GGZ Delfland

The book Computational Discovery on Jupyter by Calkin, Chan, and Corless was published November 2023 by SIAM. As part of its marketing efforts, SIAM offered to distribute a calendar for 2024 using images from the book. The authors of the book joined with Simone Conradi and Miller Christen to create images for the calendar. This note describes the construction of each image.

Introduction: Individuals with a personality disorder (PD) often report high exposure to adverse events. Given the strong link between negative life events and PD pathology, it is essential to evaluate trauma-focused treatments in this population. This study evaluated the effectiveness of eye movement desensitization and reprocessing (EMDR) therapy versus waitlist in reducing post-traumatic stress disorder (PTSD) symptoms and diagnostic status, distinguishing between patients with and without PTSD. Second, it examined the impact of EMDR therapy on adverse event memories, both meeting and not meeting Criterion A for PTSD. Methods: Participants (n = 159) were randomly assigned to EMDR therapy or a waitlist. PDs were assessed using the Structured Clinical Interview for DSM-5. PTSD symptoms and diagnoses were evaluated using the Clinician-Administered PTSD Scale for DSM-5. Secondary analyses examined the effectiveness of EMDR on various types of memory. Results: Significant group-by-time interactions showed a greater reduction in PTSD symptoms in the EMDR therapy group, regardless of the baseline PTSD diagnosis. In patients with PTSD, large effects were found post-treatment (d = 1.26; control: d = 0.28) and at follow-up (d = 1.5; control: d = 0.69). In patients without PTSD, moderate to large effects emerged post-treatment (d = 0.77; control: d = 0.18) and at follow-up (d = 1.09; control: d = 0.46). EMDR therapy reduced symptoms associated with Criterion A trauma and other adverse events. Post-treatment, 65.5% of EMDR patients lost their PTSD diagnosis, increasing to 73.1% at the follow-up. Conclusion: EMDR effectively reduced PTSD symptoms in individuals with a PD, regardless of PTSD diagnosis, and proved effective for memories that did not meet Criterion A.

BackgroundVirtual reality (VR) may improve psychological treatments for psychotic disorders. We investigated the effects of VR-based cognitive behavior therapy for paranoid ideation (VR-CBTp) compared to standard CBTp.MethodsWe conducted a pragmatic, single-blind, randomized clinical trial in seven mental health centers across the Netherlands and Belgium. A total of 98 participants with a psychotic spectrum disorder and paranoid ideation were randomized to a maximum of 16 sessions of VR-CBTp (n = 48) or CBTp (n = 50). The primary outcome was momentary paranoia, measured with the experience sampling method (ESM) at posttreatment. Secondary measures, assessed at baseline, posttreatment, and 3-month follow-up, included symptoms (paranoia, hallucination, depression, cognition, and anxiety related), social functioning, self-esteem, and schemes.ResultsBoth groups showed reductions in momentary paranoia between baseline and posttreatment (n = 56, b = −15.0, effect size [ES] = 0.65), but those were greater for VR-CBT (interaction b = 8.3, ES = 0.62). Reductions remained at follow-up (n = 50, b = −10.7, ES = 0.57) but not the interaction. Limited ESM compliance resulted in data loss; however, secondary paranoia measures did confirm improvements (ES range = 0.66–1.15, n = 78–81), but not the interaction. Both groups improved in symptoms, self-esteem, and social functioning. Interaction effects in favor of VR-CBTp were found for safety behavior, depression, and self-esteem at posttreatment, and self-esteem and anxiety at follow-up. For VR-CBTp, 37.5% did not complete treatment; for CBTp, this was 24.0%. Completers, on average, received 12.7 (VR-CBTp: standard deviation [SD] = 3.9) and 15.1 (CBTp: SD = 2.5) sessions.ConclusionsBoth CBTp and VR-CBTp are efficacious treatments for paranoid ideation, but VR-CBTp may be somewhat more effective. Limitations concern missing primary outcome data and a lower sample size than anticipated.

Aripiprazole is one of the most commonly prescribed antipsychotic drugs to children and adolescents worldwide, but it is associated with serious side effects, including weight gain. This study assessed the population pharmacokinetics of aripiprazole and its active metabolite and investigated the relationship between PK parameters and BMI in children and adolescents with ASD and behavioral problems. Secondary outcomes were metabolic, endocrine, extrapyramidal and cardiac side effects and drug effectiveness. Twenty-four children and adolescents (15 males, 9 females) aged 6-18 years were included in a 24-week prospective observational trial. Drug plasma concentrations, side effects and drug effectiveness were measured at several time points during follow-up. Relevant pharmacokinetic covariates, including CYP2D6, CYP3A4, CYP3A5 and P-glycoprotein (ABCB1) genotypes, were determined. Nonlinear mixed-effects modelling (NONMEM®) was used for a population pharmacokinetic analysis with 92 aripiprazole and 91 dehydro-aripiprazole concentrations. Subsequently, model-based trough concentrations, maximum concentrations and 24-hour AUCs were analyzed to predict outcomes using generalized and linear mixed-effects models. For both aripiprazole and de-hydro-aripiprazole, one-compartment models best described the measured concentrations, with albumin and BMI as significant covariates. Of all the pharmacokinetic parameters, higher sum (aripiprazole plus dehydro-aripiprazole) trough concentrations best predicted higher BMI z-scores (P < .001) and higher Hb1Ac levels (p=0.03) during follow-up. No significant association was found between sum concentrations and effectiveness. Our results indicate a threshold with regard to safety, which suggests that therapeutic drug monitoring of aripiprazole could potentially increase safety in children and adolescents with ASD and behavioral problems.

