Remco F.P. De Winter

GGZ Rivierduinen/Maastricht University/ Vrije Universiteit Amsterdam / Parnassia Group

Anxious-retarded depression is a two-dimensionally defined subcategory of depression derived from DSM-IV melancholia. It is related to increased plasma vasopressin, correlative plasma vasopressin and cortisol levels, and a positive family history. We now explored its relation with outcome. Seventy depressed patients were included to follow-up for t...

ACHTERGROND De psychiatrische crisisdiensten spelen een belangrijke rol in de herkenning, behandeling en preventie van suïcide en suïcidaal gedrag. Er is weinig bekend over de beoordelingen van suïcidaal gedrag door de crisisdienst. DOEL Beschrijven van relaties tussen patiëntkenmerken en suïcidaal gedrag en suïcidepogingen bij beoor­ delingen door...

ACHTERGROND Om verbeteringen in de zorg voor suïcidale patiënten in ggz-instellingen te onderbouwen zijn speci-fieke en systematische gegevens nodig over hulpverlenersgedrag jegens patiënten die waren betrokken bij suïcidale incidenten. METHODE Exploratief observationeel onderzoek naar de relatie tussen patiënt-en hulpverlenerskenmerken en gedrag v...

Aim: With the introduction of “Electronic Medical Record” (EMR) a wealth of digital data has become available. This provides a unique opportunity for exploring precedents for seclusion. This study explored the feasibility of text mining analysis in the EMR to eventually help reduce the use of seclusion in psychiatry. Methods: The texts in notes and...

Background: Outreach psychiatric emergency services play an important role in all stages of a suicidal crisis; however, empirical assessment data are scarce. This study describes characteristics of patients assessed by these services and involved in suicidal crises. Method: During a 5-year period, detailed information from psychiatric emergency ser...

Importance Suicidal ideation and suicide attempts are debilitating mental health problems that are often treated with indirect psychotherapy (ie, psychotherapy that focuses on other mental health problems, such as depression or personality disorders). The effects of direct and indirect psychotherapy on suicidal ideation have not yet been examined i...

Samenvatting Suïcidaliteit komt veel voor in de ggz. Een kleine groep patiënten met ernstige, chronische suïcidaliteit doet een groot appel op de hulpverlening. Richtlijnen bieden onvoldoende houvast en crisisinterventies werken vaak averechts. Dit leidt tot een patroon van beveiligen en beheersen, met onvoldoende perspectief op herstel en mogelijk...

Objective: To examine the safety and efficacy of a brief cognitive dual-task (using eye movements) add-on module to treatment as usual (TAU) in reducing the severity and frequency of intrusive suicidal mental images and suicidal ideation. Method: We conducted a single-blind, parallel multicenter randomized trial (No. NTR7563) among adult psychiatri...

Background This 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. Methods Conducted in the greater Rotterdam a...

In the original publication of this article, the age of visitors was given wrongly as ‘12- to 15-year-olds’ in the abstract section of the paper. This should have been ’12- to 25-year-olds’. This has now been corrected and this erratum published. The publisher apologises for the error.

Background: Highly accessible youth initiatives worldwide aim to prevent worsening of mental health problems, but research into outcomes over time is scarce. Aims: This study aimed to evaluate outcomes and support use in 12- to 25-year-old visitors of the @ease mental health walk-in centres, a Dutch initiative offering free counselling by trained...

Suicidal ideation fluctuates over time, as does its related risk factors. Little is known about the difference or similarities of the temporal patterns. The current exploratory secondary analysis examines which risk symptoms have similar time dynamics using a mathematical algorithm called dynamic time warping (DTW). Ecological momentary assessment...

Objective In 2016, the SUicide PRevention Action NETwork (SUPRANET) was launched. The SUPRANET intervention aims at better implementing the suicide prevention guideline. An implementation study was developed to evaluate the impact of SUPRANET over time on three outcomes: 1) suicides, 2) registration of suicide attempts, and 3) professionals’ knowle...

There is a notable diversity in how suicidality manifests and evolves across individuals, highlighting the need for a deeper comprehension of the fluctuating nature of suicidal ideation and other symptoms. Through ecological momentary assessment (EMA) data from 11 depressed psychiatric outpatients with suicide ideation collected over a period of mo...

Samenvatting Aan de hand van een casus van een adolescente met suïcidaliteit vanuit zowel een depressieve als een obsessieve-compulsieve stoornis beschrijven we waarom grondig analyseren van suïcidaliteit noodzakelijk is. De behandeling van de suïcidaliteit is gericht op het aanpakken van de onderliggende psychiatrische stoornissen en oorzakelijke...

This article illustrates the importance of conducting a comprehensive analysis of suicidality through the case study of an adolescent patient dealing with both depressive disorder and obsessive-compulsive disorder. The aim of treating suicidality is to address the underlying psychiatric conditions and factors contributing to the disorder. This nece...

