[Treatment of emotion regulation problems in people with neurofibromatosis type 1]. / Behandeling van emotieregulatieproblemen bij mensen met neurofibromatose type 1.

Individuals with the genetic disorder neurofibromatosis type 1 (NF1) are typically diagnosed in a medical hospital setting strongly relying on the presence of well-defined physical symptoms such as neurofibromas or pigmentary spots (known as café-au-lait spots). In mental health care settings, however, aside from a few highly specialized centres, the diagnosis and treatment of individuals with NF1 receives little attention, while the need for psychological treatment is increasingly identified, both in clinical practice and in the scientific literature. Occasional referrals of individuals with NF1 to the mental health services are often only targeted at psychological assessment. Subsequent treatment, however, is usually lacking. We describe two individuals with NF1 for whom by means of specialized clinical neuropsychological assessment, participation in a tailored dialectical behavior therapy (DBT) skills training was indicated. We exposit how they were able to develop their skills and how they themselves and their significant others experienced the treatment.

[E-health in long-stay psychiatric care: blended care psycho-education on psychosis]. / E-health in langdurige klinische zorg: psycho-educatie over psychose in de vorm van blended care.

We investigated the extent to which patients in long-stay psychiatric care can benefit from e-health applications. In our psychiatric hospital, we introduced a blended care course for psycho-education on psychotic disorders, in which we combined an internet module with face-to-face group sessions. We report on our findings, illustrated with a few vignettes.

[Could you please reduce your seclusion rates? To structure patient care by the methodical work approach]. / 'Kunnen de separatiecijfers omlaag?' Structuur geven aan behandelbeleid met methodisch werken.

BACKGROUND: Creating a safe treatment environment with a minimum use of seclusion at a ward for intensive psychiatric care is a complex process involving many actors. Although s/he is accountable for the use of seclusion, the psychiatrist's influence on actual seclusion practices is limited. The methodical work approach (MWA) to patient care is designed to improve multidisciplinary care delivery. AIM: To investigate ways in which the psychiatrist can structure the treatment and reduce seclusion rates by introducing the MWA. METHOD: We performed a quantitative analysis of the effects that the implementation of the MWA on an intervention ward had on the use of seclusion, comparing the intervention ward to control wards. We also conducted a qualitative analysis of the changes that occurred in the work process and in the roles of the various professionals involved. RESULTS: The use of seclusion had reduced significantly more at the intervention ward than it had at the control wards. The reduced seclusion rates were associated with an increase in interdisciplinary collaboration and professionalisation. CONCLUSION: By helping to limit the use of seclusion, possibly due to enhanced interdisciplinary collaboration and professionalisation, the MWA offers new horizons for mental health care professionals and their patients.

Nurses' decision on seclusion: patient characteristics, contextual factors and reflexivity in teams.

While many characteristics of patients, professionals and facilities with relevance to seclusion rates have been investigated, their relative importance is unclear. Virtually no attention has been paid to team processes and reflexivity in relation to decision making on seclusion. The aim of this paper is to estimate the effects of these factors on nurse decision making on seclusion. Sixty Dutch psychiatric nurses of four closed wards reported team reflexivity and their tendency to seclude a theoretical patient. Approachability (whether there was a good or hardly any possibility to communicate with the patient), staffing level and confidence within the team had the greatest impact on the decision to seclude. Intra class correlation was 0.30. There was a large interaction effect of reflexivity with team 4, and team reflexivity was highly correlated with team tendency to avoid seclusion. In nurses' decision on seclusion, the effects of 'pure' patient characteristics are small as compared with the effects of interpersonal and contextual factors, and nurses vary widely in their judgement. Team reflexivity is related to the tendency to prevent seclusion.

Is the social acceptability of psychiatric patients decreased by orofacial dyskinesia?

A group of psychiatric patients with and without orofacial dyskinesia (OFD) were filmed in pairs on videotape and a group of first-year social studies students were asked to select one candidate from each pair to fill a (simulated) job opening. A stationary picture (photograph) in which OFD was not visible and moving images (a video film) in which dyskinesia was visible were shown of each patient. The video effect, which was an indicator of the increase in popularity of a patient on the video film compared with the photograph, differed significantly between the OFD and control patients. Making the movement disability visible caused a relative decrease in the popularity of the OFD patients as opposed to an increase in the popularity of the control patients.