Gender-specific characteristics of alcohol use in community-dwelling older adults in Belgium.

OBJECTIVES: Gender has been identified as an important social determinant for health. This study investigates gender-specific characteristics for alcohol use (AU) among community-dwelling older adults. METHODS: This is a retrospective cross-sectional study in 1,406 community-dwelling older adults. We used standardized questionnaires to collect self-reported data on alcohol use behavior, mental health, drinking motives and resilience by using, respectively, the Alcohol Use Identification Test (AUDIT), the Brief Symptom Inventory (BSI), the Drinking Motives Questionnaire (DMQ), and the Connor-Davidson Resilience Scale (CD-RISC). Multiple linear regression was used to identify the joint contribution of those factors on AU. Hierarchical regression was used to investigate the influence of the interaction between gender and those factors on AU. RESULTS: Linear regression analyses showed different associations with AU in men and women. Hierarchical regression analyses showed that gender presented a two-way interaction effect with enhancement and anxiety variables related to AU. CONCLUSIONS: Different characteristics were found as predictors for AU among older men and women. CLINICAL IMPLICATIONS: Clinicians and health-care providers should be aware of these differences in order to provide tailored screening and intervention programs to reduce AU in older adults.

Resilience, depression and anxiety and hazardous alcohol use behaviour among community dwelling older adults.

INTRODUCTION: We examined the psychometric properties of the CD-RISC, including factor structure. Secondly, we examined if resilience factors moderate the association between negative affect and hazardous alcohol use. METHOD: The sample population consisted of 1,368 community-dwelling older adults. We used standardized questionnaires to collect self-reported data on alcohol use behaviour, depression and anxiety and resilience by using respectively the Alcohol Use Identification Test (AUDIT), the Brief Symptom Inventory (BSI) and the Connor-Davidson Resilience Scale (CD-RISC). RESULTS: Of the total sample (N 1.368), 80.1% reported using alcohol. The total sample and the drinking sample reported, respectively, a mean of 65.75 (SD 15.40) and 65.79 (SD 15.90) on the CD-RISC. Concerning the CD-RISC, exploratory factor analysis presents four factors of which three with a good reliability. Moderation analyses reflects that older adults with higher levels of resilient characteristics didn't report an association between negative affect and hazardous drinking. Alternatively, low resilient older adults did report an positive and significant association between negative affect and hazardous drinking. CONCLUSION: The CD-RISC appeared to be a reliable instrument, containing three factors. In our sample, high resilience moderated the association between negative affect and hazardous drinking and may serve as a buffer against hazardous drinking.

[Decision making and the future of mental capacity. Steps towards an uncertain future within the context of CRPD]. / Beslissingsbekwaamheid? Met het VN-verdrag Handicap naar een onzekere toekomst.

Background  Mental capacity, the criterion used today to determine who can make decisions independently, is under pressure from the United Nations Convention on the Rights of Persons with Disabilities. Aim  To outline the prevailing view, the view of the UN Convention and a middle ground. To formulate steps to apply the spirit of the UN Convention today. Method  Essay starting from the most relevant international human rights sources within the United Nations and the Council of Europe, supplemented by secondary literature on these sources. Results  The UN Convention abandons mental capacity as the criterion to determine whether a patient can make decisions autonomously. At the same time, it rejects any form of coercion applied directly or indirectly because of mental illness. Conclusion  The UN Convention does not offer a clear alternative, so the future is uncertain. Nevertheless, the important principles of the UN Convention should not be forgotten; they can already be implemented today by being aware of the role of human rights in mental health care, by placing the quality of decision-making at the center and by making less and more conscious use of coercion.

[How to understand the wokeness-paradox of multiple stigma in persons with mental vulnerabilities?] / De moeizame aansluiting van psychisch kwetsbare personen bij de wokeness-beweging.

Background  Prejudice, stigma and discrimination against people with mental health problems are largely responsible for their limited social participation. Joining the globalised wokeness movement could reduce the tendency of social injustice. Aim  To explore the reasons why people with mental health problems experience difficulties to integrate into the wokeness debate and to suggest possible solutions. Results  Intersectionality, persons with mental health problems often being part of different vulnerable minority groups, stress and public stigma, are the main reasons of the limited level of advocacy for this target group. Conclusion  The struggle against social injustice that mental vulnerable persons are victims of, remains unequal even in times of wokeness. A strategic, non-patronising cooperation between psychiatrists, patients, family members and interest groups in the media and in the public and political forum, could make it possible to join the international wokeness movement.

