[Continuous increase in community treatment orders and compulsory admissions in the Netherlands, 2003-2017]. / Stijging van BOPZ-maatregelen en dwangopnames in de ggz.

OBJECTIVE: To give a descriptive analysis of court decisions on involuntary admissions and community treatment orders in the Netherlands, and to discuss policy recommendations to contain the use of involuntary care. DESIGN: Retrospective, descriptive research. METHOD: For this study, data were obtained from the Council for the Judiciary concerning requests for court-ordered admissions to mental hospitals and community treatment orders in the Netherlands. Requests from the period 2003-2017 were included in the analysis. RESULTS: The rate of treated requests for compulsory emergency admissions increased from 43 per 100,000 persons in 2003 to 52 per 100,000 persons in 2017, an increase of 21%. The rate of treated requests for court orders increased from 44 per 100,000 persons in 2003 to 104 per 100,000 persons in 2017 (+138%). In the same period, the rate of treated requests for court-ordered involuntary admissions increased from 44 to 64 per 100,000 (+42%), whereas the rate of treated requests for community treatment orders increased from zero in 2003 to 39 per 100,000 in 2017. CONCLUSION: In the Netherlands, requests for court-ordered compulsory admissions to mental hospitals and community treatment orders continue to increase. The biggest rise in requests is those for community treatment orders. Better registration of compulsory care is needed.

Psychobiological characteristics of dissociative identity disorder: a symptom provocation study.

BACKGROUND: Dissociative identity disorder (DID) patients function as two or more identities or dissociative identity states (DIS), categorized as 'neutral identity states' (NIS) and 'traumatic identity states' (TIS). NIS inhibit access to traumatic memories thereby enabling daily life functioning. TIS have access and responses to these memories. We tested whether these DIS show different psychobiological reactions to trauma-related memory. METHODS: A symptom provocation paradigm with 11 DID patients was used in a two-by-two factorial design setting. Both NIS and TIS were exposed to a neutral and a trauma-related memory script. Three psychobiological parameters were tested: subjective ratings (emotional and sensori-motor), cardiovascular responses (heart rate, blood pressure, heart rate variability) and regional cerebral blood flow as determined with H(2)(15)O positron emission tomography. RESULTS: Psychobiological differences were found for the different DIS. Subjective and cardiovascular reactions revealed significant main and interactions effects. Regional cerebral blood flow data revealed different neural networks to be associated with different processing of the neutral and trauma-related memory script by NIS and TIS. CONCLUSIONS: Patients with DID encompass at least two different DIS. These identities involve different subjective reactions, cardiovascular responses and cerebral activation patterns to a trauma-related memory script.

Does tryptophan degradation along the kynurenine pathway mediate the association between pro-inflammatory immune activity and depressive symptoms?

BACKGROUND: Several studies have suggested that induced tryptophan (TRP) degradation through the kynurenine (KYN) pathway by the enzyme indoleamine 2,3-dioxygenase (IDO) is implicated in the relation between depression and inflammation. We investigated the role of tryptophan degradation in the relationship between inflammatory markers and depressive symptoms in the Netherlands Study of Depression and Anxiety (NESDA) and hypothesized that tryptophan degradation would mediate (part of) this association. METHODS: 2812 Participants of NESDA were included in this study including 1042 persons with current major depressive disorder (MDD). Assessments of C-reactive protein (CRP), interleukin (IL)-6, tumor-necrosis factor (TNF)-α, KYN and TRP were obtained from fasting blood samples at the baseline assessment. Tryptophan degradation was estimated by calculating the ratio [KYN/TRP]. Depressive symptoms were measured with the Inventory of Depressive Symptomatology. RESULTS: Significant associations between inflammation and depressive symptoms were found for CRP and IL-6, for the total group and the subgroup of patients with current MDD. Adjustment for KYN/TRP did not attenuate these associations. There were no significant indirect effects for CRP on depressive symptoms mediated by KYN/TRP for the whole group (B=-0.032; 95% CI: -0.103 to 0.028) and for the subgroup of patients with current MDD (B=0.059; 95% CI: -0.037 to 0.165). Also IL-6 did not indirectly affect depressive symptoms through KYN/TRP in the total group (B=-0.023; 95% CI: -0.093 to 0.045) and in the MDD subgroup B=0.052; 95% CI: -0.019 to 0.144). Finally, no significant relation between depressive symptoms and KYN/TRP was found in the whole group (ß=-0.019, p=0.311) nor in the subgroup with MDD (ß=0.025, p=0.424). CONCLUSIONS: We did not find indications for tryptophan degradation, measured by KYN/TRP, to mediate the relationship between inflammation and depressive symptoms.