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)
Humans , Decision Making, Computer-Assisted , Decision Support Techniques , Psychotic Disorders/diagnosis , Psychotic Disorders/therapy , Decision Making
Psychotic disorders have a strong negative impact on multiple aspects of daily life, including people's financial situation. This exploratory study examines the level of financial dissatisfaction and its correlates in a large cohort of people with psychotic disorders. Data from the first assessments of people with psychotic disorders (n = 5271) who were included in the Pharmacotherapy Monitoring and Outcome Survey (PHAMOUS; 2006-2020), which is conducted in the northern Netherlands, were used. The Manchester Short Assessment of Quality of Life (MANSA) was used to measure financial dissatisfaction. In addition, sociodemographic and psychiatric characteristics, substance use and global and social functioning were assessed. One-fifth to one-third of people with psychotic disorders report financial dissatisfaction, fluctuating over the year in which they were assessed. These proportions are considerably higher than in the general population. Cannabis and other substance use were associated with higher levels of financial dissatisfaction (small to medium effect). The other significant associations showed (very) small effect sizes. Therefore, we conclude that financial dissatisfaction in people with psychotic disorders appears to be relatively independent of other demographic and psychiatric characteristics, and global and social functioning. These findings are an important first step for increasing knowledge on financial dissatisfaction among people with psychotic disorders. The findings can also contribute to raising awareness about the topic for healthcare professionals working in this field.
Psychotic Disorders , Substance-Related Disorders , Humans , Prevalence , Quality of Life , Psychotic Disorders/drug therapy , Emotions , Substance-Related Disorders/epidemiology
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.
Autistic Disorder , COVID-19 , Psychiatry , Telemedicine , Humans , Autistic Disorder/therapy , Communicable Disease Control
BACKGROUND: Shared decision making (SDM) can result in better treatment outcomes. Little is known about the practice of SDM in forensic psychiatry; a context in which not only psychiatric problems are present, but also freedom restrictions and involuntary hospitalisation. AIM: To explore the current degree of SDM in a forensic psychiatric setting and to identify factors that influence SDM. METHOD: Semi-structured interviews (n = 4 triads: treatment coordinator, sociotherapeutic mentor and patient) combined with scores on questionnaires (SDM-Q-Doc and SDM-Q-9). RESULTS: The SDM-Q showed a relatively high degree of SDM. Themes like cognitive and executive functions of the patient, subcultural differences, insight into the disease and reciprocal cooperation appeared to influence the SDM. In addition, SDM in forensic psychiatry appeared to be more of a means of improving communication about the decisions of the treatment team than truly ‘shared’ decision making. CONCLUSION: This first exploration shows that SDM is applied in forensic psychiatry, however operationalised differently than the theory behind SDM prescribes.
Decision Making, Shared , Decision Making , Humans , Patient Participation , Surveys and Questionnaires , Psychotherapy
BACKGROUND: In January 2020 the Compulsory Mental Healthcare Act (Dutch: Wvggz) was implemented. The Wvggz details the rights of patients with mental illness who require compulsory care. The law aims, amongst others, to improve the legal rights of patients and those close to them, for example by enabling the possibility to draw up their own action plan (AP) or care card. AIM: To explore what health care professionals think of the possibilities for involvement by patients and those close to them, enabled by the Wvggz. METHOD: A qualitative study in which health care professionals were interviewed about the possibilities for involvement by patients and those close to them. We used thematic analysis to study the data from the interviews. RESULTS: Health care professionals were positive about the idea to involve patients and those close to them, though they indicated that patients and those close to them were already involved before the law came into effect. The main difference was that their involvement was more documented, for instance patients can write their own AP or fill out a care card. Health care professionals mentioned that both the AP and the care card offer the possibility for patients and those close to them to express and realize their wishes. On the downside, not all patient groups were able to draw up their own plan of action. Furthermore, according to the health care professionals, both the action plan and care card could give patients the false impression that their wishes can always be acknowledged. CONCLUSION: Health care professionals mention that patients and those close to them were already involved before the law came into effect. However, the ways in which their involvement is arranged and documented are different.
