Baclofen may reduce the symptoms of alcohol withdrawal, as an alternative or as an adjuvant for b... more Baclofen may reduce the symptoms of alcohol withdrawal, as an alternative or as an adjuvant for benzodiazepines, but the available data are insufficient to support baclofen-assisted alcohol withdrawal. This study investigated the need for diazepam during acute alcohol withdrawal in patients receiving baclofen. In a single-blind, dose-dependent randomized controlled trial with three study arms, 63 patients with alcohol use disorder, starting in-patient benzodiazepine-assisted alcohol detoxification, were randomly assigned to receive placebo (n = 18), baclofen 30 mg/day (N = 20), or baclofen 60 mg/day (N = 25) for 7 days. Diazepam was provided as needed based on the withdrawal symptoms stated by Clinical Institute Withdrawal Assessment for Alcohol-revised. The primary outcome measure was the number of patients in need of diazepam during alcohol detoxification. Secondary outcome measure included the between-group difference in the amount of diazepam needed during alcohol detoxification. Using baclofen 60 mg/day, 32% of patients needed additional diazepam compared to 35% on baclofen 30 mg/day and compared to 72% on placebo (P = .013). The median total amount of diazepam needed was significantly lower in patients receiving baclofen 60 mg/day (0 ± 10 mg diazepam) and baclofen 30 mg/day (0 ± 10 mg diazepam) compared to placebo (10 ± 43 mg diazepam; P = .017). Adverse events were comparable between patients on baclofen and placebo. Baclofen can reduce the withdrawal symptoms during alcohol detoxification. Baclofen was well tolerated and may be considered for the management of alcohol withdrawal syndrome, especially useful in situations where benzodiazepines should be withheld, such as patients with liver impairment.
for the development of a combined system of psycho-physical rehabilitation. The psychotherapy bas... more for the development of a combined system of psycho-physical rehabilitation. The psychotherapy based on CBT according to A. Beck, modified for children's in concordance with specialized program "Vertebra-Dinamik" to correct defects of the musculoskeletal system. The basis of the corrective "Vertebra-Dinamik" technique includes a comprehensive approach to the use of isometric and statodynamic exercises of moderate intensity with elements of relaxation. Approbation of the developed system showed its high (80%) and moderate(20%) efficiency. Conclusions: To successfully overcome cyber addiction and its negative consequences, the most optimal system is the complex application of psychotherapeutic and physical rehabilitation methods.
Substance use disorders (SUD) and attention-deficit/hyperactivity disorder (ADHD) often co-occur ... more Substance use disorders (SUD) and attention-deficit/hyperactivity disorder (ADHD) often co-occur in adults. Together, they complicate diagnosis and can negatively influence treatment outcome.<br/> AIM: To develop a practical guide to assist professionals with the screening, diagnosis and treatment of adult patients with SUD and ADHD.<br/> METHOD: A literature search and a consensus procedure between several international scientific and clinical experts. This manuscript is an adapted and summarized Dutch version of the International consensus statement on screening, diagnosis and treatment of patients with SUD and comorbid ADHD.<br/> RESULTS: The routine use of adequate screening tools enables ADHD to be detected earlier in adults with SUD. The diagnostic process for ADHD should be initiated as soon as possible in patients with SUD. Integrated treatment, involving a combination of pharmacotherapy and psychotherapy, is preferred. Long-acting stimulants with up-titration to higher dosages may be considered.<br/> CONCLUSION: Early detection of ADHD in patients with SUD is essential for adequate diagnosis and more effective treatment and follow-up for these patients.
