Parnassia Bavo Groep

Plain English summary Of the group of patients diagnosed with anorexia nervosa, approximately 20–25% develop a severe and persistent eating disorder - anorexia nervosa (SEED-AN). Families, spouses and carers struggle with a range of emotions and challenges associated with this form of the disease. Current specialised programmes often focus on the recovery of younger people. In the Netherlands, people with severe mental illness can be supported by specialised outpatient teams. These teams are often trained in the Flexible Assertive Community Treatment (FACT) method. In addition to treating the disorder, the method focuses on improving quality of life in several areas, such as social participation, work, independent living and leisure. Patients with SEED-AN are often excluded from such programmes, but could benefit from the method. With this study, we have gained a better understanding of why most of the patients with SEED-AN have not been able to use these services. Both professionals and SEED-AN patients shared their experiences and opinions. Our findings reveal a number of challenges, such as the unfamiliarity of professionals with eating disorders, but also the perceptions of SEED-AN patients who do receive this support. Collaboration between patients, professionals, family members and other supporters was considered crucial. our recommendation is network development, the use of a resource group model appeared to be helpful in this.

Background Pharmacogenetics is considered a promising avenue for improving treatment outcomes, yet evidence arguing for the use of pharmacogenetics in the treatment of psychotic disorders is mixed and clinical usefulness is under debate. Many patients with psychosis use multiple medications, which can alter the metabolic capacity of CYP enzymes, a process called phenoconversion. In clinical studies, treatment outcomes of drugs for psychosis management may have been influenced by phenoconversion. Aim Here we evaluate the impact and predictive value of CYP2D6 phenoconversion in patients with psychotic disorders under pharmacological treatment. Method Phenoconversion-corrected phenotype was determined by accounting for inhibitor strength. Phenoconversion-corrected and genotype-predicted phenotypes were compared in association with side effects, subjective well-being and symptom severity. Results Phenoconversion led to a large increase in poor metabolizers (PMs; 17–82, 16% of sample), due to concomitant use of the serotonin reuptake inhibitors fluoxetine and paroxetine. Neither CYP2D6-predicted nor phenoconversion-corrected phenotype was robustly associated with outcome measures. Risperidone, however, was most affected by the CYP2D6 genotype. Conclusion Polypharmacy and phenoconversion were prevalent and accounted for a significant increase in PMs. CYP2D6 may play a limited role in side effects, symptoms and well-being measures. However, due to the high frequency of occurrence, phenoconversion should be considered in future clinical trials.

Healthcare workers (HCWs) were at increased risk for mental health problems during the COVID-19 pandemic, with prior data suggesting women may be particularly vulnerable. Our global mental health study aimed to examine factors associated with gender differences in psychological distress and depressive symptoms among HCWs during COVID-19. Across 22 countries in South America, Europe, Asia and Africa, 32,410 HCWs participated in the COVID-19 HEalth caRe wOrkErS (HEROES) study between March 2020 and February 2021. They completed the General Health Questionnaire-12, the Patient Health Questionnaire-9 and questions about pandemic-relevant exposures. Consistently across countries, women reported elevated mental health problems compared to men. Women also reported increased COVID-19-relevant stressors, including insufficient personal protective equipment and less support from colleagues, while men reported increased contact with COVID-19 patients. At the country level, HCWs in countries with higher gender inequality reported less mental health problems. Higher COVID-19 mortality rates were associated with increased psychological distress merely among women. Our findings suggest that among HCWs, women may have been disproportionately exposed to COVID-19-relevant stressors at the individual and country level. This highlights the importance of considering gender in emergency response efforts to safeguard women’s well-being and ensure healthcare system preparedness during future public health crises.

