[Involving forensic psychiatric patients in scientific research]. / De bereidheid van forensisch psychia­trische patiënten tot deelname aan wetenschappelijk onderzoek.

Background Forensic psychiatric patients are at risk to cause damage to society in the future again, both materially and immaterially. Little is known about the pharmacotherapeutic or psychotherapeutic treatment of the specific psychopathology of forensic psychiatric patients. This is possibly due to scarcity of research in the field, which could be caused by the fact that forensic psychiatric patients are often unwilling to participate in scientific research. Aim To explore the reasons why patients are unwilling to participate in research. Method Sixty-five forensic psychiatric patients were asked about their opinion on participating in pharmacological, psychotherapy, MRI- and DNA research.  Results The main reasons for not participating in pharmacological research were 'patient's belief that they will not benefit from participation in research' and 'physical integrity' (the fear of being physically harmed by participation in research). 'General resistance' (not willing to take part for no particular reason) was the main reason for not participating in psychotherapy-, MRI and DNA research.  Conclusion In order to enhance willingness to take part in research, informing the patients in the right manner with the aim of taking distrust away, would be important. Also, it could be helpful to offer a reward for participation in scientific research, although this could lead to ethical complications.

[A study of job satisfaction among Dutch psychiatrists]. / Een onderzoek naar arbeidssatisfactie onder Nederlandse psychiaters.

BACKGROUND: Psychiatrists in the Netherlands seem to be experiencing more and more work stress and consequently less job satisfaction. Little research has been done in this field and the situation needs to be further investigated. AIM: To obtain insight into the degree of job satisfaction experienced by Dutch psychiatrists and into factors that influence their job satisfaction. METHOD: 2489 Dutch psychiatrists were asked to participate in a written enquiry. RESULTS: psychiatrists responded; of these, 852 responses were complete. The age, sex and years of experience of the respondents seemed to be largely representative for Dutch psychiatrists in general. Psychiatrists in the Netherlands seemed to be reasonably satisfied with their work, but they also experienced a considerable amount of work stress. In particular, it was organisationrelated work stress that reduced their job satisfaction. This pattern does not differ essentially from the pattern that exists in other countries or among representatives of other specialisms. In the Netherlands, however, the work setting is particularly significant. CONCLUSION: There seems to be a discrepancy between the relatively positive job satisfaction of Dutch psychiatrists and the high level of stress they experience as a result of working conditions. This situation is having a detrimental effect on job satisfaction. The implication is therefore that a number of managerial and policy measures need to be taken at various levels.

[A proposed checklist when deviating from guidelines]. / Voorstel voor een checklist bij het afwijken van richtlijnen.

Guidelines are proven to enhance the quality of medical practice. They give patients the opportunity to check whether a proposed treatment plan meets current standards. In clinical practice, however, there may be good reasons to deviate from a guideline. Such deviations must be supported by valid arguments. The authors propose a checklist of possible arguments for deviating from guidelines.

[The interest shown by medical students and recently qualified doctors in a career in psychiatry]. / De belangstelling voor het beroep van psychiater bij studenten geneeskunde en basisartsen.

BACKGROUND: In view of the current shortage of psychiatrists in the Netherlands it is important to find out what attracts medical students and recently qualified doctors to a career in psychiatry. AIM: To discover what aspects of psychiatry are of interest to medical students and recently qualified doctors and to determine what interest profile is suited to the practice of psychiatry. METHOD: Medical students and recently qualified doctors from the Free University medical school in Amsterdam and from Utrecht University medical school completed a questionnaire which investigated why certain specialisms, including psychiatry, were chosen as future careers, and which also examined the appeal of 47 aspects of a career in medicine. RESULTS: About 30% of the students expressed an interest in becoming psychiatrist. The interest was slightly greater among first-year students but decreased in the course of their medical training. About 6% of recently qualified doctors actually work in psychiatry and a larger percentage want to become psychiatrist in five years' time. The interest profile of persons interested in psychiatry differs from that of persons not interested in psychiatry and is different for men and women. CONCLUSION: The interest of students in a career in psychiatry decreases in the course of their medical training. This is in keeping with the general decrease in interest in any other career in medicine and probably reflects the current increasing focus on only one single medical specialism. The interest profile of persons interested in a career in psychiatry lies more in the communicative and psychosocial sphere and is focused in relationships that develop during long-term treatment rather than on medical-technical aspects. After qualifying as doctors, women with an interest in psychiatry often develop an interest in improvisation, diagnostics and pharmacotherapy.

[How can the results of primary-care treatment for depression be improved?]. / Hoe kunnen de resultaten van de eerstelijnsbehandeling van depressie worden verbeterd?

BACKGROUND: The results of treatment for depression are frequently disappointing. The main reasons for this are inadequate treatment and non-compliance. AIM: This article attempts to deal with the question of how patient compliance and the results of treatment for depression can be improved. METHOD: We performed a critical analysis of the literature. We searched Medline (1966- January 2002), psycinfo (1984-January 2002), Embase (1980-January 20002) and the Cochrane Controlled Trials Register (1966-Janaury 2002) for reports of randomised controlled trials. In our search we used the terms 'patient compliance', 'adherence', patient dropout', 'depression', 'depressive disorder', and 'affective disorder'. On the basis of the results of our search we compared two interventions that could be applied in Dutch practices. results We found 11 articles, all relating to treatment in primary care settings. Usual care proved to be inadequate. The quality of the usual care currently provided can be improved by extra interventions. So far there are no indications that complex interventions benefit the patient more than simple interventions, such as regular follow-up procedures. Therefore, for the time being, simple interventions are to be preferred. CONCLUSION: Treatment for depression can be improved by means of relatively simple interventions.

[Transcranial magnetic stimulation: a fascinating development]. / Transcraniële magnetische stimulatie: fascinerende ontwikkeling.

Transcranial magnetic stimulation is a novel technique for safely stimulating or inhibiting cortical brain functions. Its possible role in neurology and psychiatry is the subject of a broad field of research. At present, standard clinical implementation is not yet warranted. On the other hand, the technique as such is quite promising, especially because it can pave the way to a 'bottom-up' approach to mental disorder, starting from basic psychobiological concepts and then gradually developing in the direction of more complex clinical applications.

[Delirium during withdrawal of venlafaxine]. / Delirium bij afbouw van venlafaxine.

A 35-year-old man with anxiety and depression who was treated with venlafaxine, 300 mg a day, developed severe withdrawal symptoms in the form of a delirium during gradual tapering of the dosage. The symptoms resolved when the dosage was kept constant and did not recur when the dosage was reduced more gradually. Withdrawal symptoms are common during discontinuation of antidepressants, particularly after prolonged use of agents with a short half-life. The symptoms are usually mild and transient, especially in the case of selective serotonin reuptake inhibitors and venlafaxine. The occurrence of delirium as a result of the withdrawal of venlafaxine has not been reported previously. Even when antidepressants are being withdrawn with care, one should remain alert to the possible development of severe withdrawal symptoms.