GGZ Drenthe

Plain Language SummaryExperiencing traumatic events can lead to the development of posttraumatic stress disorder (PTSD), a condition that is burdensome for patients and their loved ones. This study investigated the effects of a novel form of psychotherapy for PTSD called multi-modal motion-assisted memory desensitization and reconsolidation (3MDR). In this treatment, patients process traumatic events while walking on a treadmill in a virtual environment. The virtual environment is personalized by self-selected pictures and music that remind the person of the traumatic events. We investigated this treatment in 134 military veterans and first responders (such as police officers, firefighters and paramedics) in three treatment centers in the Netherlands. They had PTSD after work-related traumatic events such as losing a mate in a bombing, witnessing a suicide, unsuccessful resuscitation of a child, or severe violence by hooligans. They had not received trauma therapy before. Half of the participants received 3MDR and the other half received standard trauma therapy in a sitting position. Results showed that 3MDR measured up to standard trauma therapy, even though it was given in fewer treatment sessions. Effects on a range of questionnaires (measuring PTSD, depressive symptoms, avoidance, and daily functioning) were comparable. The fact that 3MDR could be given in a smaller number of sessions may be advantageous for patients and therapists. 3MDR may also efficiently address multiple traumatic memories. Moreover, walking in 3MDR can appeal to veterans and first responders who are often physically active in their work. The findings of the study support the application of 3MDR as a first treatment for work-related PTSD.

Many patients with COPD use inhaled corticosteroids (ICS) without proper indication. We developed a multifaceted tailor-made de-implementation strategy—including a toolbox, communication plan, and training—to reduce inappropriate ICS use in general practice. We evaluated its effectiveness (i.e. decline in percentage of patients with COPD that use ICS) and other outcomes during a 15-month study in Drenthe, the Netherlands. Less patients (−4.7%,95%CI: 2.6–6.7%) used ICS at the end of follow-up and the percentage of ICS-users declined by 8.2% (95%CI: 2.9–13.4%) across the 14 practices that fully participated in the project. ICS user percentages declined significantly moreover time in the fully participation group than in the control group (beta-regression, β = −0.041,SE = 0.011, p < 0.01). While these findings are promising, further research is needed to assess additional penetration and sustainability of the strategy in the region and to explore the applicability of comparable regional ICS de-implementation plans.

The International Society for Bipolar Disorders (ISBD) Chronobiology and Chronotherapy Task Force conducted a comprehensive review to deliver concise evidence-based recommendations on the use of bright light therapy (BLT) for bipolar disorder (BD). Adjunctive BLT is likely an efficacious acute treatment for bipolar depression as implicated by higher quality evidence. The position of maintenance BLT for relapse prevention awaits further investigation. Protocols of effective BLT in BD are similar to parameters indicated for treatment of seasonal and non-seasonal major depressive disorder. Anti-manic prophylaxis (especially for BD-I) and clinical monitoring are recommended with initiation of and ongoing light treatment. Administer BLT daily, preferably in the morning or at mid-day. If mornings are prohibitive, then mid-day exposure, implemented to avoid excessively early wake times, is an acceptable alternative. Informed by the literature, target 30 min/day of BLT exposure. Patients wary of emergent hypomania or partial responders, can initiate 15 min/day and increase by 15 min each week to full response (or 30-60 min/day by the fourth week). Consider patient centred outcome assessments to evaluate mood response, safety and side effects. Clinical improvement is typically observed within 1-2 weeks, with response/remission expected by 4-6 weeks. Integration of BLT with other chronotherapeutic strategies may enhance long-term efficacy.

