Tijdschrift voor psychiatrie最新文献

{"title":"[The organization of psychiatry in the Netherlands and Belgium: who is an example for whom?]","authors":"K R Goethals, T Birkenhäger","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The medical profession such as that of a psychiatrist is a profession with three essential characteristics (specialist care, autonomy and formal recognition, and professional ethics). The 21st century is characterized by bureaucratization and marketization of healthcare. Medical sociologist Friedson described three forms of logic: the logic of the professional, the logic of bureaucracy and the logic of the market.</p><p><strong>Aim: </strong>To test the position, autonomy and effectiveness of the psychiatrist from a historical perspective. To assess developments in Dutch and Belgian psychiatry and make a comparison.</p><p><strong>Method: </strong>Two psychiatrists from Belgium and the Netherlands mention relevant developments. It is examined which form of logic is followed in these developments.</p><p><strong>Results: </strong>The logic of the professional applies to quality and further training, but is threatened by some Boards of Directors and the position of the Dutch psychiatrist. The logic of bureaucracy dominates in the new legislation on compulsory healthcare in the Netherlands. Finally, the powerful health insurers illustrate the logic of the market.</p><p><strong>Conclusion: </strong>The logics of bureaucracy and the market take the upper hand in the Netherlands, to the detriment of the logic of the professional. Extensive bureaucratization and the power of health insurers are not desirable developments for Belgium. Belgians should urgently consider the options for compulsory treatment and mandatory quality and further training.</p>","PeriodicalId":23100,"journal":{"name":"Tijdschrift voor psychiatrie","volume":"67 2","pages":"134-138"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Moving from the medical model in the present towards human centered care in the future].","authors":"F P Velders","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Mental health care is under great pressure; the current system is bursting at the seams with waiting times and cutbacks against the backdrop of major societal transformations.</p><p><strong>Aim: </strong>From the chaos of the present, this essay attempts to sketch a perspective on the future of psychiatry.</p><p><strong>Method: </strong>Using the theory of major transformations and systems change this essay zooms out to a complex systemic perspective to try to paint a picture of psychiatry in 10 years&rsquo; time.</p><p><strong>Results: </strong>Several theories of major systemic change suggest that healthcare is moving from the current medical model to human-centered care from an ecosystem that is organized around the person. There are already new initiatives that seem to be making a start in this direction. Nevertheless, the future is difficult to predict and time will tell where we will be in 10 years&rsquo; time.</p><p><strong>Conclusion: </strong>The major transformation in healthcare is moving in the direction of human-centered care in which hope and possibilities present themselves for a healthier society.</p>","PeriodicalId":23100,"journal":{"name":"Tijdschrift voor psychiatrie","volume":"67 2","pages":"76-79"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Tomorrow's psychiatry for older adults: solutions for a future-proof care].","authors":"G J Hendriks, S Sobczak, M L Oudega, H Jeuring, E van Exel, D Rhebergen, R C Oude Voshaar","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Backgrund: </strong>Psychiatric disorders in older adults are underdiagnosed and undertreated, despite their high prevalence and significant impact on medical care utilisation. Given demographic developments and the limited number of specialised psychiatrists, an age-based mental health care division is not sustainable for the future. Which solutions are future-proof?</p><p><strong>Aim: </strong>To describe solutions for a future-proof psychiatry for older adults.</p><p><strong>Method: </strong>Literature review and consideration.</p><p><strong>Results: </strong>Future-proof care requires a strategic positioning of old age psychiatrists, focusing on their specific expertise at the intersection of psychiatry and somatics, neurocognitive disorders, the psychosocial characteristics of the third and fourth stages of life, and end-of-life care. This includes an effective role in early detection and consultation in general practice, guidance during transitions in the psychosocial context of individuals, transitions from vitality to physical frailty in mental health care, and within the somatic care chain involving general hospitals and long-term care facilities.</p><p><strong>Conclusion: </strong>For future-proof care, strategic positioning of the old age psychiatrist is desirable, as well as investments in research, education, network-based care, and digital technology to flexibly respond to the evolving care demands.