The contribution of cannabis use to the increased psychosis risk among minority ethnic groups in Europe.

BACKGROUND: We examined whether cannabis use contributes to the increased risk of psychotic disorder for non-western minorities in Europe. METHODS: We used data from the EU-GEI study (collected at sites in Spain, Italy, France, the United Kingdom, and the Netherlands) on 825 first-episode patients and 1026 controls. We estimated the odds ratio (OR) of psychotic disorder for several groups of migrants compared with the local reference population, without and with adjustment for measures of cannabis use. RESULTS: The OR of psychotic disorder for non-western minorities, adjusted for age, sex, and recruitment area, was 1.80 (95% CI 1.39-2.33). Further adjustment of this OR for frequency of cannabis use had a minimal effect: OR = 1.81 (95% CI 1.38-2.37). The same applied to adjustment for frequency of use of high-potency cannabis. Likewise, adjustments of ORs for most sub-groups of non-western countries had a minimal effect. There were two exceptions. For the Black Caribbean group in London, after adjustment for frequency of use of high-potency cannabis the OR decreased from 2.45 (95% CI 1.25-4.79) to 1.61 (95% CI 0.74-3.51). Similarly, the OR for Surinamese and Dutch Antillean individuals in Amsterdam decreased after adjustment for daily use: from 2.57 (95% CI 1.07-6.15) to 1.67 (95% CI 0.62-4.53). CONCLUSIONS: The contribution of cannabis use to the excess risk of psychotic disorder for non-western minorities was small. However, some evidence of an effect was found for people of Black Caribbean heritage in London and for those of Surinamese and Dutch Antillean heritage in Amsterdam.

Producer perceptions of dairy calf management, behavior, and welfare.

Approaches for raising calves vary across commercial dairy farms and relate to behavioral opportunities and animal welfare. The objectives of this study were to evaluate how US dairy producers and calf managers perceive 1) welfare implications of varying management practices (including social housing and milk allowance) and behaviors in dairy calves, and 2) aspects of the human-animal relationship in calf rearing and relationships with on-farm management and personal calf handling habits. Survey questions were primarily quantitative (e.g., Likert scales) and addressed how common calf management practices and observed calf behaviors were related to aspects of welfare, including calf health and comfort. We additionally posed questions addressing respondent habits, management protocols, and perceptions related to human-animal interaction. Responses from 93 dairy producers and calf managers were collected via digital surveys. Social housing was viewed as being generally positive for both calf comfort and health, although this view was stronger with respect to calf comfort. Respondents from farms using social housing (56%) had more positive perceptions of social housing, viewed social play as being associated with better calf comfort and health, and considered access to other calves and "freedom to express natural behavior" as being more important for calves, compared with respondents from farms not providing social housing. Providing greater milk allowances (>7.6 L/d) was viewed as being good for both calf comfort and health, although respondents from farms providing these milk allowances (59%) had more positive perceptions than those who provided lesser allowances. Abnormal oral behaviors were viewed as being associated with both poor calf comfort and health. The welfare importance of various resources which may reduce abnormal oral behaviors (including hay and brushes) was perceived more ambiguously, although respondents from farms providing these resources, compared with those who do not, generally viewed them as more preferred by calves. We observed a positive relationship between how respondents perceived the human-animal bond (i.e., that calves enjoy contact with humans) and stated personal behavior related to calf contact (frequency of contacting calves to scratch or pet them). Respondent demographics were not related to perceptions of the human-animal relationship, but respondents identifying as female described more frequent positive calf interactions. Described aspects of human-animal interactions were not related to implementation of social housing on-farm. Job satisfaction was positively related to perception of the human-animal relationship. Overall, these results suggest that most calf management personnel place a high value on calf welfare, although farms implementing social housing appear to place a greater value on subjective calf well-being and individual perceptions of animal welfare may depend on practical experience.

Associations between disturbed sleep and attenuated psychotic experiences in people at clinical high risk for psychosis.

