The effects of treatment as usual versus a computerized clinical decision aid on shared decision-making in the treatment of psychotic disorders

Background and objectives People with psychotic disorders can experience a lack of active involvement in their decisional process. Clinical decision aids are shared decision-making tools which are currently rarely used in mental healthcare. We examined the effects of Treatment E-Assist (TREAT), a computerized clinical decision aid in psychosis care, on shared decision-making and satisfaction with consultations as assessed by patients. Methods A total of 187 patients with a psychotic disorder participated. They received either treatment as usual in the first phase (TAU1), TREAT in the second phase or treatment as usual in the third phase of the trial (TAU2). The Decisional Conflict Scale was used as primary outcome measure for shared decision-making and patient satisfaction as secondary outcome. Results A linear mixed model analysis found no significant effects between TAU 1 (β = −0.54, SE = 2.01, p = 0.80) and TAU 2 (β = −1.66, SE = 2.63, p = 0.53) compared to TREAT on shared decision-making. High patient rated satisfaction with the consultations was found with no significant differences between TAU 1 (β = 1.48, SE = 1.14, p = 0.20) and TAU 2 (β = 2.26, SE = 1.33, p = 0.09) compared to TREAT. Conclusion We expected TREAT to enhance shared decision-making without decreasing satisfaction with consultations. However, no significant differences on shared decision-making or satisfaction with consultations were found. Our findings suggest that TREAT is safe to implement in psychosis care, but more research is needed to fully understand its effects on the decisional process. (AU)

[The impact of COVID-19 according to people in care at FACT and autism teams: wave 1 and 2 and Omikron wave]. / Impact van COVID-19 volgens mensen in zorg bij FACT- en autismeteams: golf 1 en 2 en de Omikron-golf.

BACKGROUND: COVID-19 affected our collective well-being. Measures during a pandemic may disproportionately impact individuals with mental illness. AIM: To measure the impact of COVID-19 on clients of FACT and autism teams over three waves. METHOD: Through a digital questionnaire participants (wave 1: n=100; wave 2: n=150; Omikron wave: n=15) reported on:
1. mental health, 2. outpatient care experiences, 3. government measures and information services. RESULTS: Happiness was rated on average with a 6 in the first two waves, positive consequences of wave 1 (clearer world, more reflection) persisted. The most frequently mentioned negative consequences were: decreased social interactions, increased mental problems and daily functioning. No new experiences were mentioned during the Omikron wave. The quality and amount of mental health care was rated ≥7 by 75-80%. Phone and video consultations were the most frequently mentioned positive care experience; missing face-to-face contact was considered most negative. Measures were harder to sustain in the second wave. Vaccination readiness and vaccination coverage were high. CONCLUSION: All COVID-19-waves show a consistent picture. Telepsychiatry was evaluated positively. Considering the results, the mental health sector could be ready for a next lockdown taking into account possibly higher expectations of clients.

[Impact of COVID-19 on patients from from FACT or autism teams]. / Impact van COVID-19 op patiënten van ambulante FACT- en autismeteams.

BACKGROUND: Most research focuses on the impact of COVID-19 for the general population. People with mental health problems may suffer even more from its consequences. AIM: Measuring mental health, experiences with outpatient care and government measures of 105 people in mental health care in the Northern Netherlands during the first wave of COVID-19. METHOD: Anonymous, online survey among people in care with autism- or FACT-teams in the Northern Netherlands between July-September 2020. RESULTS: Few participants reported recent COVID-19-related symptoms (n=2); no participant had lab-confirmed COVID-19. Both positive (clear world, tranquility, few stimuli: 28%) and negative experiences (missing face-to-face contact with mental health care professionals: 22%) were reported. Although there was some fluctuation in happiness, the average happiness score did not change due to the first wave. Three-quarters were satisfied with their mental health care. Although in-person contact with mental health care professionals was missed, the continuation of care through (video)calling was appreciated. One third reported an increased or new care need in mental health symptoms or daily functioning. The 'physical' government measures were considered pleasant and doable, but 'social' measures were harder. Newsletters with practical information about the consequences of the measures for personal healthcare were appreciated. CONCLUSION: The results show a nuanced picture of how outpatients experienced the first wave of COVID-19. Continued monitoring is important, as long-term impact of COVID-19 cannot be predicted.

The association of cannabis use with quality of life and psychosocial functioning in psychosis.

