is positively associated with mental health. Mental health care clients amongst them use this style less often compared to non-clients. Awareness of religious coping styles and appropriate support are indicated.

When a child or adolescent is admitted to a Highamp; Intensive Care (HIC) unit for adolescents, this implies that they find themselves in a severe psychiatric crisis. The work policy aiming autonomy and recovery is a vision that has been implemented in the treatment method at the HIC unit for adolescents. This policy focuses on the recovery of young people, in which learning to understand their own story and learning taking responsibility, are essential components. Sharing these experiences from doctors and patients aims to increase knowledge about this policy. The consistent implementation of this vision and method will result in high-quality care, more recovery and reduction of urge and coercive interventions. Calls are made for a broad-based implementation of a work policy aiming autonomy and recovery in the Netherlands.

BACKGROUND: Against the treatment gap and the long delays in seeking treatment for mental health problems, primary care psychology (PCP) was added to reimbursed outpatient mental health services in the Belgian healthcare system. AIM: To describe the characteristics of patients treated within the measure of reimbursement of PCP. METHOD: A total of 350 patients participated in an online survey at the start of their PCP treatment within one of the 31 mental healthcare networks in Belgium. Besides sociodemographic characteristics, they were questioned about their mental disorders, suicidality, service use, and delays in seeking treatment. RESULTS: Almost 90% of all patients screened positive for a lifetime and 12-month DSM-5 mental disorder, mostly anxiety and depressive disorders. Over 1/3 were experiencing suicidal thoughts and/or behaviors (STB) in the last 12 months. For 49.1% of patients, PCP was the first treatment ever. The median delay in seeking treatment was 6 years. CONCLUSION: PCP in Belgium serves mostly a clinical population with high proportions of lifetime and 12-month mental disorders and STB, and many of them have been in mental health treatment before. These findings raise the question whether PCP fits the needs for the patients that are treated. ispartof: Tijdschr Psychiatr vol:64 issue:9 pages:595-603 ispartof: location:Netherlands status: published

Electroconvulsive therapy in a patient with bipolar disorder and a history of ischemic stroke This article is a case-report of a 35 year old female patient with a history of ischemic stroke who, after careful consideration and additional investigations, received a treatment with electroconvulsive therapy (ECT) for a treatment-resistant depression in a rapid cycling bipolar 1 disorder. A thorough neurological evaluation in patients with a history of stroke is important as stated by the guidelines. As the patient was clinically and neurologically stable since her stroke 2 years prior, the risk of complications due to ECT was estimated to be low. The literature shows that ECT is not associated with a higher risk of a recurrent stroke, when taking the right indications and monitoring into account.

BACKGROUND: Frontotemporal dementia (FTD) is a neurodegenerative disorder leading to dementia. Because of predominant behavioural and emotional features it often presents to the psychiatrist. AIM: Provide an overview of the genetic background of FTD with recommendations for the clinician. METHOD: Review of the international literature. RESULTS: FTD is autosomal dominant hereditary in 10-25% of cases. The clinical presentation of genetic FTD is heterogeneous. In particular, the C9ORF72 mutation can manifest as a psychiatric disorder and its disease course can be slow. This mutation is also associated with ALS. CONCLUSION: In case of a late-onset psychiatric disorder it is recommended to perform a detailed family history, including dementia, ALS and psychiatric disorders. In case of an undetermined neuropsychiatric disorder one should consider genetic testing at least including the C9ORF72 hexanucleotide repeat length, even when the family history is negative.

Although there is consensus on the importance of involving informal caregivers of people with severe mental illness, interventions are needed to support this.To explore whether the use of the 'Triangle of Care Card', an instrument developed to help strengthen the role of care-givers in their contact with workers, increases quality of cooperation and care.Three outpatient mental health teams and twelve teams for supported housing started working with the card. Information from files and questionnaires were used to monitor change and compare this with the changes during the same year in ten other teams.Use of the Triangle of Care Card was sparse. When it was used, a broader range of subjects were discussed, including the needs of caregivers. Also, clients were more involved. In teams where the card was introduced, the clients' networks became more apparent and there was an increase in face-to-face meetings with members of this network.Introduction of the Triangle of Care Card leads to change in the involvement of caregivers. However, implementation is problematic and therefore the increase in quality of the cooperation with caregivers and quality of care is yet small.

