André Wierdsma

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Currently working as assistant professor of social psychiatry at the Department of Psychiatry, Erasmus University Rotterdam, and affiliated with ESPRi (Epidemiological and Social Psychiatric Research institute).

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Andrew Gumley

University of Glasgow

Amy Hardy

Institute of Psychiatry, King's College London

Paul Lysaker

Indiana University

Wenche Ten Velden Hegelstad

Universidad San Sebastián

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Papers by André Wierdsma

Adult Attachment and Personal Recovery in Clients With a Psychotic Disorder

Schizophrenia Bulletin Open

Background Personal recovery has become a key objective in the treatment of clients with a psycho... more Background Personal recovery has become a key objective in the treatment of clients with a psychotic disorder. So far it has been established that the two attachment dimensions, ie, anxious and avoidant, are negatively associated with subjective well-being, self-esteem and hope. This study is the first to explore whether attachment styles are related to personal recovery in this population. Aims To study the effects of anxious and avoidant attachment on personal recovery in a population with a psychotic disorder. Method This cross-sectional study is part of the UP’s multicenter cohort study on recovery from psychotic disorders, in which 265 participants are currently included. Attachment was assessed using the Psychosis Attachment Measure, including the anxious and avoidant attachment dimensions. Personal recovery was measured using the Recovering Quality of Life-10 (ReQOL-10) and the Individual Recovery Outcomes Counter (I.ROC). Regression analysis was used to investigate the effec...

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[Differences in the prevalence of acute involuntary admissions between Apeldoorn, Rotterdam and Amsterdam]

Tijdschrift voor psychiatrie, 2022

Dag en nacht, dag in dag uit: crisiscentra Rotterdam

Evaluatie van het extramuraliseringsbeleid in de GGZ

UP'S: A Cohort Study on Recovery in Psychotic Disorder Patients: Design Protocol

Frontiers in Psychiatry, 2021

Recovery is a multidimensional concept, including symptomatic, functional, social, as well as per... more Recovery is a multidimensional concept, including symptomatic, functional, social, as well as personal recovery. The present study aims at exploring psychosocial and biological determinants of personal recovery, and disentangling time-dependent relationships between personal recovery and the other domains of recovery in a sample of people with a psychotic disorder. A cohort study is conducted with a 10-year follow-up. Personal recovery is assessed using the Recovering Quality of Life Questionnaire (ReQoL) and the Individual Recovery Outcomes Counter (I.ROC). Other domains of recovery are assessed by the Positive and Negative Symptom Scale Remission (PANSS-R), the BRIEF-A and the Social Role Participation Questionnaire—Short version (SRPQ) to assess symptomatic, functional and societal recovery, respectively. In addition, multiple biological, psychological, and social determinants are assessed. This study aims to assess the course of personal recovery, and to find determinants and ti...

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Aggression and seclusion on acute psychiatric wards: effect of short-term risk assessment

The British Journal of Psychiatry, 2011

Background Short-term structured risk assessment is presumed to reduce incidents of aggression an... more Background Short-term structured risk assessment is presumed to reduce incidents of aggression and seclusion on acute psychiatric wards. Controlled studies of this approach are scarce. Aims To evaluate the effect of risk assessment on the number of aggression incidents and time in seclusion for patients admitted to acute psychiatric wards. Method A cluster randomised controlled trial was conducted in four wards over a 40-week period (n = 597 patients). Structured risk assessment scales were used on two experimental wards, and the numbers of incidents of aggression and seclusion were compared with two control wards where assessment was based purely on clinical judgement. Results The numbers of aggressive incidents (relative risk reduction −68%, P<0.001) and of patients engaging in aggression (relative risk reduction RRR =–50%, P<0.05) and the time spent in seclusion (RRR =–45%, P<0.05) were significantly lower in the experimental wards than in the control wards. Neither the ...

