[Pharmacotherapy in sexual behavior disorders and intellectual disability]. / Farmacotherapie bij seksuele gedragsstoornissen en verstandelijke beperking.

BACKGROUND: Sexual behavior disorders in intellectual disability form several challenges, despite evolutions in treatment options and risk assessment. The use of antilibidinal pharmacotherapy in this population is controversial and research is inconclusive about the most appropriate treatment strategy. AIM: To highlight pharmacotherapeutic management of sexual behavior disorders in intellectual disability, its medical and ethical considerations. METHOD: A literature review to provide an overview of the available literature, which was elaborated based on clinical experience. RESULTS: We found a lack of scientific evidence on the efficacy of pharmacotherapy specifically for sexual behavior disorders in people with intellectual disabilities. The routine use of antilibidinal medication is contraindicated. Medical and ethical guidelines have been published as well as contraindications for initiating androgen deprivation therapy in the general population. The necessity of pharmacotherapy should be closely monitored and supplemented with psychotherapeutic care to cultivate the patient’s sexual skills, attitudes and knowledge. A distinction should be made between sexual behavior disorders of the ‘paraphilic type’ and of the ‘sexually maladjusted or naive type’. CONCLUSION: Multidisciplinary evaluation, risk assessment and an individualized approach are the cornerstones of high-quality treatment of sexual behavior disorders in persons with intellectual disability.

[Values under fire; ethics in forensic psychiatry]. / Waarden onder vuur; ethiek in de forensische psychiatrie.

BACKGROUND: Professionals in forensic psychiatry regularly face moral issues. For example, they have to make trade-offs between the treatment of a patient and society's security. AIM: To provide insight into some difficult, specifically forensic, dilemmas and show that forensic professionals benefit from structural ethics support. METHOD: Describing that ethics support, such as moral case deliberation, can provide support in making moral choices in forensic psychiatry. RESULTS: By participating in moral case deliberation, considerations are better substantiated and employees learn from and with each other. CONCLUSION: Moral case deliberation supports staff in jointly reflecting on moral dilemmas of the (forensic) workplace.

[Reaction on 'Does ambulantization lead to more imprisonment of psychiatric patients?'] / Reactie op 'Leidt ambulantiseren tot meer gevangenschap van psychiatrische patiënten?'.

Reaction on 'Does ambulantization lead to more imprisonment of psychiatric patients?'

[Development of a forensic psychiatric curriculum in Belgium and the Netherlands]. / De ontwikkeling van een forensisch psychiatrisch curriculum in Vlaanderen en Nederland.

BACKGROUND: Forensic psychiatry attracts considerable attention from media and politicians. All psychiatrists, not only those working in the forensic field, should be able to evaluate safety for society on the one hand and qualitative health care for psychiatric patients on the other. However, little attention is paid to specific forensic issues, in both psychiatric training and in medical school.
AIM: To map relevant topics for a forensic psychiatric curriculum in medical schools and psychiatric residency training.
METHOD: The main findings regarding educational topics in forensic psychiatry are discussed based on policy papers and scientific articles.
RESULTS: Four important topics should be covered in general psychiatric training, i.e. mental health legislation, risk assessment and management, professionalism and ethics, and expert witness training. The Netherlands has a specific training programme for psychiatrists interested in expert report writing and testimony for criminal courts. In Belgium, psychiatrists can acquire specific professional competence in forensic psychiatry.
CONCLUSION: Acknowledgement of the above-mentioned topics in the general medical and psychiatric curriculum will lead to better knowledge and competencies for all psychiatrists, both in Belgium and the Netherlands. Continuing attention and evaluation will be necessary given the high societal relevance.

[Education and training in psychiatry in 2019]. / Onderwijs en opleiding in de psychiatrie anno 2019.

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[Personalised medicine in forensic psychiatry: an example for other domains of psychiatry?] / Personalised medicine in de forensische psychiatrie: een voorbeeld voor andere domeinen in de psychiatrie?

