Dutch Psychiatrist Research Articles

Cultural competence of mental health practitioners in the Netherlands.

The importance of providing mental health from a transcultural perspective in establishing a therapeutic alliance is recognized. However, it is currently unknown how many mental health practitioners in the Netherlands feel capable of providing mental healthcare from a transcultural perspective, or if they are familiar with the Cultural Formulation Interview (CFI). The CFI is a tool used in mental health care to gather culturally relevant patient information, enhancing cultural sensitivity in treatment. It is also unknown if there is a difference between psychiatrist and psychiatry residents in terms of their cultural competence. This study aimed to assess the self-appraised cultural competence of Dutch psychiatrist and psychiatry residents, including their knowledge of the CFI, and the need for further training. A cross-sectional study was conducted among psychiatrists and psychiatry residents by means of an online questionnaire. Ninety-seven mental health practitioners completed the questionnaire. Of the psychiatrists 70% and of the residents 76% reported that treating patients from cultural backgrounds different from their own background is challenging. Only 44% of psychiatrists and 34% of residents considered themselves sufficiently culturally competent, and 56% and 47% respectively, were uninformed about the CFI. The majority of psychiatrists and residents (70 vs 84%) indicated a need for more training in cultural competence. The majority of psychiatrists and residents in The Netherlands considered treating patients from different cultural backgrounds a challenge, reported feeling insufficiently culturally competent, lacked experience with the cultural formulation interview and reported a need for more training in cultural competence.

Bedtime negotiations: Unravelling normative complexity in hospital-based prevention.

This study explores how actors deal with normative complexity in the design and implementation of practices of preventative care. Previous studies have identified conflicting (e)valuations of prevention within health care at large, but little empirical research describes how these conflicts are resolved in day-to-day interactions. Zooming in on the work of a single actor, our ethnographic study describes a Dutch psychiatrist developing a novel type of hospital bed that provides preventative psychiatric care for women in the post-partum period. Drawing on pragmatic sociology of justification, we construe 'beds'-and the time, people and resources they represent-as points of convergence between conflicting valuations of care. The results show that embedded modes of valuation in a curative hospital setting generate significant normative complexity during implementation. We identify three main strategies through which normative complexity is managed: (a) translating between different modes of valuing prevention, (b) compromising in (material) design of care beds and (c) transcending embedded valuations through moral appeals. By showing the normative complexity of prevention in practice, our study highlights the need for a diverse and situated accounting for preventative care.

Le Praecox Feeling : présentation historique du concept et aspects épistémologiques

ObjectivesThe aim of this review is to explore the multiple aspects of the « Praecox Feeling » as introduced and developed by the Dutch Psychiatrist H.C Rümke in 1941 and re-assessed over the following years by its peers. MethodsWe present a historical review of this subject from the first description to the most recent research and proposed related notions like typification processes and gut feeling. ResultsThe Praecox Feeling, as presented by Rümke, may be considered as the most sensible tool in order to diagnose schizophrenia. This phenomenon appears in the in-between of the clinical encounter (i.e. the intersubjective space). It may be felt by the clinician as an experience of bizarreness during the interaction with a patient suffering from schizophrenia. Those feelings suggest fundamental aspects of schizophrenia that can be recognized as a peculiar form of embodiment. Rümke finally concludes that schizophrenia is not diagnosed by strictly examining patients’ symptoms, but psychiatrists’ own feelings. The recognition of such feelings remains hard to describe explicitly, since it takes place in a very basic (« pre reflexive ») state. However, numbers of researchers tried to explore praecox feeling more accurately. A phenomenological approach, with Minkowski, Binswanger or Tellenbach among others, developed several related terms: “Diagnostic by intuition”, “Diagnostic by penetration” or “Atmospheric diagnosis”. Although the precocity of the diagnosis is mentioned in Rümke's original paper, it does not precisely define the Praecox Feeling, contributing to the misunderstanding of the Rümke's original formulation. The very notion of Praecox Feeling in terms of psychiatric diagnoses fell into disuse with the development and the widespread diffusion of criteriological approaches, with the risk of an impoverishment of the clinical diagnosis. However, the study of specific subjective perspectives showed a renewed interest over the last decade, especially with the contribution of cognitive and social neurosciences. Furthermore, studies on psychiatrists’ daily-practice suggest that the Praecox Feeling is still relevant. Moreover, “the subjective tool” represented by the Praecox Feeling remains as used today as it was fifty years ago, in a pre-DSM III era. Temporal aspects have, nevertheless, lead to several studies suggesting that many clinical indices are identified during the first minutes of a clinical interview, especially for schizophrenia. In order to specify this very intuitive pathway, authors developed and worked on the typifications processes that lead to such feelings, involving diagnosis through prototypes. The passive synthesis of such subtle clinical clues may induce for the clinician a “pattern recognition” phenomenon that reminds a “gestaltic” diagnosis. This specific aspect of typification may not be specific of psychiatry. The “Guts Feeling” is a notion first developed by Dutchs physicians, particularly in General medicine but also among other medicals disciplines, theoretically very close from the notion of intuitive typification. It may allow benefits in term of diagnoses, reassurance or alarm sense. It suggests that clinical experience added to criteriology provides risks reductions. The crucial role of clinical experience in the diagnosis decision making tends to be underexplored, but still represents a crucial aspect of the evidence-based medicine as firstly described.

