共找到 20 条结果
暂无摘要（点击查看详情）
暂无摘要（点击查看详情）
Professional anxieties in psychiatric practice are often insufficiently recognized and infrequently discussed, despite their potentially significant impact on the quality of care. To examine these less visible forms of anxiety and their influence on professional functioning. A narrative review based on relevant literature and clinical observations from psychotherapeutic practice. A typology of five categories of professional anxiety is identified: fear of making mistakes, fear of powerlessness, fear of aggression, system-related fears, and existential anxiety. These anxieties appear closely intertwined with defensive medicine, professional isolation, and an increased risk of burnout – factors that generally do not contribute to patient safety. Articulating and discussing professional uncertainty is essential for fostering an environment of psychological safety. A layered approach – at the individual, team, and organizational levels – is necessary to acknowledge these anxieties without pathologizing them.
暂无摘要（点击查看详情）
In recent years, a growing number of young people have requested medical aid in dying (MAID) on the basis of psychiatric suffering. This development has raised concern within the mental health care sector and has contributed to a broader societal debate. To address the following question: what can mental health care professionals do in response to a MAID request from a young person? In this essay, a group of youth mental health experts examines the issue from multiple perspectives and formulates recommendations for a practical framework to support health care professionals who are confronted in clinical practice with a young person – and their relatives – requesting MAID. MAID requests from young people based on psychiatric suffering are even more complex than those made by adults. We recommend that clinicians adopt a basic attitude of ‘not now’. This approach entails taking the wish for MAID seriously and exploring it carefully, without acting on it immediately. Instead, we advocate a strategy of slowing down and enduring. In this essay, we present a ‘not now’ conceptual framework for responding to MAID requests from young people on the grounds of psychiatric suffering. In addition to this approach, it is essential that high-quality, accessible and humane care is available to young people making a MAID request, as well as to their relatives.
Melatonin is used as a chronobiotic in the treatment of sleeping disorders to correct disturbances in the circadian rhythm, including in children and adolescents. dim light melatonin onset (DLMO) and the peak in plasma concentration of melatonin contribute to this circadian rhythm. International research shows that the number of prescriptions for melatonin among children and adolescents is increasing significantly. However, there appears to be little empirical research on the best way to taper and/or discontinue melatonin in this population. To assess the available literature regarding the best way to taper and/or discontinue melatonin in minors with sleep problems, with or without autism spectrum disorder (ASD) or attention-deficit/hyperactivity disorder (ADHD). A systematic review of the literature in the PubMed (Medline) and Embase databases. Several effects of the melatonin therapy on sleep onset, sleep latency, sleep duration, sleep efficiency, and nocturnal activity disappear after discontinuation of the treatment. However, we cannot formulate evidence-based guidelines regarding treatment duration, timing of administration, dosage, or the method of discontinuation. DLMO prior to treatment does, however, have predictive value for the effect of discontinuing melatonin therapy. A DLMO-measurement prior to starting melatonin treatment provides clinicians with insight into the expected effects of melatonin during therapy. This allows for an estimation of whether melatonin will have not only a soporific but also a chronobiotic effect during treatment. Based on this information, clinicians can consider whether initiating or discontinuing melatonin therapy is appropriate. Consequently, our literature review provides a strong argument for reimbursement of DLMO-measurements by health insurance funds.
Highly specialized consultation is a promising intervention for improving the treatment for mental disorders. To model the impact of consultation for eating disorders (EDs). An explorative economic impact analysis was conducted in 2024-2025, utilizing data on patients who had been in treatment for more than two years within specialized secondary care for EDs as their primary diagnosis (anorexia nervosa, bulimia nervosa, binge eating disorder). These data were used to model the effects of consultation for EDs. Sensitivity analyses were performed to evaluate the robustness of the findings across different estimated parameter values. Across all five care pathways, consultation for EDs was effective in: 1. reducing the burden of disease for patients, work absenteeism and direct mental healthcare costs and 2. enhancing the patient flow in mental healthcare. Consultation for EDs is a potentially promising intervention with both clinical and systemic benefits. Therefore, the Centres of Excellence for Eating Disorders aim to further investigate and implement consultation for EDs, in order to make knowledge accessible and contribute to the provision of appropriate care for patients with EDs.
Crises in people with intellectual disabilities often occur at the intersection of mental health care (MHC) and intellectual disability care (IDC). Different actors and crisis regulations with their own definitions and agreements make appropriate care challenging. Effective collaboration between MHC and IDC is essential but often not structurally organized. To distinguish between different types of crises in order to promote shared perceptions and a common language between MHC and IDC. This will improve the coordination of interventions and make cooperation between professionals more effective. Based on clinical experience and scientific background, I propose a model with four types of crises: contextual crisis, somatic crisis, overburdening, and psychiatric crisis. Better differentiation between different types of crises can be advantageous for people with intellectual disabilities. It ensures a shared perception and common language across domains, leading to better task distribution and cooperation between the various professionals involved. Better differentiation of crises can improve collaboration between MHC and IDC. This model provides tools for joint crisis management and can further improve care in the future.
