Tijdschrift voor psychiatrie
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In the course of the past 25 years in Flanders there has been a real breakthrough as far as forensic psychiatry is concerned. New types of treatment have become available for mentally disturbed offenders, whether they are in prison or in the community. A new Belgian law on mentally disturbed offenders with diminished responsibility confirms that 'internment' is still regarded as a protective measure and an alternative to punishment. The current university course in psychiatry should now be widened to include the subject of forensic mental health.
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When patients with cardiovascular disorders undergo electroconvulsive therapy (ect) they sometimes have to be treated for tachycardia and high blood pressure. ⋯ The beta-blocker of choice for use during ect seems to be esmolol; it can shorten seizure duration, although the effect is probably dose-dependent. Esmolol is also the drug of choice in ect sessions for patients without cardiovascular risk factors but who develop prolonged hypertension or tachycardia. A possible alternative is labetalol, but its longer half-life is a disadvantage, particularly if it is administered in a high dose. So far, experience with landiolol is limited, but its short half-life, greater cardioselectivity and higher potency mean that it could be a promising alternative.
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Consultation-liaison psychiatry and general hospital psychiatry have played a major role in promoting the concept of integrated care. New models for care have been developed and policy assurances about the quality of care have been expressed in the form of guidelines and indicators relating to procedure and performance. ⋯ Due to the ageing population there is greater awareness of the importance of comorbidity and more support for the concept of integrated care. These changes will promote the further development of general hospital psychiatry.
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In Belgium emergency psychiatry is a discipline that has developed only recently, following two federal pilot projects, one in 1993 and one in 2002. At present there are 10 subsidised psychiatric emergency rooms (pers) in Belgium, serving about 13,000 patients annually. ⋯ More than 4 in 10 patients were admitted to a psychiatric clinic after being referred to a per. Research suggests that the link to continuous care may reduce the 'revolving-door' phenomenon.
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Subclinical depression is a condition in which a person has depressive symptoms but does not meet the criteria for a depressive disorder. ⋯ Subthreshold depression has serious consequences for the quality of life, but not as serious as in the case of a depressive disorder. Psychological treatment is effective.