Background The mental health burden among refugees in high-income countries (HICs) is high, whereas access to mental healthcare can be limited. Objective To examine the effectiveness of a peer-provided psychological intervention (Problem Management Plus; PM+) in reducing symptoms of common mental disorders (CMDs) among Syrian refugees in the Netherlands. Methods We conducted a single-blind, randomised controlled trial among adult Syrian refugees recruited in March 2019–December 2021 (No. NTR7552). Individuals with psychological distress (Kessler Psychological Distress Scale (K10) >15) and functional impairment (WHO Disability Assessment Schedule (WHODAS 2.0) >16) were allocated to PM+ in addition to care as usual (PM+/CAU) or CAU only. Participants were reassessed at 1-week and 3-month follow-up. Primary outcome was depression/anxiety combined (Hopkins Symptom Checklist; HSCL-25) at 3-month follow-up. Secondary outcomes included depression (HSCL-25), anxiety (HSCL-25), post-traumatic stress disorder (PTSD) symptoms (PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; PCL-5), impairment (WHODAS 2.0) and self-identified problems (PSYCHLOPS; Psychological Outcomes Profiles). Primary analysis was intention-to-treat. Findings Participants (n=206; mean age=37 years, 62% men) were randomised into PM+/CAU (n=103) or CAU (n=103). At 3-month follow-up, PM+/CAU had greater reductions on depression/anxiety relative to CAU (mean difference −0.25; 95% CI −0.385 to −0.122; p=0.0001, Cohen’s d =0.41). PM+/CAU also showed greater reductions on depression (p=0.0002, Cohen’s d =0.42), anxiety (p=0.001, Cohen’s d =0.27), PTSD symptoms (p=0.0005, Cohen’s d =0.39) and self-identified problems (p=0.03, Cohen’s d =0.26), but not on impairment (p=0.084, Cohen’s d =0.21). Conclusions PM+ effectively reduces symptoms of CMDs among Syrian refugees. A strength was high retention at follow-up. Generalisability is limited by predominantly including refugees with a resident permit. Clinical implications Peer-provided psychological interventions should be considered for scale-up in HICs.

Introduction Self-injury, defined as inflicting damage or pain to one’s own body, is a way to deal with unbearable emotions. Unfortunately, it can become addictive through the rewarding effect, and this makes it also really hard to stop with this destructive behavior. Currently, there is a lack of specific treatments. Objectives The aim of the research is to investigate whether the “Protocol imaginary execution of self-damaging behavior” leads to a reduction of self-damaging behavior and the urge to self-damaging behavior. Methods We have investigated the “Protocol Imaginary execuTion of self-injury” as a potential treatment for self-injury. In this protocol the patient is asked to imagine he/she is performing the self-injury and at the same time a distracting task is offered. This ensures the working memory is double burdened as is with EMDR. We expected a reduction of patient’s self-injurious behavior. For this study, a single-case experimental design with 11 clinical patients is used, aimed to investigate whether there is a functional relationship between the treatment, the urge to self-injure and the frequency and seriousness of the self-injury. Data are analyzed with a multivariate analysis. The results of this study will contribute to expanding and improving treatment options for self-injury. Results At the moment the results are not yet available, but they will be known in April 2022. Conclusions Respondents indicate that they experience more control over self-injurious behaviour. We hope to have confirmed this in April 2022 with the analyzed data. Disclosure No significant relationships.

Due to the unprecedented impact of the COVID-19 pandemic on health care systems, there has been great interest in the mental wellbeing of healthcare workers. While most studies investigated mental health outcomes among frontline vs. non-frontline healthcare workers, little is known about the impact of various work-related variables. The present study aimed to examine the association between work-related [i.e., having contact with COVID-19 patients, being redeployed due to the pandemic and availability of sufficient personal protective equipment (PPE)] and subjective (i.e., worries about getting infected or infecting others) exposures and self-reported mental health outcomes (i.e., psychological distress, depressive symptoms, and posttraumatic stress symptoms). Between February and May 2021, 994 healthcare workers employed at a variety of healthcare settings in the Netherlands filled out an online survey as part of the COVID-19 HEalth caRe wOrkErS (HEROES) study. Mental health outcomes were measured using the General Health Questionnaire-12, the Patient Health Questionnaire-9, and the Primary Care PTSD Screen for DSM-5. Approximately 13% reported depressive symptoms, 37% experienced psychological distress, and 20% reported posttraumatic stress symptoms. Multilevel linear models consisted of three levels: individual (work-related and subjective exposures), healthcare center (aggregated redeployment and availability of sufficient PPE), and regional (cumulative COVID-19 infection and death rates). Worries about infection were associated with all three mental health outcomes, whereas insufficient PPE was associated with psychological distress and depressive symptoms. There were no differences in outcomes between healthcare centers or provinces with different COVID-19 infection and death rates. Our findings highlight the importance of adequate PPE provision and the subjective experience of the COVID-19 pandemic. These factors should be part of interventions aimed at mitigating adverse mental health outcomes among healthcare workers during the COVID-19 pandemic.

