GGZ Rivierduinen

BackgroundPatients with eating disorders (EDs), particularly anorexia nervosa (AN), experience a complex psychiatric condition often characterized by extreme food restriction, intense fear of weight gain, elevated levels of emotional dysregulation, body image disturbance, and comorbid trauma. Several of these factors can undermine the therapeutic alliance and reduce engagement with treatment, contributing to poorer outcomes. MDMA, a non-classical psychedelic, is being explored as a novel PTSD treatment adjuvans due to its ability to rapidly reduce trauma symptoms and enhance therapeutic alliance. Recent clinical trials and regulatory considerations, as highlighted in emerging research, are shaping its potential therapeutic role, and MDMA may offer a unique mechanism to disrupt maladaptive neural circuits, enhance cognitive flexibility, and facilitate emotional processing in EDs.ObjectiveTo comprehensively evaluate the potential of MDMA-assisted therapy for EDs with a particular focus on the distinct neurobiological and psychological profiles of AN and comorbid PTSD.MethodsThis paper synthesizes current research literature on MDMA, PTSD, and EDs, with an emphasis on clinical trial outcomes, neurobiological mechanisms, and therapeutic frameworks. Both pharmacological and psychotherapeutic components of MDMA-AT are reviewed.ResultsNo clinical trials of MDMA-AT have been conducted in ED populations to date. Findings from clinical trials in patients with PTSD suggest that MDMA’s pro-social and fear-reducing and neuroplastic properties may enhance emotional processing, therapeutic alliance, and cognitive flexibility - key factors that often hinder eating disorder treatment. The ability of MDMA to increase emotional openness, reduce fear responses, and promote cognitive flexibility could support deeper engagement with the therapeutic process and improve treatment outcomes in EDs with comorbid trauma.ConclusionsThe current evidence base suggests that MDMA-AT may hold promise as an adjunctive treatment for EDs echoing its demonstrated therapeutic potential in PTSD. By facilitating deeper emotional processing, enhancing patient-therapist attunement, and fostering openness to change, MDMA may help overcome avoidance, cognitive rigidity, and therapeutic impasses that often hinder progress in EDs. Its integration into clinical practice will require rigorous validation through well powered trials, alongside careful ethical and regulatory oversight, and integration into multidisciplinary treatment frameworks. Tailored dosing, patient selection, and therapist training will be essential for safe and effective implementation. Further research is warranted to fully explore this potential application.Supplementary InformationThe online version contains supplementary material available at 10.1186/s40337-025-01409-5.

Artiklen, der er respons til Qvortrup: ”Interdisciplinaritet i undervisnings- og uddannelsesfag - empiriske eller analytiske enheder i den sammenlignende didaktiks komparation af performative praktisser”, tager teoretisk afsæt i Bakhtins sprogforståelse og former sig som et dialogisk supplement til Qvortrups analyser, idet den tilbyder et sproganalytisk blik på de fund, som Qvortrup viser i sin artikel. Responsartiklen præsenterer kort Bakhtins sprogteori og argumenterer for, at Bakhtins stemmebegreb kan bruges som et analytisk værktøj, der understøtter den tilgang, som Qvortrup anlægger i sin artikel, samt at det kan styrke fund i Qvortrups artikel. Responsartiklen viser, at Bakhtins stemmebegreb kan understøtte både en bottom-up-strategi og være analytisk følsom over for individuelle forskelle og variationer mellem de enkelte elever. Responsartiklen viser gennem sammenligning med betydningen af stemmebegrebets indlejring i den moderne konstruktion af danskfaget, at der historisk er sket en forskydning over mod en vægtning af den personlige stemme. Afslutningsvist foreslår responsartiklen, at stemmefokuserede analyser af interdisciplinaritet i moderne elevtekster bliver genstand for sammenlignende fagdidaktiske undersøgelser.