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[Continuity of care following suicide-related compulsory admission]

Tijdschrift voor psychiatrie, 2008

In connection with recent articles about guidelines for dealing with persons attempting suicide, ... more In connection with recent articles about guidelines for dealing with persons attempting suicide, we investigated the quality and continuity of aftercare provided for patients admitted to a mental institution because they have attempted to commit suicide. 25% of patients received no aftercare at all. For most of the others aftercare began within two weeks; 50% of these patients were still receiving care nine months later. Follow-up studies are needed so that we can find out whether the absence of aftercare can cause problems for patients admitted to an institution because they have threatened to commit suicide.

Een lokale/regionale gezondheidsenquête: Wenselijkheid en mogelijkheden vanuit de basisgezondheidsdienst

Dutch Mental Health Patients’ and Significant Others’ Perspectives on Compulsory Treatment at Home: One Size Does Not Fit All

On January 1, 2020, the Compulsory Mental Health Care Act took effect in the Netherlands. It cont... more On January 1, 2020, the Compulsory Mental Health Care Act took effect in the Netherlands. It contains provisions for compulsory community treatment (CCT) and compulsory treatment at home (CTH). In this study, we collected the opinions of patients and their significant others on CTH and on their preferences regarding compulsory care in their homes. Patients and their significant others were involved in the experience-based co-design of a purpose-built online questionnaire. This questionnaire was completed by 624 patients and 531 significant others. Sixty-one percent of the patients and 62% of the significant others did not want compulsory treatment to take place at home but in hospital or elsewhere. Patients’ and significant others’ opinion showed few differences, except with regard to the involvement of the significant others in CTH. As the respective views of patients and significant others were mixed, we recommend that crisis plans and compulsory treatment plans should be individu...

[Accelerated increase in the number of involuntary admissions following the implementation of the Dutch Act on Compulsory Admission to Psychiatric Hospitals (BOPZ)]

OBJECTIVE To determine whether the observed accelerated increase in the number of involuntary adm... more OBJECTIVE To determine whether the observed accelerated increase in the number of involuntary admissions in The Netherlands coincides with the implementation of the Dutch Act on Compulsory Admission to Psychiatric Hospitals (BOPZ) in 1994. DESIGN Retrospective. METHOD The extent to which the number of involuntary admissions changed after implementation of the BOPZ was examined by means of Poisson regression on the basis of national data from the Patient Registration of Intramural Mental Healthcare for the period 1979-1995 and data from the Healthcare Inspectorate for the period 1992-2004. For this purpose, the curve prior to implementation of the BOPZ was compared with that following its implementation. RESULTS The number of involuntary admissions of psychiatric patients had more than doubled in 25 years, from 3101 in 1979 to 7450 in 2004. The increase in annual numbers accelerated significantly after implementation of the BOPZ in 1994. CONCLUSION There was an accelerated increase i...

[Drop-out from after-care following compulsory hospitalisation--how serious is the problem?]

BACKGROUND Little is known about the amount and quality of after-care provided for patients hospi... more BACKGROUND Little is known about the amount and quality of after-care provided for patients hospitalised as a result of a court authorisation. AIM To obtain insight into the rate of drop-out from after-care and the quality of after-care. METHOD In our study we included all patients in Rotterdam Rijnmond who, in the last 3 months of 2004, had been compulsorily hospitalised for at least one day by reason of a court authorisation. A retrospective study of patients' records let us ascertain whether drop-out from after-care occurred and let us check on the quality of the after-care provided. RESULTS 214 patients were included. Of these, 33 (15.4%) dropped out of after-care. Prior to discharge, the drop-out group received an outpatient appointment at a local clinic less often and waited longer for their first appointment at that clinic than did the 'non-drop-out' group. The medical records of the drop-out group were less accurate and there was less cooperation between communit...