BACKGROUND: Cannabis use is highly prevalent among people with a psychotic disorder. They often report sociality, coping with unpleasant affect and having positive experiences as important reasons for cannabis use, suggesting that cannabis improves their quality of life (QoL) and psychosocial functioning. However, based on previous studies we hypothesize that cannabis use is negatively associated with long-term subjective QoL and psychosocial functioning in people with a psychotic disorder. METHODS: We included 2994 people with a psychotic disorder (36.4% female), mean age 44.4 (SD 11.9), mean illness duration 17.2 years (SD 11.1), who participated in two yearly routine outcome assessments between 2014 and 2018 (interval 9-15 months) from the naturalistic PHAMOUS cohort study. Linear regression analyses were used to examine whether first assessment cannabis use was associated with QoL (ManSA) and psychosocial functioning (HoNOS). Changes in outcomes between assessments were analyzed with AN(C)OVA, to examine differences between continuers (n = 255), discontinuers (n = 85), starters (n = 83) and non-users (n = 2571). RESULTS: At first assessment, 11.4% was using cannabis. They had lower QoL (B = -2.93, p < 0.001) and worse psychosocial functioning (B = 1.03, p = 0.002) than non-users. After one year, changes in QoL and psychosocial functioning were not significantly different between continuers, starters, discontinuers and non-users. CONCLUSIONS: Cannabis users were less satisfied with their family relations and financial situation and showed more aggressive and disruptive behavior and self-harm than non-users. These differences are likely the result of patients having used cannabis for many years. Starting or discontinuing cannabis did not lead to changes in QoL and psychosocial functioning within one year.

[Decision aid for the treatment of psychotic illness: development of TReatment E-AssisT (TREAT)]. / Beslistool bij de behandeling van psycho-tische aandoeningen: de ontwikkeling van TReatment E-AssisT (TREAT).

BACKGROUND: Use of decision aids in mental health care is increasing and will also be introduced in the Dutch mental healthcare system. We describe the context of this development and discuss how decision aids could facilitate evidence-based psychiatry.
AIM: To describe the development of the decision aid TReatment E-Assist (TREAT) in the Dutch mental healthcare system that aims to optimize treatment of people with a psychotic illness.
METHOD: We describe how the TREAT application works and discuss its potential contribution to the treatment of people with a psychotic illness.
RESULTS: In a pilot study TREAT was judged as user friendly and useful. TREAT seemed to increase the integration of ROM-results in treatment and the advice offered new view points for practioners.
CONCLUSION: TREAT is a novel application which combines routine outcome monitoring results with current treatment guidelines and standards of care in order to generate personalised treatment recommendations in the context of a psychiatric treatment trajectory. A multicentre study is being conducted in different provinces in the Netherlands to investigate the effectiveness of TREAT.

Organophosphate poisoning at Chris Hani Baragwanath Academic Hospital 2012 - 2015.

BACKGROUND: Patients with acute organophosphate poisoning are frequently admitted to the Chris Hani Baragwanath Academic Hospital (CHBAH), and yet there is little literature assessing aspects of these admissions. OBJECTIVES: To determine the demographic profile, common clinical and biochemical findings, use of prognostic tools (APACHE II), management and outcome of adult patients admitted to the high care area (HCA) and intensive care unit (ICU) at CHBAH. METHODS: A retrospective data analysis of hospital records for 129 patients admitted to the HCA and ICU at CHBAH for the period 2012 - 2015 was undertaken. The demographic profiles and clinical and biochemical presentations of the patients were determined, together with their subsequent management and outcomes. Use of the APACHE II score as a prognostic tool was evaluated, and the average enzyme inhibition levels demonstrated by the patients was assessed. RESULTS: The median age of the group was 30 years, with 68.2% being male. The most common clinical finding was pinpoint pupils (96.1%) followed by a Glasgow Coma Score <13 (85.3%), fasciculations (60.5%), diarrhoea (37.2%) and seizures (10.1%). Admissions to the HCA (52.7%) predominated, with the majority of patients requiring ventilator support (99.2%). The mean (SD) duration of stay was 6.8 days for ICU (6.4) and 3.7 days for HCA (5.2). The overall mortality rate was 5.4%. Standard treatment was intravenous atropine. Blood results reflected low levels of acetylcholinesterase enzyme activity. The APACHE II score was underutilised. CONCLUSION: The findings of the study underscore the frequent use of organophosphate compounds in our area. Further studies across the country will help to highlight the magnitude of the consequences of organophosphate poisoning, as well as the burden imposed on limited healthcare resources.

