"Only One Way Out"-Partners' Experiences and Grief Related to the Death of Their Loved One by Suicide or Physician-Assisted Dying Due to a Mental Disorder.

Background: Previous research has provided insight into the grief of suicide survivors, but little is known about grief following physician-assisted dying (PAD), and no prior study specifically focused on grief following PAD due to a mental disorder. The current study aims to increase insight into experiences preceding PAD or suicide of a loved one due to a mental disorder and their impact on mental health symptoms. Methods: We performed a survey study and in-depth interviews with 27 bereaved life partners. The deceased had been in treatment for mental disorders and had died by PAD (n = 12) or suicide (n = 15). Interviews explored grief experiences and experiences with mental health care. In the survey, we assessed self-reported symptoms of grief, post-traumatic stress, anxiety, depression, quality of life, and impairments in social, and occupational functioning. Results: All participants reported generally low levels of mental health symptoms. Longer time since death and death by PAD were associated with lower grief intensity. Interviews showed various degrees of expectedness of the partners' death, and a varying impact of being present at the death on bereaved partners. Conclusion: Expectedness of the death of the partner, absence of suffering of the partner at the time of dying, and presence of physician support may in part explain the protective effects of PAD against severe grief reactions. Physicians considering their position regarding their personal involvement in PAD due to a mental disorder could take grief reactions of the bereaved partner into account.

[Complex grief: Cause of death is of influence]. / Complexe rouw: doodsoorzaak heeft invloed.

Current theories of grief assume that surviving relatives have to carry out a number of grief-related tasks after the loss of a loved one. If these tasks cannot be carried out properly and the intensity of the emotional pain does not decrease over time, we speak of complicated grief. Non-natural causes of death, such as suicide, violence, accidents or disasters, are associated with increased risk of complicated grief. The effects of euthanasia on surviving relatives are still unknown in this context. Social support may help with the grieving process. Psychological treatment of people with complicated grief symptoms is effective in many cases. Attention for complicated grief in surviving relatives, especially in cases of suicide and other non-natural causes of death, is of great importance in view of timely referral and treatment.

Association between psychological complaints and recurrence of vasovagal syncope.

PURPOSE: Vasovagal syncope (VVS), the most common cause of transient loss of consciousness (T-LOC), is often accompanied by higher levels of psychological distress. We investigated to what extent psychological complaints interact with the effects of non-pharmacological treatment in patients with frequently recurring VVS. METHODS: Patients with ≥3 episodes of VVS in the 2 years prior to the start of the study openly received non-pharmacological treatment. Before treatment initiation, we determined the level of general psychological complaints by the Symptom Checklist 90-R (SCL-90-R) questionnaire. We regularly evaluated syncopal recurrence during follow-up. We compared the SCL-90-R scores of VVS patients in our study with the corresponding scores of healthy Dutch subjects (reference population). We examined whether patients with more recurrences during follow-up had higher SCL-90-R scores at baseline and whether this association changed when adjusting for other factors associated with recurrence using logistic regression. RESULTS: Total SCL-90-R scores were higher in our cohort of patients with frequent episodes of VVS than in the reference population (142 vs. 118; p < 0.001). During the first 6 months of treatment, 42% of patients experienced syncopal recurrence(s). The SCL-90-R scores of these patients were significantly higher compared with patients without syncopal recurrence in this period (160 vs. 130; p = 0.01). After adjusting for other predictors of recurrence, especially the number of episodes before inclusion, the association between SCL-90-R scores and recurrence remained intact. CONCLUSIONS: Levels of general psychological complaints are higher in patients with syncopal recurrence during non-pharmacological treatment of VVS, even after adjusting for previous syncopal episodes.

Hepatitis C testing and treatment among active drug users in Amsterdam: results from the DUTCH-C project.

