[Online schema therapy: a cross-sectional survey among Dutch therapists]. / Schematherapie via beeldbellen; crosssectioneel onderzoek onder therapeuten.

BACKGROUND: Long waiting lists exist for the treatment of personality disorders, which can be shortened by using videoconference treatment. During the COVID-19 pandemic, by necessity, videoconferencing was used to provide schema therapy, a specific treatment for personality disorders. AIM: To investigate therapist experience of schema therapy via videoconferencing during the pandemic. METHOD: In an observational cross-sectional study, 83 schema therapists completed a questionnaire about the period prior to, and during the COVID-19 pandemic. We investigated their experience, use of, and attitude toward videoconferencing, as well as the extent to which the effectiveness of videoconferencing and face to face (F2F) schema therapy for personality disorders was found to be comparable. RESULTS: Schema therapists rated their experience with videoconferencing therapy for personality disorders during the COVID-19 pandemic positively, its use increased during this period, and therapists’ attitudes became more positive. However, the majority found videoconferencing therapy less effective than F2F treatment. Almost half of the therapists used shorter sessions or adapted exercises during videoconferencing therapy. CONCLUSION: Although therapists were increasingly positive about video conferencing therapy, they believed that F2F treatment is more effective. Randomized efficacy studies of videoconferencing therapy compared to F2F therapy are needed, also examining patients’ experiences with both forms.

[Quality systems in Dutch mental healthcare have a limited impact on the practice of care]. / Kwaliteitssystemen in de Nederlandse ggz hebben weinig impact op de praktijk van de zorg.

BACKGROUND: Quality systems have become an important and widely used method of monitoring and improving the quality of care in mental health care. However, little is known about the impact of these systems on the daily practice of care.
AIM: To determine and explain the impact of quality systems.
METHOD: A combination of qualitative (focus groups, document analysis, interviews) and quantitative (questionnaire, literature analysis) data collection and analyses based on different theoretical perspectives.
RESULTS: There are many quality systems available, while the impact on the practice of care is limited. Many systems are unknown and are not used or used inadequately. The lack of impact can be explained by role uncertainty and mistrust in the sector. The fact that certain systems are used can largely be explained by the individual preferences of professionals.
CONCLUSION: The current deployment of quality systems is very inefficient. There is no common definition of quality and the quality information from the systems is complex. This complicates the application of quality information. In addition, there is a great deal of mistrust towards the sector, which means that systems are used for control rather than for quality improvement.

[Multisystemic therapy for child abuse and neglect (MST-CAN): description of the treatment, psychiatric morbidity, and the psychiatrist's role]. / Multisysteemtherapie bij kindermishandeling (MST-CAN): beschrijving van de behandeling, de psychiatrische problematiek en de rol van de psychiater.

BACKGROUND: Many untreated psychiatric problems occur in families where there is child abuse. It is very important to find ways of ensuring that the hard-to-reach families receive adequate psychiatric assessment and appropriate treatment. AIM: To describe the treatment method and first results of multisystemic therapy for child abuse and neglect (mst-can). METHOD: We report the psychiatric problems of the first 18 families that were treated and we report the follow-up during the first 18 months. In addition, the mst-can treatment and the psychiatrist's role are illustrated by taking two cases as an example. RESULTS: Most of the families agreed to a psychiatric assessment and subsequent treatment. In most families safety improved considerably and out-of-house placements were avoided. CONCLUSION: The first results suggest that mst-can is a promising treatment for families where there is child abuse. Essential elements of mst-can are targeted psychiatric diagnostic assessment and subsequent treatment.

Fundamental radiological and geometric performance of two types of proton beam modulated discrete scanning systems.