Aims: To develop indicators to assess quality of continuing care for persons with alcohol use dis... more Aims: To develop indicators to assess quality of continuing care for persons with alcohol use disorder (AUD). Methods: A guideline-based RAND-modified Delphi method was used to develop and validate indicators regarding the process and outcome of continuing care. We systematically searched for evidence-based guidelines and existing quality indicators. A multidisciplinary expert panel prioritized recommendations using a written questionnaire followed by a group discussion. Important recommendations were then translated to quality indicators. The panel subsequently selected indicators that were measurable and applicable in Belgium. In a final round the indicators facevalidity was assessed. Results: We extracted 69 recommendations from 06 guidelines and 17 relevant quality indicators. Of all, 13 indicators remained after 03 written rounds and 02 group discussions. Conclusions: This study describes a systematic approach to develop and validate quality indicators for continuing care for AUD. The final set of selected indicators consisted of 10 process and 03 outcome indicators. As the level of evidence of effective continuing care components is very low further development of the indicators is recommended. Short summary: This study describes a systematic approach to develop and validate quality indicators for continuing care for AUD. The proposed set of indicators consisted of 10 process and 03 outcome indicators. As the level of evidence of effective continuing care components is very low further development of the indicators is recommended. Severe alcohol use disorder (AUD) is a progressive and chronic disease that results from a long-lasting exposure to alcohol. Alcohol dependence affects physical, psychological and social functioning and relapse is common. Indirect societal costs of alcohol dependence are estimated to reach up to 0.64% of European countries' annual gross domestic product, illustrating the burden of alcohol dependence to society (Nutt et al., 2015). Therefore, alcohol dependence should be recognized and managed adequately. Care for AUD typically follows an acute treatment model. Such model provides detoxification and rehabilitation in specialized
and online video) consultations in mental health [1]. This growth is reflected in the almost four... more and online video) consultations in mental health [1]. This growth is reflected in the almost four-fold increase in literature around remote mental health care between 2018 (n = 201) and 2021 (n = 749). Many studies indicated the negative effects of the pandemic on mental well-being [2-5]. In this regard, digital technologies may play a key role in the care of psychological difficulties and for providing necessary support, most specifically in a period of quarantine and social distancing. The initiation and promotion of remote (mental) health was considered one way of optimally residing patient contacts during the pandemic, but more studies on the use of remote (mental) health are deemed necessary. For many mental health care practitioners, the COVID-19 pandemic has been an opportunity towards remote care, being able to implement and evaluate remote mental health in practice. In general, implementation of online video consultations was particularly slow to start but intensified with the increasing length of the pandemic [6]. In a recent study
Media coverage of Belgium's first criminal case concerning euthanasia for psychiatric patients: A... more Media coverage of Belgium's first criminal case concerning euthanasia for psychiatric patients: A content analysis of Flemish newspapers and magazines.
A 19-year-old female was seen at the emergency department following an auto-intoxication. An ocul... more A 19-year-old female was seen at the emergency department following an auto-intoxication. An oculogyric crisis (ogc) was observed, in the absence of other extrapyramidal symptoms (eps). In a second anamnesis, patient indicated that she had taken risperidone 3 mg (an atypical antipsychotic). This particular case description of an isolated ogc shows that care providers should be attentive to the occurrence of ogc, even if the most frequent eps are absent. This case also emphasizes the importance of a complete history in order to efficiently and timely guide the care provider to the correct diagnosis.
BACKGROUND Stigma is one of the greatest challenges facing people with severe mental illness (smi... more BACKGROUND Stigma is one of the greatest challenges facing people with severe mental illness (smi) and can have profound psychological, social and professional consequences. AIM: To systematically review the evidence of effectiveness of anti-stigma interventions (anti-stigma campaigns and specific interventions to reduce public stigma and self-stigma) for people with smi and to make recommendations for clinical practice. METHOD: A systematic literature search for individual studies and reviews concerning the efficacy of interventions that reduce stigma for people with smi. RESULTS: Anti-stigma interventions have small-to-medium effects. Although head-to-head comparisons do not show a clear advantage for educational or contact interventions, results suggest that the elements of contact, recovery and continuity (for public stigma) and psycho-education (for self-stigma) may yield the greatest effects. Due to the short follow-up period of most studies, there is limited evidence on the l...
counterbalanced order. The anode was placed over F3 and the cathode on the right supraorbital sca... more counterbalanced order. The anode was placed over F3 and the cathode on the right supraorbital scalp. Active stimulation consisted of 2.0 mA tDCS for 20 min. Traditional sham consisted of 2.0 mA tDCS for the first minute and 0 mA thereafter. Novel sham consisted of 2.0 mA tDCS for three 1-minute periods (at 0, 6:40, and 13:20) interspersed between 17 min of 0 mA stimulation. After the end of each session, participants were asked if they thought the stimulation was real. They also rated cutaneous sensations and experiences before and after each session. Results: Traditional sham was perceived as "real" by fewer (9/24) participants than novel sham (16/24; McNemar's Test, p¼.016) and active stimulation (18/24, p¼.022). More participants reported tingling (15 vs. 7, p¼.008) and discomfort (13 vs. 7, p¼.031) after novel than traditional sham. Reports of tingling and discomfort did not differ significantly (p>.5) after active vs. novel sham stimulation. Reports of tingling (Phi¼.358, p¼.002) and discomfort (Phi¼.323, p¼.006) correlated with whether participants perceived stimulation as "real." Conclusions: Blinding with traditional sham is ineffective at 2.0 mA. A novel sham with 3 discrete bursts of stimulation produced better blinding, likely due to increased cutaneous sensations.