Iron and manganese removal: Recent advances in modelling treatment efficiency by rapid sand filtration.

A model has been developed that takes into account the main characteristics of (submerged) rapid filtration: the water quality parameters of the influent water, notably pH, iron(II) and manganese(II) concentrations, homogeneous oxidation in the supernatant layer, surface sorption and heterogeneous oxidation kinetics in the filter, and filter media adsorption characteristics. Simplifying assumptions are made to enable validation in practice, while maintaining the main mechanisms involved in iron(II) and manganese(II) removal. Adsorption isotherm data collected from different Dutch treatment sites show that Fe(II)/Mn(II) adsorption may vary substantially between them, but generally increases with higher pH. The model is sensitive to (experimentally) determined adsorption parameters and the heterogeneous oxidation rate. Model results coincide with experimental values when the heterogeneous rate constants are calibrated.

Minor disturbances in central nervous system function in familial neurohypophysial diabetes insipidus.

Familial neurohypophysial diabetes insipidus (FNDI) is caused by a defect in vasopressin synthesis and release as a result of a heterozygous mutation in the gene for the vasopressin prohormone. The predominant characteristic of FNDI is excessive thirst and urine production. However, vasopressin not only has peripheral endocrine effects, but also regulates numerous brain functions. We investigated whether central functions are affected in FNDI, by studying neuropsychological functioning of 23 affected members (15 males, 8 females) of a large family carrying a T/G transition mutation at nucleotide 2110 (codon 116) of the vasopressin prohormone gene (Cys116Gly). The relatively large number of family members with FNDI made it possible to compare cognitive and other CNS effects in these subjects with those of family members without FNDI. Thirty-seven adult volunteers (20 males, 17 females) from the same family and 11 non-family members (2 males, 9 females) from northern part of The Netherlands were tested. The mean age of the subjects was 35+/-12 years. Of the 63 quantified neuropsychological parameters few were statistically different between the subjects with FDNI and control subjects. Memory retrieval processes and sustained attention were worse in the subjects with FDNI. Moreover, these individuals reported significantly fewer symptoms of agoraphobia and miscellaneous symptoms, and had significantly lower scores on a scale measuring anger. The performance of FNDI subjects on an auditory verbal learning test (the 15-word test learning trial) was worse, but not significantly so, than that of the subjects without FDNI. There were subjective complaints of forgetfulness and slow recalls and those were observed in daily life by non-affected family members. These moderate differences in neuropsychological performance indicate that in human FNDI parvocellular vasopressin systems that supply the brain may be less affected or give no such serious disabilities, than the magnocellular hypothalamo-neurohypophysial system that provides vasopressin for endocrine regulation of water homeostasis.

A comparison of neuropsychological effects of thalamotomy and thalamic stimulation.

OBJECTIVE: The neuropsychological effects of thalamotomy and thalamic stimulation in patients with severe drug-resistant tremor due to PD, essential tremor (ET), or MS were compared in a randomized trial. METHODS: Complete neuropsychological evaluations at baseline and 6 months after surgery were obtained in 62 patients who underwent thalamotomy (n = 32: 21 PD, 6 ET, 5 MS) or thalamic stimulation (n = 30: 19 PD, 7 ET, 4 MS). RESULTS: Six months after thalamotomy, a decline was seen in the scores of the Stroop Color-Word Test, with the exception of the interference score. In the thalamic stimulation group, no significant changes were found on any of the cognitive tests. Age, diagnosis, disease severity, and baseline cognitive status were not correlated to cognitive changes. A difference in score changes between right- and left-sided surgery was found in verbal fluency and Stroop Test scores after both thalamotomy and thalamic stimulation. CONCLUSIONS: Both thalamotomy and thalamic stimulation are associated with a minimal overall risk of cognitive deterioration. Verbal fluency decreased after both left-sided thalamotomy and thalamic stimulation.

Malaria anticircumsporozoite antibodies in Dutch soldiers returning from sub-Saharan Africa.