BACKGROUND: Pre-diagnostic stages of psychotic illnesses, including 'clinical high risk' (CHR), are marked by sleep disturbances. These sleep disturbances appear to represent a key aspect in the etiology and maintenance of psychotic disorders. We aimed to examine the relationship between self-reported sleep dysfunction and attenuated psychotic symptoms (APS) on a day-to-day basis. METHODS: Seventy-six CHR young people completed the Experience Sampling Methodology (ESM) component of the European Union Gene-Environment Interaction Study, collected through PsyMate® devices, prompting sleep and symptom questionnaires 10 times daily for 6 days. Bayesian multilevel mixed linear regression analyses were performed on time-variant ESM data using the brms package in R. We investigated the day-to-day associations between sleep and psychotic experiences bidirectionally on an item level. Sleep items included sleep onset latency, fragmentation, and quality. Psychosis items assessed a range of perceptual, cognitive, and bizarre thought content common in the CHR population. RESULTS: Two of the seven psychosis variables were unidirectionally predicted by previous night's number of awakenings: every unit increase in number of nightly awakenings predicted a 0.27 and 0.28 unit increase in feeling unreal or paranoid the next day, respectively. No other sleep variables credibly predicted next-day psychotic symptoms or vice-versa. CONCLUSION: In this study, the relationship between sleep disturbance and APS appears specific to the item in question. However, some APS, including perceptual disturbances, had low levels of endorsement amongst this sample. Nonetheless, these results provide evidence for a unidirectional relationship between sleep and some APS in this population.

Tobacco use in first-episode psychosis, a multinational EU-GEI study.

BACKGROUND: Tobacco is a highly prevalent substance of abuse in patients with psychosis. Previous studies have reported an association between tobacco use and schizophrenia. The aim of this study was to analyze the relationship between tobacco use and first-episode psychosis (FEP), age at onset of psychosis, and specific diagnosis of psychosis. METHODS: The sample consisted of 1105 FEP patients and 1355 controls from the European Network of National Schizophrenia Networks Studying Gene-Environment Interactions (EU-GEI) study. We assessed substance use with the Tobacco and Alcohol Questionnaire and performed a series of regression analyses using case-control status, age of onset of psychosis, and diagnosis as outcomes and tobacco use and frequency of tobacco use as predictors. Analyses were adjusted for sociodemographic characteristics, alcohol, and cannabis use. RESULTS: After controlling for cannabis use, FEP patients were 2.6 times more likely to use tobacco [p ⩽ 0.001; adjusted odds ratio (AOR) 2.6; 95% confidence interval (CI) [2.1-3.2]] and 1.7 times more likely to smoke 20 or more cigarettes a day (p = 0.003; AOR 1.7; 95% CI [1.2-2.4]) than controls. Tobacco use was associated with an earlier age at psychosis onset (ß = -2.3; p ⩽ 0.001; 95% CI [-3.7 to -0.9]) and was 1.3 times more frequent in FEP patients with a diagnosis of schizophrenia than in other diagnoses of psychosis (AOR 1.3; 95% CI [1.0-1.8]); however, these results were no longer significant after controlling for cannabis use. CONCLUSIONS: Tobacco and heavy-tobacco use are associated with increased odds of FEP. These findings further support the relevance of tobacco prevention in young populations.

[Linguistic distance and psychosis in ethnic minorities]. / Taalachterstand en psychose onder mensen met een migratieachtergrond.

