[Perceptions of radicalisation and psychiatry in the relationship between mental health care and the security domain]. / Percepties over radicalisering en psychiatrie in de relatie tussen ggz en veiligheidsdomein.

BACKGROUND: The literature suggests that intersectoral collaboration is important to prevent attacks by radicalised persons with mental health issues, but it is not clear what this collaboration entails. AIM: To provide insight in how perceptions of radicalisation and mental health issues differ between mental health care and the security domain, and how this affects intersectoral collaboration. METHOD: Qualitative data were obtained through focus group discussions and interviews with professionals and training staff from mental health care and the security domain. RESULTS: The focus in mental health was on treatment of patients, while safety dominated in the security domain. Collaboration was hampered by too little understanding of, and for, each other's domain. The separation of radicalisation with mental health issues into prosecution or mental health care impaired an integrated approach. Privacy rules were experienced as a significant barrier for collaboration. CONCLUSION: Intersectoral collaboration works effectively if participants maintain their professional standards and only share information that is necessary and justified to make an effective plan. Many identified obstacles are more general in nature, and not confined to specific cases of radicalisation with mental health issues. Dutch Care and Safety Houses offer a sound base for intersectoral collaboration. Future professionals from different domains ought to be familiarized with each other's (im)possibilities, tasks, and roles.

Decision making on (dis)continuation of long-term treatment in mental health services is an interpersonal negotiation rather than an objective process: qualitative study.

BACKGROUND: Research into termination of long-term psychosocial treatment of mental disorders is scarce. Yearly 25% of people in Dutch mental health services receive long-term treatment. They account for many people, contacts, and costs. Although relevant in different health care systems, (dis)continuation is particularly problematic under universal health care coverage when secondary services lack a fixed (financially determined) endpoint. Substantial, unaccounted, differences in treatment duration exist between services. Understanding of underlying decisional processes may result in improved decision making, efficient allocation of scarce resources, and more personalized treatment. METHODS: A qualitative study design, according to Grounded Theory principles, was used to understand the decision making process. In four teams in three large Dutch mental health services, 29 multidisciplinary case conferences were observed, and 12 semi-structured interviews were conducted. RESULTS: We describe two constituent elements of decision making: the process through which decision making is prepared and executed, and the substantial factors guiding its outcomes. The first consists of: (1) steps towards a team discussion on treatment termination, (2) team-related factors that influence decisions, and (3) the actual team decision making process. The second consists of factors related to patients, professionals, organization, and wider environment. Our main finding was that discussions of treatment (dis)continuation are highly unstructured. Professionals find it difficult to discuss with patients and teams, team discussion are ad-hoc, and clear decisions are scarce. We offer four explanations: first, long-term treatment lacks golden rules on outcome and process to base decisions on. Second, in the absence of such rules professionals rely on experience but underappreciate their own biases. Third, consequently, professionals aim for decisional consensus, which however is scarce among professionals. Fourth, treatment environments are hardly in favour of changing default (continuation) settings. CONCLUSION: Clear decision making, and terminating treatment when appropriate, is systematically hampered within secondary mental health services. Since continuation is the 'easy' default option, discontinuation requires skillful and determined navigation of interpersonal negotiations. Given services' scarce means, people's large demands for help, and patients' unused potential autonomy, it is desirable to invest in decision making skills and procedures - both human and economic benefits may be substantial.

Does working with the Veder Contact Method influence the job satisfaction of caregivers? A non-randomized controlled trial in nursing homes for people with dementia.