Mental Disorders , Mental Health Services , Health Personnel , Humans , Mental Disorders/therapy , Mental Health , Qualitative Research
BACKGROUND: Conspiracy theories are popular during the COVID-19 pandemic. Conspiratorial thinking is characterised by the strong conviction that a certain situation that one sees as unjust is the result of a deliberate conspiracy of a group of people with bad intentions. Conspiratorial thinking appears to have many similarities with paranoid delusions. AIM: To explore the nature, consequences, and social-psychological dimensions of conspiratorial thinking, and describe similarities and differences with paranoid delusions. METHOD: Critically assessing relevant literature about conspiratorial thinking and paranoid delusions. RESULTS: Conspiratorial thinking meets epistemic, existential, and social needs. It provides clarity in uncertain times and connection with an in-group of like-minded people. Both conspiratorial thinking and paranoid delusions involve an unjust, persistent, and sometimes bizarre conviction. Unlike conspiracy theorists, people with a paranoid delusion are almost always the only target of the presumed conspiracy, and they usually stand alone in their conviction. Furthermore, conspiracy theories are not based as much on unusual experiences of their inner self, reality, or interpersonal contacts. CONCLUSIONS Conspirational thinking is common in uncertain circumstances. It gives grip, certainty, moral superiority and social support. Extreme conspirational thinking seems to fit current psychiatric definitions of paranoid delusions, but there are also important differences. To make a distinction with regard to conspiratorial thinking, deepening of conventional definitions of delusions is required. Instead of the strong focus on the erroneous content of delusions, more attention should be given to the underlying idiosyncratic, changed way of experiencing reality.
COVID-19 , Mental Disorders , Delusions , Humans , Pandemics , SARS-CoV-2
INTRODUCTION: Various studies have demonstrated that individuals with a psychotic disorder are at an increased risk of becoming a victim of crime. Little is known about gender differences in victimization types and in specific characteristics of victimization (e.g., perpetrator, location or disclosure). Knowledge on characteristics of victimization would provide clinicians with more insight which may be especially useful for tailoring interventions. The aim of this study is to examine gender differences in characteristics of violent and sexual victimization in patients with a psychotic disorder. METHODS: Information on violent (threats, physical abuse) and sexual victimization (harassment, assault) was assessed in 482 individuals with a psychotic disorder who received mental health care. Patients were recruited through a routine outcome monitoring study and a clinical trial. RESULTS: Men reported more threats with violence (20.7% vs. 10.5%, x2 = 7.68, p = 0.01), whereas women reported more sexual assault (13.3% vs. 3.6%, x2 = 15.43, p < 0.001). For violent victimization, women were more likely than men to be victimized by a partner, friend or family member (52.9% vs. 30.6%) as opposed to a stranger (11.8% vs. 40.3%; O.R. = 52.49) and to be victimized at home (60.0% vs. 29.3%) as opposed to on the street or elsewhere (40.0% vs. 70.3%; O.R. = 0.06). For sexual victimization, there was no difference in location and perpetrator between men and women. For sexual victimization and physical violence, no differences in disclosure were found, but women were more likely not to disclose threats with violence or to disclose threats to a professional or police (52.9% vs. 45.2%; O.R. = 30.33). All analyses were controlled for age, diagnosis and employment. DISCUSSION: Gender patterns of victimization types and characteristics are similar for individuals with a psychotic disorder in comparison to the general population. Men were at higher risk of violent victimization, whereas women were at higher risk for sexual victimization. Men were more likely to become victimized in the streets or elsewhere by a stranger, whereas women seemed to be more often victimized at home by a partner, friend or a family member. Future studies may tailor interventions preventing victimization in psychosis according to gender.
Crime Victims , Psychotic Disorders , Sex Offenses , Cross-Sectional Studies , Female , Humans , Male , Psychotic Disorders/epidemiology , Sex Factors
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.