Adult Attachment and Personal, Social, and Symptomatic Recovery From Psychosis: Systematic Review and Meta-Analysis

Despite growing evidence for the role of attachment in psychosis, no quantitative review has yet ... more Despite growing evidence for the role of attachment in psychosis, no quantitative review has yet been published on the relationship in this population between insecure attachment and recovery in a broad sense. We therefore used meta-analytic techniques to systematically appraise studies on the relationship between attachment and symptomatic, social and personal recovery in clients with a psychotic disorder. Using the keywords attachment, psychosis, recovery and related terms, we searched six databases: Embase, Medline Epub (OVID), Psycinfo (OVID), Cochrane Central (trials), Web of Science, and Google Scholar. This yielded 28 studies assessing the associations between adult attachment and recovery outcome in populations with a psychotic disorder. The findings indicated that insecure anxious and avoidant attachment are both associated with less symptomatic recovery (positive and general symptoms), and worse social and personal recovery outcomes in individuals diagnosed with a psychoti...

[Effects on scale and confidence intervals as alternatives to p < 0.05]

BACKGROUND Researchers and reviewers often use the conventional p < 0.05 as threshold in stati... more BACKGROUND Researchers and reviewers often use the conventional p < 0.05 as threshold in statistical tests. In many cases, however, the interpretation of p-values is incorrect. AIM To explain where the 5% norm originates, identify the interpretation problems that often arise and suggest some alternatives. METHOD On the basis of recent literature we examine the meaning and origin of the p < 0.05 norm. We looked closely at entire articles and short reports in the Tijdschrift voor Psychiatrie, starting with the Jubilee issue of 2008, in order to find examples of methodological problems relating to the routine use of p-values. RESULTS We found several examples of the problematic use of p-values; these included the testing of a priori unlikely, or even impossible null hypotheses, the reporting of small effects calculations based on erroneous assumptions, and incorrect interpretations of statistical parameters and p-values. CONCLUSION Research in psychiatry, like research in other d...

[Contact with the child and adolescent psychiatric services is determined by cultural and socio-economic differences]

BACKGROUND In the Netherlands access to mental healthcare is not evenly distributed over ethnic g... more BACKGROUND In the Netherlands access to mental healthcare is not evenly distributed over ethnic groups. Young persons of non-Dutch origin make only limited use of Dutch child and adolescent psychiatric services. AIM To investigate to what extent differences in the use of child and adolescent psychiatric services are related to ethnic cultural factors or socio-economic position. METHOD On the basis of data from the Rotterdam psychiatric case register we calculated the incidence-related risks for different ethnic groups and according to income level. Poisson regression analysis enabled us to take into account differences in the composition of the groups according to age and gender. RESULTS All ethnic groups have less contact than the native population with the psychiatric services, but there is also an effect of income level, irrespective of ethnicity. In the native population the number of persons seeking assistance from the psychiatric services was found to be higher in lower income...

[Medical Psychiatric Units in the Netherlands: an investigation into distribution and quality]

OBJECTIVE One of the spearheads of psychiatric healthcare in the Netherlands is hospital care for... more OBJECTIVE One of the spearheads of psychiatric healthcare in the Netherlands is hospital care for patients with a psychiatric comorbidity. In 2014, the Netherlands Psychiatric Association published ten field standards for Medical Psychiatric Units (MPUs). We catalogued healthcare in the Netherlands on the basis of these field standards. DESIGN Telephone screening, followed by a questionnaire investigation. METHOD In the period May-August 2015, psychiatrists in 90 hospitals in the Netherlands were approached by telephone with 4 screening questions. If the department complied with the screening criteria for an MPU, a structured interview comprising 51 questions followed. The interview script was tested against the field standards using the Delphi method. RESULTS The screening identified 40 potential MPUs; 37 (92.5%) wards participated in the complete interview. CONCLUSION MPUs are unevenly distributed across the country; care content is adequate, but education, tighter multidisciplina...