BACKGROUND: Ethnic minorities in the Netherlands face an excess psychosis risk, and understanding of causality remains limited. Linguistic disadvantage and other indicators of societal exclusion might play a role, and offer potential targets for public health interventions. AIM: To establish the contribution of linguistic disadvantage, indicators of social distance and perceived discrimination to the increased risk of psychoses in migrants and ethnic minorities. METHODS: We used the Dutch data from an international case-control study into psychotic disorders (the EU-GEI study). A first episode of psychosis was our outcome variable, and we used well-defined data on established confounders (e.g. age and sex) and indicators of ethnicity, social distance, linguistic disadvantage and perceived discrimination as our predictor variables. RESULTS: Ethnic minorities face an increased psychosis risk. This appears to be the case for both first- and second- generation migrants and so-called ‘Western’ and non-Western migrants. Though confounders and social distance appear to contribute, linguistic disadvantage appears to play a role in the excess psychosis risk in first-generation migrants. CONCLUSION: Reducing the social consequences of linguistic disadvantage or social distance might be a starting point for concrete public health interventions aimed at preventing the increased psychosis risk faced by first-generation migrants.

Methods for detecting heat stress in hutch-housed dairy calves in a continental climate.

Dairy calves exposed to solar radiation, elevated ambient temperature, and humidity are at risk of impaired welfare and productivity. Initial detection of thermal discomfort requires determination of optimal heat stress indicators and thresholds. Such values have recently been established in calves in chronic, subtropical, and acute continental environments but not in continuous, temperate conditions. Herein, the objectives were to determine associations between animal-based and environmental heat stress indicators and establish environmental breakpoints for hutch-raised dairy calves during a continental summer. From June to August, dairy calves (n = 63; 14 to 42 d of age) were individually hutch-housed and managed according to the dairy standard operating procedures in Arlington, Wisconsin. Calf respiration rates (RR), rectal temperatures (RT), shaved or unshaved skin temperatures (ST), and hutch internal and external air speed were measured thrice weekly at 0700 and 1400 h after a 15 min hutch restriction. Environmental indices including dry bulb temperature (Tdb), black globe temperature, and relative humidity were measured every 15 min, averaged hourly, and used to calculate temperature-humidity index (THI) using 8 different equations (THI1-8). Correlation and linear regression models were used to determine relationships within and between animal-based and environmental indicators. Environmental breakpoints were established using segmented regression models to estimate THI and Tdb thresholds for abrupt changes in animal responses. There were strong, positive correlations between animal-based indicators and Tdb or THI1-8, with the strongest association observed between unshaved ST and Tdb (r = 0.80). The linear regression of animal-based indicators with the best fit included Tdb or Tdb plus relative humidity and air speed. The threshold at which RR and RT began to rise was at a THI of 69 for both or at a Tdb of 21.0 or 21.5°C, respectively. No threshold was established for ST. Together, these outcomes indicate that Tdb is an appropriate measurement to detect thermal discomfort for calves in a temperate summer climate and individual hutch housing. Monitoring of calves is warranted before ambient temperature reaches 21.0°C, corresponding to RR of 40 breaths per minute and RT of 38.5°C, to promote calf comfort and reduce the risk of hyperthermia-related welfare and productivity consequences.

Assessing optimal frequency for image acquisition in computer vision systems developed to monitor feeding behavior of group-housed Holstein heifers.