Background Based on clinical experience, a (hypothetical) four-type model of suicidality that differentiates between subtypes with a unique pathway to entrapment ((h)4ME)was developed. The subtypes are: 1) perceptual disintegration (PD), 2) primary depressive cognition (PDC), 3) psychosocial turmoil (PT) and 4) inadequate communication/coping (IC)....

Introduction There is robust evidence that both patients with schizophrenia (SCZ) and borderline personality disorder (BPD) display mentalizing difficulties. Less is known however about differences in the way mentalization based treatment (MBT) impacts mentalizing capacity in SCZ and BPD patients. This study compares the impact of MBT on mentalizin...

Background: Even though various types of suicidality are observed in clinical practice, suicidality is still considered a uniformconcept. To distinguish different types of suicidality and consequently improve detection and management of suicidality, wedeveloped a clinical differentiation model for suicidality. We believe that the model allows for...

Background: Suicidal ideation (SI) is a significant and long-lasting mental health problem, with a third of individuals still experiencing SI after two years. To date, most Ecological Momentary Assessment (EMA) studies of SI have assessed its day-to-day course over one to four consecutive weeks and found no consistent trends in average SI severity...

Background Based on clinical experience, a differentiation model for suicidality consisting of four subtypes of suicidality was developed. 1) perceptual disintegration (PD), 2) primary depressive cognition (PDC), 3) psychosocial "turmoil" (PT) and 4) inadequate communication/coping (IC). A study was carried out to examine the validity of the propos...

ABSTRACT Background Even though various types of suicidality are observed in clinical practice, suicidality is still considered as uniform concept. To be able to improve the differentiation of suicidality -and consequently the detection, and management of suicidality in all its’ forms- we developed a clinical differentiation model for suicidality...

A clinical differentiation model of suicidal behaviors may improve clinical practice. It may be helpful to determine which type of treatment is most appropriate for subtypes of suicidal behaviors and may improve adherence to suicide prevention guidelines. Also, differentiation of suicidal behaviors may create clarity about the role of healthcare pr...

BACKGROUND Even though various types of suicidality are observed in clinical practice, suicidality is still considered a uniform concept. To distinguish different types of suicidality and consequently improve detection and management of suicidality, we developed a clinical differentiation model for suicidality. We believe that the model allows for...

Background Even though various types of suicidality are observed in clinical practice, suicidality is still considered a uniform concept. To distinguish different types of suicidality and consequently improve detection and management of suicidality, we developed a clinical differentiation model for suicidality. We believe that the model allows for...

Mental health smartphone apps could increase the safety and self-management of patients at risk of suicide, but it is still unclear whether it is feasible to integrate such apps into routine mental healthcare. This study reports on the feasibility of using a safety planning app (BackUp) and a self-monitoring app (mEMA) as components of the routine...

Introduction Intensive home treatment (IHT) is intended to prevent the (mostly voluntary) admission of mentally ill patients by providing intensive care in their domestic environment. It requires approaches to referral that ensure the delivery of the best possible acute care. Indications for referral may be improved by greater understanding of the...

Resumo Objetivo: Afeto pseudobulbar é uma forma de expressão emocional patológica, na qual o paciente com transtorno neurológico apresenta explosões de riso e choro incongruentes ao humor. Está relacionado ao isolamento social. A esclerose múltipla é uma doença relacionada a risco aumentado de suicídio. O objetivo desse estudo é verificar se há alg...

Pilot validering van subtypen bij suïcidaliteit Achtergrond Vanuit klinische en wetenschappelijke ervaring is een model ontwikkeld voor 4 subtypen van suïcidaliteit; 1)perceptuele desintegratie(PD), 2)primair depressieve cognitie(PDC), 3) psychosociale “turmoil"(PT) en 4) inadequate communicatie/coping(IC). Voor het model is een vragenlijst ontwik...

Achtergrond Suïcidaal gedrag wordt bijna altijd als een uniform verschijnsel gedefinieerd. Er is ook nauwelijks onderzoek naar verschillende vormen van suïcidaal gedrag gedaan. Mede naar aanleiding van onze klinische ervaring en vanuit bestudering van het wetenschappelijke onderzoek, constateren we dat er in de psychiatrische praktijkvoering versch...

A clinical differentiation model of suicidal behaviors may improve clinical practice. It may be helpful to determine which type of treatment is most appropriate for subtypes of suicidal behaviors and may improve adherence to suicide prevention guidelines. Also, differentiation of suicidal behaviors may create clarity about the role of healthcare pr...

Background: Anxious-retarded depression is a two-dimensionally defined subcategory of depression that has been derived from the DSM-IV melancholic subcategory. This subcategory is related to increased plasma vasopressin, a high correlation between plasma vasopressin and cortisol, and a positive family history. The original melancholic subcategory i...