</p>","PeriodicalId":23100,"journal":{"name":"Tijdschrift voor psychiatrie","volume":"67 2","pages":"84-88"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Het Tijdschrift in 2025].","authors":"H L Van","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":23100,"journal":{"name":"Tijdschrift voor psychiatrie","volume":"67 1","pages":"8-9"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Psychiatric drug development on the verge of its Rubicon].","authors":"G Jacobs","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Recent reports from the psychiatric drug development space have been feeding the expectation of novel pharmacotherapies reaching the clinic over the next couple of years. In this context, advancement of novel compounds such as esketamine, KarXT, MDMA, daridorexant and psilocybine following decades of stagnation, is undoubtedly promising. However, complacency on the side of drug developers and psychiatrist should be considered premature.</p><p><strong>Method: </strong>Discussion of literature, examples and backgrounds of drug development in psychiatry.</p><p><strong>Results: </strong>After all, compared to neurology and oncology, psychiatry is lagging behind in terms of potential new drugs targeting truly novel mechanisms of action to treat psychiatric disorders. The current situation is conceptually related to 1) lacking an understanding of the pathophysiology of psychiatric disorders, 2) limited pharmacological characterization of novel drugs, 3) equating phenomenological diagnostic categories to diseases with a biological basis, and 4) the pharmaceutical industry aiming to introduce &lsquo;blockbuster drugs&rsquo; to the market.</p><p><strong>Conclusion: </strong>Altogether, psychiatric drug development is currently undergoing something of a renaissance, but relevant stakeholders seem unable to address the shortcomings and pitfalls of the current approach, risking psychiatric drug development to fall even further behind. Improving drug development in psychiatry is only possible if clinicians, researchers, drug developers and regulators join forces in a concerted effort to address these issues.</p>","PeriodicalId":23100,"journal":{"name":"Tijdschrift voor psychiatrie","volume":"67 2","pages":"105-109"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[De behandelrelatie, verplichte zorg én de zoektocht naar perspectief].","authors":"S Berendsen","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":23100,"journal":{"name":"Tijdschrift voor psychiatrie","volume":"67 5","pages":"257-258"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144555020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Trauma-focused and personality disorder treatment for posttraumatic stress disorder and comorbid cluster C personality disorder].","authors":"A van den End, A T F Beekman, J J M Dekker, K Thomaes","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Posttraumatic stress disorder (PTSD) is associated with high rates of avoidant, dependent and obsessive-compulsive personality disorders (cluster C-PD). It is unknown whether concurrent treatment for PTSD and comorbid cluster C-PD leads to superior treatment effects, compared to standalone trauma-focused treatment.</p><p><strong>Aim: </strong>To test the efficacy of adding 52-58 sessions of PD treatment (group schema therapy; GST) to 12-18 sessions of individual trauma-focused treatment (imagery rescripting; ImRs).</p><p><strong>Method: </strong>130 adult outpatients were randomized to receive either ImRs or ImRs+GST. The main outcome was PTSD severity one year after start of treatment (CAPS-5). Secondary outcomes were cluster C-PD, psychiatric symptoms, quality of life, functioning, treatment response, remission, and dropout.</p><p><strong>Results: </strong>At 12 months, there were large decreases in PTSD severity (d = 2,4), PD symptoms and all other secondary outcomes. There were no significant differences between conditions.</p><p><strong>Conclusion: </strong>Large effects were observed in both treatment arms. The results suggests that trauma focused treatment is the preferred primary treatment in patients presenting with PTSD and comorbid cluster C-PD, after which more intensive psychotherapy aimed at the personality disorder may be considered in the case of residual personality disorder symptoms.</p>","PeriodicalId":23100,"journal":{"name":"Tijdschrift voor psychiatrie","volume":"67 3","pages":"184-0"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[The future of the Belgian psychiatric patient according to the WPA-Lancet Commission].","authors":"K R Goethals, G Dom","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>In 2017, the World Psychiatric Association-Lancet Psychiatry Commission on the future of psychiatry identified several priority areas for the next decade. Six major domains were distinguished, namely the patient and his treatment, psychiatry and healthcare systems, psychiatry and society, the future of mental health legislation, digital psychiatry and training the psychiatrist of the future. This essay examines the state of affairs in Belgium seven years after the publication of the above-mentioned document.</p><p><strong>Method: </strong>Testing the situation in Belgium based on scientific literature and policy documents, and on experience and opinion of the authors.