Introduction Cluster headache (CH) and bipolar disorder (BD) are cyclic disorders with shared clinical aspects, e.g. disturbed sleep patterns, response to lithium and a tendency to use illicit drugs. Objectives We investigated comorbidity of BD in patients with CH, prevalence of BD amongst CH family members, circadian aspects and use of illicit drugs. Methods Patients from the Leiden University Cluster headache neuro-Analysis program (LUCA) were screened cross-sectionally for BD online, using the Mood Disturbance Questionnaire (MDQ-NL) and Altman Self Rating Scale (ASRM-NL) and, if indicated, further evaluated with the Mini international neuropsychiatric interview (MINI). Circadian aspects were analyzed using the Circadian Type Inventory (CTI) and the Munich Chronotype Questionnaire (MCTQ). Results The life-time prevalence of BD in patients suffering from CH was 6.5%. Patients with comorbid BD (CH+BD) were more likely to have family members with BD (standardized OR= 1.50, 95% CI=1.15;1.95, p=0.003) and were more likely to suffer from chronic CH (OR=3.05 95% CI=1.18;7.87, p=0.02) after adjustment for age and sex. They also more often used illicit drugs, compared to patients with only CH. Circadian type and chronotype did not differ between the two groups after adjustment for confounders. Conclusions There is a high prevalence of BD in CH patients. CH+BD patients are more likely to have a positive family history for BD. CH+BD patients are more likely to suffer from chronic CH and more often use illicit drugs. In clinical practice it is important to screen for BD when treating patients with CH. Disclosure of Interest None Declared

IntroductionApathy frequently occurs in older persons but its aetiology is not understood as of yet. One hypothesis, the vascular hypothesis of apathy, suggests a link between apathy and vascular factors such as cerebral small vessel disease (CSVD), that may cause lesions in the reward network of the brain. In previous studies, a cross sectional association was found between lower blood pressure (BP) and symptoms of apathy in older persons with more CSVD, potentially through reduced cerebral blood flow (CBF). However, longitudinal studies on associations between vascular factors and apathy are scarce.ObjectivesWe investigated whether in older persons, structural and dynamic vascular factors are associated with apathy symptoms over time. We hypothesized that a higher burden of CSVD, a lower BP and lower CBF, would be related to an increase in symptoms of apathy.MethodsThis study is a longitudinal cohort study involving community-dwelling older participants of the Discontinuation of Antihypertensive Treatment in the Elderly (DANTE) Study, all using antihypertensive treatment and with mild cognitive deficits. At baseline BP was measured and apathy was assessed with the Apathy Scale (AS, range 0-42) at baseline and after four years of follow-up (n=178). Additionally, a baseline MRI sub study (n=109) was conducted to measure CSVD and CBF. Univariate and multivariate linear regression analyses were performed using CSVD, BP and CBF as determinants and the change in Apathy Scale score over time as an outcome.ResultsMean age of the population was 80 years (SD 4) and 63% was female. In the MRI sub study, no significant association was found between the summary CSVD scores (β (95% CI)=0.018(-1.089-1.125), p=.975) or it’s separate features; WMH (β(95% CI)=0.012(-0.011-0.035), p=.318), CMB (β (95% CI)=-0.017(-0.605-0.572), p=.956), lacunar infarctions (β(95% CI)=-0.413(-1.266-0.440), p=.339), and a change in Apathy Scale score. Additionally, no significant association between the dynamic vascular factors; CBF (β(95% CI)=-0.029(-0.152-0.094), p=.640), systolic BP (β (95% CI)=-0.019 (-0.056-0.018), p=.310) and diastolic BP (β(95% CI)=-0.029(-0.099-0.042), p=.425), and change in Apathy Scale score was found. The multivariate linear regression model, which incorporated all the structural and dynamic vascular parameters, age, and gender, was not significant.ConclusionsIn older persons with mild cognitive deficits, structural and dynamic vascular factors were not associated with symptoms of apathy after four years of follow-up. Our findings thus do not support a ‘vascular apathy hypothesis’. Potentially, other factors such as life style factors confound the cross sectional association between vascular factors and apathy, or different apathy syndromes may have different aetiologies. Larger studies with less baseline vascular burden, are needed to confirm our results.Disclosure of InterestNone Declared

BackgroundThis study aims to understand the complex triadic shared decision-making process in psychiatric emergency services, focusing on the choice between inpatient and outpatient care post-triage. It also identify scenarios where patient or significant others’ preferences override clinical judgment.MethodsConducted in the greater Rotterdam area, Netherlands, this explorative study surveyed patient and significant others’ preferences for voluntary or involuntary admission versus outpatient treatment, alongside professionals’ clinical indications. Descriptive statistics were used to profile participants, and preference data were used to categorize groups, revealing patterns of agreement.ResultsAmong 5680 assessments involving significant others, four groups emerged: agreement among the triad on in- or outpatient care (48.2%), patient disagrees (38.5%), significant others disagree (11.0%), and professionals disagree (2.3%). Professionals’ recommendations were followed more frequently (57.0%) than patient (9.4%) or significant others’ preferences (11.0%).ConclusionsWe observed that consensus could often be reached among the members of the triad on inpatient or outpatient care following triage. Disagreements typically occurred when patients preferred outpatient care while others favoured inpatient care, or when significant others advocated for inpatient care while others preferred outpatient care. While professionals’ recommendations held the most influence, they could be overridden in cases where valid criteria mandated involuntary care.