Computer vision systems have emerged as a potential tool to monitor the behavior of livestock animals. Such high-throughput systems can generate massive redundant data sets for training and inference, which can lead to higher computational and economic costs. The objectives of this study were (1) to develop a computer vision system to individually monitor detailed feeding behaviors of group-housed dairy heifers, and (2) to determine the optimal frequency of image acquisition to perform inference with minimal effect on feeding behavior prediction quality. Eight Holstein heifers (96 ± 6 d old) were housed in a group and a total of 25,214 images (1 image every second) were acquired using 1 RGB camera. A total of 2,209 images were selected and each animal in the image was labeled with its respective identification (1-8). The label was annotated only on animals that were at the feed bunk (head through the feed rail). From the labeled images, 1,392 were randomly selected to train a deep learning algorithm for object detection with YOLOv3 ("You Only Look Once" version 3) and 154 images were used for validation. An independent data set (testing set = 663 out of the 2,209 images) was used to test the algorithm. The average accuracy for identifying individual animals in the testing set was 96.0%, and for each individual heifer from 1 to 8 the accuracy was 99.2, 99.6, 99.2, 99.6, 99.6, 99.2, 99.4, and 99.6%, respectively. After identifying the animals at the feed bunk, we computed the following feeding behavior parameters: number of visits (NV), mean visit duration (MVD), mean interval between visits (MIBV), and feeding time (FT) for each heifer using a data set composed by 8,883 sequential images (1 image every second) from 4 time points. The coefficient of determination (R2) was 0.39, 0.78, 0.48, and 0.99, and the root mean square error (RMSE) were 12.3 (count), 0.78, 0.63, and 0.31 min for NV, MVD, MIBV, and FT, respectively, considering 1 image every second. When we moved from 1 image per second to 1 image every 5 (MIBV) or 10 (NV, MDV, and FT) s, the R2 observed were 0.55 (NV), 0.74 (MVD), 0.70 (MIBV), and 0.99 (FT); and the RMSE were 2.27 (NV, count), 0.38 min (MVD), 0.22 min (MIBV), and 0.44 min (FT). Our results indicate that computer vision systems can be used to individually identify group-housed Holstein heifers (overall accuracy = 99.4%). Based on individual identification, feeding behavior such as MVD, MIBV, and FT can be monitored with reasonable accuracy and precision. Regardless of the frequency for optimal image acquisition, our results suggested that longer time intervals of image acquisition would reduce data collecting and model inference while maintaining adequate predictive performance. However, we did not find an optimal time interval for all feeding behavior; instead, the optimal frequency of image acquisition is phenotype-specific. Overall, the best R2 and RMSE for NV, MDV, and FT were achieved using 1 image every 10 s, and for MIBV it was achieved using 1 image every 5 s, and in both cases model inference and data storage could be drastically reduced.

Longitudinal associations between alcohol use, smoking, genetic risk scoring and symptoms of depression in the general population: a prospective 6-year cohort study.

BACKGROUND: Alcohol consumption, smoking and mood disorders are leading contributors to the global burden of disease and are highly comorbid. Yet, their interrelationships have remained elusive. The aim of this study was to examine the multi-cross-sectional and longitudinal associations between (change in) smoking and alcohol use and (change in) number of depressive symptoms. METHODS: In this prospective, longitudinal study, 6646 adults from the general population were included with follow-up measurements after 3 and 6 years. Linear mixed-effects models were used to test multi-cross-sectional and longitudinal associations, with smoking behaviour, alcohol use and genetic risk scores for smoking and alcohol use as independent variables and depressive symptoms as dependent variables. RESULTS: In the multi-cross-sectional analysis, smoking status and number of cigarettes per day were positively associated with depressive symptoms (p < 0.001). Moderate drinking was associated with less symptoms of depression compared to non-use (p = 0.011). Longitudinally, decreases in the numbers of cigarettes per day and alcoholic drinks per week as well as alcohol cessation were associated with a reduction of depressive symptoms (p = 0.001-0.028). Results of genetic risk score analyses aligned with these findings. CONCLUSIONS: While cross-sectionally smoking and moderate alcohol use show opposing associations with depressive symptoms, decreases in smoking behaviour as well as alcohol consumption are associated with improvements in depressive symptoms over time. Although we cannot infer causality, these results open avenues to further investigate interventions targeting smoking and alcohol behaviours in people suffering from depressive symptoms.

[Will science follow the changing dynamics in the mental health care practice?] / De praktijk binnen de ggz is in ontwikkeling, volgt de wetenschap?