Autistic Disorder/epidemiology , COVID-19/psychology , Mental Health Services/statistics & numerical data , Autistic Disorder/psychology , COVID-19/epidemiology , Humans , Mental Health , Netherlands/epidemiology , Outpatients , SARS-CoV-2
Background: Personal recovery (PR) is a subjective, multidimensional concept, and quantitative research using PR as an outcome is rapidly increasing. This systematic review is intended to support the design of interventions that contribute to PR in psychotic disorders, by providing an overview of associated factors and their weighted importance to PR: clinical factors, social factors, and socio-demographic characteristics are included, and factors related to the concept of PR (organized into CHIME dimensions). Methods: A systematic literature search was conducted from inception to March 2020. Quantitative studies that had used a validated questionnaire assessing the concept of PR were included. Mean effect sizes for the relationship between PR-scale total scores and related factors were calculated using meta-analyses. Sources of heterogeneity were examined using meta-regression tests. Results: Forty-six studies, that used (a total of) eight PR measures, showed that in clinical factors, affective symptoms had a medium negative association with PR-scale total scores (r = -0.44, 95%CI -0.50 to -0.37), while positive, negative and general symptoms had small negative correlations. No association was found with neuro-cognition. Social factors (support, work and housing, and functioning) showed small positive correlations. Gender and age differences had barely been researched. Large associations were found for PR-scale total scores with the CHIME dimensions hope (r = 0.56, 95%CI 0.48-0.63), meaning in life (r = 0.48, 95%CI 0.38-0.58) and empowerment (r = 0.53, 95%CI 0.42-0.63); while medium associations were found with connectedness (r = 0.34, 95%CI 0.43-0.65) and identity (r = 0.43, 95%CI 0.35-0.50). Levels of heterogeneity were high, sources included: the variety of PR measures, variations in sample characteristics, publication bias, variations in outcome measures, and cultural differences. Discussion: Most interventions in mental healthcare aim to reduce symptoms and improve functioning. With regard to stimulating PR, these interventions may benefit from also focusing on enhancing hope, empowerment, and meaning in life. The strength of these findings is limited by the challenges of comparing separate CHIME dimensions with questionnaires assessing the concept of PR, and by the high levels of heterogeneity observed. Future research should focus on the interaction between elements of PR and clinical and social factors over time.
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.
Cannabis , Marijuana Abuse , Psychotic Disorders , Child, Preschool , Cohort Studies , Female , Humans , Male , Marijuana Abuse/complications , Marijuana Abuse/epidemiology , Psychosocial Functioning , Psychotic Disorders/complications , Psychotic Disorders/epidemiology , Quality of Life
AIMS: HIV predisposes patients to opportunistic infections. However, with the establishment of Highly Active Anti-Retroviral Therapy (HAART), patients' CD4 counts are maintained, as is a near normal life expectancy. This study aimed to establish the impact of HIV on the bacteriology of spondylodiscitis in a region in which tuberculosis (TB) is endemic, and to identify factors that might distinguish between them. PATIENTS AND METHODS: Between January 2014 and December 2015, 63 consecutive cases of spontaneous spondylodiscitis were identified from a single-centre, prospectively maintained database. Demographics, presenting symptoms, blood results, HIV status, bacteriology, imaging, and procedure undertaken were reviewed and comparisons made of TB, non-TB, and HIV groups. There were 63 patients (22 male, 41 female) with a mean age of 42.0 years (11 to 78; sd 15.0). RESULTS: In total, 53 patients had tuberculous, nine bacterial, and one cryptococcal spondylodiscitis. There were 29 HIV-positive patients, 29 HIV-negative patients, and five patients with unknown HIV status. The local incidence of TB spondylodiscitis was 1.54/100 000 and that of non-TB spondylodiscitis was 0.29/100 000 per annum. TB patients were younger with similar clinical presentation and infective markers, but were more likely to have a paraspinal abscess. They were also less likely to have a hyperintense disc on MRI. There was no difference between the two HIV groups. CONCLUSION: In areas of endemic TB and HIV, TB remains the most common cause of spondylodiscitis at five times the rate of non-tuberculous causes. HIV managed with HAART increases the rate of infection but does not influence the bacteriology unless there is a low CD4. There was little to differentiate the groups. TB /HIV co-infected patients were younger than non-TB and HIV-negative patients. Non-TB patients were more likely to have disc hyperintensity on MRI and TB patients were more likely to have abscess formation, but as both groups exhibited these features, neither was diagnostic. Culture confirmation remains necessary. Cite this article: Bone Joint J 2019;101-B:617-620.
Discitis/microbiology , HIV Infections/complications , Tuberculosis, Spinal/epidemiology , Adolescent , Adult , Aged , Discitis/therapy , Female , HIV Infections/epidemiology , Humans , Incidence , Magnetic Resonance Imaging , Male , Middle Aged , Retrospective Studies , Risk Factors , South Africa/epidemiology , Young Adult
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.