One hundred and twenty-five Dutch servicemen returning from central Africa after a short deployment were enrolled in a study aimed at assessing the effectiveness of malaria prevention measures. None of the persons developed an episode of clinically overt malaria during or after deployment, and no antibodies against blood stages of Plasmodium falciparum could be found. However, antibodies against the circumsporozoite protein (CS) of P. falciparum were demonstrable in 14 persons (11.2% of the study population) by an ELISA test using the recombinant CS-antigen R32tet32, while one person only was positive in an IFA test based on schizonts of P. fieldi as antigen. We concluded that the anti-CS-positive servicemen were probably bitten by mosquitoes carrying P. falciparum parasites while the IFA-positive person was possibly infected by P. vivax, P. ovale or P. malariae parasites. There was no significant association between the different antimalaria preventive measures and the development of anti-CS antibodies. Therefore mefloquine prophylaxis as the single most widely used preventive measure in this group of servicemen was possibly a major contributing factor in averting development of overt malaria.

Investigation into typical and atypical tuberculin sensitivity in the Royal Netherlands Army, resulting in a more rational indication for isoniazid prophylaxis.

SETTING: The Department of Military Health Services (DMGZ) vaccination clinic, Utrecht, The Netherlands. OBJECTIVES: To improve upon PPD skin testing procedure by introducing a double Mantoux test. DESIGN: During the first part of the study, from 1986-1988, army recruits were double-tested simultaneously with PPD and Mycobacterium scrofulacaeum sensitin. During the second part of the study, from 1989 to 1993, recruits reacting to PPD, with an induration in the range of 10-15 mm, underwent a second skin test with M. scrofulaceum sensitin. The total study population consisted of 237,692 non-BCG-vaccinated recruits. RESULTS: From 1986-1993 and average of 0.45% persons reacted with indurations > or = 10 mm to PPD. An average of 7.76% if army recruits reacted with indurations > or = 10 mm to M. scrofulaceum sensitin during the first part of the study. Using a modified ITSC (International Tuberculosis Surveillance Centre) model, 48% of the persons reacting to PPD with indurations in the range 10 mm and 15 mm were classified as false-positive. A total of 16% with indurations > or = 10 mm to PPD were classified as false positive. False-positive persons were then excluded from INH chemoprophlaxis. CONCLUSIONS: In areas with a high prevalence of non-tuberculous mycobacteria infection the use of double skin testing might be useful in differentiating between indurations due to tubercle bacilli and those due to infection with non-tuberculous mycobacteria.

Diarrhea morbidity among Dutch military service men in Goma, Zaire.

An outbreak of diarrheal disease occurring among service men of the Royal Netherlands Forces while serving in the refugee camps in Goma, Zaire, is presented. Post-travel questionnaires were given to 131 military service men returning from Goma. In addition, routine blood investigations were undertaken and stool examined for persons with abdominal complaints. A high prevalence (59%) of diarrheal disease associated with the eating of food served by a local hotel was noted. Fifty percent of persons who developed diarrhea in this period had symptoms persisting for up to 10 days. Pathogens were recovered from the stools of five persons, and four of these had Shigella organisms isolated. The outbreak of diarrhea among the service men was directly linked to the eating of food that was prepared by a local Goma hotel, the possible causative agent for this outbreak being Shigella organisms. Both military and civilian humanitarians working in areas such as refugee camps with a high prevalence of diarrheal diseases should carefully consider eating from local restaurants and hotels.

Effect of acute and chronic treatment with desglycinamide-[Arg8]vasopressin in young male and female volunteers.

A single dose of DGAVP (2 mg) and a chronic treatment of 2 weeks (1 mg/day) were given to male and female volunteers by the intranasal route. Memory, mood, vigilance, and attention were tested starting 60 min after treatment. Initial storage of abstract words was improved in the males but not in the females after chronic treatment with DGAVP. This effect persisted after discontinuation of treatment. Initial storage and learning of concrete words were not affected by treatment with DGAVP. Chronic, but not acute, treatment with DGAVP reduced the reaction time for scanning of digits in a memory comparison task (Sternberg paradigm) in both sexes. No treatment effects were found for visual memory, vigilance, attention, mood, or blood pressure. The present study indicates a sexual dimorphism in the effect of DGAVP on certain memory processes.

Diagnosis of intestinal and disseminated microsporidial infections in patients with HIV by a new rapid fluorescence technique.