BACKGROUND: There is awareness that the current paradigm that serves as the foundation for the system of mental health care services, has unintended detrimental consequences. Pilot projects such as the Mental Health Ecosystem (GEM), introducing a non-linear, complex adaptive network system of care, aim to address this situation. However, GEM does not sufficiently match with the current paradigm of reductionism and determinism. AIM: To stimulate the dialogue about the question which mental health care paradigm may align with GEM and its commitment to co-creation, self-organization, and more freedom of choice for patients. METHOD: From a philosophy of science perspective, testing broadly whether the current scientific paradigm fits with recent developments and describing another scientific paradigm, the complexity sciences. As an example case, we describe the Ecosystem Mental Health. RESULTS: GEM aligns well with complexity science and approaches the mental health system as a complex adaptive system. The concepts of emergence and feedback loops are also useful for understanding the dynamics within GEM. CONCLUSION: Complexity science, as an alternative scientific paradigm, potentially offers entry points to explore a form of contextual care within a mental health ecosystem.

Genetic and psychosocial stressors have independent effects on the level of subclinical psychosis: findings from the multinational EU-GEI study.

AIMS: Gene x environment (G×E) interactions, i.e. genetic modulation of the sensitivity to environmental factors and/or environmental control of the gene expression, have not been reliably established regarding aetiology of psychotic disorders. Moreover, recent studies have shown associations between the polygenic risk scores for schizophrenia (PRS-SZ) and some risk factors of psychotic disorders, challenging the traditional gene v. environment dichotomy. In the present article, we studied the role of GxE interaction between psychosocial stressors (childhood trauma, stressful life-events, self-reported discrimination experiences and low social capital) and the PRS-SZ on subclinical psychosis in a population-based sample. METHODS: Data were drawn from the EUropean network of national schizophrenia networks studying Gene-Environment Interactions (EU-GEI) study, in which subjects without psychotic disorders were included in six countries. The sample was restricted to European descendant subjects (n = 706). Subclinical dimensions of psychosis (positive, negative, and depressive) were measured by the Community Assessment of Psychic Experiences (CAPE) scale. Associations between the PRS-SZ and the psychosocial stressors were tested. For each dimension, the interactions between genes and environment were assessed using linear models and comparing explained variances of 'Genetic' models (solely fitted with PRS-SZ), 'Environmental' models (solely fitted with each environmental stressor), 'Independent' models (with PRS-SZ and each environmental factor), and 'Interaction' models (Independent models plus an interaction term between the PRS-SZ and each environmental factor). Likelihood ration tests (LRT) compared the fit of the different models. RESULTS: There were no genes-environment associations. PRS-SZ was associated with positive dimensions (ß = 0.092, R2 = 7.50%), and most psychosocial stressors were associated with all three subclinical psychotic dimensions (except social capital and positive dimension). Concerning the positive dimension, Independent models fitted better than Environmental and Genetic models. No significant GxE interaction was observed for any dimension. CONCLUSIONS: This study in subjects without psychotic disorders suggests that (i) the aetiological continuum hypothesis could concern particularly the positive dimension of subclinical psychosis, (ii) genetic and environmental factors have independent effects on the level of this positive dimension, (iii) and that interactions between genetic and individual environmental factors could not be identified in this sample.

The validation of a serious game for teaching ultrasound skills.

BACKGROUND: Point-of-care ultrasound (POCUS) is an important bedside diagnostic tool and is being taught in several specialties. However, mastering the required psychomotor skills takes time and learning curves are different between students. Especially learning to make the right probe movements with the corresponding changes of the ultrasound image on screen, and integrating it into a 3D mental model takes time. This precious bedside-time of trainers and physicians may be reduced using other learning methods for mastering the psychomotor skills, for example the use of serious games. Such a game is under development but it needs to be validated before widespread use can be advised. In this article we describe the development and the first three steps in the validation of a serious game for ultrasound skills. RESULTS: We have included 18 ultrasound experts and 24 ultrasound novices who played the serious game 'Underwater" and provided feedback. They concluded that "underwater" is fun to play and that movement of the 3D-printed probe resembled real ultrasound probe movements. Participants highly valued the potential of the game for training eye-hand coordination and stability of probe handling, two very important skills in performing ultrasound in real practice. Although we compared several in-game parameters such as distance and speed, no difference was observed between novices and experts. This means that content- and face validity of the serious game is demonstrated but optimal parameters to measure differences between novices and experts still have to be determined. CONCLUSIONS: Our study shows solid content- and face validity of the serious game "UnderWater" for training ultrasound skills, although construct validity could not be demonstrated yet. The game is appreciated as a promising serious game for training eye-hand coordination and learning ultrasound, which may reduce expensive bed-side teaching.