Abstract The effectiveness of intense specialised multi‐family therapy (ISMFT) for 111 multi‐stressed families, and the therapeutic alliance as a possible predictor of outcome, were examined. A repeated measures design was used, where changes in all ISMFT phases (preparation, multi‐family therapy and follow‐up) were assessed and compared for both mothers and fathers. Evidence was found for improved family functioning after the therapy period, which was maintained at 3 months follow‐up, although the multi‐stressed families still functioned in the problematic range. The therapy did however not decrease parenting stress, or did so only temporarily. Observations of the therapeutic alliance with the System for Observing Family Therapy Alliances (SOFTA) scales indicated that high therapist engagement was related to positive therapy outcomes, both at the start of therapy and later. High family engagement also predicted therapy effectiveness, but only at the start of therapy. The present study shows that solution‐focused multi‐family therapy at least seems to provide the first step in alleviating problems in multi‐stressed families.

IntroductionPatients living with psychiatric illnesses (PIs) have a high prevalence of obesity. In a 2006 survey, 91.2% of professionals in the bariatric field identified “psychiatric issues” as clear contraindications to weight-loss surgery.MethodsThis retrospective matched case–control study investigated the impact, safety, and possible relapse after bariatric metabolic surgery (BMS) in patients with PIs. Also, we tested the incidence of patients who developed PI after BMS and compared the post-procedural weight loss with that in a matched control group without PIs. The cases were matched in a ratio of 1:4 to the control patients standardized for age, sex, preoperative BMI, and type of BMS.ResultsOf 5987 patients, 2.82% had a preoperative PI; postoperative de novo PI was present in 0.45%. Postoperative BMI was significantly different between the groups when compared to preoperative BMI (p < 0.001). Percentage of total weight loss (%TWL) after six months was not significantly different between the case (24.6% ± 8.9) and control groups (24.0% ± 8.4, p = 1.000). Early and late complications were not significantly different between the groups. The psychiatric drug use and dosage changes did not differ significantly pre- and postoperatively. Of the psychiatric patients, 5.1% were postoperatively admitted to a psychiatric hospital (p = 0.06) unrelated to BMS, and 3.4% had a prolonged absence from work after surgery.ConclusionBMS is an effective weight loss treatment and a safe procedure for patients with psychiatric disorders. We found no change in the patients’ psychiatric status outside the usual disease course. Postoperative de novo PI was rare in the present study. Furthermore, patients with severe psychiatric illness were excluded from undergoing surgery and, therefore, from the study. Careful follow-up is necessary to guide and protect patients with PI.Graphical

Abstract Background Children and adolescents in mental healthcare often perceive their care needs and necessary treatment differently from their clinicians. As such discordance between young patients and clinicians may obstruct treatment adherence and compromise treatment outcomes, it is important to understand the factors associated with it. We therefore investigated the factors associated with patient-clinician discordance with regard to care needs in various areas of functioning. Methods A cross-sectional study involving 244 children/adolescents aged 6-18 participating with their clinicians in treatment at a specialized mental healthcare center. As a previous study conducted by our research group had found the greatest patient-clinician discordance in three CANSAS care needs – “mental health problems,” “information regarding diagnosis and/or treatment,” and “making and/or keeping friends” – we used univariable and multivariable statistics to investigate the factors associated with discordance regarding these three care needs. Results Patient-clinician discordance on the three CANSAS items was associated with child, parent, and family/social-context factors. Three variables were significant in each of the three final multivariable models: dangerous behavior towards self (child level); severity of psychiatric problems of the parent (parent level); and growing up in a single-parent household (family/social-context level). Conclusions To deliver treatment most effectively and to prevent drop-out, it is important during diagnostic assessment and treatment planning to address the patient’s care needs at all three levels: child, parent and family/social context.

Department of Psychiatry, Erasmus University Medical Center, CA Rotterdam the Netherlands [email protected] Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp Antwerp, Belgium. Department of Psychiatry, Erasmus University Medical Center, CA Rotterdam, the Netherlands. GGZ Delfland, Sint Jorisweg 2, 2612 GA Delft the Netherlands. Department of Psychiatry, Erasmus University Medical Center, CA Rotterdam the Netherlands.

As mental disorders impact quality of life and result in high costs for society, it is important patients receive timely and adequate care. This scoping review first aims to summarize which factors contribute to specialized mental health care (SMHC) use. Within the Dutch health care system, the general practitioner (GP) is the filter for SMHC and care use costs are relatively low. Second, to organize factors by Andersen and Newman’s care utilization model in illness level, predisposing, and enabling factors. Third, to assess equity of access to SMHC in the Netherlands. A health care system is equitable when illness level and the demographic predisposing factors age and gender account for most variation in care use and inequitable when enabling factors and social predisposing factors such as education predominate. We identified 13 cross-sectional and cohort studies in the Netherlands published between 1970 and September 2020 with 20 assessed factors. Illness level factors, disease severity, diagnosis, personality, and comorbidity contributed the most to SMHC use. Predisposing factors related to a more solitary lifestyle contributed to a lesser degree. Enabling factors income and urbanicity contributed the least to SMHC use. These results imply inequity. Factors that did not fit the care utilization model were GP related, for example the ability to recognize mental disorders. This emphasizes their importance in a system where patients are dependent on GPs for access to SMHC. Focus should be on improving recognition of mental disorders by GPs as well as collaboration with mental health care professionals.