Moving beyond psychiatric diagnosis and the medical framework towards social recovery: an interview with Jim van Os

There is a growing realization in the field of psychiatry that we are unable to free ourselves of the constraints imposed by our concepts, as well as to move beyond them. Thus, the field demands not only more robust empirical evidence but also a more sophisticated conceptual framework, which would allow for critical and innovative thinking to conceive and to build better models of mental health care. In this spirit, we present a very thought-provoking interview with Dutch psychiatrist Jim van Os, encompassing biographical issues from his academic background as well as his ideas on recovery and the Dutch experience of the recovery colleges as a “shadow mental health system” in the Netherlands. Adopting a critical stance on psychiatric diagnosis and the validity of group-level comparisons in evidence-based psychiatry, and in line with the ideals of the recovery movement, van Os points out that the process of healing should surpass symptom reduction. For him, it should take into account the long-term process of developing resilience, learning to deal with suffering through interactions with other people, building up new perspectives, goals, and existential purposes. In other words, he emphasizes the idea of social recovery and favors the thought that mental health professionals should try to “help people to relate better to their mental variation and offer them ways of doing that differently.”

Moving beyond psychiatric diagnosis and the medical framework towards social recovery: an interview with Jim van Os

There is a growing realization in the field of psychiatry that we are unable to free ourselves of the constraints imposed by our concepts, as well as to move beyond them. Thus, the field demands not only more robust empirical evidence but also a more sophisticated conceptual framework, which would allow for critical and innovative thinking to conceive and to build better models of mental health care. In this spirit, we present a very thought-provoking interview with Dutch psychiatrist Jim van Os, encompassing biographical issues from his academic background as well as his ideas on recovery and the Dutch experience of the recovery colleges as a “shadow mental health system” in the Netherlands. Adopting a critical stance on psychiatric diagnosis and the validity of group-level comparisons in evidence-based psychiatry, and in line with the ideals of the recovery movement, van Os points out that the process of healing should surpass symptom reduction. For him, it should take into account the long-term process of developing resilience, learning to deal with suffering through interactions with other people, building up new perspectives, goals, and existential purposes. In other words, he emphasizes the idea of social recovery and favors the thought that mental health professionals should try to “help people to relate better to their mental variation and offer them ways of doing that differently.”

Ausência de espiritualidade e sociose

Neste artigo, busca-se resgatar percepções centrais das obras do psiquiatra e psicólogo holandês Jan Hendrik Van den Berg; a forma como compreende o inconsciente, a releitura que faz acerca das neuroses, propondo sua substituição terminológica para socioses e ampliando o sentido contido no termo, permitindo reflexões valiosas e interlocuções profundas com a psicologia da religião. Se na época freudiana a inconscientização da sexualidade e da agressividade provocavam quadros sindrômicos bem específicos, a sociose enfrentada pelo sujeito hodierno é o esquecimento da espiritualidade. O psiquiatra advoga que a espiritualidade como dimensão humana, enquanto for negligenciada pela sociedade, continuará a produzir pessoas esvaziadas, medíocres, que não reconhecem seu lugar no mundo e tampouco conseguem desenvolver boas relações sociais. Endossa-se muito da percepção de Van Den Berg ao
 apontar o atual momento histórico de resgate da espiritualidade já que, como dimensão humana, assim como a sexualidade, deveria ser reintegrada à existência.