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.

Dans les séquences lœssiques du Dernier Glaciaire (Weichselien) du nord de la France, le Pléniglaciaire moyen (PGM, 60 - 35 ka), associé au stade isotopique marin (SIM) 3, est assez mal défini en raison d’un bilan pédosédimentaire peu épais et généralement peu contrasté. La séquence de versant de Morcourt (Somme) présente une accumulation sédimentaire exceptionnelle d’environ 10 m d’épaisseur sur laquelle des analyses géochronologiques, malacologiques et sédimentologiques ont été réalisées en vue de proposer une reconstitution paléoenvironnementale détaillée. Le cadre chronologique établi pour le complexe de sols à la base de la séquence (~ 2 m d’épaisseur) entre environ 58 et 30 ka confirme son attribution au PGM. La séquence repose sur un substrat crayeux altéré et débute par une phase d’érosion majeure du versant marquant la transition avec le Pléniglaciaire inférieur rarement enregistrée sur les sites de cette région. S’ensuit la mise en place de niveaux de colluvions puis de plusieurs niveaux de sols bruns boréaux à brun arctique dans un contexte à sédimentation lœssique faible. Dans ces horizons faiblement carbonatés (inédit pour la période), l’étude malacologique met en évidence la transition d’un environnement steppique vers une toundra plus humide. Enfin, le dépôt de lœss calcaire sus-jacent de 6 m d’épaisseur est attribué au Pléniglaciaire supérieur (PGS, 35 - 15 ka, ≈ SIM 2) par comparaison avec les autres enregistrements régionaux. L’identification d’horizons repères du PGM et du PGS et leur datation permet de proposer des corrélations longue-distance avec les séquences stratigraphiques à l’échelle de l’Europe nord-occidentale (Allemagne et Belgique), ainsi qu’avec l’enregistrement de référence des variations climatiques globales au Pôle Nord (δ18O de NGRIP). Les travaux de terrain et les analyses de laboratoire ont démontré la qualité de l’enregistrement à Morcourt, qui devient ainsi une nouvelle séquence de référence pour les lœss du Dernier Glaciaire du nord de la France.

Tobacco smoking is highly prevalent among patients with psychosis and associated with worse clinical outcomes. Neurometabolites, such as glutamate and choline, are both implicated in psychosis and tobacco smoking. However, the specific associations between smoking and neurometabolites have yet to be investigated in patients with psychosis. The current study examines associations of chronic smoking and neurometabolite levels in the anterior cingulate cortex (ACC) in first-episode psychosis (FEP) patients and controls. Proton magnetic resonance spectroscopy (1H MRS) data of 59 FEP patients and 35 controls were analysed. Associations between smoking status (i.e., smoker yes/no) or cigarettes per day and Glx (glutamate + glutamine, as proxy for glutamate) and total choline (tCh) levels were assessed at baseline in both groups separately. For patients, six months follow-up data were acquired for multi-cross-sectional analysis using linear mixed models. No significant differences in ACC Glx levels were found between smoking (n = 28) and non-smoking (n = 31) FEP patients. Smoking patients showed lower tCh levels compared to non-smoking patients at baseline, although not surving multiple comparisons correction, and in multi-cross-sectional analysis (pFDR = 0.08 and pFDR = 0.044, respectively). Negative associations were observed between cigarettes smoked per day, and ACC Glx (pFDR = 0.02) and tCh levels (pFDR = 0.02) in controls. Differences between patients and controls regarding Glx might be explained by pre-existing disease-related glutamate deficits or alterations at nicotine acetylcholine receptor level, resulting in differences in tobacco-related associations with neurometabolites. Additionally, observed alterations in tCh levels, suggesting reduced cellular proliferation processes, might result from exposure to the neurotoxic effects of smoking.