BACKGROUND: Personalised medicine promises to provide us with a diagnostic predictive system of stratification that is based on a wide variety of tests; these can include biological, cognitive, demographic, psychopathological tests and other clearly defined tests. The purpose of forensic psychiatry is not only to take care of and treat mentally impaired patients but also to engage in risk assessment and risk management.
AIM: To explain risk assessment in forensic psychiatry as a nomothetic approach to personalised medicine, and also to demonstrate the link with offence paralleling behaviour, which is an illustration of the ideographic approach.
METHOD: A discussion of recent literature and insights into risk assessment, risk management and offence paralleling behaviour.
RESULTS: Risk assessment helps us to divide patients into groups according to the risk of recidivism. The nomothetic concept is the basis of most risk assessment instruments. One of the most important tasks in risk management in forensic psychiatry is to reduce the risk factors and strengthen the influence of protective factors. The model of offence paralleling behaviour resembles in many respects the concept of integrating risk management and treatment, but shows more precisely how hypotheses can be tested in a clinical context.
CONCLUSION: In view of the great importance to society of preventing offences, forensic psychiatry is leading the way in the application of personalised medicine in psychiatry.

Predictive equations of selenium accessibility of dry pet foods.

The trace element selenium is essential to both dogs and cats. Dry diets are formulated with a large range of ingredients, which may vary in selenium concentration and accessibility. This paper reports equations to predict the average in vitro selenium accessibility from dry pet foods based on essential dietary nutrient concentrations, including crude protein, amino acids and crude fat. Predictive equations were made using stepwise linear regression for extruded and pelleted diets. The equations can be used to aid diet formulation to optimize selenium accessibility within the diet and to prevent selenium deficiency or toxicity.

[Mandatory treatment of forensic psychiatric patients in the Netherlands: costs and benefits in perspective]. / De tbs-maatregel: kosten en baten in perspectief.

BACKGROUND: So far, it is not known what costs and benefits are connected with the tbs-measure, a measure that involves a mandatory treatment programme for forensic psychiatric patients.
AIM: To explore the costs and benefits that the tbs-measure has on society, on other important stakeholders such as victims and/or next-of-kin and the forensic psychiatric patients themselves.
METHOD: We studied the relevant literature.
RESULTS: The average costs of the tbs-treatment programme are 1.5 million euros. Additional costs result from recidivism among patients after tbs-treatment. Of these, 21.2% commit another serious offence after 9 years; this recidivism rate is much lower than rates for former offenders who have not received tbs-treatment (63.8%). Other costs arise through the impact that crimes have on stake-holders. Among the benefits of the tbs-programme are a reduction in psychopathological symptoms and in risk factors and lower recommitment rates (including judicial, non-judicial, voluntary and mandatory recommitment rates). Yet another benefit is the resultant increase of protective factors.
CONCLUSION: Forensic psychiatric patients form a unique group within the mental health system in the Netherlands; these patients have multiple complex psychiatric problems and display serious criminal behavior. This group cannot easily be treated elsewhere in the existing judicial or mental health care system because these systems differ in (judicial) frameworks and have different treatment goals, and the forensic psychiatric patients have different psychiatric disorders and display more serious criminal behaviour than patients in the alternative systems. The daily costs of treatment in the tbs-system are higher that in other systems - but they are not exorbitant, given the complexity of the group. The tbs-measure therefore contributes to the safety of society.

Assessment of welfare of Brazilian and Belgian broiler flocks using the Welfare Quality protocol.

The Welfare Quality consortium has proposed a science-based protocol for assessing broiler chicken welfare on farms. Innovative features make the protocols particularly suited for comparative studies, such as the focus on animal-based welfare measures and an integration procedure for calculating an overall welfare status. These protocols reflect the scientific status up to 2009 but are meant to be updated on the basis of inter alia implementation studies. Because only few such studies have been done, we applied the Welfare Quality protocol to compare the welfare of broiler flocks in Belgium (representing a typical European Union (EU) country which implies stringent animal welfare legislation) versus Brazil (the major broiler meat exporter to the EU and with minimal animal welfare legislation). Two trained observers performed broiler Welfare Quality assessments on a total of 22 farms in Belgium and south Brazil. All of the farms produced for the EU market. Although the overall welfare was categorized as 'acceptable' on all farms, many country differences were observed at the level of the welfare principles, criteria, and measures. Brazilian farms obtained higher scores for 3 of the 4 welfare principles: 'good feeding' (P = 0.007), 'good housing' (P < 0.001), and 'good health' (P = 0.005). Four of the 10 welfare criteria scores were, or tended to be, higher on Brazilian than Belgian farms: 'absence of prolonged thirst' (P < 0.001), 'ease of movement' (P < 0.001), 'absence of injuries' (P = 0.002), and 'positive emotional state' (P = 0.055). The only criteria with a higher score for the Belgian farms than their Brazilian counterparts were 'absence of prolonged hunger' (P = 0.048) and 'good human-animal relationship' (P = 0.002). Application of the Welfare Quality protocol has raised several concerns about the validity, reliability, and discriminatory potential of the protocol. The results also call for more research into the effect of animal welfare legislation as broiler welfare on the south Brazilian farms appeared to be superior to that on the Belgian farms. Animal-based welfare assessments on a larger sample of farms are needed to evaluate to what extent these findings may be generalized.