Picturing ethnopsychology: A colonial psychiatrist's struggles to examine Javanese minds, 1910-1925.

This article explores C. F. Engelhard's struggles to construct psychometric devices for the Netherlands Indies between 1910 and 1925. A young Dutch psychiatrist, Engelhard moved to the Netherlands Indies in 1916, where he applied his clinical experience to subject Javanese individuals to mental assessment devices. He imagined that basic picture tests and one's orientation in time provided apt solutions to the cross-cultural challenges facing him. To turn his prototypes into actual tests, Engelhard had to leave his daily work environment and move into the surrounding villages. Aided by local chiefs and his assistant, Soekirman, he managed to set up temporary testing sites, where he examined hundreds of Javanese individuals. Yet despite his attempts to transform Javanese farmers into subjects capable of taking a psychological test, the Javanese remained free to make-or fail to make-meaning out of Engelhard's images. Even though the psychiatrist went to great lengths in taking into account the particular social and cultural features of psychological practice in a colonial context, a vast chasm remained to exist between him and his test takers. This article examines Engelhard's practices against the backdrop of his training as a Western psychiatrist, colonial ideology in the Netherlands Indies, and the reception of his research by other colonial scientists with a wide range of attitudes about "the native mind." (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Hoe 'tijd' psychiatrie opnieuw betoverde

In his dissertation ‘ On time and time-forms’, the Dutch Psychiatrist Paul Theodoor Hugenholtz ( 1903 – 1987 ) developed an anthropology and psychopathology based on time-experience. Hugenholtz’ dis- sertation builds on the work on time of anthropological and phenomenological psychiatrists: Ludwig Binswanger ( 1881 – 1966 ), eugene minkowski ( 1885 – 1972 ), Viktor emil von Gebsattel ( 1883 – 1976 ) and erwin Straus ( 1891 – 1975 ). Their anthropological psychiatric work on time should be interpreted in the context of a ‘new’ psychiatry of the early twentieth century, the rise of holistic science and a broad cultural, philosophical and scientific reappraisal of time. The time debate shows a reconsideration of psychiatry in which methodology, epistemology, values and the understanding of time mutually influenced each other between 1910 and 1939 . This type of psychiatry should be studied as a cultural phenomenon, without losing sight of the psychiatric aspirations of its practitioners. With the cultural historical perspective it can be understood as a psychiatric reflection on the relationship between time- experience and the meaning of human existence in a modern world.

Contradictions

Contradictions

The Utility of Assessing Nonverbal Communication in the Psychiatric Evaluation

The Utility of Assessing Nonverbal Communication in the Psychiatric Evaluation

L’inconscient au paradis: Comment les catholiques ont reçu la psychoanalyse (1920–1965) (review)

L'inconscient au paradis: Comment les catholiques ont recu la psychoanalyse (1920-1965). By Agnes Desmazieres. (Paris: Editions Payot & Rivages. 2011. Pp. 270. euro21,50 paperback. ISBN 978-2-228-90666-1.) In this significant work Agnes Desmazieres traces the ways in which some of the leading mid-twentieth century Catholic European intellectuals and professionals struggled to find a place in Catholic thought for the emerging psychological constructs about the unconscious. Written in the style of a European monograph, the author guides the reader through a terrain of cultural clashes as Catholic scholars encountered theories of the unconscious, most notably expressed by Sigmund Freud's psychoanalysis and Carl Jung's depth psychology. Desmaizieres's frequent use of subheadings proves invaluable as she presents a series of controversies that illuminate the seeking of Catholics proponents for a foothold for the unconscious. The book's historical overview offers a who's who of mid-twentieth-century Catholic European intellectuals. Desmazieres, for example, mentions the contributions by such clerical leaders as Louis Beirnaert (French Jesuit psychoanalyst), Bruno de Jesus Marie (French Carmelite psychoanalyst/theologian), Agostino Gemelli (Italian Franciscan psychologist), Andre Godin (Belgian Jesuit psychoanalyst), Gregoire Lemercier (Benedictine abbot), Marc Oraison (priest/physician/theologian), Albert Pie (French Dominican psychologist/theologian), and Victor White (British Dominican theologian). Desmazieres also mentions the influence of lay Catholic thinkers such as Rudolf Allers (Austrian philosopher), Marcy Choisy (French novelist and psychoanalyst), Roland Dalbiez (French philosopher), Joseph Nuttin (Belgian psychologist), and Anna A.A.Terruwe (Dutch psychiatrist). In addition, important North American contributions to the discussion by Leo Bartemeier (American psychoanalyst), Noel Mailloux (French Canadian Dominican, psychoanalyst), and Gregory Zilboorg (Russian American psychoanalyst) are referenced. For the purposes of revealing the Church's ambivalence toward psychoanalysis, Desmazieres discusses the influence of Gemelli in various parts of her text. The founder of Sacred Heart University in Milan, Gemelli wielded considerable influence with Popes Pius XI and Pius XII. His Thomistic training made him suspicions of both the scientism of Italian medical materialism and the reductionism of Freud's theories. …

