[A qualitative study of shared decision making related to psychotropic drugs in adolescence]. / Kwalitatief onderzoek naar gedeelde besluitvorming over psychofarmaca bij jongeren.

BACKGROUND: Shared decision making (SDM) is an evidence-based model that involves the collaborative development of a treatment plan. SDM in adolescents with mental health problems is complex. Most mental health problems arise in adolescence and psychotropic drugs are an important part of treatment. Previous research focuses primarily on caregivers’ experience with SDM. AIM: This research has the main objective to gain insight into the adolescents’ experience with shared decision making related to psychotropic drugs. METHODS: Qualitative research through semi-structured interviews with 12 adolescents (12-18 years old) between June and October 2021, followed by thematic analysis of the data using the systematic text condensation (Malterud). RESULTS: Four themes were identified in the analysis: 1) the adolescent wants to feel heard, 2) the adolescent needs support in forming and expressing his/her opinion, 3) SDM in adolescents is a complex trialogue, and 4) the decision-making process affects treatment and adherence. CONCLUSION: When we ask adolescents about their experience with SDM, we can learn the following:- Involve parents, but always tailor this to the individual adolescent and his context. – Put the adolescent at the center. – Dwell on the adolescent’s view on psychotropic drugs.

[Multi-family therapy for adolescents with anorexia nervosa]. / Multi-familietherapie voor jongeren met anorexia nervosa.

Background Anorexia nervosa (AN) is a severe psychiatric disorder. Family based therapy is the most appropriate treatment. In recent decades, a particular form multi-family therapy (MFT) has been used. Aim To provide an overview of the scientific evidence regarding MFT in adolescents with AN. Method Literature search using PubMed, PsycInfo and Web of Knowledge. Literature was searched about the treatment of AN in adolescents through multi-family therapy in day therapy setting. Seven studies were included: one RCT with a strong methodology, two smaller controlled studies and four case series. Results After completing MFT, clear significant improvement is reported in terms of weight or BMI and eating disorder symptoms. Two studies suggest MFT is more effective in accelerating weight gain and achieving weight recovery. Depressive features, individual and family factors also improve. The low drop-out rate is remarkable. Conclusion MFT as an additional treatment for adolescents with AN is promising. Based on the available evidence, a good and at least equivalent outcome in comparison with family therapy is expected. In addition, it offers several unique benefits.

[Tired of waiting: towards a joint approach of waiting times in Flemish mental health care]. / Genoeg gewacht: naar een gezamenlijke aanpak van wachttijden in de Vlaamse ggz.

BACKGROUND: Waiting times are an important barrier to timely obtaining appropriate mental health care in Flanders, but structural data is limited. AIM: To describe the waiting time problem in Flanders and propose some causal hypotheses and possible interventions. METHOD: An exploration of the available waiting time data, supplemented with literature and insights based on the results of some Flemish Centers for Mental Healthcare. RESULTS: Waiting times are especially problematic for subsidized outpatient care and care for children and youth, although the current data provide an incomplete picture. Besides capacity, important factors are the organization of the intake (e.g. assessment) and flow parameters (e.g. mean treatment duration - and intensity). CONCLUSION: Eliminating waiting lists is one of the greatest challenges for Flemish mental health care. There is a need to expand capacity as well as the smarter use of existing capacity and resources. A joint multi-level approach is required.

[Perinatal mental health care for mothers with schizophrenia in Flanders; where are we still short?] / Perinatale geestelijke gezondheidszorg voor moeders met schizofrenie in Vlaanderen; wat kan er nog beter?

BACKGROUND: Only 0.8% of the admissions to our mother-baby unit are mothers with schizophrenia, while about half of the patients with schizophrenia become mothers. Mothers with schizophrenia are more likely to live in complex problematic settings and, thereby, more frequently lose custody of their children. Also, they experience stigma against their parenting skills. Literature research shows that they therefore avoid care. However, the inclusion of their role as a mother can contribute to recovery, giving meaning and social integration.
AIM: To initiate debate on responsible motherhood in women with schizophrenia with the aim of optimizing the Flemish care provision and give an incentive towards more scientific research.
METHOD: Consultation of the minimal psychiatric data (mpd) on our mother-baby unit. Narrative literature search using PubMed with a focus on schizophrenia in the peripartum.
RESULTS: Mothers who suffer from schizophrenia are more likely to experience difficulties in social cognition and sensitivity to their children. These problems can make the relationship between mother and baby more difficult. However, this does not exclude the possibility of developing a positive attachment relationship.
CONCLUSION: A persistent case manager-driven care model, which monitors the care for this vulnerable population and focuses on reinforcing the parenting qualities, looks promising. As a result, (shared) responsible motherhood could have a positive impact on their recovery.

[Potential of participatory action research for clients, professionals and researchers in mental healthcare]. / Het potentieel van participatief actieonderzoek voor cliënt, praktijk en onderzoek in de ggz; onderbouwing en praktijkvoorbeeld.