The objective of the study is to investigate the role of mental health in the relationship between moderately low birthweight MLBW (≥ 1500 g &≤2500) and academic achievement in a large cross-country study. Data were drawn from the School Children Mental Health in Europe study (n = 4305). Achievement in mathematics and reading was categorized by teachers as being below average, average or above average. Parents reported birthweight, and both parents and teachers evaluated mental health status using the Strengths and difficulties Questionnaire. When controlling for child age, number of children in the household, maternal age, education, employment status and psychological distress and country of residence, MLBW was associated with lower odds of above average performance in mathematics and reading. Once mental health was added into the model, MLBW remained significant but mental health problems largely surpassed its influence: conduct disorders decreased the probability to perform above average in mathematics RRR = 0.37 and increased the risk of performing below average RRR = 4.45 as did ADHD and emotional disorders. A similar trend was found for reading achievement except for ADHD which decreased the probability of above average performance RRR = 0.13 and did not have a significant effect on below average performance. A path analysis highlights the prominent role of mental health. Among children attending regular education settings, MLBW is associated with academic performance but mental health has much stronger effects. Teachers and parents should be sensitized to child mental health problems and be informed of the special needs of MLBW children in order to help children overcome potential academic difficulties and to adapt their teaching taking into account mental health problems.

Background The COVID-19 pandemic is a challenge for everyone, particularly for children and adolescents with autism spectrum disorder (ASD). ASD is a developmental disorder characterised by limitations in social communication, repetitive behavioural patterns, and limited interests, and activities. It is expected that many families with children with ASD will experience more problems due to the COVID-19 pandemic and the related public health restrictions. At the same time, some may experience improved functioning, due to fewer expectations and social demands. Methods/design In a mixed-method study to identify the impact of the COVID-19 pandemic, parents of children with ASD (ages 4–21) who were in care pre-COVID-19 at one of three large mental healthcare institutions in the region of Rotterdam participated (68 for T0, 57 for T1). The aims are (1) to investigate the impact of the COVID-19 pandemic on overall functioning and autistic symptoms of the child/adolescent with ASD, as well as parental and family functioning (QUANT-QUAL), in both the short term and longer term, and (2) to investigate risk and protective factors (in light of resilience) (QUANT-qual) and (3) to investigate care and informational needs (QUAL-quant). Pre-COVID-19 baseline data will be retrieved from clinical records. Participants will fill out two surveys (one during a COVID-19 peak—January–May 2021—and one thereafter). Survey participants were invited to participate in interviews (n=27). Surveys include measures thar were included pre-COVID-19 (ie, overall functioning and autism symptoms) as well as specific measures to identify family functioning and COVID-19 impact. The semistructured interviews focus on child, parent and family functioning and care—and informational needs. Ethics and dissemination The Medical Ethics Committee of the Erasmus MC has approved the study. Findings will be available to families of children with ASD, their care providers, the funders, autism societies, the government and other researchers.

