Little is known about the relationship of Five-Factor Model (FFM) personality and therapeutically relevant variables in psychosis. To examine the relationship between personality traits and both clinical insight and distress due to (subclinical) positive symptoms. Cross-sectional and longitudinal data from the Genetic Risk and Outcome of Psychosis (GROUP) study were analyzed. Associations between patients’ personality traits and clinical insight was examined using multiple regression. Logistic regression was used to assess the relationship between personality and symptom-related distress in patients, their siblings, and controls. All analyses controlled for symptom levels. Greater self-reported insight was associated with higher agreeableness, higher neuroticism, lower extraversion, and greater severity of depressive symptoms. Researcher-rated insight was only related to symptom severity, as were changes in insight over time for both forms of insight. Higher openness was associated with a weaker relationship between the frequency of (subclinical) positive symptoms and symptom-related distress in both patients and siblings. FFM personality traits are associated with both clinical insight and positive symptom distress, independently of symptom severity. In clinical practice, personality and symptoms are difficult to distinguish. This supports the use of integrated, personalized treatment approaches.

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resembled Capgras syndrome, a misidentification delusion characterized by the false belief that a familiar person has been replaced by a double.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.

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.

This longitudinal study focuses on the question to what extent symptoms of adjustment disorder (AD) occurred in the Dutch population in response to the corona pandemic. To explore which (a) personal characteristics and which (b) pandemic, (c) health or (d) trauma-related factors are related to symptoms of AD. 2079 people (time 1) and 777 people (time 2) participated in an online questionnaire since 2020. Prevalence of adjustment disorder and the concurrent and longitudinal associations between the factors (a-d) and AD severity were determined. A third experienced severe adjustment problems at the beginning of the pandemic and half a year later. However, there were changes in the course of adjustment: a large group of people did not meet the criteria for AD at time 1, while they did so at time 2, and vice versa. The observed factors (a-d) contributed to explaining the variation in adjustment disorder severity between participants (27% at time 1 and 44% at time 2, respectively), but did not do so completely. A more person-centered approach to study predictors of transitions in symptom patterns over time is needed. While a minority developed symptoms of AD, the majority has been able to cope well with the pandemic.

Climate change is a pressing issue, with significant effects also in Europe. In particular younger generations will face negative consequences of climate change, including impact on mental health. Therefore, climate change is relevant to psychiatrists. In this article, we explain how climate change leads to mental health problems and what psychiatrists can do. Overview based on a recent European position paper on the consequences of climate change for mental health and recent literature RESULTS: Climate change leads to mental health problems on multiple levels: through direct consequences of disasters (for example, traumatization), as well as the effects of heat on mental health and adverse effects on social and societal determinants of mental health. These effects are most likely greatest in non-Western countries, where resources are limited. Additionally, there are mental complaints due to an increase in climate anxiety, especially among young people. We call on the field of psychiatry to increase and share interdisciplinary knowledge and take actions to prepare for the consequences of climate change. Actions are needed at multiple levels including preparing direct patient care for effects of climate change (e.g., preparing for heatwaves), reducing further climate change (moving towards sustainable health care systems), and by influencing the public debate.

The COVID-19 pandemic posed significant challenges for parents, due to the closure of childcare facilities and schools, the shift to working from home, and the loss of support services. To examine the extent to which COVID-related stress (CRS) and caring for psychiatrically vulnerable children (PVC) influenced parental stress and the experience of psychological basic needs during the first COVID-19 lockdown. Parents of PVC (n = 203) and parents of non-PVC (n = 919) completed questionnaires assessing parental stress and psychological needs. Associations were examined using multiple regression analyses. Parents of PVC experienced higher parental stress, greater need frustration and lower need satisfaction. CRS increased these experiences for all parents; while caring for PVC specifically contributed to higher parental stress. Notably, an interaction effect between PVC and CRS was found in total parental stress: CRS had less impact on parental stress in families with PVC. The findings underscore the need for (secondary) preventive support for all parents, and specific, accessible, and high-quality support for parents of PVC during pandemics. Moreover, targeted attention for parents both with or without PVC remains essential at policy and research levels.

Opinions differ on the societal importance of mental health care (GGZ) and the direction it should take. Is there a need for prevention targeting high-risk health groups, should more attention be paid to precision psychiatry, or is the focus better placed on promoting a mentally healthy lifestyle or accessible care in disadvantaged neighborhoods? To outline the social importance of mental health care from three perspectives: the biomedical-clinical approach, the moral-philosophical, social-critical perspective and an approach that emphasizes social inequality and disadvantage. Further I reflect on the possible importance of some innovations in mental health care for future general mental health. Literature review and consideration. Questions about the social importance of mental health care and the future direction of mental health care are typically viewed from a biomedical and clinical perspective, with the assumption that what benefits patients is also the most direct path to improved public mental health. However, other narratives also dominate the discussion, such as socio-critical approaches or perspectives emphasizing social inequality and marginalization. Anyone who examines these approaches from a public health perspective must conclude that many innovations in mental health care are largely irrelevant to public mental health, despite their impact on the relationship between society and mental health care.

Medical Assistance in Dying (MAID) on psychiatric grounds is a subject of increasing relevance to Dutch mental health care. In addition to different advantages, there are disadvantages. To highlight some consequences of MAID on psychiatric grounds and to offer solutions to mitigate these. Based on an experience story, we highlight some relevant consequences. Various relevant themes emerge. Firstly, patients can experience pressure to choose MAID. Secondly, psychiatric disorders and suicidality in particular are dynamic and difficult to predict, which conflicts with the static nature of the MAID law. Thirdly, the possibility of MAID is an additional argument to keep the quality of mental health care sufficient, even with increasing scarcity. Finally, we have to stop talking about ‘exhausted treatment options’. By recognising and minimising the disadvantages of MAID on psychiatric grounds, we create space for a practice where safety and accessibility are in balance.

Posttraumatic stress disorder (PTSD) is associated with high rates of avoidant, dependent and obsessive-compulsive personality disorders (cluster C-PD). It is unknown whether concurrent treatment for PTSD and comorbid cluster C-PD leads to superior treatment effects, compared to standalone trauma-focused treatment. To test the efficacy of adding 52-58 sessions of PD treatment (group schema therapy; GST) to 12-18 sessions of individual trauma-focused treatment (imagery rescripting; ImRs). 130 adult outpatients were randomized to receive either ImRs or ImRs+GST. The main outcome was PTSD severity one year after start of treatment (CAPS-5). Secondary outcomes were cluster C-PD, psychiatric symptoms, quality of life, functioning, treatment response, remission, and dropout. At 12 months, there were large decreases in PTSD severity (d = 2,4), PD symptoms and all other secondary outcomes. There were no significant differences between conditions. Large effects were observed in both treatment arms. The results suggests that trauma focused treatment is the preferred primary treatment in patients presenting with PTSD and comorbid cluster C-PD, after which more intensive psychotherapy aimed at the personality disorder may be considered in the case of residual personality disorder symptoms.