Background The assessment and treatment of patients with a personality disorder have made considerable progress during the last decades. Unfortunately, this progress is often limited to patients with a personality disorder in general. Patients with a personality disorder who also fulfil criteria for a severe mental illness (SMI-PD) profit less. Aim To describe the relationship between contemporary paradigms about personality disorders and the current treatment practices of patients with SMI-PD, and to assess the added value of the recently introduced paradigm epistemic trust and distrust. Method An expert group of mental health professionals, all members of the Expertise Centre for Personality Disorders, conducted a literature study and in addition organized an invitational conference and consensus meetings, resulting in an analysis and recommendations for treatment of patients with SMI-PD. Results The epistemic trust and distrust paradigm clarifies the learning process of patients with SMI-PD and the way patients benefit from treatment. We conclude with elaborations of this paradigm for five contexts of patients with SMI-PD. Conclusion The epistemic trust and distrust paradigm seems a promising concept to improve the often difficult treatment of patients with SMI-PD.

Conspiracy theories are popular during the COVID-19 pandemic. Conspiratorial thinking is characterised by the strong conviction that a certain situation that one sees as unjust is the result of a deliberate conspiracy of a group of people with bad intentions. Conspiratorial thinking appears to have many similarities with paranoid delusions.To explore the nature, consequences, and social-psychological dimensions of conspiratorial thinking, and describe similarities and differences with paranoid delusions.Critically assessing relevant literature about conspiratorial thinking and paranoid delusions.Conspiratorial thinking meets epistemic, existential, and social needs. It provides clarity in uncertain times and connection with an in-group of like-minded people. Both conspiratorial thinking and paranoid delusions involve an unjust, persistent, and sometimes bizarre conviction. Unlike conspiracy theorists, people with a paranoid delusion are almost always the only target of the presumed conspiracy, and they usually stand alone in their conviction. Furthermore, conspiracy theories are not based as much on unusual experiences of their inner self, reality, or interpersonal contacts. CONCLUSIONS Conspirational thinking is common in uncertain circumstances. It gives grip, certainty, moral superiority and social support. Extreme conspirational thinking seems to fit current psychiatric definitions of paranoid delusions, but there are also important differences. To make a distinction with regard to conspiratorial thinking, deepening of conventional definitions of delusions is required. Instead of the strong focus on the erroneous content of delusions, more attention should be given to the underlying idiosyncratic, changed way of experiencing reality.

Coercion is much discussed topic in psychiatry.Presentation of an ethics of care perspective on coercion, focusing on the moral aspects of the relationship between care recipient and caregiver, and the prevention and reduction of coercion.Clarification of the care-ethical aspects of the high and intensive care (HIC) model and discussion of the Compulsory Mental Health Care Act (Wvggz).In the HIC model, ethics of care underlies three cultural changes: from control to contact, from reactive to proactive, from individuality to solidarity. More than the older Bopz Act, the Wvggz pays attention to relational aspects of coercion, but the procedures endanger care contact.Ethics of care - in which the care relationship is the starting point - offers a perspective that is of great value to psychiatry. The development of HIC is a concrete example of this. The Wvggz emphasizes collaboration in care, but care contact is hindered in practice by a multitude of procedures.

A key ethical issue in psychiatry concerns the relationship with patients. A central dilemma is that experiential knowledge (regarding existential recovery) and professional knowledge (the framework of specific-medication-for-specific-brain-disorder) are not easily integrated into a practice of co-creation.To describe the status quo in health care and science.Qualitative review.Under the influence of critical psychiatry ('antipsychiatry'), the recovery movement, the voice hearing movement and open science, the patient voice has gained influence while the scientific framework of academic psychiatry/psychology is critically re-examined. Co-creation in mental health services is limited whilst parallel development is more successful. For example, experience-based recovery academies are developing primarily in the domain of social care whilst evidence-based specialist treatment remains the norm in mental health services. There is, however, a growing call for co-creation around recovery-oriented work in the mental health sector, despite limited institutional readiness. There is also a growing movement of user research responding to epistemic injustice and driving patient-driven innovations - although sometimes on the basis of appropriation without source awareness.Experiential knowledge is growing as the theoretical framework of psychiatry is in the process of change. This creates the conditions for co-creation of a new values-driven psychiatry.