[The morning report - an important item in the training of psychiatrists in residence at psychiatric hospitals]. / Het generaal dagelijks rapport in de psychiatrische opleidingsinstelling.

BACKGROUND: In this article we focus on the role, function and composition of the morning report in the training of psychiatrists in residence at psychiatric hospitals. We also pay attention to the way in which the case should be presented in the morning report. AIM: To make some proposals regarding ways in which the efficiency of the morning report and the case presented in that report can be improved. METHOD: We studied currently available literature and publications about the morning report and we also drew on our own experience with the morning report. RESULTS: We found very few publications that dealt specifically with morning report in the psychiatric teaching hospital. However, our studies have shown that the morning report should not be regarded purely as an instrument for passing on care details about the patient; it should also be seen as an essential link in the chain of instruction required by trainee psychiatrist. On the basis of rhetoric, constructivism and social-constructionism, we present a model for case presentation. CONCLUSION: Making improvements in the quality of the morning report is an important way of contributing to the learning process of trainee psychiatrists and staff members and should therefore enhance the status of the psychiatric hospital as a teaching community.

Performance of an animal-based test of thirst in commercial broiler chicken farms.

Animal-based measures of thirst are currently absent from animal welfare monitoring schemes due to the lack of a well-validated indicator applicable for on-farm use. In the present study, an on-farm test based on voluntary water consumption from an unfamiliar open drinker was validated in a (semi-)commercial setting. To investigate the effect of thirst on water consumption, we subjected 4 flocks of 1,500 broilers to either 0 or 12 h of water deprivation and subsequently measured the amount of water that small subgroups consumed after the deprivation period (first experiment). Broilers that were water deprived before the test drank more than control broilers (P < 0.001). In a second experiment, a similar test was performed using 20 commercial broiler flocks in Belgium and Brazil. After a pretreatment water consumption test, the birds were subjected to 0 or 6 h of water deprivation, and a posttreatment water consumption test was conducted. Only in Brazil, deprived birds drank significantly more than controls in the posttreatment water consumption test (P < 0.001). A tendency for a difference was found in Belgium (P = 0.083). Pre- and posttreatment water consumption was higher in Brazil than in Belgium (P < 0.001). Stocking density and temperature influenced, respectively, the pretreatment and the control's posttreatment water consumption in Brazil, but not in Belgium. These results indicate that the water consumption test is sufficiently sensitive to discriminate between control and 12 h deprived flocks, and in Brazil even between control and 6 h deprived birds. The location of the test within the house did not affect the amount of water consumed in either experiment, suggesting that this variable does not have to be standardized. However, the amount of water consumed by broilers able to drink freely for a long period depended on indoor climatic variables (in Brazil only) and possibly genotype. This suggests that these variables need to be considered when interpreting the test outcome in terms of the thirst level experienced by the broilers.

[Sexual disorders in the DSM-5]. / Seksuele stoornissen in de DSM-5.

BACKGROUND: In DSM-IV-TR, the subject of 'sexual and gender identity disorders' was dealt with in one chapter; in DSM-5, however, the subject is divided into three chapters, namely sexual dysfunctions , gender dysphoria, and paraphilic disorders. AIM: To discuss the above-mentioned changes. METHOD: The one-chapter version in DSM-IV is compared with the three-chapter contribution in DSM-5 and the differing criteria are tested for their clinical utility. RESULTS: There are minor changes in the chapter 'sexual dysfunctions'. The content of the chapters on 'gender dysphoria' and 'paraphilic disorders' differs substantially from the content of the sections on these subjects in DSM-IV. In the section on gender dysphoria the term 'sex' has been replaced by 'gender' and the term 'identity disorder' has been dropped. With regard to paraphilias, a distinction is now made between a paraphilia and a paraphilic disorder. The DSM-5 makes a new distinction between pathology (paraphilic disorder) on the one hand and other unusual or unconventional non-pathological sexual behavior on the other hand. In the DSM-5 the highly relevant clinical concept 'hypersexuality' has still not been incorporated as a separate category. CONCLUSION: In the DSM-5 many parts of the chapters on sexual disorders have been substantially revised.

