Tijdschrift voor psychiatrie
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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. ⋯ 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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Despite the increasing attention for people with a (borderline) intellectual disability within the field of mental health care in The Netherlands and Flanders, access to mental health care for this vulnerable group is still limited.
AIM: To explore the access to mental health care in the Netherlands and Flanders for people with borderline intellectual functioning or an intellectual disability.
METHOD: A survey of scientific literature, recent reports and available practical knowledge about mental disorders in people with borderline intellectual functioning or an intellectual disability and their access to mental health care.
RESULTS: Insufficient knowledge about mental disorders in long term intellectual disability care and insufficient knowledge of, and experience with borderline intellectual functioning and intellectual disability among mental health care providers play a role in the limited access to good mental health care. More exchange of knowledge and sharing of experiences is necessary to ultimately properly address the needs of this group.
CONCLUSION: Structural collaboration between mental health care and care for people with an intellectual disability is needed. -
A 38-year-old woman was admitted in a psychiatric hospital because of memory disorders. Dry beriberi and Korsakoff's syndrome, as a late neuropsychiatric manifestation of Wernicke's encephalopathy, were established. The beriberi symptoms decreased slowly, but the patient's memory impairments persisted. ⋯ Gastric bypass surgery is associated with an increased risk of thiamine deficiency. Excessive alcohol consumption and poor compliance with vitamin deficiency treatment both contributed to the rapid onset of these disorders. The case we describe demonstrates how important it is that patients who have undergone bariatric surgery are prescribed the correct vitamin supplements and that the treatment is continued for an appropriate period of time; this treatment is particularly important in the case of patients who are also suffering from an comorbid alcohol-related disorder.
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Heartrate variability biofeedback (HRVB) is a non-invasive treatment in which patients are assumed to self-regulate a physiological dysregulated vagal nerve. Although the therapeutic approach of HRVB is promising in various stress-related disorders, it has only been offered on a regular basis in a few mental health treatment settings. ⋯ Although this systematic review shows the popularity of HRV in literature, it does not indicate that HRVB really has been reviewed systematically. Significant outcomes of this limited number of randomised studies indicate there may be a clinical improvement when HRVB training is integrated into treatment of PTSD and depression, particularly when this integration procedure is combined with psychotherapy. More research needs to be done with larger groups and further efforts are needed to integrate HRVB into treatment of stress-related disorders in psychiatry. Future research also needs to focus on the psychophysiological mechanisms involved.
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We study the case of a 12-year-old girl who, following intra-uterine exposure to valproate, was diagnosed with foetal valproate syndrome, characterised at birth by dysmorphic features. The use of valproate during pregnancy (because of epilepsy or bipolar disorder) can cause not only structural defects in the growing foetus, but also problems in cognitive development and in adaptive and emotional/behavioural functioning in later life. We evaluate these domains of development in our discussion and suggest several other drugs, less harmful than valproate, which can be used to treat epilepsy or bipolar disorder during pregnancy.