[(Self)-compassion as an antidote for psychopathology]. / (Zelf)compassie als antidotum voor psychische stoornissen.

BACKGROUND: The prevalence of psychopathology did not decrease in prosperous countries, despite evidence-based treatment, focus on prevention and long prosperity. AIM: To investigate if the eastern concept of self-compassion can help to decrease the prevalence of psychopathology. METHOD: Literature review and interviews with experts. RESULTS: Health is defined as a state of complete wellbeing. This seems like a maintainable goal in prosperous countries. Setbacks are, however, an unavoidable part of life and therefore resilience is important. Normalizing a state of complete wellbeing comes at the expense of resilience because it increases stress after setbacks. Stress is an important precursor to psychopathology because it leads to suffering and dysfunction. The concept of self-compassion and compassion in a broader sense, refer to the capacity to be mild when setbacks occur. (Self)-compassion helps to regulate stress and can therefore improve resilience and contribute to decrease the prevalence of psychopathology. CONCLUSION: In prosperous countries, there is little attention to resilience. The concept of (self)-compassion can contribute to mental resilience and can help to decrease the prevalence of psychopathology. Therefore, it deserves a place in the diagnostics and treatment of psychiatric disorders.

[Transdiagnostic psychiatry: work in progress]. / Transdiagnostische psychiatrie: concept in ontwikkeling.

BACKGROUND: There is an increasing awareness that the current approach to clinical thought and work in psychiatry in relation to psychiatric diagnosis, treatment and research has its limitations. This necessitates a process to reform both the clinical practice and future scientific research. One way to reform this is the transdiagnostic approach. AIM: To clarify the psychological, biological and therapeutic aspects of a transdiagnostic approach in psychiatry. METHOD: An analysis of new approaches based on recent findings from the recent literature. RESULTS: Transdiagnostic psychiatry is a relatively new concept which is still under development. The examples extracted from the reviewed literature on developmental psychology, neurobiology and treatment demonstrate that this approach may lead to improvements in clinical care and generate new etiological insights. CONCLUSION: A transdiagnostic approach in psychiatry may lead to new insights that are relevant for clinical practice and future scientific research.

[A patient with a prolonged untreated psychosis]. / Een patiënt met een langdurig onbehandelde psychose.

A 30-year-old male was treated with antipsychotic medication because he had developed psychotic symptoms associated with schizophrenia. It became apparent that the symptoms had been present for many years, but, unfortunately, remained untreated. In the literature there is some evidence of a link between an untreated psychosis of long duration and a poor prognosis. Several early intervention programmes are based on this link. In this case report we illustrate that treatment of a psychosis that has lasted for many years can yield amazingly rapid results.

[Is there any point in detecting high risk factors prior to a first psychosis?]. / Wanneer heeft detectie van hoogrisicofactoren voor een eerste psychose zin?

BACKGROUND: If schizophrenia and related disorders are diagnosed and treated early, symptoms will be less severe and the prognosis will be more favourable. There is little point in screening for schizophrenia in the general population because the illness has such a low incidence. However, we do need to find out whether it is meaningful to screen genetically impaired individuals (high risk group) and specific groups of psychiatric patients (ultra high risk group). AIM: To survey the research into the (high and ultra high) risk factors for developing a first psychosis and to find out whether it makes good sense to screen certain groups of persons. METHOD: We conducted extensive desk-research and a wide-ranging search of the literature from 1990 to 2004. The key words we used in our search were 'prodrome', 'high risk', 'ultra high risk', in conjunction with 'psychosis' and 'schizophrenia'. RESULTS: In the genetically impaired group risk factors for developing schizophrenia seem to be transient psychiatric problems in childhood, schizotypical traits, anxiety, behavioural problems in adolescence, being brought up in an unstable environment and producing deviant results in neurocognitive tests. Among the patients referred to a psychiatrist it is possible to identify a special group of patients with an ultra high risk of developing a psychosis. Within ayear 40% of patients who had mild or short-term psychotic symptoms or who were genetically impaired adolescents with decreased functioning had developed a psychosis. CONCLUSION: Screening all genetically vulnerable persons in the general population has no consequencesfor treatment. Early diagnosis by psychiatrists is certainly advisable. However, larger groups and longer studies are needed in order to demonstrate conclusively the preventive effect of interventions prior to a first psychosis.