Decision Support Techniques , Outcome Assessment, Health Care , Psychotic Disorders/therapy , Adult , Decision Making , Female , Humans , Netherlands , Psychotic Disorders/psychology
AIM: The use of 'routine outcome monitoring' (ROM) in mental health care has increased widely during the past decade. However, little is known about the use of ROM outcome in daily clinical practice. We investigated to what extent ROM results were reflected in psychotic patients' treatment plans. DESIGN: Cross-sectional study. METHOD: The ROM-Phamous, a ROM-protocol for patients with psychotic disorders in which data is collected on the basis of interviews, questionnaires and physical examination was implemented in the northern Netherlands. A random sample of 100 patients was extracted from the 2010 ROM database (n = 1040), from which we determined the prevalence of a number of problem areas. We then investigated whether these problems were reflected in patients' treatment plans. RESULTS: The sample consisted of 63 men and 37 women, with a mean age of 44 years and a mean duration of illness of 18 years. The prevalence of symptoms and psychosocial problems was 13-37%; the prevalence of cardiovascular risk factors was 11-86%. The majority of problems identified with ROM were not reflected in patients' treatment plans; the opposite also occurred: psychosocial problems, in particular, mentioned in the treatment plans were not always identified with ROM. CONCLUSION: ROM and treatment should ideally be integrated in mental-health services, but currently appear to be separate processes. If improvement of integration of ROM and clinical practice succeeds it could lead to improvement of care for psychiatric patients. Further investigation is warranted. Conflict of interest and financial support: ICMJE forms provided by the authors are available online along with the full text of this article.
BACKGROUND: Routine Outcome Monitoring (ROM) has become part of the treatment process in mental health care. However, studies have indicated that few clinicians in psychiatry use the outcome of ROM in their daily work. The aim of this study was to explore the degree of ROM use in clinical practice as well as the explanatory factors of this use. METHODS: In the Northern Netherlands, a ROM-protocol (ROM-Phamous) for patients with a psychotic disorder has been implemented. To establish the degree of ROM-Phamous use in clinical practice, the ROM results of patients (n=204) were compared to the treatment goals formulated in their treatment plans. To investigate factors that might influence ROM use, clinicians (n=32) were asked to fill out a questionnaire about ROM-Phamous. RESULTS: Care domains that were problematic according to the ROM-Phamous results were mentioned in the treatment plan in 28% of cases on average (range 5-45%). The use of ROM-Phamous in the treatment process varies considerably among clinicians. Most of the clinicians find ROM-Phamous both useful and important for good clinical practice. In contrast, the perceived ease-of-use is low and most clinicians report insufficient time to use ROM-Phamous. CONCLUSIONS: More frequent ROM use should be facilitated in clinicians. This could be achieved by improving the fit with clinical routines and the ease-of-use of ROM systems. It is important for all stakeholders to invest in integrating ROM in clinical practice. Eventually, this might improve the diagnostics and treatment of patients in mental health care.
Mental Health Services/organization & administration , Outcome Assessment, Health Care , Patient Care Planning/organization & administration , Psychotic Disorders/therapy , Adult , Evidence-Based Medicine , Female , Follow-Up Studies , Humans , Male , Netherlands/epidemiology , Psychiatry/organization & administration , Psychotic Disorders/epidemiology , Surveys and Questionnaires
BACKGROUND: Metacognitive training (MCT) for schizophrenia spectrum is widely implemented. It is timely to systematically review the literature and to conduct a meta-analysis. METHOD: Eligible studies were selected from several sources (databases and expert suggestions). Criteria included comparative studies with a MCT condition measuring positive symptoms and/or delusions and/or data-gathering bias. Three meta-analyses were conducted on data gathering (three studies; 219 participants), delusions (seven studies; 500 participants) and positive symptoms (nine studies; 436 participants). Hedges' g is reported as the effect size of interest. Statistical power was sufficient to detect small to moderate effects. RESULTS: All analyses yielded small non-significant effect sizes (0.26 for positive symptoms; 0.22 for delusions; 0.31 for data-gathering bias). Corrections for publication bias further reduced the effect sizes to 0.21 for positive symptoms and to 0.03 for delusions. In blinded studies, the corrected effect sizes were 0.22 for positive symptoms and 0.03 for delusions. In studies using proper intention-to-treat statistics the effect sizes were 0.10 for positive symptoms and -0.02 for delusions. The moderate to high heterogeneity in most analyses suggests that processes other than MCT alone have an impact on the results. CONCLUSIONS: The studies so far do not support a positive effect for MCT on positive symptoms, delusions and data gathering. The methodology of most studies was poor and sensitivity analyses to control for methodological flaws reduced the effect sizes considerably. More rigorous research would be helpful in order to create enough statistical power to detect small effect sizes and to reduce heterogeneity. Limitations and strengths are discussed.