BACKGROUND: Person-centered care interventions can improve the quality of life and decrease behavioral problems of people with dementia. Although not convincingly proven, person-centered care interventions may benefit the caregivers as well. This study aims to gain insight into how working with the Veder Contact Method (VCM) - a new person-centered care method - influences the job satisfaction of caregivers. METHODS: Within a quasi-experimental study, the job satisfaction of caregivers of six experimental wards (n = 75) was compared with caregivers of six control wards (n = 36) that applied Care-As-Usual. The Leiden Quality of Work Questionnaire (LQWQ) was filled in by caregivers in both conditions. Additionally, on the experimental wards, qualitative research, i.e. focus groups with 42 caregivers and interviews with 11 managers, was conducted to obtain a deeper understanding of the influence of applying VCM on caregivers' job satisfaction. The transcripts were analyzed using deductive analysis. RESULTS: No quantitatively significant differences were found on the subscales of the LQWQ: work and time pressure, job satisfaction, autonomous decision making, social support from colleagues, and social support from supervisors. From the qualitative research, some caregivers and managers reported that implementing VCM contributed to their job satisfaction and that applying VCM supported handling difficult behavior and depressed mood of residents and contributed to team building. CONCLUSIONS: No significant effects on job satisfaction were demonstrated. Qualitative findings indicate that VCM positively influences the daily work performances of nursing home caregivers. The relation between the experience of offering quality care and job satisfaction of caregivers needs further investigation.

Help-seeking behaviour of patients with haematological malignancies treated with autologous stem cell transplantation.

Patients with haematological malignancies undergoing autologous stem cell transplantation face a life-threatening illness and stressful treatment. Although many patients report problems, relatively few patients report a need for additional professional care after treatment. We aimed to gain insight into the factors underlying this discrepancy by exploring patients' needs and help-seeking behaviour in relation to their experienced symptoms and problems. A qualitative research design following the grounded theory approach was used. Twenty patients, treated with autologous stem cell transplantation in the past 2 years, participated in an individual semi-structured interview. Factors contributing to patients' help-seeking behaviour were derived from our data and ordered in the following categories: (1) transition from symptoms to problems; (2) preference for dealing with problems themselves and with help from relatives; (3) problem categories and coping strategies; and (4) motives for (not) bringing in professional help. We concluded that the mere presence of a symptom does not lead to help-seeking behaviour: this relationship is modified by patients' personal goals, future perspective and phase of recovery. Patients seem to prefer to deal with problems without professional care. Patients' actual appeal for professional care depends on their coping strategies, social network and knowledge of available care.

[Prescribing psychotropic medication by the nurse practitioner in mental health care: an explorative study]. / Voorschrijven van psychofarmaca door verpleegkundig specialist ggz: een exploratief onderzoek.

BACKGROUND: Since January 1, 2012, nurse practitioners (NP) working in mental health care are allowed to prescribe psychotropic medication. So far, there has been very little research on the results of this decision that now let NPS share with doctors prescribing psychotropic drugs. AIM: To provide insight into how patients and psychiatrists experience the prescribing behaviours of NPS and how NPS themselves regard their extended role. METHOD: We performed an explorative study in which we used the data given in prescriptions written by NPS, questionnaires exploring patients' experiences and semi-structured interviews with psychiatrists and NPS. RESULTS: Between May 2014 and May 2015, 13 NPS wrote 3542 prescriptions for 565 unique patients. On the whole, patients, psychiatrists and NPS expressed positive views on the prescribing of psychotropic medication by NPS. CONCLUSION: Our research project confirms that the various stakeholders are satisfied with the prescribing practices of NPS. A follow-up study is needed in order to ascertain whether there are qualitative differences between the prescriptions of NPS and those of doctors.

A randomized clinical trial on the effectiveness of an intervention to treat psychological distress and improve quality of life after autologous stem cell transplantation.