Background Trauma-focused treatments for posttraumatic stress disorder (PTSD) are commonly delivered either once or twice a week. Initial evidence suggests that session frequency affects treatment response, but very few trials have investigated the effect of session frequency. The present study’s aim is to compare treatment outcomes of twice-weekly versus once-weekly sessions of two treatments for PTSD related to childhood trauma, imagery rescripting (ImRs) and eye movement desensitization and reprocessing (EMDR). We hypothesize that both treatments will be more effective when delivered twice than once a week. How session frequency impacts treatment response, whether treatment type moderates the frequency effect, and which treatment type and frequency works best for whom will also be investigated. Methods The IREM-Freq trial is an international multicenter randomized clinical trial conducted in mental healthcare centers across Australia, Germany, and the Netherlands. We aim to recruit 220 participants, who will be randomized to one of four conditions: (1) EMDR once a week, (2) EMDR twice a week, (3) ImRs once a week, or (4) ImRs twice a week. Treatment consists of 12 sessions. Data are collected at baseline until one-year follow-up. The primary outcome measure is clinician-rated PTSD symptom severity. Secondary outcome measures include self-reported PTSD symptom severity, complex PTSD symptoms, trauma-related cognitions and emotions, depressive symptoms, dissociation, quality of life, and functioning. Process measures include memory, learning, therapeutic alliance, motivation, reluctance, and avoidance. Additional investigations will focus on predictors of treatment outcome and PTSD severity, change mechanisms of EMDR and ImRs, the role of emotions, cognitions, and memory, the optimization of treatment selection, learned helplessness, perspectives of patients and therapists, the network structure of PTSD symptoms, and sudden treatment gains. Discussion This study will extend our knowledge on trauma-focused treatments for PTSD related to childhood trauma and, more specifically, the importance of session frequency. More insight into the optimal session frequency could lead to improved treatment outcomes and less dropout, and in turn, to a reduction of healthcare costs. Moreover, the additional investigations will broaden our understanding of how the treatments work and variables that affect treatment outcome. Trial registration Netherlands Trial Register NL6965, registered 25/04/2018.

Background: Anorexia nervosa (AN) is a psychiatric disorder with an ego-syntonic nature, causing many patients to perceive their AN as part of their personal identity. Therefore, an important part of treatment is the externalization of the eating disorder, in order to help patients to perceive AN as an external influence. Studies on patient experiences of externalization in treatment for AN are sadly missing. The aims of this study were to investigate, first, patients’ perspectives on the relation between identity and anorexia nervosa (AN) and second, their experiences of an externalizing approach during treatment. Method:, A qualitative interview study was conducted including fourteen patients with AN in either Family Based Treatment, the Maudsley Model for Anorexia Nervosa Treatment for Adults, Specialist Supportive Clinical Management-Severe Enduring or Cognitive Behavioural Therapy-Enhanced. Results: There are important differences in participants’ perceptions on how AN is related to identity. AN was perceived as part of identity, as alien or as a different side of the self. Patients’ experiences towards an externalizing approach were ambivalent. Externalization was considered helpful, whilst also evoking a negative response. Participants reported feeling as if all their behaviour was referred to as part of AN, which elicited feelings of not being taken seriously or being wrongfully accused of being dishonest. Conclusions: First, there is considerable variation in the perceived relation between AN and identity. Second, an externalizing approach within treatment may lead to so called epistemic injustice. Awareness of these two facts is of importance for clinicians and the therapeutic relationship because that will help them to refrain from actions that can be perceived as epistemic injustice.

Goed slapen is ook voor ouderen van groot belang voor de mentale en lichamelijke gezondheid. Slaapstoornissen komen vaker voor bij ouderen dan bij jongere volwassenen, maar zijn geen vanzelfsprekend onderdeel van het verouderingsproces. Na goede diagnostiek is verbetering van de slaap dan ook vaak mogelijk. Oorzaken van de hogere prevalentie van slaapstoornissen zijn onder andere neurobiologische factoren, het vaker voorkomen van somatische problemen, medicatiegebruik, weinig lichtblootstelling en psychosociale factoren. Insomnie is ook bij ouderen de meest voorkomende slaapstoornis. Bij insomnie is, volgens internationale richtlijnen, ook voor ouderen cognitieve gedragstherapie bij insomnie (CGT-i) de beste en veiligste behandelvorm. Het medicamenteus behandelen van chronische insomnie moet bij ouderen met grote terughoudendheid en voorzichtigheid gedaan worden, wegens mogelijk ernstige bijwerkingen. Dementie en delier gaan meestal samen met gestoorde slaap; voor deze doelgroep is een individuele CGT-i vaak niet geschikt, maar andere niet-medicamenteuze interventies, met name lichtblootstelling en een regelmatig ritme, zijn wel mogelijk.