PURPOSE: The purpose of this investigation was to compare and contrast the measured fundamental properties of two new types of modulated proton scanning systems. This provides a basis for clinical expectations based on the scanned beam quality and a benchmark for computational models. Because the relatively small beam and fast scanning gave challenges to the characterization, a secondary purpose was to develop and apply new approaches where necessary to do so. METHODS: The following performances of the proton scanning systems were investigated: beamlet alignment, static in-air beamlet size and shape, scanned in-air penumbra, scanned fluence map accuracy, geometric alignment of scanning system to isocenter, maximum field size, lateral and longitudinal field uniformity of a 1 l cubic uniform field, output stability over time, gantry angle invariance, monitoring system linearity, and reproducibility. A range of detectors was used: film, ionization chambers, lateral multielement and longitudinal multilayer ionization chambers, and a scintillation screen combined with a digital video camera. Characterization of the scanned fluence maps was performed with a software analysis tool. RESULTS: The resulting measurements and analysis indicated that the two types of delivery systems performed within specification for those aspects investigated. The significant differences were observed between the two types of scanning systems where one type exhibits a smaller spot size and associated penumbra than the other. The differential is minimum at maximum energy and increases inversely with decreasing energy. Additionally, the large spot system showed an increase in dose precision to a static target with layer rescanning whereas the small spot system did not. CONCLUSIONS: The measured results from the two types of modulated scanning types of system were consistent with their designs under the conditions tested. The most significant difference between the types of system was their proton spot size and associated resolution, factors of magnetic optics, and vacuum length. The need and benefit of mutielement detectors and high-resolution sensors was also shown. The use of a fluence map analytical software tool was particularly effective in characterizing the dynamic proton energy-layer scanning.

SU-E-T-299: Proton Pencil Beam Spot Scanning Phase Space in the IBA System and the Clinical Implications for Superficial Targets.

PURPOSE: In the treatment of superficial lesions with proton Pencil Beam Scanning (PBS), spot size is dominated by the nozzle contribution. Accuracy of phase-space modeling is therefore paramount. IBA's Dedicated (DN) and Universal Nozzles (UN) have different designs and, consequently, characteristics. Here we report the phase spaces of these two nozzles, without and with a range shifter (RS). METHODS: In-air spot fluence measurements were made for five proton energies: 225, 210, 180, 150 and 115 MeV and at five distances from isocenter pertinent to SAD-type treatments: +33, +20, +10, 0 and -10 cm ('+' implies upstream), without and with a 7.5 cm water-equivalently-thick RS (sufficient to pull back the lowest energy Bragg peak to patient surface), fixed with its upstream side 41 cm from isocenter. Data collected on a fixed horizontal beam-line with a DN and a gantry-mounted UN were compared. The full-width-at-half-maximum (FWHM) of a Gaussian fit to each spot fluence profile was extracted along the two principal axes. RESULTS: With no RS, the proton spots are ∼20-70% larger at isocenter in the UN than in the DN. Spots are less asymmetric, and eccentricity increases more slowly with energy, in the UN than in the DN. Over the 33 cm in-air travel upstream of isocenter, the spot FWHM varies by less than ∼2 mm. However, spot asymmetry becomes more severe upstream (for 115 MeV spots, 30-40% compared to <20% at isocenter for DN, but similar and <10% for UN). With an RS, spot FWHM at isocenter increases by 12.7 mm from 8.3 mm (DN) and 10.7 mm from 13 mm (UN) for 150 MeV protons (typical for brain treatments). With no RS, relatively distance-independent spot size facilitates SAD-type treatments. For patients with superficial lesions, where an RS is required and the phase space varies rapidly with distance, the RS should be permitted at two additional locations. US Army Medical Research and Materiel Command under Contact Agreement No. DAMD17-W81XWH-04-2-0022.

P300 deficits are present in young first-episode patients with schizophrenia and not in their healthy young siblings.

OBJECTIVE: To evaluated P300 (P3b) abnormalities in young first episode patients with schizophrenia and their healthy young siblings. METHODS: An auditory oddball paradigm was used to assess P300 in 53 patients, 27 unaffected siblings and 28 healthy controls. Amplitude and latency of the three midline sites (Fz, Cz, and Pz) were compared between patients, siblings, and controls by a mixed-effects regression model. RESULTS: P300 amplitude was significantly reduced in patients with schizophrenia but not in healthy siblings, when compared to healthy controls. P300 latency did not significantly differ between the three groups. CONCLUSIONS: P300 amplitude but not latency was found to be affected in young patients with recent onset schizophrenia. However, P300 amplitude and latency were found not to be affected in healthy unaffected young siblings and, therefore, did not qualify as an endophenotype for schizophrenia. SIGNIFICANCE: The failure to find the P300 (P3b) abnormality in healthy siblings of patients with schizophrenia is an important finding and should be added to P300 literature.