Homo pavlovius: Cinema, Conditioning, and the Cold War Subject

Edward Hunter, the man popularly credited with coining the term brainwashing , had a deep appreciation of the power of his new construct. In his book on this new form of mind control, first published in 1951 and then expanded on in 1956, he referred often to the “eerie sensation” this term inspired in him. 1 Many Americans shared this sensation in the first decade of the Cold War. The fear and fascination surrounding the term brainwashing presumably stemmed from the conviction that in this uncanny phenomenon the totalitarian enemy revealed its true face. If a name was needed to accompany that face, Hunter supplied that as well. The ultimate source of the “eerie sensation” emanating from behind the Iron Curtain was identified by Hunter as Ivan Pavlov, the Nobel Prize‐winning scientist and inventor of the methods the Soviets and their allies were allegedly employing on American prisoners of war (POWs) in Korea, on prominent dissidents in Eastern bloc coun tries, and on a mass scale on their own citizens. Hunter saw evidence of a deep connection between the POW camps and Pavlov’s experiments on reflex condition ing, and he furthermore claimed that the “Chinese, as a race, are undergoing mind treatment inside a Great Pavlovian Wall.” 2 From the start the problems both with Hunter’s account of brainwashing and with his picture of Pavlov as the mastermind behind it were readily apparent. Not the least of these was that Pavlov had never been a Bolshevik, and his most impor tant research had been carried out before the Bolsheviks came to power. The exact nature of the relation between Pavlovian conditioning and brainwashing was also problematic, as was, some skeptics suggested, the entire concept of brainwashing. Despite such skepticism, Hunter’s construct proved remarkably resilient—attesting not just to the skill with which the journalist and intelligence operative had woven his account but also to the degree to which it tapped into deep undercurrents of anxiety in the contemporary public. Joost Meerloo, a Dutch psychiatrist who taught

De pendel, de kloof en de kliniek.Leendert Bouman (1869-1936) en de ‘psychologische wending’ in de Nederlandse psychiatrie

The pendulum, the gap, and the clinic. Leendert Bouman (1869-1936) and the ‘psychological turn’ in Dutch psychiatry In recent historical literature, the Dutch psychiatrist Leendert Bouman (1869-1936) is named ‘the godfather of psychological psychiatry’. He is regarded as one of the exponents of a shift or ‘pendulum’ movement from a biological-materialistic to a psychological, phenomenological orientation in the Dutch psychiatry of the Interbellum. As a professor of the orthodox calvinist Vrije Universiteit of Amsterdam, he explicitly opposed a ‘soul-less’, biological-reductionist psychiatry. In addition, he played an important part in the introduction and spread of new ‘psychological’ theories and especially Karl Jaspers’ phenomenology in the Netherlands. It is one-sided and misleading, however, to refer to Bouman as a ‘psychological’ psychiatrist. Most of his scientific work was of a neurological and biological nature. He did not see biological (or nomothetic) and psychological (or idiographic) approaches as mutually exclusive, but as necessarily complementary. In this he followed Jaspers’ distinction between and complementary use of the causal connections of psychic life (explanatory psychology) and meaningful psychic connections (psychology of meaning). Boumans pluralist orientation was rooted in his fundamentally clinical attitude toward psychiatry. In his view, a psychiatrist was in the first place a clinician. In the clinic, he stressed, a psychiatrist has to view and examine each individual patient in his bio-psycho-social totality. The case of Bouman illustrates that the history of psychiatry is by far richer and more complicated than is suggested by the standard account of that history being characterized by a pendulum movement and a one-dimensional struggle between ‘somatic’ and ‘psychological’ schools. It also suggests that the interaction between theory and clinical practice should be emphasized as an important dynamic factor in the history of psychiatry – next to or even above the dichotomy between ‘biology’ and ‘psychology’.