BackgroundMajor depressive disorders significantly impact the lives of individuals, with varied treatment responses necessitating personalized approaches. Shared decision-making (SDM) enhances patient-centered care by involving patients in treatment choices. To date, instruments facilitating SDM in depression treatment are limited, particularly those that incorporate personalized information alongside general patient data and in cocreation with patients.ObjectiveThis study outlines the development of an instrument designed to provide patients with depression and their clinicians with (1) systematic information in a digital report regarding symptoms, medical history, situational factors, and potentially successful treatment strategies and (2) objective treatment information to guide decision-making.MethodsThe study was co-led by researchers and patient representatives, ensuring that all decisions regarding the development of the instrument were made collaboratively. Data collection, analyses, and tool development occurred between 2017 and 2021 using a mixed methods approach. Qualitative research provided insight into the needs and preferences of end users. A scoping review summarized the available literature on identified predictors of treatment response. K-means cluster analysis was applied to suggest potentially successful treatment options based on the outcomes of similar patients in the past. These data were integrated into a digital report. Patient advocacy groups developed treatment option grids to provide objective information on evidence-based treatment options.ResultsThe Instrument for shared decision-making in depression (I-SHARED) was developed, incorporating individual characteristics and preferences. Qualitative analysis and the scoping review identified 4 categories of predictors of treatment response. The cluster analysis revealed 5 distinct clusters based on symptoms, functioning, and age. The cocreated I-SHARED report combined all findings and was integrated into an existing electronic health record system, ready for piloting, along with the treatment option grids.ConclusionsThe collaboratively developed I-SHARED tool, which facilitates informed and patient-centered treatment decisions, marks a significant advancement in personalized treatment and SDM for patients with major depressive disorders.

BackgroundSocial recovery (SR) in people with psychotic disorders involves taking on social roles and completing daily tasks. Functional recovery (FR), particularly executive functions, is critical for these roles. Psychotic disorder patients often experience severe cognitive impairments, especially in executive functions. This study investigates the relationship between functional and social recovery in individuals with psychotic disorders and examines the effect of employment status on this association.MethodThis cross-sectional study involved people with a psychotic disorder. SR was measured using the WHO-DAS, divided into Daily Functioning (DF) and Social Functioning (SF) scales. FR was measured using the BRIEF-A and the TOL. Employment status was categorized into Non-active, Otherwise Active, and Active. The Likelihood-ratio Test (LRT) was used for model selection.ResultsData from 251 participants (mean age 41.5) showed that the BRIEF-A affected both DF and SF, while the TOL only affected DF. Only being Otherwise Active influenced DF. Employment status had no influence on SF. Being Otherwise Active positively influenced perceived disabilities in Daily Functioning.ConclusionMeasuring executive functions using both performance-based and self-report measures is important. Both measures are associated differently with perceived disabilities in daily and social functioning. Being a volunteer or looking for a job positively influences perceived disabilities in Daily Functioning.

Prolonged grief disorder (PGD) is a new diagnostic category included in global diagnostic classification systems for mental disorders. However, PGD can only be diagnosed if the severity and duration exceed socio-cultural norms. Here, we present a new supplementary module to the DSM-5 Cultural Formulation Interview: the Bereavement and Grief Cultural Formulation Interview (BG-CFI). The BG-CFI was developed to help clinicians provide a culturally informed diagnosis and guide treatment planning.We investigated the feasibility, acceptability, and clinical utility of the BG-CFI. Two participant groups (11 refugees, asylum seekers or migrants experiencing bereavement and 3 clinicians) took part in the study and were interviewed using open-ended questions on measures of feasibility, acceptability, and clinical utility. A step-by-step procedure was followed: (1) Clinicians and/or researchers conducted the BG-CFI with participants; (2) Debriefing interviews were conducted separately with clinicians and with bereaved participants.The BG-CFI was found to be a feasible, acceptable, and clinically useful tool for both bereaved participants and clinicians. Where clinicians found the interview difficult to conduct (i.e. lack of conceptual clarity or triggering emotional distress) specific changes were made to the interview format such as prompts for further questioning or recommendations for withholding or adapting questions. The BG-CFI would offer a useful complement for a reliable assessment of PGD in clinical settings working with cultural incongruity.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11013-025-09927-2.