[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.

[Proactive psychiatry in addiction]. / Proactieve psychiatrie bij verslaving.

BACKGROUND: Most substance use disorders (SUD) emerge in adolescence and early adulthood. Early interventions in young people may reduce the risk and severity of SUD and other psychiatric disorders.
AIM: To provide suggestions for proactive psychiatry in addiction.
METHOD: Literature review.
RESULTS: Comorbidity, cumulative risks and self-regulation skills each play an important role in proactive psychiatry. Early universal prevention and intervention targeted at improving self-regulation reduces the risk of a broad array of psychiatric and social problems, including addiction.
CONCLUSION: In terms of broad prevention, much can be gained by widespread, consistent implementation and normalization of universal prevention at the pre- and elementary school level. Tijdschrift voor Psychiatrie 63(2021)2, 125-128.

[Tired of waiting: towards a joint approach of waiting times in Flemish mental health care]. / Genoeg gewacht: naar een gezamenlijke aanpak van wachttijden in de Vlaamse ggz.

BACKGROUND: Waiting times are an important barrier to timely obtaining appropriate mental health care in Flanders, but structural data is limited. AIM: To describe the waiting time problem in Flanders and propose some causal hypotheses and possible interventions. METHOD: An exploration of the available waiting time data, supplemented with literature and insights based on the results of some Flemish Centers for Mental Healthcare. RESULTS: Waiting times are especially problematic for subsidized outpatient care and care for children and youth, although the current data provide an incomplete picture. Besides capacity, important factors are the organization of the intake (e.g. assessment) and flow parameters (e.g. mean treatment duration - and intensity). CONCLUSION: Eliminating waiting lists is one of the greatest challenges for Flemish mental health care. There is a need to expand capacity as well as the smarter use of existing capacity and resources. A joint multi-level approach is required.

[Adolescents with concurrent ADHD and substance use disorder; international consensus]. / Jongeren met een stoornis in het gebruik van middelen en ADHD: internationale consensus.

BACKGROUND: Substance use disorder (SUD) is common among youths with attention-deficit/hyperactivity disorder (ADHD). Co-morbid ADHD and SUD in youths complicates screening, diagnosis, and treatment of both disorders and is associated with worse treatment prognosis. Limited research in youths with SUD and co-morbid ADHD provides insufficient basis for firm recommendations. To offer clinicians some guidance on this topic, we present the results of an international consensus procedure. AIM: To summarize an international consensus on diagnosis and treatment of young people with comorbid ADHD and SUD. METHOD: In a modified Delphi-study, a multidisciplinary, international group of 55 experts strived to reach consensus on 37 recommendations. RESULTS: Consensus was reached on 36 recommendations. Routine screening of ADHD and/or SUD is important. For the treatment of co-morbid SUD and ADHD in youths, both psychosocial and pharmacological treatment should be considered. Psychosocial treatment should preferably consist of psychoeducation, motivational interviewing (MI), and cognitive behavioral therapy (CBT) focused on SUD or both disorders. Long-acting stimulants are recommended as first choice pharmacotherapy, preferably embedded in psychosocial treatment. Experts did not agree on the precondition that patients need to be abstinent before starting stimulant treatment. CONCLUSION: Clinicians and youths with co-morbid SUD and ADHD can use this international consensus to choose the best possible treatment.

[Perinatal mental health care for mothers with schizophrenia in Flanders; where are we still short?] / Perinatale geestelijke gezondheidszorg voor moeders met schizofrenie in Vlaanderen; wat kan er nog beter?