The waiting list of the expertise center euthanasia (EE) in the Netherlands for patients requesting euthanasia on the basis of psychiatric suffering has increased to two years in a short space of time.Clarity about the causes and direct consequences of the EE waiting list and an answer to the question: what now?We analyzed the EE waiting list based on various media reports, annual reports from the EE and scientific studies.The EE waiting list arose because, on the one hand, the demand for euthanasia among patients with a mental illness has increased, while on the other hand, the willingness to perform euthanasia among psychiatrists appears to be declining. The reasons for both trends seem multifactorial. The direct consequence of the waiting list is that patients with a mental illness have less access to euthanasia, which in itself can also have harmful and protective consequences.The EE waiting list is the result of an increasing number of requests and an apparent decrease in psychiatrists' willingness to perform euthanasia. In response to this situation, roughly three ways forward are conceivable: first the mental health care sector can assign itself a more active role in the field of euthanasia, second a further demedicalisation of the end of life is possible, or third a choice can be an amendment to EE's referral procedure. All of these options have potential pros and cons.

Subgroups of patients with severe mental illness are underrepresented in scientific research. One of the possible causes is the fact that in these patient groups barriers may exist to the giving of competent informed consent.Describing the ethical dilemmas that may occur when conducting research with these patient groups.We present an overview of the Dutch legislation and regulation concerning participation in scientific research, and discuss the ethical dilemmas that arise in the mentioned patient groups. We present four directions for solutions.In research with these patient groups more attention is needed for the explicit assessment and enhancement of competence. For the subgroup that is persistently incompetent, the possibilities of doing research with existing patient data without informed consent, need further exploration.Further legislative development is needed for research with patients with severe mental illness who are persistently incompetent. Herein, it is crucial to involve ethicists and organizations representing patients' and relatives' perspectives.

A clinical admission is a frightening event, especially in a crisis situation, and above all when it comes with legal measures. The effectiveness of an acute crisis admission has been demonstrated in a Cochrane review, but cohort studies of a clinic setting are not yet available.To assess and determine the treatment effects after a crisis admission in a metropolitan acute psychiatric clinic of patients with severe mental illness (SMI patients).In the context of routine outcome monitoring, the 12 HoNOS scores at admission and discharge (pre- and post-measurements) were rated by clinicians. The data of 1423 patients were analyzed by a statistician.The crisis admissions have a substantial positive clinical effect: 76 percent of the patients improved, 16 percent was stable and 10 percent worsened (effect size ES = 1.2). The patients improved most in regard to psychotic problems, aggressiveness and social problems. This applies equally to patients who have been admitted voluntarily, as well as to patients with a legal measure. The admission duration of patients is two months, except for patients with compulsory treatment (seclusion, sedation, forced medication). In this case the treatment duration prolongs to three months.Acute short-term clinical admission is an effective part of the clinical and outpatient treatment chain for patients with severe mental illness (SMI). A substantial treatment effect is achieved by the crisis admission. These findings are an important addition to the Cochrane review.

Although mental health care for prisoners with mental health problems during and after detention improves re-integration and reduces criminal recidivism, prisoners with psychiatric problems seem to have difficulties connecting to regular mental health care after detention. AIM: To describe referrals from Flemish prisons to psychiatric hospitals or external therapeutic settings in the year 2019. METHOD: All prisoners with mental health problems that were referred from a Flemish prison to mental health care in 2019 were studied (n = 577) , using data collected by the Flemish initiative TANDEM. RESULTS: The vast majority of referrals were prisoners with a substance use disorder. In total, 1 in 5 prisoners with mental health problems directly had access to ambulatory or residential mental health care. 30% of these ultimately did not appear to start with the planned treatment.Continuity of mental health care after detention is recommended and also has a social benefit. Improving cooperation between justice and external mental health care, taking into account the needs of the prisoner, is essential in the development of succesful treatment plans.