[Interplay between genetic background and environmental factors in psychiatry: current situation and future prospects]. / Samenspel tussen genetische achtergrond en omgevingsfactoren in de psychiatrie: stand van zaken en toekomstperspectief.

BACKGROUND: The hypothesis that etiopathogeneses of psychiatric disorders are determined by interplay between genetic background and environmental factors, as well their interactions can increasingly be put to direct scientific test, based on a wave of methodological, technological and knowledge developments.
AIM: To provide insight into and to provide perspective on some important scientific developments and facilitate challenges in this area.
METHOD: Narrative overview of the scientific literature and formulation of a concept and future perspective.
RESULTS: The overview points to concrete progress in the fields of genetic epidemiology, environmental analyses, gene-environment interactions and epigenetics in psychiatry. For example, recent studies have provided evidence for the existence of interactions and correlations between genetic and environmental factors, interdependence of risk-influencing effects of environmental factors, and translational neurobiological studies have identified biological processes that influence the impact of (or the response to) environmental influences on individuals mediate. These important steps to translate epidemiological research into testable biological hypotheses are facilitated by new techniques and the availability of large and relevant clinical and biological datasets.
CONCLUSION: Scientific progress on the interplay between genetic background and environmental factors enriches the conceptual framework of the etiopathogenesis of mental disorders and provides a future perspective in which we are likely to receive answers to a number of clinically relevant questions in the coming decade.
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[To what degree is the strong social gradient of mental health care accompanied by a uniformly consistent association between mental health care and social care?] / Vertaalt de sterke sociale gradiënt van de ggz zich in een uniform sterke samenhang tussen ggz en sociale zorg?

BACKGROUND: In the Netherlands, mental health care consumption is characterized by a strong social gradient, in contrast to specialist medical care. AIM: A more detailed analysis of this social gradient in relation to type of care, diagnosis and cost parameters. METHOD: Analysis of national costs data and socio-economic data at 4-digit postal code level. RESULTS: Mental health care had a strong socio-economic gradient, with a 25% to 350% difference in both healthcare consumption and treated prevalence between the least and most deprived areas. Increasing area socioeconomic deprivation was associated with an increase in complex care compared to non-complex care, in inpatient treatment compared to outpatient treatment, and treatment of severe mental disorder compared to less severe problems. The social gradient was not predictive of municipal variation in the degree of - on average weak - association between mental health care and social care. CONCLUSION: Mental problems and social problems are intrinsically connected, but the association between mental healthcare and social care is limited and very heterogeneous.

Individual and environmental factors associated with defecation while lying down in dairy cows.

Cows typically defecate while standing. Freestalls are designed to position standing cows such that their feces fall into the alley. Cows sometimes defecate while lying down, increasing the risk that feces contaminate the stall surface. We conducted 2 studies investigating cow-level and environmental factors associated with defecating while recumbent. In experiment 1, we hypothesized that conditions making it more difficult for cows to stand up (including greater age, high body weight, pregnancy, and lameness) would increase the risk of this behavior. We followed 92 cows for 12 d, scanning stalls 5 times/d using live observation. Almost half (48%) of all cows defecated while recumbent at least once; cows that spent more time lying down and that were earlier in gestation were at highest risk. Weight, parity, age, and lameness were not associated with this behavior. In experiment 2, we tested how overstocking influenced the occurrence of defecating while recumbent. We predicted overstocking would increase the occurrence of this behavior, especially when cows were in stalls at more preferred locations. We recorded stall occupancy, displacement attempts, and defecating while recumbent in 4 groups of 36 cows tested at both 100% and 150% lying stall stocking densities for 2 nights each using a crossover design. Overstocking resulted in higher stall use and more displacements, but less lying and fewer perching events. We did not detect any relationship between use of specific stalls or competition and defecating while recumbent. Most recorded displacements were associated with perching. Increased time perching increased the likelihood of defecating while recumbent, perhaps because perching cows were less dominant or more reluctant to stand up once lying down in the stall. Overstocking did not increase defecating while recumbent, likely because cows spent less time lying down. Together, these results indicate that defecating while recumbent can be common, and points to some of the cow-level factors associated with this behavior.