Antisaccade deficit is present in young first-episode patients with schizophrenia but not in their healthy young siblings.

BACKGROUND: Results of studies on antisaccade (AS) deficit in relatives of patients with schizophrenia are inconclusive. We hypothesized that AS performance in siblings of patients with schizophrenia is worse than in healthy controls and better than in patients with schizophrenia. METHOD: We included 55 first-episode patients with schizophrenia, 28 healthy siblings and 36 healthy controls to evaluate AS performance. Eye movements were measured electromagnetically by the double magnetic induction (DMI) method. RESULTS: Patients with schizophrenia had a significantly higher error rate than siblings (d=0.86, p<0.0001) and controls (d=1.35, p<0.0001). Siblings had a higher mean error rate than healthy controls but this did not reach significance (d=0.56, p=0.29). The intra-class correlation (ICC) was 0.33 for the error rate. Mean AS gain was higher in siblings than in patients (d=0.75, p=0.004) and controls (d=0.6, p=0.05). The ICC was 0.08. CONCLUSION: As parameters in strictly screened healthy young siblings of young first-episode patients with schizophrenia are comparable to results found in studies investigating older relatives. However, the statistical results (i.e. the ICCs) suggest that there is little evidence of shared environmental or genetic factors on error rate variation.

A meta-analysis of P50 studies in patients with schizophrenia and relatives: differences in methodology between research groups.

OBJECTIVE: To determine whether patients with schizophrenia as well as their relatives show deficits in sensory gating reflected by an abnormal P50 ratio and to quantify the differences from controls. METHODS: A systematic search on articles published between 1982 and 2006 was conducted. 28 patient studies that were suitable for analysis including 891 patients and 686 controls were retrieved. Six studies on P50 of relatives of schizophrenic patients were identified, including 317 relatives and 294 controls. RESULTS: In the patient studies we found an P50 effect size of 1.28 (SD=0.72). We confirmed high variability in outcomes across studies. Almost half of the studies included where published by one laboratory of the University of Colorado and these results differed significantly from the results found in studies performed in other laboratories. We found correlations between effect size outcome and sound intensity, filter settings and subjects' position which could be explained by differences between the Colorado laboratory and the other groups. In the relative studies we found a mean P50 effect size of 0.85 (+/-0.42). CONCLUSIONS: The differences in methodology and lack of reported demographics and methodology including raters blinding in some studies makes it hard to compare results across studies and to evaluate the validity and reliability of P50 as a candidate endophenotype for schizophrenia. There are large differences in outcomes from Colorado studies and non-Colorado studies. In contrast to the Colorado studies in the non-Colorado studies P50 suppression would not qualify as an endophenotype for schizophrenia. These differences might be explained by the differences in methodology e.g. lower levels of sound intensity, differences in filter settings and subjects' position. Finally we make some recommendations for future research based on the outcomes of this meta-analysis.

Failure to find P50 suppression deficits in young first-episode patients with schizophrenia and clinically unaffected siblings.

OBJECTIVE: To evaluate whether the P50 gating deficit is present in young first-episode patients with schizophrenia and their healthy young siblings. METHODS: An auditory paired-click paradigm was used to assess P50 gating in 53 patients, 27 unaffected siblings, and 28 healthy controls. P50 parameters were compared between patients, sibs, and unrelated controls by a mixed-effects regression model. RESULTS: P50 gating was not significantly impaired in patients with schizophrenia and healthy siblings as compared with controls. CONCLUSIONS: P50 gating was not found to be significantly impaired in young first-episode schizophrenia patients and in healthy young siblings. These results are in contrast with the existing literature. We suggest that P50 gating impairment may be developmentally or age dependent.