Healing the Spirit

![Figure][1] A gathering of Ugandan traditional healers. CREDIT: MARJOLEIN VAN DUIJL As head of psychiatry at Mbarara University of Science and Technology in Uganda, Marjolein van Duijl didn't get many requests for Prozac. “There's no translation for ‘depression’ in the local languages,” the Dutch psychiatrist says. But patients at her clinic or in rural villages she visited complained of disturbing trances in which they spoke in strange voices, clawed the air, and trembled. Patients blamed bewitchment or spirits of dead relatives, angered by unobserved rituals. To dig deeper, van Duijl asked 80 local healers to identify 119 patients suffering from spirit possession. She used a dissociation questionnaire to check for symptoms, such as losing spans of time or feeling disconnected, often linked to trauma in Western patients. She also used trauma questionnaires to check for experiences such as going without food or witnessing a murder. Compared with 71 healthy controls from the same villages, possessed patients scored much higher on both types of questionnaires. And, as in Western patients, dissociation and trauma were highly correlated, she and colleagues reported online 17 April in Culture, Medicine, and Psychiatry . The study is “unique” in “linking the traditional state to Western measures of trauma and dissociation,” says psychiatrist Roberto Lewis-Fernandez of Columbia University. Identifying how mental suffering is expressed in a patient's culture is essential to treatment, he says. Van Duijl, now at the Clinic for Refugees at Centrum 45 in Oegstgeest, the Netherlands, says she doesn't mind when patients seek relief in rituals with traditional healers. “If you make some space for what the patients think is helpful, you can help them in a better way.” [1]: pending:yes

Non-Verbal Behaviour of Patients with Schizophrenia in Medical Consultations – A Comparison with Depressed Patients and Association with Symptom Levels

Background: The Dutch psychiatrist Rümke introduced the notion that patients with schizophrenia could be recognised intuitively by an experienced psychiatrist, naming the process as the ‘praecox feeling’. This feeling may reflect aspects of the non-verbal behaviour of patients as shown in a medical consultation. The aim of this study was to test whether aspects of the initial non-verbal behaviour of patients with schizophrenia and depression in medical consultations differ and are associated with symptom levels in each group. Sampling and Method: The first 2 min of videotaped outpatient consultations with 78 patients (39 each with schizophrenia and depression) were analysed by researchers who were masked to the diagnosis and symptom levels of the patients. Non-verbal behaviour was assessed using a modified Ethological Coding System for Interviews. Symptom levels were rated by independent researchers on the Positive and Negative Syndrome Scale and Beck Depression Inventory. Results: The 2 diagnostic groups showed significant differences on 1 out of 6 aspects of non-verbal communication, with patients with schizophrenia exhibiting more ‘flight’ behaviour, i.e. more looking down or away, crouching and freezing. Within the group of patients with schizophrenia, more ‘flight’ and less ‘assertion’ were associated with higher symptom levels. Conclusion: Initial ‘flight’ behaviour of patients in medical consultations may be specific for schizophrenia and associated with the symptoms of that illness. Such behaviour might indicate an avoidance of potentially adverse communication, and future research should investigate whether it can also be identified in everyday social interactions other than medical consultations.

Lucid dreaming – dreams of clarity

AbstractAlthough the concept of ‘lucid dreaming’ was first coined by Frederik Willems van Eeden, a Dutch psychiatrist, and introduced at the meeting of The Society for Psychical Research held on 22 April 1913, the phenomenon of lucid dreaming was already known in earlier historical periods and its descriptions can be found in writings of Aristotle. However, modern lucid dreaming research was established only after LaBerge introduced his method for physiological investigation of lucid dreaming through eye signals in 1980. Current attempts in the field are directed at defining the neuro‐physiological correlates of lucid dreaming, an aim that still has yet to be achieved. One of the possible applications of lucid dreaming is in the field of psychotherapy where it is usually used in treating nightmares. However, other possible therapeutic potentials of lucid dreaming are still in the process of being discovered and therefore constitute a fertile area for future researchers. Copyright © 2009 British Society of Experimental & Clinical Hypnosis. Published by John Wiley & Sons, Ltd.