Pregnancy and the postpartum period is a vulnerable phase in life for women and can influence the development or course of a psychiatric disorder. These patients can receive extra guidance during this period by the POP-collaboration (Psychiatry, Obstetrics and Pediatrics) in many hospitals.To describe the characteristics of patients who received psychiatric consultation by the POP-collaboration at the LUMC and the interventions that were conducted.Data of patients who were seen at the psychiatric (outpatient) clinic for POP-guidance between 1 January 2016 and 1 April 2020 were analyzed.292 patients were seen in 310 guidance programs at the psychiatric (outpatient) clinic. Patients referred preconceptionally or during the pregnancy mostly suffered anxiety or unipolar mood disorders. Postpartum it concerned mostly psychotic disorders and bipolar mood disorders. A majority had two or more psychiatric disorders. Interventions were psycho-education, supportive contact, collaboration with their own health-professionals, adjustment of the current treatment, making a prevention plan, a prolonged stay at hospital after childbirth or (rarely) an admission to the psychiatric ward.Patients seen for guidance by the POP-collaboration at the LUMC are a vulnerable patient population with frequently complex psychopathology, and need personalized psychoeducation, supervision and treatment.

The Clozapine Plus Working Group is frequently consulted for advice on measures in case of infection with SARSCoV-2 and on vaccination against COVID-19 in patients receiving clozapine.pAIM: Inform about risks of infection with SARS-CoV-2 in patients with severe mental illness (SMI), patients with schizophrenia spectrum disorders (SSD), and patients treated with clozapine. Advise on monitoring of clozapine plasma levels and white blood cell count and differential in COVID-19 and after vaccination, as well as measures to be taken.pMETHOD: Literature research and case studies.pRESULTS: SMI patients and in particular SSD patients have an increased risk of infection with SARS-CoV-2 with more hospitalizations and higher mortality than non-psychiatric patients. Patients using clozapine may be at greater risk of infection. SARS-CoV-2 infection may cause a dangerous increase of clozapine plasma levels and generally mild and short-term granulocytopenia and lymphocytopenia, which are usually not a result of clozapine treatment.pCONCLUSION: In case of COVID-19 extra alertness is required in patients with SMI and especially SSD. In clozapine users, in case of COVID-19, reduction in dose by half to three quarters of the original dose is recommended. When patients develop granulocytopenia, SARS-CoV-2 should be considered as the cause and not immediately clozapine. SMI patients and clozapine users in particular belong to a high risk group with a medical indication for early vaccination.

Delirium is a common serious complication in dementia that is associated with poor prognosis and a high burden on caregivers and healthcare professionals. Appropriate care is therefore important at an early stage for patients with delirium superimposed on dementia To gain insight into the care of six patients with delirium superimposed on dementia, 19 semi-structured interviews were conducted focused on the experiences of caregivers and professionals. The interviews revealed four themes that appeared to play a role: 1. experiences with and views on behavioral problems of these patients, 2. recognition and diagnosis of delirium in dementia, 3. views on good care and 4. organizational aspects. Knowledge gaps about delirium in dementia, as well as ethical considerations, play an important role in organizing timely and adequate care for patients with delirium superimposed on dementia.

BACKGROUND: Posttraumatic stress disorder (PTSD) is often a chronic condition, despite the availability of various evidence-based treatment options. Psychedelics offer new treatment opportunities. AIM: An overview of the current evidence, therapeutic context, and possible mechanisms of action of different types of psychedelics in the treatment of PTSD. METHOD: A scoping review of the available literature. RESULTS: MDMA-assisted psychotherapy has shown to produce lasting reductions in PTSD symptoms in multiple RCTs. Based on a small number of studies, ketamine administration appears to lead to temporary symptom relief. Current studies are investigating whether the use of ketamine in combination with psychotherapy can lead to lasting reductions in PTSD symptoms. Classical psychedelics (such as psilocybin and LSD) induce psychoactive effects (on behavior or experience) that could contribute to the psychotherapeutic treatment of PTSD but have not yet been investigated in controlled studies. Reported positive effects extend beyond PTSD symptoms only. CONCLUSION: Psychedelics may have potential to serve as a catalyst for the psychotherapeutic treatment of PTSD. Most evidence exists for MDMA-supported psychotherapy; relatively little research is available on ketamine and classical psychedelics. Future research needs to show whether the use of psychedelics can be integrated into available treatment options for PTSD.