BACKGROUND: Only 0.8% of the admissions to our mother-baby unit are mothers with schizophrenia, while about half of the patients with schizophrenia become mothers. Mothers with schizophrenia are more likely to live in complex problematic settings and, thereby, more frequently lose custody of their children. Also, they experience stigma against their parenting skills. Literature research shows that they therefore avoid care. However, the inclusion of their role as a mother can contribute to recovery, giving meaning and social integration.
AIM: To initiate debate on responsible motherhood in women with schizophrenia with the aim of optimizing the Flemish care provision and give an incentive towards more scientific research.
METHOD: Consultation of the minimal psychiatric data (mpd) on our mother-baby unit. Narrative literature search using PubMed with a focus on schizophrenia in the peripartum.
RESULTS: Mothers who suffer from schizophrenia are more likely to experience difficulties in social cognition and sensitivity to their children. These problems can make the relationship between mother and baby more difficult. However, this does not exclude the possibility of developing a positive attachment relationship.
CONCLUSION: A persistent case manager-driven care model, which monitors the care for this vulnerable population and focuses on reinforcing the parenting qualities, looks promising. As a result, (shared) responsible motherhood could have a positive impact on their recovery.

[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.

[Personalised treatment of disorders in the use of alcohol and nicotine]. / Gepersonaliseerde behandeling bij stoornissen in het gebruik van alcohol en tabak.

BACKGROUND: There is an increasing interest in personalised treatment based on the individual characteristics of the patient in the field of addiction care. AIM: To summarise the present state of staging and profiling possibilities within addiction care. METHOD: A literature review highlighting the current scientific findings and proposing a theoretical model. RESULTS: There are currently an insufficient number of studies to allow for a fully data driven model. However, research identifying biomarkers is growing and some clinically implementable findings can be put forward. CONCLUSION: a personalised approach in addiction care holds promise. There is an urgent need for better and larger datasets to empirically support models aimed for clinical use.

[Smoking policy in mental health care]. / Rookbeleid in de ggz; documentonderzoek en enquête.

BACKGROUND: People with mental illnesses tend to smoke more often and more heavily than other members of the public and their addiction to tobacco also has harmful effects on their physical health. So far, however, limited priority was given to smoking cessation in mental health care settings. AIM: To provide insight into the formal and informal smoking policies of Dutch mental health care organisations and into the nature and extent of the smoking cessation support they offer, and, additionally, to look at the opportunities for improvement in clinical settings. METHOD: Document research on formal policies of 61 mental health care facilities, interviews with workers directly involved (n = 10), and a survey on policy implementation among staff members of treatment facilities (n = 600). RESULTS: One-third of the facilities did not have a formalised smoking policy document, and there was a marked difference between the smoking policies at the rest of the facilities. Treatment provision was limited, strongly dependent on the individual staff member, and was often not the most effective form of care (like medication). CONCLUSION: Many mental health patients really do want to give up smoking and often respond well to treatment. Psychiatrists play a key role in integrating and implementing an anti-smoking policy which will benefit their patients.

EPA guidance on mental health and economic crises in Europe.

This European Psychiatric Association (EPA) guidance paper is a result of the Working Group on Mental Health Consequences of Economic Crises of the EPA Council of National Psychiatric Associations. Its purpose is to identify the impact on mental health in Europe of the economic downturn and the measures that may be taken to respond to it. We performed a review of the existing literature that yields 350 articles on which our conclusions and recommendations are based. Evidence-based tables and recommendations were developed through an expert consensus process. Literature dealing with the consequences of economic turmoil on the health and health behaviours of the population is heterogeneous, and the results are not completely unequivocal. However, there is a broad consensus about the deleterious consequences of economic crises on mental health, particularly on psychological well-being, depression, anxiety disorders, insomnia, alcohol abuse, and suicidal behaviour. Unemployment, indebtedness, precarious working conditions, inequalities, lack of social connectedness, and housing instability emerge as main risk factors. Men at working age could be particularly at risk, together with previous low SES or stigmatized populations. Generalized austerity measures and poor developed welfare systems trend to increase the harmful effects of economic crises on mental health. Although many articles suggest limitations of existing research and provide suggestions for future research, there is relatively little discussion of policy approaches to address the negative impact of economic crises on mental health. The few studies that addressed policy questions suggested that the development of social protection programs such as active labour programs, social support systems, protection for housing instability, and better access to mental health care, particularly at primary care level, is strongly needed.

Impulsive choice predicts short-term relapse in substance-dependent individuals attending an in-patient detoxification programme.