Recovery Beyond Psychiatryby David Whitwell. London, Free Association Books, 2005, 192 pp, $29.95.

Back to table of contents Previous article Next article Book ForumFull AccessRecovery Beyond PsychiatryRICHARD WARNER M.B., D.P.M.,RICHARD WARNER M.B., D.P.M.Search for more papers by this author,Published Online:1 Sep 2006https://doi.org/10.1176/ajp.2006.163.9.1651AboutSectionsView articlePDFView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail View articleIt is not clear for whom this book is written, but it may be valuable for people with serious mental illness and their family members who are struggling to determine the place of mainstream psychiatry in their lives.Dr. Whitwell is a British psychiatrist who has worked a lifetime in acute psychiatry and has re-evaluated his work in light of the recent influence of the recovery movement. In a sort of epiphany, Dr. Whitwell advances the theory that the keys to recovery lie not in traditional psychiatric treatment but in the individual’s own efforts and in his or her environment. Psychiatry is relegated, in his present vision, to a role in providing safety and support in urgent and dangerous situations. A consequence of this view is his opposition to involuntary outpatient psychiatric treatment. This is a personal account and a staunchly nonacademic book. The author rejects evidence-based medicine in favor of “clinical judgment.” There are few references and no index. Unfortunately the nonacademic nature of Dr. Whitwell’s work lays him open to accusations of provincialism. Little is included in the book if it has not impinged directly on the author’s practice. Consequently, there is no mention of any of the models which, in recent decades, have expanded the possibility of recovery for people with mental illness. We find no mention of American models such as the psychosocial clubhouse or supported employment, which have done much to enhance consumer empowerment, competitive employment, and social inclusion, or of European models such as social firms—businesses with a social mission to employ people with psychiatric and other disabilities—that have become a powerful rehabilitation force in many countries around the world. The author pays scant attention to the treatment innovations (originally British) of cognitive-behavioral therapy for psychotic symptoms and family psychosocial intervention, both of which are included in the updated treatment recommendations promulgated by the Schizophrenia Patient Outcomes Research Team (1) . The neglect of such valuable approaches leaves the reader more pessimistic than he or she needs to be about the contributions of modern mental health approaches to the possibility of the recovery of good functioning, quality of life, and meaning in life for people with serious mental illness. Dr. Whitwell does pick up on a European development about which he is enthusiastic—the Hearing Voices Network, developed by the Dutch psychiatrist, Marius Romme—referring to it as “a major social breakthrough.” He is right to emphasize the importance of this pan-European movement that connects people with mental illness with the much larger group of people with no mental disorder who regularly hear voices. The movement provides a normalizing and socially inclusive opportunity to discuss the phenomenon and meaning of auditory hallucinations, something which is of immediate concern to many people with serious mental illness. As Dr. Whitwell comments, the hearing voices work “returns autonomy to the individuals” and allows them to develop “an understanding of their voices that ...[is]...more helpful than the usual neuro-psychiatric explanation” (p. 71). American patients will be well served if this movement expands into North America as vigorously as it has diffused in Europe.The author makes a useful contribution in questioning the “doctor knows best” paternalism that discourages patients from taking charge of their illnesses, but he misses the opportunity in this book to foster the optimism that is a fundamental element of the recovery movement.Boulder, Colo.Reference1. Lehman, AF, Kreyenbuhl, J, Buchanan, RW et al: The Schizophrenia Patient Outcomes Research Team (PORT): updated treatment recommendations 2003. Schizophr Bull 2004; 30:193-217Google Scholar FiguresReferencesCited byDetailsCited ByNone Volume 163Issue 9 September, 2006Pages 1651-1651THE AMERICAN JOURNAL OF PSYCHIATRY August 2006 Volume 163 Number 9 Metrics PDF download History Published online 1 September 2006 Published in print 1 September 2006

Hallucinations Respond To Innovative Use of CBT

Hallucinations Respond To Innovative Use of CBT

Assessment of the Safety and Efficacy Data for the Hypnotic Halcion(R): Results of an Analysis by an Institute of Medicine Committee