De huisarts heeft vaak te maken met suïcidaal gedrag wat kan worden opgevat als een symptoom dat zich uitstrekt over diverse psychiatrische aandoeningen. Ook komt suïcidaal gedrag voor zonder dat er sprake is van een "harde" classificatie voor een psychiatrische en/of persoonlijkheidsstoornis en lijkt soms meer bij een ingewikkeld existentieel geda...

Background. Suicide ideations among the elderly are highly prevalent and attempts often have lethal

Background: Each year, around 1800 patients commit suicide in the Netherlands and this number is increasing. Around 40% of these suicides received mental health care at the time. Aims: To gain knowledge about risk taxation for the prevention of suicide during ordinary or crisis consultation. Methods: By comparing data of two groups, a) recent menta...

In this case report, we will present two cases in which the Dutch municipal coroner registered a natural death, but treating psychiatrists doubted the validity of this decision on the grounds of clinical data and investigation. For both cases, we present evidence that deaths likely resulted from suicide, raising serious doubts about the accuracy of...

Resumo Objetivo: Afeto pseudobulbar é uma forma de expressão emocional patológica, na qual o paciente com transtorno neurológico apresenta explosões de riso e choro incongruentes ao humor. Está relacionado ao isolamento social. A esclerose múltipla é uma doença relacionada a risco aumentado de suicídio. O objetivo desse estudo é verificar se há alg...

Na een ongeval thuis is suïcide de meest voorkomende oorzaak van een niet-natuurlijke dood. Er overlijden 3 keer zoveel mensen door zelfdoding dan door verkeersongevallen. Toch wordt de huisarts relatief weinig geconfronteerd met suïcide. Naar schatting maakt een huisarts iedere 4 tot 8 jaar een patiënt mee die suïcide pleegt. Suïcidepogingen en de...

Differentiation of Suicidal Behaviour, a practical clinical approach

Suicide rates appear to be influenced by the economy. In the Netherlands, fluctuation in these rates in the last 10 years was mainly seen in men. The COVID-19 pandemic is likely to have a negative impact on this fluctuation. There are no reliable predictors of suicidality yet, but there are developments that could lead to better predictions. Exampl...

Suicide rates appear to be influenced by the economy. In the Netherlands, fluctuation in these rates in the last 10 years was mainly seen in men. The COVID-19 pandemic is likely to have a negative impact on this fluctuation. There are no reliable predictors of suicidality yet, but there are developments that could lead to better predictions. Exampl...

Veel personen met suïcidaal gedrag belanden in de eerste- of tweedelijns geestelijke gezondheidszorg (ggz). De Nederlandse en Vlaamse richtlijnen voor de diagnostiek en behandeling van suïcidaal gedrag zijn richtinggevend voor de beoordeling van suïciderisico’s. Contact maken over de wanhoop en de weging van stress- en kwetsbaarheidsfactoren en bes...

Study objectives: There is little literature about differentiation of suicidal behavior. Generally, suicidality is defined as an uniform phenomenon. When this is the case, mainly specific and not general "groups" are investigated (such as students, adolescents, patients with bipolar disorder etc.) or factor analytic research is done but seldom for...

In general, suicidal behaviour is defined as a uniform phenomenon and most research into suicidal behaviour has not focused on different types of suicidal behaviour(1,2). In clinical practice we do recognize different types of suicidal behaviour however those behaviours are not precisely described and/or investigated. Except for making the distinct...

Suïcidaal gedrag is een symptoom dat vaak voorkomt en zich uitstrekt over veel verschillende psychiatrische ziekten. Ook komt suïcidaal gedrag voor zonder dat er sprake is van een classificatie volgens de dsm en lijkt het soms bij een ingewikkeld existentieel gedachtepatroon te passen. Er zijn overigens in de dsm 5 maar twee classificaties waarin s...

De hersenen van adolescenten zijn nog in ontwikkeling  3 reacties  Getty Images De wet staat het toe, maar het zou eigenlijk verboden moeten worden: euthanasie bij adolescenten met een psychiatrische aandoening die uitzichtloos en ondraaglijk lijden. Dat bepleiten Pieter Jan Stallen en collega's. Het brein van jongeren is immers nog niet uitgerij...

1 Multidisciplinaire evaluatie als onderdeel van kwaliteitssystemen 1.1 Wettelijke kaders voor de kwaliteit van zorg 1.2 Kwaliteitsnormen voor de omgang met suïcidaal gedrag 2 Evaluatie van suïcide: de huidige praktijk 2.1 Prospectieve en retrospectieve risicoanalyse 2.2 Sterke en zwakke kanten van de huidige praktijk 3 KEHR SUICIDE: datagestuurd e...