[Structural changes in DSM-5: the beginning of a transformation?]. / Structurele wijzigingen in de DSM-5: begin van een hervorming?

BACKGROUND: The dsm-5 received both praise and criticism following its publication in May 2013. Some blamed the dsm classification system for the unsatisfactory diagnostic system within psychiatry. Over the last 30 years or so there have been no major breakthroughs in our field and there has been no reduction in the number of mental health problems in Western society. It is time for a change; the question is whether DSM-5 will succeed in bringing about this change. AIM: To update and analyse the structural, diagnosis-independent changes that have been incorporated in DSM-5. METHOD: We discuss the changes. RESULTS: The most important structural, diagnosis-independent changes include: 1. the separate classification of disorders that begin in childhood from those that begin in adolescence has been abolished; 2. the multi-axial system has disappeared; 3. the approach has become more dimensional, which allows for the assessment of the severity of a disorder. CONCLUSION: In the DSM-5 there are clear signs that a transformation of our psychiatric assessment system has begun; this can only be seen as a positive development, but is probably just the tip of the iceberg. Further changes are likely to occur, some in the near future, others in the long term.

Dehydration indicators for broiler chickens at slaughter.

Freedom of (prolonged) thirst is considered to be of paramount importance for animal welfare. This emotion normally results from dehydration, which can be measured using physiological indicators. Because no reliable physiological indicator for thirst was available for broilers, we aimed to identify such a measure in this study. This indicator would ideally be integrated into quality control systems in commercial slaughter plants. In the first experiment, water deprivation was manipulated systematically by withdrawing water for different durations (total water withdrawal for 0 (control), 24, 36, or 48 h, or a 10-d period with restricted access to water for 2 times 10 min per day). A significant decrease in drained blood content and BW occurred from 36 h of total water deprivation onward (both P = 0.03), whereas long-term restricted access tended to decrease drained blood content (P = 0.05). No effect of water deprivation or restriction on skin turgor was found. In the second experiment, water was withdrawn for 0 (control), 6, 12, 24, or 48 h. Plasma chloride concentration was increased after 6 h of water withdrawal, but did not rise further with longer withdrawal. If assessed at slaughter, chloride will thus mainly reflect the catching-to-slaughter interval. In contrast, plasma creatinine and hematocrit levels showed a numerical decrease after 6 h of water withdrawal, but rose again after prolonged withdrawal. Plasma creatinine values were significantly higher in 24-h-deprived birds than in 6-h-deprived birds (P < 0.01), allowing for discernment between water withdrawal during catching and transport from dehydration that had occurred on the farm. Blood sodium concentrations and plasma osmolality showed a steady increment between 0 and 24 h of water deprivation (P < 0.001 and P < 0.001 for both), and may thus be used to assess the combined effects of water deprivation on farm and during the catching-to-slaughter interval. These findings may form the basis of an on-farm or at-slaughter test that could be included in integrated animal welfare assessment schemes.

Unraveling sexual associations in contact and noncontact child sex offenders using the single category - implicit association test.

Previous studies found associations between children and sex in child sex offenders (CSOs) using the Implicit Association Test (IAT). We used a modification of this task, the Single Category-Implicit Association Test (SC-IAT) to unravel child-sex associations in CSOs. Using the SC-IAT, we were able to test whether CSOs indeed hold stronger child-sex associations relative to adult-sex associations, compared to adult sex offenders and nonoffenders. Furthermore, we examined whether contact CSOs differed from noncontact CSOs in their child-sex associations. The hypothesis that CSOs would have stronger child-sex associations, relative to their adult-sex associations, than adult sex offenders and nonoffenders was confirmed. No difference between contact CSOs and noncontact CSOs was found. Although the Sex SC-IAT was able to distinguish CSOs from nonoffenders, the sensitivity and specificity of the test was poor (AUC of .65) and needs refinement. The results of this study support the existence of a child-sex association as a distinctive characteristic of CSOs. These findings are discussed in the context of theories on deviant cognitions in CSOs and risk for sexual offending.