Recent estimates indicate a 10% prevalence of chronic insomnia in the adult population of the United States, with an associated annual cost of more than $90 billion. Since its approval in 1982 for use in the treatment of insomnia, an estimated 11 billion prescriptions for Halcion(R) (triazolam) have been filled worldwide. Concerns about the safety of Halcion began to emerge when a Dutch psychiatrist reported a possible link between the drug and a syndrome that included depression, amnesia, hallucinations, and anxiety. Since that time, the United Kingdom, Brazil, Argentina, Norway, and Denmark removed Halcion from the market, and the manufacturer, Upjohn, withdrew Halcion from the market in The Netherlands. Other countries, including the United States and Canada, modified the labeling to reduce the recommended dose and duration of treatment and to heighten awareness regarding possible side effects affecting behavior and cognition. The labeling changes raised questions regarding the hypnotic effectiveness of these lower doses of Halcion. Based on a 1996 U.S. Food and Drug Administration (FDA) task force report, the Institute of Medicine (IOM) of the National Academy of Sciences assessed the adequacy, quality, and overall confidence in the data on the effectiveness and safety of Halcion at different doses and durations, including those specified in the current product labeling. This article provides a summary of the IOM report titled “Halcion: An Independent Assessment of Safety and Efficacy Data” and a more detailed overview of the statistical analysis that led to the committee's conclusions.

Suicide, euthanasia, and the psychiatrist

In lieu of an abstract, here is a brief excerpt of the content: Philosophy, Psychiatry, & Psychology 5.2 (1998) 113-126 Abstract: In recent years attitudes towards voluntary euthanasia in certain cases such as terminal cancer appear to have become more liberal, and physicians are no longer necessarily expected to undertake all possible measures to sustain life in hopeless situations. At the same time, there has been a contrary trend in medicine with an increasing expectation for psychiatrists to prevent suicide among their patients. This divergence in attitudes regarding voluntary death in physical and medicine was made manifest in 1993 by the of Dr. Chabot, a Dutch psychiatrist who openly assisted a depressed woman in committing suicide. A subsequent court resulted in considerable publicity and opened up the debate on what has become known as euthanasia. In this paper we review briefly the historical and cross-cultural aspects of suicide and euthanasia to show how attitudes toward these practices have varied over time and place. We present the of Dr. Chabot, and then focus on three cases from clinical practice in which a psychiatrist had to make difficult decisions when faced with a patient expressing a wish to die. Finally, we consider the bioethical literature concerning voluntary death, which has been developed mainly with regard to physical medicine, and we assess how well its guidance translates to a context. Our conclusions are that the suicidal wishes of patients are not always the result of an easily treatable and reversible mental illness or necessarily of any mental illness at all; that as mental illness is not always curable, there are situations in psychiatry comparable in morally relevant respects to cases of terminal illness in physical medicine; and that the bioethical literature concerning voluntary death, focusing as it does on cases of the terminally physically ill, is often not greatly helpful in psychiatry. We therefore invite comment from philosophers, lawyers, ethicists, and others concerned with mental health on our three cases, focusing on the practical issue of management. We believe our cases are not atypical, and that the dilemmas they represent will be faced with increasing frequency in years to come by psychiatrists and other mental health professionals. Keywords: suicide, assisted suicide, euthanasia, psychiatry Introduction Suicide, assisted suicide, and voluntary euthanasia are all practices whereby a person chooses to end his or her life. In recent years popular opinion regarding assisted suicide and voluntary euthanasia in cases of serious physical illness has become more liberal, but in the field of mental health, psychiatrists are increasingly expected to prevent their patients from ending their lives by committing suicide. Do psychiatrists have a duty to prevent suicides? Must they always try to prevent, or are there cases where they should perhaps turn a blind eye or even give assistance to a likely suicide? Is there indeed ever a justification for psychiatric euthanasia? In 1993 these issues were brought to worldwide attention with the of Dr. Chabot, a Dutch psychiatrist who assisted in the suicide of a woman who was not terminally ill but suffering, and in his view suffering hopelessly, from depression. This paper examines the Chabot case together with three cases from general practice. In each of these cases, dilemmas arose for a psychiatrist regarding the treatment of a patient who wished to end their life. (Details of the cases have been altered to preserve confidentiality.) The cases will be first briefly set in their historical and cultural perspective. This highlights changes in attitudes towards voluntary death and sets the current dilemmas in context. The issues raised by the cases will then be considered and examined in the light of the bioethical literature concerning voluntary death. Our main conclusion is that the bioethical literature, which has been developed largely in reference to terminal physical illness, is often neither applicable nor particularly helpful in psychiatric...