Psychological distress contributes to impaired quality of life in hematological cancer patients. Stepped care treatment, in which patients start with the least intensive treatment most likely to work and only receive more intensive interventions if needed, could improve distress. We aimed to evaluate the outcome of stepped care treatment on psychological distress and physical functioning in patients treated with autologous stem cell transplantation for hematological malignancies. In the present study, we performed a randomized clinical trial with two treatment arms: stepped care and care as usual. Baseline assessment and randomization occurred during pre-transplant hospitalization. Stepped care was initiated after 6 weeks, consisting of (1) watchful waiting, (2) Internet-based self-help intervention, and (3) face-to-face counseling/ psychopharmacological treatment/ referral. Follow-up measurements were conducted at 13, 30, and 42 weeks after transplantation. Stepped care (n = 47) and care as usual (n = 48) were comparable on baseline characteristics. The uptake of the intervention was low: 24 patients started with step 1, 23 with step 2, and none with step 3. Percentages of distressed patients ranged from 4.1 to 9.7 %. Ten percent of patients received external psychological or psychiatric care. No statistically significant differences were found between stepped care and care as usual on psychological distress or physical functioning in intention to treat analyses, nor in per protocol analyses. The stepped care program was not effective in decreasing psychological distress. The low intervention uptake, probably related to the low levels of psychological distress, offers an explanation for this outcome. Future research should take into account patients' specific care needs. Netherlands Trial Registry identifier: NTR1770.

The relationship between challenging behaviour and anxiety in adults with intellectual disabilities: a literature review.

BACKGROUND: Anxiety and challenging behaviour (CB) often occur simultaneously in people with intellectual disabilities (ID). Understanding the associations between anxiety and CB may contribute to more accurate diagnoses and management of both anxiety and CB in this population. AIMS: To examine the relationship between anxiety and CB. METHODS: A literature review covering the period from January 2000 to January 2012. RESULTS: Seven studies about the relationship between psychiatric disorders, including anxiety, and CB were identified. These studies confirm the relationship between anxiety and CB in people with ID, although the precise nature of this relationship remains unclear. CONCLUSIONS: The study points toward the existence of a moderate association between anxiety and CB. Further research is needed to clarify the complex nature of the association between anxiety and CB.

[Good clinical practice and the maintenance of ethical standards in medical research: advice for junior researchers working in mental health care]. / Good clinical practice en medisch-ethische toetsing: handvatten voor (beginnend) onderzoekers in de ggz.

BACKGROUND: In mental health care, more and more research is being done, particularly in the field of educational programmes. Unfortunately, junior researchers are often not fully informed about the rules and regulations relating to research and about medical ethics. Therefore, they are not in a position to make considered judgements that conform to good clinical practice and acceptable medical ethics.
AIM: To give practical advice to trainees, stimulating them to think carefully about ethical standards in patient-related research in mental health care. METHODS The article provides a practice-based overview of practical advice and ethical considerations.
RESULTS: We stress that before beginning their research, researchers should think very carefully about the ethics of medical research. Instructions and guidelines relating to medical and ethical standards are to be found in: directive for good clinical practice compiled by the central committee for human research (CCMO) with the accompanying e-learning module and in the basic course 'rules and organisation for clinical researchers' (BROK). Practical tips, illustrated with examples, provide a framework for stimulating thoughts on medical ethics. Finally, it is important to improve the ways in which research is embedded in the organisational structure of teaching programmes.
CONCLUSION: Basic information about GCP and the upholding of medical and ethical standards in patient-related research can be obtained from various sources. The main challenge is to ensure that GCP is firmly embedded in patient-related research undertaken by junior researchers.

[Dutch guideline on Schizophrenia 2012: basic care within the areas of psychosocial interventions and nursing care]. / Richtlijn Schizofrenie 2012: basiszorg op het gebied van psychosociale interventies en verpleegkundige zorg.

BACKGROUND: An updated version of the Dutch multidisciplinary guideline on schizophrenia was published in 2012. AIM: We aim to provide an overview of the psychosocial interventions and nursing care which, according to the guideline, should be included in basic care programmes for patients with schizophrenia. We consider which interventions are effective and which are optional. In addition, we argue for continuous updating of the guideline so that it reflects current developments. METHOD: We conducted a systematic review on the basis of specific predefined search terms. We included articles published up to February 2010. We used the method for evidence-based guideline development in order to formulate treatment recommendations. CONCLUSION: Cognitive behavioural therapy and family interventions are scientifically proven interventions that should be included in the care programmes. Although there is no clear evidence that psycho-education is effective, it is nevertheless recommended. Optional interventions are peer support groups and, in the case of negative symptoms, psychomotor therapy. Although scientific evidence concerning nursing care is limited, we do make some recommendations. We are strongly in favour of a living guideline & rsquo; that is constantly developed and updated.

