[Transcranial direct current stimulation in substance use disorders: an update]. / Transcraniële gelijkstroomstimulatie bij stoornissen in het gebruik van middelen: een update.

BACKGROUND: Existing treatments for substance use disorders are often subject to drop-out or relapse. Transcranial direct current stimulation (tDCS) possibly has a positive effect on this problem. AIM: To give an updated qualitative review of existing studies investigating the clinical effects of transcranial direct current stimulation for people with a substance use disorder, considering the many recently published studies. METHOD: Extensive literature search in the electronic database PubMed. We included 43 studies on top of the 7 studies already included in the previous review of Herremans and Baeken (2017) in this journal. RESULTS: The majority of the studies showed a positive effect of transcranial direct current stimulation on clinical measures as craving and abstinence. However, there was little uniformity in used protocols. CONCLUSION: Transcranial direct current stimulation can be an effective treatment for people with a substance use disorder. Optimal parameters need to be established to make the treatment maximally effective and adapted to the individual patient.

[Use of depot antipsychotics in Belgium between 1997 and 2016]. / Gebruik van depotantipsychotica in België, 1997-2016.

BACKGROUND: Antipsychotics are considered the cornerstone for the treatment of schizophrenia and are increasingly used in the treatment of mood disorders. A lack of drug adherence is a frequently occurring problem. Depot antipsychotics have been co-developed in order to deal with this problem. AIM: To map the depot antipsychotics prescription behaviour of psychiatrists and general practitioners in outpatient practice in Belgium. METHOD: Analysis of sales data of antipsychotics between 1997 and 2016. Data were supplied by Pharmanet, a database within the National Institute for Health and Disability Insurance (NIHDI). RESULTS: In the period 1997-2004, outpatient sales of depot antipsychotics decreased by 20%. The portion of depot antipsychotics in total antipsychotics sales dropped from 14.9% (1997) to 8.5% (2004). After second-generation depot antipsychotics were introduced from 2004, the sales figures of depot antipsychotics increased by 83%. In 2016, 9.8% of antipsychotic prescriptions was a depot antipsychotic prescription. As of 2012, more second-generation depot antipsychotics (52.2%) were sold than first-generation depot antipsychotics (47.8%). Psychiatrists were quicker to adopt second-generation depot antipsychotics than general practitioners, a trend similar to oral antipsychotics. CONCLUSION: Outpatient sales of depot antipsychotics in Belgium were on the rise after second-generation long-acting preparations were introduced to the market. Recent Scandinavian studies suggest that an increase in prescription of depot antipsychotics may contribute to better clinical outcomes.

[Ethics of assertive outreach: a case study]. / Ethiek van de bemoeizorg: een casusbespreking.

BACKGROUND: Caregivers need an ethical compass to find a way in assertive outreach. AIM: To develop an ethical framework of gradual care. METHOD: Using a case study, the ethical framework of gradual care is presented and applied. RESULTS: The starting point is a relational view of the human being. Consequently, a first condition is that caregivers build up a relationship of trust with the client. At the same time, they assess the decision-making capacity, i.e. the ability to take responsibility for a specific choice. The option for a particular gradation of assertive care depends on the degree of decision-making capacity. The extreme form of care on the continuum is coercion. As this is the least obvious form of assertive outreach, caregivers apply additional criteria. In the case study we illustrate the ten degrees of assertive outreach. The caregivers always try to empower the client to take responsibility for a particular choice. CONCLUSION: This ethical view of assertive outreach is an addition to the legal framework and serves as an ethical reference for caregivers to draw up and apply a more refined and nuanced care plan.

[Preventing chronicity in mental health: being present earlier within the network]. / Voorkómen chroniciteit: er eerder bij zijn binnen het netwerk.

BACKGROUND: Despite the increase in treatment options, mental illness is still too often evolving into chronic serious mental illness.
AIM: To describe concrete interventions aimed at the life structure and early detection within and outside mental health care to prevent chronicity in mental health.
METHOD: According to a quadrant, evidence-based interventions to prevent chronicity are proposed. These interventions can focus on the life structure of the patient and on early identification and intervention. They can take place both inside and outside mental health care.
RESULTS: Important interventions within mental health care include complete and repeated diagnostics, including staging, profiling and somatic screening, Mental health care must also focus on early detection and early treatment for all mental illnesses and apply concrete interventions such as IPS, lifestyle interventions, shared decision-making and low threshold anti-stigma actions. Outside of mental health services, mental health first aid (MHFA), housing first, alcohol prevention and mental gymnastics can be used.
CONCLUSION: Preventing chronicity requires an integrated cross-sectoral approach and a gatekeeper approach with active and responsive mental health care. Tijdschrift voor Psychiatrie 63(2021)2, 142-149.

[Somatic and pharmacological nurse care in 2b-teams in Flanders: a cross-sectional explorative study]. / Verpleegkundige somatische en farmacologische zorg binnen Vlaamse 2b-teams: een crosssectioneel verkennend onderzoek.

BACKGROUND: In the context of the Belgian mental health care reform (project 107), 2b-teams provide care to people with a serious mental illness (smi), a population encountering regular somatic comorbidity and limited compliance with medication. Team composition and care provided by these teams is rather unclear.
AIM: To consider the team composition and to focus on the nurses' role within Flemish 2b-teams. Also, seen from different disciplines involved, to determine the desired future nursing role.
METHOD: A structured interview was used to discover team characteristics and fidelity to the flexible assertive community treatment (fact) model in 12 Flemish 2b-teams. With a digital survey containing 16 questions we explored the actual and desired nursing care, according to 151 nurses and medical physicians.
RESULTS: Despite the difference in team size and composition, it was not found to be significant. Flemish team's fact model-fidelity was average. Actual care was restricted to psychosocial interventions. Regarding desired care, significant differences were found between physicians and nurses. Caregivers within outreach teams scored items significantly higher on desired care compared to actual care.
CONCLUSION: We conclude that the team composition of Flemish 2b-team varies, with an average fact model fidelity. Team care is restricted to psychosocial interventions, while more somatic and nursing care is desired.

A cognitive neuropsychiatric analysis of psychomotor symptoms in major depression and schizophrenia.

A cognitive neuropsychiatric analysis will be proposed by presenting recent research on -1-motor control, and -2-action monitoring in two psychiatric disorders i.e. major depression and schizophrenia. Motor control is best studied from the broader cognitive neuropsychological perspective of action control. Even very simple actions implicate quite diverse brain activities reflecting the cognitive processes of planning, selection, visuomotor integration, timing, force adjustment, and action monitoring. The extent to which deficits in these cognitive processes cause slowed or stereotypic actions can be experimentally studied in clinical settings by means of graphic tasks, as will be illustrated. A central process in motor/action control is error monitoring. The last decade research on this higher cognitive control process has been booming, also because the detection of errors is accompanied by a clear peak in the EEG, known as the error-related negativity (ERN). Deficient error monitoring has been observed in several psychiatric disorders. ERN studies in major depression and schizophrenia will be discussed. Psychiatric disorders can best be understood by considering three perspectives, i.e. psychopathology, cognitive neuropsychology and neuroscience. The findings support the view that cognitive neuropsychiatry should involve the combined study of psychiatric symptoms, cognitive dimensions and neurological structures.