BACKGROUND: Impulsivity is a hallmark characteristic of substance use disorders. Recently, studies have begun to explore whether increased impulsivity in substance-dependent individuals (SDIs) is associated with a greater propensity to relapse following treatment. Despite growing recognition of its multidimensional nature, however, most studies have treated impulsivity unilaterally. Accordingly, it remains unclear whether certain facets of impulsivity are more relevant to relapse than others. The aim of the current study was to examine the relationship between multiple facets of impulsivity and short-term relapse in SDIs. As a secondary aim, we explored the role of treatment retention in this relationship. METHOD: A personality-based impulsivity questionnaire (UPPS) and three neurocognitive tasks of impulsivity [stop-signal task (SST), delay discounting task (DDT) and Iowa gambling task (IGT)] were administered in a heterogeneous sample of 70 SDIs shortly following their entry in an in-patient detoxification programme. Mediation analyses were performed to explore whether the effects of impulsivity on relapse were mediated by treatment retention. RESULTS: Performance on two neurocognitive indices of impulsive choice (i.e. delay discounting and impulsive decision-making) significantly predicted short-term relapse. The effects of delay discounting and impulsive decision-making on relapse propensity were mediated by treatment retention. CONCLUSIONS: Neurocognitive indices of impulsivity may be more sensitive to the prediction of relapse than trait-based self-report questionnaires. Post-treatment relapse in SDIs may be reduced by targeting the processes involved in impulsive choice and by improving treatment retention in SDIs with inflated impulsivity.

Assessing and treating alcohol relapse risk in liver transplantation candidates.

In Europe between 30 and 50% of all liver transplantations (LTX) are done within the context of chronic end-stage alcoholic liver disease (ALD). However, post-operatively 20-25% of these patients lapse or relapse into heavy alcohol use. Thus, assessment of alcohol relapse risk before enlisting and therapeutic follow-up during and after LTX is of utmost importance. However, as yet there are enormous differences between European countries and between transplant centers, with regard to the assessment methods and criteria and the implementation of therapeutic follow-up. Only the so-called '6-month abstinence' rule is widely used. However, there are not much scientific data validating its use in predicting relapse. Thus, there is a clear need of a more homogeneous approach, which was the focus of a symposium of the European Federation of Addiction Societies during the 14th conference of the European Society for Biomedical Research on Alcoholism, 2013 (ESBRA), entitled 'Liver transplantation: A European perspective'. In a follow-up on this symposium, the authors aim to sum up the evidence of psychiatric assessment criteria and psychiatric treatment interventions relevant in the context of patient selection and patient follow-up within ALD transplantation procedures. Based upon these findings, we propose elements of a procedure that can serve as a first step toward a model of good practice regarding addiction-specialist input within the pre- and post-transplantation period.

[Comparison between the regions of Belgium with regard to the amounts of antipsychotics prescribed during the period 2004-2012: a national survey]. / Voorschrijven van antipsychotica; landelijke vergelijking van de Belgische gewesten, 2004-2012.

BACKGROUND: Antipsychotics are prescribed frequently to treat a wide range of psychiatric and non-psychiatric indications. Over the last few years there has been a marked increase in the use of antipsychotics. However, specific prescribing patterns seem to be determined mainly by regional and national differences. AIM: In this study we compare developments in the sales of antipsychotics in the three Belgian regions (Flanders, Wallonia and Brussels) between 2004 and 2012. METHOD: For our study we used data supplied by Pharmanet regarding the sales of their antipsychotics in Belgium. Pharmanet forms part of the National Institute for Health and Disability Insurance (RIZIV), which is the organisation responsible for collecting information about the prescription behaviour of Belgian doctors. RESULTS: Between 2004 and 2012 the sales of antipsychotics in Belgium increased by 57 %. Nevertheless, the low percentage of prescriptions for long-term use (6.6-8.7 % of the antipsychotics prescribed for a treatment period of six months or longer) suggests that several important groups of patients were being undertreated. Relative to the size of the population of Belgium as a whole, more antipsychotics were sold in Wallonia and Brussels than in Flanders, a trend that remained relatively stable over time, namely over the period 2004 and 2012. The preference for second-generation antipsychotics was more pronounced in Flanders and the shift to second-generation antipsychotics occurred faster in Flanders than in Wallonia and Brussels. CONCLUSION: In Belgium there seems a clear need for a more unified and rational policy with regards to the prescribing and use of psychotropic drugs.