What makes community psychiatric nurses label non-psychotic chronic patients as 'difficult': patient, professional, treatment and social variables.

PURPOSE: To determine which patient, professional, treatment and/or social variables make community psychiatric nurses (CPNs) label non-psychotic chronic patients as 'difficult'. METHODS: A questionnaire was designed and administered to 1,946 CPNs in the Netherlands. Logistic regression was used to design models that most accurately described the variables that contributed to perceived difficulty. RESULTS: Six variables were retained in the final logistic model. Perception-related variables (feeling powerless, feeling that the patient is able but unwilling to change, and pessimism about the patient's change potential) dominated treatment-related variables (number of contacts per week and admission to a locked ward in the last year) and social variables (number of psychosocial problems). CONCLUSION: This research shows that perceived difficulty is related to complex treatment situations, not so much to individual patient characteristics. If the constructed model has good predictive qualities, which remains to be tested in longitudinal research, it may be possible to accurately predict perceived patient difficulty. When used as a screening tool, such a model could improve treatment outcomes.

Major depressive disorder in late life: a multifocus perspective on care needs.

BACKGROUND: The effectiveness of late-life depression treatment can be improved by tailoring interventions to patients' needs. Unmet needs perceived by patients suffering from a severe mental illness, e.g. depression, may have a negative impact on their recovery. AIM: The aim of this study is to gain insight into the needs of outpatients with late-life depression. METHOD: Ninety-nine outpatients (aged 58-92) receiving treatment for major depressive disorder were recruited from six specialized mental health care facilities in the Netherlands. They were interviewed using the Dutch version of the Camberwell Assessment of Needs for the Elderly (CANE-NL) to identify met and unmet needs. The Montgomery-Asberg Depression Rating Scale was administered to measure depression severity. RESULTS: Depression severity levels varied from remission (23%), mild (31%), moderate (31%) to severe depression (15%). The average number of needs reported was 8.86, comprising 6.5 met needs and 2.3 unmet needs. Most of the unique variance in depression severity was explained by psychological unmet needs, more in particular by needs representing psychological distress. The environmental, social or physical unmet needs, respectively, showed less or no meaningful predictive value for variance in depression severity. CONCLUSION: The psychological needs category of the CANE appeared to be the strongest predictor of depression severity. Systematic needs assessment may be considered as a necessary complement to medical examination and a prerequisite for the development of tailored treatment plans for older people with depression.

Clinical problems in community mental health care for patients with severe borderline personality disorder.

The objective of this research was to assess the problems that professionals perceive in the community mental health care for patients with severe borderline personality disorder that do not fit into specialized therapy. A group of national experts (n = 8) participated in a four-phase Delphi-procedure to identify and prioritize the problems. A total of 36 problems reflecting five categories was found: patient-related, professional-related, interaction-related, social system-related, and mental health care-related. Problems with attachment and dependency and social issues were important patient problems while a lack of skills was an important professional problem. Support from the patient's social system and the mental health system were identified as limited, which resulted in both the patient and the professional feeling isolated. Patient, professional, and organisational characteristics of community care differ substantially from those of specialized care. The field is thus in need of a more tailored approach that takes these differences into account.

Quality of life for long-stay patients of psychiatric hospitals: a literature study.