Sleep problems and stress are common among adults with autism and can affect physical activity, daily functioning, and quality of life. This study explores the relationships between perceived stress, sleep, and physical activity in adults with autism. To examine whether there is a reciprocal relationship between perceived stress, physical activity, and sleep in adults with autism. Seventeen adults with autism participated in a cohort study using experience sampling. Perceived stress levels were measured four times a day for 28 days via the Stress Autism Mate (SAM) app. Sleep and physical activity, expressed as the number of steps, were measured with a smartwatch (Fitbit Sense). Findings show substantial differences between individuals in how sleep, physical activity, and perceived stress are related. No consistent effect was found of sleep on stress the next day, nor of stress on sleep quality the following night. For some participants, better sleep was linked to lower stress, while others showed no relationship or the opposite pattern. Better sleep was significantly associated with higher physical activity the next day, whereas step count did not significantly affect stress. These results highlight the complexity and variability of sleep, physical activity, and perceived stress interactions in adults with autism, emphasizing the need for personalized interventions. Further research should explore the interplay between perceived stress, activity, and sleep to guide individualized care.
We discuss a case involving a 75-year-old man with Parkinson’s disease (PD) who experienced a psychotic duplication phenomenon. This resembled Capgras syndrome, a misidentification delusion characterized by the false belief that a familiar person has been replaced by a double. However, our patient did not exhibit a delusion but rather a hallucination in which he simultaneously perceived his partner in two locations. He consistently engaged with the hallucinatory experience of his partner, whom he saw duplicated at the table, without awareness of the inaccuracy of this perception. Therefore, this may be better classified as a psychotic duplication experience, or reduplicative paramnesia. A similar phenomenon has been described twice previously in Lewy body dementia, where the distinction between delusion and hallucination was also unclear. Throughout the course of Parkinson’s disease, diverse neuropsychiatric symptoms can occur, including variants of reduplication and misidentification. Distinguishing these phenomena in our case was challenging, and we discuss the underlying mechanisms.
Clinical care for adults with eating disorders in the Netherlands is under pressure due to limited capacity and long waiting times. Insight into bed capacity, occupancy, and waiting lists in specialized clinics and medical-psychiatric units (MPUs) is lacking. To gain insight into clinical capacity in eating disorder care in the Netherlands METHOD: A nationwide telephone survey was conducted among 8 clinics and 31 MPUs. Data on capacity, occupancy, waiting lists, and admission criteria were collected between August 26 and September 9, 2025. The clinics had 115 beds, with 103 occupied and 103 patients waiting. Length of stay ranged from months to longer. Some applied BMI thresholds: compulsory care was limited. MPUs had 40-45 beds, 25 occupied, and 20 waiting. Care ranged from acute somatic interventions to structured weight restoration and compulsory care. Severe capacity problems, long waiting times, varying admission criteria, and limited compulsory care highlight the urgent need for expansion of capacity, national coordination and stronger collaboration.
Many antipsychotic users at some point want to stop. They mention side effects, functioning and experiencing no benefits. To explore questions antipsychotic users and their relatives have about stopping or tapering antipsychotics. Data were used from a publicly available anonymous Q&A in which experts answered questions about mental health. Questions about stopping or tapering antipsychotics asked by antipsychotics users and their relatives were analysed using an inductive content analysis. In total 3000 questions were screened, where 426 were about antipsychotics and 194 were about stopping or tapering. The most common question was whether it was sensible to stop. Questions focused on how fast to taper, about the minimum dose, where to find support and when withdrawal symptoms or side effects would subside. Motivations were side effects, difficulties in functioning and experiencing no benefits. Barriers were lack of support and return of symptoms. Facilitators were support from others and experiencing a relief from side effects and/or symptoms. Antipsychotic users and their relatives are left with many questions about stopping. These questions reveal attitudes, preferences and concerns that are important to address when discussing antipsychotic treatment.
暂无摘要（点击查看详情）
Adolescents admitted to psychiatric High Intensive Care (HIC) units typically transition to HIC-Adults upon turning 18 years. Little is known about how adolescents, parents, and healthcare providers experience this transition. To gain insight into the experiences of adolescents, parents, and healthcare providers regarding HIC care during the transitional age (here: 16-23 years). Demographic and clinical data were extracted from patient records. Nine adolescents and ten parents were interviewed. Transcripts were analyzed using inductive thematic analysis. Seventeen healthcare providers participated in two focus groups. The adolescents admitted between April 2020 and December 2023 on either HIC-Youth or HIC-Adult (N = 280), were mostly female (69%), living at home (78%) and admitted due to suicidality (54%). Four key themes were identified: placement and ward climate, autonomy and parental involvement, staff interactions, and attention to transition. Adolescents and parents reported absence of tailored care during the transition. Healthcare providers recognized differences between units but were unaware of the impact. Adolescents on HIC-units suffer from complex issues, and central components are autonomy, safety and developmental age. Although attention to transitional care is increasing, greater awareness of the pivotal role of a HIC unit in the transition is needed.
Mental suffering lies at the heart of psychiatric practice but is often approached as a disorder, defect, or symptom – thereby eclipsing the lived experience itself. To explore how mental suffering can be re-understood as a human experience in context, and what this implies for clinical attitude. Reflective essay based on literature, philosophical analysis, and clinical experience. Mental suffering does not appear as a brain defect but as a disruption of human coherence -embodied, affective, relational, and temporal. It emerges when the natural continuity between past, present, and future falters, and a person temporarily loses their orientation in the world. Suffering is contextually embedded – in body, biography, relationships, and society – and may manifest as powerful, coercive, or opaque. Not all suffering is transparent or meaningful, yet each instance calls for presence and understanding. The clinical encounter becomes a shared hermeneutic space where experiential and professional knowledge complement and correct each other. Mental suffering calls not for repair but for recognition; not for reduction but for presence and dialogue. A clinical stance grounded in listening, resonance, and co-bearability – understanding rather than explaining – creates room for the restoration of coherence, meaning, and humanity.
暂无摘要（点击查看详情）