BACKGROUND: In participatory action research (par), researchers, practitioners and the community engage in a research process together. This research approach has the potential to assist in bridging the research-practice gap by starting from practice needs and using joint expertise and experiences to enrich scientific knowledge, optimise clinical practice and empower stakeholders from different backgrounds.
AIM: To discuss the potential benefits of par for clients, professionals and researchers in the field of mental healthcare.
METHOD: Starting from the literature on par, fundamental characteristics and benefits of this research approach in the field of mental healthcare are described and illustrated with an example from practice.
RESULTS: par in mental healthcare can contribute to enriching prepositional and practical knowledge, facilitate positive social change in care delivery, empower all stakeholders, and ultimately make a significant contribution to the integration of research and practice.
CONCLUSION: par is valuable for clients, professionals and researchers in a variety of projects in mental healthcare.

Sleep disorders during childhood: a practical review.

Sleep disorders are a common problem during childhood. The consequences are variable, and sleep disorders can influence medical, psychological and developmental aspects of the growing child. It is important to recognize sleep disorders and to treat them correctly. We discuss common sleep disorders during childhood using the 3rd edition of the International Classification of Sleep Disorders. We analyze the different sleep disorders from a clinical approach and provide an overview of adequate treatment options.Conlusion: This review discusses common sleep disorders during childhood using the 3rd edition of the International Classification of Sleep Disorders. We analyze the different sleep disorders from a clinical approach and provide an overview of adequate treatment options. What is known: • Sleep disorders are a common problem during childhood. • The consequences are variable, and sleep disorders can influence medical, psychological, and developmental aspects of the growing child. What is new: • Pediatricians should routinely screen for sleep and sleep disorders. • It is important to recognize sleep disorders and to treat them correctly.

Can psychiatric childhood disorders be due to inborn errors of metabolism?

Many patients who visit a centre for hereditary metabolic diseases remarkably also suffer from a child psychiatric disorder. Those child psychiatric disorders may be the first sign or manifestation of an underlying metabolic disorder. Lack of knowledge of metabolic disorders in child psychiatry may lead to diagnoses being missed. Patients therefore are also at risk for not accessing efficacious treatment and proper counselling. To search the literature for the co-occurrence of child psychiatric disorders, such as ADHD, autism, psychosis, learning disorders and eating disorders and metabolic disorders. A search of the literature was conducted by performing a broad search on PubMed, using the terms "ADHD and metabolic disorders", "autism and metabolic disorders", "psychosis and metabolic disorders", "learning disorders and metabolic disorders", and "eating disorders and metabolic disorders". Based on inclusion criteria (concerning a clear psychiatric disorder and concerning a metabolic disorder) 4441 titles and 249 abstracts were screened and resulted in 71 relevant articles. This thorough literature search provides child and adolescent psychiatrists with an overview of metabolic disorders associated with child psychiatric symptoms, their main characteristics and recommendations for further investigations.

[Early-onset eating disorders: a review of the literature]. / Vroeg ontstane eetstoornissen: literatuuroverzicht.

BACKGROUND: The incidence of anorexia nervosa (AN) in adolescents has increased significantly in recent years. In several studies and in the media it has been suggested that AN has recently become more prevalent in the pre-adolescence. In view of the impact that an eating disorder can have on a child, it is important to diagnose and start treating the illness as early as possible. AIM: To review the literature on the characteristics and susceptibilities of patients with eating disorders because this information can be important for early diagnosis, prevention and identification of susceptibilities to early-onset eating disorders. METHOD: We searched the literature for articles relating to early-onset eating disorders. We based our search on PubMed and on related relevant articles listed in the references. We selected 34 relevant articles published between 1987 and 2014. RESULTS: The literature lists characteristics and susceptibilities at various levels. Many types of factors are involved; examples of 'biological' factors are prior streptococcal infection, previous consultations with GP and a patients medical history; psychological factors include comorbidity, temperament, a particular personality profile, maturation-anxiety; environmental factors such as family history, family functioning and/or stressful events can play a role in the development of eating disorders. CONCLUSION The literature indicates that the early development of AN in children is related to a complex combination of etiological factors. However, there is a need for more research into this group of patients.

Modifying the 'Positive Parenting Program' for parents with intellectual disabilities.

BACKGROUND: Many parents with intellectual disabilities (ID) want and/or need professional guidance and support to learn skills and strategies to prevent and manage child behaviour problems. However, the available support is rarely suitable, and suitable support is rarely available. The aim of this study was to determine whether a popular mainstream parenting training programme, known as 'Group Triple P' (Positive Parenting Program), could be successfully modified for this parent group. METHOD: A pilot study was undertaken to determine whether a modified version of Group Triple P would engage and retain parents with ID. A non-experimental, pre-test post-test study, involving a total of 30 parents with ID, was then undertaken to obtain preliminary efficacy data. RESULTS: Parent engagement and participation levels were high. No parent 'dropped out' of the programme. After completing the modified Group Triple P programme, parents reported a decrease in psychological distress, maladaptive parenting and child conduct problems. Parents reported high levels of satisfaction with the information and support they received. CONCLUSION: Research-informed adaptation of mainstream behavioural family interventions, such as Group Triple P, could make 'suitable support' more readily available, and more engaging for parents with ID.