The aim of this literature review is to provide an answer to the following questions: (1) What is known about the quality of life and quality of care for long-stay psychiatric patients? (2) What does literature say about possible contributions that health-care professionals may make to the quality of life for this target group? We conducted an open literature search across national and international databases, and added relevant literature by using cross-references. The quality of life and quality of care for long-stay psychiatric patients has been the subject of research on a limited scale only. Publications in this field provide a picture of patients with wishes and requirements that are generally basic and modest in nature. They also show that patients greatly value good relations with their care providers. This literature review shows that little is known about the quality of life of long-stay psychiatric patients and this review also shows that the relational aspects of care provide an eminent opportunity for care providers to contribute to the quality of life of their patients. Long-stay patients need care providers who are capable of developing and maintaining a caring relationship of the highest quality that will endure for many years. In their daily work, nurses have good opportunities to develop and maintain meaningful and reciprocal relationships with severely ill people, but this is a task that makes great demands on nurses in terms of both knowledge and interhuman skills. These skills should be given special attention both in nurse education and by supervisors.

Nurses' attitudes towards self-harm: a literature review.

ACCESSIBLE SUMMARY: People who self-harm experience many problems and needs related to management of emotional and practical stress. A positive attitude among nurses is especially important given the close contact they have with people who self-harm. This article is based on a review of the literature. It includes articles that concern both general and mental health nurses who work in various healthcare settings (e.g. acute inpatients wards, community mental health, emergency departments and medical admission units). The literature shows that negative attitudes towards self-harm are common among nurses. It remains unclear how nurses' age, work experience and gender influence their attitudes. The setting in which nurses work appears to influence their attitude, as does their level of qualification. For example, mental health nurses appear to have more positive attitudes than general nurses. Nurses' attitudes can be improved with the help of education comprising reflective and interactive elements. Supervision and support from colleagues appear to be especially important for mental health nurses. Self-harm is a growing health problem. Nurses in a variety of healthcare settings play a central role in the care of people who self-harm. Their professional attitudes towards these people are essential for high-quality care. This review aims to develop insight into nurses' attitudes towards self-harm as they exist in contemporary nursing practice. A literature search was conducted in four databases, and a total of 15 relevant articles were found. This review indicates that negative attitudes towards self-harm are common among nurses. The influence of nurses' age, gender and work experience remains unclear. Healthcare setting and qualification level appear to be influencing factors. Education can have a positive influence on nurses' attitudes towards self-harm, especially when it includes reflective and interactive components. It is demonstrated in this review that a major change is needed regarding nurses' attitudes. To realize this change, nurses need to be trained and educated adequately concerning self-harm. They need time and resources to build a therapeutic relationship with people who harm themselves so they can offer high-quality care for this vulnerable group.

The practice of early recognition and early intervention to prevent psychotic relapse in patients with schizophrenia: an exploratory study. Part 1.

In this article we describe the findings of an exploratory study into the application of early recognition and early intervention methods aimed at prevention of psychotic relapses in patients with schizophrenia. We addressed several models of symptom recognition plans and indicated how patients, healthcare professionals and other persons involved may be able to list and evaluate early warning signs systematically. We also paid attention to the role of the patient's family and to the potential effects of using early recognition and early intervention methods. In a follow-up article (part 2), we will focus more specifically on factors which favourably or adversely affect the use of early recognition and early intervention methods. The results of this exploratory study will be used to design an intervention protocol for nursing staff to serve as a tool for preparing symptoms recognition plans with the individual patient and his/her social network.

The practice of early recognition and early intervention to prevent psychotic relapse in patients with schizophrenia: an exploratory study. Part 2.

In this article we describe the findings of an exploratory study into the application of early recognition and early intervention methods aimed at prevention of psychotic relapses in patients with schizophrenia. Following the results we described in part 1, we now focus specifically on factors which favourably or adversely affect the use of early recognition and early intervention methods. The following issues will be addressed: (i) information and education; (ii) attitude of health care professionals; (iii) the patient's insight; (iv) acceptance of illness; (v) motivation; (vi) other relevant patient characteristics; and (vii) continuity of care. Finally, the implications of the findings for the development of a nursing intervention protocol will be discussed.

Distress, problems and supportive care needs of patients treated with auto- or allo-SCT.