IntroductionDespite considerable efforts, tobacco use disorder persists as a significant public health issue. The effectiveness of current smoking cessation therapies is limited, leading to a growing interest in alternative treatment approaches such as psychedelics.AimThe aim of this review is to evaluate the scientific evidence regarding the role of psychedelics in smoking cessation.MethodsTo identify relevant literature on psychedelics and smoking cessation, a search was conducted in four academic literature databases PubMed, MEDLINE, PsycINFO, and Embase. Databases were searched from their inception up to March 24, 2024.ResultsOut of the 1073 articles identified in databases, 8 publications (both clinical and non-clinical studies) met the inclusion criteria, of which a total of 4 publications originated from a single study. The majority of the studies focused on psilocybin (n = 7), for which supportive evidence was suggested for the treatment of tobacco use disorder. Additionally, research was conducted with other psychedelics for smoking cessation, such as ayahuasca, mescaline, peyote, lysergic acid diethylamide (LSD), lysergic acid amide (LSA) and (dimethyltryptamine (DMT), but the evidence base for these psychedelics is too small to draw definitive conclusions.ConclusionsThere is, although limited, evidence that psychedelics, in particular psilocybin, may offer a potential avenue for combating tobacco use disorder, though more research is needed to understand their effectiveness and safety fully.

People with intellectual disabilities (IDs) often present with challenging behaviors (CBs) mostly due to inappropriate environments and mental and physical disorders. Integrative care is recommended to address CBs. However, in clinical practice, psychotropic drugs are often prescribed off-label for CBs, although the effectiveness is unclear, and side effects frequently occur. We conducted a cluster-randomized controlled study to investigate the effect of integrative care provided by a collaboration of an ID specialized mental healthcare team and participants' own ID service providers' care team on reducing CBs and inappropriate off-label psychotropic drug prescriptions compared with care as usual. Participants (N = 33, aged 19-81 years) had a moderate, severe, or profound intellectual disability and used off-label psychotropic drugs. The primary outcome measures were the Aberrant Behavior Checklist and the total dose of psychotropic drug prescriptions. At the study endpoint of 40 weeks, we found no effect of the intervention on the total ABC score and on the total dose of psychotropic drug prescriptions. In the intervention group, however, the psychotropic drug dose decreased significantly, while CBs did not change. The small sample size and not-completed interventions due to organizational problems may have affected our findings. This study illustrates the difficulties in the implementation of integrative care.

Tics can have a serious impact on the quality of life of children and their families. Behavioural therapy is an evidence-based first line treatment for tic disorders. This randomised controlled trial studied the efficacy of a brief, condensed group-based programme for children with tics (Dutch Trial Registry NL8052, 27 September 2019). Tackle your Tics is a four-day group treatment, including exposure and response prevention and supporting components, delivered by therapists and ‘experts by experience’. We collected outcome measures at baseline (T1), directly post-treatment (T2), and at three- and 6-months follow-up (T3, T4) including tic severity (primary outcome measure), tic-related impairment, quality of life, tic-related cognitions, emotional/behavioural functioning, family functioning, treatment satisfaction and adherence. Outcomes directly post-treatment improved in both the treatment group (n = 52) and waiting list (n = 54), but showed no statistically significant differences between the conditions (differential change over time T1-T2) on tic severity (Yale Global Tic Severity Scale), quality of life (Gilles de la Tourette Syndrome Quality of Life Scale), tic-related cognitions and family functioning. At longer term (T3), again no between-group difference was found on tic severity, but tic-related impairment, quality of life and emotional/behavioural functioning significantly improved in the treatment group compared to the waiting list. Mean treatment satisfaction scores were favourable for both children and parents. Directly posttreatment, Tackle your Tics showed no superior effect compared to waiting list. However, on longer term this brief four-day group treatment was effective in improving tic-related impairment, quality of life and emotional/behavioural functioning.