[The patient voice in psychiatry: not heard, co-creation, co-optation or parallel organisation?] / De stem van de patiënt in de psychiatrie: niet gehoord, cocreatie, coöptatie of parallelle organisatie?

BACKGROUND: A key ethical issue in psychiatry concerns the relationship with patients. A central dilemma is that experiential knowledge (regarding existential recovery) and professional knowledge (the framework of specific-medication-for-specific-brain-disorder) are not easily integrated into a practice of co-creation. AIM: To describe the status quo in health care and science. METHOD: Qualitative review. RESULTS: Under the influence of critical psychiatry ('antipsychiatry'), the recovery movement, the voice hearing movement and open science, the patient voice has gained influence while the scientific framework of academic psychiatry/psychology is critically re-examined. Co-creation in mental health services is limited whilst parallel development is more successful. For example, experience-based recovery academies are developing primarily in the domain of social care whilst evidence-based specialist treatment remains the norm in mental health services. There is, however, a growing call for co-creation around recovery-oriented work in the mental health sector, despite limited institutional readiness. There is also a growing movement of user research responding to epistemic injustice and driving patient-driven innovations - although sometimes on the basis of appropriation without source awareness. CONCLUSION: Experiential knowledge is growing as the theoretical framework of psychiatry is in the process of change. This creates the conditions for co-creation of a new values-driven psychiatry.

Stress reactivity as a putative mechanism linking childhood trauma with clinical outcomes in individuals at ultra-high-risk for psychosis: Findings from the EU-GEI High Risk Study.

AIMS: Childhood trauma is associated with an elevated risk for psychosis, but the psychological mechanisms involved remain largely unclear. This study aimed to investigate emotional and psychotic stress reactivity in daily life as a putative mechanism linking childhood trauma and clinical outcomes in individuals at ultra-high-risk (UHR) for psychosis. METHODS: Experience sampling methodology was used to measure momentary stress, affect and psychotic experiences in the daily life of N = 79 UHR individuals in the EU-GEI High Risk Study. The Childhood Trauma Questionnaire was used to assess self-reported childhood trauma. Clinical outcomes were assessed at baseline, 1- and 2-year follow-up. RESULTS: The association of stress with positive (ß = -0.14, p = 0.010) and negative affect (ß = 0.11, p = 0.020) was modified by transition status such that stress reactivity was greater in individuals who transitioned to psychosis. Moreover, the association of stress with negative affect (ß = 0.06, p = 0.019) and psychotic experiences (ß = 0.05, p = 0.037) was greater in individuals exposed to high v. low levels of childhood trauma. We also found evidence that decreased positive affect in response to stress was associated with reduced functioning at 1-year follow-up (B = 6.29, p = 0.034). In addition, there was evidence that the association of childhood trauma with poor functional outcomes was mediated by stress reactivity (e.g. indirect effect: B = -2.13, p = 0.026), but no evidence that stress reactivity mediated the association between childhood trauma and transition (e.g. indirect effect: B = 0.14, p = 0.506). CONCLUSIONS: Emotional and psychotic stress reactivity may be potential mechanisms linking childhood trauma with clinical outcomes in UHR individuals.

[Analysis of mental health care utilization data in comparison with medical-specialist and general practitioner health care consumption data]. / Behoefte aan en consumptie van ggz-zorg vergeleken met somatische zorg in Nederland.