Hematological malignancies and treatment with hematopoietic SCT are known to affect patients' quality of life. The problem profile and care needs of this patient group need clarification, however. This study aimed to assess distress, problems and care needs after allo- or auto-SCT, and to identify risk factors for distress, problems or care needs. In this cross-sectional study, patients treated with allo-SCT or auto-SCT for hematological malignancies completed the Distress Thermometer and Problem List. Three patient groups were created: 0-1, 1-2.5 and 2.5-5.5 years after transplantation. After allo-SCT, distress and the number of problems tended to be lower with longer follow-up. After auto-SCT, distress was highest at 1-2.5 year(s). Patients mainly reported physical problems, followed by cognitive-emotional and practical problems. A minority reported care needs. Risk factors for distress as well as problems after allo-SCT included younger age, shorter time after transplantation and GVHD. A risk factor for distress as well as problems after auto-SCT was the presence of comorbid diseases. Up to 5 years after auto-SCT or allo-SCT, patients continue to experience distress and problems. Judged by prevalence, physical problems are first priority in supportive care, followed by cognitive-emotional and practical problems.

The quality of the working alliance between chronic psychiatric patients and their case managers: process and outcomes.

The concept of a working alliance is rooted in psychotherapy and has been studied extensively in that field. Much less research has been conducted into working alliances between chronic psychiatric patients and their case managers. The aim of this review was to identify what is known about the working alliance between chronic psychiatric patients and their case managers. An extensive survey of the literature produced 14 articles for this review. The results of studies conducted show that a good working alliance has positive effects on the functioning of patients, and that the quality of the alliance depends on both patient characteristics and the behaviour of the case managers. The results also indicate that the working alliance is largely determined in the first 3 months of the contact. Further research into the development of working alliances is necessary.

Interpersonal community psychiatric treatment for non-psychotic chronic patients and nurses in outpatient mental health care: a controlled pilot study on feasibility and effects.

BACKGROUND: In psychiatric care professionals perceive some patients as 'difficult', especially patients with long-term non-psychotic disorders. For these patients few evidence-based treatments exist. An intervention program, Interpersonal Community Psychiatric Treatment (ICPT), was developed by the authors. It was evaluated with the aim to increase effective behaviours by both patients and community psychiatric nurses (CPNs). OBJECTIVE: To assess the feasibility and effectiveness of an intervention program for use by CPNs in the care of 'difficult' patients with non-psychotic chronic disorders, in a controlled pilot study. DESIGN: A mixed-methods quasi-experimental study using process and outcome measures across several dimensions. Measurements took place at 0, 3, and 6 months. SETTINGS: Three community mental health centres in the centre of The Netherlands. PARTICIPANTS: 14 CPNs and 36 long-term non-psychotic patients who were perceived as 'difficult' were selected. Patients were offered either ICPT (20) or care as usual (16). All patients and CPNs could be followed up at all measurements. METHODS: Quantitative data included type and severity of psychiatric disorder, psychosocial functioning, needs for care, quality of life and social participation. Also, service use, satisfaction with care, and quality of the therapeutic alliance were measured. Qualitative interviews were conducted with all CPNs and patients in the experimental group. RESULTS: ICPT was found feasible by both CPNs and patients. Both the experimental and control condition showed improvement on a number of outcomes. ICPT, however, resulted in significantly better results in some areas. Patients' social network size increased and their care utilization decreased. Also, the quality of the working alliance increased and perceived patient difficulty decreased, both as scored by professionals. CONCLUSIONS: ICPT is one of very few intervention programs aimed at 'difficult' non-psychotic chronic patients. In this pilot study was found that it can be successfully carried out by CPNs, is generally experienced as acceptable and useful by patients and CPNs alike, and results in some significantly better effects on both process and outcome measures. In the main study, some alterations will be made to the instruction manual and training program. Also, the diagnostic interview may be briefer, and the characteristics and treatment integrity of CPNs will be included in measurements. Further controlled and randomized research is needed to test the effectiveness of the program in a larger group of patients.