Cognitive Behavioral Therapy , Metacognition/physiology , Outcome Assessment, Health Care , Schizophrenia/physiopathology , Schizophrenia/rehabilitation , Schizophrenic Psychology , Humans
The present study aims to assess the incidence of complications related to bone lengthening procedures and to identify factors that may predict these complications. We retrospectively studied 51 lengthening procedures in 39 patients (mean age 13 years) from 2001 to 2015. A circular external fixator was used in 37 procedures and a monolateral fixator in 14 procedures. Duration of distraction, fixator's time, days of treatment, lengthening percentage, bone healing index, distraction regenerate length, distraction index, risk factors and complications were evaluated. The mean follow-up was 5 years. Complications occurred in 84 % of the procedures. Duration of distraction, fixator's time, days of treatment and distraction regenerate length were predictors of complications. Close follow-up is necessary during distraction and healing period and after fixator removal.
Leg Length Inequality/surgery , Osteogenesis, Distraction/methods , Postoperative Complications/epidemiology , Prosthesis-Related Infections/epidemiology , Surgical Wound Infection/epidemiology , Adolescent , Adult , Bone Nails , Child , Child, Preschool , Depression/epidemiology , External Fixators , Female , Follow-Up Studies , Humans , Incidence , Infant , Male , Pneumonia/epidemiology , Retrospective Studies , Risk Factors , Stress, Psychological/epidemiology , Time Factors , Young Adult
Until recently, patients suffering from both a psychotic disorder and a post-traumatic stress disorder (PTSD) were hardly ever treated for their PTSD. Many clinicians considered that the reliving of the trauma during treatment could increase the risk of psychotic decompensation. We describe a trauma-focused cognitive behavioural therapy that was used to treat a 43-year-old patient diagnosed with both schizoaffective disorder and comorbid PTSD. After five sessions the patient no longer experienced PTSD symptoms.
Schizophrenia/therapy , Schizophrenic Psychology , Stress Disorders, Post-Traumatic/therapy , Adult , Comorbidity , Female , Humans , Schizophrenia/epidemiology , Stress Disorders, Post-Traumatic/epidemiology , Stress Disorders, Post-Traumatic/psychology , Treatment Outcome
BACKGROUND: In mental health care, more and more research is being done, particularly in the field of educational programmes. Unfortunately, junior researchers are often not fully informed about the rules and regulations relating to research and about medical ethics. Therefore, they are not in a position to make considered judgements that conform to good clinical practice and acceptable medical ethics.
AIM: To give practical advice to trainees, stimulating them to think carefully about ethical standards in patient-related research in mental health care. METHODS The article provides a practice-based overview of practical advice and ethical considerations.
RESULTS: We stress that before beginning their research, researchers should think very carefully about the ethics of medical research. Instructions and guidelines relating to medical and ethical standards are to be found in: directive for good clinical practice compiled by the central committee for human research (CCMO) with the accompanying e-learning module and in the basic course 'rules and organisation for clinical researchers' (BROK). Practical tips, illustrated with examples, provide a framework for stimulating thoughts on medical ethics. Finally, it is important to improve the ways in which research is embedded in the organisational structure of teaching programmes.
CONCLUSION: Basic information about GCP and the upholding of medical and ethical standards in patient-related research can be obtained from various sources. The main challenge is to ensure that GCP is firmly embedded in patient-related research undertaken by junior researchers.
Ethics, Research , Psychiatry/ethics , Psychiatry/standards , Codes of Ethics , Humans , Practice Guidelines as Topic/standards , Psychiatry/education