[Regional differences in compulsory treatment in mental health care in the Netherlands during 2013-2017]

Tijdschrift voor psychiatrie, 2020

BACKGROUND Compulsory treatment in mental health care has continuously increased for years. Regis... more BACKGROUND Compulsory treatment in mental health care has continuously increased for years. Registration of court ordered compulsory psychiatric care is based upon counts of legal authorisations. These counts do not refer to number of individual persons involved. AIM: To report the number age-specific prevalence of coercion in psychiatric care, number of persons involved, age distribution and regional differences. METHOD: Analysis of the number of requests for compulsory care and population size according to the age groups for the years 2013-2017. We used direct age standardisation at the level of jurisdiction regions. RESULTS: The annual number of unique persons for whom compulsory care was requested was 28% less than the number of requested court orders. The annual increase in compulsory care was 3%. Per specific treatment order the increase during 2013-2017 was 12% for emergency compulsory admissions, 8% for hospital admissions, 10% for extended hospital admissions and 43% for co...

Personal Recovery in People With a Psychotic Disorder: A Systematic Review and Meta-Analysis of Associated Factors

Frontiers in Psychiatry

Background: Personal recovery (PR) is a subjective, multidimensional concept, and quantitative re... more 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...

Need analysis for a new high acuity medical psychiatry unit: which patients are considered for admission?

BMC Health Services Research

Background: The study aims were: to estimate the proportion of patients with an indication for ad... more Background: The study aims were: to estimate the proportion of patients with an indication for admission to a new high acuity Medical Psychiatric Unit (MPU), to explore the reasons for MPU-admission according to different health disciplines, and to check for differences in patient characteristics. The results of this study are to be utilized in the proposed establishment of a high-acuity MPU in a University Medical Center. Such a unit currently does not exist at Erasmus MC. Methods: Hospital in-patients were included if they received psychiatric consultation from the Psychiatric Consultative Service (PCS). As part of the study protocol, psychiatrists, other medical specialists, and nurses determined the need for admission to the proposed MPU. Patient groups were compared with respect to diagnoses, socio-demographic characteristics and patient routing. Results: One hundred and fifty-one patients were included, 43% had an indication for MPU-admission, for the other patients PCS involvement was sufficient. There was agreement on suicide attempts as a reason for MPUadmission. For psychiatrists, the need for further diagnostic evaluation was a common reason for MPU admission, while other medical specialists more often emphasized the need for safety measures. Patients with an unplanned hospital admission had a higher chance of MPU eligibility (OR = 2.72, 95% CI 1.10-6.70). The main psychiatric diagnoses of MPU-eligible patients were organic disorders (including delirium), mood disorders, and disorders related to substance abuse. The most common diagnoses found were similar to those in previous research on MPU populations. Conclusion: Different medical disciplines have different views on the advantages of MPUs, while all see the need for such facilities. The proposed MPU should be able to accommodate patients directly from the Emergency Unit, and the MPU should provide specialized diagnostic care in an extra safe environment.

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Gezondheidsenquete: per post of op bezoek?

[Regional differences in the care and treatment of compulsory admissions in the Netherlands]

Tijdschrift voor psychiatrie, 2012

In the Netherlands compulsory admissions are on the increase. However, there are regional differe... more In the Netherlands compulsory admissions are on the increase. However, there are regional differences even when demographic factors are taken into account. To find out whether there are regional differences in the type and duration of care given to detainees. On the basis of case-register data for Groningen, South Limburg, Utrecht and Rotterdam, we monitored the psychiatric history and aftercare that followed emergency compulsory admissions and we analysed the differences between patient groups ('old acquaintances', 'newcomers' and 'passers-by'). Almost 60% of patients were well known to the mental health care service and had previously received psychiatric care. 85% of the patients were still receiving care three months after admission. Even when patient and admission characteristics were taken into account, there were still regional variations in the type and length of mental health care episodes before and after compulsory admission. The continuity of heal...