</p><p><strong>Results: </strong>Psychiatry training and research are slow to keep up with demographic changes such as aging and cultural diversity. There is also a stark lack of capacity and competencies in clinical practice. The reforms within Belgian mental health care have received international appreciation in recent years. However, multi-stage care is still not getting off the ground. There is also insufficient capacity for outpatient care for patients with serious psychiatric disorders. In addition to the law on compulsory admission, the law on patient rights was renewed. Digital psychiatric care has hardly been rolled out. Finally, the training and education for the future psychiatrist is still based too much on knowledge transfer and not enough on the acquisition of skills.</p><p><strong>Conclusion: </strong>The World Health Organization and Europe praise the Belgian reforms regarding the socialization of healthcare. However, compared to future expectations for our field, a lot still needs to be done.</p>","PeriodicalId":23100,"journal":{"name":"Tijdschrift voor psychiatrie","volume":"67 2","pages":"139-143"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Cracks in the glass ceiling: an increase in female professors in psychiatry in the Netherlands].","authors":"A B Koopmans, M Lancee, M H Rubbens-Özgen, M H J Hillegers, J Zinkstok, A Dols","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Despite major progress in women&rsquo;s emancipation, women remain underrepresented in the highest academic positions.</p><p><strong>Aim: </strong>To 1. determine the percentage of female psychiatry professors affiliated with a university medical center (UMC), 2. analyze the increase in female psychiatry professors over the years relative to the number of female psychiatrists, and 3. provide a prognosis for future trends.</p><p><strong>Method: </strong>For this descriptive study we utilized data from the Dutch Association of Psychiatry and the Dutch UMC, and research questions were answered with descriptive analyses, correlation tests with a Pearson correlation coefficient and group comparisons with a two-tailed t-test. Results were presented graphically.</p><p><strong>Results: </strong>Out of 40 psychiatry professors in UMC, 14 were women (35%) and 26 were men (65%). A cautious forecast suggested this will rise to 43% by 2030. The average age at appointment for male professors was 46.3 years (SD 5.4), compared to 49 years (SD 5.6) for female professors (p = 0.17).</p><p><strong>Conclusion: </strong>Over the past two years, the percentage of female psychiatry professors has increased significantly by 11%. Despite the increase, this percentage remains low compared to the 54% of female psychiatrists in 2024 and does not keep pace with the growing number of female psychiatrists. We advocate for policies that promote diversity and inclusion, as these lead to higher quality research and does justice to our diverse patient population.</p>","PeriodicalId":23100,"journal":{"name":"Tijdschrift voor psychiatrie","volume":"67 2","pages":"89-93"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Inpatient behavioural therapy program for depression: a first effect measurement].","authors":"C Hennipman-Herweijer, C Vrijmoeth, L A Bergsma, H G Ruhé, B van den Brink","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Behavioural activation is more and more seen as an independent therapy for depression, because of its feasibility and effectiveness. The Dutch Guideline Depression recommends behavioural therapeutic interventions during (clinical) treatment for depression.</p><p><strong>Aim: </strong>To present the design of a 12-day clinical and integrated, multimodal treatment program based on intensive behavioural activation for depression. Furthermore, to examine the effect of the program on the level of depressive symptoms, total psychological symptoms and vitality over time, and to evaluate the efficacy of the programme in treating therapy-resistant cases.</p><p><strong>Method: </strong>A retrospective analysis of files of patients who participated in the program between 2019 and 2022. To examine the change over time (time + time2) of perceived depressive symptoms (Beck Depression Inventory, BDI), total psychological complaints and vitality (Symptom Questionnaire &ndash; 48), linear mixed model analyses were conducted.</p><p><strong>Results: </strong>Out of 107 patients, 54 retrospectively provided informed consent. Eventually, we included the data of 50 patients for this study. The results revealed a significant reduction in depressive symptoms and overall psychological symptoms over time, which receded slightly at follow-up. The adjusted mean BDI score decreased from 32.96 at the start of the clinical programme to 28.96 upon completion and to 28.20 one to three months later. No significant time effect was observed for vitality. Furthermore, there was no interaction effect of therapy resistance*time on treatment effect.</p><p><strong>Conclusion: </strong>Intensive behavioural activation in a multimodal program, including involving significant others, meaning-making, values and physical activation, seems to have the potential to break the vicious circle of major depressive symptoms, making it possible to continue treatment on an outpatient basis. However, the limitations of this study call for replication of the aims in further research with a larger sample and inclusion of context factors.</p>","PeriodicalId":23100,"journal":{"name":"Tijdschrift voor psychiatrie","volume":"67 4","pages":"220-224"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144209607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}