AIMS: To assess the value of a new rapid fluorescence method for the diagnosis of microsporidiosis in HIV seropositive patients. METHODS: Microsporidian spores in stools were demonstrated by using the fluorochrome stain Uvitex 2B. The new technique was evaluated in three groups of HIV seropositive patients with diarrhoea. Group 1: 19 patients with biopsy confirmed E bieneusi infection (186 stool samples); group 2: 143 consecutive patients from whom faeces were submitted for routine investigation of diarrhoea (318 samples); group 3: 16 patients with small intestinal biopsy specimens negative for microsporidia (55 samples). The new method was used to monitor spore shedding during experimental treatment with paromomycin and albendazole in four patients. RESULTS: Brightly fluorescent spores were detected in all stool samples of patients in group 1. In group 2 16 (11%) patients had spores in their stool samples. E bieneusi was found in 11 patients; in the other five another genus of microsporidia, Encephalitozoon, was recognised. Encephalitozoon spores were also found in the urine of three of these patients and in the maxillary sinus aspirate of two of them, suggesting disseminated infection. The results were confirmed by electron microscopic examination. In group 3 negative biopsy specimens were confirmed by negative stool samples in all cases. Treatment with albendazole and paromomycin did not affect the spore shedding in three patients with E bieneusi infection. By contrast, in a patient with Encephalitozoon sp infection albendazole treatment resulted in clinical improvement together with complete cessation of spore excretion in the stool. CONCLUSION: The Uvitex 2B fluorescence method combines speed, sensitivity, and specificity for the diagnosis and treatment evaluation of intestinal and disseminated microsporidiosis.

[Lithium poisoning in a newborn infant]. / Lithiumintoxicatie bij een pasgeborene.

We describe a newborn with a lithium intoxication. Her mother used lithium during her entire pregnancy. The intoxication was successfully treated with an exchange transfusion.

Effect of a single dose of des-glycinamide-[Arg8]vasopressin or oxytocin on cognitive processes in young healthy subjects.

A single dose of des-glycinamide-[Arg8]vasopressin (DGAVP, 2 mg intranasal) or oxytocin (OXT, 20 IU intranasal) was given to female and male volunteers, respectively, in a placebo-controlled double-blind trial. Memory, vigilance, attention, and mood were tested starting 10 minutes after treatment. The DGAVP dose improved delayed recognition of abstract words when measured 1 week after treatment and reduced the intercept of a memory comparison task (Sternberg paradigm). A trend was present for DGAVP and OXT to affect learning, i.e., storage processes of verbal memory in an opposite way; DGAVP improved, while OXT attenuated initial storage and the rate of storage. No treatment effects on visual memory and vigilance were found. Of the mood measures, vigor was reduced immediately after treatment with OXT.

The role of serum laminin P1 in the diagnosis of transitional cell carcinoma of the bladder.

In order to explore the possible role of serum laminin P1 in the diagnosis of transitional cell carcinoma (Tcc) of the bladder, the sera of 50 healthy control subjects and of 35 bladder-cancerous patients were measured by radioimmunoassay. In 27 patients (77%), the serum level was elevated above the upper limit of normal range. Statistically significant elevation could be determined in all stages and grades of Tcc of the bladder compared to those of normal subjects (mean +/- SD: 1.18 +/- 0.16 kU/l). Deterioration of the clinical stages or pathologic grades of the tumor was associated with a progressive increase in the mean values of serum laminin P1. A longer study with serial determination is planned to assess the prognostic significance of serum laminin in bladder cancer patients.

Coupling efficiencies of amino acids in the solid phase synthesis of peptides.

The "classical" Merrifield method was used to synthesize over 500 peptides using Boc-benzyl strategy. The peptides were prepared either manually or on a Beckman 990B synthesizer or an Applied Biosystems 430A synthesizer. Each coupling of Boc amino acid to the growing peptide on the resin was monitored with the ninhydrin reaction. Couplings were considered "incomplete" if there was 99% or less coupling and "high incomplete" if there was 98% or less coupling. The efficiency of coupling was evaluated in regard to the specific amino acids involved in the coupling reaction and to the length of the peptide at the time of the coupling. The most difficult carboxyl-reacting amino acids were histidine, threonine, arginine, valine, isoleucine and glutamine; the most difficult amine reacting residues were glutamine, leucine, alanine, arginine and isoleucine. The number of "incomplete" and "high incomplete" couplings and the total number of monitored couplings of each of the 20 carboxyl-reacting amino acids when reacting with each of the 20 amine-reacting residues were tabulated. Coupling efficiencies decreased with the length of the peptide. The conclusion of this study is that, with the chemistries and methods used in this group of peptides, no amino acid coupling can be predicted to be complete with a single coupling reaction. The study points to the need for on-line determination of coupling efficiency during the synthesis in which a recoupling step is initiated when the first coupling is incomplete.