BACKGROUND: Quantification of population-level socioeconomic-demographic factors impacting onset and course of health care consumption can help health care commissioning and public health planning.
AIM: To analyse associations between mental health care, medical-specialist care and general practitioner (GP) care with regional socioeconomic-demographic factors. Two cost parameters were examined: (i) absolute costs; and (ii) relative costs, defined as the proportion of PC3-level costs attributable to outliers (defined as costs above the 80th percentile - as a proxy for care intensity).
METHOD: Analysis of Vektis data over the period 2014-2017 in the age range of 18-65 years.
RESULTS: Mental health care cost variation was for 28% reducible to (younger) age, urbanicity, PC3-level ethnic density and PC3-level socioeconomic-demographic factors. Variation in medical-specialist care and GP care costs were reducible principally to (older) age. Costs attributable to outliers ranged from 34% for GP care to 55% for mental health care. Socioeconomic-demographic factors explained a substantial part of the variation in the PC3-level proportion of outlier costs for mental health care (31%), medical-specialist care (43%) and GP-care (33%).
CONCLUSION: Analysis of the degree and pattern of socioeconomic-demographic factors impacting mental health care can inform both public mental health planning and mental health care commissioning. Tijdschrift voor psychiatrie 63(2021)1, 39-47.

[Public mental health and the rise of eCommunities: a case study of PsychosisNet.nl]. / Publieke ggz en de opkomst van e-community's: een casestudy van PsychoseNet.nl.

Background The annual prevalence of mental disorders is 20% whereas the Dutch mental health care system annually can cater no more than 7%. This suggests a need for public mental health care, parallel to traditional one-on-one treatment services. Multi-expert eCommunities are a novel phenomenon that appear to meet part of the public mental health care need. Aim The current analysis is a case study of PsychoseNet.nl, a multi-expert eCommunity that was launched in 2015 and now has 1.5 million annual visitors. It presents a range of static and dynamic content in the realm of psychoeducation, recovery narratives, self-management, empowerment, building resilience, interactive platforms and online consulting. Methods We describe explorative and descriptive analyses on usage and functionality of PsychoseNet.nl, using the Google Analytics framework. Results PsychoseNet.nl was visited by more than three million users, generating more than 13 million pageviews. Users mainly originated from the Netherlands and Belgium. Popular sections of the website were online counseling, chat, forum and blogs. Conclusion eCommunities such as PsychoseNet.nl appear to fill a gap, and further research is required on health impact and the place of public mental health initiatives in the system of mental health services. An English version of the site was recently started as Psychosisnet.com. Tijdschrift voor Psychiatrie 63(2021)1, 56-63.

[Epidemiology and treatment of aggression in patients with psychotic disorders]. / Epidemiologie en behandeling van agressie bij patiënten met een psychotische stoornis.

BACKGROUND: Aggression is a major problem within psychiatry. During the recent years, a lot of research has been done, but many clinical decisions are still not evidence-based. AIM: This article describes three studies of the thesis 'Aggression in Psychiatry'. The overarching goal was to contribute to the current knowledge on aggression with clinically relevant results. The three studies described in this article are focused on psychotic disorders. METHOD: The first study is a survival analysis with data from a 6-year follow-up study. The second study is focused on associations between aggression and clinical factors and the effect of antipsychotics on aggression in first episode psychosis patients. The third study is a meta-analysis focused on the effectiveness of typical versus atypical antipsychotics on aggression. RESULTS: The yearly incidence of aggression in patients with psychotic disorders is around 2%. Patients with symptoms such as impulsivity, but also childhood trauma are at risk for aggression. Amisulpride appears effective against aggression during the first weeks of treatment. In patients with more persistent aggression, clozapine is most effective. CONCLUSION: Aggression is complex and heterogeneous. More research is needed, but with the findings of these three studies, we contribute to the current knowledge of aggression and treatment options.