Background: A new inpatient care model has been developed in the Netherlands: High and Intensive Care (HIC). The purpose of HIC is to improve quality of inpatient mental healthcare and to reduce coercion. Methods: In 2014, audits were held at 32 closed acute admission wards for adult patients throughout the Netherlands. The audits were done by trained auditors, who were professionals of the participating institutes, using the HIC monitor, a model fidelity scale to assess implementation of the HIC model. The HIC model fidelity scale (67 items) encompasses 11 domains including for example team structure, team processes, diagnostics and treatment, and building environment. Data on seclusion and forced medication was collected using the Argus rating scale. The association between HIC monitor scores and the use of seclusion and forced medication was analyzed, corrected for patient characteristics. Results: Results showed that wards having a relatively high HIC monitor total score, indicating a high level of implementation of the model as compared to wards scoring lower on the monitor, had lower seclusion hours per admission hours (2.58 versus 4.20) and less forced medication events per admission days (0.0162 versus 0.0207). The HIC model fidelity scores explained 27% of the variance in seclusion rates (p < 0.001). Adding patient characteristics to HIC items in the regression model showed an increase of the explained variance to 40%. Conclusions: This study showed that higher HIC model fidelity was associated with less seclusion and less forced medication at acute closed psychiatric wards in the Netherlands.

Background Early identification of patients with mental health problems in need of highly specialised care could enhance the timely provision of appropriate care and improve the clinical and cost-effectiveness of treatment strategies. Recent research on the development and psychometric evaluation of diagnosis-specific decision-support algorithms suggested that the treatment allocation of patients to highly specialised mental healthcare settings may be guided by a core set of transdiagnostic patient factors. Aims To develop and psychometrically evaluate a transdiagnostic decision tool to facilitate the uniform assessment of highly specialised mental healthcare need in heterogeneous patient groups. Method The Transdiagnostic Decision Tool was developed based on an analysis of transdiagnostic items of earlier developed diagnosis-specific decision tools. The Transdiagnostic Decision Tool was psychometrically evaluated in 505 patients with a somatic symptom disorder or post-traumatic stress disorder. Feasibility, interrater reliability, convergent validity and criterion validity were assessed. In order to evaluate convergent validity, the five-level EuroQol five-dimensional questionnaire (EQ-5D-5L) and the ICEpop CAPability measure for Adults (ICECAP-A) were administered. Results The six-item clinician-administered Transdiagnostic Decision Tool demonstrated excellent feasibility and acceptable interrater reliability. Spearman's rank correlations between the Transdiagnostic Decision Tool and ICECAP-A (−0.335), EQ-5D-5L index (−0.386) and EQ-5D-visual analogue scale (−0.348) supported convergent validity. The area under the curve was 0.81 and a cut-off value of ≥3 was found to represent the optimal cut-off value. Conclusions The Transdiagnostic Decision Tool demonstrated solid psychometric properties and showed promise as a measure for the early detection of patients in need of highly specialised mental healthcare.

Background Delirium is a serious neuropsychiatric syndrome, which requires timely treatment. However, it is easily missed, especially in older patients with premorbid cognitive disorders. Objectives The aim of the present study is to investigate the prevalence and risk factors of delirium in older outpatients with and without dementia. Method We assessed 444 patients referred to the memory clinic of a psychiatric hospital between March 2013 and March 2014. Demographic information, medical history, impairments in daily living activities (ADL) and referral information were registered. Patients underwent a psychiatric examination using the Delirium Rating Scale‐Revised‐98 and cognitive tests, a physical examination and laboratory tests. We recorded medication use and changes before and after the onset of symptoms. Results Among the 444 outpatients, 85 had probable delirium (prevalence of 19%), and 10 had sub‐syndromal delirium (2%). The most common triggers were infection (42%), drug‐intoxication or withdrawal (22%), and metabolic/endocrine disturbance (12%). Age (OR 1.07, 95% CI 1.02 ‐ 1.11) and prior delirium (OR 3.34, 95% CI 1.28 – 8.69) were independent non‐modifiable factors associated with an increased risk of delirium. The only independent modifiable risk factor was infection (OR 17.31, 95% CI 8.44 – 35.49). Conclusions A delirium was detected in one of five patients referred for dementia screening. Most patients could be treated at home. Age and prior delirium were predictive of an increased risk of delirium. This article is protected by copyright. All rights reserved.