Only a limited number of alcohol dependent patients appear to benefit from existing psychotherape... more Only a limited number of alcohol dependent patients appear to benefit from existing psychotherapeutic and pharmacological treatment modalities. This fact highlights the need for different treatment approaches. Recent evidence however, suggests a possible beneficial role for neuromodulation techniques. In particular, repetitive transcranial magnetic stimulation (rTMS) seems able to change subjective alcohol craving, an important factor in relapse risk. Further, these techniques also tend to enhance cognitive executive functioning. Recent developments and future research possibilities concerning the application of rTMS in the treatment of alcohol addiction will be discussed.
Background: In the coming years, mental health care may come into contact with patients who devel... more Background: In the coming years, mental health care may come into contact with patients who developed psychological complaints related to their critical illness and stay in the intensive care unit (ICU) as a result of COVID-19. However, the experiences of these patients are to date rarely documented. Aim: Gaining insight into the experiences of COVID-ICU-survivors. METHODS 19 COVID-ICU survivors answered a written survey four months after admission. Screening lists measured psychological complaints and sleeping disorders. Visual analogue scales (VAS) measured the influence of the pandemic context and the quality of life. A written survey mapped patient experiences. Quantitative data were analyzed descriptively and qualitative data by means of thematic analysis. Results: 50% of the participants experienced psychological complaints or sleeping disorders. A limited social network and media coverage of COVID-19 complicated the recovery process of patients. 19% of the participants experienced a reduced quality of life. A weak social network caused feelings of hopelessness. Still, patients showed great resilience. Conclusion: Most COVID-ICU survivors are resilient enough to integrate their experiences into their lives, despite the challenges the pandemic context poses on their rehabilitation. It is therefore important not to overmedicalise psychological complaints that occur during rehabilitation. Our attention needs to be directed to those with a weak social network.
Baclofen may reduce the symptoms of alcohol withdrawal, as an alternative or as an adjuvant for b... more Baclofen may reduce the symptoms of alcohol withdrawal, as an alternative or as an adjuvant for benzodiazepines, but the available data are insufficient to support baclofen-assisted alcohol withdrawal. This study investigated the need for diazepam during acute alcohol withdrawal in patients receiving baclofen. In a single-blind, dose-dependent randomized controlled trial with three study arms, 63 patients with alcohol use disorder, starting in-patient benzodiazepine-assisted alcohol detoxification, were randomly assigned to receive placebo (n = 18), baclofen 30 mg/day (N = 20), or baclofen 60 mg/day (N = 25) for 7 days. Diazepam was provided as needed based on the withdrawal symptoms stated by Clinical Institute Withdrawal Assessment for Alcohol-revised. The primary outcome measure was the number of patients in need of diazepam during alcohol detoxification. Secondary outcome measure included the between-group difference in the amount of diazepam needed during alcohol detoxification. Using baclofen 60 mg/day, 32% of patients needed additional diazepam compared to 35% on baclofen 30 mg/day and compared to 72% on placebo (P = .013). The median total amount of diazepam needed was significantly lower in patients receiving baclofen 60 mg/day (0 ± 10 mg diazepam) and baclofen 30 mg/day (0 ± 10 mg diazepam) compared to placebo (10 ± 43 mg diazepam; P = .017). Adverse events were comparable between patients on baclofen and placebo. Baclofen can reduce the withdrawal symptoms during alcohol detoxification. Baclofen was well tolerated and may be considered for the management of alcohol withdrawal syndrome, especially useful in situations where benzodiazepines should be withheld, such as patients with liver impairment.
for the development of a combined system of psycho-physical rehabilitation. The psychotherapy bas... more for the development of a combined system of psycho-physical rehabilitation. The psychotherapy based on CBT according to A. Beck, modified for children's in concordance with specialized program "Vertebra-Dinamik" to correct defects of the musculoskeletal system. The basis of the corrective "Vertebra-Dinamik" technique includes a comprehensive approach to the use of isometric and statodynamic exercises of moderate intensity with elements of relaxation. Approbation of the developed system showed its high (80%) and moderate(20%) efficiency. Conclusions: To successfully overcome cyber addiction and its negative consequences, the most optimal system is the complex application of psychotherapeutic and physical rehabilitation methods.
