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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.
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.
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.
Meningiomas are usually benign and asymptomatic. However, neuropsychiatric symptoms can arise due to intracranial mass effect. We describe the case of a 55-year-old female patient with longstanding psychiatric and cognitive complaints, which were subsequently attributed to a frontal meningioma. Following resection, the patient suffered psychotic decompensation with severe consequences. This case illustrates the complex and multidisciplinary interplay of factors contributing to psychiatric decompensation following brain surgery. Therefore, an interdisciplinary approach is essential, ideally initiated prior to surgery, for early identification of patients at risk of decompensation.
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.
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.
The centenary of Frantz Fanon’s birth in 2025 sparked renewed attention to his work. In recent years, his reception has shifted noticeably: from Fanon as a political activist to Fanon as a psychiatrist. To offer a concise exploration of the historical significance and contemporary relevance of Fanon’s psychiatric writings, and to help make this body of work more accessible to a Dutch-speaking readership. A reflective discussion based on a literature review of both the primary and recent secondary literature, including a recent narrative literature review on Fanon via PubMed. The renewed engagement with Fanon’s psychiatric writing provides a more accurate understanding of his role in the decolonization of psychiatry and sheds light on his radically innovative clinical practice as a psychiatrist. Although formal decolonization largely lies behind us, Fanon remains a vital point of reference for social and transcultural psychiatry. His work continues to issue a postcolonial challenge to the broader psychiatric field: it calls for culturally sensitive care and reminds psychiatry of its societal responsibility to confront institutional racism.
Scientific research is vital for evidence-based forensic mental health care, yet General Data Protection Regulation (GDPR) implementation created practical and ethical barriers for researchers. To explore the impact of the GDPR on research within forensic psychiatry in Belgium, focusing on GDPR legal frameworks and the tension between privacy and scientific progress. Drawing from field experience and academic literature, I discuss consequences of GDPR interpretations, the role of ethics committees, and present international examples of good practice. GDPR interpretations lead to selection bias, delays in ethical approvals, and growing concerns. Yet, countries like Finland and the United Kingdom demonstrate that responsible data collection is possible. To achieve a structural improvement of GDPR and ethical interpretations, I propose a differentiated assessment model, in which one central committee is responsible for both ethical and privacy assessments. A consistent, pragmatic GDPR interpretation is needed: safeguarding privacy without obstructing socially valuable research.
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For women with a known psychiatric disorder, the perinatal period carries an increased risk of mental health relapse. Drawing up and using a signal plan for pregnancy and the postpartum period (SPPP) can be an important intervention. Pregnant women with a mental health diagnosis have an increased risk of relapse and are at risk for the development of postpartum psychopathology. During this period a pregnancy relapse prevention plan (PRPP) can be made that describes the risks, symptoms of relapse and related interventions. The main goal of this study is to describe the lived experiences of women with a mental health diagnosis with making and using the PRPP. A qualitative study to examine the experiences of women with a mental health diagnosis with making and using the PRPP. Participants were recruited from an outpatient clinic within a ‘Psychiatry and Pregnancy’ mental health institute in the Netherlands. Twelve women with a mental health diagnosis who gave birth participated in this study. Data were collected by individual semi structured interviews supported by a topic list. Four categories/themes of findings emerged from the data; referral and starting up, making and advantage of the PRPP, care after childbirth, using the PRPP, and cooperation. The pregnancy relapse prevention plan provide pregnant women overview, predictability and tranquillity on all aspects according to the pregnancy, childbirth and the postpartum period. The support and the recognition were appreciated. The signal function of the plan was described as an added value. The involvement of the partner and caretakers were essential.
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.
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In patients with longstanding nutritional problems and gastrointestinal symptoms, underweight or with significant weight loss, mostly without an identifiable somatic cause, a diagnostic dilemma arises. There is considerable symptomatic overlap between anorexia nervosa (AN), avoidant/restrictive food intake disorder (ARFID), and somatic symptom disorder (SSD) in such cases, which can lead to divergent clinical interpretations, delayed interventions, and lack of therapeutical direction. <span class="CharOverride-2">We describe a 49-year-old patient who had been treated for several years by gastroenterologists for nausea, vomiting, and weight loss. Extensive diagnostics revealed no abnormalities, and pharmacotherapy had little effect. After several second opinions, both somatic and psychiatric, her symptoms were classified as SSS, and the patient began psychotherapeutic treatment.</span> Although the DSM-5 allows for classification, there is a lack of consensus regarding the nature of this clinical presentation and appropriate treatment strategies. We identify factors that may help differentiate between the above-mentioned classifications, though further research into underlying mechanisms remains essential. Current healthcare structures often fail to meet the complex needs of these patients. Moreover, the somatic features of this condition lead to exclusion from treatment programs. We advocate for cross-domain diagnostics and integrated care, in which biological, psychological and social aspects are regarded as equally essential components.
The professional reality of psychiatrists is complex and dynamic, requiring continual adjustments in the way the professional role is enacted. To develop a conceptual framework for professional development in light of this need for ongoing professional adaptation. Literature review and conceptual analysis. Professional adaptive capacity is manifested in the iterative progression through an adaptive cycle in which individuals develop proficiency in professional meta-competencies. Training in professional meta-competencies deserves attention in psychiatric residency training; the national training curriculum in The Netherlands provides opportunities to incorporate this focus.
Religion, spirituality and meaning making (RSM) are an important aspect of psychological health. Consequently, it is also important in child and adolescent psychiatry to engage with issues related to RSM. However, little is known about the perspective of care providers in child and adolescent psychiatry on RSM, and about the way in which this is practiced. To explore care providers’ perspectives on the importance of RSM, their ability to discuss it, and the practice. A self-report questionnaire on the perceived importance and competencies at RSM was completed by 220 of the 737 child and adolescent psychiatry care providers (30%). Although 90% of respondents indicated that they found RSM important in their therapy and feel capable of discussing it, only 10% regularly discussed RSM during intake. Barriers included a lack of knowledge of the people to refer to (for 72% of respondents), a lack of knowledge about RSM (55%), the perception of not being responsible for RSM (30%), and a lack of time (25%). Discussing RSM in diagnosis and treatment is experienced as relevant by care providers in child and adolescent psychiatry. In practice RSM is not mentioned so often. Based on this research, it is recommended to equip care providers in the field of RSM.