Objectives To estimate 12‐month prevalence and severity of mental disorders in the Saudi National Mental Health Survey (SNMHS). Methods The SNMHS is a face‐to‐face community epidemiological survey in a nationally representative household sample of citizens aged 15 to 65 in the Kingdom of Saudi Arabia (KSA) (n = 4,004). The World Health Organization (WHO) Composite International Diagnostic Interview (CIDI) was used to estimate 12‐month prevalence of common DSM‐IV mental disorders. Results Twelve‐month prevalence of any DSM‐IV/CIDI disorder is 20.2%. Most common are anxiety disorders (12.3%) followed by mood (6.8%), disruptive behavior (5.4%), eating (3.2%), and substance use (1.9%) disorders. The proportion of 12‐month cases rated serious (39.0% of all cases) is high across virtually all disorders relative to the proportions found in CIDI surveys in other high‐income countries. Younger people have significantly elevated odds of mood and disruptive behavior disorders and serious disorders. Women have significantly elevated odds of anxiety and mood disorders and serious disorders. Previously married people have significantly elevated odds of most disorder classes and serious disorders. Conclusions Both 12‐month prevalence and severity of DSM‐IV/CIDI disorders are high in Saudi Arabia compared to other high‐income countries that carried out comparable surveys.

Objectives To present an overview of the survey and field procedures developed for the Saudi National Mental Health Survey (SNMHS). Methods The SNMHS is a face‐to‐face community epidemiological survey of DSM‐IV mental disorders in a nationally representative sample of the household population in the Kingdom of Saudi Arabia (KSA) (n = 4,004). The SNMHS was implemented as part of the WHO World Mental Health (WMH) Survey Initiative. WMH carries out coordinated psychiatric epidemiological surveys in countries throughout the world using standardized procedures designed to provide valid cross‐national comparative data on prevalence and correlates of common mental disorders. However, these procedures need to be adapted to the unique experiences in each country. We focus here on the adaptations made for the SNMHS. Results Modifications were needed to several interview sections and expansions were needed to address issues of special policy importance in KSA. Several special field implementation challenges also had to be addressed because of the need for female interviewers to travel with male escorts and for respondents to be interviewed by interviewers of the same gender. Conclusions Thoughtful revisions led to a high‐quality field implementation in the SNMHS.

Objectives The DSM‐IV diagnoses generated by the fully structured lay‐administered Composite International Diagnostic Interview Version 3.0 (CIDI 3.0) in the Saudi National Mental Health Survey (SNMHS) were compared to diagnoses based on blinded clinical reappraisal interviews. Methods Telephone follow‐up interviews were administered using the clinician‐administered non‐patient edition of the Structured Clinical Interview for DSM‐IV (SCID) in separate sub‐samples of SNMHS respondents who screened positive for four disorders that are of special importance in Arab countries: obsessive–compulsive disorder, separation anxiety disorder, social phobia, and major depressive episode. Results Initial diagnoses based on the CIDI were found to have higher prevalence than those based on the SCID for all four disorders. For reasons having to do with respondent denial of symptoms in the SCID reported in the CIDI, we interpreted these differences as due more to under‐diagnoses in the SCID than over‐diagnoses in the CIDI. Nonetheless, CIDI diagnostic thresholds for three of the four disorders were increased to make sure prevalence estimates based on the CIDI were conservative. The procedures used to implement these recalibrations are described in this paper. Conclusions The CIDI interviews used in the SNMHS generated valid but conservative diagnoses of common mental disorders in the Saudi population.

Persons with mental health problems and/or substance addictions (MHPSA) are stigmatised more than persons with physical conditions. This includes stigmatisation by care professionals. Stigma is considered one of the most important barriers for recovery from these conditions. There is an ongoing debate that use of language can exacerbate or diminish stigmatisation. Therefore, we conducted an experiment examining how four different ways of referring to a person with (a) alcohol addiction, (b) drug addiction, (c) depression and (d) schizophrenia are related to stigmatising attitudes by care professionals in the Netherlands. We partially replicated two studies performed in the United States and used surveys with vignettes containing either ‘disorder-first’, ‘person-first’, ‘victim’ and ‘recovery’ language, which were randomly assigned to participants (n = 361). No significant differences between language conditions were found for any of the vignettes. Our findings suggest that subtle differences in language to refer to persons with mental health problems or substance addictions have no effect on stigmatising attitudes by care professionals in the Netherlands. However, more research is needed to determine the effect of language use on other groups, such as individuals with MHPSA.