Substance use disorders (SUD) and attention-deficit/hyperactivity disorder (ADHD) often co-occur ... more Substance use disorders (SUD) and attention-deficit/hyperactivity disorder (ADHD) often co-occur in adults. Together, they complicate diagnosis and can negatively influence treatment outcome.<br/> AIM: To develop a practical guide to assist professionals with the screening, diagnosis and treatment of adult patients with SUD and ADHD.<br/> METHOD: A literature search and a consensus procedure between several international scientific and clinical experts. This manuscript is an adapted and summarized Dutch version of the International consensus statement on screening, diagnosis and treatment of patients with SUD and comorbid ADHD.<br/> RESULTS: The routine use of adequate screening tools enables ADHD to be detected earlier in adults with SUD. The diagnostic process for ADHD should be initiated as soon as possible in patients with SUD. Integrated treatment, involving a combination of pharmacotherapy and psychotherapy, is preferred. Long-acting stimulants with up-titration to higher dosages may be considered.<br/> CONCLUSION: Early detection of ADHD in patients with SUD is essential for adequate diagnosis and more effective treatment and follow-up for these patients.
Aims: To develop indicators to assess quality of continuing care for persons with alcohol use dis... more Aims: To develop indicators to assess quality of continuing care for persons with alcohol use disorder (AUD). Methods: A guideline-based RAND-modified Delphi method was used to develop and validate indicators regarding the process and outcome of continuing care. We systematically searched for evidence-based guidelines and existing quality indicators. A multidisciplinary expert panel prioritized recommendations using a written questionnaire followed by a group discussion. Important recommendations were then translated to quality indicators. The panel subsequently selected indicators that were measurable and applicable in Belgium. In a final round the indicators facevalidity was assessed. Results: We extracted 69 recommendations from 06 guidelines and 17 relevant quality indicators. Of all, 13 indicators remained after 03 written rounds and 02 group discussions. Conclusions: This study describes a systematic approach to develop and validate quality indicators for continuing care for AUD. The final set of selected indicators consisted of 10 process and 03 outcome indicators. As the level of evidence of effective continuing care components is very low further development of the indicators is recommended. Short summary: This study describes a systematic approach to develop and validate quality indicators for continuing care for AUD. The proposed set of indicators consisted of 10 process and 03 outcome indicators. As the level of evidence of effective continuing care components is very low further development of the indicators is recommended. Severe alcohol use disorder (AUD) is a progressive and chronic disease that results from a long-lasting exposure to alcohol. Alcohol dependence affects physical, psychological and social functioning and relapse is common. Indirect societal costs of alcohol dependence are estimated to reach up to 0.64% of European countries' annual gross domestic product, illustrating the burden of alcohol dependence to society (Nutt et al., 2015). Therefore, alcohol dependence should be recognized and managed adequately. Care for AUD typically follows an acute treatment model. Such model provides detoxification and rehabilitation in specialized
and online video) consultations in mental health [1]. This growth is reflected in the almost four... more and online video) consultations in mental health [1]. This growth is reflected in the almost four-fold increase in literature around remote mental health care between 2018 (n = 201) and 2021 (n = 749). Many studies indicated the negative effects of the pandemic on mental well-being [2-5]. In this regard, digital technologies may play a key role in the care of psychological difficulties and for providing necessary support, most specifically in a period of quarantine and social distancing. The initiation and promotion of remote (mental) health was considered one way of optimally residing patient contacts during the pandemic, but more studies on the use of remote (mental) health are deemed necessary. For many mental health care practitioners, the COVID-19 pandemic has been an opportunity towards remote care, being able to implement and evaluate remote mental health in practice. In general, implementation of online video consultations was particularly slow to start but intensified with the increasing length of the pandemic [6]. In a recent study
Media coverage of Belgium's first criminal case concerning euthanasia for psychiatric patients: A... more Media coverage of Belgium's first criminal case concerning euthanasia for psychiatric patients: A content analysis of Flemish newspapers and magazines.