1 Opleiding van intermediairen en gatekeepers in de herkenning en bevraging van suïcidaliteit 2 Suïcidepreventie in de zorg, een multilevelmodel met een aantal basisprincipes 2.1 Een goed contact leggen 2.2 Bevorderen van de veiligheid 2.3 De omgeving erbij betrekken 2.4 Zorgen voor continuïteit 3 Een goed uitgewerkt suïcidepreventiebeleid als esse...

1 Parnassia Groep, Den Haag 2 VU, Amsterdam 3 Rivierduinen, Leiden 4 Sussex Partnership NHS Foundation Trust, Eastbourne England 5 Lentis GGz, Groningen Achtergrond Suïcidaliteit wordt in de regel als een uniform verschijnsel gedefinieerd. Er is weinig onderzoek naar typen van suïcidaal gedrag gedaan(1,2). In de praktijk zien we verschillende typen...

Development of smart inpatient rooms using automation and preventing using restraints in suicidal patients

Background: Specific and systematic data on health care providers' behaviour is needed to futher improve the care provided to suicidal patiënts in mental health care facilities. METHOD: Explorative observational study of all suicidal incidents (n=50) that occurred in a Dutch mental health care facility over a one year period. Incidents were evalua...

Background It remains difficult to predict and prevent suicidal behaviour, despite growing understanding of the aetiology of suicidality. Clinical guidelines recommend that health care professionals develop a safety plan in collaboration with their high-risk patients, to lower the imminent risk of suicidal behaviour. Mobile health applications prov...

Development of smart inpatient rooms using automation and preventing restraints in suicidal patients, extension

Background: The outreach emergency psychiatric service plays an important role in recognising, arranging interventions and preventing suicide and suicidal behaviour. However, little is known about the assessments that members of the emergency team make when faced with patients showing suicidal behaviour. AIM: To describe the relationships that are...

ACHTERGROND Het hebben van een psychiatrische stoornis is een bekende risicofactor voor suïcide en suïcidaal gedrag. De behandeling van psychiatrische stoornissen kan het risico op suïcidaal gedrag en suïcide verminderen. Sinds 2012 is de behandeling van een aantal psychiatrische stoornissen uitgesloten van vergoeding door de zorgverzekeraar. DOEL...

Background: Suffering from a psychiatric disorder is a well-known risk factor for suicide and suicidal behavior. Treatment of psychiatric disorders can reduce the risk of suicidal behavior and suicide. In the Netherlands, however, since 2012 the treatment costs of some psychiatric disorders have no longer been covered by health insurance. AIM: To...

Using automation in preventing using restraints in acutely suicidal patients

Using automation in preventing using restraints in acutely suicidal patients Remco Winter1, Willem Nugteren, Wouter van Maanen, Arlette van Amerongen 1corresponding author RFP de Winter MD PhD Parnassia Group The Hague/VU Amsterdam Background When acute suicidal inpatients are estimated, by clinicians, as a high risk for suicide, permanent observa...

Bij ernstig suïcidaal gedrag komt het voor dat patiënten worden opgenomen in een psychiatrische kliniek. Een opname wordt gerealiseerd als een hulpverlener door de ernstige suïcidaliteit geen mogelijkheden ziet om de patiënt verder ambulant te behandelen. Wanneer is het risico op suïcidaal gedrag zo groot dat een patiënt opgenomen dient te worden?...

Background: Outreach psychiatric emergency services play an important role in all stages of a suicidal crisis; however, empirical assessment data are scarce. This study describes characteristics of patients assessed by these services and involved in suicidal crises. Method: During a 5-year period, detailed information from psychiatric emergency ser...

Background: Admission at a closed acute psychiatric ward is a severe and possibly life changing experience for a patient. Sometimes admission is accompanied by coercive measures. Despite the impact that these measures may have on the patient, very little research has been published concerning this patient population. Aim: To obtain insight into...

https://www.ntvg.nl/artikelen/een-aanjaagteam-voor-verwarde-personen

An evaluation of a new Dutch suicide prevention tool (KEHR); datadriven evaluation and learning BACKGROUND Multidisciplinary evaluation of suicide cases effectively decreases the suicide rate in mental health care. A new suicide prevention tool (kehr) can be used in this connection. kehr has been developed on the basis of the Dutch multidiscipli...

Background: Multidisciplinary evaluation of suicide cases effectively decreases the suicide rate in mental health care. A new suicide prevention tool (KEHR) can be used in this connection. KEHR has been developed on the basis of the Dutch multidisciplinary practice guideline on the assessment and treatment of suicidal behaviour. The guideline can...

Background Randomised studies examining the effect on patients of training professionals in adherence to suicide guidelines are scarce.AimsTo assess whether patients benefited from the training of professionals in adherence to suicide guidelines.Method In total 45 psychiatric departments were randomised (Dutch trial register: NTR3092). In the inter...