BACKGROUND: Although hepatitis C virus (HCV) treatment has shown to be effective, uptake of treatment among active drug users is still low. The Drug Users Treatment for Chronic Hepatitis-C project aims to offer active drug users in Amsterdam HCV testing and treatment using a multidisciplinary approach. METHODS: The study population comprises drug users participating in the Amsterdam Cohort Studies and drug users referred to the Drug Users Treatment for Chronic Hepatitis-C unit. Drug users were offered HCV testing and, if chronically infected, medical and psychiatric screening and HCV treatment. Various specialists collaborated to provide optimal care. We assessed test-uptake and treatment-uptake and outcomes. RESULTS: Four hundred and ninety-seven Amsterdam Cohort Studies drug users were offered HCV testing: 449 out of 497 (90%) accepted. HCV antibodies were found in 267 out of 449 (60%): 183 out of 267 (69%) were HCV-viremic and 49 out of 183 (27%) were HIV-co-infected. Of the 134 HCV-monoinfected patients, 102 (76%) initiated additional medical screening and 44 started treatment by 1 July 2009. Sixty-two drug users referred from methadone clinics were also HCV-monoinfected, of whom 14 started treatment by 1 July 2009. In total 58 persons were treated: 16 (27%) with genotype 1 or 4, 42 (72%) with genotype 2 or 3. Eighty-four percent used methadone, 97% used drugs (heroin, cocaine or amphetamine) at least once in the 6 months before treatment, 19% were active injectors. Sixty-two percent used alcohol, 41% had psychiatric disease other than substance abuse. Of the 57 individuals with sufficient follow-up, 37 (65%) achieved sustained virological response. CONCLUSION: In a multidisciplinary setting, HIV-negative drug users with chronic HCV infection can be treated successfully despite active drug or alcohol use and psychiatric diseases. Therefore, access to HCV therapy using an integrated approach should be increased for this population.

Effectiveness of selection in medical school admissions: evaluation of the outcomes among freshmen.

CONTEXT: In 2000 our medical school introduced a selection procedure (SP) for 10% of the otherwise randomly selected (RS) applicants. Students with excellent high school grade point averages (GPAs) were allowed direct access (DA) to our medical school. The selection procedure focused on medical comprehension, social and ethical understanding of health care, and communication and interpersonal skills. Objectives We aimed to establish how SP students compared with RS and DA students on motivation, academic achievement, study behaviour and extracurricular activities, and how these variables were interrelated within these groups. METHODS: In 2003, all Year 1 and 2 students were given a questionnaire on motivation, study behaviour and extra-curricular activities. Primary year GPAs were obtained from our administration department. Student groups were compared using descriptive statistics. The interrelationship between outcomes was tested using structural equation modelling. RESULTS: The questionnaire was returned by 418 students (76%). Selection procedure students were significantly more highly motivated (59.4) than RS students (56.6) and DA students (52.1). This was not reflected in academic achievement (6.7), which was highest among DA students (7.2). Selection procedure students carried out more extra-curricular activities, often health care-related, and displayed more study behaviour. Academic achievement could not be explained by motivation and study behaviour but motivation affected study behaviour and health care-related extra-curricular activities. CONCLUSIONS: The more profound commitment of selected students to health care is not primarily reflected in academic achievement but in motivation, extra-curricular activities and study behaviour. Follow-up research including all pre-clinical and clinical years should demonstrate the stability of these characteristics and their effects on graduates' post-qualification clinical performance as practising doctors.

Delirium subtype identification and the validation of the Delirium Rating Scale--Revised-98 (Dutch version) in hospitalized elderly patients.

BACKGROUND: Delirium is the most common acute neuropsychiatric disorder in hospitalized elderly. The Dutch version of the Delirium Rating Scale-Revised-98 (DRS-R-98) appears to be a reliable method to classify delirium. The aim of this study was to determine the validity and reliability of the DRS-R-98 and to study clinical subtypes of delirium using the DRS-R-98. METHODS: Patients received the Dutch version of the DRS-R-98, the Mini-Mental State Examination, the Confusion Assessment Method, and a clinical diagnosis of delirium according to DSM-IV criteria, and their relatives the Informant Questionnaire Cognitive Decline in the Elderly. RESULTS: The DRS-R-98 validation cohort (n=65) consisted of 23 patients with delirium, 22 patients with dementia, and 20 non-psychiatric comparison patients. For the delirium subtype study, a second cohort comprising 54 delirious patients was investigated. Median DRS-R-98 scores significantly distinguished delirium from dementia and no psychiatric disorder. Inter-rater reliability (intra-class correlation 0.97) and internal consistency (Crohnbach's alpha 0.94) were high. Positive scores of DRS-R-98 item 4 (affect liability) and item 7 (motor agitation) predicted the presence of non-hypoactive delirium, with a specificity of 89% and a sensitivity of 57%. CONCLUSION: The results show that the Dutch version of the DRS-R-98 is a valid and reliable measure of delirium severity and distinguishes patients with delirium from patients with dementia and comparison patients. Furthermore, the DRS-R-98 is able to exclude hypoactive delirium.