A 19-year-old female was seen at the emergency department following an auto-intoxication. An ocul... more A 19-year-old female was seen at the emergency department following an auto-intoxication. An oculogyric crisis (ogc) was observed, in the absence of other extrapyramidal symptoms (eps). In a second anamnesis, patient indicated that she had taken risperidone 3 mg (an atypical antipsychotic). This particular case description of an isolated ogc shows that care providers should be attentive to the occurrence of ogc, even if the most frequent eps are absent. This case also emphasizes the importance of a complete history in order to efficiently and timely guide the care provider to the correct diagnosis.
BACKGROUND Stigma is one of the greatest challenges facing people with severe mental illness (smi... more BACKGROUND Stigma is one of the greatest challenges facing people with severe mental illness (smi) and can have profound psychological, social and professional consequences. AIM: To systematically review the evidence of effectiveness of anti-stigma interventions (anti-stigma campaigns and specific interventions to reduce public stigma and self-stigma) for people with smi and to make recommendations for clinical practice. METHOD: A systematic literature search for individual studies and reviews concerning the efficacy of interventions that reduce stigma for people with smi. RESULTS: Anti-stigma interventions have small-to-medium effects. Although head-to-head comparisons do not show a clear advantage for educational or contact interventions, results suggest that the elements of contact, recovery and continuity (for public stigma) and psycho-education (for self-stigma) may yield the greatest effects. Due to the short follow-up period of most studies, there is limited evidence on the l...
counterbalanced order. The anode was placed over F3 and the cathode on the right supraorbital sca... more counterbalanced order. The anode was placed over F3 and the cathode on the right supraorbital scalp. Active stimulation consisted of 2.0 mA tDCS for 20 min. Traditional sham consisted of 2.0 mA tDCS for the first minute and 0 mA thereafter. Novel sham consisted of 2.0 mA tDCS for three 1-minute periods (at 0, 6:40, and 13:20) interspersed between 17 min of 0 mA stimulation. After the end of each session, participants were asked if they thought the stimulation was real. They also rated cutaneous sensations and experiences before and after each session. Results: Traditional sham was perceived as "real" by fewer (9/24) participants than novel sham (16/24; McNemar's Test, p¼.016) and active stimulation (18/24, p¼.022). More participants reported tingling (15 vs. 7, p¼.008) and discomfort (13 vs. 7, p¼.031) after novel than traditional sham. Reports of tingling and discomfort did not differ significantly (p>.5) after active vs. novel sham stimulation. Reports of tingling (Phi¼.358, p¼.002) and discomfort (Phi¼.323, p¼.006) correlated with whether participants perceived stimulation as "real." Conclusions: Blinding with traditional sham is ineffective at 2.0 mA. A novel sham with 3 discrete bursts of stimulation produced better blinding, likely due to increased cutaneous sensations.
Only a limited number of alcohol dependent patients appear to benefit from existing psychotherape... more Only a limited number of alcohol dependent patients appear to benefit from existing psychotherapeutic and pharmacological treatment modalities. This fact highlights the need for different treatment approaches. Recent evidence however, suggests a possible beneficial role for neuromodulation techniques. In particular, repetitive transcranial magnetic stimulation (rTMS) seems able to change subjective alcohol craving, an important factor in relapse risk. Further, these techniques also tend to enhance cognitive executive functioning. Recent developments and future research possibilities concerning the application of rTMS in the treatment of alcohol addiction will be discussed.
Background: In the coming years, mental health care may come into contact with patients who devel... more Background: In the coming years, mental health care may come into contact with patients who developed psychological complaints related to their critical illness and stay in the intensive care unit (ICU) as a result of COVID-19. However, the experiences of these patients are to date rarely documented. Aim: Gaining insight into the experiences of COVID-ICU-survivors. METHODS 19 COVID-ICU survivors answered a written survey four months after admission. Screening lists measured psychological complaints and sleeping disorders. Visual analogue scales (VAS) measured the influence of the pandemic context and the quality of life. A written survey mapped patient experiences. Quantitative data were analyzed descriptively and qualitative data by means of thematic analysis. Results: 50% of the participants experienced psychological complaints or sleeping disorders. A limited social network and media coverage of COVID-19 complicated the recovery process of patients. 19% of the participants experienced a reduced quality of life. A weak social network caused feelings of hopelessness. Still, patients showed great resilience. Conclusion: Most COVID-ICU survivors are resilient enough to integrate their experiences into their lives, despite the challenges the pandemic context poses on their rehabilitation. It is therefore important not to overmedicalise psychological complaints that occur during rehabilitation. Our attention needs to be directed to those with a weak social network.
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